Our Guest: Carol Mallia RN, MSN, Associate Director – Division of Nursing, Massachusetts Nurses Association
This podcast gives an overview of the recovery program process for licensed healthcare professionals in the state of Massachusetts, and more specifically the support the Massachusetts Nurses Association offers. It is state number three in my series on recovery programs.
Transcript:
Welcome back, everybody, to Diversion Insights. Our sponsor today is IMI. IMI is an American medical device manufacturer specializing in devices that enhance the safety of medication from the pharmacy to the patient. Creating products for the compounding pharmacist is their sole focus, and as a result, their customers experience the quality, service, and value only a specialized partner can offer. My guest today is Carol Mallia. She is a nurse and the associate director of the Massachusetts Nurse Association. Many of you that follow my podcast know that I want to do a series on all the different states and the programs that they offer. So today we’re going to get insight into Massachusetts. The Massachusetts Nurses Association, or MNA, is the largest union and professional association of registered nurses and health professionals in the state of Massachusetts.
Terri
And as a professional association, they offer help to those suffering from substance use disorders and many other things, I’m sure. And so I want to welcome to the podcast, Carol, and thank you very much for being here.
Carol
Thank you for the opportunity to talk about such an important issue affecting nurses. It often goes untold. So I’m really grateful for the opportunity to unpack the issues of substance use in the workplace and how to best address those issues with nurse colleagues. So thank you again for the opportunity.
Terri
Absolutely looking forward to our conversation here. So the Massachusetts Board of Nursing has a program called the Substance Addiction Recovery Program, which we’ll refer to as Sarp, or maybe you call it Sarp. I’m not sure. Okay, so moving forward, listeners, if you hear that’s what we’re talking about. But the MNA, the Massachusetts Nursing Association, is different. So let’s start by delineating those two, if you would, for us, Carol.
Carol
Yes, thank you. So, as you mentioned, the board has a program and both programs, both the MNA Peer Assistance Program, which I’m responsible for, and the Board of Nursing, which is completely separate and run through the licensing board, were both originated in the was back when it was thought that, gee, we need an alternative to discipline and that this is a disease of addiction. So they were really ahead of the game, really, in Massachusetts to start out with a program. But thankfully, the people who were involved with the inception of the Start program thought that we could use a program right here at the Nurses Association for nurses to have a free, confidential program that’s not connected to their license. The fear was that many nurses would never pick up a phone and call the licensing board.
Carol
And so they were smart enough to set up really two separate entities. The licensing board has now a three year license leveraged program that is involved with getting a nurse from complaint all the way through closure towards the recovery and then back reentry into practice. But Evan A had the foresight to think, well, we should have just another support layer. On top of whether a nurse goes to Sarp or doesn’t go to Sarp, they need a venue where they can call the number and receive free, confidential, peer led support. So it’s purely a peer supported program where we have about 25 nurse volunteers that are in recovery that then field the phone call.
Carol
So I play the conduit, I take the phone call and thank you so much for calling, you’re doing the right thing and taking care of yourself and have that intro conversation. And then I move that call over to someone who’s in recovery themselves and they take it from there. And they may go to support groups, meetings with them. They may just be a sounding board for what they are doing in their recovery journey. So it’s meant to be another layer. Or if someone does not have a complaint against their license and they choose to seek help privately, they can use our services as a layer towards getting them the information and guiding them towards recovery. The whole goal of both programs really, is to move the nurse from a setting where there could be potentially impaired practice to a point of recovery and reentry.
Carol
So sort of the goals are the same, but the mission is quite different in terms of the licensing board has the responsibility of doing all the drug testing, et cetera. Ours is purely peer support for nurses who want an extra layer of support and want to hear from a nurse who’s struggled with this themselves and could really value some insight as to how to best approach this. That’s how it originated back in the ours has pretty much stayed consistent. Their program has made a number of changes throughout the years, but they both serve a very vital important role in terms of getting nurses towards their recovery goal.
Terri
Okay, so the MNA is a program of support, not of recovery. So what is your role, or do you have any in the actual recovery process when somebody reaches out for help?
Carol
Yeah, so when a nurse is calling out, sometimes we’re the first call because a lot of our calls come from our bargaining units. We represent 80 of the 85 hospitals, 23,000 members throughout Massachusetts, mostly in the hospital setting. But some in home care and school nursing. So when that first call comes in, it’s often before that has ever even they don’t even know what Sarp is at that point. You might have been identified with a problem at work. The labor rep calls me and says, I think I have one of your customers coming your way. And I say, Customer, but they don’t pay it’s free, but I have one of your clients coming your way. And then I usually get the call, and they may even be in HR at that moment many times, so that I do a number of classes on it.
Carol
And there’s so many different ways that nurses enter this situation, whether they’ve self identify or whether it’s identified at work. Once it’s identified at work, oftentimes there’s impaired practice and they will likely be reported to the board. The Massachusetts has a mandatory reporting regulation which says if you have direct knowledge and observation of a nurse who’s impaired at work and or diverting substances, that’s a mandatory reporting mechanism. So the hospitals will report it, and pharmacy honestly has a reporting mechanism as well. They’re accountable for the drugs. So if there are missing controlled substances, they were going to be reported either way in those situations.
Carol
Sometimes that first call comes in from a nurse who’s actually in HR, sitting there with HR, they might have their union rep and their manager in HR, and they’re all trying to figure out how to best navigate this nurse towards recovery. So oftentimes we can come in at that point and provide someone who’s been through the Sarp program. I have a number of graduates from the program that are great at sort of talking them down, and like, here’s what the program is going to involve. It’s going to be difficult, but you can do this. And really, it’s basically cheerleading folks through the process, because when a nurse is discovered with a substance use problem, their life is devastated. Oftentimes their job was really their last holdout of normalcy in their life.
Carol
Their relationships are strained, finances are strained, and so they’re really in a bad place, and they go to work for a sense of normalcy in their life and control. And then when that’s in jeopardy, that’s when it really becomes difficult. As I mentioned, I do classes for anywhere. Anywhere two or more are gathered. I will talk, believe me, it’s my gift. And I do talk to a lot of management groups, and I say, you really need to know how fragile that nurse is in front of you. I know you’re upset that this has gone on and how did this happen and you didn’t see it. And all of those things are kind of playing on your mind. But in front of you right at that very moment, you have a raw and fragile nurse who’s very much at risk of self harm.
Carol
So you have to put that in perspective. And one of the very important things I teach labor reps and managers is that you have to have a plan for safely securing this nurse into a safe environment, because sometimes they’re going home to a spouse who also drinks and drugs more than they should. So that’s not ideal and or there’s a risk for suicide and self harm. So I sadly can say that in the 24 years I’ve been doing this, there have been a couple of suicides, and it has always been that Friday. Pull them in and say, all right, we’ll talk about it on Monday, and then they’re not there on Monday. So this is an issue that needs to be skillfully addressed at the bedside or at the hospital setting, work setting.
Carol
There needs to be a plan as to how to safely care for them, take them off the assignment discreetly, get them some help. And one of the things I always say is kind of work with the nurse as to how to safely get them off the floor, because people are going to see that schedule. They’re just off the schedule, they just disappear. I call it the abduction theory. So you need to have a better plan for how you plan to address it. And one of the lines I teach, say, you know, ask them if it would be okay to say this on their know, say, Carol was under a lot of stress. She’s going to take some time off to take care of herself. Would you mind me saying that to them?
Carol
Because when I was a manager, I would is people are going to care about you. They’re going to worry about you. What would you like me to say on your behalf? So having a good plan for that, I think, is key. And just keep the first meeting, especially if they’re impaired at the site, keep it very focused on behaviors. I care about you. These are the behaviors I see, and we want to get you some help. So that should really be the focus. Don’t get into three months ago, you gave morphine and there was eight missing. What do you think happened to it? They can’t go there. They’re not even thinking. As soon as you accuse someone, their whole world comes crushing down. So they really need time to process.
Carol
So if you take it from I care about you perspective, you will meet the nurse in a very healthy way. And that this is a problem that affects a good 8% to 10% of our population in healthcare. We’re not immune to this disease, so why not address it in a kind and caring manner to get them where they need to do, where they have to be? There will be accountability and there will be tough things they’re going to have to do to get their license back, and we all know that. But at the very raw moment that they come to identify this problem, there has to be a high degree of sensitivity and understanding because nurses are truly beating themselves up enough with the guilt and shame anymore put on them.
Terri
Right, yeah. No, you said a few. There are some good points in there, and that is one, when there is an intervention, then that should be the phone call to you. Oftentimes it’s like, well, who do you have them call? And it’s key that your HR people or whoever’s usually leading those interventions knows how to get them plugged in. And so it sounds like with a union hospital, typically a union rep would be notified or present. And so then that’s who you educate to make sure that they know to make that call. But the other thing, too, that yes, is something and I don’t think I’ve ever addressed it in any of my podcasts or even presentations, and that is how do you explain the disappearance?
Carol
Yeah.
Terri
And so I think that is something that I’m glad you brought that up. That’s something that needs to be thought about because, yeah, they may not know what happened, but they’re going to know.
Carol
That the River Mill is going to happen either way. So it’s sort of controlling the narrative is what I call it. And it’s funny, I got a slide with an alien because it truly is an abduction.
Terri
Where’d it go?
Carol
Nobody is supposed to tell, and nobody’s allowed to talk about it. And that just fosters shame and guilt. And so we need to cut through this. And I think giving a script and a narrative to folks to say, would it be okay if I shared this on your behalf? Because there will be people worried about you. That just takes it right off there. My experience has been most say, yes, go ahead and do that, because they too, don’t know what to do. They don’t know, like, if someone calls them, should they say? Or what should they share? So there’s a lot of things we can do better at the initial intervention meeting.
Carol
And also, if someone is impaired at the moment, this is not the time to bring out the multi page spreadsheet and the wonderful graphics of how you’re the highest user, blah, blah. No, goal of step one is to get them home and safe and then schedule the meeting when they’re of clearer mind to go through, because they’re already impaired at this. If you think they’re impaired right now at work, that’s not the priority. The priority is to get them home safe. The second day of the second meeting is where you bring out the spreadsheet and say, okay, here’s what we saw. Carol, you’re off the charts on several areas. Can you explain any of this? I’m concerned. And if there is someone who’s staunchly denying it’s funny, after doing this for so many years, I see sort of two poles.
Carol
There’s the, oh, my word, I can’t believe I did this, and the remorseful acceptance of help. And then I see the no way, I’m the best nurse ever. And that’s their initial denial. And I usually tell the reps, like, just give it 24 hours, give her my number, then I’ll reach out to her if she’ll give me yours, and then we’ll give it 24 hours. Because sometimes that hard shell gets chipped away when they get home. They’re like, you need to take this opportunity to get well. They know they’ve been struggling. And sometimes it’s just that initial guard. So I think that upsets many managers when they see this, because they’ve worked so hard. They spend 48 hours figuring out the spreadsheet and getting all at least. So it was a lot of work. I’m not denying that.
Carol
And so they really wanted admission, and you might not get it. You might not get it right off the bat, but you might get acceptance to accepting help after the fact. So just keep the faith that if you do right, and give them the opportunity to feel like this is a safe place, that, yes, there will be challenges to their license, and, yes, that usually means loss of that particular position initially, but with good work and towards recovery, they will likely get back into their profession again. So I think that’s what you have to sort of support all the way along.
Terri
Yeah, and that’s true. The message is answer to your question. Yeah, no, that’s good. And I have seen that many times, too, is that they take them through that interview process and explain to them. And actually, ironically, it’s not so much the manager is like, I’m sure that they’re doing something. It’s that, no, they’re just a good nurse that has practice issues, and they’re like, we’re putting them back to work now. I’ve seen the data, and I don’t think so. And 24 hours later, they get a phone call, I need help. And it’s like, yes, okay, good. So they had time to they were able to deny it and deny it, but then they realized, now is my chance.
Carol
You touched upon a good point, though. There is the false identifying.
Terri
Absolutely.
Carol
There’s many factors in which a nurse can end up higher on the usage, and experienced nurses versus an all brand new team, right? We’ve had a lot of turnover in nursing. So if you have an old guard who’s been there and understands she’s going to take the more complex patients, she’s going to give those patients because she’s had life experience through all those, seen those types of surgeries, she’s going to medicate on a more generous nature than somebody who’s new, who’s only going to medicate when the call light goes on. So she’s going to anticipate, all right, you just had big belly surgery, and I need to get you up and moving, so I’m going to medicate you ahead of time. And so an experienced nurse has that dialogue. So they always end up on the higher end.
Carol
If you have someone with kids in college, they’re going to be working a lot of overtime. So when they come around and say, hey, could you stay to eleven? You’re like, yes, a tuition bill comes next week, so people who work a lot of overtime are going to be on the higher end. There’s just some nurses who take a certain patient population. We’ve seen that. So they worked in oncology years ago, and so when that oncology, patient ends up in the cardiac unit with some AFib or whatever, they’re drawn to that type of patient. So of course they’re going to end up more than a regular tele person. The telebration doesn’t really get any narcotics or controlled substances. So right off the bat they’re going to look like outliers because of their experience base.
Carol
So we have had false identification and I will say the computer systems that are evaluating are doing a little bit better job at monitoring trends over time. But there is those. Occasionally you get an outlier on a specific drug. It’s kind of a crazy story, but we had a nurse who she came up high on Demerol, and right off the bat I’m like, it isn’t diversion. They wouldn’t divert demerol. They just wouldn’t. I didn’t even know they even gave that anymore. It turned out she was on the highest user of this kind of unusual drug to give now. And it was because she could work with that older doctor who that’s what he ordered, and so he was a little bit difficult to work with and she managed to be able to take care of those patients.
Carol
So she ended up higher in that one category, yet she was low on everything else. So it was things like that. You can tell, but I agree with what you’re saying. Sometimes you look at the data labor rep will bring in like, oh my gosh, she’s the best nurse ever. She’s got the award for this and that, and I’m like, awesome. Yeah, but she signed out a narcotic, like right after 03:00, like 305. I don’t know about you, but I’m taking my coat off, I got my drink, I’m getting report. I am not in the med room at 305. I’m a go getter too, but I’m not in the med room at 305. So something’s up there. If you evaluate that a little bit more and unpack that there’s more going on.
Terri
Yeah, it is definitely a big picture. There are so many things that need to be looked at. The more difficult ones for me, I think, are the ones that really do like really? Is your practice that bad? You’re not doing the assessments like you should. You have delays in administrations. You’re keeping your waste until the end because you say you can’t find. And then they come in and they’re like, oh my gosh, this is horrible. I didn’t realize that you know what I mean?
Carol
And it’s just like, yeah, today’s staffing is deplorable. I’m not going to lie. I’m not even going to try to sugarcoat young. I teach a tele course, a telemetry course. And I had young nurses come in and say, carol, I start my day figuring out where I can cut my loss because I can’t possibly do what I’m assigned to do in an eight hour day. Like, that’s just never going to happen. Some post ops not getting out of bed, some blood is going to have to be like the vital signs are going to have to be delegated to a good aid. They just can’t be physically with the types of assignments they’re giving. And it’s chronic now. It used to be episodic. They’d have a bad day and oh, my gosh, call out would tip them over the edge.
Carol
No, it’s pretty much every day the nurses are dealing with chronic short staffing and so we are seeing more laxing practice because it’s survival mode. They can’t go running back and forth. So, yeah, they are holding on to the waste longer than they should and then there is no one to waste, I’m sad to say, because practice is definitely being impaired. Practice, nursing practice is being affected. We do a course now on addressing an unsafe staffing assignment. And you couldn’t have sold that program ten years ago. We’d have ten people in attendance now that is booked to capacity and we are booking multiple sessions every year. And nurses are coming with the most horrific stories that they are spread so thin then they’re floated to parts unknown with minimal orientation and competency.
Carol
So it’s any wonder that we are seeing some bad slipping in practice. And I do a program. Part of my program I do is for some facilities. This is what they want and need. I do what I call the Scared Straight, kind of tell them, like, no matter what, you have to document this or you’re going to end up on the highest user or you’re going to end up the words, hey, can you grab me tenamorphine? Those words alone could put your colleague’s license in jeopardy because they pull it on your patient and then it goes missing in action. Now she handed in, I got busy, I forgot. Those are the words that we try to get nurses. Like if you pull it, you administer it.
Terri
No handoffs. It’s not safe for them.
Carol
Be clear about your waste, document everything you give and make sure it all adds up at the end of the shift. So I call it my scared Straight. Actually, it was a phrase coined by one of the CEOs who said, carol, if I really laid down the gauntlet here, I’d have everybody in trouble because they were pulling Tylenol and stuff for themselves and just bad practices, just not good, like, you know, better. And so she said, I just want you to come in and sort of set the standard of care and then we’ll take it from there.
Carol
And I said, I agree because if it isn’t on the forefront of your brain, you’re so busy that it slips to report that we’re at a point now where I think COVID they ran so short staffed in COVID, they laid off like or Pacquiao, all those people, and they didn’t hire them back. And so now we’re in desperate need. There’s not a shortage of nurses. There’s a shortage of nurses who are willing to work in those conditions is really what the issue is now. Sad.
Terri
Yeah. Well, and I guess for relatively new nurses too, it’s probably worse because they’re not getting the benefit of the years that maybe were a little bit better, that they could focus on their dotting process.
Carol
I think it’s sad. I call it like the slow demise of the profession because they didn’t learn the best practice standards. They came in, especially the young ones. Now they’re coming in. They finished school during COVID so they didn’t get the clinical hours at the bedside. A lot of it was simulated, and that’s good. I’ve worked at SIM Lab. It’s excellent content, but it’s nothing the same as running an assignment. So I worry about our profession. I do for many reasons, but staffing is one of them, for sure.
Terri
Right, okay. So your program is no charge.
Carol
It’s free.
Terri
Do they have to belong to are they employed at a facility that is union or do you let non union?
Carol
We accept all nurses in Massachusetts and even student nurses in Massachusetts. Students kind of have a different concern in that they are a different set of resources, I should say. Not really a concern. They often work through their wellness centers on the campuses, but they are now drug tested prior to clinicals. Most clinical settings are requiring that, like a pre employment physical would include drug testing. They will do drug testing for the students prior to going to clinical. So sometimes that can identify somebody who’s struggling. So there are resources there. So we add another layer. It’s a great invite to them, to the profession of nursing. This needs to get resolved. You will have issues getting a license and maintaining that license if this stable recovery is not maintained.
Terri
So, bottom line, any nurse or soon to be nurse in Massachusetts can reach out to your organization for help if they have an issue and they need some help.
Carol
And I do field phone calls from managers, and sometimes family members will reach out because they’re just desperate. They don’t know what to do with their loved one who’s struggling, and they don’t want to call the licensing board, but they hear about us. And so I field a lot of those phone calls and just sort of giving them some help to words to say, kind of encouraging them that these problems don’t stay small in nursing. They grow like any other profession, the disease of addiction will grow if you do not address it. So we kind of encourage them to give them to tell their loved one to call us. We’ll hook them up with a peer assistant, and our peer assistants are awesome. They are nurses in recovery most five or more years, 2030 years sobriety.
Carol
And so they have a lot of wisdom behind them, and many of them work in the field of addiction so they can explain to them kind of what they could expect if they go into treatment. So they’re a great resource. And if the nurse little preliminary conversation gives me enough information, I will try to match them with a peer that has a similar substance issue, like if theirs was alcohol, I will match them with somebody who had similar problems. If I think it’s going towards Sarp, then yes, I will give them somebody who’s a Sarp graduate.
Terri
Okay, and do you help them find a recovery program?
Carol
A lot of times they’ll ask, like, where can so there are programs in Massachusetts that are focused on first responders and include nurses in that first responders. And those are usually good sites for them. A lot of it is governed by what’s on the back of their insurance card. Unfortunately, if they have insurance, then that’s where I have them start. Call that number in the back. These are some sites that would be great. Or they’ll call me back and say, call me back once you hear from them. And a lot of them don’t want to seek treatment in their own neighborhood because especially if they’re an Er nurse, they’ve worked with all those patients. They got them into those facilities, and now to be next to them in a group, that’s a little awkward for them.
Carol
It’s very difficult for nurses to be forthright in a group setting like that because a lot of people think nurses should be above this, and they, in their own community can get shamed and guilted into. I trusted you. I was a patient in your unit, and I didn’t know you had a problem, too. Kind of like, well, yeah, I’m human too.
Terri
Right.
Carol
It’s rough. It’s hard for the nurse to get good confidential treatment. It’s not easy.
Terri
Okay. How does it work with if you have a nurse who does belong to one of your facilities with your union group, they have come to you. They haven’t gone through the licensing board or anything. They’ve been able to take care of it anonymously, gone through recovery. They are either trying to work through that recovery, like stay employed through the recovery, or maybe they took some time off and now they’re coming back. But you know about them because they’re part of your union, and now they’re going back to work.
Carol
How do you usually if it’s individually addressed, that’s a very rare setting that we get people to self identify. Typically, it comes through. HR, maybe tap, and then they come in. But we have had on rare occasions, we’ve had a nurse say Carol, especially after COVID. We had a lot of nurses calling that was saying, it used to be a glass of wine. Now it’s like half a bottle to a bottle, I can’t stop. And they were coping with PTSD, so a lot of times getting them referred to PTSD and that sort of we set up a self help kind of section on our website around COVID, just helping the nurses process through. But as far as the reason, it’s confidential, so I only know really their first name, and that’s all I want to know. Due to mandatory reporting.
Carol
And I think the hospitals, when they’re involved, that’s a game changer. Once the hospital is involved, yes. Then they do have to address a.
Terri
Good that’s a good point. Mandatory reporting. If somebody calls and says, Hi, I’m so and so, and I have you’re like, don’t tell me.
Carol
And I just said oh, OK. Jill, I’m only okay.
Terri
All right. So do you get referrals from Sarp as well, or once?
Carol
Not very often. Most Sarp, once they go into the Sarp program, they have their own milieu of how they want their individuals treated. And we have had in years past, a good working relationship. So occasionally the Sarp coordinator would give us a call and say, hey, you might hear from so and give me a first name, and then I’ll take it from there. More often, they learn about it in the community we used to in Massachusetts. And this is one of the sad changes that occurred over the years with Sarp. When I first took over in my current position, we had 25 very active support groups for nurses all around the state. So they were group facilitated, they were endorsed by the Sarp group.
Carol
And these nurses were required as part of their Sarp contract, to attend one of the professional peer support groups meeting weekly all the way through their program. And so that meant that we had 25 great groups that I could refer. And you didn’t have to be in Sarp to be in these peer led sort of support weekly support groups like an A or NA, but just for health professionals. So it meant that if I did get that call, I’m drinking more than I should, I could send them there. And there was no fear that they would be then reported to the board, so it would still be treated confidentially well in 2016. And there was probably personalities involved in this. I don’t know the real reason, because when we asked, we didn’t get a very robust answer.
Carol
The Board of Nursing decided to cancel that as a requirement, cancel peer support as a requirement for a five year license leverage program. They dropped it to three years. They removed that. They changed several things in the procedures that then just made it more like a parole and monitoring type system. So, unfortunately, you know, they still require peer support, but it’s NA or AA. And as I mentioned earlier, it’s very difficult for a nurse to show up in an NA meeting with the patients they just took care of that had to commit grand theft auto and prostitute to get their drugs. And a nurse walks in who just went to work to get a whole different lifestyle, very different milieu. And not to say their addiction is any different. No, because it’s not.
Carol
But it’s hard, nurse, to come forth with what their true issues are. So they attend the meetings, but I’m not sure how much they’re able to gain out of that. So I do refer now I refer nurses to there’s a support group of the trade unions, and there’s a woman who leads that one out of the teensters, and so she does a great job. So I’ve referred a number of nurses there because it’s mostly women, and I think then they have that camaraderie. So if I have a female nurse calling and looking for some sort another layer of support, I’ve used that mechanism as well. So it’s difficult. But, yeah, the process I would love to see more referrals, but it’s just they get entrenched in their own ways, and they have their system. They have protocol. Not often that comes that way.
Terri
Okay, all right, well, your program sounds wonderful. Do you have any experiences, stories you can share with us about somebody that came through your program and how it impacted them?
Carol
Yeah, I think there’s a couple that come to mind, and I think going back to that fear of addressing the problem, I think when we had our preliminary conversation, I remember sharing a story about I had a colleague who I totally valued. She was a great nurse, fantastic practitioner, and, you know, one of those stellar nurses that you go to, like your go to nurse that you would say, oh, my gosh, can you come look at this patient? I don’t know. I’m over my head here. And she would sort it out with you, and she was so good. And then I just started to see a few practice things happen, and I’m like, that’s not her. And a little disheveled appearance. And she had bruises on her arm.
Carol
And so I was, at that point, a charge nurse, and I pulled her over into a private room, and I said, Gee, I’m worried about you. Are you okay now? I was totally going down the path of domestic situation. She had a new boyfriend, and these bruises showed up kind of suspiciously on the back of her arm. And so I was thinking domestic situation, not even thinking impaired practice at all. And she quickly had a quick rebuttal for it. And I went out on maternity leave, and my colleague called me and said, you will not believe it. This nurse. I always use the name Jill, so apologies in advance to anybody Jill, because I don’t know a nurse named Jill, so I keep using her. But Jill was found to have a problem with diversion, and she was pretty extreme at that point.
Carol
And so my paths go by. She had called the Pier Line, got connected. Her life story ends beautifully. We reconnect at a conference one time, and she says, you know, when you pulled me into a room and she knew the number, she knew the date, she knew everything. I’m like yes. She said, I so wish I had accepted the help, because I felt like you would have done it a little more gracefully. As it was, she was terminated. They let her work all day. She was terminated at 04:00 on a Friday. She lost her apartment, living out of her car, lost all connection with relationships. She finally went into the SAR program. She did amazingly well, landed on her feet, got her license back, decided, I’m not going back to that bedside. Went into another industry, case management industry, and is happy, well adjusted.
Carol
And I guess what I learned from that example is I was young and silly, and I should have seen the signs way easier than I should have been thinking of that, and I just didn’t, because right in front of me was this amazing nurse that I had worked with for years. So, of course, I didn’t think of substance use as that problem. So those are some of the good stories we see. We’ve had other young nurses really struggling. We had a young nurse, and I never forget, because it was a Friday, and she was crying on the other end, I could hear the labor up. It’s like, Carol, I don’t know what to do. Like, this is really serious, and I don’t want to live anymore. I can’t live like this. I can’t tell. Maybe I’m so embarrassed.
Carol
And when she said, I don’t want to live like this, I’m like, okay, she can’t go home. You need to get her to the emergency room. She needs a psych evaluation. We need to get her placed. And so we did, and she did very well and connected with one of our peers who had been through the SAR program. And yeah, it was a rough ride for her. Yeah, it’s tough. The SAR Program is a licensed leverage program with daily call ins for randomized drug testing, which average about twelve to 15 a year. They put practice restrictions right off the bat. So you’re not working as a nurse for at least a year, and then you appeal to get your license back.
Carol
So she did all that, and she was young, and so this was so important to her to be able to maintain her license. So she did amazingly well, and with the use of a peer that just sort of said, you can do this. You can do this, it’s hard, and yes, you will succeed. And just believing in somebody and being there that says, I did this, I was just with you, okay? I did this ten years ago, and this is what it took, and you were able to do it. So that’s really where it succeeds. It’s great to hear those stories come full fruition, and then they like to come back as peers, so they come back as a peer assistant, and then they help the next.
Carol
So it’s a way to give back to the profession that gave to them when they were struggling.
Terri
Yeah, no, I think that’s great, and I think that’s so critical because to be commiserating and encouraged by somebody who has been there, done that, as opposed to somebody who just is compassionate and it’s like, no, you can do this. I mean, that’s a very different thing.
Carol
They get what it’s like to hold that medication in your hand the first time they get it. They get what it’s like when you’re tired and you’re rotating shifts and you have a lot of your own pain. One of the sad things I learned answering that phone line for 24 years is that nursing is a profession at risk for personal injury. So my first intro is hi, Carol. It started with a knee or a back or shoulder injury that just didn’t get better, and they had to self medicate. And then that starts a vicious cycle of using prescription opiates. So we’ve seen that all too often, unfortunately.
Terri
Yeah. So we need to do better protecting them from that. Yeah. All right, well, thank you. This was a lot of great information, especially for those in Massachusetts. So if you’re in Massachusetts and you haven’t heard of this program, pass the Word, because it really meets a need for all of these people.
Carol
It’s easily found on www.peerassistance.com. And we have a little video, we have a guidebook there, we have resources, and you have access to me. So if you have questions or I welcome calls from all over the country.
Terri
Fantastic.
Carol
I wish our line was busy ringing off the phone. Not that I want to feel luck, but I wish that people felt more confident to call.
Terri
Yeah, well, it is getting the word out. And just to your point of when you confronted that nurse that you had worked with for years, I mean, don’t beat yourself up. You attempted to do something because you recognized something changed. But I’m going to guess at that time, you probably didn’t have a lot of knowledge about substance use disorders and then the diversion that comes from it. Exactly. And I think that is one message that we need to get out there, is don’t be paranoid about it and look at everybody through that lens, but we all need to be aware of it. So if something odd is happening that might be, we have to consider that.
Carol
Our guidebook addresses that, like, what to do. If you just think something’s not right but you’re not sure it has anything, you just say, I’m concerned about you. This is what I’m seeing. If it has anything to do with substance use, here’s an FMLA form. Get out, get help. Keep this problem small so that it doesn’t ever impact healthcare. The challenge right now is everyone’s so busy on the units that kind of conversation is less now because you literally just come in and you’re in a silo trying to get your you don’t notice anything. You’re noticing anything. You’re not working as a team anymore. And managers are not on the floor as much. They’re spread thin as well, and every time they come to the floor, they’re going to hear about the staffing. So it’s not pleasant for them either.
Carol
So we’re in a bad shape nursing, unfortunately, right now. My hope is that the next generation will take us to better places in nursing because it’s tough right now. Thank you so much for the opportunity.
Terri
Thank you. Thank you very much for your time. And I want to thank our sponsor. You can learn more about Imi@imiweb.com, where you can see their complete line of innovative tamper evident products, including their industry leading line of tamper evident caps, which have become an industry standard for guarding drug delivery containers such as IV oral and Nfit syringes, IV bags and medication cassettes. Thank you all for listening, and thank you, Carol, again for joining me today.
Carol
Wonderful. Thank you.
