Dual Intake Evalution

Nurses Recovery

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Specializes in Palliative.

Hi all, 

I go for my intake assessment for NHP program on Thursday and I’m extremely anxious on the outcome as my situation is unique. 
 

Last year I was working as a RPN in a palliative care unit. This unit was extremely toxic, always short staffed and recently had a management change which was not floor nurse friendly. I was almost 6 months pregnant at the time and the stress was really starting to get to me. I also have PTSD from my ex/first child as it was an extremely abusive relationship. So even though my fiancé is amazing was extremely supportive and involved throughout my pregnancy my mental health deteriorated as my pregnancy progressed. Then in November I lost my grandmother unexpectedly (she passed away on the toilet and my family and I found her there) and my ex (whom I have always tried to maintain some what of a positive co parenting relationship for our daughters sake despite the abuse and his addictions) hit rock bottom and was living in a tent. In the same weekend I had to help convince my ex’s parent to help get him into detox/rehab and bury my grand mother. At this point I started having panic attacks at work went to the doctor and took a stress leave to cope with my mental health. I was not sleeping well, exhausted, anxious and extremely depressed and just not functioning whatsoever. 
 

At the time I was dual licensed as a RPN and RN  as I have just wrote and passed my NCLEX. I was still actively seeking employment as an RN. I was offered a full time job at a hospice in the beginning of December. Despite being 6+ months pregnant they didn’t realize I was pregnant at the interview. I made sure they knew how far along I was when I was offered the position. They called me back and instead tried to offer me a casual position - which I declined as it only made sense to take full time with benefits and quit my old position as a RPN.
 

I worked 5 orientation shifts in which I now recognize I was not mentally ready to come back to work. My anxiety attacks which we’re improving came back full force, and my depression and sleep issues once again worsened. They fired me on my last orientation shift (which I’m sure they were happy about anyways so they didn’t have to pay out maternity benefits) A month later I received a report from the board of nursing in Ontario. They had reported me, but somehow chalked my anxiety/depressions up to symptoms of diversion. I was 7 months pregnant and currently have a healthy 6 month old that I’m exclusively breastfeeding. I was not taking drugs whatsoever.

After I stopped working as a nurse I worked only casually at my ex’s family bar to help out and build my confidence back. My mental health improved but I was still struggling with anxiety and depression throughout the remainder of my pregnancy. Once I gave birth in March, my mental health shifted and within a week I honestly felt like my old self again. I’ve been doing great since. Since April, I’ve moved 2 hours north, started a new job which is low stress and only one 8 hr shift a week until my Mat leave ends in March then it’ll be part time. On top of that I’ve gone through a legal battle with my ex and managed the stress in a healthy fashion! 

I am completely willing to enter a mental health monitoring contract regarding my perinatal and post partum mental health but I am scared to be labeled with a substance abuse problem. In my medical records there is stuff from when I was a 20 year old (about 10 years ago before I had my daughter and entered nursing school) talking about substance mis use. I have ADHD, do not smoke weed or do any drugs. I drink socially that’s it. 

Do you think they will still sentence me to recovery treatment/AA meetings/drug testing despite this NOT being a drug problem? 
 

Thanks!

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Did you termination letter say they thought you were diverting? Were there missing meds or failure to get a co-sign? If not, you’ll mostly likely need to have an eval for substance abuse and in that case you need to deny deny deny. Not even trying Pot in high school, family doesn’t have substance abuse hx. If you drink it’s on birthdays and holidays only. Not even a glass of wine after a tough shift. All ways to say you could have a potential problem. 
 

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Specializes in Palliative.

No my termination letter mentioned nothing about diversion. They literally just told me “I was not a good fit.” verbally. No proof of anything. According to them I gave extra PRN pain medication on two occasions (My old palliative unit case managers were very pushy on giving prns) and they could not visualize waste I has signed off and tossed in their large and half filled sharps/waste container.... which I find hard to believe considering it was filled with a month + of narcs/used needles. The of the complaint was how I was anxious, and acting frazzled. I was very pregnant (although definitely mentally unwell at that time) and definitely not diverting or using drugs... had they asked for a drug test I would’ve passed fine. They asked no questions and just fired me.
 

Had my eval today which I think went well. Any drug history I have is 10 years prior. It is in my medical hx with my doctor so I had to be honest unfortunately. I had a eating disorder when I was young and I used to mis use my adderall script to suppress my appetite. I have fully recovered from my eating disorder since then and have had no issues for 9+ years including taking adderall without issues for numerous year while in school. The main focus was about the trauma I experienced in my past and the symptoms I was experiencing/events surrounding my pregnancy and events at work. She openly recommended that if I were to become pregnant again I should follow up with a psychiatrist specializing in post partum/prenatal health. She also commented that I had good insight into my own issues. 

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Do you work in the US or Canada? Sounds like you may get a monitoring contract for mental Heath. 

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Specializes in general.

Best of luck to you! keep us updated

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Specializes in Palliative.

I work/live in Canada. And a mental health only contract is what I’m hoping for as that may actually benefit me. My fiancé and do plan on possibly having another child in the future (2-3yrs) and I’m hoping I don’t have the same experience with pregnancy, and if I do, I’ll have the support to help me. 
 

The idea of going to IOP and AA/NA meetings and declaring “I’m a addict” in my situation seems far far more traumatic. I’m also worried excess meetings and drug testing would be difficult accommodate around breastfeeding. 

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If you know you can pass a drug test urine,blood and a hair follicle test. Do not say you have a drug problem. They can’t say you do if you don’t. Like I said do not even say you tried Pot in High school. Focus more on the hx of mental health if you have an eval. 
best of luck, we are here for you 

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I don't believe they have any way of getting your medical records regarding your substance use disorder 10 years ago unless you voluntarily turn them over – if they do know about that it'll be used against you in some way, they don't care how old of a problem it is and I while I certainly wouldn't want you to villainize yourself, I hope you can understand that there are people in dual diagnosis monitoring program whose h/o substance abuse is no worse than yours.

I would have mentioned absolutely nothing about it. I think if you had denied everything they'd have absolutely no way to pin anything to you, but it seems like you are comfortable with the idea of a mental health monitoring contract (which seems crazy to me, since they really don't help, but to each their own...). If you think you could benefit from a mental health monitoring contract, you could always do something like that purely for yourself, like setting a goal of attending therapy weekly etc. 

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Specializes in Palliative.

I am in Ontario, Canada and I had to sign consent to allow them to communicate and have my medical records from my current care provider to be a part of their program. I had no choice. That or I would be dealing with the board instead and face possible marks on my license. The nhp in Ontario is only a year old, and voluntary. When I got my formal complaint I had a choice of them or the cno. 

Honestly, now that my mental health has stabilized after having my child I’d rather no contract whatsoever, but I don’t think that’s an option. My UDS will be negative. It may be wishful thinking, but hoping they can really see this was not drug related whatsoever. This was an employer who didn’t even want me after they found out I was so pregnant but could not fire me for that, but my anxiety was enough to make a report about me to our nursing board (which is legally required in Canada when you terminate a nurse). My eval was very trauma focused with very minimal discussion about drug or alcohol use in it. 

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4 hours ago, LBltc said:

I am in Ontario, Canada and I had to sign consent to allow them to communicate and have my medical records from my current care provider to be a part of their program.

I hear you on this. The BON in the US often requires similar things of people in monitoring or on probation – however, that includes the current medical record, not old medical records they have no way of even knowing exist. If there is a way of not telling them something and them having no way of finding out, I wouldn't fall on the sword over it thinking my honesty will be appreciated. I hope it all works out for you! 

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Specializes in FLOAT RN I DID IT ALL EXCEPT DELIVERY AND OR.

hello. you have a very interesting situation,would you like to chat? totally 100% support here!

pm me

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On 10/18/2020 at 7:18 PM, NuRsE ReScUe said:

hello. you have a very interesting situation,would you like to chat? totally 100% support here!

pm me

You seem like you’re with a State BON? You keep posting this genetic post on EVERYONES posts...... 

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