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Traveling was a big issue in the program I was in also. They were very strict. What they said was basically "travel at your own risk." Traveling outside the US was strongly discouraged. Within the US, you were required to get a list of 'acceptable' drop sites and be prepared to test no matter where you were or what you were doing. You still had to call every day, 7 days a week including holidays! I heard of a few exceptions being given if the person had been in the program for a good while (>1 yr) with no violations to their contract. It's important to have as good a working relationship as possible with your Case Manager. That's the person who determines (with the permission of the committee) whether you will ever be allowed an exception to the rules. It seems that rarely happens, however. They pretty much 'own' you until you're done with the program.

Yes...really, you need to consult an attorney who specializes in dealing with licensing boards. If what you're saying is true and you were unjustly penalized for false positive UDS in your diversion program, something needs to be done! On the other hand, I totally understand just wanting to go with the flow and not buck the system. We are completely at their mercy when we're in these programs. But they are not really there for us. They are there to protect the public from us addicts/alcoholics, so it's understandable that they must err on the side of safety. You do have rights though and in your case it would probably be worth consulting an attorney. I know what you mean about just going a different route than clinical nursing practice. Unfortunately those jobs are few and far between. But I wish you luck in whatever you choose. Just keep in mind that your recovery must come in first place, above your nursing license and above your career.

Congrats on your 6 months! I do not have any experience with Naltrexone myself. But I do know that you're correct in that it is not like Suboxone. Naltrexone is purely an opioid antagonist, whereas Suboxone (buprenorphine and naloxone) is a partial agonist/antagonist. The naloxone part of the drug is inactive when taken as directed sublingually, and was placed in the drug in large part to deter the illicit IV use of Suboxone. To my understanding, naltrexone will do nothing for the cravings which are so strongly associated with opioid addiction. The drug simply acts as a 'blocker' for full-agonist opiates. I also understand that there is an oral preparation of the drug as well as an implant, the implant being more 'fool proof' for the obvious reason that an oral dose could be skipped to allow opiates to 'work' for a time. I'm curious as to why it has been recommended to you. I can see how it might be viewed as sort of an insurance policy against relapse, but beyond that I wonder.... Again, my knowledge of it is limited at best. I'd like to know more about it if anyone has further information. Best to you as you go forward! It's a rough road but one we can navigate successfully with the right tools and support!

When I was in the Peer Assistance Program, the individual contract specified the minimum number of times you would be called to test. The usual was "a minimum of 12 times per year." As the other poster said....those who had relapsed would be given an amended contract which normally stated that they would be called "a minimum of 4 times per month" for several months after the relapse. It was randomized, so I know of people who were called 2-3 times in one week and then not again for 6-8 weeks. Your contract should specify at the very least, how many times per year you should expect to be called to test. Don't ever let your guard down and forget to call either. In the program I was in, a missed test was considered 'positive'...no questions asked...no excuses....nada. There was also a policy in place that if you had a specimen come up dilute per their parameters, you would be notified to retest and if you did not show up to the lab within 2 hours it was counted as 'positive.' Further, if you had 2 dilutes without a physician verified reason during your time in the Program (up to 5 years), it was considered 'positive' and you would be required to restart the entire program. So yeah, very strict policies in place....You need to know exactly what your contract states and abide by it to the letter. If you do, you can finish the program and go on your way. Best of luck! And remember that your recovery has to remain priority number one. Being an RN (or LPN) is secondary to having your life back. Take care and hope everything works out for you.

Thank you pokey! I agree with you totally....I'd rather be working with someone on Suboxone than someone in active addiction. The relapse rates of traditional abstinence-based recovery are shameful. If there is something available to bring that rate down, it should be allowed (under the proper supervision of course.) I read an article just today that stated a success rate of about 70% with buprenorphine. Compared to a less than 10% success rate with traditional recovery. I'm glad there are some some state BON's allowing it. Thanks for replying!

Thank you so much for your reply, Mag! I'm not far from you.....Oklahoma! Yeah our BON has lots and lots of meds on the NO list too. Only a few are on the YES list....Tylenol, Advil and Aleve.....pretty much that's it!! Not even Benedryl or Imodium or Sudafed either! Real sticklers us OKies! A complete adstinence program with very few exceptions. I'm so glad to be getting a few replies. Would love to see more. Thanks everybody!

Hello aws. I'm sorry for what you're going through. Battling addiction is difficult enough. Then add to it, dealing with the BON and worrying about your nursing license, and WOW!...double whammy! I applaud you for coming clean with your boss and getting into treatment. I know the Boards have come a long way over the years in their methods of dealing with those of us who are addicted to drugs or alcohol. But unfortunately I believe we are still very stigmatized. Although the BONs are good to allow us a chance for rehabilitation and reentry into nursing, I feel some of their methods are more punitive in nature than they are rehabilitative. But my opinion on the matter is neither here nor there, as their mission above all is to protect the public, and rightly so. What I believe will happen is that you will eventually meet with the BON and be offered an "alternative to discipline" or "peer assistance program" or something along those lines in order to keep your license and eventually be able to return to work under very specific guidelines. I believe this will happen whether they know about your prior rehab before nursing school or not. I'm not sure the fact that you were in rehab before will have any impact on how things will play out. If, in fact, you purposefully left out the prior rehab when it was a required question to answer before being allowed to sit for boards....that could be a problem. I would almost think that technically they could say you weren't even qualified to test for licensure in the first place. You might be doing yourself a favor by checking with a lawyer who specializes in dealing with Licensing Boards. They would be able to advise you much better than we can in terms of what the ramifications of disclosing this at this time would be. I tend to agree with everyone else though.....Honesty is best. So much of our recovery has to do with having the willingness to be completely honest. I think if you're able to do that, you will feel better and maybe even be able to move forward in your recovery that much faster. If it were me though, and I already knew I was headed for an alternative to discipline program anyway.....I would have to know what it would mean to me, my program, my ability to retain my license, etc before I would be willing to disclose the past "sin" if you will. So gather your information and then hopefully you'll find that you can disclose your past misstep and go on, having to never worry about it again. I hope so. Hang in there and remember the most important thing is....YOU and your recovery from addiction!

Thank you very much for your reply. I hope the replies keep coming in as this is of interest to me. How are you doing now, All Over Again? I hope you've done well in your recovery. Actually, that's all I wish for anyone who has battled addiction. It's a tough road whether you use medication-assisted recovery or abstinence-based recovery, that's for sure. Anyway, thank you again for your reply.

Sorry guys...I haven't used this forum much and apparently I'm not allowed to PM members yet because I don't have enough posts. I just wanted to let 'smitty' know I got his PM and that I appreciate it. I read a few of your other posts on the forum and I'd like to have an opportunity to talk with you more. It sounds like you've got quite a history, as most of us in recovery do! Anyway...mostly just wanted you to know I got your PM and say thanks. (hopefully you'll see this post!)

Thank you for your reply SWS. In fact, I had read your other posts about bupe before posting my question, so I understand your feelings about the drug. I'm glad you are doing well in your recovery....congrats on all your progress! It's a rough road indeed. As far as my username, it really has little to do with what medications I may or may not be taking. Rather it has to do with the freedom I feel in my personal journey of recovery. I didn't open this thread to begin a debate about buprenophine. There are plenty of other places online to do that. I probably should have left my opinions about it out of my post. My real goal was to gather information about whether or not the BONs would accept its use in recovery. I thank you letting me know Florida's stance. Hopefully some others will chime in about their states. Thanks again and all the best to you!

Does anyone here know, with any degree of certainty, how the various State Boards of Nursing view the use of Buprenorphine (Suboxone/Subutex) for opiate dependence and/or addiction? Do they allow nurses who are in diversion/alternative to discipline programs for addicted nurses to use buprenorphine as part of their treatment plan? My first reaction would be that they would not approve of it and would actually state that if a nurse is using Suboxone/Subutex they would be practicing in violation of their Nurse Practice Act. But I don't know that for a fact. I believe that buprenorphine is saving many lives right now of opiate addicted individuals...giving them a much better chance at sustained recovery over the long term. It does not affect the mood, produces no euphoria and in fact, in my opinion, provides a good safety net against relapse. While on bupe, the opiate receptors are loaded and taking a full agonist opiate will provide no high to the user, thereby taking away the obsession to use. There are just so many good things about this treatment modality that I cannot believe it is not more widely accepted amongst the Boards of Nursing. I have heard that most if not all, BONs prohibit its use, but I'd like to know if anyone knows that to be a fact, either by their own experience or by reading about it somewhere. I'd appreciate any responses. Thanks a lot!

Sure, babies deliver OP - but it is certainly not the optimal position, requiring a larger diameter of the head to pass through the pelvis than if baby is OA. I agree with one of the other replies - sometimes if the Mom does not have an epidural, you can do more with maternal positioning to assist baby to rotate and come down in a better position. I've also had several deliver OP with epidurals with easy descent and very little pushing. So much has do with the size of Mom's pelvis and no amount of pushing, positioning etc is going to get that baby out lady partslly. An hour and a half of pushing, in my opinion, is a pretty long push. Usually, if I've pushed with a patient for more than 30 minutes or so and we're not moving much - if Mom is comfortable and baby looks good, we talk about "laboring down" and letting the contractions do the work for an hour or even sometimes more. I love it! Babies often will come right down, avoiding hours of pushing for Mom resulting in exhaustion and a bottom that is much more swollen and sore after delivery. What about you guys - do you labor patients down often where you work?

JentheRN - sorry - didn't proofread that response very well. re: my last comments - I should have said "position" not "presentation". Presention refers to vertex/breech/etc. Not terribly difficult to learn. Some l and d nurses are authorized to do a brief U/S to confirm presentation.

checking dilation, effacement, and station is something that is learned strictly with practice. You will have a preceptor to check with you for some time until you are getting most of your exams right. Even then, you will have times when you'll need someone to check behind you because you are not sure. Some exams are more difficult than others. It is also a very subjective thing. One examiner will call it 2 cm/50%, someone else will call it 3 and 70% or whatever. For me, anything thicker than 50%, I just chart as "thick" which I think most of us do, although once in a while you'll run across some "super expert fingered" doctor who will document 20% effaced!! The nurses always crack up at that! Anyway - time and experience will get most nurses pretty accurate with dilation and effacement. What I think most nurses have more difficulty with is station and presentation. For instance you can have a patient with a closed, very posterior cervix but the head be at a zero station. Just because the cervix is difficult to reach does not mean the head is high. As for presentation - even after all my years, it is still tough for me to tell if a baby is LOA, ROA, transverse or OP. I can actually tell better if baby's OP just based on how it's coming down in the pelvis than by truly feeling the landmark sutures, etc. I know most nurses I have worked with say the same thing. So no Jen, not a stupid question! The only "stupid question" is the one that is never asked!!

I personally don't think I have ever referred to the unborn as "it". As some of the others have said, I always ask if Mom/Dad know what they're having and refer to the baby as "he" or "she" If gender is unknown, I'll often just say "baby" or "little one" or some silly name like "peanut". I worked with an OB once that always referred to the baby as "your little darlin"! Not that I find it particularly offensive, but there are many alternatives to "it". I do think it would be kind of weird to say "who are you having" though!!

Hi! I have not ever heard or read of a "rule" re: MDs seeing a patient at a designated time prior to induction of labor. Sure would be reasonable, but as most of us who have worked l and d for any length of time know - induction is almost always about pt and/or doctor convenience, not about what is reasonable!! lol!! Anyway, I have seen many patients scheduled for induction up to 6 weeks ahead of time (we do lots of inductions and the book fills up fast) Patients often have not been seen/examined by the doc for 5-7 days before induction. It is up to the RN to determine presentation, cervical status, etc and notify the doctor if induction orders do not seem appropriate for the situation. The physician usually sees the patient for the first time when AROM is indicated (strangely - that is usually at a.m. rounding time!) Then, they usually see them again at delivery time and that's it! Best of luck in updating your protocols! RN

I have been working as a nurse in OB/gyn for 17 years, most of which has been in labor and delivery (2 different hospitals - 1 doing ~ 350 deliveries/month, the other doing ~ 200/month) The rest of my time was spent as an office RN in a busy OB/gyn/perinatology office. Obviously I love this area of nursing. Like you, I only really saw myself working in this area of nursing. I was fortunate to get hired right out of nursing school. Oddly, it is now commonplace (in my neck of the woods anyway) for RNs to come to work in l and d straight out of school. Not that it's always a bad thing, but honestly I think you will ultimately be glad you spent a little time on a med/surg floor. You are right to question whether l and d is often sad, etc. I have oriented many new nurses and have had some of them tell me they were not prepared for the "other side" of labor and delivery. Obviously when it is sad, it is very, very sad! I can think of few worse things than the feeling in the pit of my gut when I am not getting heart tones on a full or near term fetus and the anxious mom and dad-to-be are looking at me with fear in their eyes and I have tell them, without telling them (because I am not a physician and cannot diagnose IUFD) that their baby does not have a heartbeat anymore. I cannot describe the pain in the crying out of that mother as her agony begins. I have shed many tears over the years as these women labor and deliver the baby they have lost. It is profoundly sad. Babies are born with anomalies (either expected or not). Some are born living, some are IUFDs. Those cases are difficult. Recently, I assisted a new RN in caring for her first IUFD - a near term baby with known defects. Sadly, the baby likely had passed away many days prior to the demise being diagnosed. Labor was induced and after 24 hours plus, the baby was delivered. Suffice it to say - what happens to the fetus after days in the uterus surrounded by amniotic fluid - is not pretty at all and there is no way to properly prepare a new nurse for that. Again, all this to answer your question regarding the sadder side of l and d. Thank God, most days are not like that. Most days are happy and things go as expected. Some days you make a difference in what could have been a disastrous outcome because you reacted/acted appropriately in a dire situation (ie cord prolapse, placental abruption, etc, etc). There are also occassional situations in which you leave work feeling disgusted because you have had to provide care for a woman who shows no care for herself or her unborn baby, and is disrespectful of you and the staff - just downright nasty! But you have to put your feelings aside and "do your thing" with a decent attitude in spite of yourself! Oh and then there are the doctors!! There have been many over the years that I have dealt with. Almost all of whom I respect greatly. Only a few of whom I like!! Seriously, they can be a pain. I try to think of it this way - They are not on the unit most of the time (I have mostly worked nights). I am their eyes and ears - they are dependent on me to get it right. As a labor and delivery nurse, there is soooo much autonomy and so many judgment calls that we make. You have to be okay with that to be happy in l and d. Overall, for me it is the dream job I hoped it would be. Just when I think I can't take it anymore, a sweet little mom willl look up at me with tears in her eyes as I lay her baby in her arms and say "Thank you so much" and I know she means it, and I know I made a difference, so I come back to work again. I apologize for the length of my response. I just got going and couldn't quit! My recommendation - inquire about shadowing an RN in labor and delivery. Also, shop around (if possible in your area) - there is a pretty big difference in working in a busy unit with 300 or more deliveries a month, high risk antepartum care, possibly a physician residency program, NICU, etc, versus a smaller hospital with fewer deliveries, no high risk care, etc. As to your question about staffing, charting - oh yeah, always problematic. I would say maybe more in l and d than anywhere - charting is exceptionally important, staffing is tough as you may start your shift with very little happening and end it with a full board and no where near enough staff! So that issue I'm afraid is universal. Anyway, best of luck to you. I have always said labor and delivery nursing is a calling. If you are called to do it - you should. You will find that it will take at least 6 months to a year before you begin to feel confident that you can handle the job. It is just so specialized, but by all means - get in there and go for it if you feel it is right for you. Let us know what happens!