What does a chemical dependency RN do?

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Hello,

I am moving this question from "careers" to "specialty nursing".

I am finishing up nursing school here and am still trying to decide which area of nursing I would like to pursue. I am interested in learning more about nursing careers other than bedside nursing. Can anyone tell me what an RN primarily does at an alcohol/drug rehab facility? I imagine RN's would do the initial assessment upon the patients arrival as well as administer daily medications. In addition, I figure they would tend to injuries and illness. What else would they do? Is it super stressfull or more relaxed than say med-surge nursing? Does this type of nursing career pay the bills? Is it competitive with hospital pay? Are there advantages to this type of nursing over bedside nursing? There are several really nice, well known, large facilities in Southern California. For example, there is a nice one in Malibu as well as the Betty Ford Center in Palm Springs. Any help would be greatly appreciated!

Thank you in advance :rolleyes:

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Specializes in Sub-Acute/Psychiatric/Detox.

Depending on the facility. The RN usually does a lot of care plans, and what you described. The LPN mostly does meds and on the floor interaction as needed with the patients.

If it isn't an RN/LPN team (LPNS thrive in this setting since your with the patients more) then the RN also does meds.

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At the psych hospital I worked at, RNs did interdisciplinary rounds, passed meds (which really is not much of a deal, occasionally we facilitated group therapy sessions. We also interacted with the patients. This was in a private psych facility.

The only thing that I found stressful was when I was pulled to the adolescent unit :p.

Oh, and searching an involuntary admission who brought everything under the sun to the hospital.

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I may be able to shed a little light on subject. I worked in an in patient detox unit near a large city on the evening shift. We had a 30 bed capacity usually only 3/4 full. I was required to either do admissions (and that's all I would do and quite busy) or on floor detox assessments and then give medication based on the assessments. Each client would be catagorized by type of substance being detoxed: either alcohol or benzodiazepine (heroin, ativan, clonopin, etc). They would then receive a score base on the assessment for each side effect found. They would receive a detox dose for each assessment of either methadone (for benzo substances) or librium (for alcohol detox). Total dose for methodone detox was 30 mg./6 day stay; for librium it would be 25-100 mg./2 hr. period based on detox assessment. We had to obtain VS each assessment and also provide "comfort meds" if their score did not fall into a detox med number, or they had already met their methodone or librium dose for that period. The clients were often "hard core" addicts who had returned in the past once they had been rehabed, and then returned to their addictions. You needed a great deal of patience to continue to work with them and support them--helping them to believe that it is possible with detox rehab to overcome their addiction and get back to the road on which they wished to travel.

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Specializes in ICU, psych, corrections.

Why were they giving methadone for a client coming off a benzo? I can understand giving methadone for heroin, which is an opiate (although I think you stated it was a benzodiazepine). I'm relatively new to psych nursing but I'm a recoving addict and this is something new to me. What's the rational for this? I would think that would just create a cross addiction for another substance.

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Specializes in Psych ICU, addictions.
Why were they giving methadone for a client coming off a benzo? I can understand giving methadone for heroin, which is an opiate (although I think you stated it was a benzodiazepine). I'm relatively new to psych nursing but I'm a recoving addict and this is something new to me. What's the rational for this? I would think that would just create a cross addiction for another substance.

I have never heard of using methadone for benzo withdrawal. Why don't they use a diazepam or phenobarbital taper instead?

I'm curious...I'm going to have to ask my resident addictionologist about this tomorrow and see what he thinks.

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I concur. I have been working in addictions for a year now and could never see prescribing methadone for someone coming off of benzos.

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Specializes in substance abuse.

I find this very odd too! I have been working in substance abuse for almost 6 years now. I actually work in a methadone clinic. Methadone and benzo's are a big NO-NO! I would love to see some research on how this could possibly be effective treatment!

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Specializes in Psychiatric, Detox/Rehab, Geriatrics.

I've worked in a drug and alcohol detox/rehab for about 4 years now and we give Phenobarbital for people coming off of benzo's, methadone or suboxone for opioid addicted people, and librium for people coming off of alcohol.

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Specializes in Mental Health and Substance Use.

I guess I should start by saying that I am an NRC which is a Nurse Rehabilitation Counselor. Where I work we work under Deligated Medical Functions which means we assess, diagnose, admit, treat, and discharge without a doctors order. I guess what I'm saying is that the RN's role varies greatly in addictions. In cases like where I work nurses may take on a wide range of roles that include both medical and psychosocial aspects of patient care or as others have pointed out they may specialize in a paticular area of care. Addictions is never boring and the relational aspect of care can be intense, challenging, and very rewarding.

I would suggest doing a bit of self reflection about why you want to get into addictions. It is no place for burned out old nurses or those just looking for something less physical. This is an at risk population that are stigmatized, miginalized, and stereotyped by the majority of the healthcare system. We need people with a high degree of passion and compassion in this line of work. It is not for everyone, but for the right people it can be an amazing career path.

Tom T RN, NRC

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I guess I should start by saying that I am an NRC which is a Nurse Rehabilitation Counselor. Where I work we work under Deligated Medical Functions which means we assess, diagnose, admit, treat, and discharge without a doctors order.

I'm confused.:confused: Are you saying, you're an RN, and you diagnose, admit, treat, .... without a doctor's order??? In the United States???

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Specializes in Mental Health and Substance Use.
i'm confused.:confused: are you saying, you're an rn, and you diagnose, admit, treat, .... without a doctor's order??? in the united states???

sorry for the confusion. i am a canadian nurse rehabilitation counsellor which means i have a four year degree (bsn) and then further education and certifications specifically in the area of addictions. much of what i do medically is covered under delegated medical functions.

"delegated medical function: a procedure/treatment/intervention that falls within the practice of medicine (e.g., adjustment of insulin dosages, initiation of continuous epidural infusions, insertion of chest tubes, harvesting of saphenous veins), however, in the interest of client/patient care, has been approved by the regulatory bodies of both medicine and nursing to be performed by registered nurses with the required competence (i.e., certification)." link here

so other than the united states part the answer to your question is yes, but who and what i "diagnose, admit, treat" is very specific and clearly defined. for anything that is not within our scope (or is even suspicious) we have an amazing support team of physicians and pharmacist to call 24/7. although we try to keep the 3am calls to a minimum. i hope that clears things up a bit.

tom t. rn, nrc

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