Linda L. Smith, ARNP, MN, M.Div., CAP Intervention Project for Nurses (IPN) Program Consultant 2010 National Council State Boards of Nursing Substance Use Disorders Guidelines Forum April 27, 2010

Our History – Our Future 2010 – What is our Vision? How do we get there?

Our Future 3 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: Experience Education-language Exposure

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 nurses 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.

Language Impairment vs. Illness Chemical Dependency/Addiction/Alcoholism vs. Substance Use Disorders (SAD) Rehabilitation/Advocacy vs. Safety Treatment and Intervention vs. Monitoring Get it right the first time vs. a process of recovery

Performance Affected IMPAIRMENT Chronic, Progressive, Sometimes Fatal ILLNESS Substance Use Disorder-DSM IV TR

* NIDA- Principles of Drug Addiction Treatment: A Research Based Guide. April 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 Nurses readiness to change is different Prochaska and DiClementes 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.

Public Board of Nursing Nursing Community Individual Nurses Nursing Employers Alternative to Discipline Monitoring Program

SYSTEMATIC APPROACH Needs Assessment Goals Planning Initiate Change Evaluate Report

Board of Nursing/Regulatory Agencies NCSBN – Guidelines; Standardization ANA- Code of Ethics Nursing Employers Consumer Groups Nurse Participant Assessment of 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 ( SB-1441www.bsa.ca.gov 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 Data Progress and Return to Work Relapse and Recidivism Monthly and Annual Reports External Audit Program Outcomes Program Evaluation Transparency Get the word out!

Review literature Look at best-practices Look at the data (quality of Program) Make on-going changes as needed Analyze 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 Records We really need to move from paper files to computer records. Can you imagine?

Newly Licensed Nurses 201,984 RN 80,835 LPN Looking forward, government analysts project that more than 587,000 new nursing positions will be created through 2016 making nursing the nation's top profession in terms of projected job growth. Dohm, A., & Shniper, L. (2007). Occupational employment projections to Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics.

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 consistency Common Language Body of Knowledge Increased Confidence/Trust Lessens Stigma

Benefits of Standardizing Programs Model of Evidenced Based Practice Increased Authority Improves Communication Better Program Effectiveness

Our Future Attitudes Accountability Advancement