Nursing Plays a Critical Role in Addressing the Opioid Crisis

Nurses are often the first point of contact for patients seeking support for substance use disorders, which are often the result of prescription medications for pain or surgery. Their skill in navigating the healthcare system, combined with their ability to serve as compassionate patient advocates, makes nurses critical in addressing the opioid crisis.

According to the National Institutes of Health (NIH), more than 47,000 Americans died of opioid overdose in 2017. More than 50 million people suffer from chronic pain — half of those with daily chronic pain — and more than 2 million have an opioid disorder.

Joining the fight

In 2015, Cleveland Clinic launched a leadership opioid task force. Cleveland Clinic Nursing Institute’s Legislative and Health Policy Council did the following:

• Helped develop alternatives to pain medication.
• Advocated for a new law to make naloxone more widely available.
• Formed a speakers bureau to provide community education about the dangers of opioids.
• Created the Caring for Caregivers program to educate employees on addiction, strategies for handling addicted patients, and how to combat “compassion fatigue.”

At the advanced practice level, Cleveland Clinic is part of the Northeast Ohio Hospital Opioid Consortium, a hospital system-based and physician-led consortium working to significantly reduce the epidemic’s impact.

Cleveland Clinic’s Catherine Skowronsky, MSN, RN, ACNS-BC, CMSRN, serves on the consortium’s Education Subcommittee. It just released for review a nursing education module draft on substance use disorder for nurses and front-line staff to use across the continuum of care. Once approved, it will be released for use in Northeast Ohio hospitals.

Addiction at every door

Nurses see patients with substance use disorders in every area of medicine. Serious infections are more common among people with substance use disorders.

Mary McLaughlin Davis, DNP, ACNS-BC, CCM, Senior Nursing Director of Inpatient Care Management for Cleveland Clinic Akron General, says acute care interdisciplinary teams meet to discuss individual care plans for difficult patients — including those who repeatedly present at the emergency department (ED) for drug-related issues.

“So many of these patients end up in the hospital, and they do not need to be,” McLaughlin-Davis says. “It’s a cycle — if we’re not helping them when they come into our EDs and setting them up with the right support, it can become a costly endeavor.”

Skowronsky says treating the acute issue a patient presents with in the ED is just the tip of the iceberg. “In so many cases, there are unmet behavioral health needs that often involve substance use disorders,” she says. “We’re making sure people are connected with services, whether those are outpatient services or treatment options, or ensuring they have a case manager in the community.”

Supporting caregivers

Karen Guzi, MSN, APRN, CNS, BCEN, a clinical nurse specialist in Emergency Services, was a panelist who discussed the power of empathy in the ED during the 2018 Cleveland Clinic Patient Experience Summit. It addressed caring for caregivers who suffer compassion fatigue. Frustration mounts when patients’ needs exceed available resources.

“A patient is discharged with instructions to follow up with a resource the next day, but they are back in the ED that night after overdosing,” Guzi says. “Staff have strong emotions when that occurs. We’ve asked our team to be empathetic to patients’ immediate needs and issues, but we lack the resources to give to team members immediately.”

In response, the Healing Services program in the Cleveland Clinic Office of Patient Experience is called to meet with staff members to process their emotions. “Although the patient’s needs are paramount, it’s not only about the patient. Equally important is helping the caregiver team deal with the stresses placed on them,” Guzi says.

Ruthann Gavrilescu, MSN, MEd, RN, Senior Nursing Director for Cleveland Clinic Community Care, is a member of Cleveland Clinic’s Regional Response & Resuscitation Committee (CCRC), which monitors emergency care provided in express care, urgent care and regional outpatient facilities. It worked on initiatives to support caregivers:

• Creating a guideline allowing caregivers to decide whether to respond to events that happen outside a building, such as an overdose patient driven to Express Care.
• Adding nasal naloxone (NARCAN®) HCI nasal spray to its formulary for emergencies. The regional CRRC is working on a nursing protocol in conjunction with the Ohio’s pharmacy, medical and nursing boards to allow

RNs and licensed practical nurses in outpatient settings to administer naloxone. Now, only advanced practice providers and physicians can administer the antidote to an opioid overdose.

• A new pharmacy policy that guides ambulatory care patients to bring unused controlled medication for proper disposal.

Educating caregivers

Jennifer P. Colwill, DNP, APRN, CCNS, PCCN, a clinical nurse specialist in the Heart & Vascular Institute, leads a group of bedside nurse pain mentors who provide education to nurses. The team looked at substance use disorder and alternative pain control methods.

“Interest is growing,” Colwill says, adding that in 2018, 307 nursing caregivers were impacted by her program. “The nurses who participated are very passionate about pain management for their patients.”

Barbara Morgan, MSN, RN, NE-BC, Associate Chief Nursing Officer of Emergency Services for Cleveland Clinic health system, and Director of Nursing for the main campus ED, says the path that leading to addiction can be complicated. “We educate our nursing staff on factors in peoples’ lives that may lead them to addiction, how we can identify it and how to be aware of our own feelings toward addiction,” Morgan says. “We need to be in touch with our feelings and unconscious biases to help in an empathetic and meaningful way.”

Guzi says, “This is not going to be a quick fix. We are going to have to maintain and sustain.”

The nursing profession, Skowronsky says, is acutely aware of the problem and its psychological and physiological impact. “Nurses are consistently voted as the most trusted profession — we are seen as less of an authority figure, less judgmental,” she says. “Patients’ view of nurses and our profession makes it even more important that we know how to receive substance abuse information and how to act on it. And we need to be able to have the right resources in place to act appropriately when we encounter patients who need help.”