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.
Thank you for your comment. I believe that a good nurse should never be comfortable with using the work "Junkie". That term is degrading and insulting. It scares me that their are nurses who still believe that is an appropriate term.
Specializes in Mental Health, Gerontology, Palliative.
On 1/7/2020 at 2:30 PM, ArmyRntoMD said:
Addiction is a choice not a disease. The first time you use is a complete choice, and while more difficult, every single time after that is a choice.
What bollicks
Addiction may start out as a choice, eg the first time someone chooses to use P (meth) however before long choice is gone. It's rather like the dog that thinks its taking its master for a walk but before long realises its on a choke chain.
That said, detox, getting clean is also a choice. I am an addict. I made that choice over 15 years ago when I found myself having to take temazepam during the day just to function after 18 months of being prescribed it by a GP to help it with sleep
I have never misappropriated medications at work. Nor has my work performance as a nurse and prior to that ever been affected by drugs. I also take steps to ensure I dont relapse including making sure any treating doctor knows never to prescribe me benzos
Addiction does not just occur from illegal drugs, it also happens from prescribed medications and I hope you never find yourself in that position
Specializes in ER, ICU/CCU, Open Heart OR Recovery, Etc.
Thank you Hppy for starting this conversation. I don't agree with all of the Levels, but this is a good way to at least get some ideas out there. I also think working with a legislator is a great idea, in terms of doing more with a chance for creating real change.
I definitely agree with the need for an end to the One Size Fits All.
Related to this, is a need for Boards of Nursing to have accountability for how they treat nurses. I understand that their job is public safety, but I've seen above and beyond in terms of punitive sanctions against nurses. I also feel that there needs to be a point where the discipline that a nurse gets, can no longer be searchable and visible to the public on the variety of databanks available.
Is this still happening? I am currently in a monitoring program. I am a nurse of twenty years. No issues with my job performance and all tests passed until the last one. I had no idea what nurses had to go through with the board!! I have been appalled at the treatment, inconsideration, and just plain disrespect a nurse is required to put up with to keep their license. Then when adding in the financial part... I have not found very many who have been positively affected by this program and feel it is doing a lot harm to many. And it never ends apparently since u have it on your license from then on. I’m not usually one to get in the middle of issues but this one I would be willing to put my all into. Plenty of time as I am jobless because of the “encumbered license”.
Specializes in Psych, Addictions, SOL (Student of Life).
On 6/6/2020 at 2:04 AM, Tracy653 said:
Is this still happening? I am currently in a monitoring program. I am a nurse of twenty years. No issues with my job performance and all tests passed until the last one. I had no idea what nurses had to go through with the board!! I have been appalled at the treatment, inconsideration, and just plain disrespect a nurse is required to put up with to keep their license. Then when adding in the financial part... I have not found very many who have been positively affected by this program and feel it is doing a lot harm to many. And it never ends apparently since u have it on your license from then on. I’m not usually one to get in the middle of issues but this one I would be willing to put my all into. Plenty of time as I am jobless because of the “encumbered license”.
Unfortunately it just sort of died. The legislator I was working with a Republican by the way lost their race and I could not find a single Democrat to even look at what I put together. I see that some states are adopting practices that are less severe and more fair but there is still a long way to go and It takes tremendous amount of time money and energy to keep something like this in front of the eyes of officialdom.
There are so many hoops and so much red tape. For example, if the facility you work at says you are suspicious for diversion, and they charge you criminally and fire you, you may nit be able to afford a lawyer. So if charged with a felony...the BON states ANY felony is a 10 year mandatory suspension. You can enter the program, but if you can't complete...or pay to piper....that felony comes in. Then you are mandatorily placed on the OIG exclusions list...which after so many years, you can apply to be removed. If they do, that is helpful, because if not then you can never work anywhere that accepts medicare/medicaid...not even shoveling snow in the Winter or as a janitor. That brings even more problems to an already strained financial situation.
It is hell. That's just a part of it all. One 5mg pill = felony charge and loss of not only livelihood, but life (in all ways except literally).
Specializes in Psych, Addictions, SOL (Student of Life).
Lust4life said:
There are so many hoops and so much red tape. For example, if the facility you work at says you are suspicious for diversion, and they charge you criminally and fire you, you may nit be able to afford a lawyer. So if charged with a felony...the BON states ANY felony is a 10 year mandatory suspension. You can enter the program, but if you can't complete...or pay to piper....that felony comes in. Then you are mandatorily placed on the OIG exclusions list...which after so many years, you can apply to be removed. If they do, that is helpful, because if not then you can never work anywhere that accepts medicare/medicaid...not even shoveling snow in the Winter or as a janitor. That brings even more problems to an already strained financial situation.
It is hell. That's just a part of it all. One 5mg pill = felony charge and loss of not only livelihood, but life (in all ways except literally).
This is why you cannot afford to not have a lawyer.
This is why you cannot afford to not have a lawyer.
There isn't anything a lawyer can do about the administrative part of it. They'll still charge you out of pocket, but all they can truly do is sit with you while you have an initial assessment by the board rep. BON trumps a lawyer for every time I've heard of it. Most people who just got fired can't afford a lawyer on top of paying the programs fees. So it sounds great on paper but in reality, it's harder. It would be amazing if every state had the same rules, but it is so vastly different, which is another hurdle. For example, some states allow MAT....some don't....one was threatened by the DOJ (Illinios), so they changed policy. They all should accept it. That's a start.
Specializes in Psych, Addictions, SOL (Student of Life).
Lust4life said:
There isn't anything a lawyer can do about the administrative part of it. They'll still charge you out of pocket, but all they can truly do is sit with you while you have an initial assessment by the board rep. BON trumps a lawyer for every time I've heard of it. Most people who just got fired can't afford a lawyer on top of paying the programs fees. So it sounds great on paper but in reality, it's harder. It would be amazing if every state had the same rules, but it is so vastly different, which is another hurdle. For example, some states allow MAT....some don't....one was threatened by the DOJ (Illinios), so they changed policy. They all should accept it. That's a start.
Talking about two different things. I was responding to your initially comment about being charged with a felony. The BON cannot bring felony charges against a nurse only a district attorney can do that and all parties accused of cimes are entitled to a free attorney provided by the state if they can't affor one.
When I had my trial, I was not appointed a public defender. They met without me even there, actually. They had me wait inside the court house and then came to me and said, "This is what we are offering you. You can either except it or take it to the higher courts".
My point is only that there are so many differences from state to state, in the programs, and the BONs that it would be hard to come up with "levels" to discipline, there would be much to consider.
Specializes in Psych, Addictions, SOL (Student of Life).
Lust4life said:
When I had my trial, I was not appointed a public defender. They met without me even there, actually. They had me wait inside the court house and then came to me and said, "This is what we are offering you. You can either except it or take it to the higher courts".
My point is only that there are so many differences from state to state, in the programs, and the BONs that it would be hard to come up with "levels" to discipline, there would be much to consider.
Were you arrested? Were you Mirandized? More important, did you request an attorney at the time of your arrest? You may have the right to appeal.
" You have the right to remain silent. Anything you say can and will be used against you in a court of law. You have the right to an attorney. If you cannot afford an attorney one will be provoded for you free of cost. "
To many accused fall into the trap of investigators telling them that don't need an attorney. Of course they do this. It makes it so much easier to convict you.
With regard to your particular case. What's done is done unless you have grounds for appeal. This information is more for those who currently find themselves in this predicament.
FYI: I was not represented by an attorney but I was not arrested for a crime. I still did a 5 year one size fits all program that cost me dearly in time, money and my dignity. Still I'm alive today and no longer impaired by drugs or alcohol so there's that.
77Mercy, RN
26 Posts
Thank you for your comment. I believe that a good nurse should never be comfortable with using the work "Junkie". That term is degrading and insulting. It scares me that their are nurses who still believe that is an appropriate term.