New addiction NP craves job

1 July 2012

The country has its first nurse practitioner in addiction, Louise Leonard. All she needs now is an NP job. FIONA CASSIE reports.

Louise Leonard’s celebrations on becoming a nurse practitioner (NP) are a bit tempered by frustration. Her clients can’t benefit from her prescribing NP skills until she is employed as an NP.

“Sadly, that’s proving to be the hardest bit,” says Leonard, who continues on as a clinical nurse specialist at Waikato District Health Board’s addiction services team.

“It’s frustrating because the whole way through this journey on the NP pathway I’ve had good support (from the DHB) and an indication that a role would be forthcoming eventually,” says Leonard.

As of late June, she was still waiting.

“In New Zealand, there is incredible inertia around NP roles,” says Leonard, who points to the fact that ten years down the track, there are still only a handful over a 100 NPs.

She is also conscious of the need to get working as an NP soon so she can maintain and build her prescribing and other NP skills and meet the competency requirements.

Sue Hayward, Waikato DHB director of nursing, says via a statement the board supports nurses, like it has Leonard, on an NP pathway in practice areas identified as meeting a population need. She says the board is still awaiting a business case for the NP role covering funding, role substitution, and patient outcomes.

Leonard first trained as a registered general and obstetric nurse at Waikato Hospital. She moved to Australia in 1983, where she nursed in oncology and in chronic pain settings. An interest in grief work led her to study for a psychology degree.

In the late 1990s, she moved into drug and alcohol nursing, which she saw as a natural progression to use her biopsychosocial (BSP) skills she had developed from her nursing and psychology training.

“I liked the fact that when you’re working with drug and alcohol clients, you are working from a motivational approach,” says Leonard. “Plus working with people’s readiness to change. That really appealed to me.”

She also had had a couple of family members afflicted by addiction.

“I knew the toll it takes and the importance of being able to access timely and evidence-based treatment.”

She spent seven years working in drug and alcohol nursing in Australia before returning to the Waikato in 2004 to continue working in the field. Leonard says as a Māori clinician she wanted to return and give something back to her own people, and as a Māori adoptee raised in a Pākehā family, she was conscious of cultural gaps in her life that she wanted to fill. Leonard says she also remains mindful that she’s an adoptee with a fortunate story, and that in different circumstances, she may easily have been one of the clients she works with.

“That certainly contributes to my passion for my work.”

It is a passion that has also seen her become international vice president of the specialty’s professional body, Drug and Alcohol Nurses of Australasia (DANA).

Leonard since her return to New Zealand has been actively promoting addiction nursing – including teaching drug and alcohol nursing in undergraduate and postgraduate programmes – and the satisfaction to be had in using the broad range of skills needed to motivate clients to change.

Leonard currently works with adults with moderate to severe dependence across the whole range of drug substances, from opioids to alcohol. Her clinical working day can involve a mix of assessing clients in the outpatient clinic, supporting people undergoing community detox and others undergoing methadone treatment, and doing consultation liaison work at Waikato Hospital with acute patients.

The liaison work includes a health promotion and education role and is all about grabbing the moment by getting in early, assessing a client’s need, and providing a timely intervention.

An example is a man in his 60s who arrived by ambulance after stumbling on the road intoxicated. When Leonard was called, in she recognised him as a client who had previously been sent for compulsory residential treatment under the Alcoholism and Drug Addiction Act but had dropped out, relapsed to drinking , and become increasingly unwell leading up to the incident. Leonard managed to grab the moment of his short hospital stay to catch up with him and his wife, assess him, and help them see the severity of the situation. This was quickly followed-up by a community visit that saw a treatment plan created and the man admitted into detox and back on the treatment track. So far, so good.

For Leonard, the reward is being able to use her broad range of skills in a timely response to build a therapeutic relationship with a patient that motivates them to change.

“Often, you are telling them things they don’t want to hear and you are recommending a plan that they don’t want to do. That therapeutic alliance is really important.”

New Addiction Nursing Framework endorsed

A pathway for other nurses to follow in specialising in addiction nursing has now been given the national stamp of approval.

The Aotearoa New Zealand Addiction Specialty Nursing Competency Framework was endorsed in May by the National Nursing Consortium.

The Drug and Alcohol Nurses of Australasia (DANA) developed the knowledge and skills framework for nurses working in addiction treatment, as a trans-Tasman project.

Leonard, the international vice president of the body, said a national nursing reference group, with Daryle Deering as project officer, worked on the New Zealand framework to address the different cultural issues and context of New Zealand addiction nursing.

“I think it’s a good piece of work and is really going to help managers, planners and funders, and educators in the future when thinking about who they need to deliver services and at what level,” Leonard says.

It is estimated that there are currently around 240 addiction nurses working in New Zealand, with the vast majority working in district health board settings.

“Increasingly, managers are understanding that nurses are a good fit in addiction work – that is, to deliver detox services, pharmacotherapy, and consultation liaison services,” says Leonard.

“There’s a lot of scope for nurses in addiction. We haven’t got enough of them, basically.”