NP and RN Prescribing in Addictions what does it look like? Louise Leonard Nurse Practitioner April 2018
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1 NP and RN Prescribing in Addictions what does it look like? Louise Leonard Nurse Practitioner April 2018
2 Outline Background AOD NP Mental Health NP Broadening the scope! RN vs NP prescribing Prescribing roles in addictions Transition from RN to NP identity crisis! Challenges, barriers and rewards - what helped?
3
4 My Background Nurse for 40 years AOD field 20 years RGON Waikato Hospital B.HSc. (Nurs) 1994 U.W.Syd B.A.(Psych) 1998 Macquaire Uni, Sydney P.G.Cert. H.Sc. (Addiction & Coexist.) Otago Uni P.G.Dip.H.Sc.(MH Nursing) - UoA Master of Nursing UoA 2010 Endorsed as NP April 2012 NP role since January 2013
5 Masters Graduation 2011
6 Area of Practice Adults (18 & over) who present to primary, secondary or tertiary services Across the substance use disorder spectrum Majority are moderate to severe dependence With physical and mental co-existing illness Require complex case co-ordination and treatment planning
7 NP Scope of Practice In pursuit of flexibility, newly registered nurse practitioners will no longer be restricted to a specific area of practice. As advanced clinicians they are trusted to practise within their area of competence and experience. Retrieved from NZNC website 07/10/17
8 Heath Practitioner s Act Covers seven / eight statutes Part 7 amendments to the Misuse of Drugs Act 1975 enables NPs and designated RN prescribers to prescribe controlled drugs for those dependent on them Methadone, Suboxone, Benzodiazepines. Implementation February 2018
9 RN Prescribing what, where and how? Minimum of 3 yrs FT practice in the area PG Dip RN prescribing (embedded in NP Masters) Practicum with authorised prescriber Satisfactory assessment of competencies Work in collaborative teams Work under supervision by NP or Dr Prescribe from a restricted list of medicines
10 RN vs. NP prescriber Key differences RN prescriber NP Prescribing authority Designated prescriber: able to prescribe specified medicines Authorised prescriber: able to prescribe any prescription medicine. Scope of practice Additional qualification Must work in a collaborative team with an authorised prescriber available for consultation Able to diagnose and treat common conditions P Dip RN prescribing for long term and common conditions Able to independently assess, diagnose and treat for a population group in an area of practice May work autonomously Consults when necessary Clinical master s in nursing
11 Prescribing roles Alcohol withdrawal management inpatient and home and ambulatory detox and relapse prevention Opioid substitution treatment - nurse led clinics, rural Benzodiazepine withdrawal management Stabilising co-morbidity (depression, anxiety)
12 Do
13 Transition From RN to NP The Challenges! Isolation No established support mechanism Pioneering role / barriers Expectations from others vs. my own - You shouldn t be doing what a RN can do Independent practice Authorized Prescriber The shift to full responsibility! Erikson s stages revisited..identity crisis!
14 Erikson s Stages Revisited
15 Erikson s Stages Revisited Autonomy vs. Shame and Doubt Shift in responsibility extended scope - Am I up to it??? Initiative vs. Guilt Am I doing enough? There s so much I don t know? Industry vs. Inferiority Can I do this? Do you feel like a fraud yet? Identity vs. Role Confusion Seismic Shift from advanced nurse in your area of practice to novice nurse practitioner / prescriber What do I let go of? How do I set new limits? How do I keep my practice safe?
16 Erikson s stages revisited 2 Generativity vs. Stagnation Finding your feet as a NP, growing in confidence, seeing the potential of the role and what you as NP have to offer your client group i.e. Advanced knowledge, extended skill set, a wealth of experience, ability to gain rapport, flexible and responsive treatment Passing it on!
17
18 The Future Looks Bright Mental Health & Addiction NPs are branching out OST, CEP, Hep C, Harm reduction Sexual Health, Palliative care, Primary care. whatever is your area of interest! NPs are gaining ground NPs, 21 MH NP. RN prescribers
19 What helped? Good support network managers, nurse leaders, senior medical staff, mentors, peers Supervision needs Clinical / Professional/ Peer Maintaining work/life balance Collegial support NPNZ /DANA/Te Ao Maramatanga College of Mental Health Nurses
20 Mentors
21 a
22 What would I advise others? Be clear about your goal Gain support from organizational leaders ( You can t do this in isolation!). Make the commitment / be prepared for hard work Push through / find ways around the barriers Don t expect others to get it! Be determined, tenacious, courageous.
23 Celebrating success!!
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