“It begins with trust,” says Andrew Penn, registered nurse and associate clinical professor at UC San Francisco’s School of Nursing.
Penn is describing how nurses can be naturals at providing care for people in psychedelic states.
“I think sometimes that nurses are often really the glue that holds the healthcare system together,” he says, adding that there are more nurses than any other type of specialty in the American healthcare system.
Quite a few more, in fact, with over 3.8 million registered nurses (RNs) nationwide, according to the American Association of Colleges of Nursing, compared to a little over 550,000 physicians currently in the U.S.
“So, you know, in some ways we’re sort of in plain sight, which makes us kind of invisible,” continues Penn. “And I think, a lot of times, people think they know what nurses do but they really don’t. The average person thinks we walk around in starched white outfits and pass out little cups of pills.”
He says this with no annoyance at all, just an observation of the occupation he’s inhabited for over 18 years.
“Nurses are really used to just being present with patients,” says Penn. It is perhaps one of the reasons why RNs are so generally trusted by patients, as well as being predisposed to caring for people in altered and vulnerable states.
“I would say anybody who has ever been a nurse in an ICU with a delirious patient for twelve hours is totally familiar with the idea of working with people in a non-ordinary state of mind,” he says. “If you’ve worked with somebody who’s delirious and pulling at their lines and thinks that they’re in a hotel room and being kept captive by aliens — which I’ve been in that situation in the hospital — that’s very applicable to working with people who are in other non-ordinary states of consciousness.”
Penn’s credentials in the medical field run the gamut from teaching psychopharmacology and clinical interviewing at UCSF School of Nursing to acting as a study therapist in phase III clinical trials of MDMA-assisted psychotherapy for PTSD. This year he co-authored an article on psychedelic-assisted therapies published in the American Journal of Nursing (AJN), the leading monthly nursing journal, that was the first psychedelic treatment article written in the revered periodical in 57 years.
“Nurses are skilled in holding space as patients endure challenging events in real time and for prolonged periods, whether that be during childbirth, a sudden illness, an anxiety attack, or the time surrounding death,” reads the co-authored article. “This skill translates well to being able to sit with a patient undergoing a therapeutic psychedelic experience, allowing space for whatever arises at physical, emotional, mental or spiritual levels.”
The point of the passage is well taken. Nurses are typically with patients for longer periods of time than nearly all other healthcare professionals combined. In the case of childbirth, which can span over many caregiver shifts, nurses are the one continuous and close connection to patients through labor, delivery and aftercare. That means a lot of time to develop close bonds and trust.
Penn describes that after attending training in psychedelic-assisted therapy and research at the California Institute for Integral Studies (CIIS) a few years ago, he and a few fellow nurses who also attended the training recognized the unique skills that RNs bring as collaborators in psychedelic therapies. What grew from those discussions with colleagues Wendy Marussich, Angela Ward and Liz Willis was the group called the Organization of Psychedelic and Entheogenic Nurses (OPENurses), which represents nurses, at all levels of training, working with patients utilizing therapeutic psychedelic medicines.
“We thought we really needed to advance the perspective of nursing in the field,” he says, “because there actually is a kind of a unique perspective that nurses bring to the care that is given to patients while they are undergoing a psychedelic therapy session.”
Along with close patient contact and the many hours working beside them, there are core skills inherent to the occupation, like recognizing nuance of movement that telegraphs discomfort and disorientation.
“Patients undergoing psychedelic therapies are exquisitely sensitive in that state to people around them,” he says. “If the person who’s tending to them has a feeling like they’d rather be elsewhere, the patient may very well pick up on that. You have to be present, and that level of presence actually does take quite a bit of energy.”
There’s also the very mundane yet important moments, helping patients through intimate and embarrassing mishaps such as patient incontinence, which can happen during a psychedelic immersion. Nurses handle those delicate situations daily without skipping a beat.
“Nurses are really comfortable with taking care of the physical body,” says Penn. “For instance, when patients have to go to the bathroom during a session, like they need help getting to the bathroom. I’ve had patients who are incontinent during a session. We might have to help somebody get cleaned up. Nurses are cool with that. It’s not a big deal.”
There’s also the fact that the psychedelic therapy field is facing a scaling predicament as a greater number of patients become interested in such therapies, while the industry simultaneously grapples with a shortage of psychedelic-trained clinicians able to handle such care. You can bet that some of those 3.8 million RNs currently working in America can assist with the growing demand.
As an increasing number of nurses pursue work in psychedelic therapy in anticipation of the rescheduling of psychedelic treatments, opportunities for education in psychedelic therapy exist at places like the Center for Psychedelic Therapies and Research at CIIS. There’s also an informative, ongoing interview series created by OPENurses.
“The growing field of psychedelic therapy will greatly benefit from nursing participation,” reads a final passage in the co-authored article in AJN. “Psychedelic-assisted therapies offer great potential to alleviate suffering and cultivate healing, growth, and peace amid illness, and nurses are well prepared to contribute.”