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The purpose of this article is to provide an Overview of the NCSBN Guidelines and recommendations for the Nursing Care of Patients Using Cannabis.1

The National Council State Boards of Nursing (NCSBN) published the NCSBN National Nursing Guidelines for Patients Using Medical Marijuana through the NCSBN official Journal of Nursing Regulations in the July 2018 Supplemental issue.2

The publishing of National Nursing Guidelines for Patients Using Medical Marijuana marks an important time in nursing history. For the first time, state nursing boards now have much needed guidance from a national level to help structure policy and decisions regarding cannabis related topics relevant to each state. Individual state boards of nursing, who were previously hesitant or waiting for federal approval to address cannabis issues, now have structure and support in implementing changes based on new and nationally recognized nursing guidelines.

The National Council State Boards of Nursing guidelines and recommendations include current legislation, scientific literature review, and nursing implications.

The topics of review relate to four (4) areas that are relevant to nurses practicing in all states, and especially where medical and adult-use cannabis laws are currently in effect or progressing.

  1. Nursing Care of the Patient Using Medical Marijuana3
  2. Medical Marijuana Education in Pre-Licensure Nursing Programs4
  3. Medical Marijuana Education in APRN Nursing Programs5
  4. APRNs Certifying a Medical Marijuana Qualifying Condition6

 

Purpose of the Guidelines

These guidelines provide nurses with principles of safe and knowledgeable practice to promote patient safety when caring for patients using medical marijuana.

Recommendations

Essential Knowledge

  1. The nurse shall have a working knowledge of the current state of legalization of medical and recreational cannabis use.7
  2. The nurse shall have general knowledge of the principles of a Medical Marijuana Program (MMP).8
  3. The nurse shall have a general understanding of the endocannabinoid system, cannabinoid receptors, cannabinoids, and the interactions between them.9
  4. The nurse shall have an understanding of cannabis pharmacology and the research associated with the medical use of cannabis.10
  5. The nurse shall be aware of the facility or agency policies regarding administration of medical marijuana.

Clinical Encounter Considerations

  1. As part of the clinical encounter for a patient using cannabis for medical use, the nurse shall conduct an assessment related to the following:
    1. Signs and symptoms of cannabis adverse effects
    2. Dose, route of administration, symptoms, relief, and adverse effects
  2. The nurse shall communicate the finding of the clinical encounter to other health care providers and note such communication in documentation.
  3. The nurse shall be able to identify the safety considerations for patient use of cannabis.11  

Medical Marijuana Administration Considerations

  1. The nurse shall not administer cannabis to a patient unless specifically authorized by jurisdiction law.12
  2. Instances in which the nurse may administer cannabis or synthetic THC to a patient.
    1. FDA-approved synthetics as per facility formulary and policy13
    2. Registered MMP-designated caregiver

Ethical Considerations

In addition to ethical responsibilities under the nurse’s jurisdictional law, the nurse shall approach the patient without judgement regarding the patient’s choice of treatment or preferences in managing pain and other distressing symptoms.14   

 

Awareness of one’s own beliefs and attitudes about any therapeutic intervention is vital, as nurses are expected to provide patient care without personal judgment of patients.15

Additional References:
  1. Nursing Care of the Patient Using Medical Marijuana https://www.journalofnursingregulation.com/article/S2155-8256(18)30095-4/pdf
  2. Journal of Nursing Regulation (JNR) July 2018
  3. Nursing Care of the Patient Using Medical Marijuana https://www.journalofnursingregulation.com/article/S2155-8256(18)30095-4/pdf
  4. Medical Marijuana Education in Pre-Licensure Nursing https://www.journalofnursingregulation.com/article/S2155-8256(18)30095-4/pdf
  5. Medical Marijuana Education in APRN Nursing https://www.journalofnursingregulation.com/article/S2155-8256(18)30096-6/pdf
  6. APRNs Certifying a Medical Marijuana Qualifying https://www.journalofnursingregulation.com/article/S2155-8256(18)30097-8/pdf
  7. A Nurses Petition for Rescheduling Cannabis https://cannabisnursesnetwork.com/2018/07/an-update-rescheduling-petition-for-cannabis-2009/
  8. Cannabis Laws by State https://www.newcannabisventures.com/state-medical-marijuana-programs/
  9. The Endocannabinoid System Basics. https://cannabisnursesnetwork.com/2018/01/basics-of-the-endocannabinoid-system/
  10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5312634/
  11. Patients Out of Time Position Statement in Support of De-Scheduling Cannabis. https://cannabisnursesnetwork.com/2018/07/patients-out-of-time-position-statement-in-support-of-de-scheduling-cannabis-from-december-2016/
  12. Colorado Law Allowing School Nurses to Administer Medical Cannabis to certified Students. https://leg.colorado.gov/sites/default/files/documents/2018A/bills/2018a_1286_signed.pdf
  13. FDA Approved Epidiolex. https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/210365lbl.pdf
  14. The ethical and legal approach to medical cannabis at the bedside.https://cannabisnursesnetwork.com/2018/07/the-ethical-and-legal-approach-to-medical-cannabis-at-the-bedside/
  15. What makes a cannabis nurse? https://cannabisnursesnetwork.com/2018/08/what-makes-a-cannabis-nurse/
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