In any kind of care, nurses utilize a problem-solving format to assess patients, identify problems, plan and implement interventions, and evaluate the outcomes. But with addiction patients, this process is compounded by problems related to the addiction and other health complications. Addiction nurses, therefore, need both generalized nursing knowledge and specialized knowledge of addictions in order to provide effective care. This combination of knowledge makes addiction nurses versatile and cost-effective providers of care.
Because
behavioral health units in hospital settings often combine addiction
and mental health programs, many addiction nurses also have
experience with a wide variety of mental health problems. The
combination of these skills is significant when one considers the
increase in patients presenting with both addiction and mental health
problems (dual diagnosis). These patients challenge both traditional
addiction and mental healthcare providers.
Typically, registered nurses receive their initial education in either a two-year community college for an associate degree in nursing, or a four-year university program for a bachelor of science degree in nursing (BSN) -- three-year diploma schools, have become increasingly rare. In each program, students study the nursing care of adults, children, pregnant women, mental health nursing and community health nursing. BSN students have two years of general college courses before entering the nursing major, including behavioral and physical science courses. Although addiction issues are addressed in all nursing specialty areas, basic knowledge in addiction nursing is often taught as part of the mental health course. Addiction nurses can gain advanced education through workshops, specialty journals and graduate programs.
The National Nurses Society on Addictions (NNSA) sponsors an annual conference on addiction nursing, an addiction nursing journal and other publications on addiction nursing. NNSA is currently the largest professional nursing organization representing addiction nursing. It has published a core curriculum on addiction nursing, and has worked with the American Nurses Association to define the dimensions of addiction nursing and develop standards. Advance Practice Nurses (APNs) are prepared at the graduate level and receive a Master of Science Degree in Nursing (MS or MSN) as either nurse practitioners or clinical nurse specialists. APNs have advanced education in pharmacology, pathophysiology and courses related to their area of specialization. In many states, APNs also have prescriptive privileges. There are several graduate nursing programs with a specialty in addictions nursing; other programs include addiction nursing as a subspecialty of mental health nursing.
Nurses with sufficient addiction experience can document their expertise in addiction nursing by passing a rigorous test to become recognized as a Certified Addiction Registered Nurse (CARN), a process sponsored by NNSA. In some states, nurses with the CARN credential are recognized as addiction treatment providers. Currently, the CARN certification is for all registered nurses; there is a separate certification for Licensed Mental Health Technicians and Licensed Practical Nurses. An Advanced Practice Specialty examination is also being developed, and some addiction nurses are certified as alcohol counselors.
The actual functions of the addiction nurse depend upon the setting as well as the expertise and interests of the nurse. On an inpatient unit, addiction nurses are involved in the full range of patient care. They are heavily involved in the detoxification phase of treatment and maintain ongoing monitoring of the patient's health status using protocols such as the Clinical Institute Withdrawal Assessment scale (CIWA). Some outpatient settings are experimenting with outpatient detoxification based on nursing assessment and monitoring via intermittent contact and a paging system.
Addiction nurses provide a wide variety of therapeutic modalities:
The addiction nurse's role in outpatient settings includes many of the same contributions, as well as telephone consultation and initial evaluation of the incoming patient.
They may also have supervisory or administrative roles within the nursing department or within the organizational environment. And not all addiction nursing occurs in a treatment setting. Occupational health nursing, school nursing and community and home health nursing are all areas in which a substantial amount of addiction nursing is practiced.
Nurses may also work in health settings as a liaison, either individually or as part of an addiction team, to provide consultation to patients with addiction problems on other hospital units. Part of their function may be education of other nurses on addiction problems within specialties such as obstetrics, adolescent care and adult care. Screening and appropriate referrals of addiction problems are important skills to teach all nurses.
Addiction nurses, particularly those with advanced degrees, are also involved in increasing knowledge about addiction and addiction nursing. This may occur through individual or group research projects. Several university schools of nursing are currently receiving federal funds for post-doctoral study in addiction research.
Nursing takes a holistic approach to patient care that identifies the physiologic, psychologic, cognitive and spiritual dimensions of each patient and plans care to include all dimensions. Individualized plans of care are developed collaboratively between the patient and the nurse. Nursing emphasizes disease prevention and health promotion through education and other appropriate means, and also recognizes the importance of the patient's family as part of recovery. This base of philosophic beliefs about people helps to develop a versatile and holistic practitioner uniquely suited to meet the multifaceted needs of the addiction patient.
Sandra Handley is a consultant to the Addiction Technology Center at the University of Missouri-Kansas City and a lecturer at the University's School of Nursing. Dr. Handley also works part-time on a dual diagnosis unit and recently completed a survey of substance abuse screening for primary care providers. E-mail: shandley@prodigy.net