Christine Murphy, fourth from left, rounds on Shapiro 7 East to review the specialized care approach for patients with substance use disorder who undergo cardiac surgery.
If there’s one thing Christine Murphy, MS, PMHCNS-BC, CARN-AP, wants people to know about substance use disorder, it’s that the disorder is a disease just like any other illness.
“There was a time when society taught us addiction was a choice within the individual’s control. We have to put that part of history behind us and help patients recover from this devastating disease, ” said Murphy, of the Psychiatric Nursing Resource Service. “With the right care and support, people do get better.”
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Murphy and advanced practice nurses throughout the Brigham are working on numerous efforts to help overcome the stigma surrounding substance use disorder and improve the care of patients and their loved ones. These are priorities for the Department of Nursing and the entire institution.
This spring, the Advanced Practice Registered Nurse (APRN) Council partnered with the Psychiatric Nursing Resource Service to organize a full-day conference for advanced practice nurses in diverse settings.
“No matter what area you practice in, you will be caring for patients with substance use disorders — inpatient, outpatient, primary care and procedural areas, ” said Caitlin Sachs, MSN, NP, of Plastic Surgery and chair of the APRN Council. “Our goal was to cover a broad range of topics related to substance use disorder to help us provide the best care for patients and recognize biases.”
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Murphy opened the conference with a discussion about the disease model of addiction. The lineup of speakers, most of whom were Brigham nurse experts, covered barriers patients face in receiving care, harm reduction, recovery-oriented care, pain management and trauma-informed care.
The keynote speaker, Monica Bharel, MD, MPH, commissioner of the Massachusetts Department of Public Health, provided an update on the progress Massachusetts has made in reducing fatal opioid-related overdoses. <
The conference concluded with reflections from a patient in recovery. “The patient was really brave, and his talk solidified for everyone what the conference was all about, ” said Barbara Lakatos, DNP, PMHCNS-BC, APN, of the Psychiatric Nursing Resource Service. “He talked about his journey through health care, the stigma he experienced and its negative effect on him. He described what clinicians did that was helpful or not helpful throughout the process. He provided tips on what he found most useful, including receiving outpatient care through the Bridge Clinic.”
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One of the topics that emerged at the conference was how nurse practitioners can receive training to prescribe medication-assisted therapy, such as buprenorphine. The state requires an eight-hour training for physicians and 24 hours of training for nurse practitioners and physician assistants, plus an online training component, to receive a waiver to prescribe. A few weeks after the conference, Elizabeth Donahue, MSN, RN, NP-C, of Primary Care, helped to organize a training for more than 60 nurse practitioners and physicians from multiple specialties at the Brigham and other local institutions.
“Right now, the education and training are optional for providers, which perpetuates the stigma of the disease, ” said Donahue. “We need to shift to acceptance and recognition of substance use disorders as chronic disease and ensure that no patient is left to suffer. We need everyone to take up this mantle if we hope to adequately address this epidemic.”
At the Brigham, behavioral health is integrated throughout all services. The hospital doesn’t have a dedicated behavioral or mental health unit on campus, although patients may be referred to other Partners inpatient care units. “That has allowed us to advance the care for substance use disorder in all areas; it is part of the care we provide to our patients, ” said Lakatos.
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That means that staff in inpatient, outpatient and procedural areas must have support, education and resources to ensure they tailor care to meet the needs of patients with substance use disorder. Nurses identified education related to substance use disorder as their highest priority via the department’s recent Learning Needs Assessment.
Murphy, who participated with interprofessional colleagues on the Brigham Comprehensive Opioid Response and Education (B-CORE) Program Education Taskforce, helped to develop resources for Brigham staff. “Our nursing contribution was offering tips on how to care for these patients, with a focus on communication, withdrawal, safe environment of care, pain and the disease model of addiction.”
Currently, Murphy, Lakatos and colleague Monique Mitchell, MS, PMHCNS-BC, are leading an effort to develop simulation training. “Patients with substance use disorder come in with medical co-morbidities, and they may be in the hospital for an extended length of stay, ” Murphy said. “They may have challenging behaviors, and nurses need to feel comfortable assessing them for pain and talking with them about their disease so that we can continue to elevate the level of care they receive.”
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Murphy and Donahue were recently appointed to the Partners Substance Use Disorder Steering Committee, which makes recommendations and provides guidance for system-wide changes related to substance use disorder.
“It’s meaningful to have acknowledgement at the Partners level that we need to do more in terms of standardizing tools, providing evidence-based care and focusing on harm reduction, ” said Murphy. “We need to teach patients to care for themselves and offer them a compassionate, stigma-free environment that says, ‘We care about you.’”
Hosted by Scott Weiner, MD, MPH, of the Department of Emergency Medicine and director of the Brigham Comprehensive Opioid Response and Education (B-CORE) Program, and Carla Monteiro, MSW, care transition specialist in the Bridge Clinic. 5–5:30 p.m. dinner and networking in the Zinner Board Room, followed by a guest speaker and movie screening at 5:30 p.m. in Bornstein.OSHKOSH - Fifty years have passed since the University of Wisconsin-Oshkosh College of Nursing was established, and the program continues to shine as a leader in educating future nurses.
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There are so many good things about the program that Linda Gobis, president of the Wisconsin Nurse Association, said it's hard to pick what specifically makes it so high caliber.
I think it's one of the best programs in the state of Wisconsin right now, she said, noting the faculty, who keep current in their clinical practice while committed to students, stand out as one of its biggest strengths.
Their students perform at the best levels in Wisconsin — they can boast the highest pass rate in the state, at 96 percent, for the National Council Licensure Exam, which students must pass to become a registered nurse. The national average is 89 percent.
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Its Accelerated Nursing program is also notable, given that it's the only one of its kind in the country, said Leslie Neal-Boylan, dean of the College of Nursing, and a new doctoral program, nurse anesthetist, is expected to be approved by the end of October. Contingent on approval, it will also be the only such doctoral program in Wisconsin.
The Wisconsin State University-Oshkosh School of Nursing had 27 students enrolled when it was established in 1966. Enrollment had grown to 150 students by the 1970s when it was renamed the UW-Oshkosh College of Nursing. That decade would also see the creation of a masters program for nurse practitioners, another first in the state.
Students by 1980 could earn a bachelor's degree for registered nurses, and in the 1990s the college established its graduate achievement program. The College of Nursing footprint continued to grow into the 2000s with a simulation lab and international clinical trip offerings, according to the website.
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More than 800 students were enrolled in 2015-16, when the college moved again into new, state-of-the-art spaces that were renovated in Clow Social Science Center. Earlier this year, the American Assembly for Men in Nursing, whose president is Brett MacWilliams, associate nursing professor at UWO, named the college the recipient of its 2016 Best School or College of Nursing Award.
With as much growth the college and profession at large has seen in the past 50 years, the basic principles of nursing have not changed, Neal-Boylan said.
What has changed is what nurses are expected to know, she said. You really have to be a scientist and a scholar.
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Diseases like Ebola and Zika have put an emphasis on population health. People live longer with chronic disease, topics once reserved for graduate school, she said. Nurses today need to know about the implications of childhood obesity, heart disease and diabetes, as well as reimbursement and patient care finances. In addition, they have to be lifelong learners with the ability to adapt to future changes.
Erin Peterson, 25, became a traveling nurse after she graduated from the university in 2013. Her current assignment is in New York City, where she works in pediatric oncology and bone marrow transplant. Though it was tough to balance classes and clinical, library time, a work schedule and social life throughout college, the tight-knit group of nursing students kept each other focused and driven to succeed, she said.
I have had the privilege to meet nurses from all over the country and can definitely tell the difference in my knowledge base, autonomy, time management and bedside manner, Peterson said via email. I believe I had excellent preparation for my career from UWO.
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Students are educated in leadership, finance and organizational behaviors; they're encouraged to get on executive boards during their careers. Fifty years ago nurses never had to do any of that, Neal-Boylan said, but it's more important than ever that they have a seat at the table as health care decisions are made.
Nursing students at UWO learn using advanced equipment, and they graduate as highly prepared,
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