WEBVTT 00:00:05.559 --> 00:00:09.880 position:50% align:middle - [Alison] You notice that the title has changed, but I felt that it's similar, 00:00:09.880 --> 00:00:13.240 position:50% align:middle but this is more specific to what I'm going to be talking about today. 00:00:13.240 --> 00:00:20.710 position:50% align:middle And we named it the "Nurse Worklife and Wellness Study" because we were reaching out to nurses for their 00:00:20.710 --> 00:00:24.640 position:50% align:middle opinions and information, and that just seemed like a more accessible way 00:00:24.640 --> 00:00:26.230 position:50% align:middle of framing the whole issue. 00:00:26.230 --> 00:00:30.330 position:50% align:middle So that's the reason for that. 00:00:30.330 --> 00:00:33.930 position:50% align:middle I want to acknowledge my team members and co-authors. 00:00:33.930 --> 00:00:38.660 position:50% align:middle It's a mix of faculty colleagues, and also Ph.D. students. 00:00:38.660 --> 00:00:44.680 position:50% align:middle And we have a website that has many of the products that we produced over the years. 00:00:44.680 --> 00:00:48.950 position:50% align:middle And no doubt, many through NCSBN sponsorship and others. 00:00:48.950 --> 00:00:55.140 position:50% align:middle So I have the QR code and a little link for that if that interests you for later on. 00:00:55.140 --> 00:00:57.720 position:50% align:middle Some background on this problem. 00:00:57.720 --> 00:01:07.680 position:50% align:middle We first looked at substance use in nurses years ago when I was 12, in the Nurse Worklife and Health study. 00:01:07.680 --> 00:01:10.850 position:50% align:middle And this was funded by the National Institute on Drug Abuse. 00:01:10.850 --> 00:01:17.960 position:50% align:middle And what we found then was overall substance use rates less than or equal to the general population, 00:01:17.960 --> 00:01:21.760 position:50% align:middle and higher rates of prescription type use, and then some different relationships 00:01:21.760 --> 00:01:27.170 position:50% align:middle with work-related factors, occupational hazards, exposures, and such. 00:01:27.170 --> 00:01:36.020 position:50% align:middle So here we're also thinking in terms of 25 years going by, and how nursing has changed so much. 00:01:36.020 --> 00:01:41.690 position:50% align:middle And even the body of evidence that we have has expanded so much in no small part to this body, 00:01:41.690 --> 00:01:50.340 position:50% align:middle but also the way that we think about nursing and study outcomes, and such, per Dr. Aiken and others. 00:01:50.340 --> 00:01:53.870 position:50% align:middle So we are overall more educated than we have been. 00:01:53.870 --> 00:02:00.860 position:50% align:middle And along with that has come much higher demands for the work, higher acuity, shorter lengths of stay, 00:02:00.860 --> 00:02:09.650 position:50% align:middle trim staffing, and all of that, contributing a lot more strain to nurses. 00:02:09.650 --> 00:02:15.580 position:50% align:middle In terms of other changes, substance use, much more of a disease model, kind of treatment-based, 00:02:15.580 --> 00:02:19.000 position:50% align:middle evidence-based approaches to addressing the problem. 00:02:19.000 --> 00:02:21.830 position:50% align:middle And moving in the direction. 00:02:21.830 --> 00:02:26.160 position:50% align:middle And I say moving because still studying today, I'm finding that we're not there yet, 00:02:26.160 --> 00:02:33.150 position:50% align:middle but of non-blaming, reducing stigma, and all of that in a disease approach. 00:02:33.150 --> 00:02:35.570 position:50% align:middle Opportunities for diversion are still a concern. 00:02:35.570 --> 00:02:44.650 position:50% align:middle I know the board I'm going to be talking about kind of use as a whole, but this very strong concerning portion 00:02:44.650 --> 00:02:48.750 position:50% align:middle for boards of nursing folks, the ones that end up in trouble, 00:02:48.750 --> 00:02:50.720 position:50% align:middle and also diversion issues. 00:02:50.720 --> 00:02:55.500 position:50% align:middle More nurses have prescribing privileges, especially APRNs that are allowed to practice full 00:02:55.500 --> 00:02:57.530 position:50% align:middle scope of their authority. 00:02:57.530 --> 00:03:00.090 position:50% align:middle And then also that we need some evaluation. 00:03:00.090 --> 00:03:03.890 position:50% align:middle There's a lot of workplace wellness offerings that are being thrown out there, 00:03:03.890 --> 00:03:08.050 position:50% align:middle and some people complain they're Band-Aids for bigger problems, etc. 00:03:08.050 --> 00:03:14.000 position:50% align:middle So that's something that we're also thinking about and have some data on. 00:03:14.000 --> 00:03:15.730 position:50% align:middle So the aims. 00:03:15.730 --> 00:03:23.590 position:50% align:middle I'm reporting today on aims one and four, which were our basic purpose to estimate prevalence, 00:03:23.590 --> 00:03:29.600 position:50% align:middle and substance use, and potential estimates of substance use disorders, relationships between those issues, 00:03:29.600 --> 00:03:31.420 position:50% align:middle and some work factors. 00:03:31.420 --> 00:03:35.090 position:50% align:middle And to try to get a handle on what do nurses know about this problem? 00:03:35.090 --> 00:03:37.550 position:50% align:middle Do they think they could identify a colleague? 00:03:37.550 --> 00:03:43.040 position:50% align:middle And if they did see something potentially concerning, what would they think they should do about it, 00:03:43.040 --> 00:03:44.610 position:50% align:middle or do they know what to do? 00:03:44.610 --> 00:03:48.140 position:50% align:middle So that's what I'm mostly talking about today. 00:03:48.140 --> 00:03:54.100 position:50% align:middle Our framework, we use sort of this model starting for the individual, going out to the community, 00:03:54.100 --> 00:03:55.000 position:50% align:middle and state and national. 00:03:55.000 --> 00:03:56.940 position:50% align:middle But really aims one and four are in the center. 00:03:56.940 --> 00:04:02.200 position:50% align:middle I'm not good with laser pointers, but here focusing more on individual knowledge, 00:04:02.200 --> 00:04:06.390 position:50% align:middle and also some things related to the work. 00:04:06.390 --> 00:04:11.210 position:50% align:middle So for our methods, it's a cross-sectional study, and we had mixed modes. 00:04:11.210 --> 00:04:16.540 position:50% align:middle We had online contact, and if we didn't hear after a certain amount 00:04:16.540 --> 00:04:20.900 position:50% align:middle of reminders from people, then we also sent a paper survey, 00:04:20.900 --> 00:04:23.990 position:50% align:middle and got a fair number of paper surveys as well. 00:04:23.990 --> 00:04:28.810 position:50% align:middle The data collection was from November to March in that time period. 00:04:28.810 --> 00:04:35.480 position:50% align:middle It does coincide mostly with the Delta wave of COVID in the U.S. 00:04:35.480 --> 00:04:40.130 position:50% align:middle If you're interested, and IRB approval, of course. 00:04:40.130 --> 00:04:44.600 position:50% align:middle Our sampling method was called balanced stratified sampling. 00:04:44.600 --> 00:04:47.320 position:50% align:middle So we selected states representative of the U.S. 00:04:47.320 --> 00:04:54.510 position:50% align:middle RN population by basically ordering them from small to large, and putting them in four chunks or strata. 00:04:54.510 --> 00:05:00.860 position:50% align:middle And then used a formula that's supposed to make the smallest standard error to how many to pick from each 00:05:00.860 --> 00:05:02.060 position:50% align:middle of the strata. 00:05:02.060 --> 00:05:07.200 position:50% align:middle So we had nine states that were selected using this process. 00:05:07.200 --> 00:05:16.400 position:50% align:middle And then once we had the states, we did a random sample of the nurses within the states. 00:05:16.400 --> 00:05:20.910 position:50% align:middle We also had access to, thank goodness, much of the states. 00:05:20.910 --> 00:05:23.770 position:50% align:middle We had access to the nurses database. 00:05:23.770 --> 00:05:34.810 position:50% align:middle And then there were two others that we got through private contacts to get their licensure lists. 00:05:34.810 --> 00:05:41.060 position:50% align:middle The substances that we included, illicit drugs, which was mostly marijuana, and some others, 00:05:41.060 --> 00:05:45.580 position:50% align:middle and then prescription type medications in these categories. 00:05:45.580 --> 00:05:49.770 position:50% align:middle Alcohol use we defined as three or more drinks per occasion. 00:05:49.770 --> 00:05:53.100 position:50% align:middle Usually for men, they use the cutoff of four or more. 00:05:53.100 --> 00:05:58.720 position:50% align:middle But since our sample is mostly female, we used three or more cutoff. 00:05:58.720 --> 00:06:04.070 position:50% align:middle Energy drinks, caffeinated beverages, we used four or more as the cutoff. 00:06:04.070 --> 00:06:08.320 position:50% align:middle Do you often or very often consume four beverages? 00:06:08.320 --> 00:06:12.760 position:50% align:middle And acknowledging that there's obviously some benefit in terms of wakefulness and whatever, 00:06:12.760 --> 00:06:16.740 position:50% align:middle but we were trying to think of the more sustained regular user. 00:06:16.740 --> 00:06:23.550 position:50% align:middle Nicotine products, including everything, vaping, what have you, and then CBD. 00:06:23.550 --> 00:06:25.570 position:50% align:middle So results. 00:06:25.570 --> 00:06:29.360 position:50% align:middle Our sample looks like some of the other samples you've heard about today. 00:06:29.360 --> 00:06:34.420 position:50% align:middle Actually a tiny bit more diverse than we've had, although could be more always. 00:06:34.420 --> 00:06:36.140 position:50% align:middle And half are working in hospitals. 00:06:36.140 --> 00:06:40.080 position:50% align:middle And that proportion has been dropping as I've been serving nurses over the years. 00:06:40.080 --> 00:06:44.540 position:50% align:middle It seems to be going down. 00:06:44.540 --> 00:06:44.710 position:50% align:middle Okay. 00:06:44.710 --> 00:06:50.930 position:50% align:middle So the substance use prevalence in nurses, these are our estimates of percentages of the different 00:06:50.930 --> 00:06:52.920 position:50% align:middle types of substance misuse. 00:06:52.920 --> 00:06:57.848 position:50% align:middle Around 10% prescription type, alcohol use 31%. 00:06:57.848 --> 00:07:02.850 position:50% align:middle And then our substance use problems and disorders, we split. 00:07:02.850 --> 00:07:10.110 position:50% align:middle And the estimate was around 11% for substance use problems, and a little over...I guess, 00:07:10.110 --> 00:07:11.960 position:50% align:middle close to 7% for substance use disorders. 00:07:11.960 --> 00:07:19.160 position:50% align:middle And I'll go into a little bit more how we define those. 00:07:19.160 --> 00:07:20.880 position:50% align:middle I want to go back on that slide. 00:07:20.880 --> 00:07:21.600 position:50% align:middle Okay. 00:07:21.600 --> 00:07:25.510 position:50% align:middle The way we define someone is having a problem or a disorder. 00:07:25.510 --> 00:07:32.300 position:50% align:middle If you said you had passed your use, you were asked a 10-point screening tool, so 10 items. 00:07:32.300 --> 00:07:34.290 position:50% align:middle And they were things like, do you need to cut back? 00:07:34.290 --> 00:07:39.750 position:50% align:middle Do you have smaller effects with the same amount, which is kind of also called tolerance. 00:07:39.750 --> 00:07:42.680 position:50% align:middle Have you been under the influence at work? 00:07:42.680 --> 00:07:44.690 position:50% align:middle Fairly serious substantial thing. 00:07:44.690 --> 00:07:48.390 position:50% align:middle So if you had one or two of those, we called you a presumed problem. 00:07:48.390 --> 00:07:51.880 position:50% align:middle And if you had three or more, we defined it as a disorder. 00:07:51.880 --> 00:07:56.130 position:50% align:middle And this was from like the DAST, APA, and some other sources. 00:07:56.130 --> 00:07:57.240 position:50% align:middle So I want to go back to this. 00:07:57.240 --> 00:08:04.370 position:50% align:middle So the other thing we did is we took that group of people and said, "Are you reporting drugs only, 00:08:04.370 --> 00:08:08.170 position:50% align:middle alcohol only, drug and alcohol together? 00:08:08.170 --> 00:08:13.380 position:50% align:middle And how do you look on the problem sort of severity scale?" 00:08:13.380 --> 00:08:20.240 position:50% align:middle Now, even though we ask those 10 items, most people said no to all of them of the past year use. 00:08:20.240 --> 00:08:21.070 position:50% align:middle "I smoke marijuana. 00:08:21.070 --> 00:08:23.500 position:50% align:middle I don't have any of those problems," for example. 00:08:23.500 --> 00:08:30.130 position:50% align:middle But the difference in terms of the proportion that say no risk, when you get to drug and alcohol together, 00:08:30.130 --> 00:08:31.660 position:50% align:middle that's only about a third. 00:08:31.660 --> 00:08:38.610 position:50% align:middle And then there's a little over a third in the low category, and a third in the disorder category. 00:08:38.610 --> 00:08:44.220 position:50% align:middle So the basic thing about this slide is if you have the drug and alcohol use reported together, 00:08:44.220 --> 00:08:53.020 position:50% align:middle you were more likely to meet the criteria for a problem or a disorder. 00:08:53.020 --> 00:08:54.450 position:50% align:middle Did that one already. 00:08:54.450 --> 00:08:54.730 position:50% align:middle Okay. 00:08:54.730 --> 00:08:57.140 position:50% align:middle Then this is aim four, we called it. 00:08:57.140 --> 00:09:02.230 position:50% align:middle And it's asking nurses what they know about the problem, and what they think you should do, 00:09:02.230 --> 00:09:04.930 position:50% align:middle and all of that, and some of the beliefs. 00:09:04.930 --> 00:09:09.580 position:50% align:middle And these kinds of questions have been asked before, and many posed by NCSBN. 00:09:09.580 --> 00:09:15.050 position:50% align:middle But we thought it would be interesting to get sort of an update read on what people are thinking nowadays. 00:09:15.050 --> 00:09:18.540 position:50% align:middle So in terms of the top, what might be a potential sign 00:09:18.540 --> 00:09:26.180 position:50% align:middle of an impaired colleague, frequent med errors, often volunteers to give meds, frequent med wasting, 00:09:26.180 --> 00:09:33.660 position:50% align:middle many absences or long breaks over three quarters of the sample thought those could all be related to problems. 00:09:33.660 --> 00:09:39.340 position:50% align:middle And we put in things like incomplete documentation, and difficulty with assignments because that could be 00:09:39.340 --> 00:09:40.290 position:50% align:middle from so many things. 00:09:40.290 --> 00:09:44.190 position:50% align:middle And if you think about the fact that we were asking during COVID, I mean... 00:09:44.190 --> 00:09:48.020 position:50% align:middle So it wouldn't necessarily be related to a substance use problem. 00:09:48.020 --> 00:09:53.070 position:50% align:middle And then the bottom is the actions and feelings, if they suspected substance use disorder 00:09:53.070 --> 00:09:54.510 position:50% align:middle in a colleague. 00:09:54.510 --> 00:10:00.210 position:50% align:middle We were kind of sad that almost 60% thought...they worry that they could lose their job and be punished. 00:10:00.210 --> 00:10:05.980 position:50% align:middle And I will say, anecdotally, in our EAP study so far from talking to some employee 00:10:05.980 --> 00:10:12.330 position:50% align:middle assistance program professionals, they sometimes work with institutions that still say if 00:10:12.330 --> 00:10:15.650 position:50% align:middle a person is caught diverting drugs, they are just fired. 00:10:15.650 --> 00:10:16.540 position:50% align:middle That's it. 00:10:16.540 --> 00:10:18.890 position:50% align:middle And then what happens to them? 00:10:18.890 --> 00:10:20.180 position:50% align:middle We don't know, but they're fired. 00:10:20.180 --> 00:10:24.650 position:50% align:middle So there's still this kind of thing going on in terms of employers. 00:10:24.650 --> 00:10:30.090 position:50% align:middle And that's from a system that has an EAP program that does work with people, 00:10:30.090 --> 00:10:32.400 position:50% align:middle and can pull them into treatment, and what have you. 00:10:32.400 --> 00:10:37.090 position:50% align:middle So they were saying, and I've come to think that that can be an indication 00:10:37.090 --> 00:10:39.160 position:50% align:middle of a severity of a problem. 00:10:39.160 --> 00:10:44.800 position:50% align:middle My brain, the part that...the receptors have taken over, and just need more, need more. 00:10:44.800 --> 00:10:50.690 position:50% align:middle And I'm not using good judgment, and whatever, to me suggests someone that's in a lot of trouble 00:10:50.690 --> 00:10:52.290 position:50% align:middle in terms of this problem. 00:10:52.290 --> 00:10:58.540 position:50% align:middle I'm not trying to debate that, but that's where I am coming down. 00:10:58.540 --> 00:11:01.860 position:50% align:middle In terms of other things, being afraid to get involved was like a 00:11:01.860 --> 00:11:02.400 position:50% align:middle fifth of people. 00:11:02.400 --> 00:11:04.170 position:50% align:middle I'm unsure what to do. 00:11:04.170 --> 00:11:08.810 position:50% align:middle Not a huge amount, but still suggests that people are needing directions. 00:11:08.810 --> 00:11:13.840 position:50% align:middle And most people said they'd report it to the supervisor, and we have 44% would report it 00:11:13.840 --> 00:11:17.750 position:50% align:middle to the board. 00:11:17.750 --> 00:11:17.850 position:50% align:middle Okay. 00:11:17.850 --> 00:11:24.470 position:50% align:middle And then in terms of nurses with substance use, what do you think that they can do or become? 00:11:24.470 --> 00:11:31.880 position:50% align:middle So some of these we thought were encouraging that acknowledge that kind of it could be anybody, 00:11:31.880 --> 00:11:35.030 position:50% align:middle that it can reflect the job stress. 00:11:35.030 --> 00:11:40.300 position:50% align:middle Not a lot thought nurses can continue to work, most can continue to work during treatment. 00:11:40.300 --> 00:11:45.590 position:50% align:middle And now that we have so many more options, I think even telehealth and some other 00:11:45.590 --> 00:11:51.340 position:50% align:middle low-access environments, there may be more opportunity for placing someone 00:11:51.340 --> 00:11:54.820 position:50% align:middle safely in a work situation, precepted and such. 00:11:54.820 --> 00:12:01.600 position:50% align:middle And then I think, in general, the notifying someone else is fairly strong, 00:12:01.600 --> 00:12:07.470 position:50% align:middle but in terms of what they can personally do, it looks like people could use some direction in terms 00:12:07.470 --> 00:12:09.180 position:50% align:middle of what they might do. 00:12:09.180 --> 00:12:14.050 position:50% align:middle I can identify impaired nurses at work by appearance or behavior. 00:12:14.050 --> 00:12:18.390 position:50% align:middle Maybe there's some concerns that people already are aware of, and they can pass those along. 00:12:18.390 --> 00:12:28.610 position:50% align:middle So the other thing I want to talk about is a study that we did on looking at exposure in your work, 00:12:28.610 --> 00:12:31.890 position:50% align:middle and how that relates to prescription type misuse. 00:12:31.890 --> 00:12:37.580 position:50% align:middle So the prescription drug misuse, I feel like I didn't say what that was. 00:12:37.580 --> 00:12:41.460 position:50% align:middle I have it on an earlier slide, but on your own more than prescribed, 00:12:41.460 --> 00:12:44.910 position:50% align:middle without a prescription, or in any other way that you're not directed. 00:12:44.910 --> 00:12:47.780 position:50% align:middle That's from the National Household definition. 00:12:47.780 --> 00:12:52.350 position:50% align:middle So that's what we consider to be prescription drug misuse. 00:12:52.350 --> 00:12:59.310 position:50% align:middle So what we did for looking at exposure was took four categories, the benzos, other sleep meds, opioids, 00:12:59.310 --> 00:13:02.680 position:50% align:middle and then non-narcotic pain medications. 00:13:02.680 --> 00:13:07.810 position:50% align:middle And anyone who reported those, we also asked about workplace exposure and related 00:13:07.810 --> 00:13:09.100 position:50% align:middle it to that. 00:13:09.100 --> 00:13:12.340 position:50% align:middle So those were things like how available is it? 00:13:12.340 --> 00:13:14.580 position:50% align:middle How often do you give these meds? 00:13:14.580 --> 00:13:17.530 position:50% align:middle What do you know about the substance? 00:13:17.530 --> 00:13:23.080 position:50% align:middle And what's the workplace controls and handling like for those? 00:13:23.080 --> 00:13:25.700 position:50% align:middle So this slide is, again, one of these busy things. 00:13:25.700 --> 00:13:29.680 position:50% align:middle And it's just from our paper, which I have a QR code for on another slide. 00:13:29.680 --> 00:13:33.610 position:50% align:middle But basically the availability is really important. 00:13:33.610 --> 00:13:35.530 position:50% align:middle That's the first set of. 00:13:35.530 --> 00:13:38.010 position:50% align:middle And if I can point it. 00:13:38.010 --> 00:13:39.340 position:50% align:middle I didn't point to the right thing. 00:13:39.340 --> 00:13:40.660 position:50% align:middle But anyway, let's see. 00:13:40.660 --> 00:13:42.480 position:50% align:middle Okay, here we go. 00:13:42.480 --> 00:13:52.060 position:50% align:middle It's significantly related to more likelihood of reporting prescription drug misuse. 00:13:52.060 --> 00:13:55.470 position:50% align:middle And the others are in the direction, they're not significant. 00:13:55.470 --> 00:13:57.830 position:50% align:middle We have probably fairly small numbers. 00:13:57.830 --> 00:14:00.610 position:50% align:middle But here we decided to make it index. 00:14:00.610 --> 00:14:08.360 position:50% align:middle Let's put all the variables together, and give a score, and see how exposure itself relates 00:14:08.360 --> 00:14:10.470 position:50% align:middle to the substance use. 00:14:10.470 --> 00:14:15.130 position:50% align:middle And the first model, the top line is a continuous index. 00:14:15.130 --> 00:14:26.220 position:50% align:middle And basically what that number means is if you report good access in your workplace, 00:14:26.220 --> 00:14:30.470 position:50% align:middle you're 38% more likely to report misuse. 00:14:30.470 --> 00:14:32.580 position:50% align:middle So that's the continuous. 00:14:32.580 --> 00:14:35.800 position:50% align:middle And then the medium to high. 00:14:35.800 --> 00:14:41.010 position:50% align:middle By the time you're in the high category of exposure, you're about three times more likely to report 00:14:41.010 --> 00:14:44.230 position:50% align:middle the substance misuse. 00:14:44.230 --> 00:14:49.360 position:50% align:middle Okay, discussion. 00:14:49.360 --> 00:14:56.160 position:50% align:middle So our summary is nurse prescription-type misuse still does exceed the general population. 00:14:56.160 --> 00:15:01.040 position:50% align:middle Nurse substance use disorder rates are similar to the U.S. population. 00:15:01.040 --> 00:15:07.360 position:50% align:middle 7.4% is what we got through SAMHSA, and it's a bit of a gender difference. 00:15:07.360 --> 00:15:14.000 position:50% align:middle So it's kind of similar, in the ballpark to our estimate. 00:15:14.000 --> 00:15:19.740 position:50% align:middle And then the workplace exposure still is a concern, and I know especially for people in the boards. 00:15:19.740 --> 00:15:25.710 position:50% align:middle And even if we show relatively small percentages out of...now we have 5 million nurses. 00:15:25.710 --> 00:15:32.800 position:50% align:middle That's a lot of people potentially with some issues of concern. 00:15:32.800 --> 00:15:37.730 position:50% align:middle Nurses weren't always confident that they could identify colleagues with a possible problem, 00:15:37.730 --> 00:15:45.950 position:50% align:middle though they did say that they would report it to someone, supervisor or a colleague, I guess. 00:15:45.950 --> 00:15:51.670 position:50% align:middle Favorable opinions of a nurse's ability to succeed in treatment and re-enter practice. 00:15:51.670 --> 00:15:55.060 position:50% align:middle That was kind of varied. 00:15:55.060 --> 00:15:56.520 position:50% align:middle I think it could use some help. 00:15:56.520 --> 00:16:03.810 position:50% align:middle And that's something that people reported they might be more willing to engage and to report if they thought 00:16:03.810 --> 00:16:04.920 position:50% align:middle there's something that could be done. 00:16:04.920 --> 00:16:08.110 position:50% align:middle And we've seen that in other areas, like patient safety and such. 00:16:08.110 --> 00:16:09.450 position:50% align:middle "Is there a solution at hand? 00:16:09.450 --> 00:16:11.990 position:50% align:middle And would something happen if I reported?" 00:16:11.990 --> 00:16:17.660 position:50% align:middle Especially with the fear of people getting fired, which is the case in some institutions. 00:16:17.660 --> 00:16:24.680 position:50% align:middle And overall, we thought general supportive attitudes toward impaired nurses in terms of what could happen 00:16:24.680 --> 00:16:26.530 position:50% align:middle as a result of job stress and all that. 00:16:26.530 --> 00:16:32.870 position:50% align:middle And thinking of the COVID situation, and the data showing more stress and more difficulties 00:16:32.870 --> 00:16:38.650 position:50% align:middle since COVID, that looks like something that should be on a radar screen. 00:16:38.650 --> 00:16:44.360 position:50% align:middle And then we had some recommendations just of giving people clear guidelines on how to and on know 00:16:44.360 --> 00:16:45.310 position:50% align:middle what to do. 00:16:45.310 --> 00:16:50.180 position:50% align:middle Sort of reminded me of that emergency handout that we got earlier today. 00:16:50.180 --> 00:16:51.590 position:50% align:middle "Here's what's going on. 00:16:51.590 --> 00:16:53.640 position:50% align:middle What should you do." 00:16:53.640 --> 00:16:56.440 position:50% align:middle Very clear steps and guidelines would be helpful. 00:16:56.440 --> 00:16:59.480 position:50% align:middle Of course, that might need to be organization specific. 00:16:59.480 --> 00:17:05.030 position:50% align:middle Still working on the culture of safety, and not blaming, and not shaming, 00:17:05.030 --> 00:17:06.030 position:50% align:middle and that sort of thing. 00:17:06.030 --> 00:17:11.030 position:50% align:middle I was saddened to hear, "Oh, we just fire people because they happened to be in a 00:17:11.030 --> 00:17:13.850 position:50% align:middle large city, and well, then they just go somewhere else." 00:17:13.850 --> 00:17:14.670 position:50% align:middle And then what? 00:17:14.670 --> 00:17:19.630 position:50% align:middle So what does that do for patient care safety, and what does that do for that person, 00:17:19.630 --> 00:17:24.850 position:50% align:middle and the resources that have gone into helping someone become a nurse, and training, and all that? 00:17:24.850 --> 00:17:26.950 position:50% align:middle Awareness of exposure risks. 00:17:26.950 --> 00:17:29.920 position:50% align:middle We think of it like as an occupational risk. 00:17:29.920 --> 00:17:36.500 position:50% align:middle And the other thing, I didn't present it, but we're seeing in the other settings nursing homes, 00:17:36.500 --> 00:17:42.500 position:50% align:middle home health, and outpatient, much higher rates of these things. 00:17:42.500 --> 00:17:48.440 position:50% align:middle And we were thinking, if you look at the exposure, in hospitals, there's more 00:17:48.440 --> 00:17:50.210 position:50% align:middle with Pyxis [SP], and accountability. 00:17:50.210 --> 00:17:55.810 position:50% align:middle And I'm not saying that's infallible, but some of these other settings are very kind of wide 00:17:55.810 --> 00:18:00.180 position:50% align:middle open compared to what we think of now today's happened in hospital settings, 00:18:00.180 --> 00:18:05.200 position:50% align:middle and especially home care with end-of-life kind of things. 00:18:05.200 --> 00:18:09.300 position:50% align:middle So there's a lot of access, and there's a lot of stress. 00:18:09.300 --> 00:18:15.240 position:50% align:middle So thinking about some of those settings as possibilities. 00:18:15.240 --> 00:18:23.520 position:50% align:middle We're not able to say someone with those issues was attracted to work in those kind of more laxed settings, 00:18:23.520 --> 00:18:25.880 position:50% align:middle or something about the setting itself. 00:18:25.880 --> 00:18:28.670 position:50% align:middle And then there's availability or accessibility. 00:18:28.670 --> 00:18:31.570 position:50% align:middle And also, I wanted to put this AJN paper. 00:18:31.570 --> 00:18:39.820 position:50% align:middle I work in the Academy of Nursing with a group on nurse fatigue, and we did this paper for AJN, sort of, 00:18:39.820 --> 00:18:45.060 position:50% align:middle I guess, what Linda Aiken was saying to try to put things out there a little more, 00:18:45.060 --> 00:18:48.760 position:50% align:middle and about nurses being more exhausted than ever, what should we do about it? 00:18:48.760 --> 00:18:55.450 position:50% align:middle It doesn't have a substance use focus, but it just sort of talks about the whole issue that 00:18:55.450 --> 00:18:58.900 position:50% align:middle we've been running into, and review some of the literature. 00:18:58.900 --> 00:19:04.010 position:50% align:middle So I thought that might be helpful for people that are interested in the topic. 00:19:04.010 --> 00:19:05.290 position:50% align:middle And thank you very much. 00:19:05.290 --> 00:19:08.130 position:50% align:middle I have time for questions, so look forward to it. 00:19:08.130 --> 00:19:26.290 position:50% align:middle I know I had to go fast through a bunch of things, so if there's something I missed, 00:19:26.290 --> 00:19:29.480 position:50% align:middle or something you wanted to hear more about, I'm happy to fill in. 00:19:29.480 --> 00:19:31.520 position:50% align:middle Oh, hi. 00:19:31.520 --> 00:19:32.240 position:50% align:middle - [Female] Hello. 00:19:32.240 --> 00:19:32.950 position:50% align:middle Thank you so much for that. 00:19:32.950 --> 00:19:36.750 position:50% align:middle I'm obviously from the UK. 00:19:36.750 --> 00:19:47.420 position:50% align:middle And my more recent work is in the area of compassionate regulation, and this whole issue about how we confront 00:19:47.420 --> 00:19:55.010 position:50% align:middle some of the challenges that regulation presents to the workforce and the workplace, 00:19:55.010 --> 00:19:57.410 position:50% align:middle and how we change regulation for the better. 00:19:57.410 --> 00:20:00.830 position:50% align:middle I think it's something that really, really concerns us. 00:20:00.830 --> 00:20:08.750 position:50% align:middle My question really is, you've got this vast experience in this area. 00:20:08.750 --> 00:20:19.140 position:50% align:middle Do you see a change in attitudes on this from the punitive blame culture, to the just culture, 00:20:19.140 --> 00:20:24.870 position:50% align:middle and the kind of restoration rather than retribution? 00:20:24.870 --> 00:20:28.390 position:50% align:middle - Yeah, I think it's moved hugely in that direction. 00:20:28.390 --> 00:20:34.170 position:50% align:middle And honestly, talking about some of the exceptions, as I had, was more disappointment because I kind 00:20:34.170 --> 00:20:35.520 position:50% align:middle of thought, "Oh, we're done with that." 00:20:35.520 --> 00:20:37.690 position:50% align:middle So it's moved hugely. 00:20:37.690 --> 00:20:43.720 position:50% align:middle And the whole peer assistance movement, and NCSBN has done a lot about pointing out stigma, 00:20:43.720 --> 00:20:46.360 position:50% align:middle and what works and what doesn't. 00:20:46.360 --> 00:20:51.840 position:50% align:middle And firing people is clearly not a solution, whether there's a shortage or not. 00:20:51.840 --> 00:20:54.740 position:50% align:middle If we don't think there is, even so. 00:20:54.740 --> 00:20:59.310 position:50% align:middle What does it say to other people still in the work environment that are also stressed when your 00:20:59.310 --> 00:21:03.360 position:50% align:middle colleague is fired? 00:21:03.360 --> 00:21:04.820 position:50% align:middle I think it's vastly different. 00:21:04.820 --> 00:21:11.390 position:50% align:middle But, of course, would like it to continue in that direction, because the evidence shows the kinds 00:21:11.390 --> 00:21:14.170 position:50% align:middle of things that can work with nurses that have these problems. 00:21:14.170 --> 00:21:20.740 position:50% align:middle And if you go more towards that, I think then you can conserve many nurses as nurses, 00:21:20.740 --> 00:21:23.400 position:50% align:middle and not lose them. 00:21:23.400 --> 00:21:30.540 position:50% align:middle We were discussing suicide risk being high when nurses are fired that have this kind of problem, 00:21:30.540 --> 00:21:35.110 position:50% align:middle and maybe not even having resources anymore to get treated, and so forth. 00:21:35.110 --> 00:21:37.280 position:50% align:middle So, yes, thankfully it's moving in that direction. 00:21:37.280 --> 00:21:42.810 position:50% align:middle And I think not just in nursing, but all of us, as we encounter more and more people 00:21:42.810 --> 00:21:48.320 position:50% align:middle with opioid problems, and all kinds of things, addictions, viewing them very differently from how 00:21:48.320 --> 00:21:49.090 position:50% align:middle we did before. 00:21:49.090 --> 00:21:51.730 position:50% align:middle So I think that's a welcome change. 00:21:51.730 --> 00:21:53.145 position:50% align:middle So thanks for your question. 00:21:53.145 --> 00:21:54.590 position:50% align:middle - Thank you very much. Thank you. 00:21:58.680 --> 00:22:02.160 position:50% align:middle - [Female 2] So to follow up on the idea, there's a welcome change because I agree, 00:22:02.160 --> 00:22:04.410 position:50% align:middle and I'm excited about it. 00:22:04.410 --> 00:22:13.000 position:50% align:middle But I arrived to Oregon after the board had voted to stop having new nurses enter 00:22:13.000 --> 00:22:15.650 position:50% align:middle into the alternative-to-discipline program. 00:22:15.650 --> 00:22:15.980 position:50% align:middle Yeah. 00:22:15.980 --> 00:22:19.290 position:50% align:middle So there is still out there not moving in that direction. 00:22:19.290 --> 00:22:25.830 position:50% align:middle And so I'm doing everything I can to kind of do more, bring data and information to the board, 00:22:25.830 --> 00:22:28.040 position:50% align:middle and see what's next. 00:22:28.040 --> 00:22:32.100 position:50% align:middle And so I heard you just mentioned about the peer model. 00:22:32.100 --> 00:22:37.060 position:50% align:middle And I didn't know if you could speak to what states are doing that, because it's been harder to find. 00:22:37.060 --> 00:22:43.700 position:50% align:middle And then if you can speak to what you found just from states that have alternative-to-discipline models, 00:22:43.700 --> 00:22:46.960 position:50% align:middle and states that don't. 00:22:46.960 --> 00:22:47.340 position:50% align:middle Thanks. 00:22:47.340 --> 00:22:54.850 position:50% align:middle - Dr. Alexander knows probably more about peer assistance models than many of us. 00:22:54.850 --> 00:22:58.400 position:50% align:middle And there are a number of states that have them. 00:22:58.400 --> 00:23:02.490 position:50% align:middle And in our EAP study, we're also talking to peer assistance providers, 00:23:02.490 --> 00:23:03.980 position:50% align:middle like in Minnesota. 00:23:03.980 --> 00:23:10.530 position:50% align:middle And what I do remember, though, is talking to nurses in states about affected nurses. 00:23:10.530 --> 00:23:12.910 position:50% align:middle And sometimes they'd say, "Oh, it's no big deal. 00:23:12.910 --> 00:23:17.930 position:50% align:middle You just call 1-800-PEER, or whatever it is, and talk to them, and they'll get you all 00:23:17.930 --> 00:23:20.330 position:50% align:middle situated and help." 00:23:20.330 --> 00:23:26.370 position:50% align:middle And so there's some amazing models that we have here of peer assistance. 00:23:26.370 --> 00:23:31.910 position:50% align:middle And then one of the things we're going to be looking at is how peer assistance and the boards work together, 00:23:31.910 --> 00:23:36.190 position:50% align:middle or do they work together, because that also varies from state to state. 00:23:36.190 --> 00:23:38.770 position:50% align:middle So that's really important. 00:23:38.770 --> 00:23:43.020 position:50% align:middle I commend you for doing that work in Oregon, to try to turn things around. 00:23:43.020 --> 00:23:51.770 position:50% align:middle That's tough, but really needed. 00:23:51.770 --> 00:23:53.570 position:50% align:middle Anything else? 00:23:53.570 --> 00:23:53.940 position:50% align:middle All right. 00:23:53.940 --> 00:23:55.155 position:50% align:middle Thank you again.