Psychedelic Nurses: A Look into the RN’s Role in Therapy and Integration

The field of psychedelic medicine is evolving. And that means there are new opportunities for therapists, MDs, and nurses to get involved in delivering therapy. We hope that nurses will get involved in this exciting, evolving field. Let’s talk about psychedelic nurses: the RN’s role in therapy and integration. 

Psychedelic medicine and nursing have very similar philosophies. The focus on patient healing is a core idea in both fields. Nurses, from LPNs (Licensed Practice Nurses) to APRNs (Advanced Practice Registered Nurses) are uniquely positioned to help deliver psychedelic therapies. 

Psychedelic Support is all about educating patients and practitioners about psychedelic medicine. We’re especially passionate about the role nurses will play in their evolving field. 

We believe nurses will play a crucial role in research, safety, and delivering psychedelic therapy to patients. 

As with all new fields of medicine, nurses will be vital to upholding standards of care as psychedelic medicine grows and evolves. Here are a few of the important ways nurses will help patients heal through psychedelic medicine.  

Nurses as Safety Advocates in Psychedelic Medicine

Patient safety is a foundational component of nursing education and practice. While MDs and therapists may have specific roles in integrating psychedelic therapy, nurses will help implement standards of safety to protect patients. These safety standards will likely be implemented before, during, and after psychedelic therapy. 

Pre-screening Questions and Preparing Patients

Pre-screening questions will help protect patients from some of the risks of psychedelic therapy. Gathering detailed patient histories is an important role in most nursing specialties, including OR (operating room), inpatient, and home care. 

Nurses are trained to pay attention to details in patient care, like knowing whether a patient had a blood thinner before sending them into the OR. A history of depression is crucial to address before discharging a mom home with a newborn. The same attention to detail and critical thinking will make nurses a valuable asset during psychedelic therapy preparation [1]. 

• Detailed Assessment: In psychedelic medicine, nurses may help perform pre-screening before therapy begins. This will include assessing their mental health history, substance use, and previous experiences with psychedelics. Understanding a patient’s history of trauma will also help the nurse and therapist guide the patient through their experiences. 

• Patient education: Nurses can prepare patients for psychedelic therapy by telling them what to expect. Preparing patients for therapy during pre-substance sessions will help patients feel at ease going into active sessions. Patients gain control by understanding their care plan, and can be active participants in their own treatment. 

• Positive Rapport: Establishing relationships with patients can also help them feel comfortable, knowing that they are in the hands of skilled and compassionate staff. As relationship-builders, nurses can bring emotional and physical support to patients in psychedelic therapy. 

Psychedelic Administration Supervision

Much like nurses in the OR, psychedelic medicine nurses can be key advocates for patient safety during active psychedelic sessions. These sessions will likely be supervised by a psychedelic therapist as well. Since the subscribing MD may not be in the room when a patient receives psychedelics, the nurse will be their eyes and ears. 

Assuring safety during these sessions will likely mean a detailed physical and mental assessment to establish a patient baseline. The nurse may orient the patient to the room and assure them that they are being closely monitored. Briefing the patient on what to expect from this experience can give them a feeling of control. 

Some psychedelics may require repeated vitals monitoring throughout the active substance session. Nurses may also administer small mental assessments throughout this session to monitor the patient’s experience. 

It’s possible that standing orders will need to be in place in case of patients’ adverse events. For instance, a patient receiving LSD therapy may benefit from a standing order of anti-anxiety medication in the case of psychosis. The nurse will be responsible for evaluating and implementing these standing orders. Any unexpected events in therapy will be reported to the prescribing MD. 

MDMA shows promise in the group therapy setting. Inpatient psychiatric nurses lead group talk sessions and help control the social milieu in these circles. Psychedelic medicine nurses delivering group MDMA therapy may have a similar role in assisting with group sessions and facilitating a positive group atmosphere. 

The simple act of “sitting” with a patient during their experience could be an important role for nurses. Helping the patient through intense feelings while creating a safe, therapeutic environment will make nurses vital during active drug sessions [2]. Ensuring that the patient feels safe before and during their session can help ensure that they have a positive therapeutic experience [3]. 

Post-session Follow-up

Nurses have an important role in monitoring patient outcomes. Following up with patients post-session not only helps clinicians keep track of outcomes, but it can help improve practice standards over time. 

After an active session, the nurse may evaluate the patient for immediate responses to their experience. Nurses may also refer patients to other resources like support groups.

Finally, the nurse will document each phase of psychedelic evaluation, therapy, and integration. As key safety advocates, nurses can help protect patients and let other clinicians focus on their roles in therapy. 

Hospice Nursing and Psychedelic Medicine

Patients in end-of-life care may especially benefit from psychedelic therapy. Palliative care providers are increasingly open to psychedelic-assisted therapy in the setting of late-stage cancer [4]. MDMA, psilocybin, and ketamine could provide relief to patients suffering from anxiety and depression during their last days. 

Hospice nurses will likely play an important role to help patients in hospice and end-of-life care get relief from psychedelics. Psychedelics could be an important tool for hospice nurses – unlike opioids, which diminish pain but raise an ethical concern by speeding up death. 

Instead of blunting pain, psychedelics can give patients insight and peace during this fearful time. Hospice nurses could give their patients relief and healing during their final days with psychedelic therapy.  

Canada’s Special Access Program now allows patients with terminal illnesses to access psychedelic medicine. Under this program, palliative care nurses have opportunities to evaluate patients for psychedelic interventions and to monitor their outcomes. 

Evaluating and Educating Patients and Family

Hospice nurses make deep, special connections. They have the unique experience of seeing patients in their homes, often among close family and friends. They help patients through waves of emotions and exhaustion and can guide patients through depression and anxiety around death. 

One of the hospice nurse’s roles may be using their skills of rapport-building and assessment to determine if a patient can benefit from psychedelic therapy. Symptoms like anxiety and depression during their regular assessment can be flags for therapy. 

Educating patients and families is another core skill of hospice nursing. This will be especially helpful when applying psychedelics to care. Making sure patients and families know what to expect may alleviate anxiety and make the psychedelic experience easier for everyone. 

Monitoring and Assessment

The hospice nurse will continue to closely monitor patients during psychedelic therapy. During these sessions, another therapist will likely be in the room. The nurse’s role may be to monitor a patient’s physical and psychological symptoms and notify the supervising MD of changes. 

Educating family may be another important RN role during active substance sessions. By answering any questions and offering family support, the nurse can enable the therapist to focus on the patient. 

Even after the active session, the hospice nurse will continue to evaluate the patient for outcomes. Ongoing support and guidance are critical components of the nurse’s role in psychedelic medicine. 

Advanced Practice Psychedelic Nurses 

Advanced Practice Nurses (APRNs), like Nurse Practitioners (NPs) and Doctorates of Nursing Practice (DNPs), could also be vital for psychedelic therapy implementation and access. 

The APRN role will likely be closer to the subscriber. Under medical supervision, NPs and DNPs may evaluate a patient and prescribe psychedelic therapy. Psych NPs can help prepare a patient for therapy by managing medications and determining their mental readiness. 

APRNs are a huge asset for patients because they help alleviate the shortage of doctors. APRN involvement will allow more people to access psychedelics and experience their benefits.  

APRNs have already helped with psychedelic access to ketamine. Many Certified Registered Nurse Anesthetists (CRNAs) deliver ketamine infusions in the clinic setting. We hope that APRNs will help increase the availability of other psychedelics as they become available. 

Key Takeaways for Nurses Interested in Psychedelic Medicine

“The growing field of psychedelic therapy will greatly benefit from nursing participation in the interdisciplinary effort to develop safe, effective clinical approaches to psychedelic-assisted therapies. . . Psychedelic-assisted therapies offer great potential to alleviate suffering and cultivate healing, growth, and peace amid illness, and nurses are well prepared to contribute.”

– Andrew Penn, MS, NP, PMHNP-BC [2]

The nurse’s role in psychedelic therapy will be multi-fold. There are so many opportunities for nurses to enter the evolving field of psychedelic medicine. By increasing patient safety, supporting therapists, and subscribing, nurses will be key players in bringing psychedelic therapy to the masses. 

Are you a nurse looking to be part of ground-breaking mental health treatments? You could help patients experience the life-changing benefits of psychedelic medicine. Join OPENurses, a psychedelic nursing organization co-founded by Andrew Penn, Wendy Marussich, Angela Ward, and Liz Willis. Check out Andrew’s talk from our monthly free speaker series on how nursing informs psychedelic medicine.

References

1. Marks, M., Cohen, I.G. Psychedelic therapy: a roadmap for wider acceptance and utilization. Nat Med 27, 1669–1671 (2021). https://doi.org/10.1038/s41591-021-01530-3
2. Penn, A., Dorsen, C. G., Hope, S., & Rosa, W. E. (2021). Psychedelic-Assisted Therapy: Emerging Treatments in Mental Health Disorders. The American journal of nursing, 121(6), 34–40. https://doi.org/10.1097/01.NAJ.0000753464.35523.29
3. Pilecki, B., Luoma, J. B., Bathje, G. J., Rhea, J., & Narloch, V. F. (2021). Ethical and legal issues in psychedelic harm reduction and integration therapy. Harm reduction journal, 18(1), 40. https://doi.org/10.1186/s12954-021-00489-1
4. Niles, H., Fogg, C., Kelmendi, B. et al. Palliative care provider attitudes toward existential distress and treatment with psychedelic-assisted therapies. BMC Palliat Care 20, 191 (2021). https://doi.org/10.1186/s12904-021-00889-x