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This story is from the Anamnesis episode called A Nurse. A Pandemic. An Addiction and starts at 26:20 in the podcast. It's from Tiffany Swedeen, RN, BSN.
We spoke with Grant Hulteen from the Washington Health Professional Services (WHPS) program, who also runs the investigative unit for the state's nursing commission. Hulteen said one-on-one interviews are common for investigators, and that most interviews during the pandemic are happening over the phone. Investigators typically ask nurses about their medical history, their work performance, and treatment. A phone call from an investigator is usually followed by a letter requesting a written statement from the nurses themselves.
He stressed that investigators only summarize their findings. They don't make recommendations to the nursing commission.
According to Tiffany, this was the one useful piece of information the investigator had shared with her. So, Tiffany wrote the letter to the nursing commission, and tried to explain how after 4 and a half years of sobriety, she had stolen fentanyl and used it.
Swedeen: I could have just written just the facts, I diverted fentanyl on this date. Yeah, I felt like it doesn't matter because the laws and the rules and the regulations are what they are. They weren't going to change it based on the stressful circumstances or whatever. So, I almost felt kind of foolish, putting in the details.
Relapse. What we're told over and over again, when we learn about substance use disorder and we're taking care of our patients is that relapse is part of recovery. And when you're in your peer support groups, there's just this compassion around it. And although some programs do say that you start over on day one, and then you count your days again from that day for sobriety, there's still this sort of encompassing, like, it's okay and we've got you, and this isn't the end. And it's normal, it's so normal to relapse. But once you're involved in, you have a contract with a licensing body, that grace is not there. You get your one chance.
June 29, a large manila envelope was in the mailbox and I just, I knew it was them. And my first thought, I guess, was to just open it and I knew I didn't want to read it alone. So, I'm just gonna set it aside.
My daughter was coming for the weekend, and I didn't want to ruin the weekend. I put it in a cupboard, so that I wasn't tempted to read it. And I was really happy leaving it in that cupboard. I made a lot of excuses to not open it up.
I waited 10 days and I took it to a friend's house. She's also in recovery. And I actually had her open it, and my big fear honestly was, what I didn't want to read was any details about the relapse itself. I wanted to just get to the part of what's next. What are the facts? What's going to happen with my license? What steps do I have to take? What's the punishment? Let's just get to that part. I did not want to rehash the shameful details.
"This is from the State of Washington Department of Health Nursing Care Quality Assurance Commission, in the matter of Tiffany R. Swedeen. This is the findings of fact, conclusions of law, and the agreed order that the commission and respondent stipulate and agree to the following procedural stipulations."
Since it's legalese, we asked a lawyer to explain the letter.
The letter represents an order outlining an agreed-to set of facts. It summarizes the extent of Tiffany's interactions with the board from the first time she was caught diverting morphine in June of 2016, through to her decision to sign onto a 5-year contract with the WHPS monitoring program, in lieu of discipline that same year. It also captures the most recent complaint when Tiffany was caught stealing narcotics a second time.
The order requires Tiffany to, among other things, participate in the WHPS monitoring program, at her own expense, until WHPS determines that Tiffany's participation is no longer required.
It Will Be Like This Until I Die
Swedeen: And, this is the part, one of the parts that I was worried about. If the commission accepts this agreed order, it will be reported to the National Practitioner Data Bank, and elsewhere, as required by law.
So, that means that anybody who looks up my license, even just to check and see if I have an active license as a nurse, so any new employer, or anybody who feels like it, really, they'll see that there's like a red circle where everybody else doesn't have a red circle. And it says that there's enforcement on my license. And it will be until I die like this. There's no way to get this cleared off your license. It stays there forever.
There was nothing in the letter that said the words "suspend" or "revoke" or "inactive." So, that was a relief.
There had been this tiny unrealistic part of me that had hoped that based on this pandemic year, and the increase in relapses, and the lack of help that was provided, that maybe I would be this outlier. And they would see the work that I've done and the advocacy that I've done and how many other nurses I have tried to help navigate this disease, this disorder, that I would be an exception to the rule. Again, an unrealistic hope.
So, to see it in black and white, that this will be on your license forever -- that's a challenging feeling, like, what that means for my future career. I'm in the middle of a master's program, about to do my preceptorship, and I have to turn in proof of licensure. Will the school turn me down? Will I not be able to continue on in that program?
The charge against me is unprofessional conduct. And there's going to be employers or organizations or facilities out there that don't want an employee, they don't want to employ someone who has this on their record. That still remains to be seen for the rest of my career, for the next 25, 30 years.
Keeping Hope Alive
Obviously, you've been in this place before. The rules have changed a little bit, the consequences have changed. I think the first time around, you described to me the options you were given as essentially being on like a pink cloud. And this is a lot different from that.
What are you doing for yourself right now to maintain hope?
Swedeen: Well, I stay very closely connected with the She Recovers organization that has a peer support group for healthcare professionals. Knowing that I'm certainly not alone. I know that. I'm not the first or last nurse to have discipline on their license.
I think what gives me, I don't know if hope is the right word, but what gives me some purpose, and some meaning, I see so much potential for improvement in the processes and the policies and the regulations to support nurses specifically who have substance use and mental health disorders. I see gaps in the policies and room for change, and if that's my mission, well then, this public discipline doesn't limit me at all. It gives me credibility.
I have 16 months left in WHPS. I will fight tooth and nail to not relapse again, and hopefully just continue on in my professional journey as a nurse and an advocate and educator. And I do not have any intention of returning to an intensive care unit in the foreseeable future.
If there's a lesson in this story beyond the idea that nurses are not in fact unbreakable, it's that when the cracks in their fictitious armor start to show, and reveal something ugly or dark that we'd rather not see, we as a society need to serve nurses better, to support them in their healing.
MedPage Today caught up with Tiffany in late December. Her long-term plan is still to be a nurse consultant who creates curricula for nursing schools and helps to improve substance use prevention and treatment programs for nurses. And she's continuing to pursue a masters' degree in nursing education.
One final note about help-seeking: Most nurses who end up in treatment don't seek out help voluntarily. The stigma of substance use is still far too great. But none of the nurses in recovery we spoke to for this story and others said they regretted being caught. When we asked Tiffany, she said for the most part she was relieved. She said she'd like to think that she would've spoken up about her relapse to her recovery group sooner, but, and I'm quoting her, "that's just not always how substance abuse works."
To learn more about Tiffany's journey, read our print series written by Shannon Firth and Kara Grant called "'Pending Wave' of Nurse Substance Use Problems?" and "How to Help Nurses With Substance Use Problems Get Help."
If you or anyone you know has had thoughts of suicide, please call the National Suicide Prevention Lifeline at 1-800-273-8255.
Check out other stories from the Nurses in Recovery episode, including "Blacked Out on Fentanyl for a Day" and "Job, License, and Livelihood on the Line."
Want to share your story? Read the Anamnesis Storyteller Tip Sheet and when you're ready, apply here!