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V O L U M E 49 ISSUE 2 FA L L 2 0 1 8
Nursing Matters
Election Priorities 2018 ... page 25
12 CANNABIS LEGALIZATION: 19 WHEN CAN RNs 40 2019 NANB
WHAT NURSES NEED ADMINISTER ELECTIONS: CALL
TO KNOW NALOXONE? FOR NOMINATIONS
The 2018 President’s Award Recipients
NANB hosted a President’s Award The 2018 President’s Award Recipients: Left: Hon. Roger Melanson, Minister of
Reception on May 9, 2018 at the Post-Secondary Education Training and
Fredericton Convention Centre. This • Véronic Ringuette, UdeM Edmundston Labour
ceremony honored future leaders from • Danica Marie Breau,UdeM Shippagan
each nursing program in New Brunswick. • Katelyn Gowlett, UNB Saint John Right: Karen Frenette, NANB President
Recipients were graduates recognized for • Mallory Smith, UNB Fredericton
demonstrating excellence in clinical • Aaryn Tays, UNB Moncton
practice throughout their education • Noémie Chiasson, UdeM Moncton
program. Congratulations to all. (not present)
12 Cannabis Legalization: What 19 When Can RNs Administer
Nurses Need to Know Naloxone?
Cover
Coming together, the
Nurses Association of New
Brunswick (NANB) and the
New Brunswick Nurses
Union (NBNU) have
partnered and identified
five election priorities and
proposed questions to party
leaders on how they intend
to address these challenges
within our healthcare 25 Nursing Matters: Election 38 2019 Online Registration
system. See page 25 Priorities 2018 Renewal: Opens October 1
for details.
2 I N F O N U R S I N G FA L L 2 0 1 8
17 42
10 Planting the Information Seed: Nursing Practice 35 RNs in Nursing Homes
and Cannabis Use Accepting the Challenge and Reaping the Rewards
NANB Virtual Forum By Dr. Rose McCloskey, Cindy Donovan, Emily MacDonald
By Karey Shuhendler
40 2019 NANB Elections: Call for Nominations
17 The Opioid Crisis in New Brunswick
An RNs Journey
By Martine Levasseur 42 2018 NANB AGM Highlights
23 OPIOID CRISIS: What is GNB’s Plan? 47 2019 NANB Awards: Call for Nominations
An interview with Dr. Jennifer Russell
the
pulse
5 Message from the President 44 Professional Conduct Review Decisions
5 Message from the Executive Director 46 Calendar of Events
7 Boardroom Notes
FA L L 2 0 1 8 I N F O N U R S I N G 3
Info Nursing is published twice annually by the Nurses
Association of New Brunswick, 165 Regent St., Fredericton,
NB, E3B 7B4. Views expressed in articles are those of the
authors and do not necessarily reflect policies and opinions
held by the Association.
Nurses Association of Submissions
Articles submitted for publication should be sent
electronically to jwhitehead@nanb.nb.ca approximately two
New Brunswick months prior to publication (April, October) and not exceed
1,000 words. The author’s name, credentials, contact
information and a photo for the contributors’ page should
accompany submissions. Logos, visuals and photos of
adequate resolution for print are appreciated. The Editor will
Nurses shaping nursing for healthy New Brunswickers. In pur- review and approve articles, and is not committed to publish
all submissions.
Change of address
suit of this vision, the Nurses Association of New Brunswick Notice should be given six weeks in advance stating old and
new addresses as well as registration number.
DESIGNER ROYAMA DESIGN
regulates registered nurses and nurse practitioners in New TRANSLATION JOSÉ OUIMET
EDITOR JENNIFER WHITEHEAD
Tel.: (506) 458-8731; Fax: (506) 459-2838;
Brunswick to ensure the provision of safe, competent and ethical 1 800 442-4417; Email: jwhitehead@nanb.nb.ca
Canada Post publications mail agreement number
40009407. Circulation 10,000. ISSN 0846-524X. Copyright
nursing care in the interest of the public. © 2018 Nurses Association of New Brunswick.
Executive Office
LAURIE JANES
Executive Director
Email: ljanes@nanb.nb.ca
SARAH O’LEARY
Executive Assistant, Corporate Secretary
459-2858; Email: soleary@nanb.nb.ca
Regulatory Services
SOPHIE NOËL
Senior Legal Counsel/ Registrar
459-2830; Email: snoel@nanb.nb.ca
The NANB Board of Directors LORRAINE BREAU
Nurse Consultant
459-2857; Email: lbreau@nanb.nb.ca
VIRGIL GUITARD
Nurse Consultant
543-1873; Email: vguitard@nanb.nb.ca
PAULETTE POIRIER
Administrative Assistant: Regulatory Services
459-2866; Email: ppoirier@nanb.nb.ca
STACEY VAIL
Administrative Assistant: Registration
459-2851; Email: svail@nanb.nb.ca
STÉPHANIE SAULNIER
Karen Frenette Maureen Wallace Joseph Gallant Dorothy Arsenault Administrative Assistant: Registration
President President-Elect Director, Region 1 Director, Region 2 (interim) 459-2869; Email: ssaulnier@nanb.nb.ca
Practice
KATE SHEPPARD
Senior Advisor Nursing Education and Practice
459-2835; Email: ksheppard@nanb.nb.ca
SUSANNE PRIEST
Nurse Consultant
459-2854; Email: spriest@nanb.nb.ca
SYLVETTE GUITARD
Nurse Consultant
740-1734; Email: sguitard@nanb.nb.ca
NICOLE CROUSSETTE
Nurse Consultant
Nathan Wickett Vicky Doiron Laura Gould Anne Marie Lavigne 459-2859; Email: ncroussette@nanb.nb.ca
Director, Region 3 Director, Region 4 Director, Region 5 Director, Region 6 JULIE MARTIN
Administrative Assistant: Practice
459-2864; Email: jmartin@nanb.nb.ca
Corporate Services
SHELLY RICKARD
Director of Corporate Services
459-2833; Email: srickard@nanb.nb.ca
MARIE-CLAUDE GEDDRY-RAUTIO
Corporate Services Assistant
459-2861; Email: mcgeddry@nanb.nb.ca
Communications and Government Relations
JENNIFER WHITEHEAD
Manager, Communications and Government Relations
459-2852; Email: jwhitehead@nanb.nb.ca
Deborah Walls Joanne Sonier Pauline Vacant
Director, Region 7 Public Director Banville-Pérusse Public Director STEPHANIE TOBIAS
Public Director Administrative Assistant: Communications
459-2834; Email: stobias@nanb.nb.ca
4 I N F O N U R S I N G FA L L 2 0 1 8
M e s s ag e f r o m
THE PRESIDENT &
E XECUTIVE DIREC TOR
Voice Your Vote! Looking to the Future: Changes in
New Brunswickers Count on Us Regulation and Membership
AS SUMMER CHANGES TO AUTUMN IN OUR BEAUTIFUL WHILE NURSES PROVIDING DIRECT PATIENT CARE
province, we will be entering an election. As nurses, we have continue with daily responsibilities; the profession of nursing
the natural capacity to take the lead on what matters for the and the health systems in which nursing care is provided
health of our patients in all clinical environments. As well, continues to evolve at a rapid pace. This rapid change is also
every nurse has the professional expertise to “raise their voice happening within other regulatory bodies across the country
and be political”. This is accomplished by supporting as British Columbia and Nova Scotia are on the cusp of
evidence, making informed choices and leading others in a implementing integrated nursing colleges for registered and
call to action. As healthcare costs continue to rise, it is licensed practical nurses. Both colleges operate within health
evident that the existing traditional model of care cannot be regulation frameworks—with a focus on supporting nurses
maintained. Transformation of our healthcare system into a to deliver optimal nursing services to the public.
proactive and preventative model is essential. A revitalized Our national professional nursing advocacy organization,
system that optimizes all health professionals to their full The Canadian Nurses Association (CNA) is also changing by
scope of practice is required, in order to meet the health care welcoming LPNs to support and develop a sustainable model
needs of our population, as well as be cost-effective and for nursing advocacy and healthy public policy...into the
sustainable into the future. As nurses, we have an important future.
role to play in the sustainability of our New Brunswick What does all this mean for nurses in New Brunswick?
healthcare system. This means, we are placing a heightened focus on all nurses
This year the Nurses Association of New Brunswick (RNs, LPNs, NPs) truly working to a maximum scope of
(NANB) and the New Brunswick Nurses Union (NBNU) have practice. RNs and LPNs have been working in a system where
partnered, in the interest of our members and the public, and family physicians and specialty physicians practice this
identified five healthcare priorities. model daily.
RNs must understand the LPN scope of practice so that
1. Access to Care. work is done collaboratively, and work is shared when and
2. Pharmacare. where necessary, not simply because the RN reserves the right
3. Long-term Care. to delegate. RNs must also learn and enact the role of
4. Mental Health & Addictions. consultant, and be prepared to provide safe, competent and
5. Nursing shortage. ethical advice when asked by an LPN colleague.
RNs and LPNs working together at the bedside must
Thousands of New Brunswickers continue to face challenges understand the shared roles and the roles that make each
in accessing comprehensive primary health services, yet we nursing category different. LPNs are expected to “consult”
have nurse practitioners unable to find employment. This with RNs and when a patient’s condition warrants more
ongoing issue and proposed solution has been raised at every complex care; RNs and LPNs must determine together—
meeting with government for several years. Access to care, as which provider has the required competencies to continue the
well as the other priorities listed above continue to present patient’s care journey.
challenges that require our political leaders to address This dynamic consultation and transfer of care process
page 24 page 24
FA L L 2 0 1 8 I N F O N U R S I N G 5
contributors this issue
10 12 17
KAREY SHUHENDLER, RN, CCHN(C), MN KATE SHEPPARD, RN, MN MARTINE LEVASSEUR, RN
Program Lead, Public Policy Programs and Senior Advisor Nursing Education Opioid Addiction Treatment
Policy of the Canadian Nurses Association and Practice, NANB Services, Edmundston
19 35 35
SYLVETTE GUITARD, RN, MN CINDY DONOVAN, RN, MSA EMILY MACDONALD, RN, MN, GNC(c)
Nurse Consultant, NANB Chief Executive Officer, Clinical Instructor, Department of
Loch Lomond Villa Saint John Nursing and Health Sciences, University
of New Brunswick, Saint John
35
DR. ROSE MCCLOSKEY, RN, PhD, GNC (C )
Professor, Department of Nursing and
Health, University of New Brunswick,
Saint John; Board of Directors,
Loch Lomond Villa Saint John
6 I N F O N U R S I N G FA L L 2 0 1 8
BOARDROOM
N ote s
The Board of Directors met on May 8 & 9,
2018 at the NANB Headquarters in
Fredericton ahead of the Annual
General Meeting on May 10.
Governance Committee CNA Membership Changes New! Entry-to-Practice Requirement
The Governance Committee presented Since its beginnings in 1908, CNA has The Board of Directors approved
to the Board for approval a Board been the national professional voice of launching a new education module as
Charter, Terms of Reference for the registered nurses, which includes nurse entry-to-practice (ETP) requirement for
NANB Governance and Executive practitioners. However, on June 18, 2018, nursing graduates in the Spring of 2019.
Committee, and role descriptions. This voting delegates at CNA’s annual The module focuses on jurisprudence
Committee continues to meet on a meeting of members voted overwhelm- (laws which apply to nursing practice).
regular basis. ingly in favour of expanding CNA’s Requirement for education/testing on
membership to include licensed jurisprudence in nursing is a standard
Board Election Results practical nurses (known as registered entry to practice component used in
The 2018 Election in regions 1, 3, 5 & 7 practical nurses in Ontario) and provinces and territories across Canada.
welcomes four new directors for a registered psychiatric nurses (regulated
two-year mandate beginning September in the four western provinces and Need to Know Files
1st, 2018. The successful candidates Yukon). Read more at www.cna-aiic.ca/ NANB’s work is focusing on developing
were: Joseph Gallant, RN; Nathan en/membership/lpnrpn. tools/resources to assist nurses in
Wickett, RN; Laura Gould, NP; and understanding and maintaining
Debbie Walls, RN. Committee Recruitment Process competency as relates to legalization of
The Board approved a new recruitment cannabis, and provincial response/
The Board would like to thank all nurses strategy for committee members using management of the opioid crisis.
for presenting themselves as candidates targeted communications both email Nurses are encouraged to review
in this year’s election and thank all and social media to attract both nurses information on the NANB website, in
outgoing directors for their contribu- and public volunteers to sit on standing future editions of the E-bulletin, and
tion to the work of the Association. committees. Info Nursing.
FA L L 2 0 1 8 I N F O N U R S I N G 7
f.y.i.
New NANB Staff
We are pleased to announce that the
Nurses Association of New Brunswick has
added two new staff members:
Nicole
Croussette RN,
BSN, accepted
the position of
Nurse
Consultant with
the NANB in
May. Since
obtaining her
BSN at the
Université de Moncton in 1991, Nicole has
worked 17 years in acute care settings with
a focus in cardiac care, nine years teaching
at NBCC within the health studies
programs and one year with social
development at nursing home services as
New & Revised
the provincial liaison officer. Nicole is
currently enrolled in a Masters of
Education program.
NANB Documents
Nicole is motivated and engaged in NANB Nurse Consultants regularly produce documents to
supporting the regulatory mandate, and support your nursing practice; many directly related to
the Board of Directors end goals. She has a questions that members have asked. In 2018, NANB has
diverse portfolio of core organizational and produced the following documents, guidelines, position
project work and will be delivering statements and FAQs. All documents are available on the
presentations to various stakeholders NANB website at www.nanb.nb.ca.
and partners.
• Standards for the Practice of Primary • FAQ: When can Registered Nurses
Stéphanie Health Care Nurse Practitioners Administer Naloxone?
Saulnier
accepted the • Practice Guideline: Managing • FAQ: Use and Misuse of Professional
position as Registered Nurses with Significant Practice Title
Administrative Practice Problems
Assistant, • FAQ: What Is a Directive?
Registration, • Position Statement: Non-Medical
effective May Cannabis Use • FAQ: Duty to Report: When am I
14, 2018. In Responsible to do so and how do I
2005, Stéphanie • Fact Sheet: Nurse Practitioners do it?
graduated from CCNB-Dieppe with a Prescribing Methadone
diploma in bilingual office management • FAQ: I’m a Registered Nurse/Nurse
systems. Before joining the NANB team, • FAQ: Are NPs Authorized to Prescribe Practitioner Practising in New
Stéphanie worked for eight years as an Methadone in New Brunswick? Brunswick. How can I get Practice
administrative assistant at the Université Advice from NANB?
de Moncton- Moncton Campus. We • FAQ: Non-medical Cannabis Use
welcome her knowledge and experience • FAQ: What do I Need to Know about
working with students, which will benefit Camp Nursing?
the registration department.
8 I N F O N U R S I N G FA L L 2 0 1 8
f.y.i.
VPH Nurses Alumnae
Bursary Recipients Hours & Dates
The NANB Office is open Monday to Friday, from 08:30 to 16:30
NANB WILL BE CLOSED
October 8, 2018 Thanksgiving Day
November 12, 2018 Remembrance Day
December 24, 2018–January 2, 2019 Holiday Closure
DATES TO REMEMBER
LOGAN ROUSSELLE was awarded $2,000
by the VPH Nurses Alumnae for the 2016-17 October 1, 2018 Registration Renewal Opens
year. At that time, he was a second-year
nursing student at UNB Saint John campus.
October 16–17, 2018 NANB Board of Director’s Meeting
Logan’s great aunt, Cleo Cyr, graduated
from VPH School of Nursing in 1973.
November 15, 2018 Payroll Deduction Deadline
November 30, 2018 Registration Renewal Deadline
January 31, 2019 Deadline for NANB Election Nominations
January 31, 2019 Deadline for NANB Award Nominations
February 25–26, 2019 NANB Board of Director’s Meeting
Follow and Like NANB Call For Entries
TESS DELL is the recipient of the 2017-18
VPH Nurses Alumnae bursary in the
on Facebook and Do you have a story idea or
amount of $2,000. Tess graduated from Twitter! article you would like to see in
the Bachelor of Nursing program at UNB, Info Nursing? Do you have
Fredericton in the spring of 2018. She is the NANB has joined the world of someone you’d like to see
granddaughter of Arlee McGee, VPH Class social media, as an added media profiled or an aspect of nursing
of 1953. presence and monitoring tool; as you’d like to read more about?
well as an opportunity to promote Please submit your ideas and
To apply for the VPH Nurses Alumnae to members, both existing and suggestions to:
bursary, please send an email with info future, of the Association’s events,
about your nursing studies. Let us know supports and services available Jennifer Whitehead,
your Victoria Public Hospital School of while increasing traffic to our Manager of Communications
Nursing connection. The deadline for existing website. and Government Relations
applications is November 30 each year
Contact either: You can follow NANB at jwhitehead@nanb.nb.ca
www.twitter.com/nanb_aiinb. 165 Regent St, Fredericton, NB
Gwen Dorcas Ferguson There is also a direct link to the E3B 7B4
gtuttle@unb.ca account from our website
homepage www.nanb.nb.ca.
Sheila Currie Harvey
sheila.currie8@gmail.com
FA L L 2 0 1 8 I N F O N U R S I N G 9NANB VIRTUAL FORUM
Planting the
Information Seed
Nursing Practice and
Cannabis Use
BY KAREY SHUHENDLER
IN LIGHT OF THE PENDING LEGALIZATION OF CANNABIS, NANB how can I help youth in my community to reduce the risk?
wanted to start a dialogue with members about nursing practice How can my workplace ensure nurses are not impaired by
and cannabis use. In May, NANB hosted a three-week Virtual cannabis at work?
Forum titled Planting the Information Seed: Nursing Practice and Another aspect of our reflection should be to examine our
Cannabis Use. During that time, there were a number of thought assumptions and biases. Is what we think about cannabis and
producing posts on how RNs think cannabis legalization will cannabis use correct? What does the evidence say? While
impact their practice and their role as nurses caring for clients cannabis is by no means a benign substance, there still
(www.nanb.nb.ca/vforum/entry/planting-the-information-seed- remains a great deal of stigma and misinformation which
nursing-practice-and-cannabis-use). Thank you for participating! have informed the perspective of the public, including nurses.
Many forum participants have articulated concerns about
To close the forum is Karey Shuhendler RN, CCHN(C), MN, cannabis as a “gateway” drug, evolving evidence suggests this
Program Lead, Public Policy Programs & Policy of the Canadian may not be the case. While cannabis use may precede use of
Nurses Association. Karey captures some of our questions and seemingly more harmful substances, researchers consider
assumptions and brings us back to thinking about the available that factors such as poverty, trauma and homelessness are
evidence and providing safe, ethical and competent care. more likely to contribute to risk for substance use disorder. It
should also be noted that dependence rates significantly
lower for persons who use cannabis than some other sub-
NANB Virtual Forum on Cannabis: Summary stances1, and there is evidence to suggest that in some cases,
W
hat a tremendous opportunity it has been to see cannabis use may actually decrease use of potentially more
nurses engaging in this essential discussion as harmful substances (Reddon et al., 2018).
Canada moves forward with legalization of non- Absolutely, there are risks associated with non-medical
medical cannabis. It is not surprising to note the wide range cannabis use, and absolutely, nurses can help their patients to
of thoughts on this topic, given that nurses work with people understand and minimize these risks.2 Arming ourselves
across the lifespan, and in a variety of practice settings, so we with accurate information about risks and harms of cannabis
know firsthand some of the implications for our patients and use not only enables us to have honest, evidence-informed
the health care system as a whole. In addition, as people we discussions with our patients/clients/communities, but it
bring to the table our personal experience, our family helps to reduce the stigma around cannabis.
experience, and all of experiences that shape the foundation As nurses, we need to be able to engage in these discus-
of what we know, and perhaps what we think we know. As the sions, since the evidence tells us that approaching substance
body of cannabis research continues to evolve, and as use from an abstinence-only perspective does not work. It does
legalization is implemented and evaluated, I encourage not work for youth, and it does not work for adults. We know
nurses to continue to stay attuned to the changes, the this because of the high rates of cannabis use in Canada,
evidence, the needs of your patients, and the needs of nurses despite the current prohibition model. Consider the following
and health care professionals.
When it comes to cannabis and implications for nursing,
just as with other aspects of our practice, we must continue to 1
About nine per cent of cannabis users develop dependence (classified as
engage in reflective practice to ask ourselves critical ques- cannabis use disorder in the DSM5) (George & Vaccarino, 2015;
tions like those asked by forum participants: What does this Lopez-Quintero et al., 2011). Comparatively speaking, the estimated
mean for my patients? Will this lead to problematic substance probability of developing dependence is 68 per cent for nicotine, 23 per
use? If we know cannabis is harmful for the developing brain, cent for alcohol and 21 per cent for cocaine (Lopez-Quintero et al., 2011).
10 I N F O N U R S I N G FA L L 2 0 1 8NANB VIRTUAL FORUM
excerpt from CNA’s 2017 discussion paper Harm Reduction for logistical questions, legal and regulatory questions, as well as
Non-Medical Cannabis Use: emotional and ethical questions. That is okay. As we move
“Cannabis is the most commonly used illicit substance in forward with this changing legal landscape, I would encour-
Canada (Canadian Centre on Substance Use and Addiction age nurses to keep asking questions. Ask questions of
[CCSA], 2014). Of particular significance are the high use rates yourselves as part of your reflective practice; ask questions of
among Canadian youth, many of whom start using cannabis your workplace to identify educational and policy needs; ask
in their late elementary school years. While rates have questions of your regulators so that you understand your
recently decreased, Canada still has the world’s highest use responsibilities; and ask questions of your associations to
rates among youth, with 28 per cent of 11-15 year olds identify what resources and information you may need. It is
reporting past year use in 2009-2010 (UNICEF, 2013). More only through our continued critical thinking that we can
recent statistics for Canadians aged 15-19, 20-24, and 25 years navigate this change while obtaining the evidence we need to
and older indicate past year use of 21, 30 and 10 per cent, improve health outcomes for those we serve.
respectively (Statistics Canada, 2017). In youth, non-medical
cannabis use in Canada has a rate 2.5 times higher than
adults age 25 and older (Statistics Canada, 2017).” References
It should be noted that forum participants raised several Canadian Centre on Substance Abuse. (2014). Marijuana for non-
ethical questions related to cannabis use, be it cannabis use therapeutic purposes: Policy considerations. Retrieved from http://
by patients/clients, or cannabis use by nurses in the work- www.ccdus.ca/Resource%20Library/CCSA-Non-Therapeutic-
place. These are all excellent thoughts to put forward to help Marijuana-Policy-Considerations-2014-en.
us break down what our responsibility may be in certain pdf#search=%22Marijuana%20for%20non%2Dtherapeutic%20
situations. CNA’s Code of Ethics for Registered Nurses (2017) purposes%22
provides useful guidance for many of these situations.
For nurses who may feel at odds with counselling a patient Canadian Nurses Association. (2017). Code of Ethics for Registered Nurses.
on how to use cannabis in a manner that reduces risk for harm, Retrieved from https://www.cna-aiic.ca/html/en/Code-of-Ethics-2017-
the values of harm reduction are consistent with the primary Edition/index.html
values of ethical nursing practice. This includes providing safe,
compassionate, competent and ethical care; promoting health Canadian Nurses Association. (2017b). Harm Reduction for Non-medical
and well-being; promoting and respecting informed decision- Cannabis Use. Retrieved from https://www.cna-aiic.ca/-/media/cna/
making; honouring dignity; maintaining privacy and page-content/pdf-en/harm-reduction-for-non-medical-cannabis-use.pdf
confidentiality; promoting justice; and being accountable.
The questions of many as to what implications legalization George, T., & Vaccarino, F. (Eds.). (2015). Substance Abuse in Canada: The
of cannabis will have on nurses’ personal use of non-medical Effects of Cannabis Use During Adolescence. Retrieved from the Canadian
cannabis is a legitimate concern as well. We can look to the Centre on Substance Use and Addiction website: http://www.ccsa.ca/
Code of Ethics for Registered Nurses (2017) for guidance on this as Resource%20Library/CCSA-Effects-of-Cannabis-Use-during-
well. Technically, legalization should have no impact on the Adolescence-Report-2015-en.pdf
sobriety of the nursing work force. Just as with other sub-
stances, be it alcohol, prescription medications etc., nurses Lopez-Quintero, C., Perez de los Cobos, J., Hasin, D. S., Okuda, M., Wang,
are still obligated to be accountable for, and maintain their S., Grant, B. F., & Blanco, C. (2011). Probability and Predictors of
fitness to practise. “If they are aware that they do not have the transition from first use to dependence on nicotine, alcohol, cannabis,
necessary physical, mental or emotional capacity to practise and cocaine: Results of the National Epidemiologic Survey on Alcohol
safely and competently, they withdraw from the provision of and Related Conditions (NESARC). Drug and Alcohol Dependence, 115,
care after consulting with their employer. If they are self- 120-130. doi:10.1016/j.drugalcdep.2010.11.004
employed, they arrange for someone else to attend to their
clients’ health-care needs. Nurses then take the necessary Reddon, H., DeBeck, K., Socias, M.E., Dong, H., Wood, E., Montaner, J.,
steps to regain their fitness to practise, in consultation with Kerr, T., & Milloy, M.J. (2018). Cannabis use is associated with lower
appropriate professional resources” (CNA, 2017, pg. 17). rates of initiation of injection drug use among street-involved youth: A
Similarly, nurses have an ethical obligation to be attentive to longitudinal analysis. Drug Alcohol Rev. 37(3), 421-428. doi: 10.1111/
signs that a colleague may not be fit to practise, and in such dar.12667
cases, take necessary steps to protect the safety of persons
receiving care. Statistics Canada. (2017). Canadian Tobacco, Alcohol and Drugs Survey:
Legalization of non-medical cannabis is complex. It raises Summary of Results for 2015. Retrieved from https://www.canada.ca/
en/health-canada/services/canadian-tobacco-alcohol-drugs-
survey/2015-summary.html
2
Consider resources such as CNA’s 10 tips for Reducing the Harm of
Non-Medical Cannabis Use or CAMH’s Lower Risk Cannabis Use UNICEF Office of Research. (2013). Child Well-being in Rich Countries: A
Guidelines https://www.camh.ca/-/media/files/pdfs---reports-and- Comparative Overview (Innocenti Report Card 11). Retrieved from
books---research/canadas-lower-risk-guidelines-cannabis-pdf.pdf. https://www.unicef-irc.org/publications/pdf/rc11_eng.pdf
FA L L 2 0 1 8 I N F O N U R S I N G 11CANNABIS FAQ
CANNABIS
LEGALIZATION:
WHAT NURSES
NEED TO KNOW
BY KATE SHEPPARD Legalization and regulation of Cannabis is planned for October 2018.
This piece of legislation is referred to as the Cannabis Act, or Bill C-45. It
will allow for national use by individuals 18 and over, personal
possession of up to 30 grams, and up to four plants per household for
personal cultivation. However, provinces and territories can further
restrict possession, sale and use.
I n New Brunswick (NB) the legal age to purchase cannabis has been set at 19 and
cannabis will be sold at Cannabis NB retail stores. Cannabis will be taxed, and the
current agreement indicates that the federal government will receive 25% of the
revenue and the province will keep the rest. A gram of cannabis is expected to be
priced at around $10.1
12 I N F O N U R S I N G FA L L 2 0 1 8CANNABIS FAQ
Why Legalization? What are the health risks and harms of cannabis use?
Legalization can be seen as a positive option for cannabis for Cannabis use is associated with various health risks and
a few reasons. Legalization will allow for: harms. Current research indicated that those include2,3:
• regulation of the quality and potency • acute cognitive and psychomotor impairments
• impaired brain development
• removes social harms (restrictions that a criminal record • dependence
places on a person’s opportunity for employment, volun- • mental health issues
teer work, travel and more) • psychosis
• respiratory effects
• decreased costs by having fewer people in the criminal • poorer pregnancy outcomes
justice system and lowering law enforcement costs2 • motor-vehicle accidents2,3
Legalization does not reduce the health risks and harms, but Youth, pregnant women and individuals with mental health
it does provide the opportunity to mitigate them.2 issues or history of psychosis or family history of psychosis
FACTS & FIGURES
• More than 9 in 10 Canadians • Cannabis use that begins early in from 10 to 20%. This is a signifi-
support nurses providing adolescence and that is described cant jump from the 1970 when
education to help them to better as frequent and continues over THC levels ranged from 2 to 8%.7
understand the risks and harms time has been associated with
of recreational cannabis use.5 increased risk of harms and some • Cannabis concentrates or
of those harms may not be fully synthetics can contain up to
• In Atlantic Canada 83.8% rated reversible. Adolescence is a 80-90% THC. High THC content
themselves as knowledgeable/ critical time for brain develop- has been identified as a factor
somewhat knowledgeable about ment as the brain is not fully contributing to acute and chronic
the effect of cannabis on things developed until around age 25.9 adverse outcomes, including
such as brain development, mental health problems and
pregnancy, mental health and • About 1 in 5 people seeking dependence.3
driving.5 substance use treatment have
cannabis related problems.3 • Cannabidiol (CBD), another
• Cannabis use is common, 10% to cannabinoid, is non-psychoactive
15% of the general adult popula- • Among youth, driving after and associated with anti-inflam-
tion report using cannabis in the cannabis use is more prevalent matory, analgesic, and
past year and usage is even more than driving after drinking.2 antipsychotic properties.8
common among adolescents and
young adults.3 • Delta-9-tetrahydrocannabinol • Heavy cannabis use during
(THC) is the primary psychoac- pregnancy can be associated with
• In New Brunswick 27.1% of tive component in cannabis lower birth weight and longer-
students in grades 7–12 have used which causes users to feel “high”. term developmental effects in
cannabis in the past year. This Users report various effects from children and adolescents such as
figure is above the Canadian its consumption, from relaxation decreases in memory function,
average of 19.3%.6 and laughing, to paranoia and the ability to pay attention and
confusion depending on the reasoning and problem-solving,
• The average age at which youth in potency and person.7 as well as hyperactive behavior
New Brunswick first try using and increased risk for future
cannabis is 14 years old.6 • Higher THC content generally substance use.9
leads to more intense psychoac-
tive effects. THC content can vary
FA L L 2 0 1 8 I N F O N U R S I N G 13SMOKING • HASHISH: Also known as “hash”,
this thick, sappy resin is derived EDIBLES
• THE “JOINT” is the most recogniz- from cannabis bud and leaves and • “EDIBLES”: Cannabis can be infused
able form of cannabis consumption. smoked in many of the same ways. in cookies, brownies, candies and all
The dried bud and leaves of the Hash oil is another common liquid sorts of foods and beverages, which
cannabis plant are rolled up like a derivative. are often preferred by those wanting
cigarette and smoked. Sometimes, to avoid smoking. Overconsumption
the tobacco of a cigar is replaces
with cannabis to make a “blunt”. VAPORIZING can be a real problem with edibles,
since potency can vary across
• “VAPING” has become increasingly different products.
• PIPES AND BONGS: Various popular in recent years for both
smoking apparatus are implemented cannabis and tobacco smokers. • CANNABIS OIL: A concentrated and
to smoke cannabis bud, with some Vaporizers heat cannabis to just distilled form of cannabis which
using water filtration to lessen the below its combustion point so a usually diluted with other oils. It
impact on lungs. vapor is released and inhaled, rather became legal for medical use in
than smoke. The health implica- Canada in 2015, and appeals to many
tions of vaporizing are the topic of health-care providers because its
much debate, but research is still in dosage can be more precisely
its infancy. controlled.
14 I N F O N U R S I N G FA L L 2 0 1 8CANNABIS FAQ
are at increased risk of health risks and harms.2,3 Nurses • Health Canada. (2017). Proposed Approach to the
should screen these clients for use during the assessment Regulation of Cannabis. Retrieved from https://www.
process and facilitate conversations about their risks. canada.ca/en/health-canada/programs/consultation-
For more information on the health effects of cannabis proposed-approach-regulation-cannabis/
please see www.canada.ca/content/dam/hc-sc/documents/ proposed-approach-regulation-cannabis.html.
services/campaigns/27-16-1808-Factsheet-Health-Effects-eng-
web.pdf. • CADTH Evidence Bundle https://cadth.ca/evidence-bun-
The evidence does indicate that the associated health risks dles/medical-cannabis-evidence-bundle/browse-evidence
and harms are modifiable and education on harm reduction
measures should be provided as needed.2,3 • Health Canada information for health care professionals
and consumer information https://www.canada.ca/en/
health-canada/services/drugs-health-products/medical-
What is NANB’s guidance regarding non-medical use-marijuana/information-medical-practitioners.html
cannabis use?
NANB supports a harm reduction approach to non-medical • Canadian cannabis survey 2017- Summary https://www.
cannabis use. canada.ca/en/health-canada/services/publications/
drugs-health-products/canadian-cannabis-survey-
2017-summary.html
What is a harm reduction approach?
“Harm reduction is any policy or program designed to reduce • Government of Canada. (2017). Health effects of cannabis.
drug-related harm without requiring the cessation of the Retrieved from www.canada.ca/content/dam/hc-sc/
drug use. Interventions may be targeted at the individual, the documents/services/campaigns/27-16-1808-Factsheet-
family, community or society”.4 Harm reduction programs Health-Effects-eng-web.pdf
have been applied to address alcohol use, sexual practices,
smoking, gaming and others. Harm reduction focuses on • Canadian Center on Substance Use and Addiction. (2016).
decreasing the adverse consequences while building a Clearing the smoke on cannabis. Retrieved from http://
non-judgmental, supportive relationship.2,4 The values of www.ccdus.ca/Resource%20Library/CCSA-Cannabis-Use-
harm reduction align with the primary values in the Code of Respiratory-Effects-Report-2016-en.pdf
Ethics for Registered Nurses (2017).2
• Drug Free Kids. (2017). Cannabis talk Kit- Know how to
talk with your teen. Retrieved from https://www.drug-
What are the harm reduction guidelines for non- freekidscanada.org/wp-content/
medical cannabis use? uploads/2017/06/34-17-1850-Cannabis-Talk-Kit-EN-10.pdf
Harm reduction guidelines for non-medical cannabis use are
available. Below are links to evidence-based harm reduction
guidelines. References
1 Government of Canada. (2017). Backgrounder: Federal-provincial-
• Canada’s Lower-Risk Cannabis Use Guidelines (CAMH) territorial agreement on cannabis taxation. Retrieved from https://
• Reducing the Harms of Non-Medical Cannabis Use (CNA) www.canada.ca/en/department-finance/news/2017/12/backgrounder_
• Lower-risk- non-medical cannabis use (New Brunswick federal-provincial-territorialagreementoncannabista.html
Department of Health)
2 Canadian Nurses Association. (2017). Harm Reduction for Non-Medical
Cannabis Use. Ottawa, ON: author. Retrieved from https://www.
Want to know more? cna-aiic.ca/~/media/cna/page-content/pdf-en/
For additional information see: harm-reduction-for-non-medical-cannabis-use
• Fischer, B., Russell, C., Sabioni, P., van den Brink, W., Le 3 Fischer, B., Russell, C., Sabioni, P., van den Brink, W., Le Foll, B., Hall,
Foll, B., Hall, W., . . . Room, R. (2017). Lower-Risk Cannabis W., . . . Room, R. (2017). Lower-Risk Cannabis Use Guidelines: An
Use Guidelines: An evidence-based update. American evidence-based update. American Journal of Public Health, 107(8),
Journal of Public Health, 107(8), e1-e12. doi:10.2105/ e1-e12. doi:10.2105/AJPH.2017.303818
AJPH.2017.303818
• Canadian Nurses Association. (2017). Harm Reduction for
Non-Medical Cannabis Use. Ottawa, ON: Canadian Nurses
Association. Retrieved from https://www.cna-aiic.ca/~/
media/cna/page-content/pdf-en/harm-reduction-for-
non-medical-cannabis-use page 18
FA L L 2 0 1 8 I N F O N U R S I N G 15OPIOIDS: AN RNs JOURNEY The OpiOid CRiSis IN NEW BRUNSWICK In the last few several years, visits to addiction services for opioid misuse disorders have increased. In 2016, according to the Government of Canada, 2,816 opioid-related deaths have occurred in the country, 29 were recorded in New Brunswick. BY MARTINE LEVASSEUR
OPIOIDS: AN RNs JOURNEY
OPIOIDS ARE NARCOTICS than can be prescribed by a to administer naloxone, an opioid antagonist, in case of an
physician or manufactured clandestinely. Opioids relieve overdose to opioid addicted patients or family members who
physical pain and are very addictive. It doesn’t take long for a worry about their loved one’s opioid use. The nurse should
patient to become addicted and see their life turned upside also demonstrate empathy for the patients, which requires
down once the drug is used not only to relieve the physical having a good understanding of what addiction is. The RN
pain, but also to relieve the emotional distress of the person. must offer counselling services in close collaboration with
This person could be you, your mother, your brother, your the social workers on the team.
partner or your daughter. The problem is addicts do not I have been a nurse working in addiction services for
always ask for help, for fear they will be judged. several years now, and this work has brought me the most in
In 2005, the Government of New Brunswick announced terms of learning and self-improvement in my professional
the opening of four methadone maintenance clinics within life, as well as in my private life. To become a better nurse in
Horizon Health Network. The clinics were located where addiction treatment services, I had to become a better person
opioid misuse rates were the highest, Saint John, Miramichi, and battle my own inner demons. This experience has
Fredericton and Moncton. In 2016, the Vitalité Health allowed me to grow and be able to provide better care.
Network adopted a plan to provide services for opioid I also put aside my own values and beliefs to provide better
addictions in zones where none existed, including care,and reminded myself that our primary goal is harm
Campbellton, Bathurst, Tracadie and Edmundston. This reduction. Furthermore, I adapted my vision by giving
service is integrated with outpatient addiction services importance to small victories and small progress such as
already offered, and thus provides several treatment options, educating about and implementing other tools to manage
including detox, support, crisis intervention, referral to other stress, educating about and providing understanding of
agencies and, finally, methadone or suboxone maintenance addiction, etc.
treatment. In conclusion, I hope you can learn from my journey. You
In collaboration with the team, the nurse responsible in cannot ask an addicted person to concentrate on other
each zone coordinates the maintenance treatment services. aspects of his or her life when their main concern is obtain-
The RN conducts several health assessments and gathers a ing drugs. To simply stop using drugs is not enough to get
history of the person’s substance use and social life to decide, better; the person needs to create a new life for themselves, a
along with the team, the best treatment option to offer. This life where it is easier to abstain from drugs, a life where they
work requires flexibility on the part of the nurse, involvement have to confront their emotional wounds that hide under
in any training offered and collaboration with partners in the their drug use. That is what healing looks like.
workplace and the community. The nurse educates colleagues, For more information on the opioid crisis, visit the website
patients and staff in other departments on methadone or www.canada.ca/opioids.
suboxone maintenance treatment. The RN also teaches how
Cannabis Legalization: What
Nurses Need to Know
continued from page 15
4 Center for Addiction and Mental Health. (2002). CAMH and Harm 7 Punch, D. (2017). Just say. Registered Nurse Journal, 29(1), 12-16.
Reduction: A Background Paper on its Meaning and Application for
Substance Use Issues. Retrieved from http://www.camh.ca/en/ 8 Canadian Agency for Drugs and Technologies in Health. (April 19, 2017).
hospital/about_camh/influencing_public_policy/public_policy_ The use of medical cannabis with other medications: A review of safety
submissions/harm_reduction/Pages/harmreductionbackground.aspx and guidelines. Retrieved from https://www.cadth.ca/sites/default/
files/pdf/htis/2017/RC0878_Use%20of%20Medical%20Cannabis%20
5 Canadian Nurses Association. (2017). Canadian supports or somewhat with%20Other%20Medications_Final.pdf
support nurses providing education on antibiotic use; feel “superbugs”
are a major problem in Canada. Retrieved from https://www.cna-aiic. 9 Government of Canada. (2017). Health effects of cannabis. Retrieved
ca/~/media/cna/page-content/pdf-en/ from www.canada.ca/content/dam/hc-sc/documents/services/
cna-research-summary-antimicrobial-resistance-and-cannabis- campaigns/27-16-1808-Factsheet-Health-Effects-eng-web.pdf
education
6 Office of the Chief Medical Officer of Health. (2017). New Brunswick
disease watch bulletin. Retrieved from http://www2.gnb.ca/content/
dam/gnb/Departments/h-s/pdf/en/Publications/NB-Disease-Watch-
Bulletin_Volume27-e.pdf
18 I N F O N U R S I N G FA L L 2 0 1 8OPIOID FAQ
WHEN CAN REGISTERED
NURSES ADMINISTER
NALOXONE?
BY SYLVETTE GUITARD Naloxone is an Opioid Antagonist which will block
or reverse the effects of opioids and treat respiratory
depression associated with opioid overdose. This
medication has been available as a prescription drug
in Canada for more than 40 years and was generally
used in hospital settings.
FA L L 2 0 1 8 I N F O N U R S I N G 19OPIOID FAQ
I n response to the opioid crisis, the National Drug What if naloxone is available as an over-the-counter
Scheduling Advisory Committee in 2016 granted naloxone drug at work?
(both injectable and nasal spray) Schedule II status on the Some settings may have naloxone over-the-counter (OTC)
National Drug Schedules (New Brunswick College of stock available.2 When supported by employer policy an RN
Pharmacists (NBCP), 2017). Schedule II medications can be may administer or recommend OTC medications without an
purchased without a prescription but are kept behind the order provided they are in their original container (NANB,
counter and provided with education from the pharmacist. 2016). For example, in Detox Centers and Addiction Services
naloxone kits are distributed mainly by the RNs to clients
that are at risk.
When I am at work can I administer naloxone?
When you are at work you need to practice in accordance with
relevant legislation, standards and employer policies. Can I administer naloxone when I am off duty?
Some employment settings (i.e. hospital Emergency Since it is considered a Schedule II medication, RNs can
Departments, Community Health Centers) have policies or recommend and/or administer naloxone when off duty
directives1 in place which may allow the RN to administer without a prescription (NANB, 2016). RNs are protected from
naloxone when specific client conditions are met. However, civil liability pursuant to the New Brunswick Volunteer
many employment settings require RNs to have a prescrip- Emergency Aid Act which provides that “a person who in good
tion from an authorized prescriber before administering or faith voluntarily and without reasonable expectation of
recommending naloxone (Nurses Association of New compensation or reward provides aid, advice or emergency
Brunswick, 2016). Always familiarize yourself with your medical services to the victim of an accident or a medical
employer policy. emergency at the immediate scene of the accident or emer-
gency is not liable for damages that result from the person’s
negligence in acting or failing to act, unless it is established
I am working with a student nurse. When can he or that the damages were caused by the gross negligence of the
she administer naloxone? person (Government of New Brunswick, 2016)”.
Student nurses are required to follow policies or directives To learn more about naloxone administration, you can
during clinical practice. As with administering any medica- consult this brochure “Overdose Survival Guide-Tips to Save a
tion students should also have the proper knowledge, skill Life” from the Government of New Brunswick at http://www2.
and supervision required to administer naloxone. gnb.ca/content/dam/gnb/Departments/h-s/pdf/en/
Can I purchase a
naloxone kit?
Naloxone can be purchased by
an RN, a student nurse or any
public member, without a
prescription in local pharmacies.
Because naloxone is a Schedule
II medication, it is considered an
OTC medication which is kept in
an area of a pharmacy where
there is no public access and no
opportunity for client self-
selection (NANB, 2016). The
pharmacist will educate the
person on how to determine if
naloxone is required, how to
administer naloxone and on
how to follow-up to assure the
effective use of this drug
(NBCP, 2017).
20 I N F O N U R S I N G FA L L 2 0 1 8OPIOID FAQ
Opioid crisis and naloxone
administration in
MentalHealth/tips-to-save-a-life_brochure.pdf. New Brunswick: Highlights
You could also refer to the Canadian Pharmacists
Association’s naloxone resources section where they have • In 2017, naloxone was administered to 282
videos, info graphs, etc. that could be helpful at suspect opioid overdose patients, of which
https://www.pharmacists.ca/advocacy/opioid-crisis/. 152 responded to naloxone (53.9%).
• There were 37 apparent opioid deaths in
What are my underlying guiding principles when 2017 of which 33 were deemed accidental
providing care? or with pending intent, including 8 related
RNs, as regulated members, are responsible to provide safe, to fentanyl or fentanyl analogs (5 fentanyl,
competent and ethical care whether they are on or off duty. 2 furanyl-fentanyl and 1 carfentanyl).
They are required to follow the Practice Standard: Medication
Administration (2016) in order to apply their knowledge about • Data for 2017 are incomplete and
the client and the medication when assessing, planning, numbers are expected to increase as
implementing and evaluating the medication administration coroner investigations continue.
process, which includes the recommendation or administra-
tion of OTC medications (NANB, 2016). RNs need to be (Office of the Chief Medical Officer of
knowledgeable of and respect the Standards of Practice for Health (OCMOH), 2018).
Registered Nurses (2012) and the Code of Ethics (2017) when
providing care to clients at all times.
1
A written order from an authorized prescriber for a procedure, treatment or drug for a number of clients when specific conditions are met. See p. 8 of
the Practice Standard: Medication Administration (2016) for further information.
2
Medications that can be purchased, without a prescription, in local pharmacies and other retail stores. See page 9 of the Practice Standard: Medication
Administration (2016) for further information.
FA L L 2 0 1 8 I N F O N U R S I N G 21OPIOID FAQ
• Support Palliative and End of Life (PEOL) clients’ and their
families for the use of opioids to control pain
How to recognize an overdose
• Advocate for best practices in harm reduction strategies
and respond?
• Refer clients and families to community resources
• Government of New-Brunswick. (2018). About
Opioids. Fredericton, NB: author. Retrieved • Respond to overdoses
from http://www2.gnb.ca/content/gnb/en/
corporate/promo/opioids.html • Adopt a trauma-informed approach3
• Government of Canada. (2017). Naloxone. • Destigmatize addiction
Ottawa, ON: author. Retrieved from https://
www.canada.ca/en/health-canada/services/ • Collaborate interprofessionally, intraprofessionally and
substance-abuse/prescription-drug-abuse/ intersectorally to address the crisis
opioids/naloxone.html#a2
(Canadian Association of Schools of Nursing, 2017)
• New Brunswick Department of Health. (2018).
Guidance on Personal Protective Equipment and To learn more about the opioid crisis in Canada, click on the
Safety Considerations for First Responders, First following link from Statistics Canada (2017): http://www.
Receivers, Provincial Correctional Officers and statcan.gc.ca/pub/11-627-m/11-627-m2018001-eng.pdf.
Provincial Sheriffs Dealing with Illicit Fentanyl.
Fredericton, NB: author. Retrieved from http:// There is also a “Provincial Opioid Toolkit” available at http://
www2.gnb.ca/content/dam/gnb/ www2.gnb.ca/content/gnb/en/corporate/promo/opioids/
Departments/h-s/pdf/en/MentalHealth/ Provincial_Opioid_Toolkit.html.
guidance-illicit-fentanyl.pdf
References
Canadian Association of Schools of Nursing. (2017). Nurses’ role in
combating the opioid crisis in Canada. Ottawa, ON: author. Retrieved
from https://www.casn.ca/wp-content/uploads/2017/09/Nurses-
How can I take action to address the opioid crisis? Role-in-Combating-the-Opioid-CrisisFINAL-EN-1.pdf
• Optimize assessments skills related to substances
use and misuse Government of New Brunswick. (2016). Volunteer Emergency Aid Act.
Fredericton, NB: author. Retrieved from http://www.gnb.ca/0062/
• Educate individual clients, families, and the public acts/BBA-2016/Chap-17.pdf
regarding substance use and misuse
New Brunswick College of Pharmacists. (2017). Position Statement:
• Optimize pain management skills Naloxone. Moncton, NB: author. Retrieved from https://nbcp.in1touch.
org/document/3203/GM-PP-Naloxone-01_Naloxone%20Position%20
Statement_Feb%202017%20EN.pdf
3
A response to caring for clients that: Nurses Association of New Brunswick. (2016). Practice Standard:
Medication Administration. Fredericton, NB: author. Retrieved from
1. Realizes the widespread impact of trauma and understands potential http://www.nanb.nb.ca/media/resource/NANB-MedStandardRevised-
paths for recovery; November2016-E.pdf
2. Recognizes the signs and symptoms of trauma in clients, families, staff,
and others involved with the system; Office of the Chief Medical Officer of Health. (2018). Surveillance of
3. Responds by fully integrating knowledge about trauma into policies, apparent opioid overdoses in New Brunswick, 2017 Q4. Fredericton, NB:
procedures, and practices; and author. Retrieved from http://www2.gnb.ca/content/dam/gnb/
4. Seeks to actively resist re-traumatization.
Departments/h-s/pdf/en/MentalHealth/New-Brunswick_opioid-
surveillance-report_2017-Q4.pdf
A trauma-informed approach can be implemented in any type of service
setting or organization and is distinct from trauma-specific interventions or
treatments that are designed specifically to address the consequences of Substance Abuse and Mental Health Services Administration. (2018).
trauma and to facilitate healing (Substance Abuse and Mental Health Trauma-Informed Approach and Trauma-Specific Interventions.Retrieved
Services Administration, 2018). from https://www.samhsa.gov/nctic/trauma-interventions
22 I N F O N U R S I N G FA L L 2 0 1 8AN INTERVIEW WITH DR. JENNIFER RUSSELL
OPIOID CRISIS IN NEW BRUNSWICK
What is GNB’s Plan?
N urses are quite concerned with the
impending opioid crisis and the
effects on patients here in New
various risk factors may include: having
an accident or injury; a family history of
mental illness or substance use
Brunswick. As professionals providing disorder; a personal history of mental
healthcare in communities and many illness or substance use disorder;
other settings, we want to support the trauma; having a circle of friends/
government by playing a key role in family that use substances/opioids.
promoting public safety. NANB would
like to thank Dr. Jennifer Russell, Chief
Medical Officer of Health for participat- How can nurses play an active role
ing in the following interview in supporting the government’s
highlighting the provincial govern- response plan?
ment’s plan to address this health crisis. Nurses in all levels of health care play a
pivotal role in the prevention of opioid
use and treatment of opioid disorders.
What is NB’s opioid crisis reality Nurses here at the Office of the Chief
and how is the provincial Medical Officer of Health, Regional
government responding? Health Authorities (RHAs) and Public
With increasing numbers of fatal and Health are playing key roles on this file,
non-fatal opioid poisonings in Canada, by leading or being members of task
some jurisdictions have declared a Considerations was developed. These groups, collaborating with partners and
public health emergency. The documents can be found on the stakeholders, and ensuring public
Department of Health has responded to following website: About Opioids- education and messaging is updated
ensure measures are in place for the http://www2.gnb.ca/content/gnb/en/ and accurate.
prevention and response to opioid corporate/promo/opioids.html. The All nurses can help by: educating
poisoning in New Brunswick. government also facilitated an Opioid patients about issues like tolerance,
To gain a better understanding of the Symposium held in December 2017 that physical dependence and opioid misuse;
situation in New Brunswick, a surveil- brought together key stakeholders and leading cultural change in pain manage-
lance and reporting process which partners along with experts in the field. ment; advocating for their clients who
captures opioid-related overdoses in The Department of Health has hired may be at risk or are experiencing opioid
emergency departments across the an individual who will perform a gap misuse; having knowledge of commu-
province in a timely fashion was analysis and lead the development of a nity resources available for harm
established. Please refer to the following comprehensive action plan to address reduction (where/how to access take
link for more information: Public issues along the continuum of care in home naloxone kits and needle exchange
Health Surveillance—http://www2.gnb. addiction services including prevention services); and being aware of risk factors
ca/content/gnb/en/corporate/promo/ and early intervention, treatment, and for opioid use.
opioids/public_health_surveillance. management of new and emerging
html. trends.
As part of the response to the opioid The Government committed 2,500
crisis the Department of Health free naloxone kits. Where will they
collaborated with partners and stake- Who is at risk of developing an be distributed in the province and
holders to develop the GNB website opioid dependency? will nurses have access?
which houses information/education The risk factors are the same for most In March 2018, an initial 1,250 naloxone
for the public on opioids. As well a substance use disorders; meaning they kits were purchased and distributed to
guidance document on Personal can be associated with genetic or 11 sites in the province. Distribution
Protective Equipment and Safety environmental vulnerability. The sites are:
FA L L 2 0 1 8 I N F O N U R S I N G 23You can also read
