Linda L. Smith, ARNP, MN, M.Div., CAPIntervention Project for Nurses (IPN)Program Consultant

2010 National Council State Boards of Nursing Substance Use Disorders Guidelines ForumApril 27, 2010

Our History – 1980-2010

Our Future2010 –

What is our Vision? How do we get there?

Our Future3 Critical Areas to Consider

Attitudes Accountability Advancement

Definition-The predisposition to respond either positively or negatively to something; an opinion or general understanding.

Attitudes (our perception) affect our behavior and decision-making.

Formed by:ExperienceEducation-languageExposure

Negative Attitudes (Stigma) regarding nurses with substance use and mental health disorders are still very prevalent in the nursing community.

Fear of being stigmatized is a major factor which affects a nurse’s willingness to seek help.

Stigma affects our Programs in many ways.

Words Like: Protect, Cover-up, Sheltered

Standardized language provides us a common means of communication.

If we cannot name it, we can not practice it, teach it, finance it, or put it into public policy.

It will help us build a body of evidence-based practices and improve quality of care .

Performance AffectedIMPAIRMENT

Chronic, Progressive,Sometimes Fatal ILLNESS

Substance Use Disorder-DSM IV TR

* NIDA- Principles of Drug Addiction Treatment: A Research Based Guide. April 2009.

Relapse rates are even lower for professionals in Monitored Programs.

By viewing addiction as a chronic brain disease and offering nurses thorough evaluation by a specialist, individualized treatment (substance and/or mental health) and, continuing care with close monitoring, carefully considered reentry, ongoing support and relapse prevention education, the opportunity for success in recovery is good.

NIDA- Principles of Drug Addiction Treatment: A Research Based Guide, April 2009.

Our major purpose is SAFETY ( to protect the public) via prevention, early intervention, close monitoring, careful consideration of reentry and on-going follow-up.

intervention (actions) vs. Intervention (formal structured)

What are our expectations?

Do we expect each nurse to respond the same way?

Process of Change Documented Series of steps Takes Time Each Nurse’s readiness to change is different

Prochaska and DiClemente’s Stages of Change Model

Nurses change over time-(Time takes Time)

Drug treatment can include behavioral therapy (such as individual or group counseling, cognitive therapy, or contingency management), medications, or their combination. The specific type of treatment or combination of treatments will vary depending on the patient's individual needs (where they are in the change process) and, often, on the types of drugs they use.

The severity of addiction and previous efforts to stop using drugs can also influence a treatment approach. Finally, people who are addicted to drugs often suffer from other health (including other mental health), occupational, legal, familial, and social problems that should be addressed concurrently.

NIDA- Principles of Drug Addiction Treatment: A Research Based Guide, April 2009.

What people see in the media has a significant effect on their health-related views and behavior.

We need to be proactive about managing our Program image.

Stakeholders-a person, group or organization that has direct or indirect stake in our Programs because it can affect or be affected by our actions, objectives, and policies.

Consumer Groups/Community Board of Nursing/Regulatory Agencies Employers of Nurses Legislators Nursing Colleagues Student Nurses

We need to assess the attitudes of our key stakeholders and design ways to impact negative attitudes/stigma.

Positive attitudes will positively affect the future of our Programs.

To be answerable to self and others.

Accountability with responsibility is one of the foundations of our Programs because we are accountable to our profession and consumers.

Alternative to DisciplineMonitoring Program

Board of Nursing/Regulatory Agencies

NCSBN – Guidelines; Standardization

ANA- Code of Ethics

Nursing Employers

Consumer Groups

Nurse Participant

Assessmentof

Needs

Citizen Advocacy Center

Regulatory Management of Chemically Dependent Healthcare Practitioners

A Forum Convened by the Citizen Advocacy Center June 17, 2009 – San Francisco, CA.

David Swankin, CAC President

Opening remarks “As worthwhile as these programs can be, they must be developed and

carried out in ways that ensure they are sufficiently accountable to the public and inspire public confidence and support”.

Discussed tension between issues of safety and rehabilitation Overview of California program audit (www.bsa.ca.gov) SB-1441 Calling for increased transparency, external audits and reviews

Self-Monitoring ▪ External Audits (Program and Financial)▪ Planning-Establish parameters/performance

measures▪ Program Evaluation (Is your Program meeting

performance measures?)▪ What are we reporting?▪ Do folks know what we are up too?

Goal Setting/

Planning

Entry and Exit DataProgress and Return to WorkRelapse and RecidivismMonthly and Annual ReportsExternal AuditProgram OutcomesProgram Evaluation

Transparency

Get the word out!

Review literatureLook at best-practicesLook at the data (quality of Program)Make on-going changes as neededAnalyze outcomes

(Individual/Program)

Evaluate

Individual outcomes depend on the extent and nature of the patient's problems, the appropriateness of treatment and related services used to address those problems, and the quality of interaction and follow-up monitoring and care between the patient and his or her treatment providers (nurse monitoring program).

NIDA “Principles of Drug Addiction Treatment”

A Research Based Guide, April 2009.

Trust and Transparency

Confidence

Funding

Attitudes about the Program

Accountability is a HUGE factor in Program future success!

Important Considerations

Review Program Legislation Consider Electronic Records Networking /Collaborate with other

States Report your data to stakeholders Educate, Disseminate, Publish Implement National Standards

Electronic RecordsWe really need to move from paper files to computer records.

Can you imagine?

Substance disorders are preventable, treatable brain diseases (chronic, progressive and sometimes fatal).

Relapse rates for addiction resemble those of other chronic diseases such as diabetes, hypertension and asthma.

Alternative to Discipline Programs do work well to protect consumers - and to restore nurses with substance abuse disorder safely back to work.

Benefits of Standardizing Programs

Offer us consistencyCommon LanguageBody of Knowledge Increased Confidence/TrustLessens Stigma

Benefits of Standardizing Programs

Model of Evidenced Based Practice Increased Authority Improves CommunicationBetter Program Effectiveness

Our Future Attitudes Accountability Advancement