Indiana Nursing Focus Article
Submitted by Indiana Professionals Recovery Program
July 29, 2018
David Cummins, MD, FASAM
Medical Director - IPRP
Fellow – American Society of Addiction Medicine
Board Certified, Addiction Medicine
Indiana Professionals Recovery Program (IPRP)
As many of you already know the state of Indiana recently awarded the contract for the impaired nurses monitoring program to a new vendor. This alternative-to-discipline and monitoring program for impaired nurses will now operate under a new name; the Indiana Professionals Recovery Program, or IPRP. Recognizing the fact that any large-scale change and fear of the unknown can be quite unsettling I wanted to take this opportunity to introduce you to our program.
The state of Indiana, including the Board of Nursing and the Professional Licensing Agency, are forward thinking and progressive when it comes to the treatment of impaired nurses. While most states have some type of program in place for nurses suffering with addiction, there is little uniformity across the nation in the way that the problem is handled. Some states are very punitive and focus on punishing nurses with addiction, others have no formal program in place at all. Many states fall somewhere in between. In Indiana nurses are fortunate to have a pathway that allows for maintenance of licensure and reentry into the nursing workforce if successful recovery from addiction is achieved. Commonly referred to as “alternative to discipline programs,” these pathways typically require professional addiction treatment, complete abstinence from mind or mood-altering substances, ongoing drug and alcohol testing, attending self-help and nursing support meetings and sometimes long-term therapy or counseling. These programs are set up through a binding contract with a monitoring program, like IPRP in Indiana, and as long as the terms of the contract are followed and successful recovery is achieved the nurse is allowed to reenter the workforce and maintain licensure. Often times disciplinary actions and legal charges are deferred (and perhaps dropped) when terms of the alternative-to-discipline contract are met.
Scope of the Problem
It is not new information to those of you reading this journal that the opioid problem in America has reached epidemic levels. Some recent statistics suggest that a person dies from an overdose every seven minutes in our country and overdose deaths are now the number one cause of preventable deaths. What might surprise you however is how prevalent this problem has become in healthcare. Conservative estimates are that 10% of the general population suffers with addiction, or what is now formally referred to as Substance Use Disorder. Most addiction professionals think this number is low and the real numbers are probably closer to 15%. With roughly 150,000 nurses currently licensed in the state of Indiana that puts conservative estimates at 15,000 addicted nurses in the workforce today. As of this writing there are only about 500 nurses in the monitoring program in Indiana, so you can see why law enforcement, licensing agencies and patients are nervous. We in the medical community, and society as a whole, have not even come close to getting a handle on the disease of addiction yet, but there is good evidence that the momentum is shifting and this is probably due to an overall increased awareness.
In future articles in this nursing journal our team from IPRP plans to discuss things like the brain-disease model of addiction, the risks of having impaired healthcare professionals in the workforce, how substance use disorder is treated and why treating the impaired nurse is better than firing him/her. Suffice it to say that addiction is a very complicated brain disease, a downright nasty disease that leads to a litany of problems that include poor self-care, undesirable and often illegal behavior, work problems, relationship issues, health complications and even premature death. To manage this disease requires working on a variety of biologic, psychologic and social problems in the person’s life with the hopes of establishing an entirely new way of living. It is tempting to think, and still accepted in some circles, that addiction is merely a moral failing or a collection of a bad behaviors. This couldn’t be further from the truth and over time we are slowly changing the tone of the conversation, not only in the medical community but in our society as a whole.
Our program at IPRP is built around the belief that addiction is a disease, it can be treated and nurses who remain sober can still be of great value to their patients. Accepting that addiction is a difficult disease to treat and many people are not exactly sure what to do, we have built our monitoring program around the basic philosophy outlined below.
Nurses deserve a chance at treatment and recovery. For one reason or another nurses often fall into a grey area in the professional world when it comes to how their drug and alcohol problems are managed. Some states are very focused on punishment and impaired nurses are dealt with very firmly, often ending their careers without chance to recover and become sober. Others are much more lenient and allow nurses to reenter the workforce multiple times without proper treatment and overlook many relapses and worsening of their disease. Still others have no formal state program in place at all. Our nurses in Indiana deserve a well thought out, robust and supportive recovery environment in which to try to achieve sobriety before they are removed from the nursing workforce forever. They deserve the best shot possible at recovery, like the chance many other addicted professionals get.
Pilots, for instance, have a very robust and wonderfully thought out monitoring program through the FAA that provides pilots with extensive substance use treatment, access to mental health treatment and medical professionals, support from other addicted pilots, long-term testing and extensive safety measures put in place to ensure their passengers are safe when they return to the cockpit. Most states, including Indiana, have very similar long-term treatment and monitoring programs for their addicted physicians that are very successful. Tight monitoring programs like these achieve 5-year sobriety rates sometimes higher than 90%, which is unheard of anywhere else in the addiction field. The reasons for this type of success are many but it essentially comes down to getting proper treatment in the beginning and very close monitoring and support for many years to follow.
I would argue that nurses are every bit as important as pilots and doctors and deserve the same chance at recovery when they become addicted. The risk to public health might even be greater with an addicted nurse at the bedside than an addicted pilot in the cockpit. Consider how awfully tragic and devastating a plane crash would be, ending the lives of perhaps 150 people at once. Very clearly this would be horrible. But the average nurse working at a relatively busy hospital touches the lives of multiple planes full of people every month. An impaired nurse who is making medication errors, exposing patients to diseases with dirty needles, neglecting appropriate patient care or stealing patients much needed pain medications poses risk to thousands of patients over the course of a year. I pray that we never see another plane crash, especially due to the actions of an impaired pilot. But I really believe we face a much more significant public health threat from addicted nurses.
For the reasons noted above we have modeled our impaired nurses program at IPRP after these other highly successful professional monitoring programs. The most notable feature of our program is that there will be a greater focus on appropriate treatment up front. Put simply, many more nurses will be sent to formal drug/alcohol treatment centers. The treatment will be done at approved facilities that are licensed and accredited and where current best practice guidelines are followed. The treatment facilities must also have oversight by a physician with specialty training in addiction. Nurses in the IPRP program will also have continued interaction with an Addiction Physician or Addiction Psychiatrist throughout their monitoring contract.
Initial assessments, interventions and referrals to treatment will be done by the team at IPRP. This is also a change from previous practice and only done in a few other states. This allows for consistency in the evaluation process and prevents shopping around for evaluators to obtain a more favorable assessment. Every case will be reviewed by multiple Addiction Counselors and the Addiction Physician on the IPRP team. We will then interface directly with the treating facility to ensure there is good treatment taking place and that the impaired nurse is being given the absolutely best environment in which to recover.
Drug testing has been expanded to offer more testing centers so that there are no interruptions. In many cases we will now be able to permit international travel to our nurses while under monitoring contract because of the many testing sites our affiliate has in other countries. Also expanded testing modalities such as hair, nails and blood will be used to allow nurses to prove their sobriety for the longer periods of time that these tests can demonstrate. Thorough drug testing is not only useful to detect nurses who continue to abuse drugs but is also the tool to prove that nurses have been successfully abstaining for long periods of time and working a good recovery program.
Monitoring contracts will be longer, now an average of three to five years. With rare exceptions, the shortest monitoring contract will be three years and in cases of severe addiction a five-year contract will be used. This is a model similar to the very successful physician monitoring program in Indiana and much like the pilot recovery model enforced by the FAA. Each year of monitored sobriety that passes raises the likelihood of long term success. The “sweet spot” in the industry for successful programs seems to be five year contracts and this is the model we will use.
Finally, we will utilize a number of other tried and tested modalities to help our nurses recover from their addiction including self-help or 12-step meetings, nursing support meetings, individual therapy and organized/supervised plans on how the nurse transitions back into the workforce. We will work hand in hand with the Board of Nursing, Professional Licensing Agency, Attorney General and law enforcement to coordinate a seamless, multiagency coalition to combat this horrible disease that plagues our nation and our healthcare workforce. We believe all of these things will lead to higher success rates, more sober nurses and safer patient care in the state of Indiana.
The IPRP Team
All of the Clinical Case Managers at IPRP are educated to the Master’s Degree level and have experience in the field of addiction. All are currently licensed or eligible to sit for licensure in Addiction Counseling. They have a variety of work experience and backgrounds that include addiction treatment facilities, outpatient counseling centers and prison system drug treatment programs. Team members have specialty training and experience in areas such as anger management, anxiety treatment, PTSD and Employee Assistance Programs. The team is led by a Program Director who has a PhD, addiction licensure and a decades long career in addiction treatment in many different arenas. Finally, the team is overseen by a physician Medical Director with specialty training and board certification in Addiction Medicine.
Please take the opportunity to visit our website at www.InPRP.org to familiarize yourself with our mission, program, the team and our process.
Michael Barrera, MS
Clinical Case Manager
Abigail Rosa, MS
Clinical Case Manager
Brittany Sholtis, MS
Clinical Case Manager
Tracy Traut, MS
Clinical Case Manager
Terry Harman, PhD
David Cummins, MD
If you or a nurse you know is suffering from addiction please reach out to us immediately. Even if you are not sure and just have some questions, please email or call us. We can talk to you about your situation confidentially and without obligation. If you voluntarily self-report to our program before you are caught at work and get in trouble with your employer, the Licensing Board or law enforcement you have the greatest chance of a successful and completely confidential recovery process. In many cases we can facilitate a phone interview the same day, an in-office assessment the following day and have a plan for treatment in place almost immediately.
If you are already in professional trouble due to substance abuse and/or addiction you too should contact us right away. Coming to IPRP and beginning treatment before you are mandated to do so is preferable and will get you on the road to recovery and return to safe practice much more quickly. Although you lose some of your confidentiality when you are mandated to report to us by law enforcement and licensing agencies, you still benefit from all other aspects of the robust recovery and monitoring program IPRP has in place.
If you are a treatment provider or facility that would like to be included on the list of approved providers please contact our Program Director Dr Terry Harman at firstname.lastname@example.org. We are looking to expand our network of approved providers to include treatment at the Residential, Partial Hospitalization, Intensive Outpatient and Aftercare levels. Addiction Physicians and Addiction Psychiatrists are also welcome and needed, please contact us.