The nurse:
‘We need to
find our voice’
‘There are half a million nurses working in this
country, but I’m not sure where our voice is’, said Dr
Carmel Clancy, head of department of mental health,
social work and integrative medicine at Middlesex
University, who is also chair of the Association of
Nurses in Substance Abuse (ANSA).
In the 1960s nurses were working in regional drug
dependency units (DDUs) and the 1980s saw an
increase of nurse specialists in community drug and
alcohol teams. In the 1990s nurses were central to
harm minimisation and there were nurse consultant
roles – but the title of nurse was now becoming
interchangeable with key worker and drug worker.
‘Non specialists are taking over nursing roles,’ she
said. ‘Nurses are there, but are not as visible. How do
we claim a stake at the table?’
The sector had ‘no idea’ of the number of nurses
working in addiction, with many falling into it by
default, through promotion or changing location.
Despite nurses seeing addiction as a specialism, they
did not receive any undergraduate training on it and
felt they were starting again when they came into
addiction, said Clancy.
Changes were afoot however, with ANSA’s
proposed merger with the International Nurses
Society on Addictions (IntNSA) in July, which would
strengthen the nurses’ voice and raise their profile in
the addiction workforce.
The law change on ‘non-medical prescribing’ in
2012 (extending the right of a professionally qualified
person to prescribe) had resulted in a growing
number of nurse prescribers, added Mike Flanagan,
consultant nurse and clinical lead for substance
misuse services at Surrey Borders Partnership NHS
Foundation Trust and chair of the National Substance
Misuse Non-Medical Prescribing Forum.
The changing landscape of the last ten years had
seen drug and alcohol treatment more performance
monitored than any area of health and social care,
he said. When commissioning moved to local
authorities in 2013, the sector had been subjected
to repeated cycles of retendering with diminishing
budgets, all of which had contributed to making
specialist addiction treatment a less attractive
career option.
So what had been the impact on nursing? Medical
roles were increasingly provided by non-medical
prescribers – which was fine if properly supervised,
said Flanagan. But with nursing posts increasingly
provided by drug workers, there was ‘a risk that
commissioners and managers may fail to fully
appreciate the impact on quality.’
The psychologist:
‘Everyone does psychosocial
interventions’
Many of the barriers and facilitators to change were
psychological, but ‘absolutely everyone’ did
psychosocial interventions now, including staff and
service users, said Dr Christopher Whiteley, consultant
clinical psychologist at South London and Maudsley
NHS Foundation Trust.
The ‘recovery juggernaut’ had involved everyone in
‘building recovery capital’ – human, physical, cultural
and social – which had helped to address issues of
confidence, joining in meaningful occupations,
maintaining accommodation and staying in recovery.
But there were challenges: with many of the
psychosocial interventions being undertaken by
people who were not psychologists, outcomes were
greatly affected by the quality of the working alliance.
Organisations were prone to heavy caseloads, high
turnover of clients and a lack of resources for training.
To be effective there needed to be synergy between
leadership, a culture of innovation, training and
supervision, he said, while more could be done with
families, peers and community networks.
Workforce development
10 |
drinkanddrugsnews
| May 2016
As Neil McKeganey said in 2010 (in
Controversies in Drugs Policy and
Practice)
, if you need to visit a doctor you
can rest assured the person you are
seeing will have had a medical
education. If you want to buy a house
you know that the solicitor has been
educated to degree level, and if you take
your dog or cat to the vet you know that
they will be one of the most highly
trained professionals around. But if you
see a drug worker you will probably be
seen by someone who has not been to
university, does not have a professional
or postgraduate qualification, and who
may have only just entered the field.
At a conference on
Workforce
development: challenges, opportunities
and the way forward
, speakers from
different specialisms painted a picture of
a sector in danger of paying the price of
undervaluing essential skills, and asked,
are we compromising service users’
safety by ‘doing it on the cheap’?
Is the focus
on recovery
undermining a
highly skilled
workforce?
DDN
reports
DR CARMEL CLANCY
DR CHRISTOPHERWHITELEY
FALSE
