NursingLink

How a Seemingly Innocuous Act Can Lead to Loss Of License

Here is a snapshot from the life of 4 nurse practitioners (NPs):
NP A was going through a tough time--taking care of an ailing parent, worrying about a son out of a job, suffering from a sports injury, and working at a disorganized hospital. Her physician was not available, so she wrote herself a prescription for 4 pills for a controlled substance to get her through an especially bad week. A pharmacist reported her to the board of nursing. She is under investigation.
NP B was going through a divorce. He had dinner and 2 glasses of wine with a friend. Later, he stopped by the hospital, where he had a moonlighting job. He was not working that night, but wanted to finish some charting. A nurse smelled alcohol on his breath and reported him to the board of nursing. He immediately arranged a drug and alcohol evaluation. The evaluator's conclusion was that he was not an alcoholic but was depressed. The board offered him its rehabilitation program as an alternative to discipline. He entered the program, under which he consented to monthly visits with the rehabilitation committee, random urine testing at his own expense, and counseling. On the way to the lab for urine testing, he had an auto accident and missed the 30-minute time frame for the test. Things went downhill from there, and he lost his license to practice.
NP C became addicted to 2 controlled substances for which she had prescriptions. An employer reported her to the board of nursing, and she entered the rehabilitation program. Well into the year-long program, a urine screen came back positive, and the board suspended her license. She says she did not relapse and that some old pills must have been mixed in with some over-the-counter analgesic in her medicine cabinet, but the board would not listen to any explanation.
NP D worked in a clinic where she regularly prescribed controlled substances for back pain. Her husband developed back pain, and she prescribed him some of the medication she commonly prescribed at the clinic. A pharmacist reported her to the board of nursing and notified her employer that she was prescribing controlled substances for her husband. The employer fired her and the board is investigating her.
I learned about these NPs because they came to me seeking an attorney. However, there is very little an attorney can do when a case is handled by a board's rehabilitation program. Rehabilitation programs are voluntary and afford the nurse an opportunity to avoid the disciplinary process (where an attorney can be very helpful) and to keep working while undergoing recovery. Here is how the Oregon Board of Nursing describes its rehabilitation program: "The Nurse Monitoring Program (NMP) is a confidential program that offers nurses suffering from alcoholism, drug addiction, mental health disorders, or physical disabilities an opportunity to seek treatment and perform monitored nursing duties without disciplinary action by the Oregon State Board of Nursing (OSBN). The OSBN believes alcoholism and drug addiction are primary, progressive, and chronic diseases, and that the resulting problems, as well as problems stemming from mental health disorders or physical disabilities, may impair a nurse's ability to practice nursing safely. The OSBN's primary concern is the health and safety of the public."
Reading this, an NP may think such a program is a safe haven. It is not. Note the last sentence in the paragraph above. The board's duty is to protect the public, not to help the nurse. I cannot say how the Oregon Board conducts its meetings with program members, but I can tell NPs in Maryland not to expect meetings with the rehabilitation committee to be warm and fuzzy. If a nurse is addicted and relapses and then reports his or her relapse to the board, in some states, the board still may allow the nurse to continue to practice. But if a urine screen comes back positive and the nurse has not previously reported a relapse, there is little the nurse can do or say to retain his or her license. Furthermore, if the committee does not like how the nurse acts at the meeting, or the nurse is late for a test or a meeting, the nurse's license is in jeopardy.
I am not criticizing the boards here. I am glad someone is overseeing nurses who have been identified or who have identified themselves as having substance abuse problems. My goal here is to warn NPs that, once they are reported, they will be going down a very treacherous path. Avoid that path.
Consider the NP who was not addicted, just had 2 glasses of wine on an evening when he had no patient care responsibilities. That simple act led to a year-long period of his life when he could ill afford mistakes or bad luck. When he did suffer some bad luck, his explanation did not sit well with the rehabilitation committee. The story goes on. He was injured in the accident, and his physician put him on a controlled substance, which, of course, showed up on the urine screens. The committee knew of his injury and of the necessity for the prescription, but every month, the NP went through an inquisition about how many pills he had taken and whether he really still needed them. The committee members were skeptical. The stress on the NP was unbearable.
Here are the take-home messages:
Do not drink alcohol if there is any chance you will need to go near a health care facility that day.

Do not drink and drive.

Never prescribe controlled substances for yourself.

Never prescribe controlled substances for a relative.

If you are in a rehabilitation program, dispose of all controlled substances in your house.

If you are in a rehabilitation program and relapse, tell the committee rather than let them find out for themselves

---