Background: The phenomenon of vicarious trauma (VT) has been the subject of considerable attention for over 30 years, but its impact on nurses in addiction services remains poorly understood, despite the established link between trauma and addiction. This research aimed to fill this gap by investigating the prevalence and risk factors of VT among nurses who work with people with addiction problems and by exploring the relationship between leadership and VT.

Aims and Objectives: The aim was to measure VT prevalence and its associated risk and protective factors among nurses who work in addiction services. The five objectives were to quantify VT prevalence, risk, and protective factors among nurses who work in addiction services; measure leadership's association with VT in nurses who work in addiction services; explore nurses' VT experiences and protective factors perceptions; determine nurses' views on leadership and its role in minimising VT; and utilise the findings derived from this study to develop evidence-based guidelines for minimising VT among nurses working in addiction services, with a specific focus on enhancing effective leadership practices.

Methods: This mixed-methods research employed a sequential explanatory approach. The study began with a quantitative survey involving nurses who work in addiction services in Europe, using the Vicarious Trauma Scale (VTS), Vicarious Trauma— Organisational Readiness Guide (VT–ORG), demographic questionnaire, and coping mechanisms assessment. Subsequently, a follow-up qualitative phase included semistructured interviews with self-selected participants. Follow-up joint display facilitated a comprehensive analysis of the data integration.

Main Findings: A substantial moderate to high VT risk (88.43%) was identified among nurses who work in addiction services. Surprisingly, they also displayed noteworthy resilience and personal growth in relation to VT. Notably, nurses aged between 36 and 55 exhibited a lower VT score (85.7%) compared to their younger counterparts (97.4%) with p=.078. Moreover, nurses holding higher positions, such as those in Administration (Clinical Nurse Managers or Assistant/Director of Nursing) (p= .013) and Clinical Nurse Specialists, were found to be at a significantly increased risk of developing VT. Interestingly, nurses from The Netherlands were six times more likely to have a lower VT score (p= .004) than their counterparts in Ireland, the UK, Portugal, and other European countries. Additionally, nurses in addiction services employ various coping mechanisms, including peer support, social support, education, nuanced detachment, and maintaining empathetic connections. Leadership within organisations and supervision emerged as crucial in addressing VT. Nurses who reported a lack of these aspects had a significantly higher risk of VT (p= .005). The absence of a clear vision of the organisation's mission (p .044), regular meetings to address trauma exposure (p= .038), clear communication on decision-making (p=.005), and proactive leadership strategies (p= .035) were identified as contributing factors to this heightened risk. Furthermore, inadequate salary and benefits (p= .033), insufficient training on vicarious trauma (p= .010), and stress (p= .021), coupled with a lack of policies supporting nurses and their families (p= .048), increased the risk of VT. Adopting a leadership approach characterised by teamwork, support, autonomy, and positive communication and a work atmosphere could significantly minimise the risk of developing VT.

Conclusion & Implications: The findings suggest that VT is a major concern for nurses working in addiction services. It highlights the significance of leadership in VT prevention and recommends a more contemporary leadership approach, such as distributed leadership. The findings contribute to enhancing the quality of care in addiction services and offer evidence-based guidelines for nurses and for their organisations for managing and preventing VT in addiction services.