Ideally, a nurses readiness to return to work is mutually determined by the treatment provider and the patient. Re-entry to practice involves determination of license status, employer policies regarding re-entry, the patients substance(s) of choice, and any work restrictions or limitations. One major consideration is that the nurse not be assigned to high stress situations upon return to work.
Nurses may have not surrendered their license while in treatment, and for these individuals, recommendations and follow-up of treatment professionals may be crucial in the difference between relapse and maintaining sobriety. For nurses who have surrendered a license, understanding PAPs regulations and monitoring helps treatment staff, as well as the recovering nurse, pursue recovery and resume practice.
Considerations regarding readiness to return to work:
When RNs return to work after treatment for alcoholism or substance abuse, it is extremely beneficial to both the individual and the organization to have a return-to-work agreement.
The agreement establishes a set of guidelines for the nurse and employer including working conditions, monitoring requirements, procedures in the event of relapse, and the length of time the agreement will be in effect, among other criteria.
Because situations vary greatly, a specific agreement is not be appropriate for all instances. The following agreement (.pdf format; Adobe Acrobat Reader required) is provided as an example, and offered as a initial guide. Additional sample agreements are available; contact the SPAN program offices for additional agreements.
Scenario Anne wants to return to her position in a high school health office after a period of outpatient treatment for amphetamine abuse. As she will have unsupervised access to prescription drugs such as Ritalin and Dexedrine, as well as any illegal substances circulating in the school, her treatment provider is urged to consider recommending employment in an alternative setting.
Frequently, when a nurse returns to practice following addiction treatment, some form of monitoring is desirable. Monitoring is required under the PAP's provisions, and for nurses who've been disciplined by the Board of Regents, there is often a monitoring requirement upon resumption of practice.
Monitoring functions take various forms, often determined by circumstances and need. For PAP participants, required monitoring ensures appropriate behavior, function, and compliance within the practice setting as well as the treatment setting. For most, PAP requires the results of frequent, randomly collected, chain-of-custody body fluids (usually urines) drug analysis. Periodic reports are required in each area where monitoring occurs. Worksite monitoring assists the recovering nurses functional capacity in practice.
NYSNA recommends the following hierarchy to determine the appropriate monitoring role: Employee Assistance Program, Employee Health Service, or a monitor who will either work on the same unit or, if in a separate area, meets with the nurse on a regular basis to properly assess the nurses work performance and adherence to contract obligations.
Contact NYSNA's Statewide Peer Assistance for Nurses at 518.782.9400, ext. 250 or by e-mail.