Unfairly forced to "Self-Report" - Please HELP!

[janepaled]

Let me preface this by saying I am not an alcoholic. I know loads of people say this, but I don't often drink. I do, however, have severe PTSD.

I told my psychologist in confidence that ever since my psychiatrist switched my medications around I have been more anxious, especially at work where I have to be around people. I also told her that I have drank before work a couple times in the past to decrease my anxiety, but that I am no longer doing this, and will not in the future since I have an upcoming psychiatrist appointment and I am hoping to have my medications changed back to what they were a few months ago.

The psychologist told me that if I agreed to substance screening she would not have to report what I said to the ethics counsel. I agreed to go to be evaluated and set an appointment.

Well - prior to substance counseling...but a few days after meeting with that psychologist (who also works for the hospital I work at) she goes and tells her supervisor and the chief of nursing at my hospital about me having drank prior to working. She then calls me and tells me that the chief of nursing said that I either "self-report" to the BoN or that they might have to put me on medical leave.

What should I do? I am no longer drinking prior to working. And even when I did, it was very few times, and I was NOT to the point of intoxication. Nor has there been any incidents at work regarding patient safety.

I feel completely betrayed by this psychologist and feel like I can't ever tell her anything in the future. I am also very scared my position/license is at risk for something that is not even going on anymore - i.e. it's not a problem anymore! I don't feel comfortable self-reporting because I do not feel like I have a problem with drinking, my problem is with PTSD and I thought I was doing everything I could on that issue. I even agreed to therapy/class 2x a week for PTSD and have been attending.

[Esme12, ASN, BSN, RN]

depending on your state she may have a duty to report what you said....some states have mandates about this.....it is always good to know your states regulations.

I would contact your malpractice carrier for legal advice before doing anything...if you do not have malpractice I would consult a lawyer knowledgeable about licensure issues.

[sallyrnrrt, ADN, RN]

esme12 said it best

[Twoyearnurse]

First let me say I am sorry you are in this position. Self medicating problems is all of our problems. It's frightening, I know, but an alcoholic has many underlying issues and alcohol is just a symptom of the disease. Have you seen the substance abuse physician yet for your evaluation? Please take what they say to heart, maybe you don't have this disease, and truly I hope you don't, but if you do there is help. In the meantime, keep your head up, our dear admin had excellent advice. And we are here for you.

A little late now but I would *never* reveal something like this to a therapist working for the same employer as I am.

I freely admit little knowledge about such things but it strikes me that HIPAA regulations would apply to a clinical psychologist.

[Twoyearnurse]

My state, Alaska, has a mandatory reporting system for any person working with vulnerable populations. Drinking before work, even if not intoxicated, puts patients at risk. The same goes for someone legally prescribed narcotics in my state. If someone's behavior puts others at risk it has to be reported- it's the same law that mandates that any healthcare professional must break HIPAA if an individual is deemed dangerous to the community.

[Mulan]

Was the conversation recorded?

Contact a lawyer.

It sounds like a violation of provider/patient confidentiality.

[Oogie]

No kind way in saying that if you admitted to your psychologist, who works for the hospital you work at, that you drank before coming to work, a RED FLAG is flying.. Patient safety is first, I wish you well in your Tx for PTSD, treat yourself well, so you can care for others.... Peace

[subee, MSN, CRNA]

Where to start...of course you have a problem with alcohol. You drank before you went to work and then tried to rationalize and minimalize what you did. And then you further blame the psychologist for your predicament when that person was just doing their job (quite well, too. Many people would have lets the seriousness of what you did slide. The buck stops with her). You also can't think clearly enough to appreciate that your nursing officer is giving you a great break. If you had been caught with AOB at work, the the consequences could be a lot more painful. You have a a diagnosis of PTSD which is associated with substance abuse. What you don't say is which state you practice in. If your state has an alternative to discipline program your license can be preserved so that you can continue to make a living. You've had a lucky, early wake-up call. Nobody got hurt, including you. Seeing a psychiatrist is important but it's just not enough. Please keep in touch with us and let us know how you are doing. There's just nothing "unfair" about any of this.

[VivaLasViejas, ASN, RN]

As a recovering alcoholic who also suffers from mental illness, I can barely see this thread for all the red flags in the OP. To be honest, the first paragraph told me pretty much everything I needed to know. I've heard it before. I've said it before. And it's all a load of bunk.

I am not saying that you're an alcoholic. I AM saying that you have a drinking problem. NO ONE who uses alcohol in a normal fashion drinks before work for "anxiety". There are plenty of other ways to cope with the discomfort, both pharmaceutical and 'natural'. It also does not matter that you "don't drink often"; the fact of the matter is, you use alcohol irresponsibly and you are lying to yourself---and us.

I used to go as long as a year between drinking binges; I was also a high-functioning working mother and Jaycees president who sometimes conducted the 0700 breakfast meetings hung over out of my gourd. I later learned that the drinking was more than likely a form of self-medication for what was then undiagnosed manic depression.

But 22 years ago, I came to understand that I was indeed an alcoholic, even though I could go months without touching a drop and I never drank in the morning, let alone before work. And I wasn't even a nurse then. I didn't have peoples' lives in my hands, people who were depending on me to be sharp and fully capable of acting quickly in an emergency. You may not think ETOH has an effect on your reflexes or thought processes, but anyone who uses it can be impaired long before s/he reaches a state of intoxication. As a nurse, you should know that. And I'm reasonably sure you do. How would you feel if you found out your nurse, or your child's nurse, was drinking before she came on duty?

Sorry if this sounds harsh, but I want you to understand that your problem is not with the psychologist who 'ratted you out', so to speak. Nor can you blame everything on your PTSD, although alcohol problems are interrelated with other mental illnesses and they certainly complicate each other.

You need to self-report, not just because your hospital will do it for you (or because it's the right thing to do), but because you are going to need all the support you can get to acknowledge your alcohol problem and obtain the proper treatment. I suspect you came to us because you know deep down that something is wrong. Please consider the advice you've received, and realize that when more than one person is telling you something, it's time to listen up.

I do wish you the best. I know how tough this road is and wouldn't want anyone to go through some of the things I have. But the good news is, recognizing that you have a problem in the first place is half the battle won.