Practice Re-entry

Ideally, a nurse’s 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 patient’s 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 PAP’s regulations and monitoring helps treatment staff, as well as the recovering nurse, pursue recovery and resume practice.

Re-entry Considerations

Considerations regarding readiness to return to work:

a willingness to continue in a supportive “continuing care” program
agreement to continue attending self-help meetings
motivation to change lifestyles and behaviors that could trigger relapses
accountability to designated personnel (i.e., PAP monitor)

Additional Considerations:

The opioid using nurse should be assigned to units where controlled substances are rarely utilized. (Doesn't apply to nurses whose primary substance of abuse was alcohol or cocaine and who hadn't diverted drugs from the workplace.)
Stable shift assignments are important. Day shifts are preferred, but 3-11 is acceptable if staff patterns and familiarity of coworkers with the returning nurse accommodate the nurse’s needs (e.g., the nurse may be required to avoid access to narcotics keys).
Employment where medications are stocked in limited quantities is desirable.
Overtime and on-call assignments should be avoided for at least six (6) months.
It is strongly recommended the nurse not accept employment with temporary/supplementary agencies, registries or services, home health care or other isolated practice areas where access to abusable substances is unsupervised, for at least one year. This doesn't apply where the nurse isn't likely to come in contact with mood altering medications, such as HMO triage.
Re-entry conditions should be outlined by appropriate personnel before returning to the workplace. Assignments must be planned.
Where appropriate, a return-to-work agreement must be developed between employer and the returning employee. This should outline conditions to be complied with before a nurse returns, and the consequences of noncompliance. The contract should be consistent with all legal requirements safeguarding the patients, the nurse, and the workplace.
Management, supervisors and collective bargaining representatives should meet with the nurse to discuss the contract and require the signature of the nurse.

Return-To-Work Agreements

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.

SPAN Sample Return-to-Work Agreement

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.

Monitoring Systems

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 nurse’s 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 nurse’s 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.