Impaired Nurses - page 7

I've just recently learned about a program for nurses that may need help with a drug or alcohol problem known as the impaired nurses. I was just wondering what your thoughts were on this subject. ... Read More

  1. by   sissiesmama
    Quote from NurseDiane
    Oh, Anne----by the way---I forgot to congratulate you on your 10 year anniversary. That is quite a wonderful feat, and I think it is awesome that you are able to show the strength and committment that you have to living life without "assistance".

    Good for you!!!

    Diane
    Thank you so much! I do appreciate it! I just wish people (either other addicts or sober co workers) wouldn't make it quite so hard to admit our vice and get help for it. I know it was the hardest thing I ever had to do, and I'm not proud of what I did, but I sure am proud of the fact that I was able to admit it, and proud of the fact that I have been able to get help and use the tools I was given in treatment and by my sponsor to facilitate my healing.

    I try when I am working with a recovering nurse to not just look at them as "damaged" or "ruined" (as I had been called by another nurse) but for the steops they are taking to live a new life and learn from the mistakes they have made. Everyone deserves a second chance, I just wish everyone was able to actually get it.

    Anne, RNC
  2. by   exnursie
    "one thing that i find odd is that in bon assistance programs, the thing that is focused on is the drug use itself----very little attention is paid to the underlying reasons for the drug use."

    one thing that people don't realize is that the bon is a regulatory agency, they are not qualified to "treat" or "diagnose" people.. their job is to ensure that nurses are safe and competent practitioners, and they do this by following the guidelines recommended by addiction specialists for rehab of addicted persons. this includes the requirement for nurses to attend support groups, in most states this is 12 step specific, but there is a slowly growing number of states that provide options to aa for those nurses who don't find aa to be beneficial.


    in a nutshell, people who abuse substances lack coping skills. they may have underlying psych problems, but this does not apply to every addict. it is up to the individual to identify what their issues are and to change their way of thinking and acting. some people need professional help, others benefit from self help and support groups.


    recovery is the sole responsibility for an individual, and the bon lays down the foundation based on the standards for treating people, that are used by treatment providers. the majority of nurses i know in recovery did find a better life because of the bon's intervention and monitoring.

    "nurses are terrified to ask for help exactly because of punitive actions by the bon, so it goes on and on until it is out of control and somebody else notices. a lot of times, bon makes the "rules" so rigid and difficult to live by, by both the nurse and any employer they may have, it adds that much more stress to the original problem. i am not saying that they should just let the nurses go on using substances and putting people's lives in danger, but they have to be a little more flexible than some of them are."

    diane, there is not a single state that has such inflexible and rigid guidelines that the nurse is destined to fail. the restrictions for work include no narc access for 6-12 months, no ot or night shifts, no charge, and rn supervision. these are all done for the sole purpose of protecting recovery by limiting the stress factors and the ability to divert easily. there are so many career choices in nursing that to accuse the bon of causing hardship sounds like the blame game.

    "i knew a nurse in florida who had a substance abuse problem, and the florida ipn made life nearly impossible for this woman. she lived 45 minutes from one of the best addiction centers in the country---hanley hazeldon, which is considering the "grand-daddy" of recovery centers---and they mandated her to go to someplace in atlanta, which would have cost her upwards of $100,000 for 3 months, which her insurance did not cover. she would have had to take a 2nd mortgage on her house to pay for it(and not having a job, it would have been rather difficult for her to pay it back---and then she would have lost her house altogether). her insurance would have covered hanley hazeldon, though-----and they wouldn't let her go there!!! do you know what she did? she surrendered her license and went voluntarily to hanley hazeldon, because her life meant that much to her, and she wanted to get help. i"

    fl ipn has a list of approved providers in fl only, and does not mandate people to one specific treatment center.

    "nurses are terrified to ask for help exactly because of punitive actions by the bon, so it goes on and on until it is out of control and somebody else notices"

    in my opinion, punitive action would be license suspension, and filing criminal charges for illegal drug use. the reality is that 40+ states allow the nurse to continue working and have a clean license if they agree to enter the alternate ( voluntary ) programs and are compliant. even those nurses who are unwilling to agree to this have the opportunity to keep their license, but their discipline action is on public record.

    i agree that nurses hesitate to self report, the reason is not because of the bon's reactions , it is largely caused by the bias and judgemental views from their colleagues and the general public.


    "she did go to a psychiatrist seeking help, and was honest to him about how she was self-medicating, and the psychiatrist turned her in to the bon----without telling her that he was doing that!!! when she got the call from bon, she almost fell off her chair----and she asked them who turned her in and they wouldn't tell her"

    fl has a state law that mandates providers and all nurses to report nurses who have violated the npa. the md would face md board action for not reporting her. i think that if she had consented to go to treatment, he would not have needed to report, but it sounds like she only went after the bon called her?
    it sounds like this nurse had more than addiction, the number of nurses who attempt suicide is low. while it is sad that she was reported by her md, and there were problems finding the right meds to treat her psych problems, this is not the norm and i don't see where the bon is to blame.
  3. by   NurseDiane
    exnursie, I am sorry if I came across saying that the BON was to blame. I do understand that they are regulatory agency and they have to keep the public safe. I think what I was trying to say is that you cannot "blanket" everyone under the same set of circumstances.

    As far as the shrink who turned her in---she was never given a chance to go into treatment voluntarily, before the BON called her. The day after she saw the shrink, the BON called her. I think the point I was trying to make with this is that he should have told her that he was going to do that, instead of doing it behind her back----how is this woman supposed to "trust" this shrink now that he has violated their "confidential" relationship from the get-go? Furthermore, the shrink did not say anything to her about going into rehab or anything----he gave her prescriptions for Prozac and other meds and sent her home. It wasn't until she tried to kill herself that things were taken seriously. I was a very good friend of hers and saw her go through all this mess, sat with her while she cried, tried to get her out of her house by taking her to a movie or out on my boat on the weekends----and I could see it in her actions and her eyes that she was not right, and it had nothing to do with drugs. Her eyes looked like a basset hound---sad, lost, confused. She could not belive that this was happening to her, that she "lost control" of herself, why was this happening to her.....I had no answers and all that I could do was be there to provide support and "watch" her and try to keep her safe.

    And, I do know for a fact that the Florida BON mandated that she go to that place in Atlanta----I saw the paperwork and sat with her while she cried about it costing $100,000 and how she couldn't afford it. (It has also been discovered that "some" BON have "deals" with certain treatment places, a "kickback" system, you wash my back and I'll wash yours kind of thing.....) They had her running every which way but loose. She was not a Florida resident, and her family was out of state, and she tried to work something out where she could go to a rehab place near her family and they wouldn't allow that either. She ended up having her license placed on "emergency suspension"---but she did go to Hanley Hazeldon in West Palm Beach because they took her insurance.

    And, not for nothing, I also heard a story about a nurse who had a bad back and was actually being treated for it already by pain management, had to drive half way across the country when her father died. She stayed at her mother's house and slept on the couch, and couldn't walk the day of the funeral because her back was killing her. She took a Lortab or something that her mother had, so she could attend the funeral and be able to drive back home when everything was done--she had forgotten to pack her own meds beause when she got the call, she threw some clothes in a bag and took off. When she got back home, since she was a travel nurse, she was taking a new assignment and they required a drug test. Well, she tested positive and and was honest and told the agency the truth, that she took her mother's Lortab for her back when she went back home for her father's funeral etc.---she had NO IDEA that it would be a problem, she was already being treated for her back--- the travel agency reported her to the state BON who raked her through the coals and made her do the same rehab thing that they mandate for other nurses!!! This nurse was not an addict!!! She was already being treated for a back injury---and the thing is, the meds she was already taking for her back were much stronger than Lortab, and she had prescriptions for them, she just didn't have a script for the Lortab. So---of course all the pain meds she was already on had to be stopped because she wasn't allowed to take any narcotics while she was in the BON program.........and she ended up on disability because she couldn't walk. So----despite the fact the the BON is a "regulatory" agency, they do implement blanket procedures and usually the same thing for everybody, no matter what the circumstances. And, I just think they need to change that mindset.

    Nurses are treated like "dirty" and "ruined" people when something like this becomes general knowledge in a hospital. They get treated like they have AIDS and are highly contagious----when they walk down a hallway, people split like the Red Sea to let them go through and they whisper about "That's the one---she's the one who uses drugs." That is why in the workplace, the only people who need to know about this is the management, and they should keep it confidential----but, nurses being the gossip hounds that they are, most of the time they can't keep it quiet. So---in addition to trying to get their life back together, they have to deal with an already difficult job being made a thousand times harder.

    You can't file criminal charges for drug use---but, nurses have sure been arrested for diverting drugs from work. And, usually they do have their licenses suspended for a certain period of time, even when they go into treatment voluntarily---it just isn't madae public at that point. One law that has fairly recently been passed by the EEOC and ADA is that a person with a prior drug history who is in recovery and not currently using drug is considered a disability and cannot be discriminated against because of that----so places can not NOT hire a nurse because of the history of drug abuse if they are in recovery, so where as before many nurses faced not being hired because of the history, that can not be used today as an excuse by a prospective employer. Otherwise, the facilities can face a major discrimination lawsuit.

    I am actually not too familiar with BON actions, as this woman's is really the only one I knew of because I was so close to her. I actually know of more physicians that have had Board action against them----and guess what? They are still practicing. I think that nurses are held to a much more stringent and higher standard than docs are. Shoot, I know of a doctor in the town where I live now, the guy is a coke addict, his wife was arrested for forging oxycontin scripts, and he is still practicing and his wife is his office manager!!! Nothing happened to this guy----doctors, for some reason, have the ability to talk their way out of stuff, make excuses and everything is okay. It is actually the same way with lawyers.

    Like I said, I do think that for the most part, BON intervention saves a lot of nurses. HOWEVER, some nurses do not "fit the mold" so to speak, and shouldn't be swept under the same "blanket" that others are under. Some circumstances are VERY DIFFERENT, and they need to open their minds and listen to their nurses and make special accomodations sometimes. That's all I was saying.
  4. by   blondnursey
    Quote from woody62
    Nurses should be monitored for the rest of their professional life. I wonder why physicians are not subjected to the same rules? Since the 'pee' test is totally random, it is impossible to guess when your phone is going to ring and you have to go in. And hand over a sample.

    I have an idea. How about requiring every nurse, in every state, to submit to random testing in order to retain their license. That way, we can ensure that no impaired nurse ever has access to patients. Or even legal drugs.

    All in favor

    Woody
    i agree!
  5. by   NurseDiane
    Woody, although I don't know you, I am laughing at your post. If they randomly tested every nurse and doctor in the country, we'd have about one quarter of what we have now taking care of patients!! I know more docs who smoke pot, drink their faces off and party than you can imagine.

    I just want to say that I have seen MANY nurses who are so morbidly obese that, if they had to respond to a code, wouldn't be able to run, or push a code cart down the hallway, or even get close enough to the bed to do CPR. Does that constitute being a harm to patients? If the BON ever tried to do anything to intervene and "help" them, there would be cries of discrimination and lawsuits all over the place. But, when it comes to treating drug abuse like the disability that it is, people think it is a person's own "fault" and their "choice" that they have this disease. Drug abuse/addiciton is a disease. It has its own DSM-IV disagnosis and is protected by the Americans With Disabilities Act. Legally, you cannot NOT be hired because of a history of drug abuse IF YOU ARE NO LONGER ACTIVELY USING. If you are actively using, there is no protection. But--clean and sober people are protected by laws!! That is good to see, because nobody's professional abilities should be "judged" based on a drug history. In fact, many professionals with drug abuse issues are usually very successful, intelligent and talented.
  6. by   blueheaven
    That way, we can ensure that no impaired nurse ever has access to patients. Or even legal drugs.


    What?????????????? This isn't going to ensure diddly squat. What about breathalyzers at the doorway of every health care facility? People have been fooling pee tests for a long time. What about the idiots/ditzys we sometimes work with? Require an IQ test before anyone starts working? Just wondering.

    As for obese nurses, they can have a disease just as deadly as drugs or alcohol. Look up eating disorders. Just because they aren't skinny as a rail doesn't mean that they don't have a food addiction or compulsively overeat. Talk to some folks in food recovery programs that have tried every diet known to man and have found recovery in the 12 steps.
  7. by   NurseDiane
    Oh, I know blueheaven---that was my point with the obese nurses (and we've all seen them, what a HORRIBLE example that is for the patients we take care of). However, if the BON or another nurse "turned them in" or tried to "help" them, then the words DISCRIMINATION would be flying all over the place---and they'd be screaming about being judged because of their appearance and their weight. However, nurses with substance abuse issues get judged and talked about behind their backs and have fingers pointed at them all the time----and they have to swallow it. The bottom line is that the people judging the nurses with substance abuse really have absolutely NO CONCEPT of what this disease entails, they look at it as a character flaw, which it is absolutely not.

    LOL---IQ tests before anybody starts working....LOL Likewise--are there any tests for laziness and not pulling your weight? How about tests for abuse of sick time and chronic lateness? How about incompetence and working in an area which is completely foreign to a nurse when they are floated to another unit? In my opinion, a nurse who lacks the skills to work in their area, or who "take advantage" of other nurses and/or the system are a hazard to patients, and often those things can't be "fixed". Taking a MICU nurse and putting that nurse in OB to cover a sick call is as dangerous as it gets---and I've seen it done.

    I am not trying to make excuses or imply that nurses who have abuse/addiction issues should be working under the influence of drugs. But, what I am trying to say is that an excellent nurse is always an excellent nurse, and should not be judged on her nursing ability because of a substance abuse problem. Nurses should be a source of support and help for someone with an addiction problem---not be "shaming" them and putting them down because of it. I notice the tone in some of the posts where a nurse is asking about "turning in" the nurse to the BON---and that tone is often riddled with anger, criticism and disgust. Furthermore, the nurses who want to "turn the in" want to do it anonymously. Why do it anonymously? Be honest and up front with that nurse---talk to that nurse, express your concern and explain to him/her that it is your responsibility to report them to the nursing administration and BON, and it is not because you are mad or want punitive action to be taken. You are doing it so that the nurse can get help and be able to return to nursing and continue being the excellent nurse they've always been. Doing that anonymously is like "hiding"---almost like the nurse doing the reporting is "shamed" for some reason.

    In my opinion and experience, nurses, who are supposed to be the most caring and empathetic people on the face of the earth, are often the polar opposite when it comes to dealing with other nurses who are dealing with substance abuse/addiction problems. Suddenly, those excellent nurses who have the issues are demoted and have become "bad" nurses, which is not true at all.
  8. by   southernbeegirl
    "an excellent nurse is always an excellent nurse"

    i totally disagree! i am an excellent nurse (IMO) but when i am using actively, i am a horrible nurse and have no business being near a patient.

    as for your friend that goes to the pain clinic....she IS an impaired nurse. just because you get your narcotics from a doctor does not mean you are not impaired.

    and as for those HORRIBLE examples of morbidly obese nurses....i'm one of those too.

    if you honestly think your friend went halfway accross the country and FORGOT to take her pain meds with her? she's got you snowed!
  9. by   southernbeegirl
    I am so grateful to the BON. Their sole job is to protect the public from me and nurses like me. When I had to go in front of the board members, it was the most horrifying experience. they raked me over the coals. a few of them didnt want to give me a second chance. they wanted to revoke my license right then and there. but a couple of them knew the people that were helping me on my side of things to get sober so they gave me one chance. if i relapse, i doubt they will give me another chance.

    so they ordered me to rehab, ordered me to have a contract with TNPAP and put my license on probation.

    all that helped me save my life!

    addicts are manipulators. the BON has to have pretty stringent rules to go by so they don't get manipulated by us.

    my case manager at TNPAP is STILL active in my recovery even after i graduated 2 yrs ago from my contract.

    i am so grateful for all of their rules. those rules, those meetings, those drug tests kept me from working impaired anymore and probably saved someone's life.

    so for that, i am forever grateful.
  10. by   NurseDiane
    southernbeegirl---I agree with you, an nurse who is working while impaired is not an excellent nurse. What I meant was an excellent nurse who is in recovery is still an excellent nurse---drug abuse does not take those skills away from you. I guess I was misunderstood.

    I think my whole point with my posts is that nurses should be more supposrtive of their peers rather than whispering behind their backs and smiling to their faces, passing judgment when they most likely have no idea what the whole story is, and just generally being completely unsupportive and making their jobs and lives a million times harder than they already are.

    As far as the nurse who went to her father's funeral.........I actually do not know her, but having had the experience of my father dropping dead on the golf course, I can totally understand being in a state of mental confusion. When I got the call about my father, I was at work in an ED in NYC, and I took a yellow cab from NYC out to eastern Long Island----but I forgot to bring my purse, any money, a coat (in March), and I sat in the back seat and trembled the whole ride, even though they medicated me in the ED because I was shaking uncontrollably. So, I can understand that situation.

    I am very glad that you got help, beegirl. I hate the gossip that happens in the hospital every day----I stay away from it. I guess I am one of the rare nurses who understands that nobody is perfect, we all have our flaws and sometimes we all need help. Needing help doesn't make us weak, but many people avoid asking for help because of that gossip and stigma.

    What I don't understand is........most people get stigmatized for using drugs and alcohol, but movie stars and musicians and celebrities get MORE attention and accolades when they enter rehab and do their time!! What a double standard, huh?
  11. by   exnursie
    and, i do know for a fact that the florida bon mandated that she go to that place in atlanta----i saw the paperwork and sat with her while she cried about it costing $100,000 and how she couldn't afford it. (it has also been discovered that "some" bon have "deals" with certain treatment places, a "kickback" system, you wash my back and i'll wash yours kind of thing.....) they had her running every which way but loose. she was not a florida resident, and her family was out of state, and she tried to work something out where she could go to a rehab place near her family and they wouldn't allow that either. she ended up having her license placed on "emergency suspension"---but she did go to hanley hazeldon in west palm beach because they took her insurance


    http://www.ipnfl.org/faq.html#impairment

    [color=#ffffff]"ipn does not provide the evaluation and/or treatment required, but does provide referrals to board-approved addictionist, psychiatrist, and/or other treatment professionals. these addictionists, psychiatrists, and/or treatment providers are located throughout the state of florida and referrals will be made to a provider geographically closest to the nurse's place of residence."
  12. by   NurseDiane
    LOL----You guys can pull all the quotes and stuff out that you want. I saw the paperwork and know her situation.

    Also---remember in that particular quote, it says "Board-approved".
  13. by   moonmaid50
    I am a nurse in recovery, still being monitored & most likely I'll continue that monitoring after my consent agreement is over. At first I was so ashamed at the pickle I'd gotten myself into I was afraid of everything. But then I started going to Caduceus & Impaired Nurse meetings & low & behold I wasn't alone any more. In fact I saw many nurses & docs I had worked with over the years.
    Yes it is hard to get a job while under contract. I tried saying "I am in a program with the Board of Nursing" and that got some understanding. But the bottom line is getting someone to take a chance on you. I've heard many people say they would hire a monitored nurse over one not being monitored but let's get real. Doesn't happen that way.
    I finally got a job as guess what?? A case manager monitoring other nurses! I finally got the point too. I see why we need monitoring, meetings, and most of all advocacy. I don't get all upset when I have to call in EVERY day or get my meeting lists signed. I like the meetings now, a lot. I miss them if I'm traveling or work keeps me away. And no, being a case manager doesn't make me a hard a$$ to the other nurses. My PHP handles Docs, PA's, & a host of health care workers but the nurses have my attention. I do my best to let them know what is going on and why. I've spent hours on the phone trying to get a broke, out of work nurse with no insurance into a decent treatment program finding help with finances and even driving a few there myself.
    We as nurses need to stick up for our sisters & brothers who need help, not throw them under the bus. Until we recognize that addiction can get it's hooks into ANYONE and that treatment really does help we are still in the stone age when it comes to our own care.

    Living happy, joyous & free

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