Evolving Cannabis Nursing Specialty Struggles for Acceptance

Lisa Buchanan worked as an oncology nurse at the Seattle Cancer Care Alliance with patients being treated for lung, head, and neck cancers when she discovered a new calling. "Those are pretty rough cancers, and some of my patients were using cannabis to help their symptoms. But there wasn't a lot of information available."

Having long been interested in cannabis therapeutics, Buchanan, RN, began teaching her older cancer patients about medical uses of cannabis. "Some of them were really interested in trying it but didn't want to go into a dispensary alone," she said.

After 25 years in traditional nursing jobs, Buchanan took a break from oncology nursing and is now a "budtender" at a Seattle cannabis store, part of a nursing specialty gaining traction in the United States. She works as a medical cannabis consultant and is part of the management team at Dockside Cannabis. "My store role is not as a nurse, although sometimes customers who have a health issue are referred to me," she said.

While stigma remains, the increasing recognition of cannabis' medicinal uses has nurses like Buchanan pushing for official recognition of cannabis nursing as a nursing specialty. An indication of interest in the subject is that the agenda for the American Association of Nurse Practitioners' national conference in June includes three workshops on medical cannabis.

"People want to use cannabis and they go into a dispensary but have no idea what they're doing or how the different products work, and could really use that support," said Buchanan. "Nurses can help fill these gaps."

Nurses face numerous roadblocks. Formal education for cannabis nursing is lacking, there's no national certification exam, and nurse licensing bodies have no plans to certify the specialty.

Weed, dope, pot, marijuana — cannabis goes by many names. Although cannabis continues to be classified at the federal level as a Schedule I substance, most states have legalized the medical or recreational use of cannabis, or both. Currently, 38 states allow the use of medical cannabis, and of those, 15 also allow recreational use.

Role of a Nurse

Cannabis nursing differs from more familiar specialties such as med-surg, labor and delivery, or critical care. Unlike other nursing specialists, cannabis nurses do not offer direct care such as taking vital signs or dispensing drugs.

They do not dispense cannabis to patients, explained Heather Manus, RN, founder of the Cannabis Nurses Network (CNN). "We can counsel patients and provide them with information, and advocating for cannabis patients is a big part of our work," said the advocate from San Diego, California.

Among the states that allow only its medicinal use, laws vary when it comes to the medical conditions cannabis can treat. Because it is still illegal, cannabis cannot be prescribed.

Instead of a prescription, clinicians may write recommendations to a dispensary that a patient will benefit from cannabis. Cannabis nurses also don't obtain the substance for patients.

Professional Credentials

The path to becoming a cannabis nurse could be similar to other types of nursing, advocates say. Cannabis nurses can be a licensed practical nurse (LPN), registered nurse (RN), nurse practitioner (NP), or doctor of nursing practice (DNP). They can hold any type of degree that qualifies them as a nurse: associate's, bachelor's, master's, or doctorate. There is no a specific education requirement.

Regardless of degree, cannabis nurses would be required to have a comprehensive knowledge of medical cannabis, such as understanding the endocannabinoid system, how cannabis affects the body, the therapeutic parts of the cannabis sativa plant, and the current medical indications for cannabis use, advocates say.

There is currently no national certification exam to become a cannabis nurse, although the American Cannabis Nurses Association (ACNA) has been trying to get nurses certified through the American Nurses Association (ANA) and its American Nurses Credentialing Center (ANCC).

The credentialing agency reports that it is not currently developing any new certification programs. The agency routinely receives requests for developing certifications, but at this time, there are no national certification guidelines for cannabis nursing, ANCC said.

In the meantime, the ACNA and CNN provide continuing education courses and training for interested nurses. Nurses can then get a certificate that shows completion of cannabis education courses, which is helpful when seeking work in this specialty.

Lack of Formal Education

The National Council of State Boards of Nursing (NCSBN) has National Nursing Guidelines for Medical Marijuana, designed to fill the gap in the literature on the nursing care of patients using cannabis. However, it is not continuing education. In addition, the nurse licensing exam has included questions about clients receiving controlled substances, such as cannabis, for more than a decade, according to NCSBN. Students report, though, that nursing schools have not added the content to the curriculum, Manus said.

A recent study of about 1350 nursing students across the United States found that while 90% of respondents believed cannabis has therapeutic benefits, three quarters also reported that medical cannabis was not part of their curriculum.

"Students are not receiving the content for a number of reasons, including that faculty have not been educated about the endocannabinoid system," said study coauthor Carey Clark, PhD, RN, AHN-BC, professor of nursing and medical cannabis at the Pacific College of Health and Science in Chicago, Illinois. "There remains a stigma around cannabis as a prohibited recreational drug, and curricula are already so full."

Clark added that even though a few questions have been added to the National Council Licensure Examination (NCLEX), she believes that it will take the NCSBN adding more and comprehensive medical cannabis questions to the prelicensure exam to ensure schools of nursing start teaching about this topic.

The study also showed that it didn't matter if students lived in a state where cannabis use was legal, either for medical or nonmedical use — there is a lack of information about cannabis in nursing school curriculums.

"Faculty also tend to present the information from a biased point of cannabis as a recreational drug with the potential for abuse versus medical cannabis having the potential for supporting healing and homeostasis," said Clark, who is also past president of ACNA.

Clark also noted that there is fear among faculty about teaching about cannabis. "They don't understand how cannabis works in the body, and they have not updated their curricula to meet the NCSBN 2018 guidelines," she said.

"Ethically, that is problematic because so many patients are using cannabis, and most nurses do not know how to support these patients in using cannabis safely and effectively."

Employment opportunities for cannabis nurses remain limited. Some work in dispensaries, like Buchanan, though she notes that they typically prefer "budtenders" to nursing professionals because of the lower salary. Others work with product manufacturers to develop educational tools, look for opportunities to become navigators within their hospital or clinical setting, or become entrepreneurs with their own consulting companies.

Eloise Theisen, RN, MSN, AGPCNP-BC, a certified adult geriatric nurse practitioner who specializes in cannabis therapeutics, owns Radicle Health, which specializes in cannabis treatment plans and education for medical professionals on the practical applications of cannabis.

Denver-based Marcie Cooper, MSN, RN, AHN-BC, education director of CNN, has been a hospice and palliative care nurse since 2007. She's also a part-time adjunct nursing faculty at a community college.

Her role includes teaching future nurses about the risks and benefits of cannabis with a focus on aging adults. Cooper hopes to add more cannabis courses to the nursing curriculum. She and other cannabis nursing advocates also hope this emerging area of patient care will soon take its place alongside other recognized and respected nursing specialties.

Roxanne Nelson is a registered nurse and an award-winning medical writer who has written for many major news outlets and is a regular contributor to Medscape.

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