Objectives: To describe the knowledge and attitudes of emergency nurses regarding caring for patients with opioid use disorder in the emergency department.

Background: Many eligible patients with opioid use disorder do not receive available emergency department services for treatment and harm mitigation. While prior study examined contributing provider factors, little is known of nursing factors. This study describes knowledge and attitudes of emergency nurses regarding patients with opioid use disorder and their evidence-based treatment services in the emergency department setting.

Methods: Anonymous email surveys with novel and previously validated questions based on The Theory of Planned Behavior Framework were distributed to emergency department nurses at a large, urban tertiary-care hospital. Chi-Square and independent samples t-tests were used in analyses.

Results: More than one third of nurses completed the questionnaire (39%, 85/218). Most showed willingness and confidence screening for substance use disorder (95% and 88% respectively). Higher confidence providing buprenorphine and take-home naloxone was significantly associated with having worked fewer years (8.33 v. 15.62 , p=0.01 and 7.38 v. 12.03, p=0.03 respectively). Confidence administering buprenorphine was significantly associated with receiving in-service training (p=0.03). Staff with knowledge of take-home naloxone, positive attitudes toward syringe service programs, and a belief in a biopsychosocial basis of addiction were significantly younger and had worked significantly fewer years than those not indicating these beliefs. Specific educational gaps were identified.

Conclusion: Emergency nurses display willingness to champion evidence-based care for patients with opioid use disorder. Younger age and having worked fewer years were significantly associated with positive attitudes towards recovery science, harm mitigation, and services knowledge. Having worked fewer years was significantly associated with greater confidence performing treatment and harm mitigation. In-service training was significantly associated with greater confidence administering buprenorphine. Further study should support generalizability and determine which staff development measures generate improved outcomes.