How I Plan to Get Out of a Rut in 2020

2019 has been a bit of a rut for me. Here’s what I plan to do to shake things up in 2020!

My accomplishments through the 2010’s:

December 2012 Completed BSN

February 2013 Passed NCLEX

March 2013 Started 1st nursing job

August 2014 Started BSN-DNP

December 2016 Completed MSN & Passed ANCC Boards

January 2017 Started 1st NP Job

July 2017 Completed DNP

March 2018 Opened Telepsychiatry Business

2019 *Crickets*

It’s a strange feeling. My entire life I focused on achieving the next academic success or the next best career move. Now my academic career is complete, my practice is as big as I want it… and what now? How do you mentally shift from measuring your success through academics and career achievements when that has been your measure of success for so long? In 2019 I have struggled to find my next move. Earlier this year I thought I would try medical writing and quickly realized I don’t have the knowledge or experience I would need for that. Then I thought I would try to break into the field of research. Again I realized that I don’t really have the knowledge or experience. What I am trained to do and what I do best is take care of patients. So, how do I grow from here? As I watch everyone else discuss their accomplishments from 2019 I realize that I have had no major accomplishments this year *Yikes*. I think 2019 has been a bit of a rut for me professionally. And being in that rut leaves me feeling burnt out. So, today, on this very last day of the decade I am going to make an action plan to get out of a rut in 2020.

My professional goals for 2020

Educate others and share my experiences. As I started blogging over the last week I began to feel a passion and excitement professionally that I haven’t felt in a long time. I realized I love teaching. I love sharing my experiences. I’m excited to carry this excitement into 2020.

Reevaluate my patient encounters. I currently do 15 minute medication checks. I’m going to research how to make these encounters more meaningful. On the practical side of that, I will see if I could maintain my current compensation by billing for longer appointments. I’m going to see how I can strike a balance between quality and quantity.

Study a new subspecialty. I am very interested in adding another subspecialty. There is a huge gap in the healthcare system between women’s health and mental health. I’m very curious to investigate and find new ways to help and educate my female patients. I’m also interested in weight loss within the mental health community. I don’t know if I can commit to becoming certified, but at the very least I would like to increase my knowledge about how to help my patients live healthier lifestyles.

My Personal Goals 2020

I have to say exercise, right? Isn’t that mandatory on this list? Seriously though, I attempted a good exercise routine multiple times in 2019 and it would stick for a few weeks and then fade away. I tried Orange Theory (which I absolutely loved by the way), but then I got tired of waking up at 5am (I am NOT a morning person at all). I got into a cycling routine for a bit and thoroughly enjoyed that, but it just kind of faded away too. So 2020 is the year to establish a routine. I don’t need it to be insane. I will take any routine I can get… more to come another time on what that routine will look like.

I will start a hobby. I have never had a hobby. EVER. I have been invested in academics for so long that all my mental energy went to writing papers, studying… all the school things. Now I am so used to spending all my time doing something I had to do, that I don’t know how to enjoy doing something just for the sake of doing it. I don’t know the hobby yet, but 2020 will be the year of hobby!

I have never put my goals in writing. So, here it is, published on the internet for everyone to see. At the end of 2020 I will come back and evaluate how I did! 2020 won’t be another rut year and I don’t need academic structure or a new career to make that happen! This is going to be a totally new experience for me and I will provide updates periodically on how it’s going.

Have you been in a rut recently? What are you going to do to make 2020 a better year? I’m open to any suggestions you might have to add to my list! I can’t wait to hear from you! Please leave your thoughts in the comments below and go to the home page to subscribe and get the latest content!

5 Steps to Help Patients Achieve Sobriety

I have 5 steps I follow every time to help my patients struggling with substance abuse. Find out what they are!

Welcome back everyone and thanks for joining! I’m so excited to see so many new subscribers! Thank you so much for the support and I hope you enjoy the content!

Today let’s talk about how to treat substance abuse! I’m calling it “The Pathway to Recovery.” I find many psychiatric nurse practitioners shy away from treating addiction. I was weary of it in the beginning as well, but you know what? It’s a niche I just kind of fell into and I really enjoy it. It’s a wonderful subspecialty in psychiatry and understanding how to treat addiction can open up a whole new patient population to you! I’m going to give you 5 steps to treat substance abuse patients! If you follow these 5 steps you can’t go wrong! I use this approach with my patients and, guess what? It works! I’m attaching the patient handout portion and an explanation of how to use the handout. Below I will explain my methods in more detail!

Step 1: Assess Motivation

Assess whether the patient is motivated to get sober. Yes, patients will walk into your office and NOT be ready to commit to treatment! Their partner, friend, or relative convinced them to come and they are trying to appease them. When working with the unmotivated patient, you will feel their resistance throughout the assessment. They will often deny that their substance use is really a problem. They will also REALLLLLLY resist medication. When this starts to happen LISTEN TO YOUR GUT! Ask the patient right away, “Do you want to get sober?” Because this process is going to be hard. It’s going to take commitment. They must be ready and motivated! Some of your patients will be ambivalent (remember the Transtheoretical or Stages of Change model in nursing school… yup, here it is!). These patients may partially engage and be willing to do some of the treatment plan, but not all. Maybe they will take a medication but not go to therapy. Meet the patient where they are. When I have an ambivalent patient who is only partially engaged I like to say, “Okay, let’s try it your way first for a month. When you come back next month if you aren’t sober we will try it my way.” They usually agree! You must get the patient to buy in and build rapport and this is part of that. If your patient is ready and committed, you are ready to jump onto the pathway to recovery!

Step 2: Assess Whether the Patient Needs to Detox Inpatient

Always ask yourself, is it safe for this patient to detox and achieve initial sobriety in an outpatient setting? MOST of the time, the answer is yes. In three years, I can only think of a handful of patients I recommended inpatient detox for. What may be an indicator that a patient needs inpatient detox first? Lack of support at home, moderate-severe withdrawal symptoms, medically unstable (particularly if their blood pressure is elevated or they are high risk for seizure), or psychiatric instability (psychosis, mania, suicidal thoughts). All the patients I sent inpatient for detox were medically unstable and/or having moderate-severe withdrawal symptoms. Blood pressures were sky high, they appeared extremely unwell, and had severe tremors. If your patient appears unwell and you are concerned for their physical health DO NOT IGNORE YOUR GUT! Patients detoxing from alcohol or benzodiazepines are your most medically high-risk patients. Opioid detox is uncomfortable, but not deadly. Alcohol and benzodiazepine detox can be deadly. If I am concerned and really feel strongly the patient needs inpatient detox first, I am very straightforward about how serious the detox process is. I say, “Detoxing from alcohol (or benzos) is extremely serious. You can have seizures, hallucinate, and be very ill. If you go inpatient you will be prescribed medications that will make your detox a lot safer and more comfortable.” If your patient is hitting close to 48 hours without alcohol they know what you’re saying is true and often they will take your advice. Once they detox, they can return to you and resume outpatient care.

I have found inpatient detox to be the fastest, safest, most reliable way to get patients to detox. They have no access to alcohol or other substances, they are medically monitored, and they are getting introduced to group therapy and support groups. Going inpatient is a significant event for most patients and leaves a major impact on them which also provides good motivation not to relapse in the future.

Step 3: Prescribe Relapse Prevention Medication

Your primary role in this treatment plan is 1) Get your patient to the right treatment setting and 2) Make sure your patient is on the right medication. If they go inpatient to detox they may come back to your office on the right medications, but you need to be sure! Substance abuse patients are more likely to stay sober with medication to prevent relapse. I like to explain to my patients “Medication is a very small, but important part of the treatment plan. The right medication can give you the foundation to move forward.” Take a look at the corresponding handout to see more about when to use each medication. In the handout I don’t go in depth on how to treat benzodiazepine abuse. That is a whole other topic that I have a really great handout for. You will most commonly treat alcohol, opioid, and cocaine dependence. Marijuana dependence is extremely common, but there are no medications studied or approved for marijuana dependence at this time. Some BIG KEY POINTS to keep in mind are DO NOT START NALTREXONE UNLESS THE PATIENT HAS BEEN OFF OPIATES FOR 7-10 DAYS and DO NOT START ANTABUSE UNTIL 24 HOURS AFTER THEIR LAST DRINK. Be sure to give your patient a list of products and foods to avoid while taking Antabuse. On that note, though, let me add that I have NEVER had a patient say, “Oh man I accidentally used too much aftershave and had the worst reaction” or “I ate chicken marsala and got so sick.” It doesn’t usually go that way. So, reassure your patients that as long as they avoid alcohol and do their best to avoid the things on the list they will be just fine. Antabuse takes 1-2 weeks to completely leave the body. So, having your patient on Antabuse provides an excellent long-lasting safety net.

Be sure to assess for comorbid psychiatric conditions. In my experience, 20% or less of patients presenting with a substance abuse disorder ONLY have a substance abuse disorder. The other 80% of patients have a comorbid psychiatric disorder. Make sure you prescribe the appropriate medications for these co occurring psychiatric disorders as well.

Step 4: Refer the Patient to a Substance Abuse Counselor

This part is so important. First, this adds an additional layer of accountability. Your patients need as many points of accountability as possible. Second, your patient doesn’t know it yet, but they are going to experience multiple phases during their recovery. The first phase (we call it the “pink cloud phase”) everything feels so wonderful and the patient is over the moon they are sober. That phase eventually evolves into a more ordinary phase where reality settles in and the excitement of sobriety has worn off. Patients need a lot of help working through this phase and onto the next ones. Patients who don’t have a therapist and aren’t anticipating this get caught off guard and are very high risk for relapse during this time. A good therapist will help the patient anticipate this new phase and can give your patient the tools to navigate through it.

Step 5: Pick a Support Group and Start Attending ASAP

Here is another layer of accountability. I am a big advocate of “90 in 90” which means a patient will attend 90 meetings in 90 days. These meetings keep their sobriety at the forefront. There are different types of meetings for everyone. The corresponding handout lists the most common support groups, their websites, and the theoretical basis for each group. If your patient attends meetings they are significantly more likely to stay sober. Also encourage your patient to get a sponsor! If your patient can only see a therapist OR go to meetings, I would encourage them to go a support group every time! This part of the puzzle is absolutely critical. Best of all, the meetings are free.

Now you are ready to treat substance abuse patients like a pro! Don’t shy away from it! Follow these steps and you will be able to have the joy of helping so many people achieve sobriety and change their lives! Now I need your feedback. The attached handout is a sampling of the type of handouts I plan to make in the future. My goal is to make a blog post that explains a concept in detail and make a handout you can use in an appointment with the patient (that will hopefully save you time explaining things) and a quick reference sheet you can put in a binder. Does this handout have too much information? Too little? Is this post too in depth? I want to provide you with the most practical information and tips to give you confidence in your practice. Let me know how I could make this information better for you! I’m looking forward to your feedback! I probably won’t leave this handout up permanently if I decide to include it as part of the Psych NP Resource File. So download it now!!