WelTec Nursing Forum November 2009 Raine Berry

Nursing and Addictions Coexisting Disorders The Addictions Nursing Workforce Current Treatment Situation Workforce Issues Matua Raki Strategies Workforce Vision

Coexisting Problems Coexisting Capable Coexisting Enhanced CEP is common

Prevalence of CEP NZ MH Survey 2004 – Te Rau Hinengaro 20.7% mental health disorder (L/T) - 45% of these had coexisting drug disorder and/or alcohol abuse - 31% met criteria for alcohol dependence -37% more than one disorder -7.7% multiple 40% with substance use disorder also met criteria for an anxiety disorder and 29% a mood disorder

CEP Associated Issues Major impairment in role functioning High prevalence of chronic medical issues e.g. chronic pain, cardiovascular disease, high BP, respiratory conditions, diabetes Suicidal behaviour associated with increased number of disorders People with diagnosed mental health disorder twice as likely to use alcohol hazardously

Dependence Diagnosis in NZ Outpatient Sample Adamson et at 2006 DiagnosisCurrentLifetimeOnset Alcohol (8.7) Cannabis (4.3) Opioid (7.1) Sedative (7.1) Amphetamine (4.0) Hallucinogen (3.7) 1 substance substances substances1646

Coexisting Disorders in an AOD Outpatient Sample Adamson et al 2008 DiagnosisCurrent %Lifetime %Onset Age Total with coexisting non-substance use/non-gambling Axis I Disorder 7490 Major depressive episode (14.1) Major depressive episode, recurrent (10.3) Bipolar 1 disorder (6.7) Substance induced mood disorder (9.3) Obsessive compulsive disorder (8.3) Posttraumatic stress disorder (11.3) Panic disorder with agoraphobia (10.4) Social phobia (7.1) Specific phobia (9.8) Antisocial personality disorder 2741

The Addictions Nursing Workforce

AOD Workforce Demographics All AODNurses Female59%82% Median age49 years 3% < 30 yrs 48 years DHB57%85% Pakeha Other European 59% 16% 62% 29% Maori15%3% Pacific3%0% Asian5%3%

Postgraduate Qualifications All AODNurses Any Postgraduate47%80% Postgraduate AOD27%50% Studying toward Postgraduate AOD 05%12%

Routine Activities Individual Therapy88% Comprehensive Assessment82% Education or other community work82% Brief initial assessment/triage79% Clinical case-management79% Facilitate groups or meetings56% Report writing94% Supervision of other staff71% Administration71% Management41%

Skills nurses bring to addictions Health education Assessment and treatment planning Coordination of care from assessment to discharge Pharmacotherapy knowledge Withdrawal management Monitoring – health, bloods, BP etc Crisis intervention Risk Management Consultation/liaison Counselling Documentation

Perceived barriers to nurses wanting a career in addictions Barriers% of responses Lack of knowledge, skills, attitudes 71 Nurses not interested71 Stigma59 Lack of understanding / awareness of roles 44 Pay and conditions38 Under-resourced21

Nursing Roles in the Addiction Context 85% of nurses in designated nursing positions Previous poor recognition of advanced practice roles 51% intend to work toward an advanced practice role including 30% Nurse Practitioner Expanded and extended practice scope

AOD Treatment Survey

AOD Treatment Position Many services struggling to meet demand - detox (residential medical and social) - youth services - coexisting problem service - residential programmes (incl. A&D Act beds)

Treatment Position Influencing factors -Lack of new positions - Lack of competent practitioners able to take clinical responsibility -Doubling of referrals from Corrections since the new Sentencing Act

Workforce Issues

Recruitment More workers in NZ labour market will retire than be recruited over next 25 years Labour demand will exceed supply in AOD from 2011 Attaining and attracting qualified and skilled staff Difficulty recruiting for specialist positions (detox, CEP)

Key issues Aging workforce - AOD age 49 in 2008, age 42 in National labour force – age 40 in 2006, age 36 in 1991 Workforce Trends - Rise in qualification level - Rise in numbers of ‘other Europeans (6% 2004, 16% 2008, Nurses 29%) - More counsellors, fewer nurses and fewer Maori Retention - high turnover (41% in AOD workforce for less than 5 years)

Matua Raki Strategies

Matua Raki Projects Capacity Building –Forecasting –Consumer workforce Capability Building - Scholarships, Internships - Mobile training and short courses - MI Internships - Families with complex and challenging issues - CEP enhancement project - Responses to methamphetamine problem

AOD Advanced Practice Nursing Project Promote flexible post-graduate AOD/addiction advanced practice professional development nursing pathways within clinical masters programmes leading to clinical Nurse Specialist/ Nurse Practitioner that incorporate postgraduate papers Strengthen national nursing leadership networks, including amongst nurses on the Nurse Practitioner pathway Strengthen strategic partnerships with nursing leaders within workforce programmes

AOD Advanced Practice Nursing Project Support strategic and operation planning within the Addiction and Mental Health sector to develop the infrastructure for the implementation and ongoing support of advanced AOD/addiction advanced practice nursing roles Assist individual nurses with achieving / recognition of advanced practice status

Summary

The capability and capacity of the AOD treatment sector improving however increasing demands on services continue Increasing the numbers in the addiction workforce not enough Nursing workforce needs to increase: –New dedicated nursing positions created –Pathways for Nurse Practitioners supported New approaches needed to: - recruitment - funding - treatment provision

Workforce Vision

By 2012 Confident and hopeful workforce Skilled / capable specialist workforce Skills and knowledge gained supported and utilised in the workplace Consumer and peer workforce well established Increased Maori and Pacific Workforce Advanced nursing roles well established with Nurse Practitioners employed in each specialist service Increased capability in PHC and allied workforces to address addiction issues The average age of the workforce matches the National Labour force average Career in Addictions attractive to graduates and school leavers

Postgraduate AOD Courses National Addiction Centre Auckland University

Prevalence of Mental Health Disorders 39% of people >16 years met criteria for a disorder at some time before interview Life-time (L/T) Risk = 46.6% Anxiety = 24.9%L/T Risk = 28.8% Mood = 20.2%L/T Risk = 28.4% Sub Use 12.3% L/T Risk = 13.8% Eating = 1.7%L/T Risk = 1.9% Te Rau Hinengaro 2006

12 month Prevalence of Substance-Use Disorders 2.6% alcohol abuse; 1.3% dependence 1.2% drug abuse; 0.7% dependence 0.9% Cannabis abuse; 0.5% dependence Higher in Maori, Pacific, younger people, males, people with less education, less income