According to the National Institutes of Health’s National Institute of Drug Abuse, researchers have determined that drug abuse and overdoses have increased during the pandemic. For an addictions nurse, this isn’t surprising. It’s an incredibly stressful time. And more stress results in more cravings for those struggling with addiction.
Hughes took time to answer our questions about being an addictions nurse.
Stephanie Hughes, MSN, APRN
How did you get interested in being an Advanced Nurse in the addiction treatment field? What drew you to it? How long have you been doing it?
My nursing career started in 1998. My first job was in a Behavioral Medicine Unit at King’s Daughters Medical Center in Ashland, Kentucky, where I cared for patients with substance use disorders. I learned how the disease of addiction affects the entire family unit as well as loved ones, and how addiction is unbiased toward socioeconomic status, level of education, or age. This disease affects people of all walks of life.
In 2002, I became the nurse manager of this unit. My leadership role at this medical center extended to the Pre-operative Cardiac Catherization/Intervention Unit. It was approximately two years later when I realized my love for behavioral medicine and returned to it. In 2008, I completed my Master’s in Nursing with an emphasis on leadership and education. This led me to serve as an adjunct clinical instructor at Ashland Community and Technical College, where I worked with RN students in their Psych rotation. I now have been a nurse for 23 years and the disease of addiction along with dual diagnosis (depression, anxiety, PTSD/trauma) continues to be my passion and calling. I continue to learn every day from colleagues and mentors, and, most of all, my patients.
Explain to me briefly what you do as an Advanced Nurse in addiction treatment. Did you have to get additional training/education to do it?
In 2014, I graduated from Frontier Nursing University in Versailles, Kentucky, with a post Master’s degree as a board-certified family nurse practitioner. I also am a buprenorphine waivered practitioner, which means I can prescribe one of the three FDA-approved medications used to treat opioid use disorder. To become waivered, you have to be a qualified practitioner, such as a nurse practitioner or clinical nurse specialist, and apply through and be approved by the Substance Abuse and Mental Health Services Administration (SAMHSA). It also helps to have practice experience in the different levels of care for substance-use disorders, from detox, residential, and partial hospitalization to intensive outpatient and outpatient opioid treatment programs. Having worked in the full continuum allows me to truly meet patients where they’re at and willing to accept care.
What types of people/clients do you serve?
Together with a specialized medical and clinical team, I serve adult men and women who suffer from substance use disorders and their families. Patients who seek treatment for addiction to drugs or alcohol are looking for the same thing any other patient is looking for—they want to be seen by qualified professionals who are engaged with them and they want to be treated with dignity and respect. It’s no different than in a hospital or other care setting; our patients appreciate and remember a friendly smile, a warm blanket, a hot meal, and their hygiene needs being met. As a nurse, I think it’s very important to remember that basic needs are just as important as passing medications and medical treatments. Many of our patients come to us lost or forgotten. Some are homeless, jobless, or estranged from their families due to their addiction. But they still deserve our care, and we help them get their lives back. The treatment we provide not only heals their brains and bodies, but gives them life skills, coping skills, and relapse prevention strategies. And we connect them to other resources in the community as well as our own alumni recovery network for support.
What do you like most about working as an Addictions Nurse?
I get to be the friendly face that greets patients during their first days of treatment. Some days I work to physically stabilize patients and treat the symptoms of detox, and others I just offer a calm, compassionate atmosphere and listen to my patients. Seeing the freedom of recovery through my patients is absolutely amazing. These individuals are some of the strongest people I have ever had the pleasure of meeting. The work they put in to their recovery is unfathomable to many.
What are your biggest challenges in this position? What are your greatest rewards in it?
The biggest challenge for me is having an up-close and personal view of the effects of this terrible disease. One exacerbation/relapse could very well result in death. The loss of so many lives is absolutely devastating.
The greatest reward for me is seeing patients who are working hard and making progress in their recovery—like seeing a patient who now has a relationship with their children and family. They may have gained employment and are able to live independently. I get to help people who will continue to work on their recovery and do amazing things. Many will stay in this field and go on to help others. It’s an amazing dynamic.
What advice would you give to someone considering this type of nursing work?
Nurses who care for people suffering from substance use disorder must empathize with our patients and families. When nurses are able to practice empathy, they are able to treat their patients as people, not diseases, and focus on a person-centered care approach.
Treatment is personalized for each patient. This is not cookie cutter treatment. Being a team player and having good communication is critical. Personalized treatment is delivered through a multi-disciplinary treatment team approach with the patient being the focal point. Many patients enter treatment confused, disoriented, and emotionally defeated. We must be the voice of our patients during these times. We as nurses have to have a strong passion for patient advocacy. This ensures we are always fighting for the very best care for our patients.
Ever wonder it would be like to work in a different type of nursing? Well, we’re here to help.
Minority Nurse will be providing interviews with nurses in various facets of the nursing field. This month, we asked Tina Seever, RN, DPCS, Director of Nursing at BrightStar Care, what it’s like to work as a home health care nurse.
How did you get interested in being a home health care nurse? What drew you to it? How long have you been doing it?
I’ve been working as an in-home care nurse for more than 20 years. Prior to making the switch to home health care I worked as an intensive care nurse at a hospital, where I provided a plethora of emergency services to patients from transplants to oncology care, and more. I also worked as a hospice nurse. In both roles, I cared for patients on short term increments, helping to get them better and discharged from the hospital in a timely manner. Working in hospice and intensive care I had to deliver tough news of loss and navigate tough conversations with families regarding their loved ones’ health. However, after exploring my options, I made the transition to home health care and became the Director of Nursing at BrightStar Care Carlsbad. BrightStar Care is a nationwide home care and medical staffing franchise that provides a higher standard of care to its clients.
What drew me to home care was the fact that I was able to invest more into my clients and the flexibility the role offered me. With home care, you’re able to assist your client during one of the most sensitive times of their life. Working in a hospital, once a patient leaves you never hear from them again. But with home care, you’re able to develop a bond with your client and see progression with their case from start to finish.
Lastly, home care helps bridge many of the gaps that exist in the health care continuum. As a home care nurse or caregiver, you’re able to continue a patient’s care after they’re discharged from the hospital. Often, family members are unaware of how to administer their loved one’s medicine, and they do not have the ability to transport their loved one to and from hospital visits to receive injections, infusions, and other critical medical services they might need as part of their ongoing care. That’s where home care steps in. Home care nurses have the flexibility and knowledge to administer care from the comfort of a person’s home to help lower hospital readmissions and ensure more seniors and those in need of care can age and heal safety at home. For all these reasons I’ve committed my career to home health care.
Explain to me briefly what you do as a home health care nurse. Did you have to get additional training/education to do it?
In my current role as the Director of at BrightStar Care Carlsbad, I am in a position where I act as a mentor to the caregiving staff and other nurses on duty, ensuring they are trained and up to date with the agency’s policies and clinical procedures. In this role I help other medical professionals make the transition to home care. However, our skilled nursing staff at BrightStar Care administer care directly to clients from the comfort of their homes. This is anything from providing clients with injections, infusions, to providing care to a client recovering from a major surgery or an injury.
Additional education is not needed to become a home care nurse outside of the qualifications it takes to become a practicing nurse in your state. It’s encouraged, however, that home care nurses have experience working in a hospital or care facility. Home care nurses should feel comfortable administering care to clients without the help of a supervisor given the independent nature of the job. Home care nurses should also have the confidence and knowledge to access any situation and act accordingly to ensure the best outcomes for their clients.
What types of people/clients do you serve? What are they looking for and what do you provide for them?
While a large portion of in-home care clients are seniors who require senior care services, in-home care can range from personal care to Alzheimer’s & Dementia care, disability services, childcare, transitional care, and more. If a nurse joins the BrightStar Care team and is not particularly skilled in a certain practice, we provide training. Home care nurses provide clients everything from infusions and injections to assisting a client with recovery from a surgery or injury.
Home care nurses also engage in reporting to monitor their client’s progression and status. They work closely with each client’s caregiver and primary care physicians to ensure care plans are aligned and goals are met.
What do you like most about working as a HHC Nurse?
I love that every day is different. We have the ability to take something that starts off as an issue and create a solution for it providing clients with higher quality outcomes. It’s immensely rewarding to witness your clients heal over time and watch as your care is directly impacting their progression. Specifically in my role as the Director of Nursing, it’s a reward to watch other nurses enter the field and become experts in home care nursing.
What are your biggest challenges in this position? What are your greatest rewards in it?
Challenges: Prior to the pandemic I would have said there were no challenges associated with being a home health care nurse, given the flexibility the role provides. However, the pandemic intensified some of the biggest challenges in health care and those changes rippled down to our industry. Currently, the biggest challenge is navigating the labor crisis that exists nationwide.
Rewards: One of the biggest rewards that home health care offers is watching our hard work with a client pay off. Watching them heal and recover is a reward that keeps me in this field. Referrals and in door walk-ins at our office are always fulfilling – to know that a client valued our services so much that they referred a friend or loved one is an amazing feeling. While the pandemic opened the door to new challenges, it also helped reinforce the safety and flexibility in-home care offers. Nurses can often choose their own schedule and are not confined to working long hours at a hospital or care facility, instead they travel from client to client lowering their exposure to large groups allowing them to work on-on-one with a client.
In this feature, we profile a particular type of nursing so that others in the field can learn about what nurses do in this position, what they enjoy about it, and how others can get into it.
Kathleen Martinez, MSN, RN, CPN, President, American Academy of Ambulatory Care Nursing (AAACN), and an infection preventionist at Children’s Hospital Colorado, gave us information about ambulatory nurses.
What is ambulatory care nursing and what do they do?
Ambulatory care nursing is unique in that it treats an individual in this fuller context of community, family, and population. Ambulatory care considers the access and quality of health care, but also evaluates the influence of other social determinants of health: economic stability, neighborhood environment, social context, and access to quality education.
I was introduced to ambulatory care nursing when I accepted a position in Children’s Hospital Colorado Telephone Triage Center. In telephone triage, an RN uses the nursing process (assessment, diagnosis, plan, implementation, and evaluation) to determine the significance of symptoms during a phone call. Every call requires all your skills and creativity. Each encounter requires total focus and attention; interpreting and clarifying information, considering availability of resources, navigating barriers, ensuring that the family understands the care instructions, or that they have called 911, or that they have transportation available to get to the ED or clinic.
And all of this is done within an eight-minute phone call, with a family you may never have met before. I was hooked! It is incredibly empowering and humbling to walk with a family through a child’s illness.
All state Nurse Practice Acts define “Dependent Practice” in circumstances where RNs are carrying out the orders of another provider, such as an MD, Advanced Practice RN, or Physician Assistant; and “Independent Practice” in circumstances where RNs are using their knowledge, skills, and training to initiate and complete tasks within the scope of nursing. Ambulatory care lives much more in the “Independent Practice” realm.
As an ambulatory care nurse, what are your responsibilities?
Well, that depends on your role. If you have a role in Care Coordination and Transition Management (CCTM), you might be checking lab results for a patient, or adjusting their medications based on those results. You may visit a complex patient in an inpatient unit who is preparing to transition home or to an extended care facility. Maybe you are doing a home visit to ensure a family can properly deliver the medications and treatments their child requires.
If you work in a clinic that performs procedures, you may be teaching a preoperative class. Or completing a post-operative wound assessment. Or completing a procedure, such as a fecal microbiota transplant in a GI clinic, or phototherapy in a dermatology clinic. Or performing a prenatal exam or well child check in a Federally Qualified Health Center.
What many people don’t understand is that the acuity of care performed in the ambulatory care setting is similar to care delivered during an inpatient stay. In fact, more than 80% of all cancer care is delivered in ambulatory care settings, including high-dose chemotherapy, preparative regimens for bone marrow transplants, and radiation therapy.
According to the Center for Medicare and Medicaid Services (CMS) 70% of all surgeries occur in an ambulatory setting. Clinics perform complex procedures such as bronchoscopies, endoscopies, and dermatologic surgeries. In all of these settings, RNs use the nursing process to provide care, education, and support.
What are the biggest challenges in being an ambulatory care nurse?
One major challenge: Broadening the scope and job responsibilities to accurately reflect our education, training, and licensure.
Federally Qualified Health Centers and Rural Health Centers are role models in allowing nurses to work to the top of their license. Nurses perform well-child checks, routine pregnancy care, and Medicare Wellness visits. They perform screenings and manage medications with the use of Standing Orders. They teach classes on managing chronic illness. They coach, encourage, and engage individuals to take charge of their health and wellness.
Other ambulatory care settings are learning from these models and creating exciting and engaging roles for RNs.
Another major challenge: Reimbursement for services remains a frustration for nursing in all settings and is a primary focus of the American Nurses Association and the Future of Nursing 2020-2030.
What are the greatest rewards in being an ambulatory care nurse?
The promotion of health and prevention of disease occurs over a lifetime, not in a single episode of care. Ambulatory care nurses meet people where life is lived: in schools, community centers, clinics, and in their homes. We walk alongside individuals through a season or a lifetime as mentors, peers, and teachers.
Statistically, only a small percentage of people are hospitalized each year, yet greater than 90% of Americans seek health care services in ambulatory care settings. And we are there to meet them!
When I was performing telephone triage, one of the most impactful statements I could make was saying, “It sounds like you are doing a great job.” Or simply, “Your child is lucky to have you as her parent.”
Creating this space of honor and trust allows the family to interact truthfully, which allows us to provide better care. It also just feels amazing to hear the relief and gratitude in the voice of the caller when their efforts are recognized and appreciated.
If nurses want to pursue a career in ambulatory care, do they need any additional education and/or training?
A Baccalaureate Degree in Nursing provides much of the knowledge and skills needed for any nursing role, including ambulatory care nursing. A strong “Transition to Practice Program” fills in any gaps and focuses on additional training. Just as critical care nursing is a specialty, ambulatory care is a specialty, requiring ongoing education and training.
AAACN offers tools and resources to support orientation and we have developed a very popular ambulatory care nurse residency program. We also provide extensive support via education events, networking/special interest groups, and targeted publications for those interested in pursuing a career in ambulatory care nursing. I always advise nurses to join an association supporting their specialty to open career doors and bond with colleagues.
To further advance the specialty, AAACN is working with the American Association of Colleges of Nursing to ensure all prelicensure programs include adequate material and experience in the ambulatory care setting.
What kind of advice would you give to a nurse wanting to work in ambulatory care?
I have been in ambulatory care-specific or associated roles for 30 years. Every year the opportunities are expanding. The Affordable Care Act of 2010 was a game changer. After half a century of hospital-focused care, there was suddenly a shift to health maintenance, disease prevention, care coordination, patient-centered care, and looking at social determinants of health as a larger context of care.
The Future of Nursing 2020-2030 calls for an increased focus on the role and value of the RN as a member of the health care team. During the 2019 Future of Nursing 2020-2030 Town Hall meetings, the focus was almost entirely on elements central to ambulatory care: environment, community, access to health and education resources, management of chronic diseases, and wearable technology. In addition, it’s important that patients are cared for in a comfortable and familiar environment. Use of telehealth specialty care decreases the burden and cost of travel. Telephone triage and telehealth visits allow sick persons to remain at home in comfort while accessing high-quality and reliable care. In some states, use of Standing Orders greatly expands the care that can be provided by the RN.
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