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.
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.
If by level 2 and 3 you are talking about people who are already in a monitoring program and continue to use, then it seems fair. But how it was written, it looks like you are talking about the original offense. See below:
Level 2: RN/LVN who failed a UDS from above level 1 OR who is found to be impaired at work.
Level : 3RN/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.
Here is where I got the one year suspension. Again, if you are talking about people who used while in a monitoring program, it looks fair to me. IL is apparently very lenient and we get an automatic one year suspension if we have a positive test while in the monitoring program, which I think is fair.
For level 3...
If all conditions are met participant may return to work after 1 year of continuous sobriety as evidenced by negative random UDS
But I am confused with your clarification. If a level one is for DUI people and level 2 and 3 are for those who are already in a monitoring program and failed to meet the terms... where are the people who's original offense is diverting or having a positive test for an opiate, for example? Let's say you have a nurse who got caught diverting norco and this is her first time getting caught. She would like to start the monitoring program for the first time. What level is she then?
Specializes in Psych, Addictions, SOL (Student of Life).
Lisacar130 said:
If by level 2 and 3 you are talking about people who are already in a monitoring program and continue to use, then it seems fair. But how it was written, it looks like you are talking about the original offense. See below:
Level 2: RN/LVN who failed a UDS from above level 1 OR who is found to be impaired at work.
Level : 3RN/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.
Here is where I got the one year suspension. Again, if you are talking about people who used while in a monitoring program, it looks fair to me. IL is apparently very lenient and we get an automatic one year suspension if we have a positive test while in the monitoring program, which I think is fair.
For level 3...
If all conditions are met participant may return to work after 1 year of continuous sobriety as evidenced by negative random UDS
But I am confused with your clarification. If a level one is for DUI people and level 2 and 3 are for those who are already in a monitoring program and failed to meet the terms... where are the people who's original offense is diverting or having a positive test for an opiate, for example? Let's say you have a nurse who got caught diverting norco and this is her first time getting caught. She would like to start the monitoring program for the first time. What level is she then?
You make some good points and your feedback is welcome. It's all very think tank now and I was actually surprised that I could get legislator to even consider the issue. There is much re fining to do. Recognizing you have a problem and getting help either voluntarily or by BON mandate should not cause you to lose you home, job, cars, or place the financial stability in jeopardy. Many nurses pulled into these programs cry for change but feel so abused and shell shocked by the process that they have no energy to fight.
Recognizing you have a problem and getting help either voluntarily or by BON mandate should not cause you to lose you home, job, cars, or place the financial stability in jeopardy. Many nurses pulled into these programs cry for change but feel so abused and shell shocked by the process that they have no energy to fight.
Again thanks for your input.
This is right where I am. I thought I was going to get some support, not hung out to dry. Even a couple of years on, shell shocked is a good way to put it. I think even those of us who've been kicked mightily by the machinations of these programs do still see where a monitoring program can be a very good thing but the way the majority of them are run now, so "in bed" with "approved evaluators" and "treatment centers," is a huge part of the problem. It's like the fox designing the henhouse and getting a cut of the egg sales.
I am gradually and barely past being angry. I am sad. I am sad for the frightened people that will be coming down the pipe after me if changes are not made. I am fortunate in that I have a great family that has educated themselves on mental illness, supported me financially, recognized the damage that this program has done to them, to me and to my career. I will make it out of this about as unscathed as one possibly can expect to. Most don't. Just on this board alone, I've seen people lose marriages, families, homes, careers, savings, everything, and even then just walk away. This is not monitoring, this is punishment. People are punished by a group of their own that claims to advocate for them and protect the public. from them like they're lepers or something.
Changes will not come in time to help me, but as a nurse I feel I have a moral and ethical obligation to attempt to start the wave of change, no matter how small. In many cases, nurses run these programs. Perhaps it is the failure to remember that moral and ethical obligation that brought us to the point where we are today.
Specializes in ICU/community health/school nursing.
hppygr8ful-
I love reading your posts. I don't have much to add here except that you're right; one size fits all doesn't work for any nurse with any discipline issue. I assume because you're working with a legislator that you are open and out to the world, which is very brave. Best of luck. Let us know what happens.
Specializes in Psych, Addictions, SOL (Student of Life).
ruby_jane said:
hppygr8ful-
I love reading your posts. I don't have much to add here except that you're right; one size fits all doesn't work for any nurse with any discipline issue. I assume because you're working with a legislator that you are open and out to the world, which is very brave. Best of luck. Let us know what happens.
Thanks - my history reads like an open book. I was fortunate enough to go to work for an employer who really supported me during my diversion years. I still work there. History is just that and we cannot shape our future without thoroughly acknowledging our past. I was done with monitoring in 2007. I want nothing but good positive reform of these programs.
This is a blessed step in the right direction. Do I agree with all the details? No but even as it stands it is much more just than the garbage that is out there now. I find it interesting that someone who went through this program 20 years successfully wasn't tortured nearly as badly as we are now. I believe this is because "improvements" were made incrementally & these BONs got in bed with the rehab industry. All of which is a crying shame because at their core these programs are a good idea. HELPING nurses with substance abuse issues keep their jobs & more importantly save their lives. In practice they an abomination
Specializes in ER, ICU/CCU, Open Heart OR Recovery, Etc.
I think this is a good start.
What concerns me even more than this is the lack of accountability that the monitoring programs and Boards of Nursing have, to the public and to the nurses they administer. I feel that is as important, or more so, than how to work with nurses that have substance abuse or mental health issues.
Specializes in ER, ICU/CCU, Open Heart OR Recovery, Etc.
SpankedInPittsburgh said:
This is a blessed step in the right direction. Do I agree with all the details? No but even as it stands it is much more just than the garbage that is out there now. I find it interesting that someone who went through this program 20 years successfully wasn't tortured nearly as badly as we are now. I believe this is because "improvements" were made incrementally & these BONs got in bed with the rehab industry. All of which is a crying shame because at their core these programs are a good idea. HELPING nurses with substance abuse issues keep their jobs & more importantly save their lives. In practice they an abomination
They got in bed together, and neither has accountability to either the public, the professions, or the nurses they allegedly "serve".
Specializes in ER, ICU/CCU, Open Heart OR Recovery, Etc.
An additional thing I'd like to see is accountability for the companies that initiate the testing, the labs that actually perform the testing, and what is done with the results. There have been many casualties of test results that have been incorrect, and I feel there needs to be options for retesting/incorrect results with real accountability for the above mentioned agencies.
These tests are NOT infallible and people shouldn't be punished for incorrect results.
Here's an interesting factoid....a certain program in a certain state that shall remain nameless at this time is registered as a FOR PROFIT Corporation. I already have an inherent dislike for the idea of for profit medicine in general but how is that for the clear objective of this to be to make as much money as possible off of the product (us). Our own BON sold us to the highest bidder to be resold to the rehab industrial complex. Anybody else feel kinda dirty now? Excuse me, ima gonna go take a shower......
After I disinfected my brain from the printed truth of knowing that nobody cares about our recovery from anything ( always have known it but seeing in print stings) I did a little research. I checked a random cross section of the states that have "alternative to discipline" programs and found that in about 20, the "ownership/management" was by either directly the BON or a non profit or a combo. Since I know the most details about mine, I thought it curious that not only is the program itself registered as a for profit, the main "evaluation/treatment" facilities that they strongly steer you towards (like fail to inform you that there is any alternative) are also for profit.
As if we have not already established that the evaluation/treatment arm need to be amputated from this mess, this, to me is screaming evidence that these people have an incentive to put people in thier program for any reason they can invent and keep them there as long as possible, thier career and sanity be ******.
Specializes in Psych, Addictions, SOL (Student of Life).
I appreciate all the comments as they are helping me get a feel for where this is going. I am putting together a basic letter that can be sent to legislators in each state. Please remember to keep this discussion productive with ideas to advance our cause. We want to appear as a strong healthy united force to be reckoned with. Understand this is not going to happen overnight but change worth having takes time.
Lisacar130
379 Posts
If by level 2 and 3 you are talking about people who are already in a monitoring program and continue to use, then it seems fair. But how it was written, it looks like you are talking about the original offense. See below:
Level 2: RN/LVN who failed a UDS from above level 1 OR who is found to be impaired at work.
Level : 3RN/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.
Here is where I got the one year suspension. Again, if you are talking about people who used while in a monitoring program, it looks fair to me. IL is apparently very lenient and we get an automatic one year suspension if we have a positive test while in the monitoring program, which I think is fair.
For level 3...
If all conditions are met participant may return to work after 1 year of continuous sobriety as evidenced by negative random UDS
But I am confused with your clarification. If a level one is for DUI people and level 2 and 3 are for those who are already in a monitoring program and failed to meet the terms... where are the people who's original offense is diverting or having a positive test for an opiate, for example? Let's say you have a nurse who got caught diverting norco and this is her first time getting caught. She would like to start the monitoring program for the first time. What level is she then?