Practicing Nurses as Leaders in Accessing and Intervening in Prescription Medication Abuse: A Mandate for the Profession

There are a number of characteristics associated with the nursing profession that when viewed together support a mandate for practicing registered nurses to address addictions in the health care environment. First of all there are over 2,900,000 nurses with active RN licenses in the US and 83% of them are employed in nursing (USDHHS-HHSA, June 2006). Secondly, nurses are viewed as honest ethical professionals. The public research company Gallup has been conducting public opinion polls since 1976 related to how Americans view the ethics and honesty of a variety of professions. The poll covers a diverse number of fields including, lawyers, teachers, firefighters, pharmacists, and politicians. In all but one year since 1999, nursing has ranked number one in honesty and ethical standards. A recent poll conducted in November 2011 demonstrates that 81% of the public voting, again chose nursing as number one demonstrating retention of their high regard for the profession (The Sacramento Bee, December 7, 2010). Along with the sheer number of nurses and the basic trust in their honesty and ethics, nurses are known to attend to their patients’ welfare and to advocate for them. Nurses work with patients at all levels of health and in all kinds of health care settings as diverse as schools, the work place, primary care, and acute care hospitals. Further, nurses in these diverse settings are educated to form intimate therapeutic relationships with patients and are most likely to have the most sustained or frequent intermittent face-to-face contact with them. This unique close contact with human beings is an opportunity that we cannot afford to waste. Nurses are patient educators and play a key role in helping patients change behavior to enhance health. Most important, nurses are educated to view humans as whole beings. This characteristic in particular directs nurses to include the assessment of all patients for addictions notwithstanding setting, diagnosis, or presenting symptoms. The mandate for nursing is especially applicable in the problem of prescription medication abuse. Prescription medications, particularly opioids, stimulants, and CNS depressants such as benzodiazepines are found in a great many homes and are easily accessible to both adults and youth. Given the inadequate laws on manufacturing and prescribing practices coupled with the casual nature in which these substances are stored in the home, it is not surprising that their abuse is a major problem among all age groups in the U.S. population. Practicing nurses are likely to come in contact with potential and actual abusers of problem prescription medications and therefore have an ideal opportunity to provide brief intervention when appropriate and refer as needed. While government regulations, monitoring programs, and public education, are important mechanisms to prevent and intervene in prescription medication abuse, the interpersonal therapeutic connection between nurses and their patients is a key component in helping people cope with life and living in a variety of healthy ways. As mentioned a key thrust of professional nursing is viewing patients as whole beings, caring for them with unconditional regard, garnering their trust, and assisting them in the direction that promotes high level functioning. For example, the professional nurse caring for a patient in the outpatient clinic with ongoing visits for wound care, will also monitor and address the patient’s general life functioning and performance of activities of daily living. Dysfunctional unhealthy coping styles can be attended to while also focusing on the problem which brought the patient to the clinic. Let’s all encourage our colleagues both formally and informally in all ways possible including through our professional organizations, work place leaders and on an individual basis to respond to this mandate without delay.