DistressedRN

You can also try plasma centers or blood banks. They're usually very recovery/monitoring stipulation friendly.

In my state you can ask for a monitoring interruption. I never asked for one when we went to the beach or mountains, but did when we went out of the country, on cruises, or to Disney. I wonder why yours is so draconian. Regardless, if you're going to a nice resort, I guarantee you that they have a FedEx pickup, maybe even daily. Call and ask the concierge..

What state are you in? I have never, ever seen a monitoring program agreement (whether it was for SUD or for a mental health issue) that doesn't beat this horse to death. Sounds like your CM dropped the ball, big time. But beyond the common sense aspect, I guarantee you there is verbiage somewhere in your contract that says something along the lines of 'will abstain from all mind altering substances, including alcohol' or something to that effect. My case manager didn't go over mine line by line, but I know that I was responsible for reading it thoroughly and if there was any question at all about what was/wasn't allowed then it was my responsibility to ask and find out. In TN, saying 'I didn't know' was not a valid excuse and even that phrase is written into our contracts. That being said, the Talbott Medication Guide is a priceless resource. It lists every single drug to avoid, as well as gives alcohol concentrations of common OTC products and cleaners. It's a good place to start if you have any doubts about what meds are safe/not safe in monitoring. It's pretty easy to Google just in case you want it for future reference.

But the thing is, it doesn't matter whether they do or not. If the agreement says no illicit substances or alcohol, then thats exactly what is expected. I see posts here and talk to nurses in my state monitoring program who drink or use THC and then act all shocked when they fail a drug screen & have to be reevaluated. What did they think was going to happen? Someone who doesn't have an SUD should have no problem abstaining from alcohol/drugs for a prescribed amount of time.

In my state you would have to immediately cease practice until they say you can return; most likely get another evaluation and possibly repeat inpatient or IOP; and definitely have increased frequency of testing.

Unfortunately, in TN the way the state guidelines for office based opioid treatment are written, it says observed drug screens.

Before Covid, in TN we had to do three a week, and had to have our location turned on and check in on the Spectrum app and check out at the end. They were big on us sharing location, but I didn't always and my case manager never said a word. I can't tell you how many times I went & checked in and sat in the car listening to music and reading for an hour instead. ?

TNPAP does not require you to serve the time at the end. However, the only time I requested an actual break in testing was when I was on a cruise and once when we were in a remote area hiking. Any time we went to the beach or to Disney or anywhere else within the lower 48, I just told my case manager that we were traveling, but I had identified several testing facilities nearby just in case. In three years I never got tested while on vacation.

I wish that the TN BON and TNPAP would get on board and recognize that recovery with MAT is evidence-based and beneficial to nurses who have had substance use disorders. I do know that they are slowly changing their attitudes toward it, and I have heard that in the near future they may start allowing it, but I will believe it when I see it. So you have to get ANOTHER evaluation? That's crazy. The evaluators that TNPAP uses are board certified in Addiction Medicine. Are they wanting something from the psychiatry angle?

I'm interested to know how that ended as well. A lot of these situations sound like they were so unfairly handled.

Dialysis, blood banks, plasma centers, ‘shot nurse’ jobs, pre-admission testing, non-bedside positions like chart review all are decent jobs for nurses with narcotic restrictions/board orders. You may have to humble yourself a little and take a job that you might not have considered before, but it will be okay, and this too, shall pass. Even though you have some clean time under your belt, my advice is don’t go back to a position where you will have access to narcotics at all. It’s one thing to feel confident right now, but quite another when you’re in the middle of a three day stretch of horrible shifts and the temptation is right in front of you. I posted this on another thread, but when you’re job hunting, frame your monitoring as a positive asset. You’ve shown that you can persevere and overcome terrible circumstances, you’re actively in a program where you HAVE to toe the line…as an employee you won’t risk being tardy or call in a lot, you’ll want to avoid getting caught up in workplace drama, and you’ll be super diligent about your charting and responsibilities because your license is on the line.

So you can frame this as a positive thing. Tell your employer that you worked in a toxic/unsafe/whatever environment and there were allegations that were unproven/untrue. However, you wanted to avoid a long, drawn out expensive legal process where you’d be unable to work while these notoriously slow to act nursing board investigated. To show that you had nothing to hide, you accepted their terms. You’re fine with being drug tested and monitored because you conduct yourself according to your states nurse practice act. As an added bonus, since they have to submit quarterly reports, you aren’t going to be tardy, have excessive absenteeism, or have any disciplinary issues. They’ll wish that they had more nurses in monitoring contracts because you’ll be a model employee. good luck!

My office has a regular urine door that is propped open that we observe through. and while our sink is functional, it isn’t allowed to be turned on before I have the urine in hand. We don’t do DOT or legal chain of custody urine drug screens at my job, just point of care and occasionally send out for confirmation if there is a contested result or there is a suspicion of adulteration or substitution.

Well, if HR and the CNO are coming, they’re going to be prepared with Pyxis or Omnicell reports that have been pulled. Every time you touched the machine is going to be in a neat little printout. Is this something you’ve been expecting? Or a total surprise?

All I had to do was email the BON in my state (TN) after I finished my monitoring program and request they reinstate my compact status. Took less than 48 hours.

ams0822 I hope you had a good outcome. I saw this post and was wondering the same thing a few weeks ago.

Then I’d absolutely fight it with every ounce of my being, because TnPap will definitely be more expensive than a lawyer. Best of luck to you.

I just completed a TNPap contract and the advice remains the same. If it’s true and you have the money, then fight it, but I would still expect some consequences for not handling narcotics appropriately. Fines, maybe a public reprimand, continuing education courses, etc. If it’s not true, consider coming clean. An evaluation from an ‘approved’ evaluator will run $500-600, then without a doubt they will recommend treatment, then they funnel participants into ‘approved’ facilities that milk every dime they can, because even if your insurance won’t pay, you MUST complete the full length of time the evaluator dictates or TnPap will turn you over to the BON. Then the facilities will recommend extended care, PHP, IOP, aftercare, etc, THEN the contract starts. 3 NA/AA meetings weekly, one Birchwood group weekly, drug testing 2-3 times a month initially (then at the end of the first year you can request for lowered testing if you have 100% compliance, employment restrictions, quarterly reports from bosses. It was doable for me, but I am an addict who was in the throes of active addiction, I knew I needed it or I would die, and I had the financial resources to pay for a month of inpatient treatment out of pocket and be off work for a while. I’ll also say this, if you do go through Tnpap, do NOT go to Bradford for treatment. Trust me.

Wellbutrin (Bupropron) is absolutely 100% allowed under a TNPap monitoring program. Buprenorphine is not.

So as I was entering my recovery journey after self reporting, the worst part was the complete lack of information online about what was happening, what was going to happen, my next steps, etc. I just sat at home detoxing while I waited on the peer assistance program to tell me what to do, and we all know they work on their own timeline. I work for a physician who has a blog and website, and he wants to build a page where nurses who are in addiction but wanting to get out can get helpful information. Information about the smartest way to approach things and and how to minimize damage to their license. For example, in my state, I tell people who have been referred to peer assistance to skip the $600 evaluation and go ahead and check into an approved treatment center because 99.9% of the time they’re going to recommend inpatient anyway. Save that money. What are some things you would have like to have known up front? Or things you think would be helpful to others just starting out?

I’m in TNPap and have missed five or six over the last couple of years. I never realize it until much, much later, when I’m looking at my history. Usually mine have been over a weekend or a holiday when I wouldn’t have gotten chosen anyway, thank goodness. My case manager has never mentioned it and I’ve never seen any increased testing. ?

Is there anyway you can work some kind of arrangement out with the staff there? I go to the same LabCorp every time I get chosen, and they know my situation and work hours, and they will take me as soon as I check in, even if someone else is there because they know I’m a quick visit, in and out.

I think a lot of it depends on the program and the case manager. I’ve never gotten in trouble or had any repercussions from my abnormal urine screens. She’s like, ‘drink more water’ and that’s it. I’ve been in over 2 years with no positive screens or any work issues, I turn my stuff in on time, and communicate well with my CM, so I think that helps. I won’t live in fear. That doesn’t help at all. I started off that way and when I relaxed and adopted the attitude of ‘you’re doing everything you’re supposed to, you’re not using, stop fretting’ it was a lot smoother.

I had my first hair follicle test four months into my TNPap contract. We usually have two of those (or a nail test) per year, four blood draws, and twenty urine drug screens per year if opiates were your DOC. Nurses in for alcohol get Peth tests thrown in there occasionally. Have you had any blood tests yet? If not, pray you don’t get one in the next month. Didn’t you have another scare recently with alcohol? Fingers crossed you don’t get picked. No judgement at all because God knows what I would be doing if I didn’t have consequences in place, so this is coming from a place that’s concerned for your wellbeing. I can’t stress to you enough how important it is to not take anything besides what you’re prescribed. I've just seen two other TnPap nurses get popped in the last couple of weeks for isolated use of a prohibited substance. They’re having to go for evaluations again, one has had to go back to inpatient, it’s a nightmare. We’ve been through enough without piling more on ourselves. It’s such a relief to never worry when my Spectrum app says ‘you’ve been selected’ because it was never that way before.

I agree with the above. Don’t tell anyone at rehab you’re a nurse. If you think you’ll slip up and mention you work in healthcare, say you answer the phones or set appointments, ANYTHING besides something that needs a license. That being said, there are many options for you, depending on the severity of your opioid use disorder. Do you think you could possibly take a week off to detox completely (even if it means checking into a facility then leaving AMA afterwards because they can’t force you to stay) then start an intensive outpatient program? A lot of those are at night and you can possibly keep working, you’d hopefully have insurance to cover it. Start going to AA or NA and work the *** out of the program. Another option is to seek help from a Suboxone clinic. Don’t tell them you’re a nurse. Tell them you’re addicted to opiates and want to do a short Subutex taper, preferably less than a month, not be on it long-term. The dosing schedule can be similar to what you would get in a rehab center, and then you could also start an IOP program. Again, get in NA or AA or Celebrate Recovery or ANYTHING to surround yourself with social support that’s non-judgemental. But I’ll be honest, if you are at that point of rock bottom exhaustion and desperation with your using and truly recognize you have a problem and need to go to inpatient, you probably do. I fought tooth and nail against it, but at the end it was the best decision I ever made. I’m one of those weirdos whose untreated major recurrent depression and severe PPD/PPP was a major cause of and worsened my addiction (not the other way around as most psychiatrists will tell you: most addicts are depressed and anxious BECAUSE of the drugs) and in my treatment plan I got started on the right antidepressants and within two weeks I was a new person and have literally never looked back as far as relapsing on opiates. Those 28 days in treatment with no other responsibilities besides working on myself and my mental health was priceless.