Having presented on the Endocannabinoid System (eCS) and the nurse’s role in cannabis medicine at many national and statewide nursing conferences, I am often asked how Registered Nurses can become “Cannabis Nurses.”
Additionally, as President-Elect of the American Cannabis Nurses Association(ACNA), I have noted that nurses are often turning to the organization for guidance on how they can begin working in this specialized area of healthcare. The answers, of course, are often related to the nurse’s cannabis and endocannabinoid knowledge, coupled with previous nursing experiences and expertise, and what roles the nurse desires to play cannabis therapeutic support of the medicinal cannabis patient. One must also consider the legality of cannabis in the nurse’s state of practice; the FDA Schedule, I status of cannabis, tends to complicate the matter of cannabis nursing practice, and nurses should always error on the side of caution when it comes to nursing practice and working with cannabis patients.
That being said, as a group we are making progress toward formally defining Cannabis Nursing as a specialty. This article will explore the current state of cannabis nursing, as well as future steps we can consider as we strive toward ensuring cannabis nursing becomes a recognized nursing specialty.
Scope and Standards of Cannabis Nurse Practice
Historically, some of the missing pieces for supporting the official recognition of Cannabis Nursing as a specialty within nursing have been both defining the domain, and creating a standard and scope of cannabis nursing practice. The standard and scope should align with American Nurses Association (2015) requirements, and be inclusive of the who, what, where, when, why, and how of nursing practice. It must be able to be applied broadly to many situations wherein nurses find themselves working with patients who use cannabis to support and potentiate their healing processes. It should furthermore acknowledge that the nurse’s role in working with cannabis patients clearly aligns with the accepted ANA standard and scope.
In response to these issues, ACNA has officially accepted version 1.0 of the Scope and Standard of Cannabis Nurse Practice that aligns with ANA’s (2015) Standards and Scope of Practice (3rd edition).
The document can be accessed here: https://cannabisnurses.org/Scope-of-Practice-for-Cannabis-Nurses
In addition to aligning Cannabis Nursing with ANA’s (2015) standards and scope, some of the highlights of the document include that the cannabis nurse uses caring-holistic approaches as they work with cannabis patients, and that the nurse is interested in not only supporting patients’ cannabis use but also potentiating the health of the patient’s Endocannabinoid System (ECS).
It is therefore imperative that the Cannabis Nurse:
• Focus on educating themselves regarding the basics of the eCS
• Know and lived experience with holistic modalities that potentiate the health of the ECS and enhance stress resilience
• Be able to apply the nursing process to cannabis patients
• Be adept at creating a caring-healing environment for the patient
Unfortunately, most of our schools of nursing do not currently include cannabis as medicine and the Endocannabinoid System as in-depth curricular topics. This leaves nurses and nursing students with the option of educating themselves around the use of this herbal medicine. When looking at educational possibilities, nurses should consider what conferences, organizations, and continuing education courses will best suit their learning needs toward understanding the action, indications, use, dosages, and side effects of cannabis as a medicine, along with understanding the nurse’s holistic role. The nurse must understand their state practice act, and be aware of legal issues related to the role of the Cannabis Nurse. Therefore, historical, ethical, and legal implications should be covered, and the nurse should have an understanding of their role as an advocate for cannabis patient populations.
One must also consider which texts might help support the nurse’s knowledge around working with patients with specific health concerns. For instance, The Cannabis Health Index (Blesching, 2015) is often a great place to start with considering patient issues. However, new scientific cannabis knowledge emerges so quickly, that the nurse must also feel comfortable accessing current peer-reviewed literature related to cannabis and specific disease or health issues.
The Nursing Process and Holistic Roles
Cannabis Nurses use the five-step nursing process to support patients: Assessment, Diagnoses, Planning, Intervention, and Evaluation. While this may seem fairly straight forward to nurses who have been using the nursing process for some time, holistic considerations must also play a role.
For instance, during the assessment step, the nurse can use strategies like motivational interviewing to garner a deeper understanding of the patient’s current health status and their goals toward potentiating their health. The nurse may also assess for what practices the patient currently has in place that helps to potentiate the health of the Endocannabinoid System: does the patient regularly exercise, receive acupuncture, or see an osteopath? Does the patient meditate, do yoga, or find other ways to mindfully reduce their stress? Is the patient willing or able to explore ways in which their own Endocannabinoid System’s health can be potentiated? And, of course, assessing the patient’s past and current knowledge and use of cannabis is a key component of this process. By creating a caring-healing presence during the assessment process, the nurse can go deeper with their ability to ascertain how this particular patient might benefit from medicinal cannabis use.
With diagnoses, the nurse should consider the patient’s health issues and determine which diagnoses might be addressed with cannabis. In this case, some diagnoses might be obvious, such as chronic pain, insomnia, or fatigue, while others may need more exploration to substantiate. But we might also consider that someone seeking out cannabis as a therapeutic tool for chronic health issues or palliation may be experiencing very important psycho-social-emotional issues that may be defined through diagnoses such as hopelessness, ineffective role performance, stress overload, social isolation, and/or spiritual distress.
PLANNING / INTERVENTION
When it comes time for planning and designing the cannabis intervention, the nurse must know about the state’s medicinal cannabis programs and resources. The nurse may work alongside an interdisciplinary team and educate those team members as needed to ensure that the patient has the best care and that the entire healthcare team is knowledge-able regarding how cannabis might benefit the patient. The nurse also ensures that the patient and their caregiver are knowledge-able regarding cannabis access, dosing, safety, and side effects, while also considering the patient’s financial ability to pay for their medicine. The nurse helps the patient find ways to track their cannabis use through a diary or logbook, and encourages them to note the effects of any given strain or particular cannabis-based medicine they may be using. The Cannabis Nurse advocates for the patient while ensuring that the process remains patient-centered.
Throughout the work with the patient, the Cannabis Nurse remains a caring-healing presence and is committed to enacting human caring theory at the bedside. Human caring is: “The guiding moral idea of nursing; human attempt to connect with others in order to protect, enhance, preserve, human dignity and humanity with integrity as one supports a person toward finding meaning in illness, suffering, pain, and existence (ANA, 2015a; Watson, 2012)” (as cited in Clark, 2017). To be truly caring at the bedside, the Cannabis Nurse must make both their self-care, and their psychoneuroimmunological health, a priority.
At the basis of the nurse’s caring-healing presence is respect, or perhaps even a deep reverence, for the person, we are called to care for; this reverence also extends to ourselves and our colleagues (Koerner, 2007). As we become present with another human being, we can recognize the value of the human before us, healing is catalyzed, and transformation occurs. We must be fully present with patients, in a reverent and caring manner to find the success we so desire in being a conduit for their healing. This is the essence of the applied art of nursing.
While I have written about this in-depth elsewhere (Clark, 2014), one of the key aspects of creating a caring-healing presence, of being able to see and be with the patient in deeply meaningful ways, is to first care for the self. The Cannabis Nurse should practice self-care activities and be on their healing journey to create a truly present caring-healing environment, which will enhance the patient’s healing potential (Watson, 2012).
Eventually, it is the goal of the ACNA to support Cannabis Nursing as an officially recognized specialty within nursing. Next steps with this process include the addition of the APRN role to the Scope and Standards of Cannabis Nurse Practice and approaching the American Nurses Association to engage in the process of receiving feedback and guidance related to the specialization process. Additionally, further development and expansions of curricula that will help enhance nurses’ growth in cannabis nursing expertise, development of cannabis nursing specific textbooks, and creation of a certification test will be required. The Scope and Standards have been shared with the National Council of State Boards of Nursing, and we remain hopeful that they will align their formal recommendations around nurses working with cannabis patients with our document. While there may be challenges ahead as we strive to professionalize this role, we are making a great movement toward supporting Cannabis Nurses in maximizing their roles.
American Nurses Association. (2015). Scope and standards of practice (3rd edition). Silver Springs, MD: Author.
Blesching, U. (2015). The Cannabis Health Index. Berkeley, CA: North Atlantic Books.
Clark, C.S. (2014). Stress, psychoneuroimmunology, and self-care: What every nurse needs to know. Journal of Nursing and Care, 3, 146. doi:10.4172/2167-1168.1000146
Clark, C.S. (2017). The Scope and Standards of Cannabis Nurse Practice. The American Cannabis Nurses Association. Retrieved from https://cannabisnurses.org/resources/ACNA%20Scope%20and%20Standards%20of%20Practice/ACNAScopeAndStandardOfPractice07172017.pdf
Koerner, J. G. (2007). Healing Presence: The Essence of Nursing. New York, NY: Springer Publishing.
Watson, J.M. (2012). Human Caring Science: A Theory of Nursing (second edition). Sudbury, MA: Jones and Bartlett.