Changes in your behavior, late reports, poor documentation, shakiness, mood swings, frequently calling in sick. Does any of this sound familiar? Could someone say this sounds like you at work, even some of the time? You know better than anyone else if you are struggling with a substance use disorder or addiction that is affecting your work as a nurse.
If so, you also probably know better than anyone how scary and insurmountable it can feel to think about the possibility of getting help and recovering. It takes time (probably away from work, something not many people can afford), commitments (that you can't ignore), and money (on top of existing financial challenges you may be facing). Seeking help is the hardest thing you may ever do, but it could very well be the best thing you ever do. How you go about it can make all the difference. Too often, nurses fearing their licenses are at risk agree too quickly to treatment programs that may have longer-term consequences that aren't initially evident. Know what you are getting yourself into.
The Lento Law Firm's Professional License Defense Team is experienced in representing nurses nationwide before state nursing boards and negotiating with them on our client's behalf. We want you to get well as quickly as possible and get back to the vocation you chose. To learn how we can help you seek the best possible outcome if you are facing possible license suspension or revocation, or if you have been referred to New Jersey's Recovery and Monitoring Program, or RAMP, discussed below, contact the Lento Law Firm Team today at 888.535.3686 or use our reach out through our response form.
Nurses Are Not Immune from Addiction Struggles
By working in the healthcare profession, you've put yourself in a position in which there is very little room, if any, for lapses in judgment, consequential errors, negligence, or inconsistency, especially if linked to substance use. Patients' lives and livelihoods are in your care, and nursing is not a vocation in which you can make irresponsible mistakes without repercussions, and for good reason.
The reality that you may be keenly aware of is that healthcare professionals are human, too. Life challenges do not discriminate by profession, just as they don't discriminate based on age, socio-economic status, and so on. This includes addiction issues, whether to alcohol or other drugs. Nursing can be stressful and traumatizing, especially if you work in a department that routinely sees patients with debilitating injuries from accidents, chronic pediatric illnesses, or patients in acute crises. It isn't unheard of for healthcare workers to turn to substances in an attempt to escape stressors on the job.
For an unlucky group of people, what may start out as a seemingly innocent way to unwind after a difficult day at work can develop into a career-, reputation-, and life-threatening problem. You would never intentionally hurt someone in your care, and you know deep down that you are not the kind of person who wants to lie, steal, or cheat. But addiction can make people behave uncharacteristically, and this can mean real trouble when you work in healthcare. You may know that you need help but aren't sure where to turn. Facing a substance use issue isn't easy, but it can help you get your life back on track before it's too late.
Alternatives to New Jersey License Proceedings
Fortunately, today, there is help for nurses needing substance use disorder treatment that doesn't automatically involve losing your job. This hasn't been true historically if you look back to the field of nursing prior to the 1980s.
The New Jersey Board of Nursing (NJBON), like other state nursing boards, knows that nurses face these sorts of challenges every day. In addition to punitive measures intended to protect patients and public health, such as suspending or revoking nursing licenses, many states also offer alternative routes to make up for mistakes, such as voluntary enrollment in a treatment program. These programs provide an immersive treatment that removes you from nursing long enough to establish that you can safely return to work.
In New Jersey, qualifying nurses can enroll in the Recovery and Monitoring Program (RAMP), managed by the Institute for Nursing for the New Jersey Board of Nursing, as a means to avoid formal disciplinary proceedings after a substance-related infraction. RAMP participation is also part of the reinstatement process for nurses who have had a licensing action taken against them. If you are struggling with alcohol, prescription medication abuse, or a problem with another type of drug, enrolling in a treatment program like RAMP may be a major step in the right direction, helping you heal, stay clean, and keep your career.
RAMP: Know What You Are Agreeing To
If the New Jersey Board of Nursing has referred you to RAMP, that likely means that you are able to show you have a diagnosed disorder and that you haven't yet harmed anyone in your practice. This is good news, but it's also prudent to get as much information as possible and to know about all of the program's requirements before signing on the dotted line. You'll want to become familiar with the program's complex set of requirements you'll need to meet to avoid discipline should you decide to accept this route.
Getting help is key, and while it can feel like a relief to take the leap, seeing clearly what you are getting into is a smart approach. Agreeing to a treatment program like RAMP can have long-term consequences for your career. For example, enrolling could be interpreted as an admission of guilt if you are under investigation. You need to be certain that if this is the case, you can accept admitting to Impaired Nursing Practice, as defined by the New Jersey Board of Nursing Laws, meaning an inability to function at an acceptable level of competency or incapacity to continue to practice with the requisite skill, safety, and judgment as a result of alcohol or chemical dependency, psychiatric or emotional disorder, senility or a disabling physical disorder.
Consult an Attorney Before Signing Up
Speaking with an attorney to discuss your options and seeking treatment with your eyes wide open can be a wise move at this point. Certainly, don't bury your head in the sand and wish your problems away. Don't automatically reject an offer to get help, but do know what accepting an invitation to a treatment program can mean for you as you think about your career outlook. Don't wait to seek legal guidance. Reach out to the Professional License Defense Team at the Lento Law Firm at 888.535.3686 or tell us about your case online.
Requirements for Completing RAMP
If you are referred to RAMP by the New Jersey Board of Nursing as an alternative to punitive measures, and you are considering enrolling, know what you can expect your first steps to involve. You will:
- Receive an enrollment packet to fill out, including an agreement to be monitored. You will need to enclose any New Jersey Board of Nursing documents when you submit the packet, which you must do within 15 days of receiving it.
- Need to find a qualifying nearby nursing peer group that has openings for new members
- Take part in an orientation phone call
- Sign up for drug screening. Once enrolled, you'll need to activate your account immediately and begin checking in daily
If you do enroll, your plan will be customized to you, but generally, you can anticipate having to participate in weekly peer support sessions and 12-step programs (90 meetings in 90 days) and submit to random toxicology screenings and daily monitoring for five years. You will also be responsible for the costs associated with the program, including the application fee, costs of evaluation, peer support group meetings, and drug testing.
RAMP Demands 100 Percent Compliance
When you enter RAMP, understand that you are agreeing in advance to complete all recommendations your RAMP team may make and that you cannot work as a nurse again until RAMP approves you returning to work. Understandably, you will not be permitted to use addictive substances, including alcohol, while you are enrolled. Finally, understand that you will be communicating honestly and openly with your employer during this time and that if you are licensed to practice nursing in other states, you must notify them of your participation in the program and provide proof that you have done so to RAMP.
Releasing Your Health Information to Others
Not only do you need to communicate with your employer about your status in treatment, but you will also be required to sign forms allowing RAMP to share your health records with others, including your primary care provider, your supervisor at work, and other state boards of nursing. This includes “Alcohol/drug use history, diagnostic impression, symptomology, biographical, family, psychological mental and social history, evaluation results, diagnosis, if any and recommendations, treatment history, prognosis, and success and/or compliance.” If you refuse, you will be dismissed from the program.
Undoubtedly, you may feel a sense of relief when considering this level of oversight. This is normal. It's difficult, if not impossible, to overcome substance use issues alone, and this type of support can be a game changer. But don't jump in blindly only to be surprised about requirements that you didn't take the time to fully understand or about the ramifications of what they may involve.
Can You Commit to a Zero-Tolerance Policy?
Be sure you have the capacity to fulfill the program's obligations, such as submitting monthly self-reports, 12-step program attendance, therapy evaluation reports, and employer evaluation reports (if you are working as a nurse). If you are taking any controlled medication prescriptions, you will also need to submit these monthly to your electronic monitoring system, including copies of your prescription or pharmacy reports.
Again, these measures are designed to help you stay accountable to yourself and others, and if you are prepared to meet these obligations, they may go a long way toward helping you overcome struggles. But do keep in mind that there isn't wiggle room. You are not able to pick and choose which portions of your treatment plan to participate in. Refusing to take part in any part of the plan, including recommendations by RAMP, will be seen as non-compliance, triggering a report to the New Jersey Board of Nursing).
Submitting to Random Toxicology Screening
Knowing ahead of time what you can and can't consume while you are enrolled in RAMP is important. You must avoid more obvious substances like alcohol and illegal drugs, but a positive drug test could also be the result of consuming CBD oil or hemp seeds, liquid cold medications, and other over-the-counter medications containing alcohol, Kombucha, food containing alcohol, and alcohol-based mouth rinses. If your toxicology test comes back positive, whether from sampling your urine, hair, blood, saliva, or nails, it doesn't matter if it's positive because of poppy seeds or an illicit substance. You'll also want to be financially prepared for the costs associated with long-term drug screenings. You are not allowed to miss tests.
Restrictions on the Floor
If you are able to work, get to know your work restrictions ahead of time to make sure this is the right decision for you. Learning this after the fact, especially by accidentally making a mistake, is not ideal. Don't make the mistake of even applying for a nursing job without approval from RAMP. Doing so would be a violation of your contract.
Remember that you will be monitored at work and that, in most cases, you will not be allowed to be in an autonomous or unsupervised role, in a critical care area, or on an on-call basis. You generally won't be allowed to work overtime, your shift hours will be limited, and you aren't permitted to work for multiple employers, including staffing agencies and yourself.
Again, not complying with RAMP's requirements and recommendations will result in a report to the New Jersey Board of Nursing. Be sure you can commit to regular attendance at peer meetings, routine drug screening, submitting reports, and avoiding non-approved medications and/or controlled substances at all times. You don't want to wind up in a situation that is actually worse than it was before enrolling in RAMP.
Be careful that you also understand the more nuanced requirements of RAMP. Perhaps lesser known is the fact that if you do not demonstrate that you are progressing satisfactorily in treatment, this could be seen as noncompliance and result in dismissal from the program.
Can You Get Your Nursing License Reinstated?
Before entering into any agreement, familiarize yourself with the timeline, as well. You should know going into it that it may be 6 or more months before you are able to request the reinstatement of your nursing license.
Once you have fulfilled all of RAMP's requirements, and you are eligible to apply for reinstatement, you may be looking at another 3 months before you can regain your license. At this point, your first step will be to draft a letter explaining how you have complied with RAMP and what you have done to establish and maintain your recovery (such as meetings or peer support groups you plan to continue to attend or therapy you plan to continue). If it is accepted, you will receive an Order of Reinstatement, which you will sign, copy, and mail to the Deputy Attorney General, RAMP, and the New Jersey Board of Nursing. You will also submit a reinstatement application online.
I'm Afraid My Nursing License Is at Risk
If your license is at risk, or if it has been suspended or revoked, it's important not to panic or jump into an alternative-to-discipline program without a clear picture of all of the details. Pause to remember that you aren't alone. Every day, there are healthcare professionals who struggle with addiction issues. Like theirs, your options for moving forward are not black and white, and you don't have to give up hope of recovering and possibly having your license reinstated without enrolling. Treatment programs like RAMP can help a vast number of healthcare professionals needing intervention. If you feel RAMP would be good for you, do enter into it prudently and ideally with the guidance of an experienced legal team.
After an incident, you may understandably feel guilt or shame, and it isn't uncommon to feel mentally and emotionally paralyzed, wondering how to move forward. The Professional License Defense Team at the Lento Law Firm will help you take the next steps to get your career and your life back on track.
Above all, we want you to recover and bounce back stronger than ever. Even if nothing has gone wrong yet, but you feel it may only be a matter of time, we encourage you to get help, starting with seeking out a strong legal team.
If you feel that a colleague, supervisor, patient, or patient's family may know you have done something wrong and you are afraid of them reporting on you, it's not too early to start thinking strategically. Perhaps someone has noticed medication irregularities or discrepancies, record tampering, or a pattern of patient complaints.
As you know, New Jersey law requires nurses to report fellow licensed professionals whenever the professional colleague “demonstrated an impairment, gross incompetence, or unprofessional conduct which would present an imminent danger to an individual patient or to the public health, safety or welfare.” A colleague who knows about your misconduct and doesn't report it could also then be investigated for professional misconduct. This could be misconduct at work, such as diverting medication, or it could be related to an occurrence outside of work, such as being stopped and arrested for intoxicated driving on the way to work. Don't wait for a report to be filed against you before planning your defense in order to retain your nursing license.
How An Attorney Can Help You
If you are feeling overwhelmed by an allegation filed against you and at the thought of losing your nursing license, this doesn't mean you need to commit immediately to a treatment program. Getting help is smart, but do so armed with all of the information available. Remember, you have legal options, and we can work through them with you.
In addition to helping you evaluate whether RAMP is right for you, we can help you navigate the path forward with the New Jersey Board of Nursing. We can help you:
- Respond to investigation and interview requests for you
- Answer the New Jersey's Board of Nursing's notice of formal proceedings, ensuring you don't default
- Discover evidence provided to support any charges against you so we can support your position
- Communicate directly with disciplinary officials and judges while advocating for your procedural rights
- Negotiate for favorable resolution of disciplinary charges by consent agreement
- Prepare for your hearing, if it comes to this, including witness and exhibit preparation.
- Draft and submit hearing briefs
- Participate in your hearing, cross-examine witnesses, and challenge exhibits
- Help you interpret the judge's ruling and, if not in your favor, work to find grounds for appeal
- Pursue your appeal
- Communicate with your employer throughout the proceedings to protect your job pending the proceeding's outcome
Call the Lento Law Firm's Professional License Defense Team Today
We are firm in our belief not only in our client's due process rights but also in their instincts about what is right for them, and we are ready to stand by you as a strong advocate and negotiator. We regularly work with state nursing boards and licensing agencies nationwide when professional licenses are at risk, and we want to be your defense.
Call the Lento Law Firm at 888-535-3686 or tell us about your situation online with your situation, and we will reply as soon as possible so we can get to work.
