The Role of Psychosocial Stressors in Shaping the Attitudes of Nurses in a Canadian Acute Care Hospital Toward Patients Who Use Substances: A Cross-Sectional Study.

AIM: To examine the extent to which psychosocial stressors, including social desirability, workload, burnout, and adverse childhood experiences (ACEs), were associated with nurses' attitudes toward patients who use substances in hospital settings. DESIGN: A cross-sectional survey design was used. METHODS: The study was conducted in a 425-bed tertiary care hospital in Northwestern Ontario, Canada. Registered nurses and registered practical nurses providing direct inpatient care were eligible to participate. Data were collected between October 14 and November 4, 2024, via an electronic survey distributed through institutional email using REDCap. A total of 412 participants completed validated instruments measuring attitudes toward patients who use substances, social desirability, workload, burnout, and ACEs. Hierarchical multiple regression analyses were used to examine associations between these variables and nurses' attitudes. RESULTS: Professional development in substance use and addiction emerged as the most consistent variable associated with more positive attitudes, demonstrating a dose-response relationship; nurses reporting ≥ 9 h of training had significantly more favorable attitudes compared with those with no training. Social desirability was significantly associated with attitudes, suggesting potential underreporting of negative views. Workload and burnout demonstrated variable, scale-dependent associations, while ACEs were not significantly associated with attitudes. Nurses working in inpatient mental health settings reported more positive attitudes than those in other clinical areas. CONCLUSION: Professional development, particularly of greater duration and intensity, was identified as a key modifiable factor associated with more positive attitudes toward patients who use substances. These findings highlight actionable opportunities for nursing leadership to strengthen practice environments through sustained education, attention to psychosocial workplace factors, and context-specific supports. Integrating these strategies into workforce planning may enhance nurse well-being and contribute to more equitable, stigma-reducing care in hospital settings.