Examining Specific Workplace Issues Faced by Addiction Care Nurses

Nurses in every area of medical care face unique and extraordinary professional and personal challenges, many of which are due entirely to the nature of their field of specialization. These challenges can be especially pervasive in the area of addiction care, where nurses are required to interact with populations at their most compromised and emotionally vulnerable at the height of addiction. As Nurses Month rolls on, Recovery Unplugged wants to discuss the daily and long-term issues that addiction care nurses face while treating clients, and thank them for their extraordinary commitment and performance.

The Need for Quality Nurses in Addiction Care

According to data from the National Institutes of Health, over 23 million American adults have battled problematic drug use at some point. Of that 23 million, about a quarter have received adequate care.  Both inpatient and outpatient care of this population has been found to be most effective when a multidimensional treatment method addressing mental, physical, emotional, and even spiritual needs is utilized.  Nurses in the addiction care field play an essential role in this care, and often wear many hats in devoting themselves to their patients’ needs.

In addition to the traditional nursing duties, such as taking vital signs, changing dressings, managing medications, and keeping patient charts up to date, these nurses are responsible for guiding patients through potentially fatal detox, some therapy, administering Vivitrol shots, patient education (including for medication, the dangers of addiction, and treatment options), scheduling specialist/outside doctor appointments, and preparing patients to leave treatment when completed.  Additionally, nurses who work in post-detox centers and programs have reported that their work typically requires a higher level of mental health services and support than previously expected.

The Rigors of Routine: A Day in the Life of An Addiction Care Nurse

The nursing field has many associated challenges, including physical stress, long shifts (typically 12 hours minimum), required schooling and education which are expensive and years-long, and the intense nature of days spent on the job. Addiction care nursing combines the traditional field work of nursing with the practices of substance abuse treatment and therapy. With substance misuse and abuse rates increasing annually, the 38,000 nurses working in substance use disorder and psychiatric settings have been faced with increasing workloads and greater associated hardships.  One such hardship is the lack of understanding and coverage by patients’ insurance companies.

The addiction care community is still fighting to be fully recognized within some sects of the medical field, and notably by the insurance industry.  Despite 43 states requiring addiction treatment coverage under commercial healthcare, not all patients in need of addiction care have insurance, and those that do are often limited by their policy’s restrictions. Whether it be the limits of what treatments the policy allows for, or the length of stay allotted by their coverage, patient care decisions are many times determined by the constraints of their insurance. When patient needs and demands cannot be met with the resources at hand, nurses feel helpless and unable to provide the level of care their patients require and deserve.

Treating the Patient’s Family

Another significant and surprising impediment to client care faced by addiction care nurses is clients’ families. Enabling and denial continue to be a considerable hindrance to patients’ best interests and treatment needs. Although well-meaning and loving, family members typically have just as hard a time as the patient admitting there is a problem. Getting help for a user or alcoholic makes some family members feel as if they are betraying their loved one’s trust, and sending someone to treatment may feel like abandonment.  As the old adage goes, family members often risk the danger of “loving someone to death.”  Nurses are faced with the daunting task of caring for patients and providing consistent treatment, regardless of what families and loved ones believe about the situation. A nurse’s duties often include providing both emotional support and the tough love and treatment a patient needs to get better.

Helping Patients Forge New Paths

One final issue these nurses face is patients’ inability to dig out the roots of their problems and completely rebuild their life around their new sobriety. Our own Amy Colicci noted that our clients often “can’t imagine things on the other side [of addiction] that are just as good or better.” When a patient’s entire identity and lifestyle have been built around their substance use lifestyle, and the “dope sickness” associated with the need to use, coming to treatment and restructuring their life seems completely foreign and often unattainable. The inability to turn to the normal coping mechanism of substance use can leave patients feeling lost at how to handle the stresses of life. This stress can lead to patients focusing on physical manifestations of mental or emotional discomfort rather than fleshing out the “why” of the situation.

For example, a patient’s new in-treatment living situation may evoke anxiety and stress. In the past, anxiety and stress have been triggers for a patient to use drugs. When faced with these triggers, and their inability to use, patients may experience headaches, nausea, stomach aches, or general uneasiness. While we may recognize these physical ailments as regular stress reactions, signaling our need to address what is bothering us, an addiction patient, having never faced these triggers with sobriety, will need help looking past the physical expressions and into the underlying issues.

Changing Perceptions and Changing Lives

Reshaping their focus to address the feelings behind the physical reactions will help patients to deal with these feelings in a healthy, therapeutic way rather than try to escape them. Nurses play a vital role in explaining these physical side effects to patients, and helping them to look past them and into the root of the problem. While they may not always provide the therapy and psychiatric treatment, they will be the first point of contact in many of these situations, and have a responsibility to their patients to be honest about what may not be a true physical ailment.

As the rates of substance use and the opioid crisis grow to ever higher numbers, the burden on nurses in the addiction treatment field grows with them. The nursing field is constantly adapting and adjusting to meet the specific needs of these patients.

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