If you could recommend changes, what would you suggest?

  1. If you were in a position to recommend changes in the manner in which regulatory agencies deal with issues like substance abuse/mental health issues, what would you recommend? Do you think the alternative to discipline models currently operating effectively provide a solution to this, and if not, what could be changed about them? What alternatives to the current system exist?

    Do the current ways that we deal with these issues truly protect the public? Do they serve to forward the nursing profession, or could the advocacy for nurses improve?
    Last edit by SororAKS on Jul 22, '16
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    About SororAKS, ADN, RN

    Joined: Oct '15; Posts: 730; Likes: 1,630
    from US
    Specialty: 12 year(s) of experience in ER, ICU/CCU, Open Heart OR Recovery, Etc


  3. by   Omaapecm
    I think it is should be absolutely mandatory that case managers/compliance coordinators be knowledgable and educated about the disease of addiction and the process. I don't mean the short lectures/chapters we receive in nursing school but some solid background in the field. I found it hard to swallow sometime. Being judged and ridiculed and reprimanded by people who really haven't got a clue about what there preaching.. I hate that these programs are so black and white. What works for one may not work for another.. I strongly feel that sponsorship and AA should not be mandatory. Don't get me wrong. I am a stronger believe of the strength and power of the unity of AA. I also know that I have seen many come through those doors that AA just wasn't a good fit for them and they went on to maintain sobriety.. I am curious to read others post😄
  4. by   dirtyhippiegirl
    Outside oversight, an actual grievance process. Evaluators and treatment providers not reliant on the monitoring program for customers/kick backs. Higher cut-off for incidental etoh exposure for Etg testing. Less reliance on Etg and pETH testing in general. Some sort of third track where people who self-report do not have to let their employers know and aren't slapped with stipulations unless they have a confirmed relapse. Along those lines, not shoving everyone into the same mold whether they got busted for pot on a pre-hire screen or were found with a syringe of propofol in the hospital bathroom. Definitely agree that mandatory AA/NA needs to go, as well.
  5. by   nurse_kee77
    I'd be likely dead if not for mandatory AA. I am a true alcoholic/addict . I would not have made it through this program this far without AA. Not would I have ever gone to AA / NA without PNAP mandating it in my contract.
  6. by   dirtyhippiegirl
    Quote from nurse_kee77
    I'd be likely dead if not for mandatory AA. I am a true alcoholic/addict . I would not have made it through this program this far without AA. Not would I have ever gone to AA / NA without PNAP mandating it in my contract.
    Good for you! I don't think there is anything wrong with mandating some form of continuing treatment, beyond private therapy. However, there should be alternatives allowed whether it's SMART, Celebrate Recovery, LifeRing, or even non-traditional step-based meetings. (Atheist/Agnostic/Buddhist stuff.)
  7. by   SNB1014
    Well for starters, I would presume the research geniuses could come up with a reasonable cut off regarding incidental exposure. I find it very sad (and laughable actually, except for the sobering reality it could happen to me!) that for a profession that wants to continue to grow in respect from peers/public and autonomy our regulating boards are ignoring evidence based guidelines. A lab test that is SENSITIVE NOT SPECIFIC and has been deemed useless by forensics/ the courts but is somehow the new gold standard to check for alcohol is ridiculous. Either fix the cut off or find a long acting specific etoh test.

    I am very well aware of patients, and others I have met in the rooms of AA, who have drank mouthwash or hand sanitizer in a desperate state. I am also well aware that someone along the way ruined it for others when they claim their positive alcohol result is due to aerosols in hair products or vanilla extract they baked with. Cmon people- how many cookies are you eating, exactly?? Lol.

    It just seems that a blanket program is laziness. In medicine we strive for individualized care and treatment plans. I understand the manipulative and deceptive traits in addiction make this difficult to always implement. But I start to feel like a core measures check list! And even in those we can mark "contraindicated/ not applicable"!

    Lastly, piggybacking off the lack of individualized tx, my great concern is how these programs can find a nurse ineligible for dual diagnoses and the like. There is not debate that substance abuse complicates depression and anxiety. But what about those, such as myself, who longggggg before ever misused a substance struggled with suicidal ideation/anxiety attacks/insomnia/ adult adhd, etc? People who struggle with that are MORE At risk to abuse substances. Many people can take or leave alcohol or maybe have tried pills in college but left it at that.... There is an underlying mental/spiritual illness that leads someone to self medicate.

    Idk, I accept that as an addict I can be stubborn, defiant and have a dangerous case of being "terminally unique"....I want my way and I want it NOW. So sometimes I wonder if the reservations/resentments I have regarding the monitoring program are really my addiction speaking to me. I get scared about voicing these thoughts in fear of being told I am in denial. I'm not. Addiction is a disease and just like , for example, someone with pneumonia.....we don't automatically intubate them, place them on crrt, levophed and antibiotics for drug resistant organisms just because we may have to do those things IF they progress into septic shock from their infection. No....we meet the patient where they are at.
  8. by   SororAKS
    How those with substance abuse and mental health issues are dealt with would be far better without the profit motive that infects healthcare as a whole. The cozy arrangements that guarantee both referrals and appropriate diagnoses are evidence of the addictions industry gone awry. See the previous post on this Recovery forum that discusses this re: Michigan HPRP. Instead, give people the option of seeing a practitioner of their own choosing and accepting those recommendations without trying to strong arm them into giving a diagnosis that is going to bring the licensee to an affiliated treatment center. Do not force someone to sign a contract.

    While I'm at it, stop calling these programs "voluntary". If one has a choice of getting their license disciplined or sign a contract then it is NOT voluntary.

    Stop treating those with substance abuse or mental health issues like criminals. They have an illness, help them to get the issues addressed without being punitive and without the "one size fits all" approach. Make the contracts, if they are indicated, truly individualized. Make people aware of what things can potentially cause false positives, but if there is one, GIVE THE NURSE THE BENEFIT OF THE DOUBT and run the test again. Set the cutoff limit in the Etg to a reasonable level and don't try to trip people up. The monitoring contracts are difficult enough without people having caseworkers and medical review officers treating them like they have relapsed before having it double checked. There ARE people that have come out positive and have not relapsed. Do not assume that people who get a "Dilute" or "Abnormal" reading have tried to tamper their specimen. Give them instructions on how they can hydrate themselves appropriately, first, and be nonjudgmental until proven otherwise. Even medical professionals might not know how 12 oz of water might affect a urine sample. I didn't. Most people don't give a second thought to what effect their fluid or food intake might have on a drug test. So stop assuming a person has relapsed until it is confirmed.

    Have financial assistance and real advocacy available for those that cannot afford the fees associated with these contracts, fees for drug testing, doctors, counselors, therapists, etc. Remember that the nurse who isn't working because he or she has been ordered not to, might not have another source of income and might not have insurance to cover the costs. Meet people half way.

    Have flexible options available for recovery groups. Not all people respond to the AA/NA message. Allow SMART Recovery and other groups.

    Don't set up conditions that are impossible for people to reasonably fulfill. The goal with these programs should be to both protect the public AND help the affected person to be treated for their illness, allowing them to practice safely-in a holistic, not punitive, manner.

    Set up statutes of limitations where records of discipline on governmental websites can be expunged after a time if the licensee involved has been able to practice without further incident. Once the licensee is eligible for removal, then it is extended to national databases.

    Do not make a licensee who has completed monitoring, complied with all the terms required of them by a regulatory agency, and demonstrated safe practice, go through it all again, for the same incident in another state the individual applies for licensure to. If the discipline is similar to what would've happened in one state, then license the individual and give them a chance to actually start over.

    Best yet? Have independent audits and review boards with a real grievance process for monitoring programs, licensing boards, etc that will actually listen to the licensee.
    Last edit by SororAKS on Jul 27, '16
  9. by   SororAKS
    As to whether these programs really do protect the public, I think back to the old days when a licensee could just move to another state or get a job elsewhere if they were caught. Those things aren't happening much anymore, but I think the current status of what we have has gone to the other extreme in terms of punitive practices.

    I do think there could be a "meeting in the middle" between the dangerous practitioner that can just move, and what we have today with the punitive practices and a permanent Scarlet Letter on the record of those who find themselves caught up in the morass.

    Until we can think in terms of real advocacy and reasonable options that protect everyone involved, that meeting won't happen.
  10. by   RegretfulLPN
    Ditto to all you wrote!
  11. by   catsmeow1972
    I am not sure how much more I could add. Everything that has been said thus far really sums it up. From the so-called voluntary nature of these programs (or is it volun-told) to the stipulations that make it nearly impossible to find employment to the permanent scarlet letter that one gets stamped with even after your punishment is up. Then there is the issue of these programs being so very punitive in the guise of supposedly helping the licensee AND the public.
    I can see the purpose in "monitoring" even for those in the mental health arena, but this whole thing in my state and others has gotten way out of hand. Mandating counseling, medication management-fine. Requiring minimal overtime and the like-also good. But mandatory 12 step attendance and drug testing for a person with no history of addiction to anything?
    So far as the "protecting the public" stuff...what about me? I am the public too. I am a healthcare professional that cares deeply for my patients. Putting me out of circulation with the use of lazy, crooked providers who use outdated modalities, unnecessary "treatment," (apparently in deference to the almighty dollar) and financially crushing requirements does nothing to protect me (and in fact worsens my illness, if i let it.) and ergo nothing for my patients. These programs may have started out as an effort to help the impaired professional but have sadly become nothing more than punishment. For those who are grateful for their existence, i commend you for taking this as a wake up call. For the rest of us, the last day of the contract cannot come too soon and I for one will find it very difficult to say that it was of any help at all. The only thing that I will be grateful for is that i will be able to put it behind me and move on with my life, the permanent mark left on my career notwithstanding.
  12. by   catsmeow1972
    Oh and if i may add another....the so-called randomness of the drug testing. twice in 48 hours? That makes $165 this month alone. I am not worried about it being anything but negative however, see the above remark about financially (and soul) crushing requirements that solve nothing and in fact simply make a buck (or 20) for someone. I'm glad i am not the sole breadwinner in a family. Sorry kids, we're sitting in the dark this month. I ask again...How is this "protecting the public."?
  13. by   peachfuzz
    I have this fantasy of digging up the dirtiest of dirt of every member of the Texas Board of Nursing investigative and monitoring division and then plaster the results on the biggest freaking billboard next to their name and face after I do a mass mailing to every nurse in the US. That's just the beginning....
  14. by   catsmeow1972
    With a nod toward my last soapbox appearance on the cost and frequency of drug tests (before i toddle off to the THIRD one in SIX days, and that's with a weekend in there!), this has passed insane in both the cost and the impact on my job. The outlay for this month for this junk, counting the group fee and all, is almost $300. I work days and have a position where, like most nurses, I cannot dance off in the middle of my shift to go pee for this. Heck, i barely have time to go pee for myself. I have no choice but to go first thing in the morning. The issue is that the lab (like all of them) doesn't open until the same time i have to be at work. Trust me, that is obscenely early. So once again, i am late for work. Every couple of weeks, i can do this. Not too big of a deal. But every other blasted day!??? I'm running out of ways to tell my co-workers why I'm late. The "I overslept" is really wearing thin.
    On the "protecting the public thing?" Yeah, whatever......