Interview with Amy Langley, FNPC

Kate Chichester
Kate Chichester
CCSME Executive Director

From your experience as a nurse, what roles can nurses take in intervening with patients with substance use issues, and how can they be empowered to do more on a patient and policy level?

Nurses, in their roles, are in ideal positions to screen for drug and alcohol use and support treatment and recovery. In Maine, nurses see many people who are drinking every day at risky levels, as well as alcohol use, opioid, and other substance use disorders. Like others, they need to avoid the stigmas and biases that can revolve around these use disorders. Or the misconception that risk for alcohol use disorder ends when you hit 70. It can be uncomfortable asking or being asked about substance use, but nurses are good at gathering important information. Nurses know how to talk to patients, not above or below them, but where they’re at. They can gather the story about what brought the person into the clinic or hospital. Nurses also are pretty good at knowing the local resources. They know what the word on the street is and who the local resources are. If they don’t know where to refer the patient, they usually know who they can go to get that person connected. Empowering nurses more on a patient level and creating educational opportunities can go a long way to addressing substance use issues.

Nurses can also help determine how to manage barriers, including staffing shortages. Nurses know how to find other nurses and understand what makes them happy, so include nurses in that conversation. Have nurses be part of the interdisciplinary team; don’t just put the nurse on the floor and say, here’s your patient assignment for the night.

Improved access to substance use disorder treatment can happen by flattening hierarchies. So again, that’s keeping nurses in all the loops, not just on the floor. Regarding policy level, nurses are very good at uniting to create a collective voice to change policies on the state or federal level or in your community. I tell nurses to use their collective voice with their peers to advocate with their local and state representatives. Nurses know what the barriers are. They can help shape or create policy based on what their patients need.

So, include nurses in all of your policy committees and your quality improvement efforts. They can be part of the solution, use them.

Amy Langley
FNPC
Kate Chichester
Kate Chichester
CCSME Executive Director

What led to your decision to become a nurse practitioner and your interest in SUDs?

My decision to become a nurse practitioner was the classic story of evolution. I had been a registered professional nurse for over 16 years. As a local and then traveling nurse, I did everything from direct patient care at trauma hospitals, rehab hospitals, long-term care hospitals, emergency rooms, and ICUs to multiple roles in nurse management. I loved it all.  At one point, I was a director of nursing services for a 114-bed subacute hospital with a large staff and budget.  I realized I knew know how to make treatment decisions because of my collective experience, listening to patients, and seeing the obstacles. But I couldn’t act on it because of my scope of practice. I had physicians saying get your NP; we want to work beside you; we want you on our collaborative team. That’s when I said, you know what? Maybe now’s the time. I realized I could parlay my years of experience and knowledge into being, hopefully, a primary care provider who could make a difference.

 

What led to my interest in substance use disorders is a layered answer.  None of us are immune to the effects of substance use disorder. Almost anybody you can talk to or will speak with can tell you at least one family member, a cousin, uncle, parent, or a coworker that has some use disorder, whether they struggled with opioid use disorder, prescription drug misuse, alcohol use disorder, et cetera. I had some of that peppered in my family, but it wasn’t at the forefront of my thinking when I started studying use disorders, at least initially. The initial push to study this is when I noticed during my time in PACU (post-op recovery room) nursing that I was often getting reports from the OR that they had a hard time getting the patient under anesthesia; that it took a lot longer to put them under and then a lot longer to get them back out. I once asked one of the anesthesiologists, “Why are we seeing this? What’s going on?” I truly had no idea. And he just said kind of bluntly, “Oh, it’s because people are using recreational opioids.” I’m like, well, I didn’t see opioids on their med list. And he said, “Oh, yeah, they’re using opioids from somewhere.” And it hit me. I’ve started to see this more often. Is this really what’s going on? And then you’d see a trend in patients when they’d wake up from anesthesia; even when their acute pain was gone, they still were asking for pain meds. They needed pain meds. Unfortunately, back then, nurses looked at it and said they’re like, oh, they’re just a ‘frequent flyer,’ ‘an addict.’ You could see that stigma starting, and nobody seem to realize the devastation of an epidemic that was unfolding.

I remember thinking, I want to figure out what this is. Then, I started seeing the patterns of patients coming back to the hospital. They were falling off a curb and breaking an ankle sometimes several times a month. They couldn’t tell you how that happened, but they knew they’d automatically get a 30 day supply of opiates for pain. That was my first cue that I think we have a problem here, at least at my little hospital in Bangor. It was shortly after that I entered the NP program. The first thing they told us when we entered the program was that you need to start thinking about your capstone project. You’ll be writing multiple chapters on this, so think of something important to you, something that you want to know more about, something that you want to spend lots of time and effort researching.

My first thought was, does Maine have an opioid prescription problem and if so, why? I did some research, and Maine was number one at the time for prescription opioid abuse (now known as Opiate Use Disorder / OUD). I spent the next three in the NP program, studying this topic from every angle, and I was fascinated by what I was learning. Since then, I’ve made it part of my practice to continually study and understand chronic pain disorders, to try to understand post-traumatic stress disorders, to understand how to help prevent an opioid use disorder from happening and/or recognize it when I see it so that I can get people connected to the right resources. One of the big things I remember saying when I was working on my capstone and talking to my capstone mentor was that I wanted to be part of the solution, not part of the problem.

Amy Langley
FNPC
Kate Chichester
Kate Chichester
CCSME Executive Director

What has contributed to the leadership Nurse Practitioners in Maine have had to advance MOUD?

Nurse Practitioners in Maine are natural leaders! By its very nature, the nursing model focuses on the whole person, including the social circle, social determinants of health, the patient support system, emotional needs, etc. These are all crucial in supporting somebody’s recovery. This humanistic approach is vital to nurses’ being at the forefront of addressing the need for and continuing to advance the MOUD model.

Bringing nurses to the table and ensuring they’re on the committees and task forces can continue to advance MOUD here in Maine. One thing that I greatly respect about Governor Mills is that when she does the annual opioid response summits, you notice it’s not just physicians; it’s also nurse practitioners, social workers, therapists, peers, and more. It’s that interdisciplinary process. That’s huge as far as keeping nurses at the policy table part of these conversations and helping them advance the role of medication and opioid use disorder treatment. Keeping NPs and nurses in the conversation is how we will keep this moving.

Nurses have moved into leadership roles, running hospitals. They emerge from the healthcare system with experience and learn how to find their voice. They naturally gravitate to leadership. We see more and more nurse leaders as time goes on. Nurses are in leadership and CEO/CNO/President and VP roles at numerous hospital and medical organizations across the state and the country

Amy Langley
FNPC
Kate Chichester
Kate Chichester
CCSME Executive Director

What has been your experience working with individuals with SUDs?

My experience working with individuals with SUDs tells me that our society still has a long journey to get where we want to be. The work is not done yet. We’ve made many advancements in recognizing opioid use disorder and substance use disorders, getting training, and advancing MOUD, but there is more to be done. Individuals with a use disorder need to access evidence-based treatment with empathy and compassion care to start their recovery.

Few things are as rewarding as when I see someone who’s beginning the process of recovery; they’re reconnecting with who they are, what they want in life, and what their life looks like outside of the clutches of a use disorder. The only comparison I can make is when you see a flower that’s been wilted, and it gets a little sunshine and a little water, and it opens up. It’s a sight to behold, seeing folks that haven’t had family connections for a long time because of the effects of their use disorder, and working to get that back and when they get there, how grateful they are. That’s the stuff that makes this so rewarding.

Amy Langley
FNPC
Kate Chichester
Kate Chichester
CCSME Executive Director

How can nurses and NPs stay engaged and find joy?

Burnout and compassion fatigue are real struggles. I tell the NPs and nurses I work with who are getting into this business that you must make time for self-care. There’s no way around it. You have to make space for yourself. You have to know what gives you pleasure outside of this role to keep your energy.

You’ve got to stay connected with your family and your peeps. Your ‘people’ are more than just family members, it is the people in your circle that encourage you, lift you up when you need it, and ground you when you need it. The Maine Nurse Practitioner Association conferences are an important part of my networking with my professional peers. Having this network of friends is part of my self-care. That’s hugely important. I hear how my colleagues manage or prevent compassion fatigue, which helps me through their collective experience. I feel renewed about my work when I go to conferences or listen to presentations by people I admire. It’s important to stay involved in committees / stay active with professional organizations / be a part of gatherings with meaningful and insightful conversations; Seek professional peers who engage, stimulate, and inspire you.

 

Amy Langley
FNPC