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'Substance misuse nurses are becoming jaded'


Ishbel Straker has seen substance misuse nursing change during her career and believes services are undervaluing nurses and stunting their professional growth

Over the years, and throughout a variety of services and career progression, I have witnessed the dismantling of nursing skills within substance misuse nursing.

I have seen nurses become jaded and lose touch of the wealth of knowledge they brought to the table.

I have seen taking a patient’s BP become a highlight of a nurse’s day and watched as nurses faded into the background until that small vocational flame was slowly extinguished and almost all confidence in the skill that was part of their makeup was gone.

I watched as the differential work was non-existent between qualified and unqualified staff.

Yet the professional intricacies were there if you looked hard enough, care plans and assessments were comprehensive and clinically lead, caseloads were routinely discussed and patients moved forward in safe, evidence based ways, referrals to specialist agencies were standard practice and joint working was par for the course.

Sadly, the further down the line we have come, the less appealing the field of substance misuse is to nurses, and who can blame them?

“We look at our patients through the eyes we are trained with”

Now I’m not stating that comprehensive care such as described above is not possible with a non-qualified member of staff, but what I am saying is that as nurses this is in our very bone marrow. It is branded within our very essence, we look at our patients through the eyes we are trained with.

That is why it is so frustrating to have that subdued within us.

It has been no surprise that nurses have become harder to recruit and retain, not only because of being deskilled but additionally having no room for growth.

Substance misuse nurses are ahead of the game when it comes to our Independent Nurse Prescribers, something which I am passionate about but what about the nurses who don’t want to prescribe? Who want to further their specialist interests and become an expert in that field in their locality, what about the nurses who want to simply nurse, or want to utilise their person centred training and be true to their roots?

Where do they fit in a world where driving yourself forward educationally/professionally is how we are recognised and valued and not by the resilience to commit to a vocation?

“We need to bring nursing back to basics and use the skills we have been trained in”

I believe the time has come for those nurses to make a stand and be recognised.

We need to bring nursing back to basics and use the skills we have been trained in.

We need to stop seeing the substance misuse client/patient/service user as an NDTMS statistic and value them holistically, not to say that we have not been already doing this but it’s high time that the services we work for support this.

We need to be recognised and developed in our clinical work, which needs to be evidenced and monitored with priority. We need to have a development structure that recognises the work that is being done and focus on the health outcomes that we are skilled in achieving.

“We deal with one of the most complex patient groups and I am passionate about being recognised in our own right as the driving force to change”

I feel nurse managers should be a high standard in every service and should be supported in driving this forward with the help of a national governing body, such as the RCN.

We deal with one of the most complex patient groups and I am passionate about being recognised in our own right as the driving force to change in such a chaotic field of work.

As Florence Nightingale once said, “Let whoever is in charge keep this simple question in their head, not how can I do this right thing myself but how can I always provide for this right thing to be done?”

Ishbel Straker is a consultant nurse


Readers' comments (2)

  • I gree with this totally, I work for a drugs team and yes everyone has been doing the same job until recently when us nurses informed our manager that we are nurses and would like to work as nurses

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  • David Solomon

    Having worked in substance misuse for a number of years including roles of a s. nurse, manager and NMP. There has been a growing fear for nurses in this field that we are slowly "fading" as a specilist group. Up and down the country, tenders, takeovers and reconfigurations have had there impact (although have always been in the process). I agree with Ishbel "NDTMS statistics" has become the priority in nursing management. We need to appreciate that drug workers, nurses and other ahp working in substance misuse make their mark on the health and well-being of our clients. Commisioners need to look at "quality" in service provision rather than "quantity" when it comes to peoples health. But the reality is that substance misuse services are becoming less valued in terms of "clinical experience" "qualifications" (that are relevant) and "skills". The focus has been placed on statistics for "payment by results". Nurses and managers need to remember that we are working with people and too often the result of a teams confused priority (stats) leads to a coroners court of our clients. More emphasis needs to be placed on better access for CPD, further trainings and developments of substance misuse forums across the country.

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