The pandemic took a heavy toll on frontline healthcare workers, especially nurses, prompting our team to look into whether states would be prepared to handle a potential influx of nurses needing help with substance use disorders.
Our reporting led us to alternative-to-discipline programs, which are charged with getting nurses back on the job while protecting patient safety.
Over the past two decades, these programs have become the standard in nurse rehabilitation — but our series found that they are vastly underused.
Reporter Cheryl Clark tracked down enrollment data from 14 states that oversee the licenses of 66% of all U.S. nurses. Frequently, states were hesitant to share these data. When they did share, Clark frequently found herself trying to determine whether the numbers were annual new enrollment or annual overall enrollment totals. Some states also mixed in nurses who came to the program via a disciplinary pathway.
Clark also took care to hone the denominator, reducing licensee totals by 20% to include those who may maintain an active license but are no longer practicing or are retired. Even with this more conservative estimate of total working nurses, enrollment in these programs was well under the expected levels of substance use disorder in this population.
MedPage Today also conducted a survey, led by reporter Shannon Firth, of state alternative-to-discipline program leaders to better understand how these programs operated and how they measured their success. The survey was sent to 46 leaders and was returned by 22, for a response rate of nearly 50%. It included about two dozen questions around outcomes, costs, operations, and governance, and revealed a lack of standardization across the majority of these aspects.
Reporter Ryan Basen heard from sources that one program in particular was especially hard on nurses. He interviewed nurses who have been through or are currently in New Jersey’s Recovery and Monitoring Program (RAMP), attorneys who have represented some of them, and officials and contractors who currently work with the program.
While the director of the program declined an interview, Basen chased down data from the Department of Consumer Affairs, which oversees the agency. The interviews and the numbers paint the picture of a program that may not have the nurses’ best interests at heart.
The reporters conclude that their series highlights the need for better methods of getting help for nurses who struggle with the disease of addiction, particularly as the pandemic rages on.
Cheryl Clark, Ryan Basen, and Shannon Firth contributed to this series explainer.
Last Updated August 03, 2021
Kristina Fiore leads MedPage’s enterprise & investigative reporting team. She’s been a medical journalist for more than a decade and her work has been recognized by Barlett & Steele, AHCJ, SABEW, and others. Send story tips to email@example.com. Follow