Amy K. Johns, RN, ONC 4665 Samels Road Williamsburg, MI 49690 March 3, 2014 Joshua M.

Meringa, RN, Chairperson Michigan Board of Nursing P.O. Box 30670 Lansing, MI 48909 Dear Mr. Meringa, My name is Amy Johns and I am an acute-care nurse at Munson Medical Center in Traverse City. I am writing today to discuss the need for improvement in the quality of care and safety for millions of people from every socioeconomic stratum and in every inpatient setting. This is a problem so widespread that only comprehensive and all-encompassing change undertaken at the state level will be pervasive enough to affect the change in nursing culture that is needed improve conditions for these patients. I am referring to the many patients who present with chronic alcoholism; a condition that carries with it cultural stigma which results in underreporting of actual alcohol consumption by the patient, and biased, inconsistent delivered by nurses and providers. Statistics provided by the CDC state that approximately 15 percent of adults are binge drinkers and 5 percent of adults can be categorized as daily heavy drinkers. It is also widely known that alcohol consumption is widely underreported. Accurate statistics and the true nature of alcoholism are difficult to ascertain. However, even with this minimal number, nurses are typically caring for several patients per week who will potentially experience withdrawal symptoms which can be life-threatening. Patient-nurse communication is fraught with difficulty due to the stigma of addiction; therefore, it is crucial that the nurse be educated in the physiology of chronic alcohol ingestion, withdrawal and the signs and symptoms of both. Addiction is a condition that thrives on secrecy and lack of understanding. It is imperative that nurses be well educated so that they may better execute the nursing process. A nurse who is undereducated in the signs and symptoms of chronic, heavy alcohol use, and withdrawal will miss crucial assessment clues and opportunities for communication and teaching with patients and families. As a requirement for licensure in Michigan, registered nurses complete 25 hours of continuing education, the content of which must meet the criteria of the Board of Nursing. One hour of this must specifically be on the topic of pain and pain symptom management. A part of the approved education on pain consists of assessment of medication usage at home prior to hospital admission. It is my contention that the statistically high number of patients who present for hospitalization who self-administer alcohol on a daily basis, along with the high physiological impact this incurs parallels in importance to assessment of self-administration of home medications. I would like to propose that the CEU requirement for registered nurse licensure in Michigan contain one hour of education specifically pertaining to alcohol abuse/alcoholism and

withdrawal. Content similar to that covered in the pain management nursing education that addresses basic psychology of addiction, physiology of the effects of alcohol on the body, physiology of withdrawal, and interventions addressing both would be beneficial on many levels. I believe that mandating education regarding alcoholism and withdrawal is a step toward standardization and improvement of care for this population. In summary, alcoholism and withdrawal from alcohol are condition that nurses see very frequently in practice but signs and symptoms may be missed due to the secrecy and stigma that surround addiction which result in decreased communication between nurse and patient. Education regarding effects of alcohol and alcohol withdrawal is needed to bring them into the consciousness of nurses. I propose that the CEU requirements for registered nurse licensure be amended to include one hour specifically dedicated to the conditions of alcoholism and withdrawal from alcohol. Thank you for your time,

Amy Johns, RN, ONC