The Nurse Addict Part 2: Recovery in the face of discipline
This series follows the stories of four nurses dealing with addiction. The following accounts have been provided on agreement of anonymity—therefore names and certain identifying details have been changed to protect their privacy. In case you missed it, here’s part one.
Nurse addicts are often high-functioning—they manage to juggle high levels of addiction while still maintaining the appearance of normalcy in their work and home lives. Add in the stigma of addiction and the fear of losing their job if they were to seek help, and their drug or alcohol abuse can go unchecked for quite some time. Coupled with heightened access to their drug of choice at work, these are the primary factors that keep many nurses trapped in an addiction cycle.
“Diverting 1 or 2 oxycodone tablets a week snowballed quickly for me,” says Sarah*. “Within a month, I found that I needed to take them daily, or I’d start to feel withdrawal symptoms. Every morning, I’d make plans to cut back, and by day’s end, I’d failed. I considered contacting the EAP provided by my hospital, but in the end, I worried that anyone I spoke with would be obligated to break confidentiality.”
Fighting back from the depths of addiction is the challenge of a lifetime on its own. For nurses dealing with addiction, reclaiming their lives comes with another added pressure: facing the Board of Nursing (BON) in order to remain in practice. When James* was terminated from his job for opioid abuse, he was simultaneously reported to the BON, a requirement of most employers.
“Waiting to hear from the Board was the worst week of my life. I knew my license was in jeopardy, so I didn’t dare look for another job. Also, phoning my parents to tell them the mess that I had created was another low. The Board was very business-like about it—seek help—on their terms—or have my license revoked permanently. There was no in-between.”
Alcohol or drugs addiction in the health care community is more prevalent than you might think. Once double the incidence of addiction rates nationwide—but improving in recent years thanks to increased vigilance and tighter controls over opioid distribution—losing this many nurses to addiction is a serious problem for our field.
To help retain nurses, state-specific rehabilitation and recovery programs function as a go-between for addicted nurses and the BON, and aim to provide support and monitoring for these nurses, should they decide to return to work.
However, the process associated with such programs is lengthy, difficult, and fraught with shame. Consequently, many nurses are not able to make it through. For the ones that can, certain stipulations must be met for at least five years, not including the acute recovery phase.
Generally speaking, the first step upon enrollment in a nurse monitoring program involves an evaluation by an addiction specialist. From there, treatment is mandated—often one to several months in-patient at a rehab facility. Nurses must then report to weekly check-in meetings; these provide a source of support, as well as accountability.
Random drug screenings are performed one to two times a week. Following completion of these first steps, an assessment is taken—often a year or two down the road—and it is only at this point that the nurse is allowed back on the job, albeit still under close surveillance.
In the state of Florida, (where our profiled nurses live), there are currently two monitoring programs—the Intervention Project for Nurses (IPN), and the Professionals Resource Network (PRN), which monitors a spectrum of healthcare workers. The nurses featured in this article all went through IPN. Established in the mid-80s and organized specifically for nurses, the mission of IPN is patient-centered, as opposed to nurse-centered.
Many nurses feel that focus while in the program—that their wellbeing is secondary to health organizations—and consequently report that the stipulations are too difficult to achieve. Many drop out. For those that enter into IPN, they can expect to return to independent practice no sooner than five years, on the condition that they strictly adhere to the program and pass a final evaluation.
Carla* almost didn’t make it through her IPN program. “Unfortunately, I popped positive for alcohol on one of my random drug screenings. Even though it was determined to be as a result of cough medicine I had taken, that one positive test knocked me back to another round of rehab, which I thought was entirely unnecessary! This time I was allowed to go out-patient, but still, there was no option to disagree with their decision—it was either go, or be kicked out of the program. This time, I had to take out a loan to cover the expense.”
Indeed, one of the major detractors to enrolling in IPN is cost. Some of the therapies and treatments that the program mandates are covered by insurance—like the rehab portion, for example—but since many nurses are also terminated from employment at the time they enter into such a program, they must pay out-of-pocket.
Currently, in-patient rehab costs thousands of dollars—per day. Such an enormous cost is prohibitive for the newly unemployed. However, this initial acute-phase rehab is non-negotiable, and puts the nurse between a rock and a hard place: they must complete the nurse monitoring program to remain in practice, but cannot work to pay for it. What’s more, depending on the circumstances of their addiction being discovered, legal counsel must also be retained simultaneously, quickly draining any savings.
The steep costs affected Kiandra* profoundly. “Because I chose to forge a prescription and was caught, my recovery process began with drug court. I was lucky that the court agreed to work with IPN—the rehab they required was actually much more intensive than what my sentencing required.
The major downside was how expensive it was. I had to complete 28 days in-patient, and then 6 weeks at an out-patient center. By the time lawyer fees were paid, plus court-costs, plus the rehab itself, I was deeply in debt. I’m grateful I made it through, but even 10 years later, I've barely made a dent paying it all off, even though I’m working again.”
The final piece of the recovery process is finding gainful employment. However, searching for a nursing job while enrolled in a license/recovery program is difficult. Nurses must disclose their active status in the recovery program during the interview process, and if hired, arrange for a designee who will monitor their performance and make weekly reports. They are not allowed to handle controlled substances until a grace period has been completed successfully. These are major restrictions, and can make finding a compliant job extremely difficult.
“Now that I’m on the other side,” says Sarah, “I’m proud of the work it took to get here. Being sober is extremely important to me, and I was really lucky to cross paths with a great support group, some amazing mentors and therapists. I actually started working in addiction medicine as a result of my overall experience! But rooted in the work I’m doing is a desire to help reform monitoring programs. There is a lot of shady conflict-of-interest stuff that goes on with them, and nurses suffer for it.”
Next up, in “The Nurse Addict Part 3: Reclaiming—life, work, and self-worth—after recovery,” we tackle some of the issues Sarah is referring to, plus take a look at what factors increase addiction in the nursing profession to begin with.