Five years ago, Lisa Oldham’s nurses at Orange Regional Medical Center saw, maybe, five, opioid-addicted patients a day. Now, the number has more than doubled, adding physical, mental, and professional stress on the 1,000 nurses working for the upstate New York hospital.
“Recently while teaching at another facility we had a patient who required four security guards to keep the patient safe so nurses could medicate so they wouldn’t harm themselves,” Oldham says. “These patients can injure a nurse, and a bedside nurse can be very fearful. It takes a lot of compassion to risk harm to care for a patient in a crisis. And we see more and more patients suffering from this.”
The nationwide opioid crisis is a headline staple.
- A 2015 review in the journal Pain found that 21% to 29% of patients prescribed opioids for chronic pain misused them, causing some to turn to cheaper alternatives like heroin.
- From 1999 to 2016, more than 200,000 people died in the U.S. from overdoses connected to prescription opioids.
- In 2016 (the latest numbers available from the Centers for Disease Control and Prevention), 42,249 drug overdose deaths from opioids occurred in the U.S.
- States with the highest death rate from drug overdoses in 2016 were West Virginia, New Hampshire, District of Columbia, and Pennsylvania.
Causes of addiction and overdoses
Addiction professionals and pundits debate the causes of addiction and overdose increases. But the topic that’s missing from screaming headlines is the toll the opioid crisis takes on battle line nurses.
“The doctors write an order for an opioid, but who comes in before and after to educate the patient? It’s the nurses,” says Pam Teuschler, nursing manager for River Oaks, an American Addiction Centers rehabilitation facility in Tampa, Fla. “This affects nurses emotionally because many times they’re unable to treat patients the way nurses are built to treat patients.”
From the first days of training, nurses learn that pain, often called “the fifth vital sign,” is what the patient says it is. “You’re trained not to judge,” Teuschler says. “Pain is their reality. It is what they report to you.”
The opioid crisis changed that. Now, pain is determined by a patient’s answers to a checklist of questions.
“Nurses are now more mechanical,” Teuschler says. “You have a list of questions, and based on their answers, nurses will medicate their patients. If patients aren’t giving the right answers, they’re not getting what they need regarding medication.”
That switch from pain reliever to pain evaluator goes against the emotional grain of many nurses, which fosters frustration and burnout. Here are more opioid-related reasons for nurse burnout.
- Opioid-addicted patients typically are cauldrons of emotions that spill onto bedside nurses. Patients frequently present as angry, agitated, and depressed– sometimes in succession; sometimes all at once.
- Aggressive patients pose a physical threat to nurses, raising anxiety levels of caretakers.
- Unlike other patients who arrive at a hospital to get well, many addicted patients arrive to score more drugs.
- Nursing gratification often is instant. Treat an ailment, and a patient feels better quickly. With opioid-addicted patients, relief takes much longer, or never.
Mertis Shearry, director of nursing at Laguna Treatment Hospital in Orange County, Calif., has worked in the behavioral health industry for 20 years and has witnessed the unraveling of the opioid epidemic in the U.S. Treating addicted patients left Shearry with fears for the future and safety of her children.
“As a nurse and mother of two active children who play multiple sports, I am constantly worried about the possibilities of my children getting injured and having to be placed on prescription pain medications,” Shearry says. “Prescription pain medications may lead to the road of addiction.”
Using education to prepare nurses for the opioid crisis
Everyday nursing is stressful; but the drama and risk that accompanies opioid addiction piles on nursing stress, anxiety, and exhaustion.
Nursing schools, hospitals, and clinics are helping nurses cope by providing classes geared toward dissecting the causes, prevention, and treatment of opioid addiction. About 200 schools connected with the American Association of Colleges of Nursing have pledged to educate students on the Centers for Disease Control’s Guidelines for Prescribing Opioids for Chronic Pain.
The University of Pennsylvania Nursing School recently began offering undergraduates an elective titled, “Opioids: From Receptors to Epidemic,” and it’s developing in-person and virtual reality simulation programs where actors pretend they’re in the throes of an opioid overdose, and students practice their response and treatment. The University of Cincinnati Nursing School now requires advanced practice nursing students to take nine hours of instruction on prescribing opioids.
Community colleges are getting into the act, too. The nursing faculty of Washington State Community College in Ohio – Ohio has the third highest opioid-related overdose death rate in the country – recently were urged to take “Understanding Substance Use Disorder in Nursing,” a four-hour course offered by the National Council of State of Boards of Nursing.
Advice for new nurses coping with the opioid crisis
Dr. Benjamin Evans, president of the New Jersey State Nurses Association, is a veteran, advanced practice nurse who says 90 percent of his patients have “co-morbid mental health and addiction issues.” Below, he provides tips for new nurses on how to protect themselves from their patients’ addictions.
- Set clear, professional boundaries with a patient, and be aware of attempts to manipulate you.
- Don’t pre-judge people with addictions.
- Learn about the disease and manifestations of substance use disorders.
- Re-frame relapse from a failure to maintain sobriety to the newer understanding that a relapse is a learning event that teaches what doesn’t work for that patient. It often takes multiple learning events before someone figures out how to maintain a sober/abstinent life.
- No one can positively affect everyone. If a patient overdoses, it is not a nurse failure.