Nurses at the frontline: increasing scope of practice to help end the opiate overdose crisis

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      By Michelle Danda and Trish Dribnenki

      Record numbers of death by opiate poisoning are happening in B.C.

      In September the provincial government announced that registered nurses will be authorized to prescribe safe alternatives to toxic street drugs. On September 24 came the the B.C. College of Nursing Professionals (BCCNP) announcement that registered nurses (RNs) and registered psychiatric nurses (RPNs) will be able to prescribe Suboxone to treat people living with opiate use disorder.

      This is an important step in addressing the opiate overdose crisis, the other health emergency that is happening in B.C.

      Nurses play an essential role in our health-care system. For decades, outreach nurses in B.C. have been at the front line of providing health care to marginalized people, particularly those in the Vancouver Downtown Eastside.

      The change in legislation will give Registered Nurses and Registered Psychiatric Nurses the autonomy to treat opiate addiction in a responsive way that is not possible with prescribing rights being solely in the hands of physicians and nurse practitioners.

      However, this legislative change alone will not change the bigger issues like stigma of people living with mental health and substance use issues, lack of resources and funding, and decades of a criminal justice response marginalizing the people who need the most help.

      Public awareness of the need to address the limitations of health-care providers and systems must be increased. The public must also be made aware of critical issues that arise when treating people with mental health and/or substance use concerns.

      This is not a quick fix. To do this safely and responsibly extensive resources for education, training, policy review, and coordination of health organization practice pathways and standards are needed to ensure that these changes are done safely.

      The changes come into effect on October 26, mere weeks from now. There is much variability in RN and RPN training, depending on their education, job training, and worksite. Substance use and addictions training is not routine training for all nurses, even nurses who work with people living with mental health and substance use issues.

      Additional nurses must also be hired to ensure that current staff are not overwhelmed and burn out because of increases in responsibilities, increases in patients, and increases in services provided. Planning and implementation may take months—an eternity in a health-care crisis that has already taken more lives this year compared to last, with three months left to go.

      Health-care delivery is changing, positioning nurses publicly to be the leaders that they have always been. The changes signal a bigger system shift away from physicians and NPs being the top tier of treatment decision-making. Health care in B.C. is set up as a hierarchy, with physicians in the top position of most responsible practitioner. Are physicians ready to give up some of their power?

      Giving RNs and RPNs the ability to prescribe medications to treat substance use issues is a move toward collaborative care. Direct care nurses are the ones who are most frequently with patients in crisis, in the hospital and in the community.

      For decades nurses in B.C. have been working community outreach, as street nurses, and in community clinics caring for people with substance use issues. For too long a limiting factor in the ability to provide timely care has been restrictions on nurses’ ability to prescribe medications.

      To provide safe, timely, competent care the floodgates cannot simply be opened with the expectation that nurses will rise to the challenge. Nurses are constantly being asked to provide more for less. Nurses have to ensure that this change in legislation helps rather that risks the most vulnerable and marginalized.

      If you are a member of the public, an individual accessing services, or a loved one, please hold us and the health organizations we work for accountable. If you are a nurse it is time to embrace this increased scope of practice, while also understanding the responsibility this entails. Make every interaction count.

      Nurses must act now, using their voice to advocate for continued system change to end this crisis, and the necessary changes in education, training, and support of the health organizations to support them.

      Trish Dribnenki is a community health nurse, western chair of the Harm Reduction Nurses Association of Canada, and champion for equitable health care for marginalized people. Michelle C. Danda is a mental health nurse, PhD nursing student at the University of Alberta, and social justice advocate. They both have extensive work and life experience in hospital and community-based mental health and substance use programs and services in Vancouver and Calgary. They are both passionate about raising public awareness of substance use and mental health, elevating the role of nurses as patient advocates, and challenging dominant health-care narratives.