The Role of Nurses in Drug and Alcohol Treatment. Carmel Clancy PhD; RMN; RGN; PGCertHE; FPH

Transcription

1 The Role of Nurses in Drug and Alcohol Treatment Carmel Clancy PhD; RMN; RGN; PGCertHE; FPH

2 Disclosure presenter

3 Acknowledgements Working Group Members Carmel Clancy ; Mike Flanagan; Lynda Greenslade; Ellie Gordon; Sue Doherty; Claudine Evetts; Martin Smith; Daniela A. Collins, Public Health England (PHE) Megan Jones; Emma Christie; Fizz Annand Other key contributors Professor Rod Thomson; Dr Mark Holland; Rosalie Weetman; Bruce Bell; Chris Fieldhouse; Joanne Bosanquet; Iain Armstrong Royal College of Nursing, the Association of Nurses in Substance Abuse (ANSA), the National Substance Misuse Non-Medical Prescribing Forum, and Public Health England.

4 Presentation Outline History and timeline of UK addiction nursing role Implications for the future role of specialist addiction nursing Recommendations and steps for advancing the preparation of this specialist role, including the challenges in gaining a recognised international accreditation framework Concerns raised by Pubic Health England (PHE) stakeholders about reducing numbers of professional nursing roles within alcohol and drug

5 Addiction Nursing in the UK Alcohol and drugs is a specialty area within the nursing career framework, defined by the service user group and specialist clinical tasks undertaken. Nurses moving into it may have completed initial pre-registration training in mental health, adult or child fields and/or learning disabilities nursing or in midwifery. From early 2018 there will be one set of NMC educational standards for registered nurses that will apply to all approved education institutions and placement providers.

6 Role Development of Nurses in Addictions Association of Nurses in Substance Abuse (ANSA) : First NHS ATU nurses part of treatment teams 1960s: Creation of Regional DDUs ( nurses appointed to posts 1980s study of ATUs reports 259 nurses working; move of services into community and emergence of CATS; CDTS; increase in nonstat and voluntary sector provision Int. Nurses Society on Addictions (IntNSA) Europe s focus on harm minimization; NXC Consultant nurse; nonmedical prescribing

7 Why Nurses come into Addictions Default Reasons Positive: related to notions of progression, for example moving into addiction nursing to gain promotion rather then because of interest in the specialty Negative or Neutral: associated with lack of choice, involuntary transfer due to staff shortages, a position becoming available, or the work setting being closer to home Magnetic Reasons The idea of working within a specialty ; prior knowledge of the working environment during their nurse education; the perception that addiction nursing offered the possibility for autonomous practice and growth; the client profile (particularly that they were not psychiatric patients ) and the general treatment philosophy and approach to care (i.e. multidisciplinary and multiagency).

8 Developmental Role Stages of Addiction Nurses Encounter Overwhelmed; Lack of specialist knowledge and skills; Performance anxiety; Fearfulness Engagement Development of tolerance; Technical skill acquisition (both formal and vicariously); Ability to set boundaries Stabilisation Therapeutic detachment; Validation Competency Clinical competence; Mentoring Mastery Consultancy; Clinical maturity; Adaptability Clancy, Oyefeso & Ghodse, 2006

9 Changing landscape of the last 10 years The drug & alcohol field is: Performance monitored more than any other area of health or social care Commissioning moved to local authorities in 2013 Repeated cycles of re-tendering with diminishing budgets All contribute to specialist addiction treatment being a less attractive career option Job insecurity Re-tendering, re-structuring, TUPE all challenge morale, recruitment

10 Impact on nursing Medical roles increasingly provided by NMPs Nursing posts increasingly provided by drug workers No idea on actual numbers (not measured) Risk that commissioners and managers may fail to fully appreciate the impact on quality

11 Public Health England (PHE) Concerns raised by Pubic Health England (PHE) stakeholders about reducing numbers of professional roles within alcohol and drug Begin work on a series of publications

12 Outlines: The roles of nurses working in alcohol and drug treatment including the contribution they can make to health and social care outcomes The added value nurses can bring to alcohol and drug treatment The competences and skills that should be expected of nurses working in alcohol and drug treatment What is required to develop and maintain these competences

13 Multiple Role Component Model for Alcohol and Drug Nursing Clinical Leadership Quality Improvement Teaching

14 Multiple Role Component Model for Alcohol and Drug Nursing Clinical Triage/assessment; Risk management; Safeguarding; Key working/case management; Psychosocial interventions; Prescribing; Physical health checks; Vaccinations; Mental health checks; Wound dressing; Health advocacy

15 Multiple Role Component Model for Alcohol and Drug Nursing Quality Improvement Developing & leading on quality governance; Clinical audit & service development; Data monitoring; Engaging in public health and clinical research

16 Multiple Role Component Model for Alcohol and Drug Nursing Leadership Leading & managing teams; Clinical supervision; Reflective practice; Partnership working; Advise to commissioners and policy makers

17 Multiple Role Component Model for Alcohol and Drug Nursing Teaching Developing training to nonspecialist staff; Continuing Professional Development in services; Mandatory training; Teaching on undergraduate and postgraduate courses; Mentoring of student nurses and junior clinical staff

18 Role Reach Across the Lifespan Prenatal Development Infancy and Toddlerhood Early Childhood Middle Childhood Adolescence Early Adulthood Middle Adulthood Late Adulthood Death and Dying Across all Settings Primary care Acute care (including hospitals) Mental health care Forensic/prison Schools Maternity Emergency care Public Health including homeless Care homes

19 Challenges and the need for remaining vigilant Future workforce safeguarding the role how do we do this if nurses are not working or visible (different roles titles that don t having nursing in the description) in this sector How do we know if role is threatened if we don t know baseline workforce numbers, or seek to capture data/information Undergraduate/prequalifying training (crowded curricula lack of trained faculty in subject specialism no champions on faculty) and the cycle begins again

20 Lack of specialist/accredited training, what does good look like and how do we measure it? Not globally recognised as an advanced practice role - ICN definition characteristics not consistently demonstrated including lack of recognized title for nurses working in addiction practice roles Need for more research on the cost implications of different skill mixes in addiction services, particularly services that do NOT have nurses, and health related outcomes

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