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.
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