Call to action! Nurses in Monitoring Programs

[hppygr8ful]

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

[JadedCPN, BSN, RN]

58 minutes ago, ArmyRntoMD said:

Addiction is a choice not a disease.

Ahhh this explains so much.

[ArmyRntoMD, BSN, RN]

You have no control over a disease. A patient with pneumonia, or cancer doesn’t make a daily choice that is the result of their condition.

The first step is admitting responsibility. As long as “it’s not their fault it’s an illness not a choice” is the slogan, it takes their autonomy to change their poor coping mechanisms.

[JadedCPN, BSN, RN]

On 1/7/2020 at 4:56 PM, ArmyRntoMD said:

You have no control over a disease. A patient with pneumonia, or cancer doesn’t make a daily choice that is the result of their condition.

The first step is admitting responsibility. As long as “it’s not their fault it’s an illness not a choice” is the slogan, it takes their autonomy to change their poor coping mechanisms.

Addiction IS defined as a disease by many reputable medical organizations including the American Medical Association.

There are many diseases that are impacted/triggered by lifestyle choices, such as diabetes type II or lung cancer from smoking. Doesn’t make them any less of a disease even though people’s choices may have impacted it. Same with addiction.

[ArmyRntoMD, BSN, RN]

How is drug addiction comparable to say diabetes? Sure poor diet and lack of exercise can make one more prone to it, but you will not become an addict if you don’t take these substances. I may get diabetes, heart disease, or lung cancer no fault of my own. I guarantee you I won’t wake up one day and find myself addicted to smack unless I made a conscious effort to stick a needle in my arm.

There’s a difference in “choices may have impacted it” and “directly caused it.”

In addition, it’s not very likely that those other diseases will affect patient care. It’s not a punishment that they shouldn’t be a nurse but simply that patients come first. No one has a “right” to any job.

[Gingernurse81]

JadedCPN, there's no need to debate this person. Maybe someday they will have the unfortunate opportunity to have their mind changed. Strange to say I hope they don't have to be in that position. However, it's pretty evident there's no budging here, and to keep arguing is wasted effort.

[ArmyRntoMD, BSN, RN]

I’ve been in that situation. I had a junkie girlfriend when I was in the army. Wealthy, daughter of a multi millionaire, (actually a nursing student who luckily never made it), who I found out was addicted to both heroin and coke. Glad I found out somewhat early on. I’m just so glad she didn’t give me something. Something how stupid we are when we’re young. Young lads out there- if she tells you “yeah my parents are super over protective and drug test me because they don’t trust me”, it isn’t because her parents are psycho. They most likely have a reason. ?

So it isn’t like it’s something I haven’t experienced.

[hppygr8ful, ASN, RN, EMT-I]

On 1/7/2020 at 5:22 PM, ArmyRntoMD said:

How is drug addiction comparable to say diabetes? Sure poor diet and lack of exercise can make one more prone to it, but you will not become an addict if you don’t take these substances. I may get diabetes, heart disease, or lung cancer no fault of my own. I guarantee you I won’t wake up one day and find myself addicted to smack unless I made a conscious effort to stick a needle in my arm.

There’s a difference in “choices may have impacted it” and “directly caused it.”

In addition, it’s not very likely that those other diseases will affect patient care. It’s not a punishment that they shouldn’t be a nurse but simply that patients come first. No one has a “right” to any job.

You are of course entitled to you own opinion which is exactly what you are espousing. Please be sure to qualify you comments as such. There is a plethora of Evidence based research on the disease model of addiction. This is why it is recognized by the AMA, the APA and listed in the DSM 5.

Hppy

[hppygr8ful, ASN, RN, EMT-I]

Please lets not lose sight of the purpose of this forum which is to bring about sensible reform to a program effecting the lives of many nurses and their families.

Thank You

Hppy

[AnnaFender]

I find your monitor program idea still too overbearing. A UDS doesnt test for alcohol so if a person gets arrested for a DUI for the first time they have to deal with the legal aspect outside of their job which will most likely require monitoring ordered by the court and substance abuse counseling. For the love of God if this happened outside of work unrelated to their practice, leave them alone. The expense and time commitment ordered by the judge is only going to push a person over the edge if they have to be scrutinized by the board too while at work! Only if someone is obviously impaired on the job or a serious error causing injury occurs should you order a drug screen and send them home and based on those results order random drug screens for no more than 6 months. And so is requiring more than 30 days of counseling. 3 yrs is ridiculous. If they are involved in criminal activity related to their practice then automatic suspension of license for up to 1 yr and termination by the employer. If the criminal activity occurred outside of work, Order monthly self report info to the board regarding conviction of the crime. If convicted depending on crime order counseling to be completed within a certain time random drug screens not to exceed twice a month while still being allowed to work. Also, if crime occurred on job pay a fine. What I'm saying is The board of nursing oversteps the criminal justice system when a nurse is facing legal issues unrelated to their job, and makes it difficult to make a living and satisfy board requirements. This only encourages dishonesty in my opinion and creates mental health issues. I understand wanting to protect the patients we serve but what rights do the nurses have to be protected from the board of nursing and the financial strain of paying for all of these things? Also if nurses satisfy board requirements why would you continue to penalize nurses for future career prospects by disclosing their health information? Last time I checked it's not illegal to have a substance abuse problem. So if a crime has not been committed why would you permanently label them? Those records should be sealed once requirements are satisfied

[AnnaFender]

Also, I do agree addiction is a choice. But the fact remains not everyone has the same circumstances in life nor does everyone have exceptional coping skills. When a police officer or veteran takes their own life or becomes an alcoholic typically they are offered treatment because their lives are important, but it seems like the nursing boards are only interested in ordering constant correction and scrutinizing without investing time in poor working conditions, or empathy for the circumstances one may be creating stress and poor coping. Usually chronic substance abuse is directly related to some sort of trauma or painful experience and not to intentionally be some irresponsible good time seeker. So when you say go to AA meetings for the next 3 to 5 yrs. That doesnt really address somebody getting their *** beat at home by their husband or a chronically I'll parent or child they may be caring for etc. Where is the empathy fir nurses that we expect nurses to show for others?

[hppygr8ful, ASN, RN, EMT-I]

2 hours ago, AnnaFender said:

I find your monitor program idea still too overbearing. A UDS doesnt test for alcohol so if a person gets arrested for a DUI for the first time they have to deal with the legal aspect outside of their job which will most likely require monitoring ordered by the court and substance abuse counseling. For the love of God if this happened outside of work unrelated to their practice, leave them alone. The expense and time commitment ordered by the judge is only going to push a person over the edge if they have to be scrutinized by the board too while at work! Only if someone is obviously impaired on the job or a serious error causing injury occurs should you order a drug screen and send them home and based on those results order random drug screens for no more than 6 months. And so is requiring more than 30 days of counseling. 3 yrs is ridiculous. If they are involved in criminal activity related to their practice then automatic suspension of license for up to 1 yr and termination by the employer. If the criminal activity occurred outside of work, Order monthly self report info to the board regarding conviction of the crime. If convicted depending on crime order counseling to be completed within a certain time random drug screens not to exceed twice a month while still being allowed to work. Also, if crime occurred on job pay a fine. What I'm saying is The board of nursing oversteps the criminal justice system when a nurse is facing legal issues unrelated to their job, and makes it difficult to make a living and satisfy board requirements. This only encourages dishonesty in my opinion and creates mental health issues. I understand wanting to protect the patients we serve but what rights do the nurses have to be protected from the board of nursing and the financial strain of paying for all of these things? Also if nurses satisfy board requirements why would you continue to penalize nurses for future career prospects by disclosing their health information? Last time I checked it's not illegal to have a substance abuse problem. So if a crime has not been committed why would you permanently label them? Those records should be sealed once requirements are satisfied

Actually the UDS administered in monitoring does check for alcohol metabolites and can detect if you drank several days prior!

[77Mercy, RN]

My situation: Nurse who after 7 years of being sober relapsed and immediately went on a leave of absence in hopes of getting back on track. This nurse never once came to work impaired and worked a desk job as a PHN. One day into her LOA she was reported by her Nurse practioner who was also having an affair with her husband. Yes- her husband was having an affair with her NP. She was immediately contacted by the health professional service program and did not agree to all the conditions of the HPSP therefore she was reported to the board of nursing and after meeting with them her license was suspended for a year. She is now sober but has not went back to nursing as she does not want to participate in the monitoring program.