School Nursing

The Relentless School Nurse: Nurse-Led Change in Treating Opioid Use

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Nurses are on the front-lines of our nation’s most pressing health issues.  The opioid crisis is one example of an overwhelming public health crisis that requires an all-hands-on approach in order to turn the tide on this epidemic. Kendrea Todt MSN, RN, is a health thought leader and nurse educator who shares her personal and professional perspective on substance use disorder.

My connection to Kendrea happened on my favorite social media platform, Twitter. Readers of this blog may recognize her name from the #NoMoreEmptyDesks initiative! One thing I know about Kendrea is that she is a prolific writer, who can capture the essence of a message in 280 characters through Twitter.

It has been my professional pleasure to learn through Kendrea’s unique and articulate nursing lens. Her nursing passion includes educating her students about the challenges, biases, and health inequities of people who battle substance use disorder. Kendrea is a champion in this specialty field. She shares her message of nurse-led change in addressing the opioid epidemic as this week’s guest blogger.


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It breaks my heart to think of lives forever lost to the disease of addiction. I had the privilege to meet Andrea when she was just a kid. She was already a gifted horse trainer and I remember watching her in amazement as she fearlessly worked with spirited horses in the ring, the wilder the better. It was obvious, she loved it. Her talents truly amazed me. It broke my heart when I later learned she developed substance use disorder and subsequently died from a fentanyl overdose. Her uncle was charged in her death; it was an overall tragedy. This picture was taken by her dear friend @raisingram not long before her death. Andrea was a veritable ray of light, so full of life. She is a victim of the opioid crisis.

It is hard to fathom that a one paragraph letter to the editor of the New England Journal of Medicine by Jane Porter and Hershel Jick, Addiction Rare in Patients Treated with Narcotics helped fuel the opioid crisis. This one fatal paragraph (five sentences) demonstrated the power of science to cataclysmically change lives.1 The 1980 letter has been cited 608 times in the literature with 439 or (72.2%) of those using the letter as scientific support that addiction is a rarity for individuals treated with opioids. Drug use skyrocketed.

Americans represent 4.6% of the world’s population and yet we consume 80% of the world’s opioids .2 We know as nurses that our profession is based upon sound science and we too blindly bought into this mantra that addiction is rare in patients with a physical need for pain medication, well I know I was taught this in nursing school. We administered pain medications and doled out pain prescriptions with dosages and quantity of pills that were in excess of the situation, which increased as pharmaceutical companies pushed their product with the guise that addiction is rare. I wonder, did we as nurses help perpetuate the opioid crisis by our lack of critical examination of scientific information and rhetoric?

America is now in crisis and I am at a loss to understand the harm that occurs to patients with substance use disorder within our sacred walls of healing. People with substance use disorder enter our facilities in need of healing and instead find themselves harmed by our words and our actions. As the most trusted profession, our public trusts us to take care of them and protect them from harm. Delving into addiction science, nurses cite a lack of addiction education as part of the problem. It is this lack of knowledge that leaves them feeling vulnerable and unprepared to care for substance users.

Patients are often misunderstood, stigmatized, and sometimes, sadly ignored. In some facilities, we control and police their every move and are sometimes visibly disturbed by their presence. Some patients are treated as lesser humans, undeserving of our time and bed space within our facilities. We act with indifference at these individuals and label them as drug seekers, clock watchers, and just in general, untouchables. We blame them for their disease and prefer for them to be cared for on specialty units. We avert our eyes from their gaze and turn our ears from their cries for help. We disparage them to other health professionals as we practice stigma in concert. We forget they are hurting humans with issues, just like us. They come to us for help, often with serious infections or other systemic issues related to their drug use.

I ask my students, in a court of law who is it that evaluates the credence of an offense or examines the offender—

A jury of peers or a jury of nurses? They get my point.

In essence, our role is to advocate for our patients in their finest and darkest moments. I find the YouTube video Nurses Change Lives by Johnson & Johnson Nursing absolutely beautiful.  Collectively, we have the capacity to change history for the better. Our beloved Florence Nightingale made certain that British soldiers suffering from alcohol issues were not stigmatized. She realized alcohol was the problem, not the person. She jumped into action to help them, not judge them.

I took an oath to care for all people, without exception, no matter the age, gender, race, religion, and now I posit, political party. I care for all humans in their finest and darkest hours. As nurses, we cannot undo the damage already done to wounded individuals suffering from the disease of substance use disorder, but we can stop the bleeding.  We must staunch the stigmatization of substance users from within. Imagine the possibilities if we stand together and form a metaphorical hedge around those suffering. We can champion for withdrawal control that is based on a patient’s stated onset of drug withdrawal symptomology. If the patient is ready for help, we can advocate for addiction consults that begin the conversation of treatment and facilitate medication assisted treatment therapy to begin while hospitalized. Harm reduction is a beautiful concept with far reaching possibilities if we embrace it.

Imagine—the possibilities of nurse led change are endless, it is true, nurses change lives, let’s change them for the better.

Buchman, D. Z., Leece, P., & Orkin, A. (2017). The epidemic as stigma: The bioethics of opioids. The Journal of Law, Medicine & Ethics, 45, 607-620.

Howard, M. O., & Chung, S. S. (2000). Nurses’ attitudes toward substance misusers. I. Surveys. Substance use & misuse35(3), 347-365Johnson & Johnson Nursing. (2018, September 14). Nurses change lives (YouTube). Retrieved from

Leung, P. T., Macdonald, E. M., Stanbrook, M. B., Dhalla, I. A., & Juurlink, D. N.1 (2017). A 1980 letter on the risk of opioid addiction. New England Journal of Medicine376(22), 2194-2195

Manchikanti, L., & Singh, A.2 (2008). Therapeutic opioids: A ten-year perspective on the complexities and complications of the escalating use, abuse, and non medical use of opioids. Pain Physician11(2 Suppl), S63-S88.

Monks, Topping, & Newell. (2013). The dissonant care management of illicit drug users in medical wards, the views of nurses and patients: A grounded theory study. Journal of  Advanced Nursing, 69(4), 935-46.

Morgan, B. D. (2014). Nursing attitudes toward patients with substance use disorder in pain. Pain Management Nursing, 15(1), 165-175.

Van Boekel, L. C., Brouwers, E. P., Van Weeghel, J., & Garretsen, H. F. (2013). Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: systematic review. Drug and Alcohol Dependence131(1-2), 23-35.

Woodham-Smith, C. (1983). Florence Nightingale 1820-1910. New York: Atheneum.

Bio: Kendrea Todt, MSN, RN 

I am a pursuing a Ph.D. student in nursing and my focus area is on addiction science. I have been a nurse since 1991 (growing more passionate each year). I seek a terminal degree to model lifelong learning to my students, demonstrating a love of true scholarship. I equate my Ph.D. journey to a love story and if you love something, you’ll chase it as far as you can, and once you reach the end, you branch out forming something akin to collateral circulation. This is where the research someone produces begins to polarize the world. My goal is to excite and ignite future nurses to push buttons and boundaries to improve the health of a nation and to realize, nurses have the collective power to change the health of a nation and world if they work together. Nursing changed me and once that transformation is realized, there is no returning to a previous self. Thirsting is not just what I do, it is what I am. No matter the level I climb to, the fundamental essence is that I am a nurse. I am on a journey to make a difference in the lives of others, charged with caring for the health of a nation.

2 thoughts on “The Relentless School Nurse: Nurse-Led Change in Treating Opioid Use”

  1. Thank you Kendrea for such a heart-tugging call for nurse to lead the change in advocating for individuals with addictions. I so agree with you that individual with Substance Use Disorders do not receive equity of care with their chronic Illness unlike those that are treated for other chronic illnesses such as diabetes, cardiac or pulmonary illnesses. You said it so eloquently with “imagine the possibilities if we stand together and form a metaphorical hedge around those suffering”. I want to be part of that nurse hedge!

  2. Thank you Eileen, you are a part of the hedge and I thank you for your post. As nurses, we must have the wherewithal to address social injustice in health care head on and counter stigma within our profession. Professional checking/debriefing is key to improving treatment outcomes.

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