Impaired Nurses

Nurses Recovery

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I've just recently learned about a program for nurses that may need help with a drug or alcohol problem known as the impaired nurses. I was just wondering what your thoughts were on this subject. Should nurses that have a problem be allowed back into the work place after they have received help? What if they have a relapse?

I've read almost all of the posts on this issue, dating all the way back to 2003......

And I have to say that in reading some of the posts, it is sickening and very sad that nurses can place blame and judge other nurses, say that they don't trust them, they wouldn't want a recovering nurse taking care of their family and that they don't belong in nursing anymore. This is the exact reason why nurses are afraid to come forward and ask for help---because of the stigma that substance abuse issues carries with it and the judgment from other people. How other nurses can sit back and criticize and judge and point fingers instead of saying that they would want to help that person in any way they could is honestly very disturbing and disheartening to me. I don't point my finger at a nurse who is obviously obese and judge her, whisper about how her thighs jiggle when she walks and how slow she is because of her weight, even when I see her shoving a piece of cake into her mouth, or a nurse who has asthma and goes out to smoke every half hour. Nobody is perfect, and life happens to everybody. We all have our downfalls The majority of times, substance abuse is only a symptom of something else that is much deeper and more complicated than any of those people judging could ever understand. I am sure we work with many nurses every day who are being treated for clinincal depression, bi-polar disorder, ADHD or some other psychiatric disorder, and we have no idea that they are taking medications to manage them. They aren't judged. If any "strange" behavior is noticed, it is written off as "having a bad day" or "PMS" or "What's up with her?" It is frequently not out in the open, because people would be judged for that too. Substance abuse, in many cases, happens to be a manifestation of a psychiatric issue that has gone undiagnosed---and, yes, perhaps the nurse has denied that they have some kind of psychiatric issue, for many reasons, but a main reason being that psychiatric issues STILL carry a major stigma with them and they don't want to be stigmatized and judged----but isn't that when they need support and help the most? To see that revealing their problems will result in everyone talking behind their back and smiling to their face is why people don't reach out for help when they really need it most, for the fear of being judged and stigmatized. Somehow, obesity, smoking, caffeine addiction are not looked at as "problems"----and I do realize that for the most part, won't result in any type of danger to the patients----but, I find that people with those problems happen to be the first people who do the whispering behind backs and finger-pointing. Everybody has their problems----and if you don't, then God Bless you, you are damn near perfect. Nurses with substance abuse issues are looked at as "dirty" and "incompetent", even if they are extremely competent, experienced and skillful, and somehow other nurses seem to think that having a substance abuse issue lessens that nurse's abilities, when that is not at all true. Substance abuse and addiction happens to be an official diagnosis in the DSM-IV, so for those of you who say it is the nurse's fault and they are solely to blame for taking the drugs you couldn't be any further from the truth!! As nurses, we all know that people with psychiatric disorders have trouble with decision making, impulsive behaviors and bad choices, and they should be treated for their DISEASE!! Until substance abuse and addiction is looked at as what it is---A DISEASE---by our own peers, the judging and whispering and finger pointing will continue.

A person who is in recovery from substance abuse and/or addiction, in my opinion, is a much stronger person than I am. I will help them in any way they need---whether that be just listening or helping them with narcotic administration or giving them a ride to an AA meeting. I find that nurses are a group tend to be very judgemental, it's the nature of the beast when you deal with a profession that has so many women. We shouldn't try to be punitive, we should try to be helpful and supportive, because that is what they need the most.

Thank you so much PRESLA. I will heed your advice. There is a clause in my contract that implies I cannot litigate with the Board.... I need to see if that is an absolute. I sure do feel like a criminal. I feel like I did right in the very beginning of my recovery. Yuck. Thank you again, stay in touch.

I don't know how to PM you, since I just joined this group today but........I am curious to know how your case turned out. I find it VERY INTERESTING that in your contract you cannot litigate with the Board----I wonder why they feel it is necessary to put that in there? If the Board felt comfortable in their decisions, they would not need to put that kind of clause in anyone's contract!! Even so...........I don't know what happened (I hope it wasn't a negative outcome), but if I were you I would have done some research regarding that "clause" about not litigating with the Board. Their should be some sort of legal appeals process in every state to challenge the decision of any regulatory body, whether that be nurses, police, firemen, teachers, etc., especially when it comes to licensed professionals.

Please let me know what happened.

Specializes in ER, TRAUMA, MED-SURG.

Hi NurseDiane - Welcome! I am glad to see you here with us. I have been a nurse since 1991 and was diverting narcotics at work in 1999. A lot of the staff - co workers and so called friends acted like they were scared I was contagious, I guess guilt by association. People smiling at your face, then knifing you in the back when you turned around. I left that facility when I went to treatment and found another job (eventually) after the BON approved me to work. I had been around other nurses in my situation before I got caught, but tried to not judge, I didn't know their situation, what led them to this, ect. I always had hoped I would get the same. Wrong, in a lot of people's eyes. Oh, well.

So, I made it through, and will celebrate 10 years in recovery on August 15th of this year. It sure would have been nice to have met someone like you at work when I was going through all that.

Anne, RNC :yeah::yeah:

Specializes in LTC, MDS, Education.

Yes, NurseDiane, I agree with everything Anne said! :yeahthat: And we're really glad to have you join us here at allnurses!

:hrns&wlcm:

Thanks Anne and "bedpan"!!! (I am laughing at even typing the word bedpan....LOL)

Listen, I guess with age comes wisdom, and in my years of life on this earth, one thing that I've learned is ALL OF US, no matter who we are, cannot claim to be saints---and who in the hell am I to pass judgment on anybody? We all need help every now and then, and we are going to base giving our aissistance on WHAT exactly the problem is that someone needs help with? Sometimes life tears us apart----and I find that nurses are a very proud group of people, not asking for help lest they be cast in a light of not being "strong", and that is not the case at all. It is the strength inside of us that gives us the guts to ask for help.

In life and in nursing, I have found that the less people know the better off I am!! However, I have gotten to the point that I honestly do not care what they know and what they don't know---if they want to be superficial and shallow, passing judgment and whispering behind my back, then they can certainly do that. I, on the other hand, choose not to take part in petty gossip----because over the years I have seen what kinds of nurses are the ones who are engaging in the gossip, and trust me, they have no right to be gossiping about anybody!! I can't stand the "smile to your face, stab you in the back" mentality---I honestly can't be bothered with that crap. I choose to live my life happily and positively, lending a hand or a shoulder or an ear to whoever might need it at the time. I can "keep a secret", and when someone talks to me they can be assured that anything they have said to me stays within my two ears. Other nurses have actually gotten mad at me because I am so private----at one hospital I worked at where I was a supervisor, rumor actually went around that I was a lesbian because nobody knew about my personal life, if I was married or single, who I was dating, if I had kids, etc. And, let me tell you----nurses HATE that kind of stuff!!! Do you know why? Because then they have nothing to talk about!! So, in turn, they make stuff up...........pretty sad, isn't it?

As I said in my previous post----drug abuse/addiction, more often than not, is only a symptom of something that runs much deeper than just wanting to get high, especially when it comes to nurses. One thing that I find odd is that in BON assistance programs, the thing that is focused on is the drug use itself----very little attention is paid to the underlying reasons for the drug use. Threatening a nurse to stay clean or intimidating them does not do any good----you can "stop" using the drugs because you are afraid of the consequences, but the underlying problems are still there, much like the term "dry drunk". As far as I am concerned, EVERYBODY could benefit from living their lives according to the 12 Steps---but, see, this would be very difficult for the "loud and proud" to do, because then they'd have to lay their skeletons on the table and they are terrified to do that. Do you know why? Because then they would be subject to the same judging and finger pointing that they themselves have done for so long. You have to dig down deep inside yourself and pull everything out, and then share it with others----only then can you get the help and support that you need and that can pull you out of whatever hole you've benn sitting in for so long. By the time a nurse starts using drugs or alcohol, usually the underlying problem has been going on for so long this is the only way they know how to cope with it. Nurses are TERRIFIED to ask for help EXACTLY because of punitive actions by the BON, so it goes on and on until it is out of control and somebody else notices. A lot of times, BON makes the "rules" so rigid and difficult to live by, by both the nurse and any employer they may have, it adds that much more stress to the original problem. I am not saying that they should just let the nurses go on using substances and putting people's lives in danger, but they have to be a little more flexible than some of them are. I knew a nurse in Florida who had a substance abuse problem, and the Florida IPN made life nearly impossible for this woman. She lived 45 minutes from one of the best addiction centers in the country---Hanley Hazeldon, which is considering the "grand-daddy" of recovery centers---and they mandated her to go to someplace in Atlanta, which would have cost her upwards of $100,000 for 3 months, which her insurance did not cover. She would have had to take a 2nd mortgage on her house to pay for it(and not having a job, it would have been rather difficult for her to pay it back---and then she would have lost her house altogether). Her insurance would have covered Hanley Hazeldon, though-----and they wouldn't let her go there!!! Do you know what she did? She surrendered her license and went voluntarily to Hanley Hazeldon, because her life meant that much to her, and she wanted to get help. I have since moved from Florida and I often wonder what happened to her----she was a SUPERLATIVE nurse with a graduate degree, very experienced, highly skilled and compassionate, she was just going through a really bad time with depression and decided to take the matter into her own hands rather than ask for help because she was afraid of the backlash. And, actually, now that I an thinking about it---she did go to a psychiatrist seeking help, and was honest to him about how she was self-medicating, and the psychiatrist turned her in to the BON----WITHOUT TELLING HER THAT HE WAS DOING THAT!!! When she got the call from BON, she almost fell off her chair----and she asked them who turned her in and they wouldn't tell her. When she went back to this shrink, she said something about the BON now being involved and he said something like "Oh, yeah---I was the one who turned you in." Now---talk about violating a person's trust!!! And, now she is supposed to open up to this shrink and lay her **** out for him to "treat" her? He misdiagnosed her---put her on Prozac and something else which made her ABSOLUTELY crazy (she tried to kill herself on those meds) and when she kept going back to him, she would tell this guy she didn't feel right, but he told her to keep taking it because it took a while to work. Finally, when she tried to kill herself and was Baker acted in the ED, she was admitted to a psych unit and the shrink she was seeing discontinued all the meds he had put her on...........great doctor, huh? And this is the type of stuff that I am sure goes on every day, which is so unfortunate. If you're going to turn someone in to the BON, be up front about it---especially if you are a treating physician!!!----and be honest to this person who is obviously having a hard enough time as it is.

I don't know----I know this post is long enough----I guess I have "softened" over the years, maybe, but just because we are nurses does not mean we are infallible and don't suffer from the same things everybody else in society does too. If people could have a little more understanding, a little less intolerance and a whole lot more compassion maybe we as a people and us as nurses could make asking for help not as "embarrassing" as it is.

Oh, Anne----by the way---I forgot to congratulate you on your 10 year anniversary. That is quite a wonderful feat, and I think it is awesome that you are able to show the strength and committment that you have to living life without "assistance".

Good for you!!!

Diane

Specializes in ER, TRAUMA, MED-SURG.
Oh, Anne----by the way---I forgot to congratulate you on your 10 year anniversary. That is quite a wonderful feat, and I think it is awesome that you are able to show the strength and committment that you have to living life without "assistance".

Good for you!!!

Diane

Thank you so much! I do appreciate it! I just wish people (either other addicts or sober co workers) wouldn't make it quite so hard to admit our vice and get help for it. I know it was the hardest thing I ever had to do, and I'm not proud of what I did, but I sure am proud of the fact that I was able to admit it, and proud of the fact that I have been able to get help and use the tools I was given in treatment and by my sponsor to facilitate my healing.

I try when I am working with a recovering nurse to not just look at them as "damaged" or "ruined" (as I had been called by another nurse) but for the steops they are taking to live a new life and learn from the mistakes they have made. Everyone deserves a second chance, I just wish everyone was able to actually get it.

Anne, RNC

"one thing that i find odd is that in bon assistance programs, the thing that is focused on is the drug use itself----very little attention is paid to the underlying reasons for the drug use."

one thing that people don't realize is that the bon is a regulatory agency, they are not qualified to "treat" or "diagnose" people.. their job is to ensure that nurses are safe and competent practitioners, and they do this by following the guidelines recommended by addiction specialists for rehab of addicted persons. this includes the requirement for nurses to attend support groups, in most states this is 12 step specific, but there is a slowly growing number of states that provide options to aa for those nurses who don't find aa to be beneficial.

in a nutshell, people who abuse substances lack coping skills. they may have underlying psych problems, but this does not apply to every addict. it is up to the individual to identify what their issues are and to change their way of thinking and acting. some people need professional help, others benefit from self help and support groups.

recovery is the sole responsibility for an individual, and the bon lays down the foundation based on the standards for treating people, that are used by treatment providers. the majority of nurses i know in recovery did find a better life because of the bon's intervention and monitoring.

"nurses are terrified to ask for help exactly because of punitive actions by the bon, so it goes on and on until it is out of control and somebody else notices. a lot of times, bon makes the "rules" so rigid and difficult to live by, by both the nurse and any employer they may have, it adds that much more stress to the original problem. i am not saying that they should just let the nurses go on using substances and putting people's lives in danger, but they have to be a little more flexible than some of them are."

diane, there is not a single state that has such inflexible and rigid guidelines that the nurse is destined to fail. the restrictions for work include no narc access for 6-12 months, no ot or night shifts, no charge, and rn supervision. these are all done for the sole purpose of protecting recovery by limiting the stress factors and the ability to divert easily. there are so many career choices in nursing that to accuse the bon of causing hardship sounds like the blame game.

"i knew a nurse in florida who had a substance abuse problem, and the florida ipn made life nearly impossible for this woman. she lived 45 minutes from one of the best addiction centers in the country---hanley hazeldon, which is considering the "grand-daddy" of recovery centers---and they mandated her to go to someplace in atlanta, which would have cost her upwards of $100,000 for 3 months, which her insurance did not cover. she would have had to take a 2nd mortgage on her house to pay for it(and not having a job, it would have been rather difficult for her to pay it back---and then she would have lost her house altogether). her insurance would have covered hanley hazeldon, though-----and they wouldn't let her go there!!! do you know what she did? she surrendered her license and went voluntarily to hanley hazeldon, because her life meant that much to her, and she wanted to get help. i"

fl ipn has a list of approved providers in fl only, and does not mandate people to one specific treatment center.

"nurses are terrified to ask for help exactly because of punitive actions by the bon, so it goes on and on until it is out of control and somebody else notices"

in my opinion, punitive action would be license suspension, and filing criminal charges for illegal drug use. the reality is that 40+ states allow the nurse to continue working and have a clean license if they agree to enter the alternate ( voluntary ) programs and are compliant. even those nurses who are unwilling to agree to this have the opportunity to keep their license, but their discipline action is on public record.

i agree that nurses hesitate to self report, the reason is not because of the bon's reactions , it is largely caused by the bias and judgemental views from their colleagues and the general public.

"she did go to a psychiatrist seeking help, and was honest to him about how she was self-medicating, and the psychiatrist turned her in to the bon----without telling her that he was doing that!!! when she got the call from bon, she almost fell off her chair----and she asked them who turned her in and they wouldn't tell her"

fl has a state law that mandates providers and all nurses to report nurses who have violated the npa. the md would face md board action for not reporting her. i think that if she had consented to go to treatment, he would not have needed to report, but it sounds like she only went after the bon called her?

it sounds like this nurse had more than addiction, the number of nurses who attempt suicide is low. while it is sad that she was reported by her md, and there were problems finding the right meds to treat her psych problems, this is not the norm and i don't see where the bon is to blame.

exnursie, I am sorry if I came across saying that the BON was to blame. I do understand that they are regulatory agency and they have to keep the public safe. I think what I was trying to say is that you cannot "blanket" everyone under the same set of circumstances.

As far as the shrink who turned her in---she was never given a chance to go into treatment voluntarily, before the BON called her. The day after she saw the shrink, the BON called her. I think the point I was trying to make with this is that he should have told her that he was going to do that, instead of doing it behind her back----how is this woman supposed to "trust" this shrink now that he has violated their "confidential" relationship from the get-go? Furthermore, the shrink did not say anything to her about going into rehab or anything----he gave her prescriptions for Prozac and other meds and sent her home. It wasn't until she tried to kill herself that things were taken seriously. I was a very good friend of hers and saw her go through all this mess, sat with her while she cried, tried to get her out of her house by taking her to a movie or out on my boat on the weekends----and I could see it in her actions and her eyes that she was not right, and it had nothing to do with drugs. Her eyes looked like a basset hound---sad, lost, confused. She could not belive that this was happening to her, that she "lost control" of herself, why was this happening to her.....I had no answers and all that I could do was be there to provide support and "watch" her and try to keep her safe.

And, I do know for a fact that the Florida BON mandated that she go to that place in Atlanta----I saw the paperwork and sat with her while she cried about it costing $100,000 and how she couldn't afford it. (It has also been discovered that "some" BON have "deals" with certain treatment places, a "kickback" system, you wash my back and I'll wash yours kind of thing.....) They had her running every which way but loose. She was not a Florida resident, and her family was out of state, and she tried to work something out where she could go to a rehab place near her family and they wouldn't allow that either. She ended up having her license placed on "emergency suspension"---but she did go to Hanley Hazeldon in West Palm Beach because they took her insurance.

And, not for nothing, I also heard a story about a nurse who had a bad back and was actually being treated for it already by pain management, had to drive half way across the country when her father died. She stayed at her mother's house and slept on the couch, and couldn't walk the day of the funeral because her back was killing her. She took a Lortab or something that her mother had, so she could attend the funeral and be able to drive back home when everything was done--she had forgotten to pack her own meds beause when she got the call, she threw some clothes in a bag and took off. When she got back home, since she was a travel nurse, she was taking a new assignment and they required a drug test. Well, she tested positive and and was honest and told the agency the truth, that she took her mother's Lortab for her back when she went back home for her father's funeral etc.---she had NO IDEA that it would be a problem, she was already being treated for her back--- the travel agency reported her to the state BON who raked her through the coals and made her do the same rehab thing that they mandate for other nurses!!! This nurse was not an addict!!! She was already being treated for a back injury---and the thing is, the meds she was already taking for her back were much stronger than Lortab, and she had prescriptions for them, she just didn't have a script for the Lortab. So---of course all the pain meds she was already on had to be stopped because she wasn't allowed to take any narcotics while she was in the BON program.........and she ended up on disability because she couldn't walk. So----despite the fact the the BON is a "regulatory" agency, they do implement blanket procedures and usually the same thing for everybody, no matter what the circumstances. And, I just think they need to change that mindset.

Nurses are treated like "dirty" and "ruined" people when something like this becomes general knowledge in a hospital. They get treated like they have AIDS and are highly contagious----when they walk down a hallway, people split like the Red Sea to let them go through and they whisper about "That's the one---she's the one who uses drugs." That is why in the workplace, the only people who need to know about this is the management, and they should keep it confidential----but, nurses being the gossip hounds that they are, most of the time they can't keep it quiet. So---in addition to trying to get their life back together, they have to deal with an already difficult job being made a thousand times harder.

You can't file criminal charges for drug use---but, nurses have sure been arrested for diverting drugs from work. And, usually they do have their licenses suspended for a certain period of time, even when they go into treatment voluntarily---it just isn't madae public at that point. One law that has fairly recently been passed by the EEOC and ADA is that a person with a prior drug history who is in recovery and not currently using drug is considered a disability and cannot be discriminated against because of that----so places can not NOT hire a nurse because of the history of drug abuse if they are in recovery, so where as before many nurses faced not being hired because of the history, that can not be used today as an excuse by a prospective employer. Otherwise, the facilities can face a major discrimination lawsuit.

I am actually not too familiar with BON actions, as this woman's is really the only one I knew of because I was so close to her. I actually know of more physicians that have had Board action against them----and guess what? They are still practicing. I think that nurses are held to a much more stringent and higher standard than docs are. Shoot, I know of a doctor in the town where I live now, the guy is a coke addict, his wife was arrested for forging oxycontin scripts, and he is still practicing and his wife is his office manager!!! Nothing happened to this guy----doctors, for some reason, have the ability to talk their way out of stuff, make excuses and everything is okay. It is actually the same way with lawyers.

Like I said, I do think that for the most part, BON intervention saves a lot of nurses. HOWEVER, some nurses do not "fit the mold" so to speak, and shouldn't be swept under the same "blanket" that others are under. Some circumstances are VERY DIFFERENT, and they need to open their minds and listen to their nurses and make special accomodations sometimes. That's all I was saying.

Specializes in LTC, SNF, PSYCH, MEDSURG, MR/DD.
Nurses should be monitored for the rest of their professional life. I wonder why physicians are not subjected to the same rules? Since the 'pee' test is totally random, it is impossible to guess when your phone is going to ring and you have to go in. And hand over a sample.

I have an idea. How about requiring every nurse, in every state, to submit to random testing in order to retain their license. That way, we can ensure that no impaired nurse ever has access to patients. Or even legal drugs.

All in favor:lol2:

Woody:balloons:

i agree! :yeah::yeah:

Woody, although I don't know you, I am laughing at your post. If they randomly tested every nurse and doctor in the country, we'd have about one quarter of what we have now taking care of patients!! I know more docs who smoke pot, drink their faces off and party than you can imagine.

I just want to say that I have seen MANY nurses who are so morbidly obese that, if they had to respond to a code, wouldn't be able to run, or push a code cart down the hallway, or even get close enough to the bed to do CPR. Does that constitute being a harm to patients? If the BON ever tried to do anything to intervene and "help" them, there would be cries of discrimination and lawsuits all over the place. But, when it comes to treating drug abuse like the disability that it is, people think it is a person's own "fault" and their "choice" that they have this disease. Drug abuse/addiciton is a disease. It has its own DSM-IV disagnosis and is protected by the Americans With Disabilities Act. Legally, you cannot NOT be hired because of a history of drug abuse IF YOU ARE NO LONGER ACTIVELY USING. If you are actively using, there is no protection. But--clean and sober people are protected by laws!! That is good to see, because nobody's professional abilities should be "judged" based on a drug history. In fact, many professionals with drug abuse issues are usually very successful, intelligent and talented.

That way, we can ensure that no impaired nurse ever has access to patients. Or even legal drugs.

What?????????????? This isn't going to ensure diddly squat. What about breathalyzers at the doorway of every health care facility? People have been fooling pee tests for a long time. What about the idiots/ditzys we sometimes work with? Require an IQ test before anyone starts working? Just wondering.

As for obese nurses, they can have a disease just as deadly as drugs or alcohol. Look up eating disorders. Just because they aren't skinny as a rail doesn't mean that they don't have a food addiction or compulsively overeat. Talk to some folks in food recovery programs that have tried every diet known to man and have found recovery in the 12 steps.

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