Substance abuse is a growing problem for medical professionals, especially nurses. Yet, rather than receive treatment and support, nurses face disciplinary action and risk losing their licenses.
Substance abuse is one of only several problems facing nurses. Burnout, PTSD, staffing shortages, and lack of support in the workplace: It's not surprising that two out of three nurses have or are considering leaving the profession.
These problems existed before the COVID-19 pandemic, which has worsened many of these problems. In November 2022, Pennsylvania reported a 30 percent shortage of RNs. This is a 10-percent increase in three years.
Stress, PTSD, and burnout can all contribute to substance abuse. Nurses were on the frontlines during the pandemic. In 2022, approximately 75 percent of nurses reported some level of cognitive failure. While exact numbers are difficult to find, studies indicate the pandemic increased the risk of substance abuse in the nursing profession.
Protecting patient safety is important. The problem is that punishing rather than supporting nurses who are struggling with mental and physical health issues, including substance abuse, doesn't solve the problem.
As the focus remains on discipline rather than treatment, nurses may hesitate to seek treatment. They may not realize they have a problem until they have issues in the workplace.
If you're a nurse who is facing disciplinary action due to substance abuse issues, you need an ally in your corner. You've worked hard to get your nursing license and build a career. You need treatment and support that will let you return to nursing. The Professional License Defense Team at the LLF Law Firm can help. Call us at 888-535-3686 or fill out our online form.
Nurses: Understaffed, Overworked, and Burnt Out
Workplace stress and burnout increase the risk of substance abuse. Even before the COVID-19 pandemic, nurses were dealing with these issues.
In 2023, the University of Pennsylvania School of Nursing released a study of over 70,000 nurses. The study asked nurses about their workplaces shortly before the onset of the pandemic and 18 months later. Some of the study's key points:
- Seventy percent of nurses reported a lack of trust in their employer's leadership at the start of the survey. That number rose to 78 percent during the second round of questions.
- About 65 percent of nurses said their workplace had staffing shortages before the pandemic. Less than two years later, three-in-four nurses worked in places with staffing shortages.
- Even before the pandemic, a majority of nurses reported burnout. Eighteen months later, 60 percent of nurses were dealing with burnout.
Burnout isn't about just needing a vacation. It can have mental and physical side effects that increase the risk of depression, substance abuse, and suicide. From a workplace standpoint, burnout increases the likelihood of mistakes, including in patient care.
Heavy workloads and lack of support from management increase the risk of burnout. Burnout, rather than an individual problem, should be viewed as a systemic failure in the workplace.
Nurses who don't trust their employer's leadership and administration are less likely to feel comfortable asking for help. This lack of support, in turn, makes it more likely a nurse will suffer workplace stress and be more susceptible to substance abuse.
The COVID-19 pandemic exacerbated existing issues for medical professionals. It also increased the number of nurses suffering from PTSD. According to one 2022 study, approximately half of nurses are dealing with various PTSD symptoms. An increased number of nurses also report feeling burned out very often.
Similar to burnout, PTSD increases the risk of substance abuse. Substance abuse can start gradually and build, and it can be a way to self-medicate.
Numerous studies highlight the need for better support of medical professionals, especially nurses. A report by the CDC found that better working conditions decreased the risk of burnout.
The University of Pennsylvania study found that many programs intended to help support nurses are ineffective. An investigation by the Pennsylvania Capital-Star found that, over a 24-year period, lobbyists in Pennsylvania contributed over $3 million to defeat laws to improve working conditions for nurses.
Put another way, nurses in Pennsylvania are not only dealing with increasingly poor working conditions, including the risk of physical attacks by patients, but active efforts to block improvements to their working conditions. Rather than support nurses, substance abuse and other issues are treated as one that affects individuals, meaning they're often blamed and disciplined.
Treatment, Not Punishment
In 2017, several nursing organizations released a statement on the need to focus on prevention, treatment, and recovery for substance abuse rather than punishment. The statement emphasized the importance of effective alternative-to-discipline treatment plans.
The current system creates a vicious cycle for nurses contending with substance abuse. Fear of discipline can lead to more stress, which can, in turn, lead to an increased risk of substance abuse and depression.
Substance abuse is a disease that requires treatment. Viewing substance abuse as a chronic medical condition rather than bad behavior increases positive outcomes.
Pennsylvania Disciplinary Process
Disciplinary proceedings against a nurse begin when someone files a complaint. Anyone may file a complaint with the Pennsylvania Department of State's Bureau of Professional and Occupational Affairs. Complaints may be filed anonymously.
Upon receiving a complaint, the Bureau of Enforcement and Investigation will assign an investigator to the case. Investigations follow six general steps:
- Complaint
- Initial Review
- Investigation
- Decision on proceeding with disciplinary charges
- Case hearing
- Reporting and Enforcement
The Bureau forwards all completed investigations to the Professional Compliance Office. A prosecuting attorney will then decide whether to file formal disciplinary charges.
All nurses have an opportunity to respond to the allegations made against them. If nurses disagree with the hearing decision, they can appeal the decision to the Commonwealth Court.
Nurses may also opt to settle via a Consent Agreement and Order. Either the nurse or Pennsylvania may suggest a settlement. Both sides will negotiate on what facts they agree upon and any disciplinary action. The board must approve all consent agreements.
Voluntary Recovery Program
Nurses and other medical professionals dealing with substance abuse issues may be eligible for the Voluntary Recovery Program (VRP). The purpose of VRP is to provide guidance and monitoring while receiving treatment and recovering from substance abuse or other mental and physical disorders.
Each nurse will work with a VRP case manager. VRP doesn't provide treatment, and a nurse will be responsible for paying for treatment.
One of the advantages of the VRP is that, while participating in VRP, any disciplinary action will be deferred as long as a nurse makes progress in the program and follows the given terms and conditions. This includes suspension and revocation.
Eligibility
To participate in VRP, nurses must meet certain criteria. All of these steps must be completed through a VRP-approved provider. The steps to qualify for VRP:
- Evaluation: A nurse must undergo an evaluation that includes verifying the existence of a diagnosed mental or physical disorder, such as substance abuse
- Treatment Plan: VRP must approve all treatment plans, and a nurse must follow the recommended treatment plan
- Terms and Conditions: A nurse must comply with all requirements of VRP participation
- Consent Agreement: The nurse enters into a consent agreement with the licensing board
While not listed on the main page, another condition of VRP participation is that a nurse acknowledges that they have a substance abuse problem.
Certain events and actions will make a nurse ineligible for VRP. Pennsylvania currently bans the following from participating in VRP:
- Any nurse who has pled guilty or no contest or been convicted of either a misdemeanor or felony under the Controlled Substance, Drug, Device, and Cosmetic Act
- Any nurse who has been involved in incidents involving significant patient harm
- Nurses who have been involved in the sale or distribution of controlled substances
- Any nurse who has committed “sexual boundary violations”
- Any nurse who unsuccessfully participated in a similar program in another state
- Any nurse who previously declined to participate in VRP
There are no exceptions to these exclusions. If you're unsure if you're eligible for VRP or know you're ineligible, contact the Professional License Defense Team at the LLF Law Firm. We can help you with alternative options and defend your license in the disciplinary process.
Consent Agreements
All nurses must submit a Personal Data Sheet as part of participating in VRP. This information will be forwarded to the Department of State's Legal Office for drafting a consent agreement. You must have an opportunity to review the Consent Agreement before signing. The Board won't see your consent agreement until after you sign it.
Pennsylvania considers a consent agreement to be a non-public document. It also isn't considered discipline and is separate from a disciplinary consent agreement.
A nurse will need to include the following information on the Personal Data Sheet:
- Name and contact information
- Their diagnosis, such as substance abuse
- Any consequences related to their condition, such as employment problems or accidents
- Their evaluators
- Current or most recent treatment provider
- Pending legal charges, if any
- Details on any misdemeanors or felonies to which a nurse pled guilty or no contest, was found guilty, received probation without verdict, or accelerated rehabilitation disposition (ARD) under any federal or state drug laws or DUIs
- Previous participation in any state's monitoring program
Nurses must agree to participate in VRP for at least three years.
Criminal charges can be especially difficult when petitioning to participate in VRP. A DUI or conviction under some drug statutes can indicate the need for substance abuse treatment.
Similarly, relapses are common when recovering from substance abuse. The current restrictions on participation for those who haven't completed previous programs fail to acknowledge the challenges of substance abuse recovery.
If you're struggling with substance abuse and need support, the Professional License Defense Team at the LLF Law Firm can help determine how to seek treatment while maintaining your license.
Terms and Conditions
Once admitted to VRP, nurses must abide by both their consent agreement and the terms and conditions required by the Professional Health Monitoring Programs. Some of these terms and conditions include:
- Complying with their VRP-approved treatment plan
- Following treatment provider recommendations
- Abiding by any restrictions on employment, including not working in positions that require a license until cleared to do so by a case manager or provider
- Abstaining from all drugs, alcohol, and other controlled substances with the following exceptions:
- When a nurse is a bona fide patient of a licensed healthcare provider, and the provider knows of the nurse's impairment and participation in VRP
- When all prescriptions are prescribed by that provider and approved by a nurse's VRP case manager
- Within 48 hours of receiving any prescription, a nurse provides written notification to the VRP, which includes:
- The name of the licensed healthcare provider
- Information about the prescription, including dosage and strength
- The diagnosed illness or condition
- Avoiding all products that contain poppy seeds and alcohol, such as mouthwash and foods such as vanilla extract and kombucha
- If unsure if an item would be on this list, nurses should check with the VRP before using
- Undergoing random drug testing
- Providing monthly proof of attendance at required support groups
- Paying all costs as part of VRP participation
These terms and conditions are not exclusive. Nurses may have additional terms and conditions as part of their consent agreement. When beginning the program, nurses should make sure they and their VRP case manager discuss their specific limitations and requirements for participation.
As long as you are in the VRP program, all disciplinary action against you will be suspended. The exception is if new complaints or workplace issues occur.
Work Limitations
VRP, along with your treatment providers, will determine what limitations are on your ability to work as a nurse. They may forbid or limit your work. Even once you return to work, you may have limitations or be under direct supervision.
Your case manager should inform you of all of the conditions that attach to your ability to work. Failure to follow these conditions could mean you're kicked out of the VRP program and/or sent for additional disciplinary action.
At the same time, working restrictions may be too severe. Conditions to return to work may be unrealistic or seem indirectly intended to force you out of the medical field. As part of the consent agreement and your entry into VRP, you need to advocate for yourself and make sure that all conditions are reasonable.
Unduly Restrictive Conditions
Recovery from substance abuse takes time. While Pennsylvania has a vested interest in patient safety, excessive terms and conditions or unreasonable requirements can hinder progress without benefiting anyone. One of the challenges for nurses who want to participate in VRP is ensuring that the terms and conditions imposed on them are not unduly restrictive.
Nurses should not simply accept any terms and conditions VRP suggests. Those that aren't realistic to accomplish or
Costs
One of the challenges of recovering from substance abuse is the cost. By one 2022 estimate, substance abuse treatment costs between $15,000 to $27,000.
The average salary for an RN in Pennsylvania is $76,000. In other words, RNs receiving treatment for substance abuse should expect to spend between 20 and 36 percent of their pre-tax income on treatment.
These numbers are also averages. Cost can vary wildly depending on each nurse's situation, and treatment is unique to the person. It can sometimes take time to find the most effective treatment option.
VRP requires all nurses to cover the fees and costs of their treatment, less any amount covered by their health insurance. This includes nurses who are limited or restricted from working in the medical field.
These costs can be a significant source of stress on a nurse, which can be detrimental to recovering from substance abuse. As much as possible, nurses should point out the financial realities of seeking treatment and push for the fewest number of restrictions on their ability to work.
FMLA
Under the Family and Medical Leave Act (FMLA), some nurses will be able to take unpaid time away from work to treat their substance abuse. Nurses are covered by FMLA when:
- Their employer:
- Has 50+ employees within 75 miles of the nurse's workplace
- Is a government agency
- They've been with the same employer for at least one year
- In the past year, they've worked at least 1250 hours for that employer
FMLA requires that nurses receive treatment for their substance abuse either from a healthcare provider or through a referral from a healthcare provider.
FMLA prohibits employers from firing employees who need to take medical leave. The law does have an exception for substance abuse.
Employers aren't required to abide by FMLA for an employee's substance abuse issues when:
- An employer has an established substance abuse policy on when the employer may fire an employee for substance abuse
- The employer communicates this policy to employees
- The employer applies this policy in a non-discriminatory manner
For some nurses, FMLA can be a useful tool in their substance abuse treatment.
Long-Term Recovery
Recovering from substance abuse isn't easy. It's not simple going from Point A to Point B. Treatment and recovery is a challenging process without an endpoint.
Recovery is a lifelong process. Up to 50 percent of individuals relapse in their first year. Treatment should be tailored to the individual, and it can take time to find the most effective treatment for someone. Even when two people have an addiction to the same drug, a method that works for Person 1 may not work for Person 2.
VRP doesn't currently allow for this type of nuance in treating substance abuse. Failing a drug test, making insufficient progress, or previously failing out of the VRP program or a similar program: All of these events can potentially end a nurse's ability to participate in and benefit from VRP.
Individuals recovering from substance abuse do need structure during and after treatment. Ensuring a nurse isn't a danger to patients, other staff, or themselves is important. They may need limitations in their job or with their job responsibilities.
The problem is when the restrictions are overly strict or fail to properly support a nurse's recovery. An employer may put conditions on your return to work that seem less designed to support you and more designed to nudge you out the door.
That a condition placed on you is well-meaning doesn't make it more effective. That an employer claims a restriction is for patient safety doesn't mean it actually affects patient safety.
For some nurses, a shift in their career or position may be a necessary part of their recovery. Other nurses may continue in the same workplace or position. Both groups require identifying healthier outlets for their stress and ways to dodge high-risk situations that can heighten the chance of relapse.
As much as possible, nurses should be in control of their treatment and recovery. A nurse should be the one to decide on either maintaining or changing their career path as part of their recovery from substance abuse.
Simply monitoring a nurse isn't enough. Until the VRP program better reflects the realities of recovering from substance abuse, nurses have the responsibility to ensure their treatment plan minimizes their risk of relapse or otherwise violating the VRP terms and conditions.
Advocate for Your Career and Future
For nurses in Pennsylvania who are dealing with substance abuse, one of the challenges is how much of the responsibility falls onto them. They're the ones who are disciplined as a result of industry problems. Rather than support, they risk losing their career when they have a substance abuse problem.
Even once in Pennsylvania's VRP program, nurses must satisfy requirements with little space for failure. That's why creating reasonable terms and conditions is such a key part of the recovery process.
The Professional License Defense Team at the LFF Law Firm appreciates the many challenges nurses face. We provide support and guidance for nurses facing substance abuse, disciplinary issues, and other problems that threaten their ability to work as a nurse. We advocate for our clients. Call us at 888-535-3686 or fill out our online form.
