The Women's Project - Carol Troy
Please Ask for Help
Mindy White R.N. MSN
Nurses with drug and or alcohol problems are not the best judges of what they need. Please ask for help. Be aware that you can protect your health, your license, and your livelihood if you ask for help before you are confronted at your place of employment. The realities are that once you have been reported to the Board of Nursing, been investigated and had sanctions brought against you, the board is mandated to report you to a National Data Bank. That information is then reported to the Office of Inspector General (OIG), a department of Health and Human Services.
The OIG was mandated by Congress to protect the Health and Welfare of the nations poor and elderly. Under this program certain individuals may be excluded from providing services to entities that receive Medicare funding. What this means, is that if you are excluded you may not work in any agency or facility which receives Medicaid or Medicare funding, in any capacity.
The Social Security Act authorizes OIG to exclude individuals based on particular circumstances. The act does specify when the OIG must exclude and when they may exclude.
The OIG must exclusions are when an individual or entity has been convicted of:
- Medicare or Medicaid related crimes (misdemeanor or felony).
- Patient abuse or neglect (misdemeanor or felony).
- Felony health care fraud (not related to Medicare or Medicaid).
- Felony controlled substance violations.
The OIG may exclude based on:
- Convictions for misdemeanor health care fraud (not related to Medicare or Medicaid).
- Convictions for misdemeanor controlled substance violations.
- Disciplinary actions taken by licensing boards or other Federal or State health care programs.
- Quality of Care issues related to denial of services, excessive/unnecessary services or substandard care.
- Prohibited activities such as false claims, fraud, or kickbacks (with or without convictions).
- Default on health education assistance loans.
Being excluded may be one of the many consequences that can happen if you leave the decision of when you start treatment up to others. Remember, the primary aim and goal of the Board of Registered Nursing is to protect public safety.
Being healthcare professionals, educated, committed, and having an intimate knowledge of pharmaceuticals cannot protect you from the ravages of drug and or alcohol addiction. If you are having problems with drugs and alcohol contact us through Peer Assistance Task Force at PATFANAMaine@aol.com or the local recovery program in your area.
The Nurse Educator's Role in Substance Abuse Education and Treatment: Accountability and Commitment
- Beth Clark, RN, Ph.D.
Substance abuse poses perplexing challenges for nursing education. Nurses encounter substance abuse in every area of practice, yet many nursing programs assign three or less hours of classroom content to this complex issue. Nurse educators are an aging breed, and many were socialized at a time when substance abuse was considered a moral weakness. Although the disease concept has been more widely accepted, stigma and stereotyping remain rampant in nursing education and practice. This can interfere with access to assessment and treatment for people who abuse substances, especially if the abuser is a nurse. Nursing students must learn to give excellent clinical care for substance withdrawal and treatment, but must also be given the opportunity to examine and challenge their own attitudes toward substance use and its treatment.
Nursing education, like professional practice, is highly stressful. Stress, the availability of substances, and nurses' attitudes toward self medication with over the counter and prescription medications all contribute to the high incidence of substance abuse within nursing. Chemical dependency is so common among nurses that it has been described as an occupational hazard of the profession. Nurses who abuse substances often report that they started prior to or during nursing school. This suggests the need for nursing educators to address not only clinical issues related to substance abuse treatment, but also how the student and nurse can engage in self care to mitigate the effects of stress and burnout. Students should be aware of the prevalence of substance abuse within the profession, the legal and professional ramifications of abuse and diversion, and how to respond if a colleague is impaired. Neither punitive approaches nor enabling behaviors are appropriate responses to substance abuse among students and colleagues.
A final issue for nursing education is what to do with a student who is impaired, particularly in the clinical setting. The student who abuses substances may not fit the typical stereotype of a substance abuser. He or she is often in the top 1/3 of the nursing class, and well respected by faculty and peers. Behaviors may not follow a clear pattern typical of substance abuse, and it could take several semesters for a pattern to emerge. The faculty member may avoid confrontation for fear of being wrong, not knowing what to do in the situation, or concern about the possible educational repercussions for the student.
There are some simple things that nursing faculty must remember. Substance abuse impacts all areas of the student's life, and compromises both client safety and standards of clinical performance. Once discovered, substance abuse can be successfully treated. Effective treatment can strengthen the student's educational performance, professional competence, and quality of life. Nursing schools should develop a clear policy for dealing with substance abuse that is consistent with university policies and State Board regulations. Once substance abuse is suspected in a nursing student, the faculty's role is to confront and refer for professional evaluation, not to diagnose and treat. Nursing students who have abused substances should be provided the opportunity for treatment rather than discipline and dismissal. A specific and detailed contract with the student can ensure that the process for treatment and reentry into coursework is clear and consistently followed.
Model policies from many nursing programs can be accessed through the web, and the nursing literature is replete with suggestions for policy development and approaches to intervention. If, as a nursing educator, you find yourself asking, "I care, what can I do?", there are some simple answers. First, examine your own experience with and attitudes toward substance abuse. Become informed about the incidence and prevalence of substance misuse within nursing education and practice. Examine ways to decrease stress within your educational program and teach self care as part of the nursing curriculum. Review the university and program policies toward substance abusers and participate in policy revision and development. Maintain an index of suspicion when behaviors suggest substance abuse is present. Basing policy on an ethic of care and an understanding of substance abuse as a treatable disease can make identification and enforcement of policy less stressful for the faculty member. Educators must help students to think about their own personal vulnerability to the misuse of substances both in their student and the nursing roles. Finally, educators must help students to confront the possibility of dealing with an impaired colleague. Nurse educators must make a commitment to facing the issues of substance abuse boldly, imparting accurate information, and to challenging existing stigma and stereotypes. The outcome will strengthen both nursing education and practice.
( Beth Clark, RN, PH.D. teaches at UMO)
Who is MASAP?
The Maine Association of Substance Abuse Programs is recognized as the voice of substance abuse prevention, treatment and recovery throughout the State of Maine. With membership representing the majority of agencies, providers and the continuum of services focused on abuse of and addiction to alcohol and other drugs, MASAP is a presence acknowledged by national, regional, and state entities as a shaper of public policy and an advocate for continuous improvement in evidence based practice for substance abuse prevention and treatment. The mission of MASAP is to support the systematic development and maintenance of the continuum of substance abuse services: prevention, treatment, educational services, and recovery. Integral to MASAP's mission are its major programs: the Maine Association of Prevention Programs, with membership exceeding 1000, and the Maine Alliance for Addiction Recovery, a grassroots organization of individuals, their families and friends, and others entering into, living a life of, or interested in Recovery.
MASAP has been and continues to be active in influencing federal public policy, especially related to confidentiality of patient records, insurance reimbursement, federal program standards, and national organizations of direct service providers. The State Association of Addiction Services, a coalition of national state provider agencies, is currently led by a MASAP Board member. MASAP is a member of SAAS and The Legal Action Center. The MAAR Director and Board President are members of the federal SAMHSA Faces and Voices of Recovery panel.
MASAP continues its advocacy for a variety of consumer groups, from prevention through recovery. A significant portion of MASAP's time is focused on the State planning process and legislative advocacy for substance abuse prevention, treatment and recovery. In close collaboration with the Office of Substance Abuse, The Governor's Commission on Substance Abuse, and other collaborative and mutually collegial state, public, and private entities, MASAP is a prominent and influential player in Maine and, with ongoing interactions at the state and national legislative levels, has had ongoing and major effects on policy and funding decisions.
The Maine Alliance for Addiction Recovery (MAAR), a MASAP Program, is a grassroots advocacy group composed of people in recovery, family members, and friends interested in addiction recovery issues. The general public is normally only aware of the devastating effects of addiction. MAAR members' work together to reduce stigma associated with chemical addiction and work to educate the public and policy makers about issues of recovery, treatment of addiction and substance abuse. MAAR's objectives are to move Recovery from personal redemption to a level of social acceptance., to remove barriers to recovery for those still suffering from alcohol or drug addiction, to improve access to treatment, to encourage more SOBER housing programs, to increase and improve treatment for the prison population of this state thus reducing recidivism., and to support alternative sentencing programs.
For information about MASAP and MAAR, contact Ruth Blauer, Executive Director, MASAP at 207.621.8118 or rblauer@masap.org
The Women's Project
Carol Troy
The Women's Project is a statewide program of PROP (Portland Regional Opportunity Program) Community Action and funded by the Maine State Office of Substance Abuse. Our mission is to increase access to treatment and recovery services for Maine women affected by substance abuse. A staff of outreach nurses provides interim therapeutic case management and support to clients and helps them identify and overcome their barriers to recovery.
Nurses also provide clients with community linkages and encourage them to consider important lifestyle changes. Clients receive education and information on public health issues, including TB, HIV/AIDS, Hepatitis and the effects of tobacco, alcohol and other drugs on fetal development during pregnancy.
The Women's Project services are provided at no cost to clients and confidentiality is assured. In addition to managing client caseloads, staff conduct presentations to a variety of service providers and community groups on health issues and other concerns facing women in need of substance abuse treatment and recovery services. The Women's Project confidential toll-free line is 1-800-698-4959 x243 in the Portland area and 1-800-611-1779 in the Bangor area.
What is Peer Assistance? 
