WelTec Nursing Forum

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WelTec Nursing Forum November 2009 Raine Berry
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Nursing and Addictions

• Coexisting Disorders
• The Addictions Nursing Workforce
• Current Treatment Situation
• Workforce Issues
• Matua Raki Strategies
• Workforce Vision

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Coexisting Problems

• Coexisting Capable
• Coexisting Enhanced
• CEP is common

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Prevalence of CEP

• NZ MH Survey 2004 Te Rau Hinengaro
• 20.7 mental health disorder (L/T)
• - 45 of these had coexisting drug disorder
  and/or alcohol abuse
• - 31 met criteria for alcohol dependence
• - 37 more than one disorder
• - 7.7 multiple
• 40 with substance use disorder also met criteria
  for an anxiety disorder and 29 a mood disorder

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CEP Associated Issues

• Major impairment in role functioning
• High prevalence of chronic medical issues e.g.
  chronic pain, cardiovascular disease, high BP,
  respiratory conditions, diabetes
• Suicidal behaviour associated with increased
  number of disorders
• People with diagnosed mental health disorder
  twice as likely to use alcohol hazardously

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Dependence Diagnosis in NZ Outpatient
SampleAdamson et at 2006
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Coexisting Disorders in an AOD Outpatient
Sample Adamson et al 2008
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The Addictions Nursing Workforce
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AOD Workforce Demographics
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Postgraduate Qualifications
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Routine Activities
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Skills nurses bring to addictions

• Health education
• Assessment and treatment planning
• Coordination of care from assessment to discharge
• Pharmacotherapy knowledge
• Withdrawal management
• Monitoring health, bloods, BP etc
• Crisis intervention
• Risk Management
• Consultation/liaison
• Counselling
• Documentation

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Perceived barriers to nurses wanting a career in
addictions
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Nursing Roles in the Addiction Context

• 85 of nurses in designated nursing positions
• Previous poor recognition of advanced practice
  roles
• 51 intend to work toward an advanced practice
  role including 30 Nurse Practitioner
• Expanded and extended practice scope

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AOD Treatment Survey
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AOD Treatment Position

• Many services struggling to meet demand
• - detox (residential medical and social)
• - youth services
• - coexisting problem service
• - residential programmes (incl. AD Act
  beds)

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Treatment Position

• Influencing factors
• - Lack of new positions
• - Lack of competent practitioners able to
  take clinical responsibility
• - Doubling of referrals from Corrections since
  the new Sentencing Act

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Workforce Issues
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Recruitment

• More workers in NZ labour market will retire than
  be recruited over next 25 years
• Labour demand will exceed supply in AOD from 2011
  
• Attaining and attracting qualified and skilled
  staff
• Difficulty recruiting for specialist positions
  (detox, CEP)

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Key issues

• Aging workforce
• - AOD age 49 in 2008, age 42 in 1998
• - National labour force age 40 in 2006, age
  36 in 1991
• Workforce Trends
• - Rise in qualification level
• - Rise in numbers of other Europeans (6 2004,
  16 2008, Nurses 29)
• - More counsellors, fewer nurses and fewer
  Maori
• Retention
• - high turnover (41 in AOD workforce for less
  than 5 years)

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Matua Raki Strategies
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Matua Raki Projects

• Capacity Building
• Forecasting
• Consumer workforce
• Capability Building
• - Scholarships, Internships
• - Mobile training and short courses
• - MI Internships
• - Families with complex and challenging issues
• - CEP enhancement project
• - Responses to methamphetamine problem

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AOD Advanced Practice Nursing Project

• Promote flexible post-graduate AOD/addiction
  advanced practice professional development
  nursing pathways within clinical masters
  programmes leading to clinical Nurse Specialist/
  Nurse Practitioner that incorporate postgraduate
  papers
• Strengthen national nursing leadership networks,
  including amongst nurses on the Nurse
  Practitioner pathway
• Strengthen strategic partnerships with nursing
  leaders within workforce programmes

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AOD Advanced Practice Nursing Project

• Support strategic and operation planning within
  the Addiction and Mental Health sector to develop
  the infrastructure for the implementation and
  ongoing support of advanced AOD/addiction
  advanced practice nursing roles
• Assist individual nurses with achieving /
  recognition of advanced practice status

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Summary
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• The capability and capacity of the AOD treatment
  sector improving however increasing demands on
  services continue
• Increasing the numbers in the addiction workforce
  not enough
• Nursing workforce needs to increase
• New dedicated nursing positions created
• Pathways for Nurse Practitioners supported
• New approaches needed to
• - recruitment
• - funding
• - treatment provision

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Workforce Vision
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By 2012

• Confident and hopeful workforce
• Skilled / capable specialist workforce
• Skills and knowledge gained supported and
  utilised in the workplace
• Consumer and peer workforce well established
• Increased Maori and Pacific Workforce
• Advanced nursing roles well established with
  Nurse Practitioners employed in each specialist
  service
• Increased capability in PHC and allied workforces
  to address addiction issues
• The average age of the workforce matches the
  National Labour force average
• Career in Addictions attractive to graduates and
  school leavers

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Postgraduate AOD Courses

• National Addiction Centre
• Auckland University

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Prevalence of Mental Health Disorders

• 39 of people gt16 years met criteria for a
  disorder at some time before interview
• Life-time (L/T) Risk 46.6
• Anxiety 24.9 L/T Risk 28.8
• Mood 20.2 L/T Risk 28.4
• Sub Use 12.3 L/T Risk 13.8
• Eating 1.7 L/T Risk 1.9
• Te Rau Hinengaro 2006

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12 month Prevalence of Substance-Use Disorders

• 2.6 alcohol abuse 1.3 dependence
• 1.2 drug abuse 0.7 dependence
• 0.9 Cannabis abuse 0.5 dependence
• Higher in Maori, Pacific, younger people, males,
  people with less education, less income