Abstract
Public health research reports “alarming” levels of “risky,” or even “hazardous,” alcohol consumption among the female-dominated and historically-feminized professions of nursing and midwifery. Accounts of these practices presuppose alcohol as inherently harmful and largely enact the drinking of nurses and midwives as a maladaptive response to “cope” with the demands of a high-stress occupation. Relaying a boundary of acceptable/unacceptable and healthy/harmful responses to professional demands, we argue that such accounts minimize or erase agency and pleasure while simultaneously reiterating familiar gendered discourses of women as vulnerable. Mobilizing a narcofeminist approach that attends to the creative, liberatory, and life-affirming possibilities of psychoactive substance consumption, we analyze data drawn from interviews with 25 nurses and midwives about drinking with their colleagues. In a workforce shaped by gendered expectations of comportment and care, and normative notions of health, we examine how nurses and midwives negotiate and navigate multiple boundaries—healthy and harmful, professional and personal, appropriate practices of care, and expectations of femininity and motherhood—through and with alcohol. Centering the above tensions, our analysis illuminates how drinking together with colleagues fosters camaraderie and solidarity, plays a supportive and productive role in nurturing professional relationships and, more broadly, can be liberating and generative of a life well-lived. In conclusion, we argue that rather than reducing the drinking of nurses and midwives to a maladaptive and straightforwardly harmful effort to “cope” with work, it is better understood as part of work itself.
Introduction
Public health research identifies “alarming” levels of “risky,” “hazardous,” or “harmful” alcohol consumption among the female-dominated and historically-feminized profession of nursing and midwifery (Perry et al., 2015; Searby et al., 2023). These reports inform concerns that the drinking of nurses and midwives compromises their capacity to provide care and the health and wellbeing of this workforce more generally. In this article, we aim to scrutinize and complicate these assumptions. We do this through analysis of qualitative data gathered through interviews with nurses and midwives working across Australia.
Contemporary concerns with alcohol consumption practices can be situated in a context of transformations in policy and practice responses to alcohol. In Australia, and internationally, alcohol consumption is associated with a considerable burden of social and health harms (WHO, 2024). Substantial research, policy, and health promotion resources are invested in efforts to reduce or prevent alcohol consumption, with a new emphasis that drinking can never be “risk free” (Australian Institute of Health and Welfare, 2021; World Health Organisation [WHO], 2024) and the World Health Organization warning that “there is no safe amount that does not affect health” (2023). This conflation of drinking and harm, regardless of context or individual experience, is evidence of a striking shift in how alcohol is understood and enacted in policy settings in Australia and elsewhere. According to Keane, Moore, and Graham (2022, p. 407), policy has shifted from positioning alcohol as “part of culture, with benefits and harms manageable through the promotion of moderation” to an “inherently harmful and toxic substance, whatever its pattern of use.”
In line with these transformations, there is growing public health attention to alcohol consumption practices among Australian workers—those in “unskilled,” trade, managerial and professional occupations (Di Censo et al., 2025; McEntee et al., 2022; Pidd et al., 2011). Nurses and midwives have begun to receive this attention. Together, nurses and midwives comprise the largest clinical workforce within Australia, with an estimated 500,000 registered or enrolled, of which 98.5% are female (Australian Health Practitioner Regulation Agency, 2025). The Nursing and Midwifery Board of Australia's Standards for Practice require registered nurses and midwives to support and provide resources to not only optimize patient health, but to ensure their own health and well-being are maintained (Nursing and Midwifery Board of Australia, 2016, 2018). Importantly for our analysis, this concern with the health of the workforce is expansive, with practices such as diet and exercise under scrutiny along with alcohol consumption (Perry et al., 2018; Ross et al., 2017). Beyond this, given their responsibilities as carers in medicine, nurses and midwives are also positioned as “role models” whose breaches of decorum and health norms can compromise not only their individual health, but the credibility of the healthcare profession itself. Some commentators extend these expectations even further, holding nurses and midwives responsible for the health of us all. As Perry, Gallagher, and Duffield (2015, p. 1) argue, nurses “health-related behaviors” have broad implications: Nurses provide the bulk of both health education and health care; anything that diminishes their credibility as role models and health educators or their availability and ability to deliver quality care is potentially disadvantageous for the health of the population.
Threaded through this scrutiny of nurse and midwife alcohol consumption are implicit assumptions that presuppose alcohol as inherently discrediting and harmful and largely enact this drinking as a maladaptive response to “cope” with the demands of a high-stress occupation. For example, Mercer et al. (2023, p. 2) write: Some nurses may use coping mechanisms such as drugs and alcohol, which can cause lifelong health problems and jeopardize their professional nursing license. In contrast nurses who pursue healthy lifestyles become better role models, advocates, educators, and providers and promoters of healing for their patients and communities.
These concerns place feminized health professionals such as nurses and midwives in a complex bind. Reflecting established feminist interrogations of alcohol “double standards,” in which women's consumption is held as doubly problematic because it compromises their position as legitimate feminine subjects (see, e.g., Ettorre, 1986), nurses and midwives are held accountable not only for inappropriately managing their work stress, but also asked to sacrifice their desires and pleasures (often in their private time) to uphold the status of healthcare more generally. These expectations unfold within a context of chronic under-investment in the healthcare workforce linked to persistent understaffing, escalating workloads, and administrative burden. Yet, the workforce impacts of these conditions are backgrounded by a focus on drinking, a process that obscures the structural conditions that produce issues such as burnout and shifts responsibility onto individual nurses and midwives to manage and contain their impacts (see International Council of Nurses [ICN], 2023).
The significant political and ethical implications of these approaches to these drinking practices warrant attention. In this article, we contribute such attention through an examination of the meanings and practices of collective drinking events among nurses and midwives. Rather than reproduce approaches that position the drinking of nurses and midwives as intrinsically harmful to themselves and the healthcare profession, regardless of when and where it occurs, we adopt, instead, a narcofeminist framing that simultaneously attends to the creative, liberatory and life-affirming possibilities of alcohol and other drug consumption, alongside any potential harms. We take this issue as a “matter of care,” with care understood broadly as “productive doings” that support liveable relations (de la Bellacasa, 2011, p. 93). Care is intimately implicated in our analysis: as feminized nursing and midwifery professionals, our research participants are expected to care. Narcofeminism is underpinned by care for lives lived well, and we, as researchers, take seriously our ethico-political obligations to take care in the ways we represent and construct the subjects and objects of our research. In our careful analysis, then, we attend to the multiple ways in which gender, working conditions and practices, professional identities, and alcohol shape each other in nurse and midwife accounts of drinking with colleagues. In conclusion, rather than accepting alcohol consumption as an inherently harmful practice that hinders nurses’ and midwives’ capacity to perform their occupational duties, we argue that these social consumption practices can be generative in relation to the specific demands of their job.
Literature Review
Qualitative research examining nurse and midwife drinking practices in Australia is scarce, with the field primarily made up of quantitative studies using self-report measures gathered via workforce surveys (see e.g., Perry et al., 2015, p. 18; Searby et al., 2023; Smith, 2007). Over the last two decades, reported prevalence of harmful drinking within this cohort in research has varied, yet recent Australian public health literature generally constitutes these practices as highly concerning, even “alarming” (Searby et al., 2023). Searby and colleagues, for example, reported that 26% of the nurses and midwives in the study were drinking at “risky or hazardous levels,” with a further 10% drinking at “high-risk” or “harmful levels” (Searby et al., 2023). It is worth noting that while this study singles out nurses and midwives’ drinking patterns as distinct, these statistics mirror research examining the alcohol consumption patterns of working Australians generally, of whom 38% drank alcohol at “risky levels” (McEntee et al., 2022). This suggests that the level of concern about nurse and midwife alcohol consumption may reflect the double standards to which they face, at least as much or more than any substantial health risk associated with their drinking practices.
In addition, as we have noted, much of the research on drinking practices of nurses and midwives commonly presupposes alcohol consumption as inherently harmful and a maladaptive response to “cope” with the demands of a high-stress occupation, most recently exacerbated by the COVID-19 pandemic (Foli et al., 2021; Mercer et al., 2023; Searby et al., 2023). Shiftwork, long working hours, and traumatic workplace incidents are regularly reported to heighten risky alcohol consumption, necessitating targeted interventions to ensure the ongoing safety of healthcare professionals and their capacity to provide adequate care (Mercer et al., 2023; Monroes & Kenaga, 2011; Schluter et al., 2012). While qualitative research focused specifically on the drinking practices of midwives is lacking, research focused on nurses has echoed these findings, arguing that alcohol consumption is used as a coping strategy to manage emotional distress encountered in their roles (Foli et al., 2020, 2021; Ross et al., 2018). Most recently, Australian qualitative research has examined these practices as a reward for managing or a way to cope with the stress of the COVID-19 pandemic and its ongoing impacts (Searby et al., 2024, 2025). The authors argued that this increase in alcohol consumption requires urgent attention due to its potential to contribute to individual burnout and further destabilize a chronically understaffed workforce.
Given the highly feminized character of this profession, this research has several gendered implications, despite male nurses being identified as drinking at riskier levels (Perry et al., 2018; Searby et al., 2023). Of course, research that enacts women as especially vulnerable to the harms of alcohol and characterises drinking as excessive is not new (Day et al., 2004; Ettorre, 1986; Keane, 2002). More recently, Keane (2023) demonstrates how discourses of women's drinking during the COVID-19 pandemic constituted them as both “an effect of harm and a cause of harm” (p. 808). This is also reflected in the gendered assumptions underpinning scholarly research on occupational drinking. For example, within this work, at times men's drinking has been constituted as a reward for hard work while women's drinking is positioned as a troubling way to cope with negative emotions related to hard work (Peltier et al., 2019; Ruisoto et al., 2017). More recently, sociological research has sought to move beyond these binaries to instead focus on how drinking is incorporated into the demands of work (see Buvik 2020; Keane, 2022; Rimstad et al., 2023). For example, Rimstad argues that for Norwegian women working in London, the pub functions as an “expanded office,” a vital site where they must adapt to informal after-work drinking culture to navigate workplace communication, social norms, and career-related expectations. However, such research is yet to focus specifically on the alcohol consumption of nurses and midwives and how the specific interplay of health, gender, and care can shape understandings of and responses to these practices.
We contribute to this literature by analyzing the implications of framing nurses’ and midwives’ drinking primarily as a coping strategy. Our analysis explores not only the impoverished understanding of these practices generated through such approaches but also their implications for the labor conditions of a highly stressful occupation and a feminized public-facing workforce.
Approach: A Narcofeminist Analysis of Drinking, Pleasure, and Stress
This article utilizes a narcofeminist approach to examine how nurses and midwives articulate the relationships between drinking, work, pleasure, and well-being in their collective drinking practices. Emerging from grassroots drug user activism, narcofeminism has recently begun influencing alcohol and other drugs scholarship. Originating in the collective action of people who consume drugs (particularly in Eastern Europe and Central Asia), narcofeminism integrates a feminist agenda with drug user rights to provide a framework for thinking beyond moralizing and pathologizing understandings of and responses to alcohol and other drug use, with a particular focus on their gendered implications. As director of the International Network of People who Use Drugs, Judy Chang argues, narcofeminists are invested in examining “the categories of meaning assigned to bodies under the twin structures of prohibition and patriarchy” (2021, p. 271). Chang argues that by focusing on the gendered politics of alcohol and drug consumption, narcofeminism seeks not only to reduce harm but to “construct more positive realities and subjectivities of women who consume drugs” (Chang, 2021, p. 285).
Alcohol and other drug scholarship informed by narcofeminism seeks to examine what substance use can do as a feminist practice (Dennis et al., 2023a). That is, this research not only examines how drugs can be used as “regulatory technologies”—as feminist research has done for decades (see, e.g., Boyd, 1999; Campbell, 2000; Ettorre, 2007)—but also addresses the ways of living and thriving that women who use drugs (and other marginalized groups) generate or co-produce through consumption practices. Narcofeminist-informed research thus adopts a political and ethical stance that embraces the complexity of drug use, attending simultaneously to its pleasures and benefits, as well as its risks and harms. This attention to dynamism, what Dennis et al. (2023b) describe as a “double vision,” challenges reductionist and largely binary understandings of substance consumption practices and their effects. It offers, instead, a heuristic that encourages “more radical and complex ideas and understandings of drugs use, and drug using subjectivities” (Chang, 2023, p. 768). In doing so, narcofeminism calls for responses to alcohol and other drugs that are capable of addressing harm (including interrogating conceptualizations of “harm” itself) without disregarding the generative, creative, and life-affirming potentials of drug consumption, including, in our case, drinking.
Our analysis here sits in conversation with other narcofeminist research examining, for example, women's alcohol consumption in domestic contexts (Keane, 2023), young women and gender diverse people's partying (Farrugia et al., 2025) and sexualized drugs in queer communities (Azbel, 2023). Informed by these examples, we also attend to “positive realities” (Chang, 2021, p. 285) produced through collective drinking among nurses and midwives, which includes a focus on the multiple and diverse effects of these practices, such as pleasure, fun, or connection, including how they may intertwine with harm. This contrasts with much scholarship in this area, which routinely reduces these practices to harm alone (see, e.g., Mercer et al., 2023; Perry et al., 2015). Rather than pathologizing the drinking practices of nurses and midwives and assigning them as “health role models,” our approach does not expect them to sacrifice their rights to pleasure, relaxation, and a private life because of their professional responsibilities. Additionally, we mobilize an explicitly feminist orientation that, inspired by narcofeminism, does not prematurely judge their alcohol consumption as a maladaptive coping mechanism, a practice that compromises their capacity to perform their jobs, or even a reward for fulfilling these expectations. In mobilizing the narcofeminist “double vision,” we examine simultaneously the beneficial and the negative qualities of the alcohol consumption practices articulated by the nurses and midwives in this study. In doing so, we are able to better understand how drinking practices can be meaningful and generative through the, at times oppressive, demands of the nursing and midwifery.
Method
This analysis stems from qualitative research investigating drinking cultures among nurses and midwives and lawyers. 1 The aim of this project was to investigate the cultural and social practices, meanings, processes, and settings that shape collective drinking among these professional occupational groups, and to identify opportunities to promote positive encounters with alcohol. Data for the project were gathered through in-depth interviews, non-participant observations at licensed drinking venues, and a survey. In this article we analyze data generated from 26 in-depth, semi-structured interviews with nurses and midwives working across Australia. We focus here on nurses and midwives as their accounts were shaped by specific gender dynamics relating to their positions as a feminized health workforce. 2 Recruitment was conducted through promotion on social media platforms, industry newsletters and communications, and referral via snowballing. Participants were aged 18 years or over and were currently employed in a nursing or midwifery role in Australia. Participants were recruited from urban and regional locations across Victoria, South Australia, Western Australia, New South Wales, and Queensland. Interviews were conducted between November 2023 and July 2024 with 23 women and three men. This gender breakdown broadly reflects the workforce composition, which comprise predominatly women; however, we draw from the three male participants to ensure their perspectives are captured. Participants had varying levels of education, experience, and scope of practice, and they worked across a range of roles (management, education, and clinical) in both private and public hospitals and community settings. In total, we interviewed 22 nurses, two midwives, and two participants who held qualifications in both midwifery and nursing. Alcohol consumption practices varied among participants, from those who drank regularly during the week, only when socializing, and one participant who did not drink at all.
Depending on participant preference and geographic location, interviews were either conducted in person, online, or over the telephone. Prior to the interview, the interviewer explained the project aims to participants, detailed the kinds of questions that might be asked during the interview, and obtained informed consent. All interviews were conducted by the first author and ranged from 28 to 51 min in length. The semi-structured interview guide explored work-related drinking and included questions about how and why colleagues get together to drink, when and where the drinking takes place, and more general questions about what happens during these events. Given interviews were conducted soon after a series of COVID-19 restrictions (including physical distancing, lockdowns, and closure of licensed venues), interviews also addressed drinking patterns during the pandemic and any subsequent changes since. Participants were reimbursed A$50 for their time and contribution to the research. Interviews were digitally recorded and then transcribed verbatim by a professional transcriber.
All de-identified transcripts were coded within NVivo15 data management software (Lumivero, 2025). Most generally, two distinct types of collective drinking events emerged in participant accounts: (1) spontaneous after-work drinks and (2) pre-organized social events (e.g., end-of-year party and team celebrations). These accounts were analyzed using an iterative inductive approach: codes were developed based on research questions, the literature, and the interviews themselves. The first author conducted initial coding using the inductive constant comparison method (Seale, 1999). This was presented to the second author and further refined with another round of analysis by the first author. From here, the first and second authors developed an analytical frame informed by the “double vision” of narcofeminism, carefully examining participant accounts of their alcohol consumption practices to illuminate relations and tensions across multiple boundaries of professional and personal, healthy and harmful, appropriate practices of care and expectations of femininity and motherhood. This was presented to the second author and further refined with another round of analysis by the first author. The final stage of analysis was undertaken in developing the article draft, which was later refined in response to contributions from all co-authors. By utilizing this approach, we do not analyze these data as straightforward accounts of lived experience but as specific articulations of these relations and tensions enabled or co-produced by the research design, including and beyond the conceptual approach of this article (Jackson and Mazzei, 2022).
Analysis
Our analysis attends particularly to the ways professional responsibilities, gender and alcohol come together in participants’ accounts of drinking with colleagues. In a workforce shaped by biomedical notions of health, gendered expectations of comportment and care, and increasing enactments of alcohol as a toxic substance, we find nurses and midwives navigating these expectations and understandings through and with alcohol.
“We Look Out for Each Other”: Navigating Work, Health, and Drinking
The nurses and midwives we interviewed often articulated drinking as an important element in navigating their professional responsibilities and the effects of their challenging work. Within this, participants framed going for a drink with colleagues as a way of supporting their wellbeing: commonly described as an opportunity to “debrief,” “wind down,” or “relax” after a “shitty shift.” As Tim
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(nurse manager) discussed, “drinking was never the primary goal of a night out” after a tough shift, rather it was an opportunity to discuss “what we did, what we could have done better, who did what.” Similarly, Jin (intensive care nurse), who described heavy drinking as “a big part” of her Korean culture, said she regularly goes out for a drink with a colleague after any “incidents” at work. She explains: We just talk about if it was a death or sometimes near misses […] Sometimes, we talk about policies and procedures, like “How would you do this?” And then we’ll just talk about it, like “How do you feel about this? These kinds of things happened,” and then, yeah, we just drink enough. You can come home and you can speak to your partner, or your housemates, or whatever it might be about what happened on shift, but only the people that you work with, one, feel comfortable talking about some of the things that might have happened, and two, actually understand why you think that way about an incident—and not necessarily an incident. It might just be like run-of-the-mill really busy, or it might be an expected death of an elderly person, but it just didn’t happen well.
These extracts illustrate that drinking together offers valuable opportunities to debrief, offer collegial and emotional support, and manage the demands of a job that routinely encompasses challenging experiences such as patient deaths and “close calls” that takes place in a fast-paced environment. As is clear in Jin and Toby's accounts, these opportunities to give and receive support and understanding in relation to work experiences are unique to their drinking with fellow nurses and midwives. They highlight the important place that drinking with colleagues can hold when managing professional demands more generally. Talking with colleagues while drinking together can be read as practices of care, where these material and affective communications act to “repair the world” after the disruptions of difficult workdays, so as to make living better (de la Bellacasa, 2011). In Toby's account, we can also see care practices entangled with boundary work. He draws distinctions between nurses (inside) and non-nurses (outside) and refrains from fully describing his workday experiences with non-nurses to avoid causing. Jane, a community nurse and midwife, likewise articulates how debriefing with colleagues relieves her of a requirement to care for non-nurses who may find her everyday work experiences confronting: I’ve always said that nurses experience things in one day, that the majority of people will never experience in their lifetime. And I think, to be able to sit down over a glass of wine and relax a little bit, and have someone understand that part of you and you don’t have to explain or feel bad—“I'm sorry I’m ruining your day because I’ve told you about my own experience”—because this person is not going to feel that way because they also have had a wild day. They experienced it with you. They’re gonna validate you. And you’re just going to feel normal because it is normal. I had a shot. I was buying rounds, [and] we’re all sitting at tables outside. A few of the [nurses] had done pre-drinks before so they were pretty tipsy and loud […] And then we got, like, the group Christmas photo and so that was, like, maybe at like 9:30 pm. And then some people were too drunk so they went home. So, there are a few that were, like, you know, couldn’t sit up straight and it was like, “You need to go home now. We’ll call you an Uber.” I would say there's, like, good cohesiveness, in that we look out for each other. Like, no one's going to get left behind. I think that is the health care thing.
Alongside Fi's description of the convivial atmosphere, hedonism and “heavy” drinking of these events, she articulates an ethic of care among colleagues. Connecting care to her profession or the “health care thing,” Fi describes a shared sense of responsibility for everyone's well-being and safety during consumption events. Reflecting other narcofeminist research, Fi's account positions care as an aspect of pleasure and fun, rather than a separate concern (see Azbel, 2023; Farrugia et al., 2025). Beyond fun, these caring practices contribute to a sense of solidarity and intimacy among colleagues. In this way, by drawing together the fun, group cohesion and care that characterize these events, Fi's account also connects drinking practices with a nursing subjectivity. Approached in this way, these drinking practices are co-productive of nursing labor, that is, her work and that of her team is shaped by drinking and shapes their drinking.
Just as occupational identities are shaped by consumption events in Fi's account above, our participants also articulated a relationship between the negative effects of their profession and their drinking practices. Jane (community nurse and midwife), for example, describes how her drinking changed in relation to work-related stress: I quit the hospital work I was doing […] I think I’d been burnt out for a long time […] I’d had a number of really, really traumatic experiences in the hospital across the years and also studied for seven years, and I just hit a wall and I burnt out clinically quite badly. So, it's taken me a long time to heal my body. I had adrenal fatigue. So, I’ve had to redo my drinking because I couldn’t do it anymore, but I enjoy it socially and culturally. So, my husband used to be a chef, and has a lot of hospitality worker friends, so [drinking is] fundamental to our lifestyle. I find that hospitality people and health [workers] are very similar: work hard, play hard, and unsociable hours.
Research commonly reduces alcohol consumption among nurses and midwives (and other women) to managing or “coping” with stress (Foli et al., 2021; Mercer et al., 2023), and among our participants, several accounts articulated relationships between alcohol consumption and work conditions and stress. As such, it could be tempting to interpret these as examples of “drinking to cope,” often constituted as intrinsically maladaptive and harmful (Holahan et al., 2001; Rodriguez et al., 2020; Rousseau et al., 2011). However, we argue that this provides a highly partial account of these experiences. Our participants offer more dynamic accounts that simultaneously speak to the pursuit of pleasure alongside harm and the instrumental purposes of alcohol consumption in relation to work. As Jane says: I love to just get a buzz quickly, even if that means that it's gonna be a detriment to myself. And I think that happens a lot in [nursing]. I think it happens a lot in low-key levels, just in everyone's home. Just drinking alcohol with dinner. And it's something to help you sleep because your body clock—I think alcohol in helping you sleep is a big thing as well.
“We Were Buzzed Up To Be Out Together”: Navigating Professional and Personal Relationships
Alongside the opportunities for debriefing and providing care and support, participants’ accounts emphasized how drinking together contributed to building deeper professional and personal relationships. Many participants, such as Linda (alcohol and other drug [AOD] nurse), said drinking with colleagues could help produce “special moments where you get to know them a bit better.” For participants such as Jane, it enabled the opportunity to establish different relationships beyond those defined by professional roles: I think, going out drinking with your friends from work because you see, you know each other so intimately on one level. You have seen each other in really hectic circumstances, and you work long nights together and you cry together and you’re frustrated together. [Sometimes] you’re happy. [At other times] you see patients die together. But then you’re in the world, you’re not in your scrubs and [you’re] drinking with each other, with makeup on. And the way that you engage with the rest of the world, and it's like a bit—I remember it being really exciting to do that with my nursing friends, because it was like, “I know so much about you but this is a new you.” And I would find my nursing friends were a bit wild, a little bit more wild. It's like we were buzzed up to be out together, and more silliness would happen.
Toby discussed how he liked going out for drinks with nurses from his team because they enjoyed each other's company (“we all got along so well”): We spent more time with each other than we did our own families, partners, or housemates, just because of the work that we did. So, you’d just be like, “What are you guys up to tomorrow? I’ve got a day off. Do you wanna go out for dinner and drinks?” Or whatever it might be. For me, it's the social interaction. So, I would go for the social connection and just to check in with my colleagues. But I wouldn’t engage in drinking personally as a way of coping. I find that, for me, I have other ways that I prefer to process tough situations. It's so important. You’re working together in life-or-death situations so you need to build some level of relationship and trust and sometimes repair relationships too. I think, in social [drinking] situations, you can let people know that in the heat of the moment you might have been stressed. But actually, this is who I am and this is me as a person, not just me under pressure.
Dan, also in a managerial role, says he regularly attends social events for his team at local bars, wineries, or a bowls club nearby. At these events, he explains, there is “a conscious effort to build up morale in the team to get people together and have some fun activities.” He added that alcohol was central to these events, helping everyone “relax,” and that “it would be a weird experience if alcohol wasn’t involved.” As nurse managers, fostering interpersonal relationships is an essential part of Kelly and Dan's duties. Rather than hindering their work, Kelly's drinking is implicated in caring practices that enact her as more than a manager or a nurse and in ways that “repair” and build “trust” with colleagues. For Dan, it is a way of connecting and building “morale” in fun ways. In these accounts, drinking practices not only build connection, but are restorative of professional and personal relationships.
Kendal (AOD nurse), who had recently migrated from the United Kingdom, recounted how drinking not only helped her make friends in a new city but also improved her capacity to do her job well: I think you communicate well with somebody [in a work setting] that you have a good relationship with outside of work. I've got a friend at work that's probably the closest to me, and we would go out more so for coffee or we always ask for our breaks together. And when we go out for [alcoholic] drinks, we can chat, chat, chat, and then we work really well together. We have fun. We’re always [saying] “We need to go in the same area.” It's like if there's an overdose or something and we’re on it together […] There's no, “I'm greater than you,” or no power […] You just get each other on the same level and it's nice.
While participants often emphasized the productive aspects of drinking, there were also instances where participants such as Sharon (AOD nurse/midwife) described how workplace drinking could feel “cliquey,” and how this shaped professional opportunities: Because its female dominated, if you’re in with the popular girls and you’re going out socialising and [drinking] and then a job comes up, you’re more likely to get that job because you’re in that group.
Beyond this, it is important to note that the centrality of drinking as a way of building professional relationships can be implicated in exclusion, particularly for employees who do not drink for religious or cultural reasons. While our participants did not directly discuss feeling excluded, they described having to negotiate these drinking practices. For example, Tim (nurse manager), who described himself as having Asian heritage, recognized that drinking alcohol while socializing was very much part of the “Aussie culture” and something that he had to “assimilate” to when he started working in nursing. While Fi was Anglo-Australian herself, she noted that nurses from an Indian heritage often volunteered to swap shifts and work during the end-of-year celebration: “They’ll be like, ‘I’ll work the Christmas party’ cause I don’t drink and I don't want to be around that.” In an interview, Devna, an intensive care nurse from Nepal, said she does not drink alcohol for religious reasons and explained that while she does not feel directly excluded by the drinking culture at work, she prefers to socialize in other ways, adding, “to be honest, I’ve got more [nurse] friends from outside of my work. I’ve got more friends that are from my own background.”
The accounts in this section, each in different but related ways, emphasize the importance of not reducing the drinking of nurses and midwives to a harmful coping mechanism. Rather, for these nurses and midwives, drinking is one of several interrelated practices that establish, maintain, foster, and sometimes repair professional and personal relationships that are central to fulfilling professional responsibilities. Just as drinking can be restorative and productive, these generative possibilities are not experienced by all and may produce exclusion, particularly for nurses from cultural backgrounds that do not center drinking so readily. Yet overwhelmingly, our participants discussed examples where drinking might be understood as a narcofeminist strategy to improve—rather than diminish—the ability to fulfill expectations of an extremely demanding profession while also maintaining personal friendships. Drinking in these accounts is both a way of doing work while also taking a break from work; a space where pleasure and harm, belonging and exclusion co-exist.
“You Don’t Have to Care for Anyone”: Celebration and Liberation
While much of our analysis seeks to rebalance the public health emphasis on harm, this is not to suggest that our participants were not concerned about the negative effects of drinking. Along with some of the issues mentioned in the previous sections, many participants discussed how drinking can produce mild negative effects broadly understood as hangover symptoms like nausea, fatigue, muscle aches, “hangxiety,” or disturbed sleep. Audrey (mental health nurse), for instance, described the negative impact of hangovers: “It's a waste of a day, you know, you can’t get anything done […] if you’re hungover. It's a terrible feeling […] it's torture.” Other participants discussed feelings of regret or anxiety following a heavy drinking session. For example, May (practice nurse) recounted feeling “horrified” after she felt like she drank too much alcohol at a work event and “embarrassed” herself. However, it is perhaps unsurprising that drinking remained appealing given that these undesired effects pale in comparison to what were described as the “harsh,” “stressful,” or “traumatic” aspects of nursing and midwifery, including experiences of “OVA” (occupational violence and aggression). In this context, drinking offered more than a break from work despite the hangover—it offered moments of liberation from what Jane characterized as her oppressive job. As nurses we’re in a system of oppression […] We’re working hard in an altruistic role because we wanna help people and we’re not being paid enough, and we’re the only citizens, really, apart from a few others, who are having to leave our homes [during COVID], not going to be able to work from home. I got sick from the hospital two or three times with COVID, definitely from patients. So, we were very at risk. It's something for me! That's something that no one can take away. It's my moment [emphasis added] where I get to sip a bottle of beer and have a dart [cigarette] on the balcony and that's it.
Taking into consideration the “oppressive” character of nursing, again it could be tempting to view Jane's beer on the balcony with accompanying cigarette as a harmful “coping” mechanism to the stressful, under-appreciated and poorly renumerated conditions of her working life. Yet to do so, would be an oversimplification, one that misses the explicit prioritization of Jane's own pleasure within that “moment,” a moment that no one (or no job) can take away. In this way, coping and pleasure are not straightforwardly distinct motivations or experiences, nor is “drinking to cope” straightforwardly harmful or counterproductive. Rather, Jane's description of her drinking practices, particularly in the context of working during the COVID-19 lockdowns, can also be understood as a resistant and experimental practice that interrupts the demands of care and productivity by introducing moments of pleasure in coping, as well as autonomy and transformation (see also Keane, 2023).
Moreover, participants such as Kendal explain the multiple positive embodied affects that drinking with other nurses afforded: I guess it's making you feel a bit more relaxed and confident to maybe say things that was maybe bothering you or whatever. But then also just that people are all normal and we can see each other outside of work and you’re not just labelled as a nurse, you’re actually labelled as somebody, as a person. It doesn’t have to be a drink, but—I don’t know—I think it's just about having fun and being vulnerable with people that can relate to you, and drinking and that makes you maybe just relax a little bit more and let your guard down.
Many participants discussed how their drinking decreased with the onset of parenting responsibilities. For example, Kate (nurse) explained she used to be a “big drinker,” but since having her first child, she only drinks monthly rather than “multiple times a week,” events that require her to plan “weeks, sometimes months in advance.” Relatedly, Sarah, an intensive care unit nurse, said her drinking has reduced, explaining: “I guess my priorities have changed. And I'm also more tired as well because the kids are just exhausting.” Both male participants who had children recounted similar dynamics. For example, Tim said that he rarely drinks at night these days because he has to “settle the kids” in the evening.
Despite the opportunities to drink decreasing with parental responsibilities, participants like Fi, who recently returned to work from maternity leave, described the ongoing importance of collective drinking in the context of family responsibilities. Below, Fi argues that drinking offers respite from domestic labor, care, and motherhood constraints: At those [drinking] events, you know, like nurses are predominantly women, predominantly mothers. Like, you know, might not be married, so it's like, your kids don’t come, your partner doesn’t come. So, it's like your night off as well. And you might not have gone out with just your friends, you know, without your husband or without your kids or whatever, for a little while. So it's that kind of build up as well, where it's like, “Oh, we’re out. Let's just go crazy.” This hardly ever happens. It only happens every few months or something.
She adds: I think nursing is such a caring job. Then you go home and then you care for your children, and people will be nurses forever, for a long time, but like it's nice to go out and you don’t have to care for anyone, you know. And so there's that freedom of, like, “Fuck it.”
Audrey, a nurse manager at a mental health facility, discussed a “really intense year” where “there was a lot of tragedy at work amongst our patient group,” which affected how her colleagues drank together. She explains: After that horrific year last year, our Christmas party was particularly wild, because everybody had been through so much together. So, it was beautiful. But it was probably a lot looser than it had been historically, because it was just everyone blowing off steam after an intense year and feeling very bonded by going through such a difficult time together. People say nurses work hard, play hard, and I think that's very true. And I figured that out really quickly. It was just as soon as I got into the profession. I met very few nurses who said, “Oh, I don’t drink.”
Yet Audrey's perspective above illustrates that it is more than nurses liking to drink “hard.” Rather, their drinking practices become meaningful and generative through the, at times stifling, demands of a job, in ways that cannot be reduced to a harmful way of coping. Rather, pleasure and harm co-exist within participants’ accounts of drinking and coping. Their investment in the “wild,” “beautiful,” and “loose” atmosphere of these events supports the bonding needed for productive professional relationships, which enhance their capacity to endure troubling work conditions. Of course, it's important to acknowledge that opportunities for liberation through “loose” collective drinking are not equally accessible to all. For example, Ehani (nurse), also from Nepal, explains that she was raised in a “culture where drinking is bad.” Since migrating, she now enjoys a drink but finds it “annoying” when colleagues drink “too much” and, “become the person they are not.” She added that she would never “get so loose” in public, as she worries about her safety, explaining, “I limit myself when I'm drinking outside. And then at home, I don't have limits.” While participants generally highlighted the generative possibilities offered by drinking, Ehani's account emphasizes that these are shaped by and within cultural and social norms that shape availability and individual investment. Holding these issues together, these practices can be understood as narcofeminist in orientation in that they also offer liberatory moments where the gendered expectations of nursing and family life are paused, if only for a moment.
Conclusion
Research indicates that for many nurses and midwives, including those interviewed as part of our study, alcohol consumption are routine and commonplace. Much public health research characterizes this as a cause for concern, a problem not only for the health of individual nurses and midwives but also for the public health system itself. Taking a different orientation, we used a narcofeminist approach, sensitive not just to harms but to the positive and meaningful aspects of drinking as they take shape through gender and professional expectations. By analyzing the generative possibilities routinely effaced by calls for nurses and midwives to reduce alcohol consumption (e.g., Mercer et al., 2023), we argue that the drinking of this workforce should not be reduced to a maladaptive and straightforwardly harmful effort to “cope.” Rather than pathologizing individual drinking practices, we explore how participants valued what drinking contributed to performing their roles, which includes managing stressful and traumatic events. In this analysis, nurse and midwife alcohol consumption is neither just to cope nor just to socialize.
Instead, we examined how drinking can be generative in relation to the specific demands of nursing and midwifery and can contribute to wellbeing more generally. Alongside harm, we emphasized how alcohol consumption can offer moments of reprieve and pleasure and facilitate professional relationships and opportunities to support one another. For many of our participants, rather than diminishing their capacity to perform their care roles, drinking events have the potential to deepen or consolidate friendships, enhance and repair workplace relations in ways that strengthen their ability to work together in highly challenging contexts. Alongside the demanding nature of healthcare work, we argue that alcohol consumption offered liberatory moments of pleasure and celebration, allowing individuals to inhabit modes of living beyond the gendered and feminized expectations of work and life more generally. While these moments are not equally available to or experienced the same way by all, the routine individualizing and pathologizing focus on coping overlooks the pleasurable and potentially generative aspects of collective and individual alcohol consumption, and offers limited insight into other social-mediated effects, including harms such as exclusion. Given this dynamic, we see a need for more expansive research that examines how the significance of alcohol in nurse and midwife sociality impacts those individuals who cannot or choose not to drink. This seems particularly pertinent given the healthcare sector's growing reliance on an increasingly ethnically diverse workforce, within which the alcohol consumption practices examined here may not be customary.
More broadly, these drinking practices play an important role for nurses and midwives, whose occupational stressors include not only the day-to-day duties of care work, but also extend to the inequitable demands that they embody all the “values” of healthcare (Perry, Gallagher, & Duffield, 2015). Within this approach, nurses and midwives are expected to be role models and reduce their drinking outside work hours to better represent a health system that, at times, is not always experienced as a benevolent employer but potentially a harmful one (ICN, 2023; McDermid et al., 2020). A problem with looking at drinking (or indeed any consumption practice) in isolation is that it calls on individual nurses or midwives to fix systemic issues such as burnout by, in this case, taking up advice to drink less or not at all. This approach both ignores the broader causes of issues like burnout and asks nurses and midwives to give up meaningful and pleasurable practices that not only contribute to private relaxation, but also the social relationships required to work well. Considering these dynamics, research about and interventions into the drinking practices examined here must be designed with awareness of their place in social and professional life, including their role in managing the negative impacts of institutional deficiencies. They must take a non-judgmental approach that supports nurses and midwives to live well, during and outside of work, on their own terms. Where responses are required, they should approach drinking and working conditions as co-productive and, as such, address them concurrently. Overall, examining the drinking of nurses and midwives within the professional and other social relationships that shapes its meaning and effects emphasizes that it should not be so straightforwardly understood as a maladaptive way of coping with or taking a break from work, but part of work itself.
Footnotes
Acknowledgments
We express our thanks to the participants who gave so generously of their time, insights, and experiences. This article also benefited from the insights of anonymous peer reviews. This project was supported by multiple project partners: La Trobe University, Monash University, Victoria Health Promotion Foundation (VicHealth), and Eastern Health and Nursing and Midwifery Health Promotion Victoria (NMHPV). The views expressed are those of the authors and not necessarily those of VicHealth, Eastern Health, and NMHPV.
Ethical Considerations
The research received approvals from the La Trobe University Human Research Ethics Committee (HEC20096; HEC22300; and HEC24170).
Consent to Participate
All participants gave their informed verbal consent.
Funding
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by an Australian Research Council Linkage Project grant (LP180100449), involving funding from the Australian Research Council and project partner, VicHealth (grant number LP180100449).
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Data Availability Statement
Not applicable.