IPN issues- 2015

[NurseEmRN]

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!!!!!!

[catsmeow1972, BSN, RN]

I too am still slogging along, counting the days until I can wake up from this nightmare. Not much has changed. I am choosing not to work for the duration. I have satisfied the work requirement as well as all other facets of the contract and am merely waiting the time and scratching chalk marks on the wall of my cell. I am choosing this because I am tired of thier inappropriate interference in my professional life.

A curious bit of info I found out however (this is public record too)...IPN is registered as a for-profit corporation in the state of Florida. We are nothing but a way for a few certain people to make a buck off of. Nice, huh?

[NurseDiane]

Well, that is quite interesting. That means that they CAN be sued and cannot claim immunity to legal action because they are a governmental entity. If they are a private entity, which being registered as a non-profit would indicate, they are fair game for lawsuits. Of course they would try to use immunity as a defense to get a lawsuit dismissed, but they'd have a hard time proving it.

[NurseDiane]

The legitimacy of 12 step programs is beginning to be challenged in a very serious way by some very qualified individuals, which could very well flip the "addiction medicine" specialty on its head. The outright contradiction of addiction being a "disease" & then simultaneously being considered a "moral failing" by traditional 12-step programs does not coincide and rehab/treatment cannot continue on this slippery slope of a "higher power" and "working the 12 steps" being the solution to a "disease". 12-step programs are religion-based and there is nothing that can legitimize worshipping a "higher power" as a treatment for addiction. Nor is the "Serenity Prayer" something that will maintain sobriety---it is a great group activity for cohesiveness & support among members to raise their morale, but that's about it. Today's healthcare is based on evidence-based practice & positive outcomes. There is absolutely no scientific evidence that supports a religion-based 12-step rehabilitation program, and the dismal outcomes is proof of that. Those that have been in control of the "addiction medicine" arena, that have made (and continue to make) a crap ton of money from all of the questionable rehab that has an extremely poor success rate, which is utilized in the majority of rehab facilities, are fighting those new theories tooth & nail----if it is shown that there are other ways of treating addictions with evidence-based methods that have more positive outcomes instead of multi-month inpatient admissions where people do nothing more than 12 step meetings, support meetings, art therapy, 3 meals a day, writing in a journal---all to the tune of tens of thousands of dollars---that have far better success rates, those folks raking in a ton of money from running "scam" treatment facilities are going to be in for a rude awakening. The one thing that nursing boards fail to address is the significant psychiatric contribution to the problems nurses have. Forcing a nurse with untreated clinical depression or bi-polar disorder into an addiction program when there is no evidence of drug/alcohol abuse is irresponsible at best, negligent at worst and proves that the motivation for their actions is not the "safety of the public", it is for financial gain. If there is a psychiatric problem that results in a nurse not being able to safely practice, they don't need to go to Talbott House in Atlanta for a 3 month inpatient stay, at their own expense for tens of thousands of dollars, to treat an addiction problem. A nurse suffering from clinical depression or bi-polar disorder needs psychiatric evaluation, treatment & management. They don't need random urine screens. They don't need 12-step meetings. They don't need restriction from giving pain meds at work. They don't need to pulled away from working in ICU, ED, PACU, OR, home care, etc. The same thing applies for isolated DUI's----making a stupid mistake, that did not occur at work or threaten the safety of patients, does not deem a nurse an alcoholic. There is no treatment facility for stupidity (although, as a business venture, it sounds pretty promising........).

I am just waiting for the day when a BON gets sued for mandating a nurse into a diversion program or locking them into a multi-year contract for substance use/abuse/addiction when there is no evidence to support it, and the nurse committing suicide because the real problem was severe depression or another mental health issue that was not taken seriously or managed properly by the BON, due to the BON's focus being roping nurses into multi-year, financially unsustainable "contracts" for financial gain & job security. There are a few accounts of physicians committing suicide after being forced into physician's health programs without evidence to support any substance use/abuse/addiction. The BON and physician's health programs cannot be allowed to continue to hide behind the "immunity" they enjoy as an "arm" of a governmental agency. Until lawsuits start to get filed against these state agencies that ruin people's lives, nothing will change.

[sheracraft]

So I have a question for you; affinity says to check in online to know if you have to test that day, however, all the sites I see don't have screening hours till 7:30am and they all close early. If I work 12hr shift (7a-7p) how am I supposed to go for testing that day?

And also, because the nurse support group is every Tuesday at 5:30pm assuming it lasts at least an hour, I wouldn't be able to work a day or night shift on Tuesdays, correct? How are they making it this impossible??!?

[catsmeow1972, BSN, RN]

They don't care if the requirements impact your ability to get/keep a job. After all there are stipulations in these contracts that make it super difficult to find a nursing job (no nights, no overtime, gotta have a nanny looking over your shoulder, no floating, etc.) In some cases, for some people, some restrictions may be appropriate, but these seem to be standardized no matter why you have the misfortune of being here.

With all of that, on the off chance you might find someone to give you an opportunity with all of that baggage, you still have to add that "carry-on" too. Me? I made it a point to be on the doorstep of the lab at 7am wether I was working that day or not ( I can't wait to be able to sleep past 4 am) If I am working, I am in and out in 5 min. I chose a LabCorp right across from my job and then hauled into work. My NM got a text and she covered for me until I got in. If I'm not working, I did so because I didn't want to sit there forever. The days of that inane gaggle session masquerading as a nurse support group? I just had to be off that day. We did self scheduling and I scheduled myself off.

The powers that be that designed this ****show don't care that you may have difficulty getting/keeping a job in order to live and/or keep up with the financial demands that are placed on you, by them. I believe there is a line from The movie Goodfellas that says it best..."**** you, pay me" or something to that effect.

[FighterRN2018]

Nurse EmRN-can you please pass on the names of any attorneys that you recommend? I need to get advice from an attorney regarding IPN.

[catsmeow1972, BSN, RN]

TOS state that we can't specifically recommend any doctors, lawyers, etc. by name but you can look up TAANA (The American Association of Nurse Attorneys). Google it and look for your state. You will find the couple of major law firms for Florida that handle this sort of thing. Most lawyers will give you a bit of time on the phone for free or for a nominal charge. My suggestion is to do this BEFORE committing to anything with IPN. Generallly they can't prevent you from having to deal with those vultures but they may be able to blunt the near criminal aspect. I know I wish I had known, but hindsight...well....