Call to action! Nurses in Monitoring Programs

Many Nurses who suffer from addictions to alcohol and other substances are currently in monitoring programs all over the country. On their face these programs serve to protect the safety of the consumer as well as provide the impaired nurse with a path to return to safe practice.

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Call to action! Nurses in Monitoring Programs

The problem is that most state Board of Nursing programs utilize a "One Size Fits all." approach that places all nurse with mental health and substance abuse impairments in the same program. The also require this approach for the one time offender who possible had a DUI or a positive test for marijuana.

The current standard is Inpatient Treatment followed by Out-patient treatment, Random drug testing 4-8 times month (3 to 5 years) , Mandatory AA/NA attendance(3 to 5 years) , placed off work for up to 2 years. All of this at this paid for out of pocket by the nurse in question. The average 5 year cost to "Voluntarily" participate in these programs is between $35,000.00 to $50,000.00.

I am currently working with a local legislator on a bill that would impose program limits on BONS and standardize individualized programs such as the following...

Level 1

RN/LVN with 1st time DUI and no practice issues.

Mandatory AA/NA/Celebrate Recovery or other alternative to 12 step programs for 1 year with Random UDS to be preformed 2 time per month at participant cost. Participant allowed work without workplace monitor but must file monthly proof of support group meetings

Level 2

RN/LVN who failed a UDS from above level 1 or who is found to be impaired at work.

Immediate suspension from practice. Assessment by a qualified addiction specialist covered by the participant's insurance and not connected with a treatment facility to avoid conflicts of interest. If found to have a diagnosis of substance abuse disorder the program is as follows. Mandatory Inpatient or out patient program as indicated by addiction specialist's assessment. AA/NA/Celebrate Recovery or other alternative to 12 step programs for 3 years with Random UDS to be performed 2 to 4 times per month at participant cost. With a fourth year of UDS monitoring 1 time per month. If all conditions are met participant may return to work after 6 months of continuous sobriety as evidence by negative UDS results with the following UDS schedule year 1: 3-4 times per month. Year 2: 2-3 times per month. Year 3: 1-2 times per month. Workplace monitor is required.

Level 3

RN/LVN who has failed above program or is found to have diverted medications from the facility they worked at or for the NP who has written fraudulent prescriptions.

This participant may pose a real and present danger to public safety. As such practice shall be suspended and participant will have an assessment by a qualified addiction specialist covered by the participant's insurance and not connected with a treatment facility to avoid conflicts of interest. If found to have a diagnosis of substance abuse disorder the program is as follows. Mandatory Inpatient or out patient program as indicated by addiction specialist's assessment. AA/NA/Celebrate Recovery or other alternative to 12 step programs for 4 years with Random UDS to be performed 4 to 8 times per month at participant cost. With a fifth year of UDS monitoring 1 time per month. If all conditions are met participant may return to work after 1 year of continuous sobriety as evidenced by negative random UDS with the following UDS schedule year 1: 4 to 8 times per month. Year 2: 3 to 7 times per month. Year 3: 2 to 5 times per month. Year 4: 1 to 2 times per month. Workplace monitor is required.

Level 4

RN/LVN who has failed all the above levels or who has engaged in criminal activity related to their substance abuse to the extent that a suspension/revocation of license is warranted.

Subject should also face prosecution and criminal penalty as warranted by law enforcement jurisdictions in the State/County where the resident resides.

This is just a rough draft and I am looking for Input/suggestions. I know there are those here who feel a nurse who was found to be impaired should never practice again and you are entitled to your opinion - but nurses should not lose their livelihoods when they are actively trying maintain their sobriety or for a one time mistake of getting behind the wheel after having a drink. (Understand I do not condone driving under the influence and person's with DUI should deal with the criminal consequences of their behavior. )

I also need input on how to address the issue or the nurse with a mental health diagnosis who does not have a substance abuse disorder diagnosis.

All replies with be kept confidential and I will not share your replies or user information with anyone outside this forum.

Thank You

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hppygr8ful

About hppygr8ful, ASN, RN, EMT-I

(allnurses Guide)
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Specializes in Psych, Addictions, SOL (Student of Life).

I want to add that I am leaving town for 5 days to attend the APNA conference so may not be back to ALL NURSES until 10/23/17. So I didn't just drop a trolling lure and run.

Peace out

Hppy

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Specializes in Psych, Corrections, Med-Surg, Ambulatory.

Hppy, I have no experience with monitoring programs so I don't know if my input has any value. I read your post and it does seem like a well thought-out plan. I was appalled when you said it could cost up to $50,000 to get one's career back. Maybe there are times when that is warranted, but you're right. A one-size-fits-nobody system certainly does need to be overhauled.

Good luck with fostering some necessary changes.

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Specializes in OR.

I agree that a good first step is to allow initial evaluations by an addiction specialists/psychiatrist of the participants's choice, getting rid of this bit where the program chooses the evaluator. Additionally the program choosing where treatment, if recommended is acceptable needs to stop. The cozy relationship between evaluators and treatment facilities and programs needs to stop. That! is a big one.

There does need to be some consistency because unfortunately there are so many people in these programs but i like your idea of levels, based on what got a person here. It sounds like a bizarre comparison but almost like levels of custody in prison. There are certain privileges associated with certain levels and appropriate behaviors.

i think there should be an entirely separate category for those with mental health diagnoses. Sometimes those mental health diagnoses may involve minor substance use issues (overdose suicide attempt for example). But that does not make a person an addict in need of 12-step indoctrination. The boilerplate contracts that are issued currently can actually do more damage to such a person. Forcing such a person through drug/alcohol rehab and ignoring the psychiatric issues and needed medications is extremely dangerous. A participant with a mental health diagnosis may benefit from a more detailed contract.

A little personal vignette: when i first arrived on the horizon of the program, i don't deny that i needed some type of treatment. i had had a major decompensation episode. What i needed was perhaps partial hospitalization in a behavioral health facility, which have undoubtedly been covered by my insurance . What I got, thanks to my states program (and their "approved evaluator") was 6 months of in and outpatient drug and alcohol treatment paid for with $40, 000 cash and a great case of PTSD.

Had I gotten a truly impartial evaluation at the start, i would have gotten the appropriate treatment. I am an example of why change is needed.

Feel free to use my experience as an example why.

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Specializes in ICU; Telephone Triage Nurse.

In 1994 a diversion option program consisted of outpatient treatment lasting approximately 10-12 months if you had already been through the acute withdrawal phase, 3 months of no narcotic keys, NA/AA meetings 3 times/WK (your sponsor signed all meeting dates, you mailed the list in once a month), nurse recovery meetings once a week (we had to start paying the volunteer moderator $5.00/wk half way through), calling Sonora Quest lab every week day to see if your color was randomly selected (you could also be called by a real person as they saw fit), and work place reports once a month which your supervisor had to fill out. Random urine drug screens were $50.00, and because I quit my job for a short time (while falling apart at the seams) I qualified for public assistance BH, which covered my outpatient treatment. The program lasted 3 years, and if you toed the line then the last 6 months were step-down: no more calling Sonora Quest every week day (they called you at random) and meetings were optional. If you got through the entire 3 years clean your record was wiped clean too - no record remained of your diversion option program.

In AZ it was (is) called CANDO: Chemically Addicted Nurses Diversion Option.

Twenty years after finishing the program it still operates today.

I never realized how fortune I was to do my treatment then. Things have changed - not for the better either.

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Specializes in ER, ICU.

Great post. Thanks for advocating for nurses, and ultimately our patients.

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This is stricter than any program from any state I have heard of, of the ones that have these programs. Your level 1 protocol is stricter than how my state handles what you call level 3's. The 8 drug tests a month (and you know very well how expensive they are), along with one year suspension, would put a lot of nurses in recovery into homelessness. I'm not complaining about being monitored, but this is too strict and would make sobriety difficult. In my state, unless you get probation, they usually do not mandate a work site monitor either. The problem with having to have a work site monitor is that it makes getting a job very difficult. Also, how do you pay for the mandated inpt and output treatment if you have an automatic one year suspension? I was caught diverting from my employer and my employer offered me a last chance agreement, where they would test me once a month and offer me a new position away from narcotics. This wouldn't even be possible under your plan. Is this really what you want? I wouldn't have even been able to go into treatment because I would have immediately lost my insurance under your plan. I wouldn't have commented except that I recognize your username and thought you would have a little more compassion.

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Specializes in OR.

I think maybe the idea is more to start some dialogue on what should be done instead of claiming that they advocate for the nurse and then turning right around and doing what they do. Many people that have "ideas" including those who run these disasters of so-called assistance programs have no real clue of the destruction that is done to peoples lives. Or they do and don't care. Either way, no one deserves to be treated like that by their own.

Most of us have been cowed by the brute bullying that goes on in these programs (guilty until proven innocent and proving innocence is expensive and difficult) and I think this post is an effort to get those of us inside talking about changes. Are programs necessary? Yes. Does there need to be some type of punitive point to them? Yes, in some situation, but not across the board and not boilerplate. That is what suggestions are needed regarding.

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I just wanted to add... that I did self report anyway to the BON and I do 13-16 tests/year, so a little more than once a month. I would be a level 3 under your plan. My restrictions are that I have to be on vivitrol and have to have approval from my case manager for what type of nursing job I can do, and I feel that is adequate. My employer doesn't know anything about what happened because the BON in my state didn't mandate that for me, since I didn't get probation.

I don't agree with the distinction between a level 2 and 3. A nurse could be high on crack cocaine and go to work impaired and be a level 2, whereas another nurse could divert one tramadol and be a level 3. I do very much agree with lesser restrictions for the DUI and marijuana people, but again the restrictions you proposed for even level 1 are much harsher than what my state does for the level 3's. I do agree with having the evaluation be done by an addictionologist not connected with a treatment facility to avoid conflict of interest.

The worst part about your plan is the automatic one year suspension. Not everyone is married with a supportive spouse. There are a lot of single moms. So if they get an automatic one year suspension, they would have to immediately get a non nursing related job just to pay bills. Problem with that is you can't take FMLA and go to treatment with a brand new job, you know. You have to wait for a year. So you'd be dooming any single moms out there or anyone without a husband with a well paying job to not be able to go to treatment until a year later. I guess a lot of nurses are fired and have this problem anyway, but some voluntarily self report to their BON's... who would choose to self report if they are going to get an automatic one year suspension?

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Specializes in OR.

Just this brief tossing around of ideas shows how important it is that people be looked at individually. But Just like the fact that recovery has become an industry, as long as there is easy money to be made by taking advantage of others when they are in need, that is sadly unlikely to happen.

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Specializes in Psych, Addictions, SOL (Student of Life).
Lisacar130 said:
This is stricter than any program from any state I have heard of, of the ones that have these programs. Your level 1 protocol is stricter than how my state handles what you call level 3's. The 8 drug tests a month (and you know very well how expensive they are), along with one year suspension, would put a lot of nurses in recovery into homelessness. I'm not complaining about being monitored, but this is too strict and would make sobriety difficult. In my state, unless you get probation, they usually do not mandate a work site monitor either. The problem with having to have a work site monitor is that it makes getting a job very difficult. Also, how do you pay for the mandated inpt and output treatment if you have an automatic one year suspension? I was caught diverting from my employer and my employer offered me a last chance agreement, where they would test me once a month and offer me a new position away from narcotics. This wouldn't even be possible under your plan. Is this really what you want? I wouldn't have even been able to go into treatment because I would have immediately lost my insurance under your plan. I wouldn't have commented except that I recognize your username and thought you would have a little more compassion.

I don't know what state you are in But several states California, Florida. Ohio to name just a few are positively draconian in nature. People are put in a 5 year nightmare for a 1 time DUI which indicates nothing more than spectacular case of bad judgment. My level 1 does not suspend practice at all just requires AA/NA attendance and no workplace monitor. Texas has recently adopted changes to make these programs more individualized. I won't even get into what a person with no demonstrated substance abuse history, but a mental health diagnosis goes through. I have great compassion for all my brothers and sisters in recovery and an impaired nurse should not practice until their disease in in remission. Employers are not required by laws. Also by law under the ACA your insurance can't cancel you if you lose your job.

In my own case I was a severely depressed individual with PTSD and a fondness for alcohol. One day I attempted Suicide and immediately fell into the "IMPAIRED" category even though I never missed a day or work, never drank before or during work, didn't divert, didn't do any illegal drug and had not criminal record except for two traffic tickets 20 years prior. I was forced into a 5 year one size fits all program that cost me about $45,000.00. I had to take out a 2nd mortgage on my house. It's all behind me now and I am a much healthier person but five years of this nonsense was just too much.

Hppy

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Specializes in Psych, Addictions, SOL (Student of Life).
Lisacar130 said:
I just wanted to add... that I did self report anyway to the BON and I do 13-16 tests/year, so a little more than once a month. I would be a level 3 under your plan. My restrictions are that I have to be on vivitrol and have to have approval from my case manager for what type of nursing job I can do, and I feel that is adequate. My employer doesn't know anything about what happened because the BON in my state didn't mandate that for me, since I didn't get probation.

I don't agree with the distinction between a level 2 and 3. A nurse could be high on crack cocaine and go to work impaired and be a level 2, whereas another nurse could divert one tramadol and be a level 3. I do very much agree with lesser restrictions for the DUI and marijuana people, but again the restrictions you proposed for even level 1 are much harsher than what my state does for the level 3's. I do agree with having the evaluation be done by an addictionologist not connected with a treatment facility to avoid conflict of interest.

The worst part about your plan is the automatic one year suspension. Not everyone is married with a supportive spouse. There are a lot of single moms. So if they get an automatic one year suspension, they would have to immediately get a non nursing related job just to pay bills. Problem with that is you can't take FMLA and go to treatment with a brand new job, you know. You have to wait for a year. So you'd be dooming any single moms out there or anyone without a husband with a well paying job to not be able to go to treatment until a year later. I guess a lot of nurses are fired and have this problem anyway, but some voluntarily self report to their BON's... who would choose to self report if they are going to get an automatic one year suspension?

I never say anywhere 1 year suspension. 6 months suspension with demonstrated sobriety.

Also level 2 is for people who have failed level 1 and been found to be impaired I at work . Scenario

A person gets a DUI. Goes to AA/NA for 1 year no suspension from work. becomes a level 2 if they fail to attend their meetings fail a random UDS or are impaired at work. It doesn't say you can be high on cocaine and still practice.

If you fail level two - relapse and engage in criminal activity you move to level 3

Etc... I don't think you read it through.

Still these are only suggestions that's why I put it out there for input.

Hppy

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