Roles and Perceptions of Nurses During Implementation of a Medication Treatment for Opioid Use Disorder National Initiative

Abstract

Background: In the United States, a national priority exists to improve access to medication treatment for opioid use disorder (MOUD). Nurses can be an essential component of that care. We examined the perceptions and evolving roles of nurses in a national Veterans Health Administration (VHA) initiative designed to improve MOUD access within general medical settings. Methods: From April 15, 2021, to June 16, 2021, we recruited nurses participating in VHA's Stepped Care for Opioid Use Disorder Train the Trainer Initiative-a national program intending to implement MOUD in general medical settings-to participate in an interview about their roles, perceptions, and experiences. The respondents answered our inquiries through an interview or responded to an email solicitation with written responses, which were then recorded, transcribed, and independently coded to identify themes. Results: Nurses from 10 VHA facilities participated in an interview (n = 7) or completed the questionnaire (n = 4). Inadequate staffing, high patient-to-provider ratios, and time constraints were identified as barriers to MOUD care. Mentorship activities, existing VHA informational resources, and patients' willingness to accept treatment were identified as facilitators of MOUD care. The Stepped Care for Opioid Use Disorder Train the Trainer Initiative processes were acknowledged to promote role confidence, which in turn increased job satisfaction and empowered nurses to become content experts. Respondents often identified nurses as local lead facilitators in MOUD care. Conclusions: In a national initiative to implement MOUD within general medical settings, nurses identified several barriers and facilitators to MOUD implementation. Nurses play vital collaborative care roles in enhancing access to MOUD.

Closing the Opioid Treatment Gap Through Advance Practice Nursing Activation

“…Historically, low physician uptake and use of the DEA waiver is informed by deficits in physician knowledge and by low physician interest and satisfaction in treating patients with OUD (Andraka-Christou & Capone, 2018; DeFlavio et al, 2015; Huhn & Dunn, 2017; Kirane et al, 2019; Louie et al, 2019; Shuey et al, 2021). Less is known about APRN provider barriers and facilitators to MOUD treatment, although evidence is growing (Andraka-Christou et al, 2022; Radmall et al, 2022). APRNs have only been prescribing buprenorphine for OUD since 2017, whereas physicians have been doing so since 2003.…”