President’s Message   --  Jo Eland, PhD, RN                  

NURSING OWNS PAIN

Last year when the results of the election were announced at the business meeting a member sitting next to Joyce Willens stated, “You’ve elected the photographer president?”  Joyce, of course, clarified the situation that I brought a little bit more than photography to the presidency.

First off, let me say that I am honored and humbled to be your president for the upcoming year.  In preparation for this responsibility I have redesigned the ASPMN web site twice, have served on the original Product Line Manager (PLM) task force, served two back-to-back terms on the Board of Directors and last year as your president-elect.  From my perspective it is now or never.

My journey in pediatric pain began in 1971 as a faculty member supervising students on a pediatric oncology unit in Omaha, Nebraska.  At that period of time children were diagnosed with advanced disease, little could be done for them and many died.  As if the death of a child wasn’t enough, these children also died in pain with only Tylenol occasionally being offered for relief.  The only thing worse than watching your child die from cancer would be to see them dying in pain.  Watching so many children die in unrelieved pain caused me to begin reading everything I could about pain and soon found there was virtually nothing written about pediatric pain.  The memories of so many children dying in unrelieved pain left a lasting impression that has never left me.  The rest, as they say, is history because that led to a master’s degree, a doctorate, research, teaching traveling and a crusade on behalf of children in pain that has lasted over forty years.

ASPMN is in a very special moment in time where many of the dreams of our founders and early leaders are becoming true.  In April of this year, the current Board of Directors, the Past Presidents and Founders gathered at the University of Virginia to place our historical items in their historical archives.  It was a wonderful event and we were all so pleased to place our history where it can be preserved and used by students for further research.  Ellyn Schreiner, a member of the Board of Directors, has to be given a great deal of credit for the effort she put in to find our missing materials, organizing our materials and preparing the scrapbooks.  The members of ASPMN will forever be in her debt for preparing these materials.

During a dinner meeting prior to the conference in Tucson, I was sitting across the table from current board member Melanie Simpson where, in the course of our discussion, she stated “I own pain at our institution!”  By that she meant that she was the person who would advocate, persist, take ownership and insist on improved pain management.  The more I thought about it I believe she was right, Nursing Owns Pain! 

Connie Wright RN, MSN from the University of Chicago in support of that phrase said, “Although bedside nurses don’t order meds, they do ultimately have control over the PRN meds (and telling them it does not mean “please restrict narcotics”), can speak to timing of adjunctive meds with opioids to provide more ATC effect vs. snowing the patient and then leaving them hanging for hours with no coverage, and can be the “voice” of the patient and ask for consideration of ATC timing of some meds by order.  “Own” should not mean we are stuck with the duty, but should mean we (nurses) take pride that we can artfully, tactfully, knowledgably manipulate and successfully subdue our patient’s pain issues.”  The theme of this year and perhaps every year should be “Nurses Own Pain” and we can let this phrase energize us to carry out this very special advocacy on behalf of our patients.

We have become the organization that organizations are coming to request input on nursing and pain.  Our “Man on the Hill”, Wade Delk, has represented us in countless activities ranging from the FDA to input on issues in Washington State, Ohio, New Jersey and sat on a 30-person panel at the White House to represent us.  Imagine that – one of 30 at the White House!   Our past presidents who have left this earth, Jeanne and Annabelle, have to be looking down from heaven and smiling broadly at this accomplishment.  For those of you who do not know, we have Wade as a 50% employee of ASPMN and in my opinion hiring him was one of the smartest things this organization has done.  He reads widely, asks good questions, is empathic and truly believes in what we do.  Our efforts in many national and state issues must continue to protect nursing practice and continue our advocacy for our patients.

One of the state issues ASPMN was involved in last year was in Washington State.  The Executive Committee (Current President, President-Elect, Immediate Past President and Jerrie Lynn Kind, our Executive Director) was made aware of a piece of legislation that had been introduced as a bill in the legislature.  After reading a copy of the bill it was transparent that a young person from a prominent family had died from an overdose of opiates and that the family had a connection with a member of the legislature.  After doing our homework about this bill that indeed was the case.  A young person had been provided with opiates from a pill mill run by a nurse practitioner (makes me VERY sad). 

Without going into all of the details of the bill, perhaps the most disturbing piece from my perspective was requiring people with persistent pain and probably cancer pain were going to be required to consult with a pain specialist for ongoing supervision in the treatment of their pain.  In a perfect world this would be a great idea but there aren’t nearly enough pain specialists in the State of Washington (we checked) to even come close to providing care for this large number of pain patients.  In spite of the efforts of many, this restrictive piece of legislation passed.  How it is going to be funded and the follow-up to track these patients remains an issue.  It is rumored that the State of Oregon is interested in this type of law for its citizens.  ASPMN must keep our finger on the pulse of this type of legislation and provide input on behalf of nursing and patients.

Perhaps the only great thing about this legislation is that it shows the power of one family’s influence on the creation legislation that has now became law.  The question arises for all of us is “Who do we know that has had a remarkably positive experience with pain treatment whether they it be a persistent or cancer pain problem?”   As nurses we need to keep lists of the individuals who have had these experiences, who we can empower to speak on behalf of excellence in pain treatment either in a proactive role or in a reactive mode to similar pieces of legislation.  Perhaps nurses could have their own little rapid response team of former patients and their families.  Our patients also know powerful people who also could legislate proactively those who suffer from pain. 

The New Jersey legislature acted on behalf of people in pain last year when they passed a law that prevented insurance companies from requiring that people’s pain treatment had to begin with NSAIDs and then when proven unsuccessful move to opiates.  ASPMN did provide testimony and received some nice media attention on this matter.

We also need to be prepared to speak ourselves whenever we have the opportunity in the public sector.  Members of the Board of Directors are going to Washington DC in late October for media training with Denzenhall Resources (supported by a generous grant from Purdue Pharma, LP) and are attempting to go in early to “go to the Hill” with Wade to speak on behalf of nursing and people in pain.  In the future we will also have an online webinar for anyone else who would like to improve their skills. 

As you read this don’t be afraid of picking up the phone to call some member of the legislature or the media as we have important messages.  Wade Delk, in his report (at the conference) used a great analogy from the movie Hook which starred Dustin Hoffman as Hook and Robin Williams as the adult Peter Pan.  In a line from the movie the adult Peter Pan says, “You don’t look as big as you used to!” and Hook replied, “I look much larger to ten-year-old boys!”  Members of the state and national legislature don’t look very big to me either and all I need to do is to put the face of a former patient (the choice is large) who suffered from severe pain in my head and I can become formidable. 

There is no question in my mind that all ASPMN members have similar pictures in your head that can make you rise up to the occasion.  It’s an election year and legislators around the country both at state and national levels know we are not happy with them so let’s make it a point to help them see pain through our eyes!

When ASPMN becomes aware of state or federal legislation regarding nursing and/ or people in pain we will inform you.  Even if you have never provided input before you may need to step up to the table and speak or write.  You can only fail at this request if you stay silent.

We all need to take it upon ourselves to “Spread the Gospel of Pain” whenever we can.  Long ago we learned that talking about what we do as a nurse is a guaranteed social conversation killer.  However, the time has come when we need to speak up because the public is so terribly confused between people who have the disease of addiction and individuals who take opiates for pain. 

Every nurse who has ever administered an opiate has faced this question.  We need to speak up at schools, churches, social gatherings and with the media.  If there is a presentation being made at a local school, then we need to be present to support the efforts to eliminate prescription drug abuse but to REMIND people that people in pain may need their analgesics as much as a diabetic needs insulin or a person with hypertension needs their anti-hypertensives.  We need to support people who have the disease of addiction and remind others that this is a chronic disease and just like any chronic disease has times when things are not going so well and the individual slips back into past habits.  In our practice lives we have all seen diabetics who have suddenly had a desire for pecan pie and end up being admitted in DKA.  The same is certainly true for individuals with addiction problems but, unfortunately for high profile celebrities, their slip-ups are headlines in the national news and not presented as a person with a chronic disease.  As a result, the public misunderstandings’ concerning addiction is magnified over several times.

In this year I would encourage you all to “OWN PAIN,” support your local chapter of ASPMN (and if you don’t have a local chapter start one), and whenever possible speak on behalf of people in pain whether it is at your church, school, legislature or the national scene.  We need your input, no, let me rephrase that, patients need your input.

In closing, I would remind you of our mission statement:  To advance and promote optimal nursing care for people affected by pain by promoting best nursing practice.  And our overarching goal which is becoming a reality:  Be the leader whose preeminent voice and unparalleled resources catalyzed the integration of pain management nursing into all aspects of health care.

Together, let's have a great year!

Jo