KyBeagle

You’re correct, it does. They did tell me in my first meeting, when I signed the agreement, to notify them when going out of town. Based on my experience with KARE, if I had been out of town & provided a sample, nothing would have come of it. We definitely weren’t prisoners. They understand that things come up daily & a 2 week notification wouldn’t be feasible. Honestly, I think the inclusion is more of a protection for the program. If something came up, couldn’t find a place to test, didn’t get the test, etc., then liability would be on the Participant, not the Program, base on the signed Agreement. However, I DID always notify them, simply based on the trends observed within my HP group. Not selected to test DURING vacations but always a day or 2 upon return, LOL! If there was the slightest chance they were pausing testing during the dates I provided them, I was taking advantage of that. Of course, I still worried about being selected & make alternative plans in case I was. But, thankfully, it never happened.

@solarex This is a great point. I always did this, as well, and I’m glad you thought to mention it. In fact, when my primary collection site built a new facility & moved, I was aware because I was in there regularly. However, I didn’t notice that their address listed on the Affinity site wasn’t updated -UNTIL 6 MONTHS LATER! When I finally caught it, I immediately contacted Affinity to let them know. It took another 2 months for it to be updated. (When I contacted them a 2nd time, they said they were waiting on official verification from the office). So- yeah. Always call & double-check accuracy. You don’t want to find yourself in a pinch if the info is outdated.

In KARE (KY), the agreement stipulates that you must notify your Case Manager 2 weeks prior to travel. It isn’t worded as “permission” & my Case Manager never treated it as such. Per the KARE handbook: “Your Case Manager must be informed of any travel affecting your drug testing obligations (I.e., vacations, etc.) in writing at least two (2) weeks prior to the start of absence from home. You must contact Affinity (via webiste or phone) to obtain information regarding collection sites should you be selected to test while away from home. Regardless of the reason for being away from home, you are still held accountable for meeting all requirements of the random drug screening program, including contacting Affinity on a daily basis”. In KY, you don’t get “vacation days”. You’re expected to check in daily, including weekends & holidays. Case Managers do not “excuse” you from testing during out-of-town trips. However, I was aware of only 1 instance that someone was actually selected to test while on vacation, and this person vacationed frequently. The majority of nurses in my Health Professionals group (including myself) were always “randomly selected” to test within a day or 2 of returning from vacation! So we always notified our Case Manager before travel, speculating that perhaps CMs sometimes DID arrange vacation-free testing, if a participant was compliant, but did not want us to be aware (to avoid vacation relapses). Regardless,when making travel plans, after booking a hotel, I would always check the Affinity app & find the testing sites closest to my hotel. I usually scoped everything out a few days or week before traveling, making sure I found sites that best suited my travel plans, in case I was selected. If traveling outside the US, going on a cruise, etc., KARE CMs look at these on a case-by-case basis. If you’re compliant in the program, you don’t have to wait 5 years for your dream vacation. I’ve known several nurses that had trips abroad approved & were just subject to additional testing upon return. So, definitely a few extra hoops to jump through, but vacationing is certainly possible. I took a couple each year. When planning your itinerary, just remember to include a some flexibility in the mornings, in case you’re selected to test.

My program (KARE) used Affinity for testing. Payment for the UDS was through them. People do things differently. Some pay their account at the time of testing. I was worried something big could financially hurt me (BESIDES TESTING) & I would not have the $$ someday. So whenever I received my tax refund each year, I always deposited about $600-$800 into my Affinity Account so I wouldn’t stress about finances. When balance would start dropping as the year progressed, I’d start adding $100-$150 here & there. The clinic I used for testing wasn’t through Labcorp so I had to pay the $15 - $20 collection fee at the time I was tested.

I “graduated” a couple years ago from KY’s KARE program. I had saved a copy of my Affinity result log & pulled it up to answer your question. (By “result log”, I just mean the dates of the tests & the vague “positive” or “negative” result). As far as testing frequency- it varied. First year, I had a total of 24 tests at exactly 2 per month. Program Year totals: 2 (23 tests); 3 (18 tests); 4 (19 tests); and 5 (20 tests). In years 2-5, I usually tested 2x/month but sometimes once per month. The final 6 months of the program I had a couple of months with testing 3x/month. The frequency was random- I had 40 days between tests- and also had 5 days between tests. I only had one blood test. The rest were urine. No hair tests. The price for the majority of UDS’s was $41.50 (plus a collection site fee of $15-$20, depending on where I went ). I would also have about 4/year @ $65. (I’m guessing the $65.00 also tested etg). It was very obvious that the frequency increased the final 6 months of my 5th year. I had just gone about 4 months in a row with 20-35 days between tests & my bank account was SO appreciating the rest ? - then… BAM! I had a spell of something like 6 tests in 7 weeks, with only 5-7 days between a few of them! When I asked my CM, she said it was very common for Affinity to increase the frequency towards the end of the program to ensure compliance. My checking account did not like being woken up from it’s nap! ? ??

While at home sick today, I came across your post again from a year ago. And literally almost DIED. ☠️The laughter caused a coughing fit so intense that I couldn’t get under control until I took a Duoneb treatment. (Okay, maybe I didn’t almost actually die, but it sure felt like the Duoneb was lifesaving)! I can’t believe that I had forgotten about your post. Just curious if the Infection Preventionist is still in her position at “CBG”? I think I remember you saying in another post that the Health Dept was already well aware of her crazy beliefs, because they had heard from other people. And I’d LOVE to know… with the additional protective measures that weren’t available a year ago… is it now safe for VACCINATED nurses to talk on the phone????️☎️ ?

I’m not a CRNA but I’m an RN. I was in the program 2014-2019 & VERY compliant. I think was striving to become their poster child. I asked a couple of times if the 5 year “sentence” could be reduced- that answer is a hard “NO”! As I progressed through the 5 years, I had my contract updated to reflect that I was allowed to administer controlled meds w/o visual supervision & work in a supervisory/managerial role. But these happened at the timeframes that’s usually stipulated in the KARE contract, after showing continuous compliance. They weren’t things I negotiated independently.

I’m simply curious to know how this story ends! I feel like I’ve been watching a movie on TV & the cable went out right before the end! Did HR get back with you? Did you work Saturday?

That’s fantastic! I wish more programs provided leads for potential employment opportunities.

When I entered my state’s 5 year diversion program several years ago, I applied & was hired into a Case Management/your position. Initially, after thanking my lucky stars for getting a job, I had planned for it to be short-term until my narcotic stipulation was removed in 12 months. However, I loved the job & found it intellectually challenging without the fatigue of 12-13hrs running circles in the ED. 7 years later, I’m still in the same role just expanded to a lead/charge type position. I would’ve never switched from ED to this type of nursing position had I not been forced to leave ED. Although I wish I had made better choices 7 years ago, I’m grateful that the situation lead me to this job. I love it!

Congratulations! Now you can breath again!

791750 is a urine drug test specific for Kratom (Mitragynine). The code is actually listed on Labcorp’s website which is unusual. For most panels, Affinity had created CPT codes that are different than what is listed on Labcorp or Quest’s websites (to keep participants from knowing what’s being tested). I don’t think Kratom is something they routinely check unless they either have a suspicion of it being used or if it was your DOC before entering IPN. For example: When I was in my state’s ATD program, I knew that Ambien wasn’t something that they routinely checked - but they could. There was a nurse in my Healthcare Professionals group that “randomly” got picked for a special “O” panel test every month that rest of us never got. However, since one of her DOC was Ambien, we suspected that’s what that panel was. When I was almost out of the program (2019), someone mentioned how trends had changed, giving an example that buprenorprine used to only be included on a few select panels, but was now being added to the majority of the routine panels. For 5 years, I simply assumed that every banned medication was on every panel. From Dilaudid (my DOC) to Benadryl. I was afraid that if I EVER rationalized taking a Benadryl or any other banned OTC med without a doctor’s note, it would guarantee that I’d be tested for that particular med the next day, LOL!

@Stainahb @RNforthecause I'm thankful to see 2 nurses who didn't NEED a disciplinary or ATD program escape this punishment. Too many times I've come across stories like both yours on this forum, and seen nurses trapped into 3-5 year contracts that they didn't deserve. Mainly, though, I just want to thank you both for giving updates. I used to be on this forum quite often, back when I was in my state's 5 year ATD program (which I DID deserve). It can be SO frustrating to come across posts where the OP asked a question but never returned to give an update. In this circumstance, not just ONE but BOTH of you returned a year later with updates on your individual situations. That's wonderful! Just letting you know that's very much appreciated! I'm sorry that you got a public reprimand @RNforthecause but I'm glad you're both otherwise unscathed. Best Wishes!

In 2019, I completed the 5 year KARE program (KY). They utilize LabCorp (Affinity). I never had a Hair test & only one blood test in 5 years. Otherwise, it was urines 1-2 times/month (3X/month once). Urine tests were usually $41.50. Three - four times per year I would have a $65.00 urine test (I’m guessing these included etg). Tests were paid directly via the Affinity app. Collection site fees were $10 at Labcorp sites. However, the closest Labcorp was about 45 miles away from me. Thus, my specimen collections were always done at a nearby occupational therapy (OT) office. Collection site fee were paid directly to them each visit. Fees were $20.00 for a “Dry room” collection or $45 if observed (had 2 observed in 5 years). The one blood test (PEth) that I had was $120 or $130 for the test (can’t recall exactly) & $20 for the collection site fee. Since I never had a hair test, I don’t know what KY’s actual hair tests cost but heard they were expensive. The collection site fee for hair at the OT clinic that I utilized would have been $40. In 5 years with KY’s program through Affinity, I had a total of 104 urines, 1 blood test, & no hair tests. I had to check in 7 days/week. I couldn’t see a pattern to the “randomness”. Sometimes I was picked after a holiday & sometimes not. I was never picked on a holiday or weekend (although, in the past year or so, I’ve read on this site that one nurse in the KARE program was picked on several Saturdays in the last 2 months that she was in the program). I was never picked out-of-state when on vacation although I knew a nurse that was. I guess that I could see a difference in the frequency. In both the first AND last 12 months of the program, I had 2 tests/month (with 3 times in one month about 3-4 months before finishing). The middle 3 years I would have 4-5 months each year with only 1 test (2X the other months). With the exception of no weekend selections, I still never saw any type of a pattern with the randomness.

I think these are excellent tips. Although, I have never actually seen these all written down together, I pretty much followed all of these in my 5 years in KARE & successfully completed my program. I agree with 8 all tips (well, mostly). My only disagreement is the statement regarding the first year. OK, I know that there are historically “peak times” for relapse & 1 or 2 fall within the first year. However, I will say that my first year was the best. I was new to the program, sober, and did NOT want to lose my license. Being reported to the BON was MY “rock bottom”. That first year, I was equivalent to an “A+ Student”, dotting every I & crossing every t. There was NO WAY that I wanted to be discharged. Unencumbered license was my goal & within sight (well... 5 years away, but still doable). I did continue to follow these tips in the years 2-4. However, I wasn’t as tense or paranoid. Daily Affinity check-ins & random UDS became the norm in my life- routine. I knew what I could & could not eat. With weekly meetings I improved my coping skills, rarely having cravings but handling them in a healthy way if I did. Okay- I definitely agree with you on the last year. I STILL followed these tips & continued my sobriety. The first 6 months of the 5th year was status quo. The the last 6 months- OMG! Yes, I felt restless! I was irritated by the daily check-ins and the monthly paperwork that I had to send in. I was just TIRED of it! I had NEVER resented the KARE program until the final 6 months. Prior to that I had always felt grateful for it- allowing me to keep my license & remaining confidential. But, WHEW! The day I completed, I felt a 100lbs were lifted from my shoulders. I have continued my sobriety (graduated 1 year ago). No, I was never compelled to use opioids during that 5th year. I just was chafing to return to a “normal life” that didn’t involve panicking every time we were on vacation or out of town, praying that I wouldn’t get chosen for a UDS (inconvenience). Basically, I did what @StarlaBanks says to do- I put my head down & powered through. And FINISHED! Anyway- I’ve completed the program & happier today than I was most days before the KARE program. Those 5 years gave me time to figure out other, healthier coping mechanisms for my life, other than just retreating to oblivion with narcotics. I’m much happier now.

@Questions2020 Kentucky’s Alternative to Discipline program (KARE) is a standard 5 year program. Unlike the Disciplinary route, it remains confidential. I completed the program in 2019 & have an unencumbered license with no disciplinary actions.

I have moderately controlled asthma & work in a busy ED. At the moment, approximately 40% of our admissions are COVID +. I’m in contact with R/O COVID & COVID patients every shift that I work and wear the appropriate PPE. I’ve not had any issues the past 8 months of COVID season. In fact, I’ve actually had LESS symptoms with my Asthma this year than the past 10-15 years. I attribute this to not being triggered by allergens or chemicals that may trigger wheezing (think- hospital cleaning supplies) since I’m wearing a mask so often. Hppy- I laughed OUT LOUD at your reply. I’ve both read & interacted on this site for several years now. And this was the FIRST time that actually read something aloud to my husband... who ALSO laughed & agreed with you. Yes- the health & well-being of BOTH my husband & myself are much safer with me working in a COVID unit than staying at home. Both of us working outside the home is what’s probably helped us achieve a strong, 24 year marriage, LOL!

This^^ I agree 100%.

This is heartbreaking for me to read - yet I’ve read enough discouraging stories on here to know that this is all to common. I was an a 5yr ATD program because I needed to be. I never had any issues about being in one because I knew that’s exactly where I needed to be. In fact, I was very grateful to the KY BON for a second chance. I had actually known NOTHING about their ATD program for addiction until I screwed up, threatened my own license, & desperately needed the program. I was fortunate to have the same Case Manager for the entire 5 years. If I had the same experience as @Bravo-rn47 during my first year, I have no idea what the repercussions would have been (besides me likely having a meltdown from anxiety). However, in my 2nd - 5th year, I really don’t believe I would have even been given a 6 month extension. By then, I had an excellent rapport with my CM, she knew I always emailed with questions/concerns. I DO believe that I would have probably seen an increase in testing, as I would still have to PROVE that missing a test was legit. However, I don’t believe I would have faced such a drastic consequence as Bravo. I know that this may vary state-by-state & also by Case Manager. And I completely believe Bravo when he/she was told how “lucky” he/she was to only get a 6 month extension! I’ve seen stories by nurses would would have been discharged from the program after missing a test. For me- someone who benefited from KY’s program & successfully “graduated”, it’s heartbreaking to hear about someone that’s playing by all the rules, yet is penalized for an occurrence out of their control (even with detailed receipts & subsequent negative testing). Hang in there, Bravo. Even though it can absolutely suck at times, the grass is still greener after you’ve completed! And there’s always lots of support on this site! KyBeagle

I just want to share a word of caution. If your nursing license is actually revoked, you have a much higher likelihood of being placed on the OIG’s exclusionary database. If that happens, a certificate in another healthcare related field would be worthless. You wouldn’t be able to work in any facility that accepts reimbursement from Medicare or any state Medicaid programs- In any capacity. Even if you left the clinical aspect of healthcare, you wouldn’t be able to work in any job field (administrative assistant, secretary or even housekeeping), much less any with a certification, in a facility that accepts federal payments. That will knock out any hospitals, skilled care facilities, home health, clinics, MD offices, etc. I was in an ATD program but in a different state (KY). The threat of the OIG alone was enough to ensure that I followed every aspect of my 5 year program to the letter. After working in the nursing field for > 20+ years, I was to the point that healthcare seemed to be all that I knew. I had shopped around for a different job in the few months leading up to signing my agreement. During this time I realized that the alternative jobs that I felt that I qualified for, were still in healthcare-related fields. If you’re new to nursing & have interests in other fields outside healthcare, you may have more options than I felt that I did. However, as an ATD Program graduate that’s back working FT in nursing, I’m very grateful that I stuck it out. Yes, it was very costly & definitely anxiety-ridden, for sure! But I’m back to the pay grade that I should be earning with my years of Nsg experience in hospital nursing.

Thankfully, I am safe! I wear a mask when talking on my cell phone, gloves when surfing the internet, & a tin foil hat... ? ?⛑️

@hppygr8ful I’m pretty sure that Spanked finished just a few months after I did. His reply on this thread is from December 2017.

There were several nurses enrolled in my Healthcare Professional group that claimed their Affinity expenses as medical deductions on their taxes. I was probably the only one that didn’t. Instead, I enrolled in the medical Flex Spending Account (FSA) offered by my employer. Throughout the year I saved all my invoices/receipts related to SUD treatment (counseling, specimen collection fees) & printed Affinity’s online invoices. Around mid-October each year, I would submit everything to my FSA plan for reimbursement. One week later I would receive a nice fat check to use for Christmas shopping! Although it was technically my (tax free) money, it didn’t seem like it. Instead, it felt like someone was handing me a generous $2400 Christmas bonus. More importantly as expensive as life was during those 5 years (tests, tests, tests), it ensured that I had money available before Christmas (my main goal). Anyway, just wanted to throw out another option for anyone interested. Sorry! I don’t have any information regarding claiming this as a tax deduction (as a business expense). I would only be guessing!

Deep Breaths! I'm sorry you have such a rough time. You’re describing what I always feared in the KARE program. I missed 3 check-ins spread over a 5 year period (which my CM was gracious about) but I never missed a test. I do remember talking to the KARE program coordinator back in 2014 when I first signed my KARE contract & asking about what happens if the inevitable happens (missed test beyond my control). She gave me a weather related example- such as if I missed because weather conditions were too dangerous to drive, keep copies of weather reports for proof & notify my assigned CM immediately via email. In your case, do your have tow truck documentation? If so, keep it as proof & send to your CM. Have you had any issues before? Missed monthly paperwork? Many missed check-ins? Any positive tests? With my past KARE experience, the more compliant you are over the course of the program, the more understanding your CM will be. I had a great relationship with mine & I frequently communicated with her (always getting clarifications to my questions, etc). I’ve heard horror stories on here from other states (especially Florida) but my experience in KY was awesome. IF you can’t get there, email your CM immediately tonight & hold onto your tow truck receipt if you have one. I really don’t know how they’ll react- but approach your CM BEFORE s/he contacts you. And WOW!! 5 tests in 3 weeks! That’s a LOT! PLEASE update us with what happens!! Sending you best wishes from KY!

CONGRATS! You’re almost there! The finish line is just up ahead! ?‍♀️With over six years behind you, that finish line is now within sight. YOU CAN DO IT! This is a little long, but I remember back in October 2019 - I was hungry to read anyone’s end of program experiences. YES, YES, YES! What you’re feeling is COMPLETELY normal! I was in my program for 5 years (5 years & 1 day to be exact). I spent the first 4 1/2 years feeling overall appreciative. I needed to be in the program, my actions put me right there, I GREATLY benefited, & I was so thankful to keep my license. I was fortunate to get a nursing job & work for almost the entire time. Then at 4 yrs 7 months, I started feeling anxious. Imagining ALL the “what ifs”. Incidental etg, accidental missed test, etc. That led to sleepless nights, fatigue,. At around, 4 yrs 9 months...time started CRAWLING! It was the first time that I REALLY TRULY began feeling resentful. Sure, I’d felt inconvenienced many times over the first 4 1/2 years (e.g. the headache of coordinating out-of-town travel, morning diet changes to prevent dilution, etc.) but knowing it was the consequences of MY actions, I hadn’t truly felt resentment until those last 3 months. It’s kind of comparable to high schoolers with “Senioritis” (just much worse, IMO). Almost to the end of the journey- but not there yet. Desperately wanting to just MOVE ON! Looking back to those final 3 months, my irritability & increased anxiety derived from this- The EXCITEMENT of accomplishing a challenging, expensive, long-term program that required 110% long-term dedication & commitment - at war with the FEAR that something would go wrong at the very, very end- derailing my career with the welfare of my family at stake. We’ve ALL heard the horror stories! At the time, those seem to resonate more than all the personal success stories I’d read on here (smh)! Also, I was in my program for just 1 extra day. Since my 5 year anniversary fell on a Sunday, I couldn’t be discharged until Monday. (The CM or program coordinator actually has to log into Affinity & click a button to unenroll you). That last 24 hours was the looooongest for me. I didn’t sleep a wink until 5am, when I could check-in to see if I’d been selected for testing. (I wasn’t, whew)! So yeah- I was a little (lot) anxious & irritable at the end! More so than at any point in my journey to achieving & maintaining sobriety. However, I found great support in this forum. Whether just reading about the similar experiences by others who went on to successfully complete their programs- or directly posting my fears & getting supportive feedback from the wonderful cheerleaders in this forum, I managed to keep my sanity! @New mommy 26 Just keep doing what you’ve already been doing for 6+ years. That’s the very best advice I can give. I had actually shared some of my feelings with my CM (I was lucky to have a really good one for the entire 5 years). She’s the one that gave me that common sense advice. She only cautioned that I remain diligent & not become “lax” at the end. She had witnessed premature celebrations in our state’s program - to the downfall of the nurse. Don’t celebrate too soon with a Robitussin DM for your cough or a poppy seed bagel for breakfast! NOT until you've received a discharge confirmation from your program & you’re unable to log into your Availity/Spectrum App (or Recovery Trek, etc). Availity will have a message that says “Please Activate Account”. Lemme tell you- it was a GREAT feeling to see that message! Again, I had checked-in at 5am that morning. When my CM emailed me the discharge documents around 1pm, I tried Availity again & no longer had an active account. My anxiety/irritability completely vanished. That stifling weight that had been on my shoulders immediately dissipated. I’m surprised I didn’t literally float up in the air, LOL! Take a breath- you WILL get there! RELAX! Just keep doing what you’ve been doing. After 6 years you’re a PRO— you’ve GOT this! And in 30 days (give or take 10 days) we’ll all be here to congratulate you! ?