Job, License, and Livelihood on the Line

— After diverting drugs, the foundation begins to crack for this nurse

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This story is from the Anamnesis episode called A Nurse. A Pandemic. An Addiction and starts at 11:09 in the podcast. It's from Tiffany Swedeen, RN, BSN.

There are a few things you should know at this point in the story. This was not the first time Tiffany had been caught stealing medications.

In 2014, Tiffany's doctor prescribed her hydrocodone/acetaminophen (Vicodin) for migraines. She became addicted and from there, her substance use escalated.

In 2016, her hospital caught her stealing morphine. Now, a lot of hospitals, including Tiffany's, have this automated system for dispensing narcotics. So, if the same nurse removes too large a dose of medication or does this too frequently, the system flags the hospital pharmacy. Tiffany doesn't know how she was caught, but she was.

Her hospital put her on leave so she could get treatment. She was prescribed buprenorphine/naloxone (Suboxone) -- a medication for opioid use disorder -- and she enrolled in an alternative-to-discipline program, or an ATD.

ATDs are meant to be less punitive than traditional nurse monitoring programs. But as my colleagues Cheryl Clark and Ryan Basen have reported, just how progressive or punitive these programs are really varies across states.

Nurses in these programs typically are allowed to return to work and to keep their license clear of discipline as long as they meet certain requirements.

And so, on January 6, as Tiffany sat with her manager and another nurse waiting for someone 2 hours away to come and do a urine drug test, that's what was on her mind, how she'd been given this free pass nearly 5 years earlier. And now everything -- her job, her license, her livelihood -- was all on the line once more.

She was scared. She thought about leaving. She even considered trying to tamper with the test, but didn't see how she could. Ultimately, Tiffany decided the best thing she could do for herself and her career was just to follow the protocol. And when she had a moment alone with her manager, Tiffany let her know her urine would be positive for fentanyl.

'I Wanted to Go Home and Be Alone and Cry'

Swedeen: And I tried to comfort myself, I guess in some way, by recalling the nurses that I know that have been successful, that have relapsed. Almost everybody I know has. Everyone in recovery. So, I tried to give myself a little bit of that reassurance that this isn't what I wanted, but it was the truth.

So, after I handed off the sample, I just wanted to go home and be alone and cry, and call my case manager, and figure out what in the world to do with myself. And they wouldn't let me leave of my own accord. They wanted me to leave my vehicle, and have somebody pick me up -- or, if I tried to leave, they were going to call the police.

And so, it was kind of -- I felt like a miracle, actually. I do have a friend in the program that lives just minutes from the hospital. And I sent her a text. And I said, Are you home? I'm in trouble. And she texted me right back, and she was home, and she did have the day off work, and she knew exactly what I was going through, because she's been through it herself.

And so, when I told my manager that I had a ride, that was the end of it. She walked me outside and my friend drove up and she was already crying. And yeah, I got in my car and I mean I worked there 16 years. So, my whole nursing career from my very first nursing job in 2005. And I probably never will go back.

I do best when I am productive, and taking care of others. And what I kind of did was just ... I really intentionally tried to treat myself and follow the steps that I would tell somebody else to do.

Because what I wanted to do was pull the covers over my head, or put myself in a dark closet and never come out. That's what I really wanted to do. I wanted to drink.

And one of the brilliant things about that is the tools that I have cultivated over time really did kick in when they needed to -- like they ... I was devastated. And I was so scared, there's so much uncertainty. There was so much I didn't know. I was so terrified that I was going to lose my other job. That's what I was thinking. I won't have income. I won't have health insurance. How am I going to do this?

But another part of me that I guess is working -- okay, could kind of see clearly that all of the worry about the future, wasn't going to help me in that moment. That it was okay that I didn't know everything right now. And that if I just focused on the next phone call, or the next appointment to make, that this would eventually kind of be okay.

After her urine test and after calling her case manager, the next thing Tiffany had to do was meet with a drug and alcohol evaluator. The evaluator recommended she enroll in a relapse prevention program.

The stakes are high for nurses who are caught diverting narcotics and in some cases one offense is enough to be led out of a hospital in handcuffs. But Tiffany's hospital didn't choose that route. And the ATD in Washington state, Washington Health Professional Services, or WHPS for short, agreed with the evaluator's recommendation.

But WHPS also extended her contract -- meaning she would be subject to just over a year of additional monitoring before she could graduate.

The community college, Tiffany's second job, allowed her to return to work teaching after a brief pause. But in mid-February, someone from the college phoned and told her that the hospital where she'd diverted narcotics would not allow her to teach there, even though she'd previously been told she could.

That change meant moving from full-time to part-time work, and it meant missing the graduation of students that Tiffany had been working with for 2 years.

But the other big player in this is the nursing commission -- they're the ones that decide what will happen to Tiffany's license, and she had yet to hear from them.

Swedeen: So, it was about 10 days after the relapse occurred, and I was home -- not working, just trying to do the next right thing for my recovery. And really, I had to decide whether I even wanted to try to keep that job. Not in the ICU, I knew that I couldn't stay there, I wouldn't be allowed to, but just with this organization at all.

And I decided that for my sake, and for the hospital, I guess, that it just made the most sense for me to resign. My manager said that, she would support me if I wanted to try to work in a different department, but this was my second basically breach of integrity. It was the second time I've diverted narcotics from that hospital. And I just felt that it made the most sense that I step away from bedside care. And I was lucky that I had this other job as an instructor that I did have that choice, because a lot of nurses don't.

And out of the blue, I received a call from the nursing commission.

The Interrogation

Swedeen: I was walking my dog after getting lunch. And [the caller] introduced herself and asked if we could talk. It didn't feel like I had much of a choice. But as she began to ask me questions, it became apparent that it was more of an interrogation. This was worse than the day of the UA [urine analysis].

The investigator made some accusations that were completely false. She said, what I've heard is that you were uncooperative on the day of questioning, that you refused to answer questions about the drug that you diverted, that you refused to come in for questioning -- which shocked me, because as I said, I told my manager exactly what I had diverted even before they did the drug test.

I've never been through a police interrogation, but I've seen them on TV. And that is what it felt like. She was poking holes in my story and twisting my words. And she accused me of ... she didn't use the word "resignation." She said you self-terminated in order to avoid consequences -- basically, you cut and ran from this job.

I was in complete shock. I was horrified, because I felt like she was stating it as though these were facts that my former employer told her that the hospital or HR had told her. And I was confused because that's not how things went at all. There was no day of questioning and she said it as though there was a date I was supposed to come in and speak to them, to the hospital, and that I refused to show up.

And I was racking my brain, because I was so confused about her timeline. I was confused. She said, well, you obviously got pulled off the floor because they thought you were impaired at work. And that's not how it went, either. I did the urine analysis 3 days after the date of diversion.

And when she said that I self-terminated, she said, I don't understand how you could walk away from frontline workers, who need you there right now. She said you of all people know how bad the hospitals are hurting for nurses. It makes no sense that you would resign. She said the front line is hurting, and you left them.

I felt like I had been given some false hope -- basically that relapse is a terrible thing, and no, you can't work with patients anymore, right, or at least, not right now. Not for the foreseeable future. But you're still in WHPS, you're doing the right thing. You're totally engaged in your recovery. But I've already seen an expert evaluator. And I've been given sort of support along the way, other than I guess those two things happened a couple days apart -- first getting the phone call that said, yes, we gave you a badge and you filled out all the paperwork, and you brought your students into our organization as an instructor, but we changed our mind; you can't ever come back.

And then 2 days later I got this phone call completely out of the blue, that nobody had even said would happen.

So, yeah, my whole foundation just was cracking. Like, maybe this is all not going to be okay. Maybe the worst things possible, which in my mind would be like revocation of my license, loss of a career.

Maybe those things really will happen?

Check out other stories from the Nurses in Recovery episode, including "Blacked Out on Fentanyl for a Day" and "TK."

Want to share your story? Read the Anamnesis Storyteller Tip Sheet and when you're ready, apply here!