Podcast: Support for nurses and midwives struggling with substances with Adam Searby

Episode: 30
Guest: Dr Adam Searby
Duration: 40:17
Tags: Substance use disorder, addiction, drugs, alcohol, mental health
Soundcloud: Listen to Episode 30

For many nurses and midwives, talking about problems related to substance use can be challenging, anxiety provoking and evoke complex feelings including fear, shame, and stigma. Many do not know where to start to access support.

We thought you may need a helping hand if you are struggling with this issue yourself or supporting someone who is struggling. 

On this episode of the Your Health Matters podcast we speak to Registered Nurse Dr Adam Searby, lecturer at the School of Nursing and Midwifery, Faculty of Health, Deakin University and president of Drug and Alcohol Nurses of Australasia (DANA).

We discuss the complexity of substance dependency, its impact on nurses and midwives and the range of emotions it evokes. Adam outlines the key elements of the DANA position statement, Problematic Substance Use by Nurses and Midwives.

DANA believes that protection of the public from possible harm and protection of the profession from disrepute, resulting from a nurse or midwife misusing substances is paramount in addressing this issue. Prevention, early recognition, and intervention, along with effective treatment programs, are essential.

We discuss the research project Adam is leading and encourage nurses and midwives to participate: Alcohol Consumption in Australian Nurses: An Action-Design Study.

The research does not set out to demonise the practice of social drinking among nurses and midwives but to understand the impact of stress on the alcohol use of nurses and midwives. The preliminary data indicates a link between the increasing work stress particularly caused by the COVID-10 pandemic and alcohol consumption. 

Adam encourages any nurse, midwife or student dealing with problematic substance use to get help early and shares the inspirational story of Rachel Shuster, a nurse in recovery who shares her story on the podcast Health Professionals in Recovery Episode 3: Hold on to That Last Glimmer of Hope. Check out the episode here. Rachel will leave you with hope and encouragement that recovery is possible.

We also discuss the research of Marea Topp, a New Zealand nurse who completed her PhD on New Zealand nurses’ altered work performance because of problematic substance use and the risk of working with a hangover on quality of care and safety. Check out her thesis, New Zealand Nurses’ Alcohol and Other Drug Use. 

We hope the podcast encourages you to access support if you are dealing with problems related to substance use. If you’d like to talk, take a minute to reach out for support — give Nurse & Midwife Support a call on 1800 667 877.

Your health really does matter!

Mark Aitken RN
Stakeholder Engagement Manager
Nurse & Midwife Support

Dr Adam Searby
Lecturer, School of Nursing & Midwifery, Faculty of Health
President, Drug and Alcohol Nurses of Australasia (DANA)
Dr Adam Searby has worked in clinically in mental health and alcohol and other drug (AOD) settings, and is currently a lecturer at Deakin University in Melbourne. Adam has completed research into the alcohol and other drug nursing workforce in Australia and New Zealand, including the challenges faced during the COVID-19 pandemic. He has recently commenced work on a project examining alcohol consumption among Australian nurses. Adam is the current president of the Drug and Alcohol Nurses of Australasia (DANA), a board member of both the Australian Alcohol and other Drugs Council (AADC) and the Australasian Professional Society on Alcohol and Drugs (APSAD), and a working group member of the National Centre for Clinical Research on Emerging Drugs (NCCRED).

Mark Aitken [0:09] Welcome to the Nurse & Midwife Support podcast: Your Health Matters. I'm Mark Aiken, the podcast host. I'm the Stakeholder Engagement Manager with Nurse & Midwife Support, and I'm a registered nurse. Nurse & Midwife Support is the national support service for nurses, midwives and students. The service is anonymous, confidential and free, and you can call us anytime you need support. 1800-667-877, or contact us via the website: nmsupport.org.au.

On this episode of the Your Health Matters podcast, we will discuss supporting nurses, midwives and students with substance dependency or problematic substance use, and the complex issues that surround it. My guest to do this is Dr. Adam Searby, lecturer at the School of Nursing and Midwifery, Faculty of Health, Deakin University and president of Drug and Alcohol Nurses of Australasia (DANA). Hello, and welcome, Adam.

Dr Adam Searby [1:20] Thanks, Mark, and thanks for having me. It's really good to be invited to speak on this podcast on such an important issue.

Mark Aitken [1:28] We're very pleased to have you and grateful, Adam, to have you here discussing this really important issue and this area of interest for nurses and midwives and those who support us. Could you tell our audience a bit about yourself, Adam, and why you have a particular interest in this area?

Dr Adam Searby [1:51] Sure. I started as a nurse in 2008, that was my grad year. I probably took a little bit of a strange path to get here. I started in a neurosurgery and neurotrauma ward, really had a set idea about where I wanted to go and follow the critical care pathway into intensive care, but very quickly realised that it wasn't for me. I was more interested in the behaviors rather than the critical care aspect of working in that environment.

So I made the big leap—and it probably seems like a really big leap for those that work in ICU, to work in an inpatient mental health unit—probably one of the busiest in the state, which was a big shock coming from an intensive care unit to work there, but never looked back really. I moved into the community to work into older adult mental health, and it was in these settings really that I started to see the burden of what we call 'dual diagnosis', which is people with a mental illness and alcohol and drug use disorders. That really piqued my interest in drug and alcohol nursing as well as the models of care we provide for people who present with drug and alcohol issues.

I went to Turning Point and did a Graduate Diploma in Drug and Alcohol Nursing to go further, which then led me into a PhD looking at dual diagnosis in older people. I've got to be honest, I had absolutely no idea what I was going to do with it, but it led me to work into a couple of other drug and alcohol settings as well. So really, like most people as we've found out, talking to drug and alcohol nurses, fell into drug and alcohol nursing. I also then fell into academia. When I finished my PhD, I had no real idea what I wanted to do with it. I fell into academia when I finished it, and a job came up along the way teaching both mental health and then drug and alcohol.

I was probably the same with DANA, I met them in a conference. I've been to a couple of conferences locally beforehand, but their committee bumped into them in of all places, Florida, in the United States. There was a big international nurses' conference over there on drug and alcohol. Half their committee was there and my kids had begged me to take them over there. So kind of fell into DANA there. And the rest is history, as they say. I'm now their current president.

Mark Aitken [4:02] What an interesting career, Adam, and I think a lot of nurses and midwives listening to the podcast will relate that they 'fell into' their jobs. That's certainly been the case for me, in many of my positions too. Great to hear your story. I know a lot of people listening, Adam, will be interested in DANA, and how DANA membership supports nurses and midwives. I know you've recently released a position statement, 'Problematic Substance Use by Nurses and Midwives. Could you talk a bit about DANA and the position statement please, Adam?

Dr Adam Searby [4:40] Certainly. So DANA is the peak organisation for nurses with a professional interest in alcohol and other drug issues. I think that's our official line. That's what we put on the banners, anyway. But the reality is we've got a really broad membership. We obviously cover drug and alcohol nurses and nurse practitioners, but we also have a lot of nurses and midwives working outside those traditional drug and alcohol areas, who work with people who use alcohol and other drugs.

Up until the recent pandemic, and like lots of organisations, we ran a fantastic conference that had great events, networking, and a coffee cart. I'd like to say that's my input into DANA, being from Melbourne. But like everyone else, we've had to put those off for a bit. We're hoping to get back to those next year. We've done a webinar thing a little bit, but we've been steering away from it. As we were talking about just before we started Mark, everyone's got Zoom fatigue. It's getting a little bit difficult for people to sit in front of their computer for webinars. But we've also done some research work in how nurses work with people who use alcohol and other drugs. Most of our initiatives really stem from this, to provide scholarships for drug and alcohol nurses looking to take the step further and become nurse practitioners, which is a real growth area in our specialty. Mental programs, the nurse treatment and prescribing. We've also partnered with a lot of organisations to deliver alcohol and other drug information to those so called 'non drug and alcohol nurses', but are still working with people with drug and alcohol issues in their practice...which I think, we could probably argue, is a lot of us; particularly if we work in areas like emergency, or mental health.

But our position statement really sprung from a lot of the work that was done by the International Nurses' Society of Addictions in the United States, really lovely position statement around treating our own, basically. We have fantastic members who work in this space and often talk about treating our own. Drug and alcohol nurses, treating other nurses. We were really looking to provide some guidance and move away from that punitive approach that we've often seen in Australia, unfortunately, to a more supported approach that we're seeing emerge in the States. It was really about self-reporting, getting help to remain in practice.

Mark Aitken [6:52] It's a really interesting document, Adam. Thanks for sharing that information, we will add the link to it and to the DANA website as part of the show notes for this podcast. If you're interested, you can access that. I would highly recommend that every nurse, midwife and student have a look at that position statement. There's some very useful information and useful links for how you can access support. Part of that support, and thanks for including it, Adam, is Nurse & Midwife Support. If any nurse, midwife or student listening to the podcast is concerned about their problematic substance use or dependency, please contact Nurse & Midwife Support; 1800-667-877, or via the website, nmsupport.org.au. We're here to support you.

Adam, could you talk a bit about the incidence of substance dependency in the nursing and midwifery professions please?

Dr Adam Searby [7:56] Sure, I've got to say that this is a bit of a difficult question to answer. Well, this surprised me anyway, when I started looking, there's very little research data. There's a couple of older papers that have really small samples. One looks at about 60 across three countries. Another one, about 10 years old, looked across a big group of nurses and doctors, and they quote around 10% [of] nurses and midwives [have] with what they consider problematic alcohol use.

In terms of substance use, we're really in the dark. There hasn't been a lot of research done at all around substance use. We can look at the National Household Drug Survey data, but we all get lumped in with health professionals and reported as a group, all health professionals. You can imagine, it's really difficult then to tease out nurses' attitudes, and drug and alcohol use from those of say, optometrists, where you're in a big group, but that tends to mirror that 10% round alcohol use.

We've recently partnered Deakin University with the Nurse and Midwife Health Program in Victoria, to launch a study into alcohol consumption among Australian nurses. We're pretty advanced into this study, and we're in the tail end of running a national survey. We've had almost 1300 participants respond to the survey to date, using the AUDIT screening tool, which some listeners might have heard of before, and it's probably used in clinical practice. The 'Alcohol Use Disorders Identification Test', I think it stands for. It's a really good standardised test, really specific in picking up risky drinking. We asked our participants to do that.

As we mentioned before, Mark, some work around stress as well, looking at the stress that's going on in the profession at the moment. The rates we got out of that, which is really concerning to me, was a lot beyond the 10%. So we're looking at 27%, who on that AUDIT tool, have a designation of risk or high risk drinking. 32% of participants reported that their alcohol consumption had increased since the beginning of this COVID-19 pandemic we're going through. Probably not surprisingly, 61% reported that their work stress had increased as well in the pandemic.

They're preliminary results, but they do indicate to us that there's a big impact on nurse and midwife mental health and alcohol consumption at the moment, particularly in the wake of what we're seeing going on in the community. We certainly know that the work nurses and midwives are doing at the moment, it's a really tough gig. That seems to show through in our research. At the moment we're doing some interviews as well, we've just finished the first round of interviews to explore this. There's lots of this coming out in the discussion, people talking about the level of stress, coping with what's happening at the moment. PPE, uncertain case numbers, watching these numbers every day, what's going to happen to the health system, we're really seeing it playing out in the media at the moment, but it was certainly echoed in our research.

Mark Aitken [10:59] It's really interesting, Adam, to get information on that and to put it in the context of the COVID-19 pandemic, which has obviously challenged and stressed nurses and midwives, and continues to challenge and stress nurses and midwives in perhaps ways we never thought we would be stressed and challenged. Just to create a bit of context, we're recording this on the 30th of September, 2021. We're certainly very much, in Melbourne and in Sydney, and parts of New South Wales, and also parts of Victoria, in the eye of the storm of the pandemic. So a big shout out to all the nurses and midwives, working incredibly hard to care for those impacted by the pandemic. And a reminder to look after yourselves and each other, because Your Health Matters. If you need support, as I said before, please contact Nurse & Midwife Support, 1800-667-877, or via the website, nmsupport.org.au.

Adam, why is substance dependence in the nursing midwifery professions a concern? Why should we be worried about it?

Dr Adam Searby [12:17] I've got to say that look, we've really set out not to demonise the practice of social drinking among nurses. As I just mentioned, this is preliminary data, but there does seem to be a link between this increasing work stress and alcohol consumption. We've got lots of research that exists that shows this is the case in other industries, and lots of this stuff was done pre-pandemic in a so-called more normal world. We can all think back to 2019 and think, we didn't know what was coming, right?

This has been a huge shake up, particularly for our industry. But really, this is the first work we could find that was looking at nurses and midwives. Given that we've started it in amongst the pandemic, it kind of reflects just how difficult the situation's getting for us. As you mentioned before, Mark, we're sitting here, and I think today was the highest number of cases in Victoria over 1400?

Mark Aitken [13:15] Yeah, that's right.

Dr Adam Searby [13:16] I heard that this morning on the news and immediately thought of my colleagues who are at the coalface, as we say. This is real shattering news, if you think about how we've been trying to control the pandemic, and it's gonna have a big flow-on effect to what people are doing in health services. This is a big concern.

I think it does show that there's a link and hence the importance of recognising particularly problematic alcohol use in nurses, it seems to be amongst our survey participants that lots of people are using this as a coping mechanism. In lieu of other methods, I don't want to go out there and say nobody does this. But I know there's a history in nursing of saying, 'this is what we have to put up with in nursing'. [There is] a lack of critical incident debriefing, we've kind of filled that void with that informal debrief where we head off to the pub after work. I know Mark and I have had this discussion, we can name the pubs we used to go to close to the hospitals we used to work in. I think most nurses would do that. It's just recognising this can become a pattern that can not only impact on work performance, but people's personal lives as well.

Mark Aitken [14:32] Yeah, good points, Adam. In many ways that was like, normalised, that...after a difficult shift or challenging work period, we'd all get together at the pub and use it as a form of support and debriefing. In a way it was a badge of honour that you still got up the next day and went to work. I know there's some really interesting research that a researcher in New Zealand has done on nurses and midwives working with a hangover and the impact of that on safety. Are you able to talk about that or point to that research, please Adam?

Dr Adam Searby [15:14] Yeah...it was a colleague, I think, in DANA, who has done the research as part of her PhD study. But it exists as a PhD study rather than being published, which is a bit unfortunate because it was a really good study, and interesting outcome to say that nurses were turning up hungover. We often think of drug and alcohol use in nursing and midwifery, and we hear stories in our professions about...inverted commas here, 'The Nurse who was caught stealing Schedule A drugs from work', but we don't really hear as much about about this: the nurse who turns up to work after a big night out, impaired by substances, or hungover.

As I mentioned before, we don't really hear about nurses and midwives who have experienced a critical event without that adequate support, and they've turned to drugs and alcohol to cope. If we think about how we would address this, and barriers to implementing any sort of intervention to drug and alcohol use, you're just taking it a step further from recognising there's an issue and thinking about how we'd manage it across our profession. It seems that—and I'm guilty of this as well—we're really good at providing advice to our patients or clients, consumers, on their drug and alcohol use, but we're not as great at taking that advice ourselves. Again, we kind of fall into this super nurse, we're in the cape. It's almost a badge of honor that we selflessly look after people.

This is really what we've seen in the pandemic as well, we've been the last profession to be recognised in terms of work stress, that's a little bit of my take on it. Again, press conference before where we've got the 1400 cases, nurses were mentioned frequently, but I can't really remember a point where we've gathered so much media attention as a standalone profession and the impact of this on us. There is that notion that we just get on with it, deal with it. This is what we put up with.

Mark Aitken [17:03] Yeah, as you say, Adam, many nurses and midwives are going home after a stressful shift and having that, you know, glass or two or three or four of wine as a way to decompress and to relax. What would you say to a nurse or a midwife who is doing that, perhaps having one too many at the end of a shift, and what could they potentially do, instead of ending up drinking the whole bottle of wine?

Dr Adam Searby [17:35] I'd say that when we did the AUDIT, the Alcohol Use Disorders Identification Test, I did do a little pilot with a few of my colleagues and I caught this...almost a realisation. Lots of them filled it out, and didn't really think about having that three or four glasses of wine after a shift as being considered risky drinking amongst the AUDIT. So I think there's a minimisation of that.

I come back to that thought that I don't want to demonise people's social drinking. I think as nurses, we've all gotten together with colleagues and chewed the fat about work and the world in general and what's going on. We're not trying to demonise that. But I think as a coping strategy, we saw this a lot in the research, that a few people realise that their consumption had escalated, certainly in the context of COVID, PPE. Other things we see going around, like redeployment, off to testing, moved out of your specialty, those kinds of things. Fear of redundancy, even colleagues, nurses who are working in other areas, support areas, education, are all facing this as well. So there's lots of stressors out there.

My advice would be to contact the good people at Nurse & Midwife Support or the Nursing & Midwifery Health Program Victoria, even for advice. I mean, if you're concerned about it, and you're thinking, this could be an issue for me, I know there's plenty of information on both of those websites you can look at, and see some strategies around managing it. In our qualitative interviews, we certainly did talk to some people who have been down this road, experiencing lots of stress at work. Their drinking had escalated from three or four a night as you mentioned before, Mark, to being really quite what we consider problematic, in want of another word, daily impact on work performance and other roles. I would encourage people, if they're concerned, to seek help early,

Mark Aitken [19:35] Yeah. Reach out for support, 1800-667-877, 24/7. The service is anonymous, confidential and free. I think you made a really good point before, Adam, when you said, it's really useful to undertake the AUDIT screening survey about alcohol use, and that is available on the Nurse & Midwife Support website. So if you go into the website, nmsupport.org.au, and you search 'alcohol', you'll find that screening tool in the content, and we'll put the link to that in the show notes.

Why do you think, Adam, [that] it's important for nurses and midwives with concerns about their alcohol or substance use to seek support early? What do you think might be some of the barriers that would stop people from doing that?

Dr Adam Searby [20:32] As I mentioned, with seeking support early...just before COVID hit, I had the opportunity to go to an international nurses' conference in Baltimore, in the United States. I met a nurse over there, a so-called 'impaired nurse' who described a story of basically being really high-performing at work and being under a lot of stress, and kind of progressing from being prescribed opiates to the other end of the scale, which was diverting opiates and injecting them at work. This came to attention by her being found overdosed at work basically, needed the work [inaudible], ended up in her own emergency department. This had come out to her family.

She spoke really well. I was fortunate to hear this story, it really opened my eyes to what nurses go through in this situation. She spoke about the financial cost, the cost to her relationship. Her husband wasn't aware of this happening, none of her family were aware of it happening. Her husband got the phone call about the overdose. The cost to her professional career, and the amount of monitoring and programs she had to go to which, of course, in the United States, came all out of her own pocket...and just the work she had to do to get back into the profession.

The real take home message from her was seeking help early, and having a culture where people can seek help early, is vital to prevent a lot of this happening. It was really eye-opening to hear how much money she'd spent just to maintain her career. Again, this is the United States, so as we know healthcare is a lot more expensive, as is legal fees and the like. But I think it really highlights why it's important to seek help early. Getting help and support early can prevent a lot of these things happening.

That's a very extreme example, in that it's someone diverting drugs from work. As I said they tend to be the stories that we hear going around hospitals, about people diverting drugs, being discovered overdosed or worse, and crashed cars with a boot full of drugs, and those kind of stories that I'm sure get built up as they get passed along. But in this instance, it was the actual story of this happening and an event that had happened that it really derailed her career.

She was really supportive and pushing [that] it's really important to get help early. That would be my take home message there, just to steal from her little story. She does have a podcast where she talks about this at length, '[Health] Professionals in Recovery,' I think it's called. Her name is Rachel Shuster. She sits on the board of a group called IntNSA. If you're curious to hear about that story, it's a great podcast, she tells it in complete, absolute, no-holds-barred honesty. How she got there, the impact it had on her, and I think for people who are working in this space treating nurses, it's certainly a real eye opener to hear that...gone on a bit of a tangent there! But coming back, seeking help, and I think now especially we're going through a really unprecedented time.

I keep talking about this, but lately, we've started seeing things like health professionals not being able to go to work in the uniform because they're being abused, spat on, sworn at...people being assaulted in COVID testing stations. I'm hearing from colleagues who work in the big healthcare services about Code Greys, aggression, violence, really bubbling up and almost unprecedented in some of those health services. So it's natural that we'd experience heaps of stress, and as humans, there's got to be an outlet to manage that stress.

I think that's why, if you're feeling that way, there is support out there. I definitely recommend you get that support early, rather than it getting to the point where you're facing loss of registration, basically. There's a real fear for us in this situation that if goes that far, this is a possibility. You can lose your registration, your career. But I do know...and again, to talk back to Mark's group, Nurse & Midwife Support, and the Victorian program, they're very good in navigating this pathway if you seek help from them early.

Mark Aitken [24:50] They're really important points, Adam, and I think what that [points] to is really the complexity of the issue for people, but also the importance of [that] we see substance dependency, or problematic alcohol substance use, as a health issue rather than a lifestyle issue. If we are aware of a colleague with a problematic substance dependency issue, that we really manage that in a very collegial, supportive, caring way, because I think over the years people have been reported, but they haven't felt supported. So while we have a role in reporting, particularly if that is occurring at work, or people are working under the influence of alcohol and/or other drugs, that people are supported through the process of notification.

Dr Adam Searby [25:50] Just to go back to the barriers, I think there's still a lot of stigma around that so-called 'impaired practitioner' that we see in our AHPRA documents. Lots of fear around losing your registration, as I mentioned, but there's hefty penalties to pay. I mean, our national act and registration scheme is really swayed towards healthcare consumers and protecting healthcare consumers, which is, of course, a very important consideration. But I think it's created a fear of early reporting or seeking help, not just for drugs and alcohol, but any form of mental health.

I use that analogy of the supernurse wearing the cape, selflessly caring for others, pushing my mental health and how I feel to one side. I get in there, and I get my PPE on, and I work with people with COVID coming in through the door, increased demand, I think it sadly still exists in lots of clinical areas. I really feel that we're, we're due for a culture change. Just to steal from a mental health campaign for the general public that was on recently, I think we need to start asking each other "Are you okay?" a little bit more.

Mark Aitken [27:03] Yeah, absolutely, Adam. I wrote a blog for R U OK day and in that blog, I said, Absolutely. We need to have each other's backs and look out for each other and ask that question. "Are you okay?" It's really vital at the moment that we actually take a moment to check in with ourselves and ask ourselves that question, "Am I okay?" I want to put that out to nurses and midwives to just take a moment and check in with yourself and ask, "Am I okay?" And if you're not okay, please reach out for support, 1800-667-877. I think you mentioned two really important points here, Adam. One is the fear people have of disclosing or admitting that they think they might have an issue, and also the shame that people experience as a result of perhaps been labeled as having a drug or an alcohol problem or addiction. Can you talk a bit about the experience of shame for people and how they perhaps can manage that, or reflect on it, and then seek support?

Dr Adam Searby [28:17] I think this hits back to the stigma, and the stories we hear, really. I think I mentioned this already, [they] are really around theft of drugs, people turning up really impaired and putting patients in danger. Certainly working as a drug and alcohol nurse, when I worked with nurses, it was really nurses who had been caught rather than self-reported. They openly describe this shame to you.

Now, interviews as well, we saw this come through, there was a real kind of disconnect for people who realised...there was one participant who spoke about working in a gastroenterology board while having a really heavy alcohol use disorder, I suppose you could probably call it, if we were to diagnose it. That real disconnect between "I know what I'm doing is really bad for me," but looking after people as well who were in end stage liver failure as a result of drinking. So that jarring experience of going, "This could be me, but how do I seek help?" This person talked about really having that realisation: "But how do I seek help?"

There certainly is a real stigma around reporting and I think again, it goes back to our culture of 'just get on with it. This is what we do.' We often do that in lots of other areas. You know, a patient assaulted me, I just get back on with it. This happens to nurses. It's a shame but this is what we do. It almost comes across as a bit of weakness, doesn't it, to put your hand up and say, "I'm not okay, and I need help."

I think we need a real cultural shift. I'm really hoping that this is one of the silver linings out of what's going on at the moment, is that we do have a cultural shift and recognise that we're not invincible, and that sometimes we do need help. There's no shame in seeking that help; we work in an environment where it's supported.

Mark Aitken [30:11] Completely agree, and that leads really nicely to this question, Adam. How can a manager support a nurse or a midwife who discloses they have a substance dependency? What are the really important things for that manager to consider?

Dr Adam Searby [30:28] Well, firstly, I want to say I think it's great that there would be a workplace culture out there, I'm kind of talking broadly about this 'needing to change' but I'm sure there are cultures out there where a nurse or midwife can approach their manager. Not just to disclose but to put their hand up and say, I need help. I still think we need to see a real shift where that's supported. People are able to seek help early, rather than drug and alcohol use being detected and being seen as an endpoint to someone's career and then them having to go through the process of justifying why they should be able to maintain their registration and continue to be a nurse or midwife.

But I would definitely say, and I know this through conversations we've had previously, Mark, and Glen as well, we've had conversations around how managers can do this and self-reporting in depth. I definitely recommend any manager that has a staff member approach them, seeks help from either of the programs, Nurse & Midwife Support or Nursing & Midwifery Health Program Victoria. They're the experts in walking this path, they can provide advice that meets the aims that we need to in terms of AHPRA, protecting patients, supporting our colleagues, and getting them to seek help and treatment.

I certainly know from my own practice, we ask about lots of things in mental health, lots of areas: drug use, people's relationships, domestic violence, suicide as well, it becomes quite normal to ask these questions. I know there's a bit of a thing in nursing around, "I can't really ask that." Certainly get that from students. When I used to go out clinically, they would say "I can't believe you just asked them about all of those things in an hour." It's really normalised.

I think we need to normalise lots of this. Being able to ask questions if people are okay. But I really think that we get worried about, "What if someone says, 'No'? What do we do with that?" So that's why I would recommend certainly being in contact with the support programs who have worked in this area, and have experience with guiding managers who are supporting staff in these areas.

Mark Aitken [32:34] Great points, Adam. Thank you. What supports out there do you know about, Adam? What programs, perhaps rehabilitation support programs, to support nurses and midwives with substance dependency? I mean, apart from contacting us for information and support, I know that SHARP, the Self-Help Addiction Resource Center are working with their own domestic branch, and the Nursing & Midwifery Health Program Victoria, on a specific inpatient residential service for nurses and midwives with substance dependency. We'll have a blog about that as part of this newsletter, which this podcast is about. Are you aware of any other programs, Adam, that nurses and midwives can access?

Dr Adam Searby [33:22] There's lots of programs specifically, but it's great to hear that there's a development on a very specific program for nurses and midwives. I think that's fantastic to hear. Lots of very specific programs. But I'd say if you're a bit worried, and you want to seek help, but want to keep it separate from nursing, I'd definitely say a call to someone like DirectLine, run by Turning Point still, I think?

Mark Aitken [33:49] Yeah, that's right.

Dr Adam Searby [33:49] Still run by Turning Point, a really good source of knowledge counselling, being able to seek more advice on services who can help you in your area. I think they're a really great resource. I used to forever give patients their phone number when I worked in drug and alcohol just because it's a service that's available at all times, they're really across everything. Big shout out to those that work on DirectLine, it's a really valuable resource sitting outside specific nurse and midwife support.

I think all of those generic services are great. We've got lots of services in Victoria, the systems a little bit...I'm gonna say, piecemeal, it's a little bit fragmented, I suppose, in the way it's run, as in different services do different things. But of course, we have DirectLine that can point you in the direction of services, groups like Alcoholics Anonymous, Narcotics Anonymous, that exist out there.

Then we go through to the more formal treatment services. Lots of them are run by non-government organisations or religious organisations. Uniting Care, Salvation Army. There's definitely lots of programs out there. I've worked in this field and I feel that it can be a little bit tricky to navigate for people hence why I would suggest going to somewhere like Nurse & Midwife Support, or the Victorian program, or DirectLine for guidance, if you feel that you're at the level where you need more intensive support and possibly entering treatment, I would strongly recommend approaching [them] to help guide you through the process.

Mark Aitken [35:29] Adam, your research is ongoing? Nurses and midwives interested can still complete that survey, is that correct?

Dr Adam Searby [35:37] Yeah, the survey is still open. We've got quite a few results, and we're looking at winding it up soon. But it's still open at the moment. We're looking to do another round of interviews. We're starting to look at what's available in terms of interventions for alcohol use. Apps, it usually comes down to. Things like the Hello Sunday Morning app, and whether they're suited to us as nurses or midwives. We will run another round of interviews shortly, and this will inform some work that we're doing around whether interventions like that, like that Hello Sunday Morning app work for us as a group.

It's a very broad kind of general public intervention that's out there, but we're a very specific profession, nurses and midwives. We have lots of really interesting little quirks. I mentioned before that we like to advise people, but we're not so good at taking our own advice. We have a lot of things that are oral tradition, of 'this is the way we've always done it', we hand lots of things down by that 'I'll show one, do one, teach one,' philosophy. 'This is how we do it.' So we're very specific, and I'm going to say special, pair of professions that really need our own intervention. This is what we're working out now, whether it is feasible for us to have our own specific intervention. This will feed into more research, but we're really hoping to start releasing some data. I think we'll have some stuff out by the end of the year.

Mark Aitken [37:05] Thanks, Adam. We'll put a link to that survey as part of the show notes for this podcast. If you're interested in undertaking that survey, please do so, the data will be really important in terms of informing services, and the app. So very exciting work, Adam, thanks for leading that and it's been great to be part of it. I can't believe we've come to the end of the podcast, Adam, it's such an interesting subject and I know, nurses and midwives will be really interested in that. As we come to the end, what would you say to a nurse or a midwife who is listening to this and they're suddenly concerned about their substance dependency?

Dr Adam Searby [37:47] I would definitely suggest that they have a look at the Nurse & Midwife Support or Nursing & Midwifery Health Program Victoria website, there's some fantastic resources and I sound like I'm giving your organisations a huge plug Mark, but I do think that that's the ideal place to start. I think there's some fantastic resources there, great people that run these services who understand nurses and midwives, because they are nurses and midwives. So I would definitely recommend jumping on the website and having a look. You might feel that a phone call might be the way to go to discuss it further. That would be my recommendation.

I would like to also acknowledge anyone listening, and all the nurses and midwives out there who're working in the midst of the pandemic at the moment, I certainly take my hat off to you. I think there's not a lot of people who will say it, but also thank you. We really appreciate what you're doing. I take my hat off to you. I think this is probably one of the most difficult things we've ever faced as a profession. So we're thinking about you, out there, in PPE, on the front lines.

Mark Aitken [38:56] I couldn't agree more Adam, I completely reiterate what you've said. If you're listening to his podcast, and any of the things that we've spoken about have raised issues for you, please, please, reach out for support. You can contact Nurse & Midwife Support for any issue you need support for. Anonymous, confidential and free, and the service is provided 24/7. 1800-667-877 or via the website, nmsupport.org.au.

Thanks Adam, you've been a great guest. I really appreciate your time, your wisdom and the incredible work and support you're doing supporting nurses and midwives with problematic substance use and concerns about alcohol and/or drug issues. Thanks again. Look after yourselves, and each other, everybody. Your Health Matters. I'll speak to you next time. Take care.