RN and RPN Perceptions and Experiences of Prescribing Opioid Agonist Therapy to People with an Opioid Use Disorder in British Columbia

Abstract

Study background

British Columbia (B.C.) has suffered a significant loss of life every day due to the unregulated drug poisoning crisis that has affected this province since 2016 (B.C. Coroners Service, 2023). In September 2020 the B.C. Provincial Medical Health Officer, issued a provincial health order to allow registered nurses (RNs) and registered psychiatric nurses (RPNs) to diagnose and prescribe pharmacological treatment for opioid use disorder (OUD) (Ministry of Health, 2020).

Purpose

To understand how RNs and RPNs in B.C. experience their expanded role as nurse prescribers of opioid agonist therapy (OAT).

Methods

Utilizing Sally Thorne's (2016) Interpretive Description method, a purposeful sample of RNs and RPNs across the province who actively prescribe OAT to people with an OUD were interviewed about their experience and perceptions.

Results

Key findings of this study include insights into the positive and challenging experiences of prescribing OAT in B.C.; operational implementation considerations for RNs and RPNs prescribing OAT; and the strengths and flexibility that RNs and RPNs can bring to OAT care.

Conclusions

Findings within this research are relevant to other Canadian provinces considering implementing RN/RPN OAT prescribing as a strategy to increase access to pharmacological treatment for people with OUD.

Keywords

RPN OAT prescribing RN OAT prescribing nurse prescribing opioid agonist therapy opioid use disorder toxic drug supply crisis overdose crisis

Get full access to this article

View all access options for this article.

References

Abram

M. D.

(2018). The role of the registered nurse working in substance use disorder treatment: A hermeneutic study. Issues in Mental Health Nursing, 39(6), 490–498. https://doi.org/10.1080/01612840.2017.1413462

Andrilla

H. A.

Jones

K. C.

Patterson

D. G.

(2020a). Prescribing practices of nurse practitioners and physician assistants waivered to prescribe buprenorphine and the barriers they experience prescribing buprenorphine. The Journal of Rural Health, 36(2020), 187–195. https://doi.org/10.1111/jrh.12404

Andrilla

H. A.

Patterson

D. G.

Moore

T. E.

Coulthard

Larson

E. H.

(2020b). Projected contributions of nurse practitioners and physician’s assistant to buprenorphine treatment services for opioid use disorder in rural areas. Medical Care Research and Review, 77(2), 208–216. https://doi.org/10.1177/1077558718793070

Banka-Cullen

S. P.

Comiskey

Kelly

M. B.

Gutierrez

Menon

(2023). Nurse prescribing practices across the globe for medication-assisted treatment of the opioid use disorder (MOUD): A scoping review. Harm Reduction Journal, 20, 78. https://doi.org/10.1186/s12954-023-00812-y

Bardwell

Lappalainen

(2021). The need to prioritize research, policy, and practice to address the overdose epidemic in smaller settings in Canada. Canadian Journal of Public Health, 112, 733–736. https://doi.org/10.17269/s41997-021-00504-9

Bates

A. E.

Martin-Misener

(2022). Facilitators and barriers to nurse practitioners prescribing methadone for opioid use disorder in Nova Scotia: A qualitative study. Canadian Journal of Nursing Research, 54(1), 15–26. https://doi.org/10.1177/0844562121996222

B.C. Center for Disease Control . (2023). Mental health and substance use: Examining the societal consequences of the COVID-19 pandemic. http://www.bccdc.ca/health-professionals/data-reports/societal-consequences-covid-19/mental-health-and-substance-use

B.C. Center on Substance Use . (2021a). Decision support tool: Nurse prescribing. BC Centre on Substance Use. https://www.bccsu.ca/wp-content/uploads/2021/02/DST-Nurse-Prescribing.pdf

B.C. Center on Substance Use . (2021b). Decision support tool: For RN and RPN Prescribing of Methadone or Slow Release Oral Morphine for Continuations, Titrations, or Restarts. https://www.bccsu.ca/wp-content/uploads/2021/11/DST-Nurse-Prescribing-Methadone-SROM-final.pdf

10.

B.C. Center on Substance Use . (2022, January). Risk mitigation in the context of dual public health emergencies. https://www.bccsu.ca/covid-19/

11.

B.C. Center on Substance Use & B.C. Ministry of Health . (2017, June 5). A guideline for the clinical management of opioid use disorder. https://www.bccsu.ca/wp-content/uploads/2017/06/BC-OUD-Guidelines_June2017.pdf

12.

B.C. College of Nurses & Midwives . (2020, September). Registered psychiatric nurses scope of practice. Revised RN and RPN scope of practice standards approved by BCCNM board. https://www.bccnm.ca/BCCNM/Announcements/Pages/Announcement.aspx?AnnouncementID=205

13.

B.C. College of Nurses & Midwives . (2021). Scope of practice for nurse practitioners. https://www.bccnm.ca/NP/ScopePractice/Pages/Default.aspx

14.

B.C. College of Nurses & Midwives . (2023). BCCNM board approved new RN and RPN certified practice for opioid use disorder. https://www.bccnm.ca/bccnm/Announcements/Pages/Announcement.aspx?AnnouncementID=466

15.

B.C. Coroners Service . (2022). Death review panel: A review of illicit drug toxicity deaths. https://www2.gov.bc.ca/assets/gov/birth-adoption-death-marriage-and-divorce/deaths/coroners-service/death-review-panel/review_of_illicit_drug_toxicity_deaths_2022.pdf

16.

B.C. Coroners Service . (2023). Unregulated Drug Deaths in BC: January 1, 2013- Aug 31, 2023. https://www2.gov.bc.ca/gov/content/life-events/death/coroners-service/statistical-reports

17.

Benner

(2004). Using the dreyfus model of skill acquisition to describe and interpret skill acquisition and clinical judgment in nursing practice and education. Bulletin of Science, Technology & Society, 24(3), 188–199. https://doi.org/10.1177/0270467604265061

18.

Birks

Davis

Smithson

Lindsay

(2019). Enablers and barriers to registered nurses expanding their scope of practice in Australia: A cross-sectional study. Policy, Politics & Nursing Practice, 20(3), 145–152. https://doi.org/10.1177/1527154419864176

19.

Bryant-Lukosius

DiCenso

Browne

Pinelli

(2004). Advanced practice nursing roles: Development, implementation and evaluation. Journal of Advanced Nursing, 48(5), 519–529. https://doi.org/10.1111/j.1365-2648.2004.03234.x

20.

Clancy

Kelly

Christien

(2019). State of the art in European addictions nursing: Perspectives from the United Kingdom, Ireland, and The Netherlands. Journal of Addictions Nursing, 30(3), 139–148, 7/9. https://doi.org/10.1097/JAN.0000000000000293

21.

Comiskey

Galligan

Flanagan

Deegan

Farnann

Hall

(2019). Clients’ views on the importance of a nurse-led approach and nurse prescribing in the development of the healthy addiction treatment recovery model. Journal of Addictions Nursing, 30(3), 169–176, 7/9. https://doi.org/10.1097/JAN.0000000000000290

22.

Dreyfus

S. E.

Dreyfus

H. L.

(1980). A five-stage model of the mental activities involved in directed skill acquisition. Unpublished report, University of California.

23.

Finnell

D. S.

Tierney

Mitchell

A. M.

(2019). Nursing: Addressing substance use in the 21st century. Substance Abuse, 40(4), 412–420. https://doi.org/10.1080/08897077.2019.1674240

24.

Forbes

V. J.

Jessup

A. L.

(2004). From expert to novice: The unnerving transition from experienced RN to neophyte APN. Journal of Holistic Nursing, 22(2), 180–185. https://doi.org/10.1177/0898010104266067

25.

Ford

(2011). Interpersonal challenges as a constraint on care: The experience of nurses’ care of patients who use illicit drugs. Contemporary Nurse: A Journal for the Australian Nursing Profession, 37(2), 241–252. https://doi.org/10.5172/conu.2011.37.2.241

26.

Gagnon

Rudzinski

Guta

Schidt

R. A.

Kryszajtys

D. T.

Kolla

Strike

(2023). Impact of safer supply programs on injection practices: Client and provider experiences in Ontario, Canada. Harm Reduction Journal, 20, 81. https://doi.org/10.1186/s12954-023-00817-7

27.

Government of Canada . (2021a, June). Federal actions on opioids to date. https://www.canada.ca/en/health-canada/services/opioids/federal-actions/overview.html#a1

28.

Government of Canada . (2021b, Dec 14). Opioids Data, Surveillance and Research. https://www.canada.ca/en/health-canada/services/substance-use/problematic-prescription-drug-use/opioids/responding-canada-opioid-crisis.html

29.

Hilton

B. A.

Thompson

Moore-Dempsey

Hutchinson

(2001). Urban outpost nursing: The nature of the nurses’ work in the AIDS prevention street nurse program. Public Health Nursing (Boston, Mass.), 18(4), 273–280. https://doi.org/10.1046/j.1525-1446.2001.00273.x

30.

Hunt

M. R.

(2009). Strengths and challenges in the use of interpretive description: Reflections arising from a study of the moral experience of health professionals in humanitarian work. Qualitative Health Research, 19(9), 1284–1292. https://doi.org/10.1177/1049732309344612

31.

Interior Health . (2021). The toxic drug crisis in BC’s interior region 2022: Medical health officers report part 1. https://www.interiorhealth.ca/sites/default/files/PDFS/the-toxic-drug-crisis-in-bc-interior-region-part-1.pdf

32.

Interior Health . (2022). The toxic drug crisis in BC’s southern Interior region 2022: Medical health officer report part 2. https://www.interiorhealth.ca/sites/default/files/PDFS/toxic-drug-crisis-bc-southern-interior-region-part-2.pdf

33.

Joel

L. A.

(2018). Role development: A theoretical perspective. In Joel

L. A.

(Ed.), Advanced practice nursing: Essentials for role development (4th ed., pp. 33–42). F. A. Davis Company.

34.

Jokiniemi

Haatainen

Pietilä

A.-M.

(2015). From challenges to advanced practice registered nursing role development: Qualitative interview study. International Journal of Nursing Practice, 21(6), 896–903. https://doi.org/10.1111/ijn.12334

35.

Jozaghi

Dadakhah-Chimeh

(2018). A call for action to combat the growing synthetic opioid epidemic: The need for the creation and expansion of addiction and psychiatric nursing programs. The Journal of School Nursing, 34(1), 11–13. https://doi.org/10.1177/1059840517746729

36.

Kameg

B. N.

Mitchell

(2020). Technology-based educational approaches to address opioid use management by advanced practice registered nurses. Issues Mental Health Nurse, 41(10), 940–945. https://doi.org/10.1080/01612840.2020.1749917

37.

Klein

Geddes

Hartung

(2020). The geographic impact of buprenorphine expansion to nurse practitioner prescribers in Oregon. The Journal of Rural Health, (2020), 1–8. https://doi.org/10.1111/jrg.12538

38.

Kuehn

A. F.

(2018). The kaleidoscope of collaborative practice. In Joel

L. A.

(Ed.), Advanced practice nursing: Essentials for role development (4th ed., pp. 116–142). F. A. Davis Company.

39.

Lennon

Fallon

(2018). The experiences of being a registered nurse prescriber within an acute service setting. Journal of Clinical Nursing, 27(3-4), e523–e534. https://doi.org/10.1111/jocn.14087

40.

Miles

Huberman

Saldaña

(2020). Qualitative data analysis: A methods sourcebook (4th ed.). Sage Publications.

41.

Ministry of Health . (2020). Order of the Provincial Health Officer. Registered nurse and registered psychiatric nurse public health pharmacotherapy. Government of BC. https://www2.gov.bc.ca/assets/gov/health/about-bc-s-health-care-system/office-of-the-provincial-health-officer/covid-19/covid-pho-order-rn-pharmacotherapy.pdf

42.

Nguyen

Muench

Andraka-Christou

Simon

Bradford

W. D.

Spetz

(2022). The association between scope of practice regulations and nurse practitioner prescribing of buprenorphine after the 2016 opioid bill. Medical Care Research and Review, 79(2), 290–298. https://doi.org/10.1177/10775587211004311

43.

Pauly

(2014). Close to the street: Nursing practice with people marginalized by homelessness and substance use. In Guirguis-Younger

McNeil

Hwang

S. W.

(Eds.), Homelessness & health in Canada (pp. 211–232). University of Ottawa Press.

44.

Pearce

L. A.

Min

J. E.

Piske

Zhou

Homayra

Slaunwhite

Irvine

M. A.

McGowan

Nosyk

(2020). Opioid agonist treatment and risk of mortality during an opioid overdose public health emergency: A population-based retrospective cohort study. International Journal of Population Data Science, 5(5). https://doi.org/10.23889/ijpds.v5i5.1530

45.

Polit

D. F.

Beck

(2017). Qualitative research design and approaches. In D. F. Polit, & C. Beck (Eds), Nursing research: Generating and assessing evidence for nursing practice (10th ed., pp. 463–490). Wolters Kluwer | Lippincott Williams & Wilkins.

46.

Priest

K. C.

Gorfinkel

Klimas

Jones

A. A.

Fairbairn

McCarty

(2019). Comparing Canadian and United States opioid agonist therapy policies. International Journal of Drug Policy, 74, 257–265. https://doi.org/10.1016/j.drugpo.2019.01.020

47.

Spetz

Chapman

Tierney

Phoenix

Hailer

(2021). Barriers and facilitators of advanced practice registered nurse participation in medication treatment for opioid use disorder: A mixed methods study. Journal of Nursing Regulation, 12(2), 5–22. https://doi.org/10.1016/S2155-8256(21)00052-1

48.

Streubert

H. J.

Carpenter

D. R.

(2011). The conduct of qualitative research: Common essential elements. In D. Breckenridge, L. Nagelsmith, T. Risling, & J. Rya (Eds), Qualitative research in nursing: Advancing the humanistic imperative (pp. 18–32). Lippincott, Williams & Wilkins.

49.

Strobbe

Hobbins

(2012). The prescribing of buprenorphine by advanced practice addictions nurses. Journal of Addictions Nursing, 23, 82–83. https://doi.org/10.3109/10884602.2011.649026

50.

Thorne

(2016a). Qualitative research in the applied disciplines. In Morse

& University of Utah (Eds), Interpretive description (pp. 24–36). Left Coast Press.

51.

Thorne

(2016b). Scaffolding a study. In J. Morse & University of Utah (Eds), Interpretive description (pp. 53–72). Left Coast Press.

52.

Thorne

(2016c). Strategizing a credible study. In J. Morse & University of Utah (Eds), Interpretive description (pp. 87–104). Left Coast Press.

53.

Thorne

(2016d). Constructing data. In J. Morse & University of Utah (Eds), Interpretive description (pp. 126–139). Left Coast Press.

54.

Thorne

(2016e). Conceptualizing findings. In J. Morse & University of Utah (Eds), Interpretive description (pp. 163–176). Left Coast Press.

55.

Tierney

Finnell

D. S.

Naegle

M. A.

LaBelle

Gordon

A. J.

(2015). Advanced practice nurses: Increasing access to opioid treatment by expanding the pool of qualified buprenorphine prescribers. Substance Abuse, 36, 389–392. https://doi.org/10.1080/08897077.2015.1101733