Barriers for helping impaired healthcare workers There are several reasons nurses do not report colleagues suspected of SUD. These include the following (NCSBN, 2018a; 2018b): ● Fear that colleagues will lose their jobs if they are reported ● Lack of explicit policies and procedures that address SUD, impairment, addiction, and reporting of such issues ● A work environment that lacks compassion and willingness to help impaired nurses recover Best practices for prevention of drug diversion Many healthcare workers struggle with the idea that a colleague may be involved in drug diversion. Actually, about 15% of healthcare workers have drug dependency at some point in their careers, although the rates of SUD and addiction are equal to the general population (Nyhus, 2021). Unfortunately, easy access to controlled substances contributes to higher rates of dependence. Proper wasting and disposal of controlled substances may thwart diversion. This problem is multifaceted and requires a multidisciplinary approach. Change principles applied to substance use disorder Integrative therapy looks beyond a single psychotherapy approach and emphasizes change principles rather than limited techniques. The stages of change identify an individual’s readiness to change, which is the period of time and tasks completed to move toward the next stage (Norcross & Beutler, 2019). The stages are precontemplation, contemplation, preparation, action, and maintenance. Precontemplation is where change is not in the foreseeable future. Individuals in this stage need to be made aware of the problem. Lack of insight prevents the individual from seeing the consequences of harmful/addictive actions. It is important to understand that the individual is in denial and tends to defend the actions. Resistant, unmotivated, and unwilling to change are descriptors for this stage. Additionally, the individual may obsess about the negative rather than focus on the benefits of change (Norcross & Beutler, 2019; Raihan & Cogburn, 2022). Contemplation . The second stage is contemplation, marked by an awareness of the problematic behavior. However, the individual still determines if the problem is worthy of correcting. Therefore, the avoidance of conflict results in no commitment to the matter. The problem is at the center, but the individual never acts meaningfully. This causes the individual to remain stuck for about 6 months (Norcross & Beutler, 2019; Raihan & Cogburn, 2022). Preparation . In the third stage, the individual can acknowledge the problematic behavior and commit to correction. The practice combines intentional conduct where individuals gather Conclusion While the number of people misusing and abusing prescription opioids and other controlled substances is a national public health concern, nurse practitioners can help bring this epidemic under control with appropriate assessment, prescribing, and monitoring of patients receiving opioid analgesics. Understanding the CSA and state regulations is the first step in this process. Optimizing the care of the patient experiencing Allen, J. P., Loeb, E. L., Narr, R. K., & Costello, M. A. (2021). Different factors predict adolescent substance use versus adult substance abuse: Lessons from a social- developmental approach. Development and psychopathology, 33(3), 792–802. https://doi. org/10.1017/S095457942000005X • American Academy of Family Physicians (AAFP). (2021). AAFP chronic pain toolkit. https:// www.aafp.org/dam/AAFP/documents/patient_care/pain_management/cpm-toolkit.pdf • American Association of Nurse Practitioners (AANP). (2022). State practice environment. https://www.aanp.org/advocacy/state/state-practice-environment References •
In addition to protecting patients, employers have ethical and legal obligations to help nurses and other employees whose functioning is impaired due to substance use. State Boards of Nursing often have assistance programs designed to protect patients and save the lives and careers of those dealing with substance use disorder. Nurses must review the options offered by their respective State Boards of Nursing. These programs are generally designed to be confidential, nonpunitive, and therapeutic. A prescriber should take precautions that can minimize drug diversion, including ● Exercise caution when prescribing controlled substances with other medications that are sedating ● Detailed documentation when prescribing or choosing not to prescribe ● Ensure the DEA number or license number is confidential unless disclosure is required ● Adhere to strict refill policies ● Use state PDMPs with every patient encounter ● Collaborating with pharmacies and managed care plans seeking to determine the medical necessity of controlled substances information from various sources like self-help books and psychotherapy while developing an action plan. For example, individuals comment that smoking is terrible (Norcross & Beutler, 2019; Raihan & Cogburn, 2022). Action . Change happens during the fourth stage. Total abstinence is expected for less than 6 months. During this stage, the individual has confidence that willpower will improve the journey of change. Individuals are willing to receive assistance and support and develop short-term positive reinforcement, which counteracts potential triggers that lead to relapse. Unfortunately, many individuals need clarification on this stage of change and forego the work required to act on changing behavior (Norcross & Beutler, 2019; Raihan, N & Cogburn, M., 2022). Maintenance . Continuing new behavior change is the focus of the fifth stage. Individuals have maintained total abstinence for more than 6 months. This stage gives individuals the confidence to maintain positive lifestyle changes without fearing relapse. Thoughts of old habits often return, but the temptation is resisted. Individuals require support as they re-evaluate reasons for change, acknowledge success and consider potential triggers (Norcross & Beutler, 2019; Raihan & Cogburn, 2022). Ultimately, the goal is to create an action plan to prevent relapse since the first 3-6 months of abstinence is difficult to achieve. After that, treatment becomes individualized with a fluid and dynamic evolution (Norcross & Beutler, 2019; Raihan & Cogburn, 2022). acute pain is critical to prevent the progression of pain to a chronic disease state, leading to the possible long-term use of opioid analgesics. The clinical decision to initiate chronic opioid therapy should be made judiciously as part of a treatment plan that includes multiple modalities, not just opioid analgesics. Appropriate monitoring and communication between the clinician and patient can lead to desired outcomes. • American Medical Association (AMA). (2021). Report shows decreases in opioid prescribing and increases in overdoses. https://www.ama-assn.org/press-center/press-releases/report- shows-decreases-opioid-prescribing-increase-overdoses • American Psychiatric Association [APA]. 2013. Diagnostic and Statistical Manual of Mental Disorders, Fifth edition, text revision (DSM-V-TR). American Psychiatric Association. • Anheyer, D., Haller, H., Lauche, R., Dobos, G., & Cramer, H. (2022). Yoga for treating low back pain: A systematic review and meta-analysis, Pain, 163(4), e504-e517. https://doi. org/10.1097/j.pain.0000000000002416
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