"Don't tell me where your priorities are. Show me where you spend your money and I'll tell you what they are."
James W. Frick
As a professional nursing organization, the International Nurses Society on Addictions (IntNSA) has a responsibility, even an obligation, to promote positive change in addictions treatment. As noted on its Web site, IntNSA states that "we believe that all nurses must maintain a basic level of knowledge and skills in addictions." Yet, how is this being accomplished?
A few months ago, I was asked to do a presentation for a multihospital system on the neurobiology of addiction and treatment implications across specialties and the lifespan. I was surprised to see the large number of attendees, which included psychologists, social workers, physicians, counselors, and nurses. Although most attendees were from the psychology and addictions units, a significant minority were from other areas. As usual, at the end of the presentation, many of the attendees had questions and comments. Although many of the questions and comments were expected, I was quite surprised by a few. For instance, several of the psychologists and a physician were impressed that a "nurse" was so knowledgeable about addictions; the social workers and counselors knew very little about addictions treatment; and, as usual, none of the nurses-both registered nurses and licensed practical nurses (LPNs)-had any knowledge of the existence of our professional organization, and those nurses practicing outside the addictions units had very little, if any, knowledge or skills in treating patients with co-occurring addiction issues. Also quite noticeable was that the professional groups present never interacted with each other. Subsequently, I did a literature search on addictions treatment utilizing several databases. A glaring observation is that there are very few articles done collaboratively with nurses and other professionals.
Getting back to what our obligations as a professional nursing organization are and as a result of my experience described above, it seems that there are many areas requiring serious improvement. It is clear that we need to do the following:
1. Improve knowledge of our existence by doing a much better job marketing the organization and recruiting new members.
2. Improve the competency of all nurses-both registered nurses and LPNs-because nurses continue to be recognized as major members of the treatment team. We must educate not only those nurses working in the field of addictions but also those who do not specialize in this area. As we all know, patients with addictive disorders can be found in every practice setting and with multiple physical and psychiatric problems.
3. Because the trend in hospitals is to utilize LPNs minimally, this group of nurses seems to be gravitating toward elder care and addictions treatment facilities. There is currently no formal education or measure of competency for this group.
4. There is a need for nurses to work more collaboratively with other team members to publish more research and clinical practice articles. We need to show our value proactively and routinely.
5. Nurses working in a collaborative environment should be encouraged to provide training to all care team members, including our nonnurse colleagues, related to the compre hensive, integrative, and holistic treatment issues for those with addictive disorders.
The dilemma we face is that we must change to meet the needs of the future as the U.S. healthcare model changes from rewarding for quantity to rewarding for quality. We must be more innovative in recognizing our problems and improving the quality of care. Moving toward what we are calling "the new healthcare"-a healthcare delivery system refocused on care quality, patient safety, efficiency, cost effectiveness, accountability, transparency, and population health-is undoubtedly a massive challenge for every stakeholder group in the healthcare system. Aren't nurses a major part of this refocusing effort?
I believe our starting point is to ensure that the leadership in our organization is capable and prepared to address these issues. We need to allow each member to contribute their unique value to the organization. This includes recognizing people's strengths and connecting them with organizational responsibilities that use their talents.
Today, more than ever, we need to identify what our priorities are. Our leadership should never sit still. We need to work together to continue building our professional organization, our profession, and the recognition of our specialty practice.
IntNSA is a force that will improve addictions treatment. Where are we spending our money?