WEBVTT 00:00:06.980 --> 00:00:10.090 position:50% align:middle - [Rodrigo] Good afternoon, and thank you for inviting us to join you this afternoon. 00:00:10.090 --> 00:00:11.960 position:50% align:middle We sincerely appreciate it. 00:00:11.960 --> 00:00:16.980 position:50% align:middle You know, on the way here Claudia and I got nervous, nervous, like we have done hundreds of times when we're 00:00:16.980 --> 00:00:21.770 position:50% align:middle presenting this content, we get nervous about something that you may not expect 00:00:21.770 --> 00:00:23.340 position:50% align:middle or may not have anticipated. 00:00:23.340 --> 00:00:26.130 position:50% align:middle It's not because we're not prepared for the content. 00:00:26.130 --> 00:00:29.750 position:50% align:middle It's not because we have stage fright or apprehension speaking. 00:00:29.750 --> 00:00:31.210 position:50% align:middle It's because something much bigger than that. 00:00:31.210 --> 00:00:34.770 position:50% align:middle But to explain that a little bit more detail, we have to go back in some time. 00:00:34.770 --> 00:00:37.880 position:50% align:middle Twelve years ago, to be exact, it was about 2012. 00:00:37.880 --> 00:00:43.300 position:50% align:middle I had been out of the treatment program for about a year and I was still currently unemployed. 00:00:43.300 --> 00:00:48.670 position:50% align:middle Claudia was working tirelessly to keep the family together, to keep the finances together, 00:00:48.670 --> 00:00:51.660 position:50% align:middle and we had so much professional uncertainty and personal uncertainty. 00:00:51.660 --> 00:00:55.850 position:50% align:middle We really didn't know what was going to happen next and where we were going to go. 00:00:55.850 --> 00:00:58.420 position:50% align:middle However, we know that we wanted to tell our story. 00:00:58.420 --> 00:01:02.670 position:50% align:middle We had been through a lived experience, a trauma of sorts that we thought was going to be very 00:01:02.670 --> 00:01:06.220 position:50% align:middle helpful if other people could hear that story as well. 00:01:06.220 --> 00:01:10.710 position:50% align:middle So, we got the idea that we wanted to put this out in front of as many people as we can and see what happens. 00:01:10.710 --> 00:01:15.310 position:50% align:middle We started making some phone calls, and as you can imagine trying to get on stage 00:01:15.310 --> 00:01:23.060 position:50% align:middle as an opioid-addicted anesthesia provider with a family member, it wasn't a very exciting possibility for a 00:01:23.060 --> 00:01:24.260 position:50% align:middle speaker for many folks. 00:01:24.260 --> 00:01:26.390 position:50% align:middle We had a lot of, "Thank you, but no thanks. 00:01:26.390 --> 00:01:28.070 position:50% align:middle That's not exactly what we're looking for." 00:01:28.070 --> 00:01:32.490 position:50% align:middle And then we came across this gentleman who to this day is one of our good friends, and he said, "You know, 00:01:32.490 --> 00:01:34.330 position:50% align:middle I have the perfect venue for you to speak at. 00:01:34.330 --> 00:01:36.030 position:50% align:middle I heard your story, it is very compelling. 00:01:36.030 --> 00:01:37.410 position:50% align:middle I like you two as people. 00:01:37.410 --> 00:01:40.960 position:50% align:middle I'd like to invite you to come and be one of the keynote speakers at our presentation 00:01:40.960 --> 00:01:44.000 position:50% align:middle for our conference." We said, "Phenomenal. We'll do it." 00:01:44.000 --> 00:01:50.370 position:50% align:middle The organization happen to be an organization that was of individuals, a group of individuals that was tasked 00:01:50.370 --> 00:01:53.370 position:50% align:middle with investigating diversion in healthcare. 00:01:53.370 --> 00:01:58.980 position:50% align:middle They worked for hospital systems and their sole purpose was to find the diversion amongst healthcare providers 00:01:58.980 --> 00:02:02.120 position:50% align:middle and help mitigate some of those consequences that happen with that. 00:02:02.120 --> 00:02:07.600 position:50% align:middle So, as a result, we drove about five hours to this venue and we're off stage feeling nervous, 00:02:07.600 --> 00:02:09.930 position:50% align:middle just like we did this morning when we were coming on stage. 00:02:09.930 --> 00:02:13.500 position:50% align:middle And he gets on stage to introduce us and he says, "Ladies and gentlemen, 00:02:13.500 --> 00:02:15.900 position:50% align:middle I'd like to introduce you to this live specimen. 00:02:15.900 --> 00:02:18.710 position:50% align:middle This is the live specimen I've been talking to you about." 00:02:18.710 --> 00:02:22.350 position:50% align:middle Now, as you can imagine, we were both very taken aback by that and a little bit 00:02:22.350 --> 00:02:26.300 position:50% align:middle curious as to who exactly were who they were talking about, even though we knew it was us. 00:02:26.300 --> 00:02:30.970 position:50% align:middle And as we get on stage and the title of this presentation, "Catch Me If You Can," pops up on the 00:02:30.970 --> 00:02:34.850 position:50% align:middle screen behind us, we hear one of the gentlemen in the back of the room with a Stetson hat and 00:02:34.850 --> 00:02:36.350 position:50% align:middle the cowboy buckle. 00:02:36.350 --> 00:02:39.010 position:50% align:middle He stands up and he says, "Oh, we're going to catch you. 00:02:39.010 --> 00:02:40.150 position:50% align:middle We're going to catch all of you." 00:02:40.150 --> 00:02:46.660 position:50% align:middle And it was at that moment that we knew what we were going to be facing if we continued on this journey. 00:02:46.660 --> 00:02:49.760 position:50% align:middle It was much more than addiction and mental health. 00:02:49.760 --> 00:02:56.200 position:50% align:middle It was stigma and the way culture and the way society views addiction amongst healthcare providers and mental 00:02:56.200 --> 00:02:58.620 position:50% align:middle health against healthcare providers. 00:02:58.620 --> 00:03:00.620 position:50% align:middle To this day, we still feel some of that. 00:03:00.620 --> 00:03:04.540 position:50% align:middle And I tell you this for this reason, if during the course of this presentation, 00:03:04.540 --> 00:03:07.890 position:50% align:middle you feel a little uncomfortable, you have some disagreements, 00:03:07.890 --> 00:03:11.460 position:50% align:middle it may hit a nerve the wrong way in some certain aspects. 00:03:11.460 --> 00:03:14.510 position:50% align:middle That's okay. That's very welcome. And it's very normal. 00:03:14.510 --> 00:03:21.750 position:50% align:middle Our goal for this presentation is to generate discussion, to stimulate conversation, and to move the 00:03:21.750 --> 00:03:26.400 position:50% align:middle needle forward for our organization and for our colleagues in regards to mental health and addiction 00:03:26.400 --> 00:03:29.810 position:50% align:middle within our profession. 00:03:29.810 --> 00:03:33.020 position:50% align:middle And with that, my name is Rodrigo, and this is Claudia. 00:03:33.020 --> 00:03:37.600 position:50% align:middle We've both been in the healthcare profession as direct care providers in the field of nursing in some regard 00:03:37.600 --> 00:03:39.980 position:50% align:middle for over 40 years, collectively. 00:03:39.980 --> 00:03:44.150 position:50% align:middle There's a line that you see on this screen here, this yellow line and everything above that line seems 00:03:44.150 --> 00:03:46.810 position:50% align:middle to be so simple, intuitive to me today. 00:03:46.810 --> 00:03:49.150 position:50% align:middle And Claudia has always had this part correct. 00:03:49.150 --> 00:03:51.160 position:50% align:middle It's what's really important. 00:03:51.160 --> 00:03:55.250 position:50% align:middle I'm a husband and a father, and that's what I associate myself as today. 00:03:55.250 --> 00:03:58.120 position:50% align:middle And Claudia has always seemed to have that order correct. 00:03:58.120 --> 00:04:00.420 position:50% align:middle She's a mother and she's a wife. 00:04:00.420 --> 00:04:02.180 position:50% align:middle Everything else is our day job. 00:04:02.180 --> 00:04:04.130 position:50% align:middle This is what we kind of do day by day. 00:04:04.130 --> 00:04:06.110 position:50% align:middle And that's all it is at this point. 00:04:06.110 --> 00:04:09.680 position:50% align:middle We're co-founders of Parkdale Center, which is a behavioral health and mental health 00:04:09.680 --> 00:04:12.680 position:50% align:middle treatment center for healthcare providers, professionals. 00:04:12.680 --> 00:04:18.570 position:50% align:middle We work with a couple of state monitoring programs to make sure that we can help assist nurses as they 00:04:18.570 --> 00:04:22.310 position:50% align:middle re-enter the profession after they have an experience with mental health or with substance use 00:04:22.310 --> 00:04:23.700 position:50% align:middle disorder as well. 00:04:23.700 --> 00:04:28.750 position:50% align:middle One of the things that we didn't expect getting into this profession is that we now consult for hospitals 00:04:28.750 --> 00:04:33.870 position:50% align:middle and we help them identify and mitigate any kind of risk and fallout in terms of the 00:04:33.870 --> 00:04:35.490 position:50% align:middle impaired healthcare provider. 00:04:35.490 --> 00:04:41.240 position:50% align:middle So, we're getting this firsthand perspective of a lot of different areas when it talks to substance 00:04:41.240 --> 00:04:44.670 position:50% align:middle use disorder, mental health, and the healthcare provider. 00:04:44.670 --> 00:04:49.680 position:50% align:middle I think to start this conversation, we want to tell you a story about one of our children. 00:04:49.680 --> 00:04:52.890 position:50% align:middle She is now on her own and she's working as a social worker. 00:04:52.890 --> 00:04:58.740 position:50% align:middle But as she was leaving high school, going into college, there was an area that she had to get addressed 00:04:58.740 --> 00:05:00.610 position:50% align:middle before she went off to school. 00:05:00.610 --> 00:05:03.620 position:50% align:middle The same kind of rite of passage that most kids that age do. 00:05:03.620 --> 00:05:05.820 position:50% align:middle And that's removal of her wisdom teeth. 00:05:05.820 --> 00:05:08.710 position:50% align:middle Now, what does that have to do with what we're talking about today? 00:05:08.710 --> 00:05:14.580 position:50% align:middle You'll soon find out. She had to go get her evaluation first to get her wisdom teeth extracted. 00:05:14.580 --> 00:05:18.590 position:50% align:middle And we took her there to the hospital and she got her evaluation done. 00:05:18.590 --> 00:05:19.700 position:50% align:middle She met with the nurse. 00:05:19.700 --> 00:05:22.443 position:50% align:middle She met with the billing coordinator, of course. 00:05:22.443 --> 00:05:26.050 position:50% align:middle She met with about four or five people and they said, "Yep, these teeth need to come out. 00:05:26.050 --> 00:05:27.570 position:50% align:middle They need to do it before you go out to college. 00:05:27.570 --> 00:05:32.770 position:50% align:middle So, what we're going to do next is send you to get your labs done, your pre-op paperwork." 00:05:32.770 --> 00:05:38.050 position:50% align:middle So, the next day we show up at the laboratory and she met about three or four people that day as well. 00:05:38.050 --> 00:05:39.180 position:50% align:middle They drew her blood. 00:05:39.180 --> 00:05:40.680 position:50% align:middle They got her insurance card. 00:05:40.680 --> 00:05:46.360 position:50% align:middle They did some pre-op work for the surgery that was scheduled a couple of days later and then sent us home. 00:05:46.360 --> 00:05:50.370 position:50% align:middle A couple of days later, we showed up for the surgery and we got there early and 00:05:50.370 --> 00:05:52.530 position:50% align:middle we met another handful of individuals. 00:05:52.530 --> 00:05:55.790 position:50% align:middle We met some of the nurses, the anesthesia provider who would be providing 00:05:55.790 --> 00:05:57.430 position:50% align:middle services that day. 00:05:57.430 --> 00:06:01.140 position:50% align:middle We met the surgeon, of course, the nurse, the recovery room nurse. 00:06:01.140 --> 00:06:05.930 position:50% align:middle And we had all of our instructions for how we should take her home and care for her on that day. 00:06:05.930 --> 00:06:09.137 position:50% align:middle And it was at that moment that Claudia and I realized something 00:06:09.137 --> 00:06:11.660 position:50% align:middle as they're wheeling our daughter off to surgery. 00:06:11.660 --> 00:06:15.240 position:50% align:middle - [Claudia] So, while we were in the waiting room, we were both anxious and nervous, 00:06:15.240 --> 00:06:19.850 position:50% align:middle probably more anxious and nervous than we should have been, especially since we're both in healthcare. 00:06:19.850 --> 00:06:22.980 position:50% align:middle We're both nurses. We understand what takes place in surgery. 00:06:22.980 --> 00:06:24.580 position:50% align:middle But we were really nervous. 00:06:24.580 --> 00:06:29.840 position:50% align:middle And what we realized was that we started thinking about all the people she came in contact with, 00:06:29.840 --> 00:06:34.200 position:50% align:middle and we knew statistically speaking, that one to two of the people that she came in contact 00:06:34.200 --> 00:06:37.020 position:50% align:middle with was struggling with a substance use disorder. 00:06:37.020 --> 00:06:40.200 position:50% align:middle They were either coming in hungover, they were actively using, 00:06:40.200 --> 00:06:42.570 position:50% align:middle or maybe they were looking for their next fix. 00:06:42.570 --> 00:06:46.490 position:50% align:middle If we're lucky, it was the person who took her insurance card or the person who greeted her 00:06:46.490 --> 00:06:52.080 position:50% align:middle at the door. But if we're not so lucky, maybe it's the surgeon or the anesthesia provider or 00:06:52.080 --> 00:06:53.970 position:50% align:middle the nurse who's taking care of her. 00:06:53.970 --> 00:06:57.270 position:50% align:middle And as you can see, it's really all a game of chance. 00:06:57.270 --> 00:06:59.970 position:50% align:middle So, we want to talk to you today about six different things. 00:06:59.970 --> 00:07:01.840 position:50% align:middle We want to talk to you about our story. 00:07:01.840 --> 00:07:04.350 position:50% align:middle Why we're here today and why we're doing what we do. 00:07:04.350 --> 00:07:07.820 position:50% align:middle Also, we want to talk to you about substance use disorder in America, 00:07:07.820 --> 00:07:13.880 position:50% align:middle substance use disorder in the profession, and is addiction a disease or is it a choice? 00:07:13.880 --> 00:07:16.950 position:50% align:middle Also, managing the impairment of a healthcare worker. 00:07:16.950 --> 00:07:20.250 position:50% align:middle So, what do you do if you're the one struggling with a substance use disorder? 00:07:20.250 --> 00:07:21.680 position:50% align:middle Do you know how to get help? 00:07:21.680 --> 00:07:24.560 position:50% align:middle Or if your colleague needed help, do you know what you would do? 00:07:24.560 --> 00:07:27.050 position:50% align:middle And the last one is the provider wellness. 00:07:27.050 --> 00:07:30.070 position:50% align:middle How do you take care of yourself and what should you do to take care of yourself? 00:07:30.070 --> 00:07:35.230 position:50% align:middle - So, to get this started, we want to start telling you a little bit more about our story. 00:07:35.230 --> 00:07:39.590 position:50% align:middle And I think this is going to make a lot more sense when we get through it to you, and we tell it as our story. 00:07:39.590 --> 00:07:43.510 position:50% align:middle But this story has been repeated so many times across the country. 00:07:43.510 --> 00:07:48.010 position:50% align:middle And just at the treatment center alone, we've heard the same story 3500 times now 00:07:48.010 --> 00:07:51.410 position:50% align:middle with healthcare providers who have gone through a very, very similar... 00:07:51.410 --> 00:07:56.630 position:50% align:middle We tell people all the time if you change the name of the hospital and the facility, 00:07:56.630 --> 00:08:01.050 position:50% align:middle you change the precipitating event, the rest of the story is the same with healthcare providers. 00:08:01.050 --> 00:08:03.980 position:50% align:middle You can almost lay them right on top of each other. 00:08:03.980 --> 00:08:08.180 position:50% align:middle So, before Claudia and I met, I'll tell you the background for me because this is a 00:08:08.180 --> 00:08:09.580 position:50% align:middle very similar background. 00:08:09.580 --> 00:08:15.720 position:50% align:middle I grew up in what would be considered middle America and mom, dad, brother, sister, white picket fence, 00:08:15.720 --> 00:08:20.480 position:50% align:middle private school education, everything seemed to be the American dream, 00:08:20.480 --> 00:08:22.180 position:50% align:middle so to speak. 00:08:22.180 --> 00:08:27.970 position:50% align:middle It took me a long time to realize how significant this part was, but it was so significant that it took me 00:08:27.970 --> 00:08:29.750 position:50% align:middle about 25 years to undo it. 00:08:29.750 --> 00:08:37.950 position:50% align:middle But I was primed and conditioned from a very young age to realize that my accomplishments and my successes 00:08:37.950 --> 00:08:40.980 position:50% align:middle to me correlated with my acceptance and my approval. 00:08:40.980 --> 00:08:44.040 position:50% align:middle And even in some cases, to the love that I received growing up. 00:08:44.040 --> 00:08:49.650 position:50% align:middle In other words, the better I did, the more I did, the more I succeeded, the more I felt accepted, 00:08:49.650 --> 00:08:50.910 position:50% align:middle the more I felt loved. 00:08:50.910 --> 00:08:54.610 position:50% align:middle And it was something that it was early on very easy for me to do. 00:08:54.610 --> 00:08:59.560 position:50% align:middle I'll just do a little extra and I'll get a couple extra hugs and a couple extra pats on the back. 00:08:59.560 --> 00:09:03.870 position:50% align:middle That situation had played out repeatedly throughout my life. 00:09:03.870 --> 00:09:09.610 position:50% align:middle I went to an accelerated program in nursing school and I graduated with my first degree, my bachelor's degree, 00:09:09.610 --> 00:09:17.270 position:50% align:middle at the age of 20. I spent the next eight years what I would describe on this...it was this very chaotic, 00:09:17.270 --> 00:09:23.240 position:50% align:middle super speed climbing the corporate ladder through the nursing profession, picking up as much accolades and 00:09:23.240 --> 00:09:26.130 position:50% align:middle awards and certifications and training as I could. 00:09:26.130 --> 00:09:30.220 position:50% align:middle I experienced the trauma E.R., and the ICU, and the neuro ICU. 00:09:30.220 --> 00:09:35.480 position:50% align:middle I went on to anesthesia school and became a nurse anesthetist in 2004, 00:09:35.480 --> 00:09:38.630 position:50% align:middle and this was as fast as I could and as high as I could. 00:09:38.630 --> 00:09:43.550 position:50% align:middle I took on some roles at the university, being a clinical preceptor and an instructor. 00:09:43.550 --> 00:09:49.700 position:50% align:middle And the first time I remember catching my breath, ironically, was at the end of that eight-year run when 00:09:49.700 --> 00:09:54.150 position:50% align:middle I could finally take a big, deep breath and I landed as a chief anesthetist at a 00:09:54.150 --> 00:09:55.490 position:50% align:middle hospital in a surgery center. 00:09:55.490 --> 00:09:56.960 position:50% align:middle And that's where I met Claudia. 00:09:56.960 --> 00:10:00.350 position:50% align:middle - So, Rodrigo and I met working in surgery. 00:10:00.350 --> 00:10:05.880 position:50% align:middle And one of the things that I noticed early on about Rodrigo was that he was well liked, well respected. 00:10:05.880 --> 00:10:08.580 position:50% align:middle He was everyone's go-to person, highly intelligent. 00:10:08.580 --> 00:10:12.760 position:50% align:middle And I remember he was the one that would always get the Employee of the Month award. 00:10:12.760 --> 00:10:15.770 position:50% align:middle And there were times where he would get the award months in a row. 00:10:15.770 --> 00:10:20.350 position:50% align:middle And, you know, after a few years of dating, Rodrigo decided to join a baseball league. 00:10:20.350 --> 00:10:24.900 position:50% align:middle And I remember this particular situation, this day like it happened yesterday, because little did I 00:10:24.900 --> 00:10:27.370 position:50% align:middle know that it would forever change our lives. 00:10:27.370 --> 00:10:29.550 position:50% align:middle Rodrigo was playing a baseball game. 00:10:29.550 --> 00:10:34.290 position:50% align:middle He jumped up to catch a ball and when he came back down, he landed on his ankle. 00:10:34.290 --> 00:10:36.020 position:50% align:middle From a distance, I knew he was in trouble. 00:10:36.020 --> 00:10:37.720 position:50% align:middle I saw the way he landed on his ankle. 00:10:37.720 --> 00:10:40.060 position:50% align:middle His ankle swelled up immediately. 00:10:40.060 --> 00:10:41.670 position:50% align:middle We went to the E.R. 00:10:41.670 --> 00:10:43.750 position:50% align:middle While we were in the E.R., they gave him some opiates. 00:10:43.750 --> 00:10:46.320 position:50% align:middle That was the first time Rodrigo had ever taken an opiate. 00:10:46.320 --> 00:10:48.190 position:50% align:middle They gave it to him obviously for the pain. 00:10:48.190 --> 00:10:52.420 position:50% align:middle But we found out that he had torn all the ligaments on his ankle and that he was going to require 00:10:52.420 --> 00:10:54.150 position:50% align:middle some extensive surgery. 00:10:54.150 --> 00:10:58.480 position:50% align:middle They told him he had to wait a few days, so they kept him on opiates for a few days until the 00:10:58.480 --> 00:11:02.440 position:50% align:middle swelling was down. Then they did the surgery and he was on opiates as well. 00:11:02.440 --> 00:11:06.100 position:50% align:middle Then he went through physical rehab and also was on opiates. 00:11:06.100 --> 00:11:07.910 position:50% align:middle So, he was on opiates for a few weeks. 00:11:07.910 --> 00:11:11.080 position:50% align:middle And I remember during this time, even when he was home and he was just going 00:11:11.080 --> 00:11:12.950 position:50% align:middle through his rehab, he was different. 00:11:12.950 --> 00:11:14.470 position:50% align:middle Rodrigo was quiet. 00:11:14.470 --> 00:11:15.730 position:50% align:middle He was withdrawn. 00:11:15.730 --> 00:11:17.270 position:50% align:middle He was irritable. 00:11:17.270 --> 00:11:19.200 position:50% align:middle He was disconnected from the family. 00:11:19.200 --> 00:11:22.740 position:50% align:middle But of course, at the time I thought, "Well, it's because he just had a major surgery. 00:11:22.740 --> 00:11:24.100 position:50% align:middle He's going through a lot." 00:11:24.100 --> 00:11:27.840 position:50% align:middle One of the things I noticed was that he was going through his medication really fast. 00:11:27.840 --> 00:11:32.560 position:50% align:middle At one point, his physician had given him a prescription for four days of pain medication. 00:11:32.560 --> 00:11:34.020 position:50% align:middle He went through it in two days. 00:11:34.020 --> 00:11:38.200 position:50% align:middle And as a nurse, I thought, "Well, he obviously needs stronger medication or more." 00:11:38.200 --> 00:11:39.290 position:50% align:middle So, we're calling the physician. 00:11:39.290 --> 00:11:41.110 position:50% align:middle We're getting more medication for him. 00:11:41.110 --> 00:11:43.090 position:50% align:middle But this went on for weeks and weeks. 00:11:43.090 --> 00:11:46.570 position:50% align:middle And after about six weeks, it was time for Rodrigo to get back to work. 00:11:46.570 --> 00:11:51.120 position:50% align:middle And I was super excited because I thought, "Well, if he gets back to work, maybe the old Rodrigo 00:11:51.120 --> 00:11:52.130 position:50% align:middle will come back. 00:11:52.130 --> 00:11:56.190 position:50% align:middle He'll be connected again, happy, social, and all the things that I loved about him 00:11:56.190 --> 00:11:57.210 position:50% align:middle would come back." 00:11:57.210 --> 00:11:59.080 position:50% align:middle So, here it's time to get back to work. 00:11:59.080 --> 00:12:03.280 position:50% align:middle He's back at work and I noticed right away that he was different at work. 00:12:03.280 --> 00:12:06.280 position:50% align:middle But again, he had been off for a while, so it made sense. 00:12:06.280 --> 00:12:09.000 position:50% align:middle But this went on for weeks and weeks and months and months. 00:12:09.000 --> 00:12:14.730 position:50% align:middle And after about six months, I realized that Rodrigo was struggling and he was 00:12:14.730 --> 00:12:15.980 position:50% align:middle having a hard time with something. 00:12:15.980 --> 00:12:20.410 position:50% align:middle At the time, I didn't know what it was, but when I figured it out that he was struggling 00:12:20.410 --> 00:12:26.210 position:50% align:middle with addiction and he needed help as a colleague and as a loved one, I didn't know what to do. 00:12:26.210 --> 00:12:29.680 position:50% align:middle I did everything in my power to get him help just the best way that I knew. 00:12:29.680 --> 00:12:31.360 position:50% align:middle But I didn't know a whole lot back then. 00:12:31.360 --> 00:12:33.090 position:50% align:middle So, I did what I could. 00:12:33.090 --> 00:12:39.000 position:50% align:middle And, you know, eventually, after a few weeks, he finally ended up in a treatment center. 00:12:39.000 --> 00:12:41.200 position:50% align:middle He was escorted out of the facility at work. 00:12:41.200 --> 00:12:43.430 position:50% align:middle He was there one day and he was gone the next. 00:12:43.430 --> 00:12:45.630 position:50% align:middle Everything just happened so fast. 00:12:45.630 --> 00:12:50.890 position:50% align:middle But as a healthcare worker and as a loved one, I was left just at a loss of words because I had no 00:12:50.890 --> 00:12:52.640 position:50% align:middle idea how we even got here. 00:12:52.640 --> 00:12:54.370 position:50% align:middle Like, how does this happen to someone? 00:12:54.370 --> 00:12:57.950 position:50% align:middle As Rodrigo described, someone who came from a very good family, 00:12:57.950 --> 00:13:01.780 position:50% align:middle someone highly educated, and how does addiction come into our home? 00:13:01.780 --> 00:13:03.090 position:50% align:middle Like, why does this happen? 00:13:03.090 --> 00:13:10.950 position:50% align:middle - The worst part about that time was that on the surface it looked like bad decisions. 00:13:10.950 --> 00:13:12.480 position:50% align:middle And there certainly were some bad decisions. 00:13:12.480 --> 00:13:19.590 position:50% align:middle It looked like a character flaw maybe. It looked like poor willpower, no willpower at all. 00:13:19.590 --> 00:13:22.200 position:50% align:middle But underneath the surface, and there's just like one scratch 00:13:22.200 --> 00:13:29.920 position:50% align:middle underneath the surface, it was filled with shame, and guilt, and remorse, and worry, and fear. 00:13:29.920 --> 00:13:36.420 position:50% align:middle And it had become probably the exact opposite of the way that I was raised. 00:13:36.420 --> 00:13:39.890 position:50% align:middle Like as long as you do good things, you're going to get a lot of love and now you're 00:13:39.890 --> 00:13:41.730 position:50% align:middle doing bad things, nobody's going to love you. 00:13:41.730 --> 00:13:45.050 position:50% align:middle That was the thought process during that whole time, which was, you know, 00:13:45.050 --> 00:13:49.740 position:50% align:middle even 12 years later now is difficult to wrap my head around that kind of feeling of being in that 00:13:49.740 --> 00:13:55.560 position:50% align:middle kind of space. But nonetheless, the whole event and this whole traumatic event, because it truly was a 00:13:55.560 --> 00:13:58.380 position:50% align:middle traumatic event, and it lasted about nine months. 00:13:58.380 --> 00:14:03.690 position:50% align:middle And when I say it lasted nine months, it meant from the top of the professional and personal 00:14:03.690 --> 00:14:07.460 position:50% align:middle mountain where I was, in a sense, the golden child. 00:14:07.460 --> 00:14:13.010 position:50% align:middle And I felt like the golden child and the people around me treated me like I was the golden child, to this 00:14:13.010 --> 00:14:14.830 position:50% align:middle replaceable, go off to the side. 00:14:14.830 --> 00:14:18.210 position:50% align:middle You get everything that's coming to you kind of position as a nurse. 00:14:18.210 --> 00:14:25.010 position:50% align:middle I had a hard time wrapping my head around how it could go from the top to the bottom so quickly, and which 00:14:25.010 --> 00:14:30.310 position:50% align:middle leads us to believe that there has to be more than just because I took a prescription for an injury, 00:14:30.310 --> 00:14:32.240 position:50% align:middle this has happened. There has to be more. 00:14:32.240 --> 00:14:37.430 position:50% align:middle Not everybody that takes a medication, an opiate, for example, becomes addicted to the medications. 00:14:37.430 --> 00:14:38.690 position:50% align:middle So, why is that? 00:14:38.690 --> 00:14:43.760 position:50% align:middle And to understand that at the very basic root level, we have to trace this all the way back 00:14:43.760 --> 00:14:47.510 position:50% align:middle to the beginnings, all the way to where this starts. 00:14:47.510 --> 00:14:50.030 position:50% align:middle We know it starts in one of two places or two roads. 00:14:50.030 --> 00:14:52.380 position:50% align:middle Think of it as two roads eventually converging. 00:14:52.380 --> 00:14:57.620 position:50% align:middle A precipitating event will help that convergence like an injury or a prescription. 00:14:57.620 --> 00:15:01.940 position:50% align:middle But these two roads are our lived experiences, our personal experiences, the way that we were raised. 00:15:01.940 --> 00:15:09.760 position:50% align:middle And the second road is culture and society, and how the United States treats this and how our profession treats 00:15:09.760 --> 00:15:12.760 position:50% align:middle this and thinks of it, and how society treats it and thinks of it. 00:15:12.760 --> 00:15:18.660 position:50% align:middle And unfortunately, a large percentage of us as healthcare providers will have these roads converge, 00:15:18.660 --> 00:15:20.070 position:50% align:middle and that's when these decisions are made. 00:15:20.070 --> 00:15:21.910 position:50% align:middle And we're going to talk about that a little bit. 00:15:21.910 --> 00:15:27.170 position:50% align:middle What does substance use disorder look like, and how prevalent is it in the United States currently? 00:15:27.170 --> 00:15:32.610 position:50% align:middle - So, what we know is that one in three people personally know someone with a substance use disorder. 00:15:32.610 --> 00:15:36.890 position:50% align:middle So, these are our friends, our co-workers, our colleagues, maybe our neighbors. 00:15:36.890 --> 00:15:42.360 position:50% align:middle And 1 in 7 people, so about 15% live with someone with a substance use disorder. 00:15:42.360 --> 00:15:46.120 position:50% align:middle So, these are our parents, our children, our spouses, our loved ones. 00:15:46.120 --> 00:15:50.400 position:50% align:middle And my heart always goes out to this population because that was me not too long ago. 00:15:50.400 --> 00:15:55.930 position:50% align:middle And I remember how envious and jealous sometimes I was of my colleagues when they used to end their days. 00:15:55.930 --> 00:16:00.030 position:50% align:middle They used to tell me how excited they were to end their day and go home to their families, and spend time 00:16:00.030 --> 00:16:04.780 position:50% align:middle with their kids and their spouses, and do homework, and all the things you do as a mom and as a parent. 00:16:04.780 --> 00:16:07.810 position:50% align:middle And sometimes for me, it was the scariest part of my day because I didn't 00:16:07.810 --> 00:16:09.300 position:50% align:middle know what I was walking into. 00:16:09.300 --> 00:16:11.680 position:50% align:middle Was I walking into someone who was sober? 00:16:11.680 --> 00:16:15.430 position:50% align:middle Was I walking into chaos or maybe an overdose? 00:16:15.430 --> 00:16:21.730 position:50% align:middle And 1 in 10 people, so about 10% of the population meets the DSM-5 criteria for a substance use disorder. 00:16:21.730 --> 00:16:26.160 position:50% align:middle So, now these are our doctors, our nurses, our pharmacists, and all the other occupations and all 00:16:26.160 --> 00:16:28.890 position:50% align:middle the other people that suffer from this disease. 00:16:28.890 --> 00:16:34.220 position:50% align:middle - So, when we're trying to figure out why did this happen and how did we get to this point, 00:16:34.220 --> 00:16:39.530 position:50% align:middle you don't have to look too far back in time to be able to trace this back when we're looking at the United 00:16:39.530 --> 00:16:41.525 position:50% align:middle States and the problems with substance use disorder 00:16:41.525 --> 00:16:44.150 position:50% align:middle and how that parlays over into the healthcare industry as well. 00:16:44.150 --> 00:16:51.160 position:50% align:middle So, you look at things like the infamous fifth vital sign. I was a very young nurse when I first had this 00:16:51.160 --> 00:16:56.880 position:50% align:middle intuition that there was something around this that wasn't really kind of sitting right. And the stories 00:16:56.880 --> 00:17:00.830 position:50% align:middle would go like this or my recollection of the events at that time was like this. 00:17:00.830 --> 00:17:03.950 position:50% align:middle Every weekend we would have the same group of people. 00:17:03.950 --> 00:17:08.670 position:50% align:middle When I was working in the emergency room, patients, they would come in and they would almost ask 00:17:08.670 --> 00:17:15.050 position:50% align:middle what they wanted. I worked in an inner city, a very high acuity, a very noncompliant patient population, 00:17:15.050 --> 00:17:17.170 position:50% align:middle and a high incidence of sickle cell. 00:17:17.170 --> 00:17:22.260 position:50% align:middle So, the same group of people would come in and they would say, "I need 50 milligrams of this, please, 00:17:22.260 --> 00:17:23.140 position:50% align:middle and make sure you flush it. 00:17:23.140 --> 00:17:26.460 position:50% align:middle And if you wouldn't mind, please use the portacath that I have here." 00:17:26.460 --> 00:17:29.227 position:50% align:middle And I thought that was odd the first couple of times I heard it, 00:17:29.227 --> 00:17:32.430 position:50% align:middle and I would take it back to the attending in the emergency room and say, 00:17:32.430 --> 00:17:33.480 position:50% align:middle "Well, I'm looking at her. 00:17:33.480 --> 00:17:39.150 position:50% align:middle It doesn't look like she has that much pain, but she's saying that her pain is off the roof and this 00:17:39.150 --> 00:17:40.360 position:50% align:middle is what they want." 00:17:40.360 --> 00:17:44.450 position:50% align:middle And physician, without hesitation would say, "Well, that's what you give them. 00:17:44.450 --> 00:17:45.980 position:50% align:middle Go ahead and give it to them. It'll be fine. 00:17:45.980 --> 00:17:48.440 position:50% align:middle Treat them every week, just give them their medication." 00:17:48.440 --> 00:17:49.610 position:50% align:middle I always thought that was odd. 00:17:49.610 --> 00:17:54.600 position:50% align:middle And I also thought it was odd that there was an assessment part about pain. 00:17:54.600 --> 00:17:58.150 position:50% align:middle Even if the differential diagnosis didn't include a pain component. 00:17:58.150 --> 00:18:00.680 position:50% align:middle They came in for COPD, they came in for asthma. 00:18:00.680 --> 00:18:04.510 position:50% align:middle We had to not only chart but assess their pain control at that time. 00:18:04.510 --> 00:18:11.810 position:50% align:middle And it wasn't until months and months later that I realized that the patients already knew that as well. 00:18:11.810 --> 00:18:18.380 position:50% align:middle The patients knew that by being satisfied with their request for pain, that would have a direct correlation 00:18:18.380 --> 00:18:22.410 position:50% align:middle into what their satisfaction reports would be off of their visit. 00:18:22.410 --> 00:18:26.360 position:50% align:middle And then it took me months after that to realize that the insurance companies would look at those 00:18:26.360 --> 00:18:29.720 position:50% align:middle satisfaction reports and determine reimbursement for the hospitals. 00:18:29.720 --> 00:18:36.950 position:50% align:middle So, you can see that this correlation of pain is the fifth vital sign, patient satisfaction, 00:18:36.950 --> 00:18:41.810 position:50% align:middle financial incentive, insurance reimbursements all tied together. 00:18:41.810 --> 00:18:47.290 position:50% align:middle And I had started to notice, like a pot of water starting to bubble, that this was going 00:18:47.290 --> 00:18:49.680 position:50% align:middle to be something, this was going to be significant. 00:18:49.680 --> 00:18:55.760 position:50% align:middle I've been in the industry since 1996 as a professional nurse and I have seen this continue to increase. 00:18:55.760 --> 00:18:57.150 position:50% align:middle And when is this going to stop? 00:18:57.150 --> 00:19:01.070 position:50% align:middle The momentum is continuing to increase in that direction. 00:19:01.070 --> 00:19:06.860 position:50% align:middle I think we've done a little bit better job with that fifth vital sign of pain to add some more objectivity 00:19:06.860 --> 00:19:11.560 position:50% align:middle or at the very least, not associate that directly or indirectly. 00:19:11.560 --> 00:19:16.200 position:50% align:middle however you look at it, with financial incentives for the physicians and for the hospitals and 00:19:16.200 --> 00:19:21.350 position:50% align:middle for the providers, which is a very dangerous road that we've been on for the past 30 years or 40 years, 00:19:21.350 --> 00:19:22.550 position:50% align:middle as you can see. 00:19:22.550 --> 00:19:24.700 position:50% align:middle So, if you look at that, what has that done? 00:19:24.700 --> 00:19:29.050 position:50% align:middle If you're looking at that as the starting point, what has that parlayed into today? 00:19:29.050 --> 00:19:31.050 position:50% align:middle What are we being experienced today? 00:19:31.050 --> 00:19:37.730 position:50% align:middle Well, what it has turned into is this whole idea of our society as a society of consumption. 00:19:37.730 --> 00:19:40.050 position:50% align:middle We're a consumer society today. 00:19:40.050 --> 00:19:46.370 position:50% align:middle So, when we look at 80% of the world's opiates are prescribed in the United States and 90% of the world's 00:19:46.370 --> 00:19:50.690 position:50% align:middle hydrocodone is prescribed in the United States, it begs to ask the question, 00:19:50.690 --> 00:19:53.490 position:50% align:middle what is the rest of the world doing for pain management? 00:19:53.490 --> 00:19:59.900 position:50% align:middle Claudia and I were very recently in a medical mission in Africa, and it was an incredible experience. 00:19:59.900 --> 00:20:03.370 position:50% align:middle And the most incredible thing was the people that we met there. 00:20:03.370 --> 00:20:05.300 position:50% align:middle They were just so grateful for... 00:20:05.300 --> 00:20:10.410 position:50% align:middle Despite materialistically not having very much, they were more grateful than any population than we had 00:20:10.410 --> 00:20:12.080 position:50% align:middle ever worked with. 00:20:12.080 --> 00:20:15.680 position:50% align:middle They knew that we were coming to do surgery, free surgery for this very, 00:20:15.680 --> 00:20:17.950 position:50% align:middle very underserved community up in the mountains. 00:20:17.950 --> 00:20:22.220 position:50% align:middle And they lined up four days or five days before, it was a first come, first serve. 00:20:22.220 --> 00:20:27.020 position:50% align:middle So, Claudia and I spent the first two days with our team doing pre-op assessments. 00:20:27.020 --> 00:20:30.890 position:50% align:middle We just wanted to set up the schedule and see who was going to be eligible for these services. 00:20:30.890 --> 00:20:35.590 position:50% align:middle At the end of that two days, our surgery schedule was set for two weeks. 00:20:35.590 --> 00:20:41.670 position:50% align:middle There was still a large gathering of people waiting for a cancellation so they can fill in the spot. 00:20:41.670 --> 00:20:45.170 position:50% align:middle At the end of that first surgical day, which was our third day there, it was a long day. 00:20:45.170 --> 00:20:47.290 position:50% align:middle It was about a 20-hour day if I remember correctly. 00:20:47.290 --> 00:20:49.720 position:50% align:middle And I remember Mr. Martin, who was one of the locals. 00:20:49.720 --> 00:20:54.030 position:50% align:middle He kind of worked his way through the crowd and he came up to us and he said, "I have 00:20:54.030 --> 00:20:56.300 position:50% align:middle this abscess, dental abscess." 00:20:56.300 --> 00:20:58.670 position:50% align:middle And it was so big it was closing off his eye. 00:20:58.670 --> 00:21:00.640 position:50% align:middle And the pain, it was evident. 00:21:00.640 --> 00:21:02.260 position:50% align:middle He said, "Can you do something about that?" 00:21:02.260 --> 00:21:06.910 position:50% align:middle And I said, "Well, we don't have a spot on the surgical schedule and if we take you back now, 00:21:06.910 --> 00:21:10.720 position:50% align:middle we might have a rush at the door of people trying to get in and do this." 00:21:10.720 --> 00:21:14.740 position:50% align:middle And just then one of the residents who was with us on our team walked by and he said, 00:21:14.740 --> 00:21:15.920 position:50% align:middle "I could just do it right here." 00:21:15.920 --> 00:21:19.860 position:50% align:middle And it was literally an incision, some suction, some pressure. 00:21:19.860 --> 00:21:23.480 position:50% align:middle And the whole procedure took about four, five minutes. 00:21:23.480 --> 00:21:26.620 position:50% align:middle But during the course of it, his eyes started watering because he was in obvious pain. 00:21:26.620 --> 00:21:29.090 position:50% align:middle And my eyes started watering because he was in obvious pain. 00:21:29.090 --> 00:21:32.950 position:50% align:middle And at the end of it, he takes a step back and Mr. Martin looks at us and he 00:21:32.950 --> 00:21:36.320 position:50% align:middle gives us his big, beautiful smile and he hugs us and he thanks us. 00:21:36.320 --> 00:21:39.540 position:50% align:middle And I said, "Mr. Martin," it really took me back if you remember. 00:21:39.540 --> 00:21:41.490 position:50% align:middle I said, "Mr. Martin, didn't that hurt?" 00:21:41.490 --> 00:21:43.790 position:50% align:middle And he said, "Well, of course, it hurts. 00:21:43.790 --> 00:21:45.780 position:50% align:middle You put a knife in my face. And of course, it hurt." 00:21:45.780 --> 00:21:50.500 position:50% align:middle And then the next thing that he said changed my perspective on all of this. 00:21:50.500 --> 00:21:54.880 position:50% align:middle He said, "The pain is the same in the U.S. as it is in Africa. 00:21:54.880 --> 00:21:57.090 position:50% align:middle We just think of it differently here. 00:21:57.090 --> 00:21:59.010 position:50% align:middle We just think of pain differently here. 00:21:59.010 --> 00:22:04.210 position:50% align:middle And that really set into motion a series of events that would change the way that I practice and the way that I 00:22:04.210 --> 00:22:10.120 position:50% align:middle talk to people about their expectations and how pain should fit into their lives and when is enough, enough, 00:22:10.120 --> 00:22:11.080 position:50% align:middle and when is not enough. 00:22:11.080 --> 00:22:16.570 position:50% align:middle It was very profound to hear at that time. When we're looking at overconsumption in this country, 00:22:16.570 --> 00:22:20.490 position:50% align:middle you can look at another classification of medications as well, the amphetamines. 00:22:20.490 --> 00:22:23.880 position:50% align:middle Eighty percent of the world's amphetamines is prescribed here in the United States. 00:22:23.880 --> 00:22:31.000 position:50% align:middle And when you look at statistics like 1% of prescribing, practitioners prescribe 25% of the prescriptions 00:22:31.000 --> 00:22:37.520 position:50% align:middle for opioids and 50% of the total dosages for opioids, we know that there is an inherent problem with the 00:22:37.520 --> 00:22:39.550 position:50% align:middle overriding of the prescriptions as well. 00:22:39.550 --> 00:22:45.120 position:50% align:middle So, all of these things are kind of compounding and factoring and creating this perfect storm 00:22:45.120 --> 00:22:46.510 position:50% align:middle for healthcare providers. 00:22:46.510 --> 00:22:51.430 position:50% align:middle And there's a reason why healthcare providers are suffering from this profession, in this profession, 00:22:51.430 --> 00:22:54.340 position:50% align:middle with this regard in a lot of different areas. 00:22:54.340 --> 00:23:01.670 position:50% align:middle Claudia's going to paint a picture or two of some of the typical APRNs and RNs that we have worked 00:23:01.670 --> 00:23:08.390 position:50% align:middle with in the treatment center side, and the dosages and the amounts, they may seem shocking to you and 00:23:08.390 --> 00:23:09.500 position:50% align:middle surprising to you. 00:23:09.500 --> 00:23:11.080 position:50% align:middle And they are to us as well. 00:23:11.080 --> 00:23:15.770 position:50% align:middle But we can say through personal experience and through my personal experience and through going through this 00:23:15.770 --> 00:23:18.600 position:50% align:middle several thousand times, these numbers are really accurate. 00:23:18.600 --> 00:23:22.770 position:50% align:middle And it's going to be your job to think about what does this look like if this is your colleague? 00:23:22.770 --> 00:23:27.810 position:50% align:middle - We've treated nurses who have been taking 20 to 30 Vicodin pills a day, 00:23:27.810 --> 00:23:32.370 position:50% align:middle some 300 milligrams of morphine IV every day for 6 months. 00:23:32.370 --> 00:23:33.930 position:50% align:middle So, these are people that we've treated. 00:23:33.930 --> 00:23:39.950 position:50% align:middle And sometimes we think as providers that if we're in the hospital, that we would be able to notice someone 00:23:39.950 --> 00:23:41.410 position:50% align:middle who's that impaired, right? 00:23:41.410 --> 00:23:42.990 position:50% align:middle Because this is a lot of medication. 00:23:42.990 --> 00:23:48.450 position:50% align:middle Even when we first started, when we got in this field, I couldn't believe the amounts that we were hearing. 00:23:48.500 --> 00:23:51.470 position:50% align:middle At first you think, "Well, there's no way that someone can naturally take that much." 00:23:51.470 --> 00:23:54.390 position:50% align:middle But unfortunately, there is a way, right? With tolerance. 00:23:54.390 --> 00:23:57.110 position:50% align:middle So, when you look at that, you know, sometimes we think, "Well, 00:23:57.110 --> 00:24:02.950 position:50% align:middle what are we really supposed to be looking for when we're looking for someone in the workplace or even if 00:24:02.950 --> 00:24:06.390 position:50% align:middle it's a loved one? What are some of the classic things that you're looking for, right?" 00:24:06.390 --> 00:24:09.910 position:50% align:middle So, you're looking at things like someone being disheveled, right? 00:24:09.910 --> 00:24:14.990 position:50% align:middle You think, well, obviously if someone's coming to work with that much medication on board or if they're drunk 00:24:14.990 --> 00:24:17.050 position:50% align:middle with alcohol, they're going to be disheveled. 00:24:17.050 --> 00:24:19.060 position:50% align:middle Maybe they might not be able to hold a job. 00:24:19.060 --> 00:24:20.320 position:50% align:middle They might lose their job, right? 00:24:20.320 --> 00:24:22.180 position:50% align:middle Because they're coming in late. 00:24:22.180 --> 00:24:25.780 position:50% align:middle Maybe they're looked at as being irresponsible, degenerates. 00:24:25.780 --> 00:24:30.930 position:50% align:middle We hear that a lot, criminals because maybe they're stealing from work, or dirty, right? 00:24:30.930 --> 00:24:33.200 position:50% align:middle They're not keeping their hygiene up. 00:24:33.200 --> 00:24:37.280 position:50% align:middle They're coming to work with their hair messy or they're just not keeping up their hygiene because 00:24:37.280 --> 00:24:38.410 position:50% align:middle they're too sick. 00:24:38.410 --> 00:24:43.460 position:50% align:middle Well, this is one of the reasons that I didn't figure out that Rodrigo had an addiction problem early on was 00:24:43.460 --> 00:24:46.010 position:50% align:middle because Rodrigo didn't fit this profile. 00:24:46.010 --> 00:24:47.290 position:50% align:middle He was the complete opposite. 00:24:47.290 --> 00:24:49.210 position:50% align:middle He came to work every single day. 00:24:49.210 --> 00:24:51.110 position:50% align:middle There were days where he came in early. 00:24:51.110 --> 00:24:53.640 position:50% align:middle He stayed after. He picked up call. 00:24:53.640 --> 00:24:56.340 position:50% align:middle He was always at work and he was always giving people breaks. 00:24:56.340 --> 00:24:58.090 position:50% align:middle And he was our overachiever. 00:24:58.090 --> 00:25:01.613 position:50% align:middle Like I mentioned earlier, he was getting awards every month sometimes. 00:25:01.613 --> 00:25:07.230 position:50% align:middle He had great patient satisfaction reviews. So, he was our overachiever, but we didn't know it. 00:25:07.230 --> 00:25:08.830 position:50% align:middle A lot of us didn't know. 00:25:08.830 --> 00:25:11.790 position:50% align:middle So, when we think about this, what should we be looking for? 00:25:11.790 --> 00:25:15.290 position:50% align:middle If we're looking at the healthcare system, if you're looking for someone at work or you think 00:25:15.290 --> 00:25:19.130 position:50% align:middle someone might be struggling, let's take a look at what we should be looking for. 00:25:19.130 --> 00:25:23.210 position:50% align:middle - So, the Talbott Recovery Center, which is the oldest treatment provider for healthcare 00:25:23.210 --> 00:25:29.630 position:50% align:middle professionals in the country, did a report in 2014, and we emulated that same study at Parkdale in 2018. 00:25:29.630 --> 00:25:31.150 position:50% align:middle It's a very simple study. 00:25:31.150 --> 00:25:35.120 position:50% align:middle We asked the loved ones and the co-workers and the family members, 00:25:35.120 --> 00:25:39.140 position:50% align:middle "Describe for us your loved one, your healthcare provider who is impaired. 00:25:39.140 --> 00:25:40.750 position:50% align:middle Describe for us them. Tell us about them. 00:25:40.750 --> 00:25:41.880 position:50% align:middle Tell us what they look like." 00:25:41.880 --> 00:25:43.990 position:50% align:middle And this is what they look like. 00:25:43.990 --> 00:25:45.000 position:50% align:middle This is the cheat sheet. 00:25:45.000 --> 00:25:48.600 position:50% align:middle If you want to know which provider is going to be at risk, this is what it is. 00:25:48.600 --> 00:25:51.120 position:50% align:middle They're intelligent, they're well-liked. 00:25:51.120 --> 00:25:55.400 position:50% align:middle They graduate in the top 25% of their class, they're supervisors, they're directors. 00:25:55.400 --> 00:25:57.070 position:50% align:middle They have advanced degrees. 00:25:57.070 --> 00:25:59.670 position:50% align:middle They're in positions of power and authority. 00:25:59.670 --> 00:26:02.130 position:50% align:middle This is on the surface of what this looks like. 00:26:02.130 --> 00:26:06.660 position:50% align:middle So now, again, not everyone who has these characteristics is going to become addicted or have a 00:26:06.660 --> 00:26:08.220 position:50% align:middle problem with substance use disorder. 00:26:08.220 --> 00:26:10.310 position:50% align:middle But these are very, very common characteristics. 00:26:10.310 --> 00:26:14.110 position:50% align:middle And as Claudia alluded to, these are the things when you look at them on paper and 00:26:14.110 --> 00:26:17.560 position:50% align:middle you see their performance and their behaviors and they're coming in early and they're taking all the 00:26:17.560 --> 00:26:22.170 position:50% align:middle breaks and they're winning awards, that may cause you to have a second doubt of, "Are 00:26:22.170 --> 00:26:23.740 position:50% align:middle they doing something? Are they not? 00:26:23.740 --> 00:26:25.260 position:50% align:middle Is this just my imagination? 00:26:25.260 --> 00:26:26.380 position:50% align:middle I don't want to be wrong. 00:26:26.380 --> 00:26:27.780 position:50% align:middle I'm not going to say anything. 00:26:27.780 --> 00:26:29.330 position:50% align:middle It's not my problem. 00:26:29.330 --> 00:26:30.460 position:50% align:middle It's their problem." 00:26:30.460 --> 00:26:36.067 position:50% align:middle All of those things that are kind of compounding the decision-making that Claudia and thousands of people 00:26:36.067 --> 00:26:40.070 position:50% align:middle that were in Claudia's position are faced with every day. 00:26:40.070 --> 00:26:45.360 position:50% align:middle So, when we're looking at the healthcare providers and the APRNs, and I say APRNs especially because there's a 00:26:45.360 --> 00:26:49.880 position:50% align:middle different level of access, there's a different level of supervision, 00:26:49.880 --> 00:26:54.390 position:50% align:middle there's a different level of ability to obtain the medications and a different level of stress in a 00:26:54.390 --> 00:26:55.550 position:50% align:middle lot of cases. 00:26:55.550 --> 00:27:00.800 position:50% align:middle So, when we're looking at the risk factors and why is it more prevalent in healthcare providers as opposed 00:27:00.800 --> 00:27:04.070 position:50% align:middle to the general populations, it's for the following reasons. 00:27:04.070 --> 00:27:07.610 position:50% align:middle Healthcare providers and being a healthcare provider is a risk factor in itself. 00:27:07.610 --> 00:27:09.340 position:50% align:middle It's a high stress job. 00:27:09.340 --> 00:27:11.320 position:50% align:middle You have access to medication. 00:27:11.320 --> 00:27:14.780 position:50% align:middle You have knowledge and the ability to use the medications and you know how you need 00:27:14.780 --> 00:27:16.360 position:50% align:middle to use these medications. 00:27:16.360 --> 00:27:18.050 position:50% align:middle So, it's that combination. 00:27:18.050 --> 00:27:20.610 position:50% align:middle And we're talking about these two parallel roads. 00:27:20.610 --> 00:27:24.400 position:50% align:middle This is the professional roads that's running parallel with society's role. 00:27:24.400 --> 00:27:26.766 position:50% align:middle So, on society's side on the outside, 00:27:26.766 --> 00:27:29.120 position:50% align:middle we know what culture is going to think and society is going to think. 00:27:29.120 --> 00:27:34.590 position:50% align:middle We know all about the stigma and we know about the incidences and the prevalence of SUD, 00:27:34.590 --> 00:27:38.250 position:50% align:middle substance use disorder, accessibility, opioids, addiction. 00:27:38.250 --> 00:27:40.400 position:50% align:middle We know all of that. It's just sitting there waiting. 00:27:40.400 --> 00:27:45.900 position:50% align:middle And then on the professional side that's running parallel, we have access to these same medications. 00:27:45.900 --> 00:27:52.610 position:50% align:middle We have a profession in an organization maybe sometimes self-imposed of a desire to not want to ask for help or 00:27:52.610 --> 00:27:56.260 position:50% align:middle not being able to ask for help or not having permission to ask for help. 00:27:56.260 --> 00:27:59.600 position:50% align:middle And then like we've talked about, it's this precipitating event that joins these two 00:27:59.600 --> 00:28:05.910 position:50% align:middle roads and that's when the substance use disorder or the struggles with mental health or the overconsumption 00:28:05.910 --> 00:28:08.790 position:50% align:middle of medications, that's when that occurs. 00:28:08.790 --> 00:28:13.580 position:50% align:middle So, one of the things that we do often when we're treating patients and this is very, 00:28:13.580 --> 00:28:18.310 position:50% align:middle very telling in our profession as nurses, when we're treating our patients after a substance use 00:28:18.310 --> 00:28:25.590 position:50% align:middle disorder and we do a whole track on relapse prevention track, we preface the entire program, 00:28:25.590 --> 00:28:28.860 position:50% align:middle the relapse prevention program, with stay away from this acronym. 00:28:28.860 --> 00:28:35.180 position:50% align:middle This acronym is HALT, H-A-L-T, and we develop an entire program to enable them and 00:28:35.180 --> 00:28:38.500 position:50% align:middle to empower them to stay away from this acronym of HALT. 00:28:38.500 --> 00:28:43.130 position:50% align:middle And what that stands for is hungry, angry, lonely, and tired. 00:28:43.130 --> 00:28:48.210 position:50% align:middle So, those are oftentimes precursors to that thinking that says, 'I'm hungry, angry, lonely, and tired. 00:28:48.210 --> 00:28:49.780 position:50% align:middle I sure could use a..." 00:28:49.780 --> 00:28:55.480 position:50% align:middle Fill in the blank, a drink, another pill, whatever you want to put in that blank. 00:28:55.480 --> 00:29:00.460 position:50% align:middle And we spent a lot of time saying, hungry, angry, lonely, tired are precursors to the next step, 00:29:00.460 --> 00:29:03.250 position:50% align:middle which is the bad decision of starting to use something. 00:29:03.250 --> 00:29:09.090 position:50% align:middle So, now think about the nursing career and think about your last time that you felt hungry, angry, 00:29:09.090 --> 00:29:10.510 position:50% align:middle lonely, or tired. 00:29:10.510 --> 00:29:14.080 position:50% align:middle I spent just about three years of my residency feeling like that every day. 00:29:14.080 --> 00:29:17.320 position:50% align:middle I think it was a prerequisite in a lot of cases. 00:29:17.320 --> 00:29:22.410 position:50% align:middle Those were my days as nurse and I have many, many days as a nurse where I felt that. Today we work 00:29:22.410 --> 00:29:29.570 position:50% align:middle really hard to make sure that we stay out of that area because that is certainly a risk factor of that. 00:29:29.570 --> 00:29:34.440 position:50% align:middle We are working with and we have worked with many hospitals in the past and this is a really interesting 00:29:34.440 --> 00:29:36.880 position:50% align:middle finding that we've come across. 00:29:36.880 --> 00:29:44.130 position:50% align:middle So, when we discover impairment at work, when we discover diversion at work, so in other words, 00:29:44.130 --> 00:29:47.950 position:50% align:middle healthcare providers who are taking medications from the hospital for self-use, 00:29:47.950 --> 00:29:52.220 position:50% align:middle either diverting them from a patient or taking extra from the pharmacy or from wherever, 00:29:52.220 --> 00:29:55.680 position:50% align:middle or not wasting their medication and using that for self-use. 00:29:55.680 --> 00:30:01.540 position:50% align:middle We've developed with a Community Health Network about a 60, 65-point questionnaire. 00:30:01.540 --> 00:30:05.750 position:50% align:middle Now, it's in its infancy stage now, but what we're seeing with those results and our 00:30:05.750 --> 00:30:10.960 position:50% align:middle partners that are doing a phenomenal job at this, is very surprisingly, 00:30:10.960 --> 00:30:14.230 position:50% align:middle the common characteristics of those profiles. 00:30:14.230 --> 00:30:19.160 position:50% align:middle Very little of them have to do with drug-related activities like overconsumption, 00:30:19.160 --> 00:30:24.720 position:50% align:middle taking more medication out of the pharmacy, mismanagement in the charting of your dosages 00:30:24.720 --> 00:30:26.180 position:50% align:middle that you're giving. 00:30:26.180 --> 00:30:30.920 position:50% align:middle Three of the top five have nothing to do with diversion from the hospital. 00:30:30.920 --> 00:30:34.060 position:50% align:middle It talks about things like have you had a recent traumatic event? 00:30:34.060 --> 00:30:36.920 position:50% align:middle Yes. Do you feel more stressed? Yes. 00:30:36.920 --> 00:30:38.910 position:50% align:middle So, it's these social things. 00:30:38.910 --> 00:30:42.480 position:50% align:middle It's these personal things, it's these well-being things that are leading 00:30:42.480 --> 00:30:47.960 position:50% align:middle into being precursors to why people have a subsequent problem with addictions or mental health 00:30:47.960 --> 00:30:51.800 position:50% align:middle in the workplace. 00:30:51.800 --> 00:30:57.270 position:50% align:middle One of the surprising risk factors that we have seen in the past couple of years is COVID. 00:30:57.270 --> 00:31:01.430 position:50% align:middle Now, who would think that COVID has anything to do with what we're seeing in terms of substance use disorder 00:31:01.430 --> 00:31:03.210 position:50% align:middle and mental health in our profession? 00:31:03.210 --> 00:31:07.650 position:50% align:middle Well, we don't have to speculate too much because we have this blueprint that's played out in front of us. 00:31:07.650 --> 00:31:13.580 position:50% align:middle And if we look back into the events that happened on 9/11, we can see this step-by-step repetition 00:31:13.580 --> 00:31:15.350 position:50% align:middle of history of what's happened. 00:31:15.350 --> 00:31:20.030 position:50% align:middle So, if you recall those events of September 11th, we remember right afterward these first responders were 00:31:20.030 --> 00:31:26.570 position:50% align:middle rushing into these buildings and there were levels of heroism that we've never seen before. 00:31:26.570 --> 00:31:31.060 position:50% align:middle We stood on the sidelines and we applauded them and we thank them and we put them on commercials and we pinned 00:31:31.060 --> 00:31:34.630 position:50% align:middle superhero capes on them and we thank them for their service. 00:31:34.630 --> 00:31:39.500 position:50% align:middle Well, after time and everything kind of got back to normal, the attention and the spotlight wasn't 00:31:39.500 --> 00:31:40.630 position:50% align:middle on them anymore. 00:31:40.630 --> 00:31:47.350 position:50% align:middle So, what we have seen since then in the immediate aftermath of that is with that first responder group 00:31:47.350 --> 00:31:54.080 position:50% align:middle of individuals, increases in divorce, increases in addiction, alcoholism, suicide, 00:31:54.080 --> 00:31:58.070 position:50% align:middle bankruptcy, domestic violence, all of the above. 00:31:58.070 --> 00:32:03.907 position:50% align:middle We saw that immediately afterward because of the trauma that was associated with that and the lack of maybe 00:32:03.907 --> 00:32:06.641 position:50% align:middle insight and the lack of support and care and resources. 00:32:06.641 --> 00:32:11.205 position:50% align:middle So, now we have this thing that happened in a couple of years ago of COVID, and we've done the 00:32:11.205 --> 00:32:14.510 position:50% align:middle exact same thing. It was a traumatic event for our country. 00:32:14.510 --> 00:32:19.040 position:50% align:middle But these first responders equivalent, which is our healthcare providers, 00:32:19.040 --> 00:32:20.870 position:50% align:middle are running back into the hospitals. 00:32:20.870 --> 00:32:24.634 position:50% align:middle And we don't know if there's enough PPE and protective gear, but they run in any way. 00:32:24.634 --> 00:32:27.680 position:50% align:middle We don't know what they're bringing home to their family, but they do it anyway. 00:32:27.680 --> 00:32:31.400 position:50% align:middle So, as we stand on the sidelines, the best that we can do is pin superhero capes on them 00:32:31.400 --> 00:32:35.460 position:50% align:middle and put them on commercials and thank them and applaud them and be gracious for them. 00:32:35.460 --> 00:32:39.210 position:50% align:middle And now we're seeing everything kind of settle down and getting back to normal. 00:32:39.210 --> 00:32:44.960 position:50% align:middle And we are probably the first stop on the treatment center side because what we're seeing is with our 00:32:44.960 --> 00:32:48.580 position:50% align:middle healthcare providers, an increase in mental health issues, 00:32:48.580 --> 00:32:52.560 position:50% align:middle an increase in depression, an increase in substance use disorder and addiction 00:32:52.560 --> 00:32:56.520 position:50% align:middle and alcoholism, an increase in divorce, and increase in domestic violence. 00:32:56.520 --> 00:32:58.950 position:50% align:middle And it's just getting started now. 00:32:58.950 --> 00:33:06.200 position:50% align:middle And it's behooved all of us collectively to stop this now, stop this as fast as we can and do our part 00:33:06.200 --> 00:33:09.930 position:50% align:middle to at least recognize that this is a thing that's happening. 00:33:09.930 --> 00:33:15.550 position:50% align:middle We've had more people at the center that come in that say, you know, everything was fine up until COVID. 00:33:15.550 --> 00:33:17.120 position:50% align:middle And then they tell us their experience. 00:33:17.120 --> 00:33:22.100 position:50% align:middle It was like they're barely holding it together with all the normal stresses of life and family and job and 00:33:22.100 --> 00:33:24.290 position:50% align:middle occupation and patience and responsibility. 00:33:24.290 --> 00:33:28.600 position:50% align:middle And they get this one little push with the COVID and it's pushed them over into areas that 00:33:28.600 --> 00:33:29.770 position:50% align:middle they never expected. 00:33:29.770 --> 00:33:33.370 position:50% align:middle And they're saying the exact same thing that I've said, the exact same thing that Claudia said, 00:33:33.370 --> 00:33:37.360 position:50% align:middle the exact same thing that thousands of our patients have said is, "I didn't think it was ever going 00:33:37.360 --> 00:33:40.030 position:50% align:middle to happen to me. I never thought that this would be me." 00:33:40.030 --> 00:33:42.190 position:50% align:middle And we've heard that time and time again. 00:33:42.190 --> 00:33:48.610 position:50% align:middle So, as we look into our profession and more specifically advanced practice registered nurses, 00:33:48.610 --> 00:33:52.730 position:50% align:middle I like to think of them as the heartbeat of the nursing profession 00:33:52.730 --> 00:33:57.540 position:50% align:middle in a lot of regards. It's the specialty programs that allow us to provide 00:33:57.540 --> 00:34:05.540 position:50% align:middle incredible services in the realms of anesthesia and education and midwifery and nurse practitioners. 00:34:05.540 --> 00:34:11.800 position:50% align:middle It is such an important avenue to be able to provide services to our patient population. 00:34:11.800 --> 00:34:14.486 position:50% align:middle So, what does that look like in terms of addiction and mental health, 00:34:14.486 --> 00:34:16.280 position:50% align:middle and substance use disorder? And what are we seeing? 00:34:16.280 --> 00:34:24.880 position:50% align:middle So, you can see by the numbers here that if you look at that 15%, there should be a lot of people, advanced 00:34:24.880 --> 00:34:27.510 position:50% align:middle practice registered nurses that are receiving help and receiving treatment. 00:34:27.510 --> 00:34:29.780 position:50% align:middle But we know, unfortunately, that's just not the case. 00:34:29.780 --> 00:34:34.570 position:50% align:middle So, what that tells us is what are we seeing? Anecdotally, what are we seeing on the front lines? 00:34:34.570 --> 00:34:38.360 position:50% align:middle And what that tells us is that there's a lot of people out there that are currently suffering, a lot of APRNSs 00:34:38.360 --> 00:34:42.120 position:50% align:middle that are currently struggling unnecessarily that don't have to. 00:34:42.120 --> 00:34:48.690 position:50% align:middle Now, there's a couple of data points here that we have hard numbers on and that you can extrapolate into your 00:34:48.690 --> 00:34:51.160 position:50% align:middle specific profession or your specific arena. 00:34:51.160 --> 00:34:56.430 position:50% align:middle So, we monitor some of the nurses that are entering back into the field of practice in Indiana 00:34:56.430 --> 00:34:57.650 position:50% align:middle and West Virginia. 00:34:57.650 --> 00:35:00.190 position:50% align:middle We monitor them after they've had a substance use disorder. 00:35:00.190 --> 00:35:04.060 position:50% align:middle So, we already know that they've had a problem or they've had an issue. 00:35:04.060 --> 00:35:09.060 position:50% align:middle So, what we know is that in Indiana, for example, there's 400 nurses that were monitoring after 100,000 00:35:09.060 --> 00:35:11.370 position:50% align:middle plus nurses in the state of Indiana. 00:35:11.370 --> 00:35:17.640 position:50% align:middle If you look at that 10% to 15%, we can relatively say that there's 10,000 to 15,000 00:35:17.640 --> 00:35:21.130 position:50% align:middle nurses that should be having a problem with substance use disorder. 00:35:21.130 --> 00:35:24.760 position:50% align:middle We have our eye on about 400 of them currently in the state of Indiana. 00:35:24.760 --> 00:35:29.800 position:50% align:middle So, out of those 400, the overrepresentation, because of the reasons we mentioned before, 00:35:29.800 --> 00:35:32.410 position:50% align:middle about 23% of them are APRNs. 00:35:32.410 --> 00:35:37.500 position:50% align:middle So, out of that total population, almost one in four of them are APRNs because of the 00:35:37.500 --> 00:35:41.390 position:50% align:middle stress and the access and the medications that they have available to them. 00:35:41.390 --> 00:35:47.300 position:50% align:middle So, if you look at it in terms of that, what the take-home message is that this is happening a lot. 00:35:47.300 --> 00:35:53.200 position:50% align:middle It's out there, but very few APRNs and very few nurses and healthcare providers are receiving the help and the 00:35:53.200 --> 00:35:55.250 position:50% align:middle treatment that they need. 00:35:55.250 --> 00:36:00.080 position:50% align:middle So, now back to the age old adage of, is this a choice or is this a disease? 00:36:00.080 --> 00:36:05.260 position:50% align:middle You know, when we do this presentation live, we pull the audience and we can see, you know, 00:36:05.260 --> 00:36:07.690 position:50% align:middle 90% of the audience will say it's a disease. 00:36:07.690 --> 00:36:12.730 position:50% align:middle But we do see a lot of hesitation in raising your hand to this as a choice. 00:36:12.730 --> 00:36:16.570 position:50% align:middle I think they probably may feel that, but they don't want to raise their hand entirely. 00:36:16.570 --> 00:36:21.020 position:50% align:middle So, I like the way Dr. Gabor Maté, who is an addictionologist in Canada, how he says it. 00:36:21.020 --> 00:36:27.550 position:50% align:middle He says, "Although the initial actor ingestion is voluntary, cessation of the disease process is not." 00:36:27.550 --> 00:36:31.180 position:50% align:middle What that means is it was my choice to take that pill the first time. 00:36:31.180 --> 00:36:36.150 position:50% align:middle And then after I realized that I may have a substance use disorder, it was my choice to take that pill 00:36:36.150 --> 00:36:37.370 position:50% align:middle the second time. 00:36:37.370 --> 00:36:41.810 position:50% align:middle But after the disease process took over it was certainly not my choice anymore. 00:36:41.810 --> 00:36:47.730 position:50% align:middle Bigger things were in play to answer that question of is it a disease or is it a choice? 00:36:47.730 --> 00:36:50.140 position:50% align:middle We have to look at some of the neurobiology of the addiction. 00:36:50.140 --> 00:36:51.500 position:50% align:middle What does this look like? 00:36:51.500 --> 00:36:54.140 position:50% align:middle As you can remember, we'll talk about the reward pathway system. 00:36:54.140 --> 00:36:59.890 position:50% align:middle And I put this...we talk about this because we want to really illustrate how much of a pull this is, 00:36:59.890 --> 00:37:01.940 position:50% align:middle how much of a choice this really is not. 00:37:01.940 --> 00:37:07.580 position:50% align:middle And we're looking at the reward pathway system and we're talking about why can't people just stop? 00:37:07.580 --> 00:37:09.870 position:50% align:middle Why can't providers just say no? 00:37:09.870 --> 00:37:11.930 position:50% align:middle I knew that I had a problem. 00:37:11.930 --> 00:37:14.160 position:50% align:middle I knew I needed some help like all our providers do. 00:37:14.160 --> 00:37:16.760 position:50% align:middle But what was pulling so hard about it? 00:37:16.760 --> 00:37:22.510 position:50% align:middle So, when we're looking at a choice versus a disease, I want to just reflect on a primary disease that you're 00:37:22.510 --> 00:37:28.950 position:50% align:middle familiar treating, anyone in your specialty that you're treating, diabetes, high blood pressure, 00:37:28.950 --> 00:37:31.890 position:50% align:middle eclampsia, preeclampsia, anyone of those diseases. 00:37:31.890 --> 00:37:36.690 position:50% align:middle And you look at our differential diagnosis list of parameters and you'll see that they're the 00:37:36.690 --> 00:37:38.270 position:50% align:middle same for addictions. 00:37:38.270 --> 00:37:42.060 position:50% align:middle There's a prognosis, there's signs and symptoms, there's a treatment plan, 00:37:42.060 --> 00:37:44.380 position:50% align:middle there's a care plan associated with it. 00:37:44.380 --> 00:37:47.070 position:50% align:middle There's medications that may or may not work for it. 00:37:47.070 --> 00:37:49.260 position:50% align:middle The relapse rates are similar. 00:37:49.260 --> 00:37:51.140 position:50% align:middle The cure rates are similar. 00:37:51.140 --> 00:37:52.820 position:50% align:middle The treatment is similar. 00:37:52.820 --> 00:37:56.440 position:50% align:middle So, if you look at addiction and you compare it to any other primary disease, 00:37:56.440 --> 00:38:01.230 position:50% align:middle they check off all the same boxes with almost the same data points on each one. 00:38:01.230 --> 00:38:06.420 position:50% align:middle Something to consider when you're trying to toil in your head, is this a disease or is this an addiction? 00:38:06.420 --> 00:38:10.900 position:50% align:middle When we're looking at how much of a pull, how much is this addiction pulling to make these 00:38:10.900 --> 00:38:17.500 position:50% align:middle decisions that are unethical, immoral, or irrational, but they keep doing it? Why is that? 00:38:17.500 --> 00:38:23.640 position:50% align:middle If you're looking at just the dopamine levels, you can see here how much of a pull this is every time 00:38:23.640 --> 00:38:24.900 position:50% align:middle they have a decision. 00:38:24.900 --> 00:38:31.520 position:50% align:middle "Do I go home and I hug the kids, and I play with the kids outside, or do I have one more drink or one more 00:38:31.520 --> 00:38:35.440 position:50% align:middle opiate, or one more whatever it is," you can see what they're going up against. 00:38:35.440 --> 00:38:42.130 position:50% align:middle A physiological tug of war, a neurobiological tug of war that's changing the 00:38:42.130 --> 00:38:43.800 position:50% align:middle plasticity of the brain. 00:38:43.800 --> 00:38:47.480 position:50% align:middle They lose that frontal cortex, the ability for that frontal cortex 00:38:47.480 --> 00:38:48.650 position:50% align:middle to make these decisions. 00:38:48.650 --> 00:38:53.600 position:50% align:middle So, over the course of the addiction, the driver of the machine is not the 00:38:53.600 --> 00:38:55.040 position:50% align:middle frontal cortex anymore. 00:38:55.040 --> 00:39:01.070 position:50% align:middle It becomes the reward pathway system that is reflex reward, fix, manage, and control, flight or fight. 00:39:01.070 --> 00:39:02.580 position:50% align:middle It's all buried right in that center. 00:39:02.580 --> 00:39:04.860 position:50% align:middle And that's why it's so hard. 00:39:04.860 --> 00:39:10.760 position:50% align:middle So, now that we know that it's a disease that is surrounded by some poor choices, at least initially, 00:39:10.760 --> 00:39:13.410 position:50% align:middle how do you manage it when you come across it? 00:39:13.410 --> 00:39:19.720 position:50% align:middle How are you going to manage this back into your little corner of the world where... 00:39:19.720 --> 00:39:22.840 position:50% align:middle This is where Claudia lived, she knew something was wrong. 00:39:22.840 --> 00:39:25.920 position:50% align:middle My colleagues and my co-workers knew something was wrong. 00:39:25.920 --> 00:39:32.090 position:50% align:middle But how do you manage it in a system that currently does not advocate for a linear approach to treat the 00:39:32.090 --> 00:39:33.080 position:50% align:middle impaired healthcare provider? 00:39:33.080 --> 00:39:39.190 position:50% align:middle - And one of the things that you can see that's really interesting when it comes to nursing is that there 00:39:39.190 --> 00:39:42.049 position:50% align:middle really isn't a one-way path, unfortunately. 00:39:42.049 --> 00:39:44.580 position:50% align:middle Sometimes you have to deal with the licensing board. 00:39:44.580 --> 00:39:48.030 position:50% align:middle Sometimes you have something to do with the office of the Attorney General. 00:39:48.030 --> 00:39:49.760 position:50% align:middle Maybe it's a legal issue. 00:39:49.760 --> 00:39:52.290 position:50% align:middle The ATD, that's the Alternative to Discipline program. 00:39:52.290 --> 00:39:55.150 position:50% align:middle So, maybe that's the monitoring program for your state. 00:39:55.150 --> 00:39:59.220 position:50% align:middle Sometimes you have to work with them first, or sometimes you go there and you don't need treatment 00:39:59.220 --> 00:40:00.530 position:50% align:middle or vice versa. 00:40:00.530 --> 00:40:02.320 position:50% align:middle There's treatment center issues as well. 00:40:02.320 --> 00:40:05.960 position:50% align:middle Sometimes you have to deal with the treatment center to find out what your next recommendations are. 00:40:05.960 --> 00:40:10.850 position:50% align:middle But when you look at this, just this illustration here, you can see how it's so confusing, 00:40:10.850 --> 00:40:15.790 position:50% align:middle it's so difficult to figure out what's your path back to work or even your path back to sobriety. 00:40:15.790 --> 00:40:20.670 position:50% align:middle There are just so many different options that every state, depending on where you live, 00:40:20.670 --> 00:40:26.260 position:50% align:middle if you live in Indiana versus you live in West Virginia or Texas, everyone does things so differently that 00:40:26.260 --> 00:40:27.890 position:50% align:middle there isn't one way to do it. 00:40:27.890 --> 00:40:31.410 position:50% align:middle Unfortunately, we get patients that come into our treatment center that want... 00:40:31.410 --> 00:40:35.720 position:50% align:middle They heard from another colleague from a different state that they did certain things to get back to work. 00:40:35.720 --> 00:40:38.910 position:50% align:middle But unfortunately, you really have to follow what your state says. 00:40:38.910 --> 00:40:44.160 position:50% align:middle So, I think that's where the confusion happens sometimes, is that we don't know sometimes what the 00:40:44.160 --> 00:40:48.930 position:50% align:middle right answers are. You know, when Rodrigo went through his addiction, I didn't know. 00:40:48.930 --> 00:40:53.130 position:50% align:middle I knew about a lot of these things, but I didn't know who I called first, right? 00:40:53.130 --> 00:40:57.910 position:50% align:middle If I had known back then what I know today, I would have called our Alternative to Discipline 00:40:57.910 --> 00:40:59.200 position:50% align:middle program day number one. 00:40:59.200 --> 00:41:03.110 position:50% align:middle The second that I realized that Rodrigo was in trouble, I would have called. 00:41:03.110 --> 00:41:05.260 position:50% align:middle Instead, I was chasing Rodrigo around. 00:41:05.260 --> 00:41:08.920 position:50% align:middle And, you know, if you're someone who's who has experience with addiction, 00:41:08.920 --> 00:41:13.340 position:50% align:middle you don't chase somebody around who has an active addiction because they're going to deny it. 00:41:13.340 --> 00:41:18.020 position:50% align:middle It's very hard as a loved one to intervene that you do need to get other people involved. 00:41:18.020 --> 00:41:20.450 position:50% align:middle But I didn't know those things, so I chased them around, 00:41:20.450 --> 00:41:24.870 position:50% align:middle tried to get them the help that I thought I was trying to do, but it just never worked. 00:41:24.870 --> 00:41:29.970 position:50% align:middle So, that's, you know, just to finish up this one here, it's just...it's very complicated. 00:41:29.970 --> 00:41:32.660 position:50% align:middle And unfortunately, there is no one way to do things. 00:41:32.660 --> 00:41:38.020 position:50% align:middle - And if you take this list and it's a very complicated decision tree, it really is. 00:41:38.020 --> 00:41:40.040 position:50% align:middle So we broke it down here on this slide. 00:41:40.040 --> 00:41:43.890 position:50% align:middle You take that same list with those same options and you think of it as a pendulum. 00:41:43.890 --> 00:41:47.840 position:50% align:middle If you do too much of one, it's going to be a very punitive, non-therapeutic, 00:41:47.840 --> 00:41:49.850 position:50% align:middle non-beneficial way to address it. 00:41:49.850 --> 00:41:54.920 position:50% align:middle And if you swing the pendulum too far the other way and it becomes too treatment-centric and treatment-focused, 00:41:54.920 --> 00:41:59.910 position:50% align:middle and it almost appears to be a little bit coddling, it's not beneficial and it's not therapeutic and 00:41:59.910 --> 00:42:01.360 position:50% align:middle it's not effective. 00:42:01.360 --> 00:42:06.110 position:50% align:middle The pendulum is sitting right in the middle and who to call you can see is highlighted there. 00:42:06.110 --> 00:42:11.240 position:50% align:middle First of all, the institution will have mandatory reporting requirements and sometimes that includes 00:42:11.240 --> 00:42:12.440 position:50% align:middle some legal entities. 00:42:12.440 --> 00:42:14.580 position:50% align:middle There's no getting around that. You have to do that. 00:42:14.580 --> 00:42:17.700 position:50% align:middle And from the treatment recovery point of view, that's actually a good thing. 00:42:17.700 --> 00:42:20.380 position:50% align:middle A little bit of a consequence is not a bad thing at all. 00:42:20.380 --> 00:42:23.900 position:50% align:middle And then the Alternative to Discipline programs, if you're fortunate enough to be in a state that has 00:42:23.900 --> 00:42:29.970 position:50% align:middle an Alternative to Discipline program, that can make the complete decision tree simplified 00:42:29.970 --> 00:42:35.390 position:50% align:middle for you, because their obligation and their role is to then contact the next people who need to be involved, 00:42:35.390 --> 00:42:39.660 position:50% align:middle whether it be the board of nursing or the office of the Attorney General for further investigation. 00:42:39.660 --> 00:42:42.750 position:50% align:middle So, think of these decisions as you're making as a pendulum. 00:42:42.750 --> 00:42:47.610 position:50% align:middle And when you look at this slide, it really kind of shows you if you get too far one way, 00:42:47.610 --> 00:42:50.650 position:50% align:middle who you're going to be calling first, if you get too far the other way, 00:42:50.650 --> 00:42:55.040 position:50% align:middle neither one of those are going to be therapeutic or beneficial to you, to the institution, 00:42:55.040 --> 00:42:59.590 position:50% align:middle to your patients, to your provider who is suffering and struggling. 00:42:59.590 --> 00:43:05.360 position:50% align:middle So, our strong suggestion and advice after working with nearly every alternative program and board of nursing 00:43:05.360 --> 00:43:10.770 position:50% align:middle across the country, is to keep that pendulum in the middle, maintain and support your mandatory 00:43:10.770 --> 00:43:14.750 position:50% align:middle reporting requirements, fulfill those reporting requirements absolutely. 00:43:14.750 --> 00:43:19.130 position:50% align:middle And then help your colleague out by doing the right thing and making that right call to the right person. 00:43:19.130 --> 00:43:23.110 position:50% align:middle It's not to eliminate the need to have consequences or accountability. 00:43:23.110 --> 00:43:28.230 position:50% align:middle As a matter of fact, it's the best way to do it to ensure accountability. 00:43:28.230 --> 00:43:30.070 position:50% align:middle We know what works. We have the formula. 00:43:30.070 --> 00:43:34.210 position:50% align:middle And I don't mean we, I mean historically throughout the industry, 00:43:34.210 --> 00:43:36.060 position:50% align:middle we know what works. We know what doesn't work. 00:43:36.060 --> 00:43:41.890 position:50% align:middle And this is the very quick cheat sheet on how to manage the impaired healthcare provider. 00:43:41.890 --> 00:43:46.630 position:50% align:middle - So, what we know is if someone goes through a detox, meaning they stop using drugs, maybe they start, 00:43:46.630 --> 00:43:50.270 position:50% align:middle they stop on their own, they just decide to stop using one day, 00:43:50.270 --> 00:43:55.200 position:50% align:middle or maybe they go into a treatment center for withdrawal management, or they're incarcerated and they're forced 00:43:55.200 --> 00:43:56.330 position:50% align:middle to stop using. 00:43:56.330 --> 00:44:01.690 position:50% align:middle We know that they have a 10% success rate, so 90% of these people will still relapse. 00:44:01.690 --> 00:44:03.280 position:50% align:middle They'll go back to using. 00:44:03.280 --> 00:44:09.390 position:50% align:middle Now, if someone detoxes, they stop using and we add some type of structured 00:44:09.390 --> 00:44:11.290 position:50% align:middle stability where they're being monitored. 00:44:11.290 --> 00:44:13.450 position:50% align:middle Maybe it's the Alternative to Discipline program. 00:44:13.450 --> 00:44:16.570 position:50% align:middle Maybe they're doing drug testing, maybe they're the ones making sure 00:44:16.570 --> 00:44:17.880 position:50% align:middle they're staying compliant. 00:44:17.880 --> 00:44:21.860 position:50% align:middle Now, as you can see, the numbers go up, now they have a 60% success rate, 00:44:21.860 --> 00:44:25.390 position:50% align:middle but unfortunately, 40% will still go back to using. 00:44:25.390 --> 00:44:29.320 position:50% align:middle Now, if they go through detox, they stop using and they get treatment. 00:44:29.320 --> 00:44:35.940 position:50% align:middle And treatment might be a facility that can treat their addiction, but also their depression and their anxiety. 00:44:35.940 --> 00:44:37.860 position:50% align:middle And they also are doing the monitoring. 00:44:37.860 --> 00:44:39.380 position:50% align:middle So, they have all three pieces. 00:44:39.380 --> 00:44:44.140 position:50% align:middle They stop using, they're doing treatment and they're being held accountable with some type 00:44:44.140 --> 00:44:45.580 position:50% align:middle of monitoring program. 00:44:45.580 --> 00:44:50.920 position:50% align:middle Now, you look at the numbers, with the 1-year mark, they're at 85% success rate. 00:44:50.920 --> 00:44:52.920 position:50% align:middle And now at the 3-year mark, they're at 90%. 00:44:52.920 --> 00:44:58.573 position:50% align:middle And if we can get them to 5 years, you can see the numbers are 95%. 00:44:58.573 --> 00:45:01.030 position:50% align:middle And that's really the goal is to get them there. 00:45:01.030 --> 00:45:05.560 position:50% align:middle And, you know, a lot of Alternative to Discipline programs are now moving towards a five-year model where 00:45:05.560 --> 00:45:07.420 position:50% align:middle they are keeping them longer. 00:45:07.420 --> 00:45:10.420 position:50% align:middle And some of the things that they do while they're in this five-year contract, 00:45:10.420 --> 00:45:12.920 position:50% align:middle they're doing things like random drug screens. 00:45:12.920 --> 00:45:16.500 position:50% align:middle They're making sure that these people that have a substance use disorder, 00:45:16.500 --> 00:45:19.590 position:50% align:middle that they're being held accountable, that they're doing meetings, 00:45:19.590 --> 00:45:22.380 position:50% align:middle that they're well to go...and that they're fit for duty as well, right? 00:45:22.380 --> 00:45:26.820 position:50% align:middle Because as a nurse, I want to make sure that my colleague, if they're coming back to work and they have 00:45:26.820 --> 00:45:31.730 position:50% align:middle a SUD and maybe they were diverting from the hospital, that they're safe to practice and that I don't have 00:45:31.730 --> 00:45:34.640 position:50% align:middle to worry about their patients being affected. 00:45:34.640 --> 00:45:38.800 position:50% align:middle - So, part of the reason why I, for example, had to take a year off of work, 00:45:38.800 --> 00:45:44.460 position:50% align:middle my professional organization suggested and required that I did was to get to that 85% success rate 00:45:44.460 --> 00:45:46.880 position:50% align:middle after that first year out. So, why is that significant? 00:45:46.880 --> 00:45:48.860 position:50% align:middle That's the same rate as the general population. 00:45:48.860 --> 00:45:53.770 position:50% align:middle So, we talked about 10% to 15% of the general population has a problem, the substance use disorder. 00:45:53.770 --> 00:45:58.090 position:50% align:middle So, a year after work, after following these steps, would get me back into that ballpark. 00:45:58.090 --> 00:46:01.350 position:50% align:middle And then statistically speaking, if you get them past the year mark, 00:46:01.350 --> 00:46:08.190 position:50% align:middle there'll be a much better statistical chance to take as opposed to hiring somebody completely off the street 00:46:08.190 --> 00:46:09.620 position:50% align:middle that you don't know anything about. 00:46:09.620 --> 00:46:14.940 position:50% align:middle You can see here that it's really important to incorporate some kind of monitoring or accountability. 00:46:14.940 --> 00:46:18.660 position:50% align:middle The nursing profession as a whole does a really, really nice job with this. 00:46:18.660 --> 00:46:22.750 position:50% align:middle The challenge is it's not as uniform as it could probably be. 00:46:22.750 --> 00:46:27.270 position:50% align:middle So, when we're looking at these ATD programs or Alternative to Discipline programs, 00:46:27.270 --> 00:46:30.930 position:50% align:middle they're not disciplined, hence the name, Alternative to Discipline. 00:46:30.930 --> 00:46:36.470 position:50% align:middle They work with the boards of nursing to provide an alternative pathway as opposed to being disciplined. 00:46:36.470 --> 00:46:38.510 position:50% align:middle So, think of it as you get your one chance. 00:46:38.510 --> 00:46:40.320 position:50% align:middle You get your re-entry program. 00:46:40.320 --> 00:46:44.460 position:50% align:middle You get this one chance to figure out the issue, work on the problem, 00:46:44.460 --> 00:46:50.080 position:50% align:middle display objectively sobriety and continued wellness, and continued health. 00:46:50.080 --> 00:46:52.640 position:50% align:middle So, this is a little bit of a busy slide. 00:46:52.640 --> 00:46:54.910 position:50% align:middle So, we'll keep this up there for you so you can kind of look through this. 00:46:54.910 --> 00:46:59.040 position:50% align:middle But on the left here, you can see there's three different types of programs 00:46:59.040 --> 00:47:02.170 position:50% align:middle that the state may or may not offer. 00:47:02.170 --> 00:47:06.750 position:50% align:middle The first type is a third party, the third party who is contracted with the State Board 00:47:06.750 --> 00:47:11.850 position:50% align:middle of Nursing to provide this service for the nurses of that state. 00:47:11.850 --> 00:47:16.030 position:50% align:middle This is one physical step separation from the Board of Nursing. 00:47:16.030 --> 00:47:21.140 position:50% align:middle It allows the participant to enter the program voluntarily, and sometimes the boards of nursing won't 00:47:21.140 --> 00:47:25.580 position:50% align:middle even know about it unless the participant becomes non-compliant. 00:47:25.580 --> 00:47:29.020 position:50% align:middle So, these types of programs are very successful. 00:47:29.020 --> 00:47:33.700 position:50% align:middle They provide the accountability, they provide the re-entry, they provide the advocacy, 00:47:33.700 --> 00:47:38.270 position:50% align:middle they provide a formal way to enter the program voluntarily and confidentially as well. 00:47:38.270 --> 00:47:40.420 position:50% align:middle The nurses in these programs do very well. 00:47:40.420 --> 00:47:44.920 position:50% align:middle The second type of program is where the Board of Nursing doesn't offer that typical alternative 00:47:44.920 --> 00:47:48.340 position:50% align:middle to discipline program, but they have an Alternative to Discipline track. 00:47:48.340 --> 00:47:52.210 position:50% align:middle So, the Board of Nursing actually manages it and monitors it and says, 00:47:52.210 --> 00:47:53.740 position:50% align:middle "We're going to give you one chance. 00:47:53.740 --> 00:47:56.170 position:50% align:middle You do everything we ask you to do. 00:47:56.170 --> 00:47:59.150 position:50% align:middle This is your one chance to make the most of it." 00:47:59.150 --> 00:48:01.410 position:50% align:middle Final point to make about this data. 00:48:01.410 --> 00:48:06.740 position:50% align:middle This information was extrapolated from the National Organization of Alternative Programs website. 00:48:06.740 --> 00:48:08.790 position:50% align:middle It's a kind of a work in progress. 00:48:08.790 --> 00:48:14.270 position:50% align:middle It's an excellent resource if you want the updated list of programs and the types of programs that they have 00:48:14.270 --> 00:48:16.630 position:50% align:middle with the contact information as well. 00:48:16.630 --> 00:48:19.400 position:50% align:middle So, please visit that website and you can get the most updated. 00:48:19.400 --> 00:48:25.070 position:50% align:middle It's a very small percentage currently that do not offer an Alternative to Discipline program 00:48:25.070 --> 00:48:29.410 position:50% align:middle of some type, but it is changing almost monthly. 00:48:29.410 --> 00:48:30.640 position:50% align:middle So, visit that website. 00:48:30.640 --> 00:48:34.230 position:50% align:middle Often, you'll get a lot of really good up-to-date information on that as well. 00:48:34.230 --> 00:48:35.810 position:50% align:middle So, now here we are. What do we do? 00:48:35.810 --> 00:48:39.690 position:50% align:middle What do we do with all this information and how do we start to make a difference individually and 00:48:39.690 --> 00:48:40.930 position:50% align:middle within our profession? 00:48:40.930 --> 00:48:45.770 position:50% align:middle So, if we're looking at the future of APRNs and wellness in terms of provider wellness, 00:48:45.770 --> 00:48:47.210 position:50% align:middle what does that look like? 00:48:47.210 --> 00:48:54.210 position:50% align:middle I can tell you just kind of anecdotally that every patient that comes in that we've treated ever from the 00:48:54.210 --> 00:48:59.600 position:50% align:middle beginning of our first patient in 2015 to currently, they have a characteristic that's in common 00:48:59.600 --> 00:49:00.670 position:50% align:middle with each other. 00:49:00.670 --> 00:49:02.430 position:50% align:middle And we get asked this question a lot. 00:49:02.430 --> 00:49:04.500 position:50% align:middle Describe for us what your patients look like coming in. 00:49:04.500 --> 00:49:09.720 position:50% align:middle If I had to sum it up in one area, it would be balance and more particularly 00:49:09.720 --> 00:49:10.840 position:50% align:middle lack of balance. 00:49:10.840 --> 00:49:16.870 position:50% align:middle They don't maintain that balance in their life and they come in real heavy on one side of their professional 00:49:16.870 --> 00:49:20.530 position:50% align:middle and personal life. They're working way too much and they're not doing enough of this. 00:49:20.530 --> 00:49:24.110 position:50% align:middle And I have struggled with that personally for a very long time. 00:49:24.110 --> 00:49:28.350 position:50% align:middle But that goes back to that first slide that we showed you is when I was unbalanced, 00:49:28.350 --> 00:49:32.770 position:50% align:middle everything underneath that yellow line in my introduction was the juggling, was all the plates 00:49:32.770 --> 00:49:37.500 position:50% align:middle spinning and Claudius seems to have this figured out since the very beginning. 00:49:37.500 --> 00:49:41.200 position:50% align:middle So, maybe you can share with us a little bit of what you do to make sure that you maintain your balance. 00:49:41.200 --> 00:49:46.980 position:50% align:middle - So, for me, for myself, I do things like exercise, meditation. 00:49:46.980 --> 00:49:49.870 position:50% align:middle I spend time with my kids, with my family members. 00:49:49.870 --> 00:49:50.950 position:50% align:middle I make time for friends. 00:49:50.950 --> 00:49:53.066 position:50% align:middle Sometimes it's just walking my dog 00:49:53.066 --> 00:49:57.220 position:50% align:middle or just spending some alone time and really finding that healthy balance. 00:49:57.220 --> 00:50:01.670 position:50% align:middle We all have different versions of balance, but one of the most important things for me is just 00:50:01.670 --> 00:50:04.490 position:50% align:middle really taking the time out and being able to just unwind. 00:50:04.490 --> 00:50:09.310 position:50% align:middle And I know that's a really hard concept sometimes, especially if you're a mother and a wife, and you work 00:50:09.310 --> 00:50:11.410 position:50% align:middle full time and you're in the nursing field, it's hard. 00:50:11.410 --> 00:50:13.690 position:50% align:middle Sometimes it's challenging to just take a time out. 00:50:13.690 --> 00:50:17.940 position:50% align:middle And one of the things that I've really done well, I'm really proud of myself for, 00:50:17.940 --> 00:50:20.280 position:50% align:middle is that I have learned to say no. 00:50:20.280 --> 00:50:25.310 position:50% align:middle And I think that was something that I had a really hard time doing when I was a young nurse over 20 years ago. 00:50:25.310 --> 00:50:31.760 position:50% align:middle But I always wanted to stay over and take call and help out, and sometimes in the profession we have to do 00:50:31.760 --> 00:50:36.740 position:50% align:middle these things, especially with the shortage that we sometimes feel obligated to do these things. 00:50:36.740 --> 00:50:42.030 position:50% align:middle But there were so many times that I missed out on very important events with my kids because I couldn't 00:50:42.030 --> 00:50:46.310 position:50% align:middle say no, I couldn't say no to the patient who needed me or I couldn't say no to my colleague, 00:50:46.310 --> 00:50:47.990 position:50% align:middle but I missed out on a lot of things. 00:50:47.990 --> 00:50:50.780 position:50% align:middle And there's a healthy balance of yes and no, correct? 00:50:50.780 --> 00:50:55.260 position:50% align:middle I mean, we do have to help out when we can, but there are some times that you have to say no. 00:50:55.260 --> 00:51:00.350 position:50% align:middle And I think that's probably one of the harder things that I see in the profession is just saying no and 00:51:00.350 --> 00:51:04.480 position:50% align:middle feeling that no is a complete sentence. 00:51:04.480 --> 00:51:06.630 position:50% align:middle We want to leave you with one last thought. 00:51:06.630 --> 00:51:10.910 position:50% align:middle Every 20 minutes someone in our country dies of a prescription drug overdose. 00:51:10.910 --> 00:51:14.840 position:50% align:middle Just in the time we were here today, three people have lost their lives. 00:51:14.840 --> 00:51:20.850 position:50% align:middle And as you can imagine all of the families and friends and just the people that have been affected by this. 00:51:20.850 --> 00:51:25.202 position:50% align:middle We thank you for your time. And we are open for questions.