Our Guest: Deborah Koivula, RN, BSN, CARN, Outreach Coordinator Statewide Peer Assistance for Nurses New York
Learn about New York’s peer assistance program for nurses. They are a great resource, maybe an even better resource than those in NY realize. It is worth listening too, even for those in other states, to get an idea of what their program offers to support facilities throughout their state. We touch on medication assisted therapy and considerations around that. Join Deborah and me for a good discussion.
Transcript:
Terri
Welcome back, listeners. Our sponsor today is IMI. IMI offers a comprehensive line of products to increase pharmacy efficiency and safety. All IMI products are manufactured in the United States in their FDA registered ISO certified facility under the strictest quality standards. Check them out. I’m sure they will be at ASHP. My guest us today is Deborah Koivula. Deborah is the outreach coordinator for the statewide Peer Assistance for Nurses program in New York. It’s also known as SPAN, so you’ll probably hear us refer to it as SPAN. This is the next podcast in the series of podcasts to cover the various states. And so today it is New York’s turn. Now, Deborah welcome.
Deborah
Thank you.
Terri
Based on the name Peer Assistance for Nurses, I think we can probably assume it is just for nurses. Is that correct?
Deborah
It is. We’re a peer assistance program for I think, you know, based on the needs that we see within the profession, we have expanded it to include nursing students. So we do welcome students into the program as well.
Terri
That’s excellent. Yeah. If they recognize early on that they’re struggling with something, then it’s good to get them in and try to get them help before that becomes more of an issue. What is the mission of the program overall?
Deborah
So our mission is really to be the resource around substance use and substance related issues for nurses in New York State. And then we are kind of duly focused in that we support nurses, but we are also charged with protecting public safety as well. So by helping nurses to sometimes step away from practice and pursue their recovery treatment, we’re helping to protect public safety as well. So we’re kind of duly focused that way.
Terri
Yeah, absolutely. All right, can you give us an overview of how does somebody get connected to your program? Is it always come through someone being reported or can they get in there anonymously or how does that work?
Deborah
So we’re so lucky. In New York State, we have a confidential program that is based on a self referral process. So if a nurse is seeking support, they can come to us confidentially. Outside of a report that’s maybe going to the Board of Nursing or to the Office of Professional Discipline, there’s an opportunity for nurses to come forward individually and seek assistance on their own. And with that said, oftentimes the nurses that come to our program, although they are self referred, they are being guided perhaps by a colleague or by a mentor in the community, possibly an administrator, an HR person, someone that is involved in their employment. Sometimes it’s a family member. So we will speak with and guide any referral source. Sometimes it’s a treatment provider who’s referring them to our program.
Deborah
But the idea is that the program is set up confidentially so that the nurses can come to us without fear of automatic reporting to the Office of Professional Discipline or other entities around substance related issues.
Terri
Okay, so if they come to you anonymously, you are not obligated to report them to the licensing.
Deborah
Correct? That’s correct, Terri. We’re not obligated to report based on the issues that the nurse is dealing with. There may be a need to report to the board, but we encourage the nurse to self report. And in New York State, we are so lucky to have an alternative to discipline program where if the nurse meets criteria for alternative to discipline options, they are able to maintain that program and admit to that program confidentially as well. So if there is concern around imminent danger, obviously as licensed nurses ourselves, we always have concern about reporting, but our program is set up so that the nurse can come forward for help and assistance.
Deborah
And that’s one of the reasons we encourage early intervention, whether that’s early self intervention or intervention from an employer, from another entity, we want to try to avoid discipline or impact on the license when it’s possible.
Terri
Sure, that makes sense. So give us an overview of your program. What do you provide at what time, I guess, in that treatment recovery process? Do they usually get engaged with you? What do you provide for them?
Deborah
The majority of our clients that are coming into the program right now are cases that are related to diversion and opiates specifically. That’s what we’re seeing right now. And so oftentimes the referrals are coming from an employer, they’re coming from HR, they’re coming from some type of employee support. And the place of referral can vary from case to case. But the nurses are usually referred from their employer. They’re reaching out to us individually. And then what we can do in those moments are quite a bit of things in regards to the intervention. We can provide some support at that time of intervention and then we serve as a support and resource for connecting the nurse to treatment, if that’s necessary. And oftentimes that’s the case.
Deborah
And then what I like to say about our program is that the heart and soul of our program are the support groups that we offer because we’re peer assistance and peer support based. We have a network of support groups that exist throughout the state and they’re broken down regionally that are managed by six regional coordinators throughout our state program. And by coming into our program and agreeing to participate, the nurse has access to those confidential support groups, which become a really critical space for the nurse to explore issues around their recovery that they will address in treatment.
Deborah
But have kind of a unique space in the nursing realm to talk about how their recovery how their substance use impacted or continues to impact possibly their nursing practice, how their recovery impacts their nursing practice, the needs that they’re going to need if and when they do return to practice. So we give the nurses in New York State a very confidential and unique space to explore those issues with other nurses who have been through similar issues and have had success with the process.
Terri
And is this a program where even after recovery, 510 years down the line, they can stay engaged in and still have those discussions and meet with those groups?
Deborah
It is. We like to say that we’re a resource not just for the crisis, but for the career. And so we encourage nurses to continue to stay involved with SPANand to consider the ways that they’re involved in SPANas their recovery grows, as their career grows and their return to work process continues. So we have different ways that nurses can participate. For example, our groups are run by nurses, and oftentimes those nurses are nurses who are in recovery themselves and looking to give back and to support other nurses. And so there are opportunities to get involved in different ways, and we encourage that.
Terri
Okay. Yeah, I saw on your website you have some looks like maybe once a month, I think there’s the one in November is or was I’m not sure if it’s past mindfulness training and I think how you deal with stress and that kind of stuff. So I saw that type offering.
Deborah
Wellness sessions as well. We offer some wellness sessions that are focused on mindfulness focused on other areas like meditation, things that really augment recovery and self care wellness in general. But they’re available to any nurse who wants to log in and join those sessions, which is nice to the general nursing public. You don’t necessarily have to be an active participant in SPANto benefit from those wellness sessions. Sometimes they’re educationally focused on other related topics, so they vary.
Terri
That’s good to know that resource is out there. For if I were advising somebody in New York with their program, and if they had a suspicion of a particular nurse only for diversion, would it be safe to say that SPAN’s phone number would be the only resource that they would need to remember? If they had a nurse that they suspected, start with SPAN, and then SPAN would get them connected in whatever way they needed to be connected.
Deborah
I think that I wouldn’t say it’s the only resource, I think depending on the situation, but we as the resource can link to other resources as necessary. If there were concerns around aversion definitely refer the nurse to SPAN. And I say there is no harm. And SPAN should always and can always be involved in some way, whether it’s for immediate support, whether it’s for education, or to assist with a referral to another. Yes, you know, the SPAN program is definitely a comprehensive resource in New York state, and we work sometimes collaboratively with other states as well where our borders kind of cross and we have nurses from other states like Connecticut or Massachusetts, new Jersey, those areas.
Terri
Okay, all right, well, that’s interesting. Yeah. So it doesn’t just have to be. Is there a charge for your peer support services?
Deborah
That’s another nice feature and something that I’m so proud of for our program is that there’s no fee for service at the time of need. We are very fortunate that there was legislation set up early in the program for us to receive funding through the state licensing fees. And so that’s what supports our program and allows us to be so comprehensive across the state and to provide such broad services in regards to the peer support, the group access, and the educational, the free educational offerings and support that we offer the community.
Terri
That’s really nice. Yeah. I’m not sure that’s the case in all states for some of these peer support groups. So that’s fantastic. Do I recall your do you have some affiliation with the union, the nurses union?
Deborah
We are administered through the New York State Nurses Association and they do function as a union. We serve all nurses in New York State, though, and so although we are administered through the NYSNA program, are available to all nurses in New York State, and we do try to educate around that. So regardless of union membership or union activity, we are available to any individual nurse or to any facility, and we function confidentially around that as well. So it’s a nice service that really promotes the well being of all New York State nurses regardless of membership.
Terri
Okay. So most likely, hopefully a facility that is union, those union representatives would know definitely to call you, whereas the ones that aren’t union may not be aware of it. And that’s where the education piece to get the word out comes in.
Deborah
Yeah. Okay. That’s the focus of ours. Yes. To make sure that all nursing and administration are aware of that. And so we do partner with the community to make sure that they know how to access us. We work with nonunion hospitals just as well, and they know to contact us directly through their administration. But you’re right, if a facility is union, whether it’s our union or any number of other unions, union reps are informed and aware of the SPAN program.
Terri
Okay. All right. Do you know, you may not well be aware of this, but once someone graduates in New York because I know different states handle it differently. In New York, if somebody graduates from a treatment program and they were reported to their licensing board, does that stay on their license forever? Or is it wiped clean once they’ve gotten the all clear through the recovery program?
Deborah
Well, in New York State, a report to the Office of Professional Discipline is not necessarily public record for the public to see on the licensing website. What becomes public is if there is discipline executed on the license. So if discipline is executed, then that does become public record, but making a report does not. There’s investigation that goes on kind of behind the scenes and a report to the Board of Nursing if they need to consider or look at disciplinary action.
Terri
Okay. Yeah. You had mentioned there’s a nondisciplinary pathway and a disciplinary pathway, which I’m assuming is probably fairly consistent in states. Right. Patient harm, a nurse not being willing to volunteer, and then something else happens down along the line and then it becomes disciplinary as opposed to voluntary, those types of things.
Deborah
That’s my experience, too, Terri, and I think it’s fairly consistent. We do have some exclusion criteria in New York State around the Professional Assistance Program, and it is specific to patient harm and then that other piece that a nurse does need to be willing to participate and demonstrating willingness to participate in an alternative to discipline program. That’s a key piece of the criteria, I think, consistently across the states with the alternative programs, for sure.
Terri
Yeah, definitely. Okay. Are you aware of are there programs like yours for other disciplines in New York?
Deborah
There are. The Professional Assistance Program monitors over 50 licensees, and so that includes social work or pharmacy, et cetera. So any license that could be impacted, they monitor that. Nursing, I think, like many states, is the largest licensed profession, and so a majority of their focus is nursing. But they do offer support and monitoring for other licensees.
Terri
Yeah. Do you know if there are any peer assistance type programs like what you do, just focusing on that peer support piece of it for the other disciplines? Or do they typically go through whatever the professional board offers?
Deborah
They have the monitoring, and there are some peer support organizations like Caduceus, and then there are some supports through the pharmacy, but they’ve been less structured than what we offer through SPAN. There are some other peer supports as well through the AANA, which is focused on nurse anesthetists. And there are some peer support programs for physicians specifically, and they have a physicians program in New York, so there are some, but I’m not familiar with them being quite as structured as we have for the nursing body.
Terri
Sure. Yeah. And like you said, there are more nurses. That’s why they kind of get picked on. When we talk about diversion, it always like and the nurse, it’s like, okay, well, the rest of us are doing it too. The other but they do make up the majority. Okay. Yeah.
Deborah
And I’ve seen efforts I’m sorry, I don’t mean to cut you off. No, go ahead. I have seen efforts online to especially regionally, like in Connecticut for some efforts to organize for some of the other licensees. So I think we’re in a really interesting time where it’ll be fun to see what peer support services emerge for those other licensees in the next few years.
Terri
Right, yeah. People are getting more and more educated, it seems, on the need for this and the disease. From that then typically should come more programs. What are you seeing in your experience, medication assisted treatment versus not? Do you see it going one way or the other, or in general, is there a thought in the state of do they allow them to return to work on Mat? What do you see there?
Deborah
So medication assisted therapy is a really interesting topic. I think it’s a really hot topic for us, not just here in New York, but across the board. The state of New York does allow a nurse to be on a medication assisted therapy. It’s something that we encourage to have reviewed and observed by their treatment providers and it’s left to be individualized. That said, there are efforts to and I think some interest to look at this topic further and to kind of standardize some of the process, especially considering some of the higher risk or higher acuity professional practice areas like Anesthesia. We’ve had it suggested, and I think some of the literature supports mats that are non opioid related, non sedating and so a lot of encouragement around medications like Vivitrol.
Deborah
And so medication assisted therapy, we have a position on that we do support it as an adjunct to treatment and as an important piece of treatment. But the evaluation of that and the impact on the individual needs to be assessed by the treatment providers. And so we’ve seen nurses do very well with Mat and not have cognitive impact from it. And we have had nurses who have required medication assisted therapy, like Methadone, who maybe have had some cognitive flowing from higher doses that were required for their treatment. And so their evaluation, their monitoring reflected those needs as their recovery was the priority. And return to practice may sometimes be delayed in those situations and there may need to be some considerations made. But it’s very individualized because we want people to prioritize their recovery and their safety.
Deborah
There’s a lot of interesting discussion and a lot of discussion, I think a lot of best practices that will be emerging around this topic.
Terri
Right? Yeah, well, as you mentioned, the priority should be the recovery piece. Right. But I think a lot are focused on getting back to work. Probably from a financial perspective, you’ve put a lot of time and energy into your degree and you need to support yourself, right? So if you don’t have that help in supporting yourself, then I think the focus can jump very quickly to how fast can I get back to work, which if you don’t prioritize the recovery, I think you could sabotage the recovery. Right, because you’ve got the wrong focus. But that’s interesting that some could be on Mat and have cognitive impairment and others not. So you mentioned standardizing the process, which would be the process of review and assessment, but certainly not standardizing the actual process to each know each individual is different.
Terri
So when we talk about should people return to work on Mat, it depends really, is the answer, right. I mean, there is no yes, they should be able to. And I don’t know. From your experience, do you see people start on mat and then eventually go off of that, or is it typically a very multi year? I mean, once they’re on it, that’s what they need. They need to remain on it.
Deborah
I think it depends on the medication and again, depends on the individual and what their needs are. I’ve seen it used shorter term, and then I have seen it used long term, and there are cases where it’s encouraged to be for longer term. So it really is kind of case by case and something that really should be evaluated by an addiction specialist, the physician or the provider that’s providing that supervision and that treatment, and something that can be reviewed by the treatment team who’s overseeing the patient’s care. And it’s ultimately an individual decision to pursue return to work. But for someone in recovery, it is a team review and a team feedback process to take those steps. I’ve seen it work in both directions, and I’ve seen it work effectively in both directions, Terri.
Deborah
I think it really just depends on the drug of choice that the person struggles with and what their medical needs are around the treatment.
Terri
Sure, that makes sense. Yeah.
Deborah
Okay.
Terri
All right, well, this is great information. Is there anything else that you would like to say? Either if there’s a nurse out there that knows that they have an issue, or for the facilities in New York on how to handle an intervention and include you should they have you on standby? Any last words that you’d like to share on that?
Deborah
I appreciate that. I think having SPAN on standby is a nice concept. That’s a nice idea. Ideally, I would encourage facilities and employers to have SPAN information really embedded and hardwired into their systems, into their processes, into their policies and procedures, around diversion surveillance, into their policies and procedures, around reasonable suspicion and testing of an employee that you are concerned about possibly being impaired. Having recovery friendly language embedded into those policies and the phone numbers and the contacts, the resources embedded into those policies is so critical, especially given the high turnover that we see, especially right now in healthcare. We want to make sure that policies and practices are hardwired, regardless of turnover, that folks really know that SPAN is an available resource in very creative ways and would encourage you to actually invite SPAN into some of the planning processes around that.
Deborah
We can give confidential feedback and education to policy and procedure development, any kind of multidisciplinary surveillance teams that you’re putting together, organizing around diversion surveillance, any policies related to that and interventions. When you identify a nurse that maybe is diverting, how do you support that nurse towards treatment and recovery? Even if simultaneously there are needs for DEA reports or for OPD reports, things like that, we can always be involved as a support and should be involved as a support to hopefully mitigate some of the risk for a spiral into that time where people are losing their job or maybe having to step away from practice. The financial stress mounts and they’re facing those peri job loss, critical times where suicide is a high risk, things like that. So any proactive steps to include SPAN would be fantastic. We also offer free education.
Deborah
We’ll come on site to do orientation for new hires. We can do grand round sessions. Education on any kind of a repetitive basis around this issue is really critical. Or wellness fairs, any events that you’re having to promote wellness or promote safety for nurses. We’re always happy to be involved in those kinds of activities, and welcome it.
Terri
Wow. It sounds like SPAN is a fantastic resource for the state of New York. So, yeah, spread the word. Listeners out there. If you’re not in New York, make sure someone in New York knows about them, because that’s a lot that you do. Yeah, it really is. All right, well, thank you, Deborah. This was great information. Keep up the good work. Thank you to you and your team for all that you do. It’s important work that you do.
Deborah
Thank you. Thank you, Terri. Appreciate it.
Terri
Thank you, everyone, for listening. Please hit that subscribe button. And I want to thank our sponsor, whose product line is an active deterrent to diversion. See IMI’s complete line of innovative tamper evident products and how they work at imiweb.com.
