Monitoring program

Waiting for the BON to act can take months or even over a year. The problem is that if you wait for the board to reach your case, the options they give you are usually more punitive like public discipline, suspension, or probation.

What actually protected my license long-term was getting ahead of it and self-reporting to monitoring program THE SAME DAY my incident happened. When you self-report, most states allow a non-disciplinary path through a monitoring program. That route usually avoids a public mark and keeps your license intact.

Also, just because you diverted a single pill doesn't automatically mean you'll be sent to treatment or inpatient rehab. Monitoring programs don't use a "one size fits all" approach. In my case, even with multiple months of stress and burnout behind my situation, I wasn't sent to inpatient rehab and they looked at my history, evaluations, clean drug screens, and the fact that it was a one-time lapse, and they focused instead on mental health support, therapy, and accountability.

Most of what monitoring required from me included things like:

1. regular toxicology tests

2. individual therapy (weekly or biweekly) 

3. weekly group therapy

4. weekly peer-support groups (NA or AA)

5. daily check-ins through the portal

6. a worksite agreement once I was ready to return (this agreement includes having a liaison at work who is willing to send quarterly reports on your behalf, and 6 months of narcotics restriction).

I know it sounds like a lot, but most programs allow you to virtually attend therapy. 

It wasn't easy, but it absolutely prevented my license from being publicly disciplined.

If you're worried about suspension or revocation then, YES, reporting yourself and entering monitoring is often the safest option. It shows insight, honesty, and willingness to address whatever led to that moment. Boards respond much better to that than to silence or waiting for them to take the lead. A lot of nurses wait for the board to act, and by the time the BON does it's too late. Believe me, I have read so many stories of nurses who wish they reported early.

You're not alone. A lot of nurses have made a one-time mistake during extreme burnout or stress. What matters most is how you handle things from here. If you decide to self-report, it might feel scary at first, but it can genuinely protect your career and your long-term license status. In the beginning, it'll feel like your world has been shattered, but you do get used to it! 

Best of luck! 
 

PS: you can always call the monitoring program anonymously with questions 

Thank you so much, I feel like I do need to report to the monitoring program. The first time I dealt with addiction in nursing, I didn't report to monitoring and I waited for the board to get up with me and it took 2 1/2 years and by the time they got to me, I had already been through inpatient rehab because my first time with drugs and alcohol was worse than this time. My probation was public, and I will always have a history of probation on my license. 
I do have a question about monitoring though. Can you apply for a job right away while you're in the monitoring program or do they have a waiting period?  I am in the process of applying for jobs so I probably need to make sure it is one that is monitoring friendly like nothing unsupervised such as home health. Thank you for taking the time to respond. I appreciate you.! 

mississippiRN71 said:

Thank you so much, I feel like I do need to report to the monitoring program. The first time I dealt with addiction in nursing, I didn't report to monitoring and I waited for the board to get up with me and it took 2 1/2 years and by the time they got to me, I had already been through inpatient rehab because my first time with drugs and alcohol was worse than this time. My probation was public, and I will always have a history of probation on my license. 
I do have a question about monitoring though. Can you apply for a job right away while you're in the monitoring program or do they have a waiting period?  I am in the process of applying for jobs so I probably need to make sure it is one that is monitoring friendly like nothing unsupervised such as home health. Thank you for taking the time to respond. I appreciate you.! 

 

Most programs have a short period at the beginning where you're considered "not yet cleared,” and then they issue your practice restrictions.

When I entered monitoring, I wasn't allowed to work for about 3 months until they completed my evaluation, set up my treatment plan, and gave me the okay to return. Once you're approved, you can apply to jobs that are monitoring-friendly and able to accommodate restrictions.

Since money is always an issue, I would weigh your options.

PS. usually you're not allowed to work until your evaluated by a medical professional who "oks" you to return to practice 

Does the monitoring program cost anything to enroll?

mississippiRN71 said:

Does the monitoring program cost anything to enroll?

I paid 600. Usually it's around that price. You also pay for all of your therapy, and tox screens. 

I have experience from an administrative point of view. Hospitals are required to report diversions to the BON, they may also report to LEO. I've seen them do both although LEO was with IV narcotics. The MBOA used to be aimed more at rehab than punishment. My experience is from several years ago. With any BOA, honesty and accountability is always the best policy and it will get better results for you.

Thank you John. I had a negative drug screen though . I wonder if that will make a difference- maybe prove I couldn't haven taken much. That 1 pill got out of my system faster than I expected. I do take bp med they has hctz in it and I had coffee , water and also an energy drink they day so I'm suprised my urine wasn't invalid . I figured I would have to retest the next day but I didn't . 

John - what is the LEO? Is that legal action? 

mississippiRN71 said:

John - what is the LEO? Is that legal action? 

Law Enforcement Officer/Officials. "LEO" is the criminal side/case being reported to the police/detectives/District-Prosecuting attorney for potential prosecution. Because a case/incident is reported to law enforcement doesnt mean its going to be prosecuted. Basically, anytime a nurse diverts, it gets reported to law enforcement of some type such as DEA because its a reportable offense. DEA is a regulatory agency, but has a law enforcement arm. The federal government (DEA) doesnt like to get involved with the criminal-prosecutory side of things and prefers to defer to the States, unless you have 1 of 2 situations described below.

Who is More likely to be Prosecuted? If you sold the diverted medication. If you tampered with large amounts of vials. For example, you open 5 or 10 Fentanyls, remove the medication for yourself, and you replace with Saline for patient care. These are the big two and when nurses serve time, 95 plus percent are involved in one of these 2 areas above.

Sometimes, nurses are charged for diversion when its clear the nurse is an addict, but its self use (diverting the waste), pixis overpulls, and the nurse doesnt do major tampering as described above. In these cases that are charged (which is less likely than more likely), the nurse will be given a way out by the court system. For example, "if nurse completes rehab, x, y, z, and does a drug treatment program over a 4 or 6 month period, etc, then charges are dropped, or charges are reduced to misdemeanors." 

Very, very, very, very rarely are nurses acrually convicted of felonies and actually do time in prison when they diverted and used for themselves. It's rare. The overwhelming majority of nurses in prison for diversion did not simply divert. They sold it on the street/ran a business OR they were involved with major tampering of vials.

Don't report yourself. Take time off go on a medical leave if you must you can just say for your mental health that's it. Just don't. I did it it was a nightmare and I was treated like crap. Ended up relapsing and am now going to be monitored by the State, aka I will be in public records. Just don't

ALWAYS consult an attorney before you sign a contract. ALWAYS.

Rn0987 said:

ALWAYS consult an attorney before you sign a contract. ALWAYS.

I respectfully Agree and Disagree. I'm not a fan of "ALWAYS, NEVER, All of the time, None of the time." I'm old enough now to have experienced enough good, bad, and stuff in between in all facets of life in which words like Always and Never rarely apply.

Consult a lawyer in MOST cases before signing a contract, but not All (in my oponion). Here would be the exception and why I would not consult a lawyer in the following situation which Happens to a substantial amount of nurses reading this forum and who are in monitoring and it happened to me. ....

I diverted many times. Was caught at work with Pixis evidence. I admitted it. People noticed I was high. I had a positive drug screen. My state was a 5 year monitoring program for nurses wo divert at work. What did the BON offer me with the consent order? 5 years of monitoring, license not suspended but put on probation for 5 years until completion, no narc privileges for 6 months, quarterly reports from my employer for the first 2 years, no home health or community health. Required supervision for the first year back to work. The above is Standard for someone who diverts. Its automatic in my state and very similar in most other ststes with some small variations of course. With the evidence above that was clearly against me, a LAWYER was NOT going to get me out of ANY of the above. It was locked in. One benefit of an attorney in the above situation of which the BON often throws a bone to the attorney is........After 4 years of monitoring, the nurse can petition the BON to be released from monitoring if their record is perfect and this means the lawyer can get it to where the nurse doesnt have to do the full 5 years. By the time the BON agrees to release you, it comes out to about 4 years and 3 months served in monitoring compared to 5 full years. In the above situation with the evidence they had, this is what a 10,000 dollar attorney would have got me....9 months out early. The 10,000 dollars cost MORE than the 9 months of additional tests which woukd have cost about 3000 dollars, so that's 7,000 dollars difference. I did not get an attorney. I spoke with about 10 other nurses in my state with nearly exact circumstances above and 4 had lawyers and their lawyers cost them 10,000 dollars and they did get out at about 4 years and 3 months compared to the nurses like me that got out at 5 years. But.....because they had a lawyer, they didn't start monitoring until on average, 6 months after I did, so the difference in finish time was only about 3 months, AND.....because they had a lawyer, all of the questions they had with the BON during their 4 years and 3 months monitoring time with the BON had to go through the attorney, and so did the BONs answers, so one simple question could turn into a 2 week to 6 week process before an answer was given. With me, I could simply call the BON compliance office and get an answer to any questions during my 5 years and have that answer in seconds.

Other key things. When you have a lawyer, the BON will not speak to you directly in those 4 or 5 years. Every question you have, every request that is BON related must go through the attorney. That is stressful. For example, my narc privileges. I petitioned at 6 months to get mine back. I sent an email. In 2 hours, I had a response granting me updated privileges. For the nurses with the lawyer? They petitioned, BON had to approve it at a meeting, then send the letter back to the lawyer, and then the lawyer give it to the nurse. That whole process for them getting narc privileges approved was about 4 to 6 weeks? Mine was 2 hours. Its these little things most people do NOT think about when they say "Get a Lawyer." Understand that once you are "in" and commit to a lawyer, the BON certainly grants you that commitment regarding communication and all communication over the next 4 to 5 years will go through that lawyer at a snails pace. Most people don't think about this. It doesnt even cross their minds when they get a lawyer and think not just about the immediate up front contract, but the next 4 to 5 years regarding how incredibly slow communication is with the BON when you want an answer to one simple question and trust me, you will have at least 4 to 5 questions pop up for the BON over those 4 to 5 years. 

The above is my personal example and experience. If you have other situations such as a DUI, or you didn't do anything wrong other than a Pixis error or 2, or a weak complaint about someone saying you looked drunk or high at work, or when they don't have a positive drug test. I would absolutely Get a Lawyer in these situations and not sign any document without a lawyer, BUT.....in the case where evidence is overwhelming, you diverted, they caught you, positive drug test, clearly high at work, etc., you are NOT getting out of it and a lawyer can do little to nothing in this specific situation. You are losing thousands of dollars in this situation of which you are only paying for a "false emotional comfort," and its false because the outcome is the same With or Without a lawyer in THIS Specific Situation I gave you above.