Would you tell the BON about brief relapse?

[LilRedRN1973]

I'd like to hear what everyone's opinions are on this matter. I had over 6 years of sobriety and then because I stopped putting my sobriety first, I relapsed briefly. Thankfully, I came to my senses, re-established relationships with God and my sponsor and started back with meetings. I did everything the BON had taught me to do during my 5 year contract with them.

My question is would you tell the BON? Now? When it was time to renew your license? I have discussed this briefly with my sponsor but am wondering what others would do. I know that when it comes time to renew my license in a little less than 2 years, I will be faced with this decision as well since we have to do a short paragraph of why we had been disciplined in the past, a description of our program of recovery, our sobriety date, etc. Obviously, by putting down a different sobriety date, it could potentially be a red flag to the board.

There would be many repercussions to being placed on another 5 year contract. And some of them would be severe and life altering. And yes, I understand relapsing has devastating effects as well, one of which is death. I just want to know when you get right down to it, what would you do?

Thanks!

[Omaapecm, ASN, RN]

great post Maverick!

[BostonFNP, APRN]

Again this really isn't my area of expertise and I honestly do feel for those in recovery and the uphill battle they need to fight.

I also feel the the BON's role is to protect patients, and unfortunately, this may make individual recovering RNs have to jump through more proverbial hoops, but that is the nature of providing the necessary structure to protect patients. At least in theory I suppose.

I remain surprised, at not only the posts encouraging dishonesty, but the rationale being used for it.

Lets for a moment replace "drug abuse" with "child abuse" for a hypothetical:

The permanent black mark on my license for a first, very brief, offense is evidence of what they think of "my kind."

If an individual has a history of a single and brief episode of abusing a child do you think that "mark" should fall off their record so they can go back to work in a school?

You had a relapse, you are not using now. Does having a relapse mean that you shouldn't be able to practice nursing?

If an individual abused a child and didn't get caught does that mean they shouldn't be held accountable for that action if discovered at a later time because they are not currently doing it? Should they be able to keep their job in a school?

[dirtyhippiegirl, BSN, RN]

^What if you replaced child abuse with bipolar disorder?

[Twoyearnurse]

I have to just say this, comparing substance abuse disorder with child abuse is off base. Substance abuse disorders fall on the mental illness spectrum. I will always have substance abuse disorder, I don't get to just wake up well , ever. I have to manage my disease throughout my lifetime, the same as any other person who has a chronic disease- high blood pressure, bipolar disorder, diabetes.

The board of nursing protects the public, absolutely. Agreed! However , they are not a means to an end in managing chronic illness. I am grateful for my board over site- because it gives me a second chance at nursing. Keyword here is nursing- i just started my monitoring in January and spent the year prior in sobriety without their help or over site.

[BostonFNP, APRN]

Absolutely I understand your post about substance abuse being a mental health disorder. I made a bold comparison to simply highlight a point.

But it is also not correct to compare it to hypertension, or depression, or bipolar disorder as none of those illness also involve breaking the law and (for the most part) do not place patients at risk.

I have a number of patients under my care that have polysubstance abuse disorders or alcohol abuse disorders. It has always been my experience that those that are successful in remaining sober are those that take full responsibility for their actions and are active in their recovery no matter how long they have been clean. Unfortunately, I see many others who chronically relapse, and they almost always have an excuse why they did and why it's not their fault or take no responsibility/face no repercussions for it.

Just my two cents, though I am sure it is unpopular.

Sent from my iPhone.

[Twoyearnurse]

Then let's take comparisons completely out of it for accuracy sake.

I also know many people in recovery, and many of them have relapsed. Some fly planes for a living. Some are nurses like me. Some are teachers. We even have a police officer. We have bankers, and emts, taxi drivers, food servers. And many of these have relapsed...yet....most are not and would not be put on a contract.

Most are asked to do rehab, and then that's it. No long term monitoring. And they do relapse, but they are not required to admit this to anyone.

Honestly is a huge part of recovery. But honesty does not mean we have to tell everyone everything all the time. 12 step programs say that to stay sober we are honest with ourselves, another human being, and our higher power. A slip does not indicate a pattern of behavior, until it does.

[Twoyearnurse]

I don't think you are particularly wrong about someone being honest with their board. I do think honesty with some entities requires thorough evaluation before reaching a determination. Otherwise every nurse I have ever known who drank and drove and didn't get caught would also have been under contract.

[Earthmama]

Child abuse? Seriously?

I've refrained from responding because I am torn on my answer. Is honesty necessary in recovery? Absolutely. Is the BON monitoring needed for nurses in active addiction? Of course. Does each slip require a new monitoring contract? I really don't know. That depends on the strength of that individual's program and their recommitment to their sobriety. Is there any way for us to know those variables in this particular arena? Probably not. The only red flag for me is that the OP states she is restricting herself in her exposure to narcotics while working. Does she require monitoring for this? I don't know, I would recommend speaking to your counselor for an added perspective. So as you can see, I have more questions than answers, hence my lack of response. But back to my original question.

Child abuse? Seriously? Come on, man.

You're seriously comparing felony assault on a minor with a relapse? The act of child abuse is in and of itself a reason to forever deny licensure. Child abuse is a criminal act, addiction (as was eloquently stated by a previous poster) is a chronic disease capable of management. Is addiction dangerous if left untreated? Of course. But in NO way is it even on the same page as child abuse. The fact that it was put there is shameful. I won't pretend that I don't have a personal stake in this. I am an addict and this comparison hurts me. This is not, and has never been, who I am. But the protective addiction nurse in me is also hurt, my patients are sick, and yes they often break the law, but they are more than common criminals. Addiction is not a moral failing, it's much, much more complicated than that.

And ps. Addiction does not necessarily involve breaking the law. I treat patients every day who are alcoholics or addicted to prescribed pain meds that are law abiding citizens.

[Mavrick, BSN, RN]

OP has determined that she suffered a RELAPSE not a mere slip. The two months of dishonesty to her self, husband, sponsor, employer and BoN show a lack of true concern for the serious consequences of her actions. It would be an inconvenience to get another job or restart her retirement planning, not a real disaster. Obviously the first warning by the Board did not have the desired effect. Like a previous poster said the Board presumably has the safety of the public as it's rationale for granting a license to patently untrustworthy individuals. We're human and going to be a risky bet in the best of circumstances. Throw in the sneaky dishonesty that comes with addiction and you walk a very slippery slope.

I, of course, have no idea what the life-story behind those who would support not self-reporting a deliberate violation of agreed upon conditions required to maintain a license to practice nursing. Yep, it sure would be an inconvenience.

I'm not giving advice, just sharing how this RN with an addiction continues to work in stressful situations with access to PRN IV medications and not a lot of supervision.

OP is already planning her next relapse because the consequences of this one aren't necessarily devastating.

OP needs help not complicity. That's what makes Tough-Love so ...... tough.

Gotta go, just got called back in to work.

[BostonFNP, APRN]

Child abuse? Seriously?

As I mentioned, I purposely chose something that was overtly exaggerated in order to make a point not to suggest the two are equal.

You're seriously comparing felony assault on a minor with a relapse? The act of child abuse is in and of itself a reason to forever deny licensure. Child abuse is a criminal act, addiction (as was eloquently stated by a previous poster) is a chronic disease capable of management.

Just playing devil's advocate here, but do you think the people that abuse children are suffering from a mental illness? I would argue that they would have to be, and then there is a chronic illness that can be managed. Also what if a relapsing nurse is diverting narcotics from a pediatric patient, isn't that child abuse as well as substance abuse? Does that warrant lifetime license ban? What if it is an adult oncology patient?

Is addiction dangerous if left untreated? Of course. But in NO way is it even on the same page as child abuse. The fact that it was put there is shameful. I won't pretend that I don't have a personal stake in this. I am an addict and this comparison hurts me. This is not, and has never been, who I am. But the protective addiction nurse in me is also hurt, my patients are sick, and yes they often break the law, but they are more than common criminals. Addiction is not a moral failing, it's much, much more complicated than that.

Again, my post was a hypothetical, and one that was chosen to be overtly exaggerated to make a point not to imply that the two are equal. lease don't let my words hurt you, they are there to promote thought not to judge anyone or insult anyone.

And ps. Addiction does not necessarily involve breaking the law. I treat patients every day who are alcoholics or addicted to prescribed pain meds that are law abiding citizens.

As do I. Even diabetics addicted to food. It comes in many forms. The OP case has to do with breaking the law, hence my post about breaking the law.

[CryssieD]

[COLOR=#000000] [/COLOR][COLOR=#000000]Wow—this is still going on? OK, look. You don't call the police every time you exceed the speed limit, or fail to brake completely at a stop sign—do you? No one is perfect, and I wish some of the people with judgmental attitudes would remember that they are neither perfect nurses nor perfect people; I feel quite comfortable with my assumption that all nurses have made mistakes, but they have not reported their lack of complete competence to the BON for Board monitoring of incompetence. Not every human, mistaken moment requires Board intervention. Relapse is part of addiction( just as honest mistakes are part of nursing), unfortunately, and what it requires is assistance from the appropriate persons; many of us who have experienced Board monitoring programs are of the (educated) opinion that these programs are not necessarily the best option in this situation—sadly, they are often more destructive and punitive than actually helpful. OP has expressed understanding of his/her actions, resources, and personal responsibility. No one has advised him/her to just let it go—we are all in agreement that OP needs to learn better management of his/her addiction issues. But posters who assume that an addict who has had a relapse is de facto unsafe to practice clearly do not fully understand substance use and abuse issues; you can use—and, frankly, even abuse--without being so out of control that you are a danger to the public. Those who assume otherwise are not being honest with themselves about nurses who drink or use other substances on their own time (which is another subject entirely) yet have not had any professional problems because of it. I suspect this is an indication of poor understanding; nurses don't necessarily understand addicts any better than the general public, who consider them criminals first and actual people second.[/COLOR]

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[dirtyhippiegirl, BSN, RN]

Throw in the sneaky dishonesty that comes with addiction and you walk a very slippery slope.

Not all addicts are dishonest. You are making a lot of sweeping generalizations about addiction and what it takes to stay sober. Like this:

OP is already planning her next relapse because the consequences of this one aren't necessarily devastating.

Please remember that what it takes to keep YOU sober is not necessarily what it takes to keep another person sober and that your sobriety does not mirror anyone elses' sobriety.