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Marijuana for Therapeutic Use

Clinician’s Corner

Angela Totora, MBA/HA, RN
Director of Nursing

Marijuana for Therapeutic Use

There is a lot of talk about medical marijuana.  Do you know what that means to you as a nurse?  Here are a few topics that might help you understand this complex issue. 

Obtaining and using medical marijuana is a complex and somewhat uncertain environment that is created due to the conflict between state and federal laws.  Marijuana is considered a Schedule I substance.  More clearly stated, it is regarded as a federally illegal drug.  Therefore, pharmacies cannot shelve it, doctors cannot prescribe it, and insurance plans cannot cover the expense of it. 

Who Can Recommend Medical Marijuana?

Each state holds unique characteristics for developing medical marijuana programs. These programs include provisions regarding the process of procuring a certification for the use of cannabis.  The medical marijuana programs identify the requirement of a healthcare provider-patient relationship needed to recommend the medical use of marijuana.  Remember, each state defines its legislation with very few commonalities to the other states.  

In Louisiana, only a marijuana certified doctor can complete a recommendation.  At present, a Louisiana doctor can only serve 100 medical marijuana patients at any given time.  This physician must coordinate all of the patient’s medical care.  

Who can obtain Medical Marijuana?

Louisiana does not require patients to join a registry or get a medical marijuana card, as some other states do.  They must obtain a recommendation from a marijuana-certified doctor in Louisiana.  This written recommendation serves as proof of the patient’s eligibility based upon the diagnosis of a qualifying condition.  These conditions include but are not limited to:

Cancer, Crohn’s Disease, Chronic Pain, Destructive or physically aggressive behaviors, Epilepsy, Glaucoma, Hepatitis C, HIV, Muscular Dystrophy, Parkinson’s Disease, Post-Traumatic Stress Disorder, Seizure Disorders, Spasticity and Wasting Syndrome.

What qualifies as Medical Marijuana?

Tetrahydrocannabinols (THC) or a chemical derivative of tetrahydrocannabinols in any of the following forms, as provided by an approved Louisiana licensed medical marijuana dispensary:

  1. Oils, extracts, tinctures, or sprays
  2. Solid oral dosage forms, e.g., capsules or pills
  3. Liquid oral dosage forms, e.g., solutions or suspensions
  4. Gelatin-based chewable
  5. Topical applications, oils, or lotions
  6. Transdermal patches
  7. Suppositories

Inhalation, raw or crude marijuana are not legal forms of medical marijuana in Louisiana.

Where do you get Medical Marijuana?

The Department of Agriculture and Forestry has issued two growing licenses in the state of Louisiana.  Louisiana State University and Southern University hold these licenses.  Even with a recommendation, Louisiana patients cannot cultivate their own marijuana plants.

Medical marijuana has to be in the original pharmacy-issued container to be considered valid medical marijuana.  The required labeling is still to be determined.

Nursing Challenges on Medical Marijuana Handling:

I cannot stress enough how important it is that you research and follow your facility policy and process for the use of medical marijuana.  The Louisiana Hospital Association has issued the following recommendations:

  1. No licensed hospital personnel shall possess or administer medical marijuana. Staff will not under any circumstances procure, store, or handle medical cannabis for the patient.
  2. The patient, the patient’s family or the person chosen by the patient will assume responsibility for safely securing the medical marijuana at all times while on the hospital campus
  3. Pharmacy staff may not assume possession at any time.
  4. A note in the medical record should indicate that the patient is currently utilizing medical marijuana. It should never be documented on the MAR.
  5. Only marijuana in a certified, recognized medical marijuana pharmacy/dispensary container should be accepted.

Impairment Testing:

Multiple reports presented to Congress concluded that the current lab test cannot provide an objective threshold establishing impairment based on a specific level of THC or its metabolites. A positive lab test indicates the presence of THC or THC metabolite.  A peak THC level can occur when low impairment is observed, and high impairment can be observed when THC levels are low.  The metabolization of THC is very individually subjective.

The best advice I can give you is to stay informed.  This topic is hot and quickly changing.  To stay current, utilize multiple resources:

  1. List of Physicians licensed to recommend marijuana – https://www.marijuanadoctors.com/medical-marijuana/la/
  2. State Law: La. R.S, 40:1046et seq.
  3. Louisiana State Board of Examiners: https://www.lsbme.la.gov/
  4. Facility specific policy

References:

Journal of Nursing Regulation. The NCSBN national nursing guidelines for medical marijuana. Volume 9, issue 2, July 2018 supplement.

LA Hospital Association. Marijuana for therapeutic use draft policy.

Marijuana Doctors. Qualifying for Medical Marijuana in LA in 2019. Dr Joseph Rosado. April 9, 2019.

National Council of State Boards of Nursing. Medical Marijuana and nursing practice: current legislation, scientific literature review, and nursing implications PowerPoint. Kent Gowen, Maureen Cahill. 2018.

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How To Avoid The Most Common Mistakes A New Traveler Makes

Everyone has to start somewhere and when you’re new to travel nursing it can be a lot to take in. It’s smart to understand what’s realistic and unrealistic in the world of travel nursing. Most importantly you should know what is expected of you and what you should expect from your agency and hospital. It’s always better to be over prepared than under prepared when taking your first contract.

Make sure to know what you’re getting into, ask questions, join forums, and do your research. So that you can make informed decisions. Don’t be scared to tell you’re recruiter what you want, communication is key when it comes to the relationship between a recruiter and nurse. Also, check out this related article

6 Questions Every Nurse Should Ask In An Interview

• Understanding and doing your own research on the facility you will be contracted to

• Having an unrealistic understanding of what travel nurses earn

• Not communicating with the recruiter the expectations for compensation, scheduling, etc

• Not realizing that committing to a travel contract means that you are to make every effort to successfully complete the assignment

• Missing out on the opportunity to ask the right questions about the unit/client expectations during the interview

• Not reading the terms of the contract that the nurse is signing

• Not understanding the value and importance of building a good working relationship with their recruiter

10 ways

10 Ways To Be A Professional

Have you heard the nurse manager say, “that nurse didn’t act professionally?”  What did that mean?  Isn’t it enough to do your job, and show up on time? What else should you do to be seen as acting professionally?

Professionalism is demonstrated by you providing the care that you would give to your family, or would want to receive yourself.  We all know what it looks like to be seen as “unprofessional,” but how can I display professionalism?  Below are ten ways to be professional:

  1. Have competence – You need to hold the ability to remain calm and confident in moments of high stress, pressure, and critical situations. You need to stay level headed in the day to day bedside actions.  Obtain the skills necessary to provide the best, safest care possible.
  2. Be reliable – Arrive on time, complete your charting on time, administer medication on time, and avoid canceling shifts you have agreed to work.
  3. Honesty – Patients and their families need to know they can trust you. Tell the truth in all situations.
  4. Integrity – Be known for always doing the “right thing.” Don’t give them a reason to think otherwise.
  5. Show respect – Treat all people as if they matter because they do. Your co-worker learns that you respect them when you report on time and complete your work.  Treat them as you want to be treated.
  6. Remain current – seek out ways to update your skills. Healthcare changes daily, stay aware of the new advances within your specialty. 
  7. Be positive – Maintain an upbeat, positive attitude. No one likes a pessimist or a complainer.
  8. Support others – Work as a team. When we work together, we create a sense of synergy. Working as a team, we are much stronger as compared to working alone. Teamwork fosters creativity and learning.  It provides the best results for the physical and psychological needs of the patient and the job satisfaction for the nurse. Working as a team also reduces chances for errors, because there is cross-checking of work and constant communications.  The success of a squad is the sum of all its parts, not just one individual.
  9. Stay work focused – Don’t let your personal life impact your work time. Avoid the gossip mill and the unit drama.  When your contract ends, they will all still be friends.
  10. Listen carefully – Take the time to listen before you speak. Everyone wants to be heard.  Give them a chance to explain their perception.  Listen for the real message, not just the words. 

 Dr. Carolyn Jarvis, APRN, has said: “The character of the nurse is as important as the knowledge she possesses.” (as cited in Bradshaw, 2011); I agree.  Having integrity in the work that you do and the relationships that you build is imperative in all aspects of life.  Honor the profession you have chosen – Act Professionally. 

Reference Bradshaw, A. (2011, May 13). Compassion: What history teaches us.   Retrieved from https://www.nursingtimes. net/roles/nurse-educators/compassion-what-historyteaches:.us/5029818.article

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LWCC recognizes Advantage Medical Professionals as a 2018 recipient of LWCC’s Safest 70 Award

Caption: Joe Spitale, President & CEO of Advantage Medical Professionals, LLC, accepts the LWCC 2018 Safest 70 Award.Pictured from left to right are: Parke Ellis (GEB), Dawn Bahm (LWCC), and Joe Spitale (Advantage Medical Professionals).

Each year, the Louisiana Workers’ Compensation Corporation (LWCC) evaluates the safety performance of its 20,000 plus policyholders across the state of Louisiana and recognizes the top companies for their outstanding safety programs. These “Safest 70” have demonstrated exemplary safety practices and a real dedication to workplace safety. LWCC recognizes Advantage Medical Professionals as a 2018 recipient of LWCC’s Safest 70 Award. With this designation, it makes it the sixth time Advantage has received this recognition in the award’s existence.

 

LWCC acknowledges the Safest 70 policyholders for their efforts in providing their employees with a safe work environment and helping to prevent on-the-job injuries. These policyholders have distinguished themselves as leaders in regards to employee safety within their industry and Louisiana. 

 

“It is a privilege to have LWCC recognize Advantage Medical Professionals as a recipient of this significant award for the sixth time,” said Joe Spitale, President & CEO of Advantage Medical Professionals. “To be honored numerous times highlights Advantage’s continuous dedication to providing its employees with a culture of workplace safety.”

 

LWCC is the largest workers’ compensation carrier in Louisiana. The Safest 70 Award recognizes excellence, outstanding performance, and commitment to workplace safety, and is based on the effectiveness of safety efforts in preventing injuries and controlling costs. The award recognizes Advantage’s contribution to achieving a higher standard and maintaining a consistent workplace safety history.

 

la COMPACT state

The Compact is Coming to Louisiana!

Louisiana is the 31st state in the nation to enact the Nurse Licensure Compact (NLC). The NLC increases access to care, protects patient safety, and reduces costs while supporting state-of-the-art health care delivery. The NLC has been streamlining the licensure process since it was first launched in 1999. The NLC is ideal for travel nurses, and saves nurses who want to take a job in another state the hassle of going through the process of obtaining a separate license.

Currently, all Louisiana licensed nurses hold “single state” licenses. This provides you the authority to practice in the state of Louisiana.  Thanks to the Louisiana legislature agreeing to the nurse licensure compact effective July 1, 2019, all Licensed Practical Nurses, and Registered Nurses who reside in Louisiana and plan to practice in another compact state can convert to a compact license which allows you to practice in multiple states.

 FYI – this does not apply to APRN licenses (sorry guys your time will come).

Highlights regarding a Louisiana Compact License:
  1. You must reside in the state of Louisiana
  2. You must hold an active, unencumbered Louisiana Nursing License
  3. Must not have been convicted or pled guilty to a felony offense under state or federal criminal law
  4. Must not have been convicted or entered into an agreed disposition of a misdemeanor offense related to the nursing practice as determined by the board
  5. Must not be enrolled in an alternative program/the recovering nurse program
  6. The multistate license provides you the “privilege to practice” only in other compact states
  7. If your residency moves from one state to another, you must apply for a new primary state of residency license. To see a map of the states in the compact see

https://www.ncsbn.org/nurse-licensure-compact.htm.

  1. You must submit a Multistate Conversion Application
  2. Submit fingerprints for an FBI background check (this requires an additional fee)
  3. Submit the conversion fee of $50.90
  4. Your renewal requirements for renewal remain unchanged and unaffected by the conversion application

As a final portion of the state becoming part of the compact, every employer is required to register each nurse into the Nurssys system (www.nursys.com).  This process will guarantee immediate notification to all employers of any board action taken in any state. If a board action occurs, your license will automatically convert back to a single state license.

For more information on the NLC visit:

https://ncsbn.org/index.htm

https://www.lsbn.state.la.us/

https://www.ncsbn.org/compacts.htm

https://www.ncsbn.org/nlc-toolkit.htm