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Substance-Use Disorder Awareness added to UofM SON Curriculum April 20, 2017

Posted by mariemanthey in Academia, Nursing Peer Support Network.
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With high-stress jobs and access to sometimes-addictive medications, some nurses are at elevated risk of developing substance-use disorder.

The very real issue of substance-use disorder among nurses isn’t something that gets talked about all that much in nursing schools. A new curriculum created by the University of Minnesota School of Nursing and made available to nursing schools around the state is trying to get that timely conversation started.

It’s almost as though the profession has been avoiding talking about the issue, said Christine Mueller, RN, Ph.D., associate dean of academic programs at the U of M School of Nursing.

“If substance-use disorder gets talked about in nursing programs at all, it is usually very superficial,” she said. “At the University of Minnesota, prior to the development of this curriculum, we had not been intentional about making sure that this was an official part of the conversation. But now we’ve created a way to devote an entire class session or online module to the topic. ”

This focus is important, Mueller added: “At the end of the day, substance use disorder among nurses is a quality and safety issue for patients, and we have a big focus on patient quality and safety in our program.”

With high-stress jobs and access to sometimes-addictive medications, some nurses are at elevated risk of developing substance-use disorder, Mueller said. Though at an estimated 10 percent, the rate of addiction among nurses is no higher than in the general population, the risks of coming to work impaired or diverting patient medication could put lives on the line.

Jace Gilbertson, a senior in the U of M’s BSN program, said that nurses with addiction issues sometimes find themselves in a particularly tough spot. And it’s not something they warn you about in school.

“As nurses, we are right there on the front lines,” Gilbertson said. “When I finish my degree, I’ll be working in an emergency department. That is a chaotic environment where things happen fast and the stress levels are high. In the nursing profession, there is that stigma and shame around the idea of substance use, but by just being a nurse we put ourselves at a higher risk of coping with stress by using medications and alcohol. Being open about that risk could help stop a lot of problems before they get out of hand.”

Designed to respond

The curriculum, which was developed by Mueller and Dina Stewart, a University of Minnesota doctor of nursing practice (DNP) candidate, was “prompted by the fact that there had been some press about nurses who have substance-use disorder and the role of the Board of Nursing plays in this issue,” Mueller explained. “Our school decided to be proactive and work with the Board of Nursing and others to think about what we could do together to address the issue of substance-use disorder in nurses. One very obvious thing that a school of nursing could do is to ensure that our students are knowledgeable about the topic. That’s where our new curriculum came in.”

Christine Mueller, RN, Ph.D.

Christine Mueller, RN, Ph.D.

The curriculum was added to the University’s degree program this semester. Other nursing schools around the state are also in the process of incorporating it into their programs.

The curriculum’s goal, Mueller explained, “is for students to develop an awareness about substance-use disorder in nurses and about the risks that substance use creates.”

Mueller said that she and Stewart designed the module in part to provide answers to common questions that nursing students ask, including “Why are nurses more at risk for substance-use disorder? What can nurses do to mitigate that risk? What can a nurse do if they come in contact with colleagues that have substance-use disorder? How can you recognize the problem? What is your responsibility if you suspect diversion?”

The format worked well for Gilbertson.

“In this module, we learned how to recognize the signs and symptoms of an impaired nurse,” he said. “We learned it is not a punitive thing to report a colleague if you suspect substance use — it is for the benefit of that nurse to help them get he help they need and put the patient first. It puts the integrity of the profession front and center.”

Real risks — and help

The curriculum also provides important information and warnings about the real risks of substance-use disorder for nurses and their patients.

“We try to help students understand the consequences,” Mueller said. “If you come to work impaired, you could lose your job or you may not be able to work until you deal with the problem. If you get to the point where you divert medication, that is a felony, and you can’t practice in this state if you have been convicted of a felony.”

This information hit home with Gilbertson, who sometimes struggles with what he sees as a pressure for perfection within the profession.

The curriculum helps nursing students step away from the myth of the “perfect nurse,” he said: “As nurses we re not immune to suffering from substance-use disorder, even though we are some of the most trusted people in the hospital. As our patients’ advocates, we have to be strong all the time and not show any weakness. Because there is a stigma around substance use and addiction problems, nurses try to hide their addictions. That’s when things can get dangerous.”

Jace Gilbertson

Jace Gilbertson

The course also includes a recorded interview with University of Minnesota School of Nursing graduate and substance-use disorder advocate Marie Manthey. In the interview, Manthey tells the story of her own struggle with substance use when she was a practicing nurse.

“Marie’s story really brings it home for students,” Mueller said. “She does a great job explaining how substance use can be so insidious in the profession.”

Through Manthey, students also learn about the Nurses Peer Support Network, a program designed to help nurses recover from substance-use disorder and support them in their recovery.

“One of the most important things for new nurses to understand it that substance-use disorder is a disease, not a moral deficit,” Mueller said. “People can recover from this. We try to make that point clear in the curriculum.”

Realizing that it is possible to recover from substance use disorder and continue working in the nursing profession was an important realization for Gilbertson.

“There are steps a nurse can take to be rehabilitated from substance-use disorder,” he said. “It is reassuring as a nurse going into the profession to know that there is a safety net and there are people out there caring for you.”

Part of closing course

At the U of M, the new curriculum is now a required element of the program’s final “Transition to Practice” course. Mueller explained that the placement was intentional, serving as a key introduction to the realities of life as a working nurse — and as a reminder of the importance of being aware of the risks that substance-use disorder creates.

“It made a lot of sense to place it in our curriculum in the last semester or the last year of the program when students are beginning to think about transitioning to practice,” she said.

Gilberson agreed.

“I think the curriculum is placed well,” he said. “It’s a good reminder of how we should be taking care of ourselves as we go into the profession of nursing, a good call to action for nurses just entering the workplace, a good opportunity to teach nurses early on that this is a reality that they may face during their careers.”

R & R continued, with the Nursing Peer Support Network January 3, 2016

Posted by mariemanthey in Announcements, Nursing Peer Support Network, Professional Practice.
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Here it is the first Sunday in January and I am actually keeping my resolution to post regularly!   Sort of squeezing it in a busy day but here it is.   The third area of my current interest and energy choice is the Nursing Peer Support Network we recently created in Minnesota.   Many of you know that I have been an active member of the larger nursing community for many decades….over 50 years as a nurse.  Some of you also know that for  37 of those years I have been in recovery from the disease of alcoholism……in fact, the majority of my ‘visible’ contributions to nursing have been accomplished during these 37 years.

At no time during this period of my recovery, during which I have been an active participant in a 12 step program …..did I even SEE what generally happens to nurses who become addicted to either drugs or alcoholism.   During the past 2-3 years, I have seen this clearly and am frankly appalled.   Two issues in particular ‘appall’ me;

One is the lack of knowledge nurses have of the continuum that exists from taking that first Percocet or Vicodin ….by ‘diverting’ it from a patients supply…….to a consequence a few years later when up to 15% of them are facing criminal proceedings even perhaps a felony conviction, which essentially means loss of ones license to practice nursing.   We are not doing a good job of making this danger clear to nurses.    

The second issue is the paradoxical thinking that leads to an enormous issue of profession shame about the stigma of addiction.    The paradox that we hold simultaneously in our ‘profession’s mind set’ is that addiction is both a disease and a moral failure.

The ambivalent feelings and attitudes many nurses have about addiction can be attributed to many factors having to do with family issues, as well as experiences caring for addicts.   Nevertheless, as a profession we really need to step up in a mature understanding that addiction is a disease from which individuals can recover and return to their profession with full capacity to be highly effective practitioners.

Many states have programs to help nurses into safe recovery.    Minnesota did not until we established one a little over a year ago.   It is called the Nursing Peer Support Network and the website is http://www.npsnetwork-mn.org.

I will periodically be posting more on this topic as recovery from addiction is a process very similar to what we in nursing are doing in recovery from a state of co-dependency to our rightful state of full professional status.   I have learned so much in this past year and feel deep passion about the necessity to face the stigma of addiction fully, in order to help the ‘still suffering addicted nurse’.


Happy New Year January 2, 2011

Posted by mariemanthey in Professional Practice, Values.
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One of my New Year’s Resolutions is to post on the blog more often and use it for the kind of conversations that promote healthy interactions and pride in our profession.

One way I want to do that is to encourage nurses to reflect deeply on the meaning of our work, as the connection to our deepest values helps energize our work. It is rewarding to an individual nurse to appreciate deeply the privilege we have in alleviating pain and increasing comfort at any and all levels of our patient’s vulnerabilities. Experiencing this intrinsic reward is important for each nurse’s self-care.

Another  goal I have is to keep bringing up certain realities about staffing I call these “hidden truths”  that need to be acknowledged and understood by nurses and by the system.

  • nursing work is never done
  • nursing work is unpredictable
  • nursing work is uncontrollable (it is based on pt. acuity and  MD orders, neither of which nurses will ever legitimately control
  • there is always more work to do than time available.
  • prioritizing involves deciding what NOT TO DO when there is more work to do than time available.  The truth is there has always been and will always be more work to do than time available.

More of my thinking on this topic is in Creative Nursing Journal, Vol 15, Number 2, 2009.  The article is entitled, A Brief Compendium of Curious and Peculiar Aspects of Nursing Resource Management.  It is time for staff nurses to quit driving to work fearing they will be short-staffed and driving home at the end of their shift angry because there wasn’t enough help.

Finally, I encourage you to view this short video. It is meaningful for nurses and people at many different levels of being.

Happy New Year!


Primary Nursing tips November 1, 2009

Posted by mariemanthey in Leadership, Professional Practice.
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Logistics of assignments complicate Primary Nursing so much that many people feel it is impossible in today’s health care system.

I say Nonsense!   Keep it simple and it works!

Pragmatic not Perfect!

Short term patients need short term goals!

Do nothing that violates your common sense!

Decide in favor of the patient and it will be in favor of the nursing!

Nine times out of ten the problem is either unskilled leadership at the NM level or unhealthy interpersonal relationships among the staff. Both of those need to be solved, then let the staff decide the logistics — of both their schedules and assignment continuity.

It works!  And patients need it more today than ever before.

Is Polite “Doing For” Really Enough? January 17, 2009

Posted by mariemanthey in Professional Practice.
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One of the consultants at Creative Healthcare Management recently sent me this description, written while her daughter was receiving care at a major medical center in the Midwest. My question to readers is this: if you see yourself in this description, what can you do to “be with” rather than just “do for” your patients?  Or does anyone want to explain why “doing for” is really enough? Responses are welcome.

“Care has been fine, but not extraordinary.  They  received Magnet designation in 2007 and have a great deal of pride.  Everyone asks each time they leave the room if there is anything else we need — and they have clearly received customer service training (AIDET).  The manager just visited our room and was gracious and emphasizing that we let them know if there is anything they can do.  The trouble is, they are doing … But there is no “curiosity”, no whole picture perspective — when asked the nurses rarely know the plan — I rarely see a therapeutic process; the nurse comes in to give meds, check if there is anything needed.  So very nice, polite — but detached.  I found myself charting my perspective using the boundary diagram from my article in the field guide on boundaries for the therapeutic relationship. Underinvolvement is the main descriptor I would use.

We have had some lovely exceptions. The pharmacist, who we know from the transplant team, spent 20 minutes with us yesterday making sure that we had all questions answered and providing some background information. A physician sat at eye level and began by asking Alicia about her and what this means in her life right now.  She was able to talk about school, and it went on from there.  He was extremely encouraging — reminding us that it has always been the case that my daughter would outlive the life of her kidney, and that we will take each challenge as it comes.  We do not have the biopsy results yet, but if it is early rejection we are dealing with, that can be treated and the kidney can continue to serve her.

I try to stay clear and unemotional about the lack of professional consciousness I see in so many nurses.  I feel so sad, because when they only focus on the things they are doing, they lose sight of the human being and the power of their care and they lose the amazing satisfaction that would come from a connection.  I am clear that it would take no more time to connect and involve the patient than to come in and out doing for the patient.  I believe the nurses on this unit like their work, and that transplant nursing would be extraordinarily satisfying.  So, the nursing care is fine.  The question is, is that enough?  I have nothing I would complain about, and I believe most patients would say the care was very good because the staff is responsive.  My daughter asked why so many people (nurse,  physician, nurse practitioner) give her the same information as though she is hearing it for the first time.  Not one nurse has asked Alicia about herself or what this hospitalization means to her — what she might be worrying about — what is most important to her.  This morning as I walked for my coffee I noticed no one looked up anywhere through the hallways to the cafe, so I began initiating and spoke to people even when they were looking at the ground.  I got responses in return and I am teaching my daughter how to be the initiator of relationships so that she can be seen and receive what she needs.  I have also had to work with her to monitor her responses (she got rather hysterical when experiencing pain and not feeling heard by the nurse — who I understand called her a whiner– I was out of the room at the time) — I followed up with the nurse and worked to help her feel safe and less defensive, we came up with an approach to Alicia’s pain and by the end of the day it was managed.  I had to intervene though, because I could see that the nurse was irritated with her and I want Alicia to learn how to care for relationships so she does not get written off.  She will need to be an expert as she will be needing care all of her life. “

The Salon Last Night:: Dec. 6, 2007 December 7, 2007

Posted by mariemanthey in Nursing Salons.
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There was a large group here last night, several returnees and several first-timers. The mix of newbies and old-timers was energizing, and provided both balance and passion to the discussion. Mid-career nurses brought workplace dysfunctionality experiences to the discussion, while students and new grads expressed concern about being accepted as members of a nursing staff after they graduate and about being able to handle the incredible stresses and workloads required of staff nurses in today’s hospitals. Because we were able to listen to each other intentionally we quickly found common ground to express ways to handle various situations within the workplace and to acknowledge the value of the wide age-distribution that exists in nursing today.

One nurse spoke with deep feeling about a terminally ill seven-year-old whose disfigurement in death was extremely disturbing to this nurse in her second year of practice. Older nurses were able to help this young nurse see this experience from a perspective that was both comforting to her and that allowed her to see the value she brought to this patient by her compassionate presence. It is this kind of support and perspective that is only available from seasoned nurses who have learned these things from their own experience.

It brought to my mind again the importance of using reflective practices to absorb and learn from the often incredible experiences we nurses have in this work of ours. In the old days when student nurses lived in dorms there were usually times and opportunities to talk about the sometimes mind-blowing sights, sounds and smells of nursing, of dealing with life and death and disfigurement. In today’s health care reality, nurses often don’t have time to even talk to colleagues at work, and end up suppressing or stuffing unprocessed feelings. These Salons provide that kind of opportunity and really deserve to be replicated. I would like to help anyone get one started, and I have a written description of the way to do it which I am happy to share with everyone.

The Latest Salon Report November 2, 2007

Posted by mariemanthey in Academia, Nursing Salons, Values.
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Last night we had our monthly salon at my home. About half the group was new and the other half had been here before. This time only one student nurse came and one fairly new graduate working as a staff nurse and 3 attendees were not nurses, one teaches at health related topics at a local college, one is a retired physician I have known for a long time and the other was a visitor from Iceland who wanted to see how a salon worked. Most of the rest were middle-aged staff nurses and nurse managers from various hospitals around the Twin Cities.

Although many topics were raised during the initial check-in, we ended up focusing on a wide-ranging discussion related to staffing/resource issues, social justice and inequities in the health care system so often part of the every day life of a nurse.

A manager at a local ER told about three patients who died on the floor of the ER vestibule, collapsing as soon as they arrived, having stayed away from care until the last possible moment because they have no insurance.  She also told of a man who cut his leg and waited for a friend to drive him to the ER as he couldn’t afford an ambulance. This man had an arterial bleed and had lost enormous amounts of blood before he arrived. In this ER visits are increasing astronomically while care hours/visit are continuously reduced to increase margins.

A NICU nurse talked about the cost of caring for multiple birth babies (5 or 6) the result of infertility treatments who stay in NICU’s for months. Often staffing throughout their life is 1:1 or 2 nurses/baby. The last group six births resulted eventually in one baby actually living. A nurse manager of a medical ICU talked about the hundreds of thousands of dollars spent during the last few weeks or months of care for catastrophically failing people in their nineties.

The student is now in her public health rotation and wonders why the savings created by keeping people healthy isn’t part of the economic equation.

This may sound like an overall pessimistic evening, but it was far from it. I can’t really explain what happens at a Salon, but we seem to be able to connect with our positive values and experience strength just from knowing each others’ experiences and values.

I am definitely sensing from this discussion and others that have been occurring recently that the “Voice of Nursing” is in the process of become loud enough to be heard. I’m not sure just how this will happen, but I sense a real strengthening of our commitment to make the world a better place coupled with an awareness that we are strong and can be stronger.

I am encouraging all of us to initiate conversations about social justice in all of our professional meetings. Specialty organizations looking for great programs for their meetings could do what the Zeta chapter of Sigma Theta Tau did here last week when three nurse leaders presented brief comments about social justice issues in their workplace. The discussion that ensued was energizing and confidence-building. This concept of social justice has a rippling effect that continues to strengthen with each new discussion.

Going Live March 31, 2006

Posted by manthey in Creative Health Care Management, Leadership, Nursing Salons, Professional Practice.
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So, here we are: after a few months of talking planning and learning by trial and error, we are ready to get my blog up and out there for everyone to see. I go forward in this with very mixed feelings.

First of all I’m excited because I see this as a new way for nurses to come together, discuss important issues, gain strength and focus while recognizing and respecting differences. I believe this kind of discussion will clarify our understanding of complex issues and help us discover new truths.

That is the good news. The hesitation is because I’m not exactly sure what a blog is and exactly how it works. Friends of mine in the office of Creative Health Care Management are helping me with all that and assure me it is a good idea and entirely doable. So … here goes.

I’ve always believed that professional nursing occurs at the point of interaction between the RN and the patient whether that is the bedside in the hospital; the exam room in the office or clinic; or in the patient’s home. So to me, the staff nurse position is the one we need to focus on for development, enrichment and support.

I’ve enjoyed the big challenge of tackling and removing the barriers, both external and internal, which interfere with the nurse delivering the very, very highest level of competent compassionate care during those moments of interaction with the patient. This has involved changing the focus of management to leadership. That means the individual staff nurse must mature and develop enough to manage his or her self, relationships, and practice. It also means organizations have to change so they support creative problem solving of the staff nurse at the bedside. Obviously this has been a tall order. But Primary Nursing was a giant leap forward from which many lessons were learned that are still being operationalized today.

In all my 50 years in this field, I have never been so convinced that we have what it takes to move nursing into true mature professionalism. I have a profound sense of the changes in organizational dynamics that has occurred in my lifetime. Every time I speak with a group of nurses, I am amazed and energized by the incredible passion for patient care alive in nursing today.

A few years ago, I started a Nursing Salon. My intent was to bring nurses together to talk about the big issues of the day and to get in touch with the down-deep values of nursing. These Salon meetings always restored our hope.

Our cumulative wisdom is now so much more accessible due to the electronic revolution. Nurses from all around the world, in all settings and specialties can pool our experience and knowledge, thus increasing the intellectual capital available to all of us in the field. I hope this blog can play a role in energizing and informing the lives of those who visit.