Substance Use Nursing in Rural Contexts

An Addiction Practice Pod interview with Kate Hodgson

Harms associated with substance use and the toxic drug supply affect all parts of the country. However, clinicians working in rural areas face different circumstances than those in urban centres due to resource constraints and unique relationships with communities they serve.

In a recent episode of the Addiction Practice Pod, we spoke with Kate Hodgson, Nursing Practice Consultant with First Nations Health Authority (FNHA), about her perspective on rural substance use nursing.


Q: Rural substance use nursing may be a new concept for some of us. Can you tell us about substance use nursing in a rural context?

A: I think that rural substance use nursing is its own specific skillset because rural communities have a unique set of needs. Often, nurses that come from urban settings are surprised at the scope of practice for rural substance use nurses. One day we might be doing more social work things, or maybe even more physician or nurse practitioner type things, [for example] referring clients to other care providers or managing episodic and chronic illness autonomously, depending on the remoteness of the community.

Early in my career, I was given the very strong message that, in order to be a good nurse, you needed to have urban experience, otherwise you might not have the technique or knowledge to respond in crisis. And that's not necessarily true. [As rural substance use nurses], we’re doing primary care, we’re doing urgent care, we’re doing substance use nursing, we’re doing counselling. But really rural substance use nursing relies on that ability to be flexible and to develop meaningful therapeutic relationships.

Q: If I was a nurse from an urban centre going to work in a rural community, what tips would you give?

A: A tip that I would give someone is that no intervention is too small. Oftentimes as rural substance use nurses we can feel like we're driving people around quite often. You know, for some people that can be a bit tiring, but these are very low-cost and low-risk interventions that create a significant sense of safety and build relationships. Giving someone a ride to the pharmacy or having coffee with someone weekly really engages people in care and helps them feel seen and feel heard.

Q: How have you navigated being both a nurse and a community member?

A: I really honor the fact that, for many people, I am not only a care provider. [I think it’s important to] treat the people that were providing care for as neighbors, as community members and engage in more of a reciprocal relationship. We live in the same rural community and we have a lot of similar experiences.

What we've seen is that this connection can build someone's recovery capital when they're wanting to reduce substance use or engage in more recovery-oriented care. Sometimes that trust and that feeling of having a community member that cares and supports them can help shift [people] into action [and] into recovery when that aligns with their goals.

But [navigating these different roles] is very complex and it can be very challenging. You never really feel like you're not the community nurse, [even] when you're out with your family or at home. I think it's par for the course of being a rural health care provider.

Q: What's something surprising that happened to you in the past year that you didn't get trained about, or didn't think you'd have to do.

I think the reality of nurse prescribing [for opioid agonist treatment] in rural communities [was surprising]. This is really where nurse prescribing is intended to be the most effective … where you have low density of prescribers. [But] what we've experienced working with nurses in rural communities is that many of them have never even supported someone in taking Suboxone, let alone prescribing it. So there's this huge leap in knowledge that rural nurses are taking and, [this can be] very daunting for many nurses and they have a lot of questions about this. Nurses are moving forward and engaging in [prescribing], but it's a very tall order to ask.

Q: What is your vision of what nurse prescribing could look like in the future?

A: I really hope to bring nurse prescribing into the virtual space in order to have equitable access to resources. When we bring [a nursing position] to one community, then there's often the question, well, how come we're not bringing those same resources to other communities across the province? By engaging nurse prescribers in a virtual platform, nurses can provide accessible services across the province.

The other piece is recruiting nurses from other areas of nursing to be engaged in substance use care. So really trying to share that substance use care is fun. It's rewarding, and by engaging folks that might be experiencing substance use, it really goes a long way.


Kate Hodgson works with FNHA’s Four Directions Team.  In doing this work, she acknowledges that she is a White settler and lives as a humble guest on the traditional territory of the Tla’amin Nation peoples.

Listen to the full interview and other episodes of the Addiction Practice Pod here.