solarex

If you haven't smoked THC, that is no issue. You are fine. The danger is this....Most State Boards in the last 5 years are selecting the testing sites for where nurses go for evaluations. It did not use to be this way. The Board would say, we need an evaluation from somewhere in our state within one month. Now, the Board actually has contracts with certain facilities in their states to which they send nurses who are referred. What's the problem with that? If the chemical eval declares that you have a program, then the Board takes them at their word, but there is more to it. If the facility doing the chemical eval finds that you have a problem, then that facility also adds another nurse to the pool of those requiring random drug testing over the next few years, so it is going to make a buck by having you, or some other nurses having to come back and randomly test there over the next few years. Unfortunately, the rate of nurses who are Referred by the Board for a Chemical Eval to a Facility that the Board picks, the overall rate in New York State in the year of 2020 was 89%. That means, the facility told the Board that for every 10 nurses that presented to it for a chemical eval, almost 9 in 10 was declared to have a problem. That's New York State. I don't know about Louisiana. Trust me....prepare for an alcohol hair test IF the Board told you go to to that exact place in which you are being evaluated. They are very stringent and its more than drug testing. You could test Negative on Drug Test, but there are chemical eval written-paper-interview tests they do that can cause them to report that you have a problem and need to be in monitoring EVEN IF you test negative in urine and hair tests.

When you enter a program, most programs will want you to attend 3 recovery meetings per week, which is either AA, NA, Celebrate Recovery or Smart Recovery or a combination of those above. You will call in everyday to check in and when you call, if you are selected to give a drug test, you have to give a drug test that day. Those are the big requirments. Here's the thing though, when you enter a monitoring program, they are going to want you to attend a 6 week hospitalization program, a 6 week IOP program, and a one year aftercare program which is 1 hour to 1.5 hours meeting once per week of Aftercare. You will not have time to work while in the PHP program. That's pretty much all day. You will be able to work regarding having enough time while in an IOP program and onward. The Board doesnt' have the power to tell you whether you can or can't work in a place outside of nursing. If you want to be a Druck Driver or waitress or warehouse worker, they don't have the power to tell you that you can't work somewhere and they won't do that. They will simply tell you that you better be at those meetings and not miss a daily check in. Anything that hinders your recovery is a no no, but working somewhere outside of nursing while your license is suspended is fine. For nurses who are suspected of diversion. Warning to you. Many for some reason or another love to wait until the Board Investigation is over which can take up to 2 years, and when it's over, the nurse thinks, OK, I will just start the monitoring program then. It doesn't work like that. If you are determined to be diverting and lets say the 18 month mark comes up and the Board finishes its investigation. They are going to make you go to a 6 week Partial Hospitalization Program somewhere, then do a 6 week IOP program, and a one year Aftercare Program, and if diverting, your license usually suspended for 1 year, and they want you to get this rehab part done while that license is suspended. So, there is more to it than simply starting your monitoring program when the investigation is over. Again, this is another reason I tell nurses to get to rehab immediately after caught diverting and do not wait for the investigation. Get to rehab, and while you are in rehab, call your state monitoring program from the rehab program and get the paperwork in, get enrolled so when you return from the 6 week PHP program back to your home, you are immediately checking in, being monitored the moment you return home. This is viewed as OVERwhelmingly FAVORABLE by the Board and your punishment is usually much less by the time the Board finishes the investigation.

1. Rose, please don't post about things you have no clue or concept of what you are talking about. I am a CRNA and use to set on the California Board prior to CRNA school while an RN. I did it for 2 years. I have seen over 25 nurses criminally charged in my time. After leaving the Board, I diverted 4 years later as a CRNA and have been through both sides of the process, both the working for the Board side, and then actually being an offending nurse who diverted. 2. Hospitals can't "charge you criminally." A Hospital isn't a Prosecutor. The DA is the Prosecutor. What did I write in the previous post? I did NOT write anything about "Hospitals Charging Someone." That's not possible. What I DID write was....hospitals and the Chief of Pharmacy has a DUTY, by LAW, to NOTIFY the local/county police and the DEA and the State Board in diversion cases because diversion is a criminal act. As to whether the District Attorney decides to prosecute a nurse is not simply based on "what the Hospital wants to do." LOL. That has ZERO to do with it. It's about three things. The first is how many cases does the DA have and does he have the time to fool with you. Usually, that answer is no. I can tell you that Southern States are far likelier to bring charges compared to western more liberal states. 2nd, the volume of evidence plays a part. For example, is the evidence overwhelming and obvious. 3rd, and often the biggest factor involved if the first 2 criteria above are met. For example, if the DA decides he or she is going to bring charges and has the time and money to do so, and the evidence is overwhelming, then the 3rd factor is your behavior AFTER getting caught. Are you denying, lawyering up, not responding to the Board, and MOST important, have you yet to enter a recovery program. Of all the people that do get charged criminally, I can tell you this, 99 percent of them meet these three criteria above. Aside from your nurse license. Just put that aside. Any lawyer will tell you the this. If you have a drug problem and the evidene is overwhelming against you, GET to rehab IMMEDIATELY. Why? It can literally make the difference in whether or not you are criminally charged. If a DA is thinking about bringing charges, the first thing they do is look to see what you are doing at present, and if you are in rehab, in monitoring as well, your changes just went WAY down of being charged. Even if charged, if you have gone to rehab and are in monitoring program, the changes of those charges being dropped go trough the roof. Again, Hospitals are not in the legal criminal field. A hospital doesn't decide whether or not you are charged. We are talking about criminal law, not civil law. In criminal law, the District Attorney, who represents the citizens of the State you live in decides whether to bring charges regardless of what a Hospital wants to do. Let me assure you of this. In EVERY suspected diversion case in America, the Hospital-Chief of Pharmacy has a duty to report to the DEA, and the Board of Nursing. If not, the hospital can and will be fined millions of dollars, and the Chief of Pharmacy can lose his or her license to practice, so I promise you, they report it. Again, reporting it, and then a District Attorney bringing criminal charges are two different things, but once again, your actions, your behavior AFTER you have been caught diverting can dramatically effect the odds of whether or not you are charged criminally. Last of all, Rose stated you could not talk to the Board and your license suspended for a year or 2, and then you get it back. What nurses don't understand is that it is pretty easy to "get your license back." That's not difficult. The problem is when you get that license back in 2 years, the stipulations that follow. The Board will say, yep, you got your license back, congrats, now here are the stipulations you have that allow you to keep it, and if you don't the following, we will revoke it. And when revoked, you aren't getting it back. Choose another profession quickly. As for those stipulations after you "get it back." You are on probation. You will attend 3 recovering meetings weekly and your Supervisor at Work will send the Board a report every 3 months, and you can't have access to controlled substances at work, and you should have completed a 6 week PHP program, a 6 week IOP program, and a one year Aftercare Program, and you will call in daily and be in random drug testing. These conditions above last for 5 years, but we will give you your controlled substance ability and privaleges back after 1 year to 18 months. By the way, we need to approve where you work before the first day that you start work and will be contacting your Supervisor frequently via phone or email to check in on you, and oh yea, good luck getting a nursing job without narcotic privaleges. The only place that will hire you is Dialysis if you are lucky or a plasma center, and both have long hours and pay very little. But hey, "you have your license back." My point is....when you here the words, "you got it back," most nurses who just don't think very clearly either choose not to, or don't have the ability to tell you what "having your license back" involves. I just told you, and was being honest.

In California, everyone does NOT get a key restriction. This totally varies based on what the nurse did, for example, diluted urine specimen when applying for a job compared to proven Diversion of narcotics while at work. Those two are radically different. When does the Board give you credit from another Board? They are looking for one key thing and that is.....have you been monitored (as in....daily check ins and random drug testing). They will want proof that you have been monitored and if monitored for 2 years and you can provide the proof, then you will get credit, but.........they are not going to accept "you monitoring yourself."

I am in Sacramento, and use to be on the Board. I'm now in NYC

Then....you need to fight. I would first and foremost, acknowledge the receipt of the investigation. 2nd, I would immediately get a chemical evaluation and then send this to the Board. From that point right there, the Board has no case against you. What you did was in the past and you paid for it, and you have the proof that you don't have a substance abuse issue. IF the Board does not stop.....after you have given them the chemical eval, obtain an attorney. I would not obtain an attorney yet. The chemical eval showing you don't have a substance abuse issue should do it. That should end it. But, if that doesn't end it, I would then get an attorney.

The hair test for alcohol is very, very likely IF.....IF the Board is picking the chemical eval facility for you. If they are saying to you, "we want you to go here." Then it's very likely. If you have some say so in which chemical eval facility you are going to, then it's 50-50.

Your license was suspended and you are still drinking....as in.....ANY amount of alcohol shows poor judgement. It begs the question of....how much do you truly care about your licence. With the volume of alcohol that you drank in the last 90 days, a hair test for alcohol will easily show a positive test. It's automatic. At a chemical eval, it's 50-50. If you are being referred to that chemical eval facility by the Board, then it's likely they will do a hair test. It's not automatic, but highly likely. You said your license was suspended. Did the Board specifically say in your suspension order that you must refrain from all mood altering substances? I'm betting they did. If they didn't, then tell the truth. Tell the evaluator you drank wine. Again....that is if you aren't prohibited from drinking wine or alcohol. If you are prohibited....and I would think you are, you really need to ask yourself how important your license is. Because....if they do a hair test, you are going to test positive. It's automatic. If a urine alcohol test, you will be good to go if no alcohol in 6 days.

A previous med error and IPN are not the same thing. You don't get placed into a monitoring program due to a simple med error. Is there more to the story? Was the med error something just a bit more than a med error.....as in....narcotics went missing and you called this a med error, but it's actually a bit more than med error? Are you saying that you are being investigated by the Board for a simple med error that you reported? If so, acknowledge the investigation and comply. Why do you need a lawyer? If it was a med error, what do you have to hide? But, if there is something more to the story that you are telling (and there usually is with these discussions) and your "med error" was related to drugs that went missing, or if your "med error" was one in which your previous stated they gave some type of disciplinary action. If the med error or discipline was related to narcotics, I suggest you immediately go get your own Chemical Eval from a Treatment Center and send that to the Board on your own showing that you don't have a chemical issue. That will nip it in the bud and end it right there. Now, if you truly and simply did....have a med error in your previous state and it was only that and not narcotic related, or if your previous board required some type of chemical eval when they disciplined you, then send that copy to the board, and then I suggest you tell the truth and say yes, I made a med error, just like probably everyone on the Nurse Board and on this Board has had a speeding ticket at some time. People make mistakes, but what I am getting at is...........is there just a little something extra that happened in what you are calling, "a med error." DO NOT IGNORE IT! The investigation will go on without out you. At least acknowledge that you have received the notice of investigation. You have to do that. Even if you had a lawyer, the lawyer will tell you that you have to acknowledge that you have received the email. Now, complying, speaking to the Board, telling your story to them is NOT required. That is where the lawyer could come in. Here is the thing, if it's in the past and the discipline with the previous board is over with and you have nothing to hide, then I wouldn't get a lawyer.

For any nurses in monitoring programs, be careful requesting vacation time. Some of you will have allowed maximum amount of vacation time specified in your monitoring agreement per year. Some will say it's at your case managers discretion. Some will not say anything about it other than that you simply have to clear it with your case manager before going. Here is what I am getting at and why it's important to think twice. If your monitoring program is for alcohol and is 4 years, or lets say it's for Diversion and it's 5 years and you request vacation time which means.....you are getting permission to travel and you are getting permission to not have to check in daily while on vacation for a week or 2. Here is what is happening across the country with monitoring programs. Many of them are tacking on your vacation time to the end of your monitoring discharge time. For example, if you are doing a 4 year monitoring agreement and you are within a month of discharge, you may not be discharged in one month. Monitoring programs are moving to this. They are looking back and adding up the vacation time you took over the past 4 years, and lets say it's 8 weeks total. You just added 8 weeks to your 4 year monitoring period. Is it a big deal? No, not really, but it is an extension and it is a real thing. They are doing this more and more. What I have seen many nurses and monitoring programs do is this. You simply take vacation and still call in every day and if selected to test, then you test at the site where your vacation is and you are the one responsible for knowing where that site is. Many monitoring agreements......actually most of them.....do not require you to "request vacation or travel" if it's inside the USA. Some do, but most don't. They absolutely and obviously do require you to request permission to travel/vacation AND be exempted from having to check in daily while on vacation. The easiest thing, and keeping with your routine, might simply be to travel, go on vacation, and treat it like any other day and check in and be prepared to test if selected. I know for some....for some people, you are required to get permission to simply leave the state or travel regardless of whether you are requesting to check in or not check in, but most monitoring agreements don't require that. Most only request you get permission to travel if you are planning on not checking in daily while you are on your trip and vacation.

First of all, you did not disclose WHY you have a chemical dependency evaluation. 2nd. Alcohol usage can be detected in the hair for up to 90 days. The test is more qualitative than quantitative and here is what I mean. They can detect, going back to 90 days, if you have been drinking or had a one time-one night binge on alcohol versus the accidental alcohol mouthwash or hand sanitizer. They can't tell if you have been drinking every day or every week, but they can get an idea of the overall volume and they can tell the difference in that versus accidental alcohol contact like alcohol pads for finger sticks and injections to patients or perfume or mouthwash. Important....think of a giant string of yarn that is Blue. If you had one night where you got hammered 2 months ago and that was it. You did not drink at any other time in the last 3 months, they can at the tiniest level with the highest powered microscopes, identify that giant string of yarn that is blue and with a 100 percent certainty, they will find that giant string of yarn with a completely and perfectly encircled yellow color that is sized literally within a couple days before or after and they can time it based on the length. It's actually not hard for them to do. If you drank for example once every 2 weeks. They can see and estimate those times based on the discolorations of the reagent that is ALARMINGLY accurate and simple to see with a microscope, and they have a mathematical formula based on your hair length sample and the size of the discoloration that can estimate the frequency of your use and the approximate time, and yes, this is so scientific that it has held up in court for over 2 decades. As for the Pleth. If you are having a chemical dependency eval, in addition to the hairtest, they will do a urine test for alcohol. The type they do will be the most sophisticated/most accurate possible. As of 2023, the most sophisticated urine alcohol tests can detect alcohol metabolites for up to 6 days with very, very good reliability. This is why so many people lose their licenses and get kicked out of monitoring programs. It happens all across the USA after a 4 day weekend. Lets say there is Christmas coming up. For example, it's Friday the 21sr of December, so the 24th is a Holiday which is a Monday and the 25th is a Holiday which is Tuesday. The nurse who is in monitoring calls in very early on Friday morning at the earliest time possible and they are NOT selected to randomly test that day. The nurse knows they are off over the next 4 days and doesn't have to call in again to see if they are selected to test until Wednesday. What does the nurse do? The nurse calls in sick on Friday and instead, plans on getting themselve a stiff drink or cold brew. Surely, 5 days is enough to clear the alcohol if they are selected to test the following Wednesday when it's time to call in again. Well, 5 days is NOT long enough to clear it. You would be amazed how many nurses are removed from monitoring programs and licenses suspended or revoked around late December every year because of the 4 day Holiday. It's incredible how many nurses call in sick to work on the last working day before the Holiday to give themselves what is basically a 5 day weekend instead of a 4 day weekend so they can get their alcohol in them soon, which gives them more time to clear it. When it happens, and the nurse gets selected and tests positive on Wednesday when having to call in again, what does the monitoring program and board do? They immediately call your employer and ask a simple question. Was she or he sick on Friday, the day before the 4 day weekend, or did she take time off, doctors appt, etc? Boards know this. They have seen every trick in the book, and that trick is repeated with every 4 day weekend all across the country by nurses who think they are the only nurse in the United States to come up with their brilliant idea.

False. It is now 5 for anyone coming in with Diversion History and here is why. First, I have cut and pasted from their website "Generally, the Program length is between three (3) to five (5) years. However, the actual length of time will depend on how well you respond to your individual recovery plan." A one time DUI, one time failed drug test with no history of diversion at work after the Board thoroughly checks? These are the kind of incidences where you will get 3 to 3.5 years. IF....again...if you are diverting and the reports and pharmacy records and behavior supports Diversion, I will again repeat, you ARE doing 5 years, period. In the last 5 years, 14 states have gone to 5 year programs for Diversion Cases. These state use to be 3, 3.5 or 4 years. Why the move to 5 years for basically ALL Diversion Cases? The research supports this from recovery centers across the United States. Nurse Anesthetists. One of the leading research groups in Nursing as it relates to recovery is nurse anesthetists because they have overwhelmingly high amounts of substance abuse. Because of this, the AANA (their national organization) has invested lots of dollars into Recovery Research. For example..how to treat it..how to prevent relapse, best methods, etc. One of their research arms is Parkdale Center near Chicago. It's technically in Indiana. Parkdale, with the AANA, have done tons of research on recovery and this research has been shared with pretty much every nurse board and nurse monitoring program in the USA. Their research is leading the way. The data that has come out of there places strong emphasis on 2 things... 1. The good- getting nurses back to practice within 6 months, as long as they are in active recovery and monitoring. 2. The not so good- Monitoring should be 5 years for all Diversion cases, or cases where it's obvious that the person is addicted to substances in order to decrease the chances of relapse at the highest level. Even when you see a state monitoring program out there that says, "plans are individualized regarding treatment and length of time is 3 to 5 years." Trust me...your "individualized plan" is going to have the number 5 on it, if you were diverting. Again....a one time DUI with no history of any issues or a one time failed drug test for example....when applying for a job and not ON the job? These are the 3 to 3.5 year type things. For the person who is addicted, or a 2nd DUI, diverting at work, you are NOT finishing a program before 60 months. I work in this area and know what I'm talking about.

There are circumstances where waiting is better due to not being in that state, or traveling, saving money, etc. I get that, but by in large...and in most cases, getting the clock started is better. Trust me on this. I have talked to hundreds....not 20 or 30 or 50, but probably 200 nurses that are either in monitoring programs or they are finished with them and about 180 out of that 200 have all told me the same thing. "Why on Earth did I wait for well over a year until the Board finished investigating when I could have started earlier and had it over with." I have heard that statement well over 100 times. Many of these nurses were approaching well over 18 months waiting...close to 23 months (almost 2 years) before the Board had an official decision and consent order. A very stressful process that could have taken 5 years had been lengthened to nearly 7 years. 7 years is 70% of one decade! It's stressful waiting on the Board to finish their investigation and get everything finalized. You are better off starting monitoring/diversion program immediately because you are in the program, you are being monitored, you know that you are doing the right thing and trending in the right direction and TRUST ME, the Board will have favorable action at NOT throwing the book at you, if you are in the monitoring program for the 1.5 years or sometimes more while the investigation in ongoing. It looks VERY good for you compared to playing the lawyer game, having your lawyer do every piece of communication with the Board on your behalf, only to get the EXACT same thing to happen to you as if you would not have had a lawyer. You are GOING into the monitoring program for 5 years. The exception? Obviously if you are not addicted or you have not taken drugs, and you are being accused of something to where you truly don't need to be in a 5 year program, then sure, lawyer up. Otherwise, you are Wasting 10,000 dollars for a lawyer. GET INTO Monitoring/Diversion Program literally the day that you are caught diverting. Get signed up that fast, and your life will be better. Your license WILL come out BETTER in the long run and it's actually LESS stressful for you in the long run by entering a monitoring program EARLY.

No there isn't. You are absolutely not under any work restrictions UNTIL the Board says you are. If you are being investigated by a nurse board and the evidence looks overwhelming to the point that the Board can not wait the average 12 to 18 months before the investigation and punishment is decided, they will do an quick injunction forbidding the nurse from practice until the investigation is over. A nurse will know quickly if they get an order from the Board to stop working. If you haven't received an order to stop working from the Board, and only a notice that you are under investigation, you can continue to work while in the Diversion Program. The program is VOLUNTARY until.....the nurse board finishes the investigation and decides you have a problem. It become INVOLUNTARY after that. Either way....the 5 year clock has started once you enter the program and are being monitored/drug tested. IF....again....IF you wait until the investigation is over and 1.5 years have gone by, and you then Enter into the diversion monitoring program, your 5 year clock does not start until that date. You have basically just lost 1.5 years do to ignorance.

No, I did not wait until the investigation was over before entering my monitoring program. Why? Because I wanted the clock started. It's a 5 year monitoring program. The state is going to want you to do 5 years of being monitored (daily check in/random drug testing) and nurses are just plain ignorant, completely ignorant for "waiting until the investigation is over" before entering the monitoring program. Often 1 year to 18 months has passed before the Board makes a decision. You could have already had 1.5 of the 5 years DONE before the Board made a decision, but what do ignorant nurses do? They wait-stress themselves out/worry themselves sick for the 12 to 18 months time it is taking for the Board to finish the investigation and make a decision, then when the decision is made, the Nurse just got to add another 5 years of stress into the mix on top of the 18 month waiting period. Ignorance. Monitoring program/diversion program. If the Board decides you don't need monitoring 1 year after you have already quickly enrolled into the diversion/monitoring program, then great, you just leave the diversion/monitoring program when the Board decided you don't need it. The thing is, over 97% of diversion cases brought to the Board will end up requiring monitoring for the nurse for 5 years. Get on the clock. Get the clock started. Absolutely DO NOT WAIT to enter into diversion/monitoring. Get into it quickly because you are getting the clock started on this nightmare coming to an end quicker.

IMMEDIATELY get into the program. Get into California's monitoring program and start your daily check in's and random testing NOW. Why? Because you are going to get 5 years of required monitoring/drug testing from the Board when this is done, and that timeframe starts from when you enter the States Monitoring Program in California. It is not based on when the event for diverting happened or when the Board makes a decision after the investigation. The clock (the 5 year clock) starts when the you enter the program. People are ignorant for waiting. They think...."my issue happened in 2023 of June, so I will let the Board investigate and do nothing different, and by December of 2024 when the Board makes a decision, I will only have about 3.5 years of monitoring to do because my event happened in June of 2023." It doesn't work that. If the Board makes their decision in December of 2024 for you to be in monitoring for 5 years, it starts from the day that you entered monitoring, whether that was back in June of 2023, or it will start in December of 2024 if you haven't entered monitoring yet. Here's is what will happen. You are going to be in a program that requires you to do 5 years of drug monitoring/daily check in's/random drug testing. The sooner you get into a monitoring program, the quicker the 5 years are over with. And know, the Board doesn't allow you to "monitor yourself" LOL. The Board will only count you being in the California Nurse Monitoring Program (whatever the official name is I don't know, but every state has one). As for Subutex and you "slipping one time." For starters, you were given access to Subutex for a reason. You just don't magically awaken one day and have Subutex by your side and then you having to make the decision of whether or not you need to take one. You were prescribed it BECAUSE you already had a problem, so don't go there. You aren't fooling anyone.

Here is the thing. You being "more than confident that you can remain clean" isn't the decider. You being more than confident that you can remain clean is the standard BEFORE you begin diverting. Once you have been diverting and you are now caught, the standard and expectations and rules to allow you back into practice set by the Board is not based on your perception of whether you can remain clean. That standard is no longer considered. If you have diverted and the Board say 28 days residential, I would do it. Why? You aren't just looking at your nursing license, you are also doing the 28 days to help decrease the chances of criminal charges. Pharmacies have a duty to report not only to the Board, but also to the DEA and Police Detectives (locally-county or state) and those detectives are made aware of every diversion case. You decision to do what the Board says regarding 28 days has a huge part in whether or not you are charged criminally.

Folks, nobody should be "calling in" everyday in the year of 2023. The overwhelming majority of states now have an App on your phone where you simply click the button each morning and it instantly tells you if you have been selected to test or not. When you click the button, this is your check in, and you then test if you have been selected or not selected. The State's Monitoring Program and or Board (whichever runs it-it doesn't matter which one) will have a contracted Drug Monitoring Test Provider such as RecoveryTrek or Affinity (two of the most common). Both of them have apps on your phone where you simply do it like muscle memory when you kill your morning alarm. You hit one button on your phone, and instantly you have just checked in for the day and if everything is lit up in green, you don't pee that day. If it's red, you pee that day. It literally takes 3 to 4 seconds daily to check in. It's not that tough folks. It becomes like muscle memory and you do it when you turn your alarm off. Takes less than 5 seconds to check in.

Nobody wrote that is was a crutch. Nobody wrote that everyone was the same. I have a valid opinion because I am a CRNA and work in a pain clinic and do pain management, so I know something or to. You do NOT need Subutex to survive or be out of pain. You need it to GET off of drugs because you are NOT completely off of drugs yet MENTALLY. You do not need Adderall to survive. There are other ADHD (Non controlled-non amphetamines). When you are having an attorney or yourself argue or state your case with the Board on why you need the controlled substance, you can call it what you wish. If it's not a loophole then fine, it is still AN ARGUMENT. An ARGUMENT implies....YOU have yet to surrender and submit to addiction. You are STILL holding on. That attitude or the back and forth with the Board on why you need the medicines implies in EVER addiction medicine circle, that you are showing signs of not being able to turn it over. Now, you may not like that, but that's the way it is. Again, do you want the stress of arguing and the back and forth calls and email with the Board and added to that, the monthly reports required by your Doctor and you being responsible for it if he didn't send the report. That stress goes on for 5 years. Do you really want that instead of simply....getting pain injections and steroids with local anesthetics and taking Lyrica and other non opioids that actually removes any OPIOIDS from your life and actually TREATS your pain, and guess what, they are non controlled. You don't have to worry with the back and forth battles with the Board and the emails and mandatory Physician monthly reports. Why on earth some nurses choose this path. The path of actually adding MORE stress to an already stressful situation is just amazing to me. It's the ultimate form of ignorance.

Look, lets approach this from a recovery perspective. If you are still....notice that word, STILL trying to find legal loopholes and you are trying to "do battle" with what the nursing board must continue to "allow" you to take, you are so SCREWED. The chances of you remaining sober are near ZERO, so I suggest you just quit the program now and safe yourself time. Sure....you can get your attorney to argue and get a deal where the Board has to allow you to "get your fix" with Buprenorphine or whatever other addictive FIX such as Adderall that you are STILL not letting go of, that's fine. But that attitude is a gigantic indicator of whether you use again. It's like an alcoholic who only drinks "Odouls." They are STILL holding on that fix, no matter how slight. I've been in the monitoring program for 4 years. 1 more to go. Just do what you are told and keep that mouth shut. That's 50% of your problem. That mouth....that attitude. That's how we got here (including myself). Sure, you can argue it to where they allow you to take your Buprenorphine or Adderall or whatever fix that you still want to get, but they quickly require a monthly report from your physician Directly to the Board in the form of a report, and the Board can and DOES do that. They require proof of that script each month. If your physician NP misses one report, or if he or she is out of town and forgets, or if one stroke of the keyboard is off when he sends the email and that report is late, you are done. The Board remembers the arguing and pleading and attorney and your actions, and you will not get any slack. It's a lot less stressful to get past the "Fix." Stop it with the Subutex and Adderall, get through the stress of letting that go, and you don't have the stress of each month, every month, for 60 months in a row, you better not be off one time with your provider sending the Board the report. The Board doesn't care about your "technicality" which is the Dr. was sick that day, or "he forgot to do it." You are DONE if that report misses, and you have to be perfect, 60 months in a row. What are the odds of anyone, even if you are doing everything correctly, not hitting one stroke of the keyboard wrong when they do it for 60 times? What are the odds you Doctor isn't on vacation 60 times in a row when that report is due. You are BEGGING, you are PLEADING for DISASTER if you go this route. Let the FIX go. Certainly, take the meds that you actually need like your BP meds, cholesterol, etc. As for the Board. Yes, they are there to protect the public. They are also there to MAKE MONEY. Here's an example. We have the nurse compact thing, so lets say you get in trouble in California and you are licensed also in 2 other states, for example, Nebraska and Colorado. The correct thing to do for your non-home states like Nebraska and Colorado is to accept the monitoring agreement you have in your home state of California, and have your California Monitoring Program Case Manager simply send your quarterly report to Nebraska and Colorado and that be simplified for you. But....Most Boards don't do this. Colorado and Nebraska want you to meet THEIR requirements which usually means, one of those weekly meetings they call Aftercare which basically you have to pay for, even if via Zoom all the way from California. That is WRONG. It should actually be legally challenged. Boards shouldn't be able to get away with this. After all, it was State Boards who were the one's arguing for the Nurse Licensure Compact many years ago to simplify things, but when it comes to money, things all of a sudden aren't so simple. Yes, the Boards are there to protect the public and do a good job, but don't kid yourself on their need for income.

And you are correct 100%. Here is the thing though, one wouldn't need to worry about police. Because you tell a therapist you frequently drive drunk will not get a police call because police need you to be drunk driving the car to convict you, otherwise, every AA member of every meeting in the USA would have law enforcement at their homes. The concern is the obvious elephant in the room and that is....patient care. If you tell a therapist you are providing patient care drunk or high, then that can get a report to the Board without fear of HIPPA violation by the therapist. What I recommend for any nurse seeking outpatient therapy with a substance abuse or alcohol problem that has used or sometimes uses/under the influence while providing patient care is.... 1. Stop, go immediately to rehab, and rehab has a definition to it. It is simply Not 1 or 2 weeks in a dry out ward. Think more like....12 weeks and more on that below to truly call it "rehab." 2. If you will not go to rehab and want to pursue the outpatient therapy thing, STOP using at work obviously, but tell the therapist you have a substance use problem and never discuss your use at work. If you are asked directly, you simply say that you do not feel comfortable discussing that, and this statement is more than enough to protect you from a therapist contacting the Board as you have not admitted to using while providing patient care and it takes a full-absolute admitting of your own words saying that in order for a therapist to confirm it and report it. You would have to literally say the words. A therapist can not "reasonably deduce" that you are likely using at work, so they report you. It doesn't work like that and it can't be vague. You would literally need to say the exact words in order for a therapist to be exempt of HIPPA and report it, and trust me, they always error on the side of HIPPA, and most would not report it anyway, even if you admitted to it, but some would, and you wouldn't want to take that chance. 3. The therapist obviously needs to know that you have a substance/alcohol problem of which you are there for, and the amount you use per day, and that is it. The therapy for your treatment can be guided from there. You do not go into details about using at work and if asked, you simply say I do not wish to talk about that, and you will be fine 100% of the time. 4. From a recovery perspective, if you are a nurse who uses at work, then your addiction is way, way, way beyond a successful treatment with only psychotherapy/outpatient therapist. You need to immediately and absolutely ensure you complete a 6 week partial hospitalization program PHP followed by a 6 week intense outpatient program (IOP). Your odds of beating the addiction with only an outpatient therapist and not completing the PHP and IOP part are not zero, but they are less than 1% according to the studies. If you are addicted enough (and I was) to where you divert at work, or you use at work or in the parking lot at lunch, you are LITERALLY pissing in the wind by trying to overcome your addiction with only outpatient therapy once per week. It will not work and the data shows that. 5. How many people that divert from work or use in the parking lot at lunch that do not Yet choose to go to rehab (PHP and IOP-12 weeks) believe that they are that 1% that will beat and "tackle" their addiction with only outpatient therapy? Nearly 100% of them reading is believe it. I know that I did. This is what makes substance abuse/addiction (alcohol and drugs) so deadly. Notice I used the word "Yet" regarding your choice to go to rehab in line 2 of this paragraph. You can make that choice now on your own and avoid the State Board, or 99% of the time as the numbers show, the State Board will make that choice for you because you have a 1% chance of beating addiction without true rehab which is 6 weeks of PHP and 6 weeks of IOP (12 weeks total) and if you keep working in nursing, you will get caught because you can't stop without completing rehab. It's not quite mathematically impossible to stop with only outpatient therapy once per week, but it's very close. A good outlook....if you do a 6 week PHP where you stay at the facility, then you come home and do IOP which is 6 weeks total by zoom meetings which are 9 total hours per week for 6 weeks, and you then do an Aftercare program which is 1 meeting per week for 1 hour for 52 meetings total (1 year) and during this time, you ALWAYS attend a minimum of 2 recovery meetings weekly be it AA, Celebrate Recovery, NA, or SMART recovery, and you do those 2 meetings weekly for 5 years, your chances of relapse are 9%. 9 out of 100. The chances of any nurse who has never used has a 1 in 10 chance of having a Substance A use problem of 10% in the future, so if you follow the steps above, after 5 years, your chances of reuse are LESS than all other nurse who have never used! Check this out...if you are 3 years into it and you decide you only need 1 meeting in recovery per week instead of 2, and you regularly only attend 1, then your risk for relapse goes to 75%. If you attend zero meetings per week, your risk goes to 88%. There is a proven, statistically step by step process for recovery that is proven and does work, as long as you comply. If you shortchange on any of these steps, relapse rate skyrocketd.

I'm not sure where you are getting your vendor. I do the ordering of anesthesia medications/inventory in my dept and I can assure the cost is 2 times that of neo/stig reversal. When used for high risk post op respiratory complication patients, the long term cost is similar to neo/glyco when recovery time and post oo respiratory events are figured in. Most patients having surgery in the USA are not high risk for post op respiratory complications. 1. As for effective reversal and weakness in PACU, there is zero question that Suggam. Is more effective. The same applies to Methadone compared to Fentanyl in open heart surgery. We still don't use Methadone for hearts. We know TURPS fair better with Robots, yet we still perform some without them. If you have 2 of 4 TOF with a person without major risk for post op resp. complications, neostig/glyco is a solid option and cost effective. This is not to say we Never use Sugamm. I use it regularly when the cost and risk ratio align to the patient. 2. The data is overwhelmingly clear that when plastic surgeons close a wound, the patients have less residual scar tissue long term and better cosmetic appearance. How come plastic surgeons aren't coming to the ER very much, or the OR for that matter? It's because the Surgeon or FA/PA or ER Doc does an adequate job in closing that is cost effective. Sugamm. is a wonderful drug that has its use, but like anything else, in a specific situation that calls for it, and there are many that do, but there are more that do not until the cost for the average patient and surgery approach the same as neostig/glyco, and that margin has narrowed, but it is still wide.

Your California license will be suspended likely and your home state of MN, which is where I think you practice will suspend your license and make you go to therapy including a 6 week PHP, followed by a 6 week IOP, followed by 1 year of Aftercare. Your compact state ability will stop and you will only be allowed to practice in your home state. 1. If you surrender your California license, there is a high likelihood you may never practice nursing again in ANY state. You were in a discipline program and never reported it to the other state you were licensed in. That's a major major no no. If you commit no no number 2 by surrendering your license 9n California, then that's 2 no no's for California and you likely end up on the Federal OIG exclusion list for 5 years which means you can't work anywhere in any state as a nurse (even if MN says you can). See the thread about licensing surrenders and how dangerous this can be. 2. I recommend this.....go to rehab immediately. Complete a 6 week PHP and 6 week IOP. Hope that California SUSPENDS your license and this way, you are not under a Cali monitoring agreement and you avoid the OIG exclusion list. This way, you are under the MN monitoring agreement only which is where you live. Additionally, you were caught on camera taking the Fentanyl and you were already in a discipline program. There is the possibility of criminal charges in the future. How do you radically decrease the chances of criminal charges? You go and complete rehab. 3. By completing rehab, you also make a few things more likely. It's is more likely that California suspends your license and does not revoke it. A surrender I equal to a revoke. Both likely get you on an exclusion list. A suspension is what you want from Cali. You simply never renew it and you are not under a monitoring agreement. Also, your home state of MN sees rehab by you as favorable and it will allow you to get back to work quicker and likely with less restrictions in your monitoring program compared to never completing rehab. Lastly, detectives/police do work with the state boards and hospitals. Someone that gets help is far more likely to not be charged compared to someone who lawyers up and fights the process (in which they still lose 95% of the time but are out of 10 grand for a lawyer). It is one thing with limited evidence, but when clearly on camera, it's a slam dunk case for a prosecutor if they want to go that route. Therapy overwhelmingly decreases the chances of criminal charges. Not going to therapy and lawyering up makes the police/prosecutors foam at the mouth and come after you. 4. For some God unknown reason, across the USA nurses have had the following two statements Passes around for decades regarding what to do and they couldn't be further from the truth and amazingly, even in 2022, this prevailing thought still occurs and it is.... A. "Get a lawyer." B. "Just surrender your license because you know you will never practice in that state again anyway." It is the 2 dumbest off the cuff statements that ruins careers. You only get a lawyer if you are absolutely not guilty. You know allegations are false and you don't mess with any substances. The second time for a lawyer is if you are criminally charged. That's it, a lawyer does zero good except for these 2 situations and getting a lawyer BEFORE you are criminally charged may actually increase your chances of being criminally charged. Again, 2 exceptions above for lawyers, otherwise you are paying 10 grand for the Exact same consequences that will occur if you would not have had a lawyer. And of course, the ole....surrender your license. Absolutely devastating and probably worse than getting a lawyer. Could and often leads to a 5 year Federal OIG exclusion where you don't and can't work as a nurse in any state in any facility.

Very true. Historically by Court precedent and case law, if a nurse is voluntarily seeking help from a mental health professional and going on his or her volition without being mandated by the Board or a monitoring program, that is seen as a major positive and progression and will not be reported. Additionally, if going to a therapist, be open in stating you use and what you use, but you do not have to disclose your source of use. The therapist needs to know you have a substance abuse problem and that guides the treatment and therapy. If you have diverted from work, there is no point is saying that.

From a pure recovery standpoint and not from a career, BON, or job standpoint, but purely recovery. The odds are absolutely overwhelming that you use again in some form or fashion without completing IOP. The data and numbers just are overwhelming and it's why monitoring/assistance programs require it. Even if completely changing job fields and leaving nursing and your issue was with something you had access to in the hospital, the odds are overwhelming that substance issue/addiction is switched to another form of addiction and it doesnt even have to be substances. An old saying in recovery...."I am moving from NYC to Chicago and leaving my addiction behind in this dang city"! The problem is.....when you move to Chicago, you take yourself with you. If....again.....If you have an addiction, it does not care that you change career fields. It cleverly can and usually morphs into something else, be it food, gambling, sex, video games, etc. Without IOP, the odds are very, very high.