The Future of Nurse Monitoring Programs : Attitudes, Accountability and Advancement

1. 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 The Future of Nurse Monitoring Programs:Attitudes, Accountability and Advancement

2. Nurse Monitoring Programs(Alternative to Disciple/Diversion) Our History – 1980-2010 Our Future 2010 – What is our Vision? How do we get there?

3. Nurse Monitoring Programs Our Future 3 Critical Areas to Consider • Attitudes • Accountability • Advancement

4. Attitudes • 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

5. Attitudes • 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

6. Standardized Language-Influences Our Success • 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 .

7. Changing Language Changes Perceptions (Attitudes) 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

8. Illness vs. Impairment Chronic, Progressive, Sometimes Fatal ILLNESS Performance Affected IMPAIRMENT Substance Use Disorder-DSM IV TR

9. Comparison of Relapse Rates Drug Addiction vs. Other Chronic Illnesses* Relapse rates are even lower for professionals in Monitored Programs. * NIDA- Principles of Drug Addiction Treatment: A Research Based Guide. April 2009.

10. 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.

11. 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)

12. What are our Attitudes about change? • 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)

13. There are a variety of evidence-based approaches to treating addiction • 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.

14. Attitudes-Our Image • 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.

15. Assessing attitudes of key stakeholders 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

16. Final Word about Attitudes • 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.

17. Future of Nurse Monitoring Programs-Accountability 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.

18. Accountability-To Whom? Alternative to Discipline Monitoring Program

19. Accountability

20. Accountability-What is expected? • Board of Nursing/Regulatory Agencies • NCSBN – Guidelines; Standardization • ANA- Code of Ethics • Nursing Employers • Consumer Groups • Nurse Participant Assessment of Needs

21. Consumer Expectations • 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

22. Accountability-What? • 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

23. Data Collection and Reporting • 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!

24. Accountability- Evaluate • Review literature • Look at best-practices • Look at the data (quality of Program) • Make on-going changes as needed • Analyze outcomes (Individual/Program) Evaluate

25. Accountability Influences Individual Outcomes • 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.

26. AccountabilityInfluences Program Outcomes • Trust and Transparency • Confidence • Funding • Attitudes about the Program

27. Accountability Accountability is a HUGE factor in Program future success!

28. The Future of Nurse Monitoring Programs -Advancement Important Considerations • Review Program Legislation • Consider Electronic Records • Networking /Collaborate with other States • Report your data to stakeholders • Educate, Disseminate, Publish • Implement National Standards

29. Advancement Electronic Records We really need to move from paper files to computer records. Can you imagine?

30. Advancement Education and Dissemination 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 2016. Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics.

31. Educate, Disseminate • 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.

32. National Standards of Care Benefits of Standardizing Programs • Offer us consistency • Common Language • Body of Knowledge • Increased Confidence/Trust • Lessens Stigma

33. Advancement Benefits of Standardizing Programs • Model of Evidenced Based Practice • Increased Authority • Improves Communication • Better Program Effectiveness

34. The Future of Nurse Monitoring Programs Our Future • Attitudes • Accountability • Advancement