IPN issues- 2015

Published

I was employed at a hospital January 2012- August 2014. I have 8 years experience as an RN, with NO issues. I was working as charge RN on PCU ( critical care unit), having worked my way up from staff RN. I was what you called " a nurse's nurse". I worked overtime, helped everyone out, and took on the difficult patients etc. My patient satisfaction score was high, and my yearly evaluation was excellent. I loved my job, my coworkers, and the patients. I love being a nurse.

In May 2014- my "husband" ( been together 23 years not legally married) attempted suicide. He has serious depression - and it cycles. This was from a car accident when he was 19 yrs old. He was in a coma for a week, and has been dealing with this mental illness ever since. I was working alot so I didn't realize how bad he was getting until the night he tried to hurt himself( he had been having "episodes" since feb. and would call me at work crying, and yes that affected me too). I tried to stop him and he attacked me, and I called the police on him. He went to jail. I also found out he was having an affair. I was devastated.

Not only was I dealing with the above, but I was having issues with my gallbladder/liver( pancreas?). I worked and was sick, with severe RUQ pain and nausea/vomiting. It became worse in June, and I had some imaging done. I was supposed to get an ERCP but I was terminated before I could use my insurance to do the testing.

The DON - saw me sick in the parking lot! I still went to work ( when I could) - and worked a lot for this hospital.

On top of that, my mother was in the hospital at the same time with sepsis and pancreatitis. So it was a ROUGH couple of months for me. But NEVER was I so emotionally upset or physically ill that I was a danger to public safety/patient care.

The first time I even knew anything was " amiss" with my nursing was after I told my boss about my husband attacking me etc., and I called out of work for a couple of days. My manager said " we need to talk. do you have anything to tell me? I said no , why? I had already told her everything about what I was going through, I had nothing to hide. I thought she was concerned about me. She stated" we had a nurse here once who's husband did the same thing and she was taking meds home to him". I said, "excuse me? She said that it has come to her attention that I was not wasting meds until the end of shift. I explained to her that no, WE all don't waste until the end of the shift because we are so freaking busy that we don't have time to stop for every waste in the pyxis. That is a bad nursing habit, but it is the real world of nursing. We all watch each other waste, and we all waste at the end of the shift. I told her that even all the ICU nurses do it, and it was common practice in our units. She checked in on this and guess what? There were signs up everywhere to "waste meds when you pull them " and there was a big to-do with all the nurses. So they couldn't write me up for that. The next thing I know - I am getting a "talk" again, this about charting a pain scale of 0 then half an hour later giving a pain med. It happens. Someone was a 0, then they started to hurt. Now, I have been at this hospital for almost 2 years and I have NEVER had in issue, now all of a sudden I feel that it's a "witch hunt" to get rid of me. All this has happened since I told them about my husband. My manager went behind my back and asked my patients if they received their pain meds, and they all said yes ( and what a great nurse I am etc.). So I had sign a paper that said" I will make sure I document pain scale accurately " ( something like that). So then a week or two later, I get a call saying I needed to come in and meet with the ADON and my manager.

I show up, and the ADON - tells me- "I don;t know what kind of nurse you are, but I don't like you."

Huh? They proceed to tell me that I am in "trouble", for not scanning all my meds ( they only care about the narcs- not antibiotics, IV fluids, or any of the other meds I didn't scan). Then they ask me about the 1 mg of morphine, and 0.25 mg of morphine I didn't waste in the pyxis. Over almost 2 years, these are the only two things I didn't waste in the pyxis ? She "assumed I gave them" therefore I gave a dose larger than was ordered- I am sure I charted in the computer the correct dose, but may have been so busy I forgot to do so in the pyxis. Geez, I know a lot of the nurses I worked with who forgot to waste meds too but they still have jobs. Or whose scans rates were really low. They are still working. Then she states i gave narcotics to a patient within 24 hours of discharge, and this was against policy. What policy? I have been a nurse long enough to know that we medicate patients 2-4 hrs up to discharge. This patient stayed an extra 4 days after his "supposed " discharge. This same patient was a pain in the butt- a "pain management -pt". He was on a TON of oral pain meds, plus a patch, plus he was evaluated for pain meds from a pain management doctor in the hospital. This doctor prescribed all his home pain meds, including dilaudid 2 mgs every 2 hours as needed. The surgeon who worked on this pt discontinued his most of his home pain meds, so yes, the pt needed pain meds every 2 hrs. I called the doctor several times to address this pt's pain complaints, and charted everything. I am told that I gave this pt more meds than any other nurse for one shift. This pt was self medicating when he first came in with his secret "stash" that I told his girlfriend not to bring in. You take away someone's meds and give them lower doses, they have issues. He was angry, and a clockwatcher. I took care of him for a week, trying to help him not be so angry and miserable. I never gave him medication outside what was ordered. ADON even checked the times I gave it-( every three hrs not just every 2) my manager asked this pt if he received his meds, and he said yes. ADON says " do you know what this looks like?'" I was completely blown away by all this, and felt like there was nothing I could say or do. I was not disciplined or warned about any of this. Then "threatened" - "contact IPN or I turn you into the board of nursing". 2 day window. I worked 7 days in a row for them when they were so short - staffed they couldn't get any one in to cover. I worked my ass off for this company and I feel like something's not right. I feel like I was wrongly terminated. If they thought I was having a problem- why not offer me a leave of absence? I had a lot going on in my personal life, but I never was a danger to patient safety- or violated the nurse practice act.

I guess I was just another warm body to them.

So I called IPN, and the intake lady told me they treated " burnout- stress, mental issues, not just drugs or alcohol issues". I thought I would get evaluated then be able to work. Get therapy, etc. I was wrong.

My first evaluator stated I was fine and had no issues.( except for mental health - recommended therapy etc.) I had a hair test done and it was positive for tramadol, which I had taken from a friend who told me it was not a controlled substance. Well, tramadol just became a controlled substance the end of August, and I didn't know that. But NOTHING else.

Then I had to do a repeat hair test, and it was negative. I tried looking for work and of course it is very hard to find a job with "key restriction" ( I was told this was because I didn't scan my meds all the time). In the mean time I have had negative UAs, one dilute, one abnormal.

About 5 - 6 weeks ago I was really sick. I had a migraine, sinus infection, and acute gallbladder/pancreatic pain. I dark urine, clay stools, RUQ severe pain, and nausea/vomiting. I was a mess. The only thing I kept down was smoothies- when I could keep something down. I also mix my smoothies with liquid vitamins. I was sick for approx. 3-4 days. All I had were smoothies. I had to pee in a cup while this was going on, and tested positive for ETG( etg?) So I was surprised when I found that out. Of course my case manager thinks I am a total boozer now, not taking into consideration that all my other tests are negative. So I offer to take a PEth test, and she declines stating I need to be "reevaluated". I did , and the new addictionologist didn't think I had any problems. I explained to him the only thing I found with ethanol in it was my liquid vitamins- 5.7%) and I sent him the label. I had used a different brand before that didn't have any etoh in it- ( GNC) but since I have no income I used a "bargain" brand that didn;t show ethanol on the website- who puts ethanol in vitamins??? Anyway, a week later ( 4wks from my positive UA) I have to take a PEth test. Another 2 weeks go by, and I see on the affinity website it is positive. Another week goes by ( today) I find out that IPN requires me to go to INPATIENT HOSPITALIZATION for my alcohol issue. *****?? My level was 27- and the cutoff was 20- I have read several conflicting reports on PEth, and I can assure you that I have not been consuming the required 7-8 drinks a day for 2 weeks to get that number. I have never had any issue with alcohol or drugs, I have never even asked for pain meds with my RUQ pain, or my ovarian cyst pain. Anyway - needless to say I feel like telling IPN what to do with their "recommendation". I can get a second opinion - should I? I have no income to pay for this new IPN requirement. I worked hard to be a nurse, and I am sad that this is what nurses who have issues have to go through. I didn't even know you could talk to a lawyer before signing an IPN contract!! I was forced into this, and I wasn't even in my right frame of mind. I was burnt out from work, and my personal life. I felt like I had no choice.

I tripped in urine during this time at this hospital and had to do a random UA- it was negative.

So, history for me- childhood abuse, and sexual assault while I was working as an RN in the middle east 2010-2011. I am in therapy, and that's really all I needed. Time off from work, and therapy. Not more stress, or inpatient rehab!!! I went from having NO issues with and substance - now I am a raging , unsafe alcoholic......the power of IPN!!! Unbelievable.

I thank you for your time, and look forward to talking to you. I appreciate any advice you may have. Please let me know if there is anything else I can provide for you that may help you evaluate my case.

Sorry that I rambled- I wanted to get everything out - I am sure you hear from nurses with worse cases than mine. I am grateful for any information you may have regarding my situation- If you think I have a case- I could sell my car. But I not going to rehab.

I went to school after I got fired- I graduated with my esthetician license. I am currently looking for a job in this field, since I can't take the Hospice job I got accepted for due to my "alcohol addiction"....seriously - IPN is not a good program for nurses. I would eventually like to start a fund for nurses going through this- to help pay attorney /rehab/ testing etc costs since they don't have jobs either.

Sincerely,

NurseEmRn

( felt good to write my story - and get it all out!)

letter to potential attorney

Am I crazy??????? I am now!!!!!!

Unfortunately you are in a predicament. I am an addict. I cant take narcotics. My history proves it. If I take one then ten might really make me feel better. Crazy. I am an educated person. I too can and have done many critical procedures on patients. But, I have addict brain. So, for me the inability to take medications that may encroach on my sobriety due to monitoring is a healthy stop sign that I need. Now, I fell and sprained my ankle with a high grade tear after 2 yrs sober. The first thing I thought of before I ever got up was how I would need narcotics. i was able to take motrin and didnt get narc script. Having said that. This type of thought process is what many addicts struggle with, and what many boards have experienced. So, there is a tendancy for some to be cookie cutter. It is a shame you are getting railroaded. Try to fly under the radar. Based on your situation I just dont think they are going to bend. I am not from Fla so I have no basis other than a hunch. Best of luck friend.

Specializes in PDN; Burn; Phone triage.
Unfortunately you are in a predicament. I am an addict. I cant take narcotics. My history proves it. If I take one then ten might really make me feel better. Crazy. I am an educated person. I too can and have done many critical procedures on patients. But, I have addict brain. So, for me the inability to take medications that may encroach on my sobriety due to monitoring is a healthy stop sign that I need. Now, I fell and sprained my ankle with a high grade tear after 2 yrs sober. The first thing I thought of before I ever got up was how I would need narcotics. i was able to take motrin and didnt get narc script. Having said that.

Just out of curiousity -- what would you have done had the NSAID not worked for your pain? Would you be open to taking narcotics for post-surgical pain? What if you ended up on my old unit with, say, a 25% burn?

Stick a bullet between the teeth and bite down. That's it. Suck it up like they did in the old days on the warfields.

I would request toradol injections and do a lot of praying. Withdrawal for me is he double hockey sticks. Plus I dont have desire or cravings now. My addiction is a one eyed monster waiting for me to peek through that door and if I do he is going to grab me and I will be in a fight for my life again. I just pray for protection thats just me...

Specializes in OR.

I've said it before: if this kind of thing works for you, great. I'm happy there is something out there for you. But you know what? NOT all of us are addicts or have drug problems, etc. I'm sorry I don't have an 'addict's brain." Not everyone on the planet is addicted to something. My first thought on that fall was NOT about drugs. It was actually "oh ****, ouch!" Nonetheless, some of us have gotten railroaded into being labeled something we are not, because people are lazy, crooked and if they are nurses, have forgotten why they became nurses to begin with. Also in the process of being herded into the "recovery industry", some of us are denied the help we truly need, like appropriately focused psychiatric care. All done with the rant, for now.

Oh and the knee seems to be okay, albeit a lovely shade of black and blue. A bit stiff, but like with the rest of my prison sentence in IPN, I will survive.

I agree. It is unfortunate that the approach for everyone isnt tailored to their situation. Each state has their own way and many punitive and some are supportive. Glad your knee is better. Hope you work this out in your favor.

Specializes in PDN; Burn; Phone triage.
I would request toradol injections and do a lot of praying. Withdrawal for me is he double hockey sticks. Plus I dont have desire or cravings now. My addiction is a one eyed monster waiting for me to peek through that door and if I do he is going to grab me and I will be in a fight for my life again. I just pray for protection thats just me...

That's cool. I'm always curious how people handle these things. I don't really identify as a general "addict" per se -- I've had legitimate scripts for narcotics (partial thickness grease burn to my foot, OUCH) and benzos (I'm nuts) before without developing an affinity -- but the potential for needing those drugs is at least there which it is not with alcohol, so that's rough.

Specializes in ER, ICU/CCU, Open Heart OR Recovery, Etc.

The fact that these programs aren't as individualized as they should be has always bothered me.

And, in dealing with the content of what they're dealing with, EVERY CASE SHOULD BE TREATED INDIVIDUALLY, not put under an umbrella or blanket of "standard" contract orders. Somebody who is suffering with a psychiatric disorder that makes a suicide attempt, who has never used drugs before, should not be characterized as an addict. They should be characterized as a person with serious clinical depression, and given appropriate treatment for that----not forced into a contract program that will do nothing to treat their underlying problem, and will only push them into financial ruin by being mandated to see "approved" providers and "approved" rehab places. The thing is, no program or nursing board would get kickbacks from a qualified psych provider who was actually treating a disease properly and accepting insurance payment for it. And a provider who wasn't on the board's "approved list" would not get the referrals for evaluations that cost $1,000, that they won't accept insurance for.

A qualified psychiatrist does not treat every patient the same, yet it is okay that diversion programs and nursing boards treat everyone the same, no matter if they have an addiction problem or not. That's where the problem lies.

Furthermore, publishing this sensitive information on the internet does nothing except cause embarrassment and shame to the person for the rest of their lives. Employers in health care can access the information if they want----all they have to do is access the federal databank to find out about a potential employee. It is totally unnecessary for a nurse's personal history to be flung out in public for the world to see. This constitutes continued punishment after the sentence for the "crime" has already been served, which is unconstitutional. But they don't care because apparently the law doesn't apply to them.

Specializes in OR.

Given that mental health issues are also considered a disability under the ADA (and for Social Security, FYI) I was forced off work over this nightmare for approximately 16 months. Six of that was being stuck in that ridiculous "program." The other ten was spent driving all over the bloody state looking for a job. (I am fortunate in that I can easily relocate) Seeing as how I was not sure that i was ever going to go back to work, I applied for Social Security disability. I was rejected the standard 2 times and then retained a lawyer. I got that back pay which included the time that while IPN permitted me to work, I could not find a job. It's near impossible to get a job when you have the standard dumb restrictions on a contract. Also the stress of the whole experience made it tough to get through an interview without crying. After the lawyer was paid, I came away with a lump sum amount equal to about 4 months of my salary as a nurse. To be honest, I used to think those commercials from disability lawyers on TV were sleazy because they took a healthy chunk of the back pay for their services. i have totally changed my tune. The firm that I used took care of everything from gathering records to putting together the case for the hearing to being with me at the hearing. For that they got 25% of the back pay and i feel that they earned every penny of it. The reason for approval was depression. Straight substance abuse is highly unlikely to result in a disability designation by Social Security, but mental health issues (even with a side of substance abuse) stand a better chance of approval.

I'd love to throw that at IPN but I know it would be useless.

I took some of that money and paid the stupid "investigative costs" on this whole thing. I'd like to know exactly what they investigated. Since I was dumb enough to call these ahem, "people" myself there was no investigation. I requested some type of acknowledgment that this obligation was satisfied. I'm pretty sure the BON will ignore that too, just like they ignored every effort I (and my lawyer) made to let them know that there was no reason to "board order" me into monitoring, since I had already done it myself almost 2 years prior.

For those folks that are in the same canoe as me, I encourage you to attempt a disability application. It can be done as a "closed claim" which means you get a chunk of money and not a monthly check. it also allows you to go back to work, if you have not already. Closed claims also have a higher chance of approval.

As guilty as i felt about tagging myself as disabled, my representing attorney said that I had worked and paid taxes my entire adult life. This should be considered insurance for when I could not work. I've come to agree with him.

Awesome, just awesome. I love it. Legally, a person that is not currently using drugs and that is in recovery is categorized as disabled pursuant to the American With Disabilities Act.

I don't know about anybody else, but I would also request an itemized invoice for the "investigative costs"----isn't that what you paid the stupid evaluator for? And why the IPN people receive a salary? It's not like they hired a P.I. to follow you. Anyone that does work can do an itemized invoice and account for every member of the team or individual doing the work, every task they did and the amount of time that it took. I wouldn't pay it until I got that.

By the way, I found out something quite interesting just now: When applying for a New Jersey license, there is a $5 fee for a "nonrefundable Alternative to Discipline Fee". Why should a nurse who is not in an alternative to discipline program have to pay $5? Perhaps New Jersey's program should be investigated as well. If they are paying salaries with that automatic, "nonrefundable" fee, then there is something seriously wrong with this whole picture.

The problem is, if this were thrown into the wide open, most of the public wouldn't think any of it is a scam----they fall into the "I wouldn't want a nurse on drugs to take care of me" mentality. They wouldn't see it as a scam & for-profit thing---they would think it is a just punishment for "bad nurses".

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