Greetings. On behalf of the American Association of Nurse Anesthesiology, it is my pleasure to introduce you to today's webinar, Support and Resources for Managing the Impaired Provider. The Impaired Provider. The purpose of this webinar is to provide you with the tools, resources, and information needed to help manage the impaired health care provider. The following information can be applied to an impaired colleague or to yourself should that be needed. All case studies and situations presented in this program are based off of actual CRNA or rRNA experiences. AANA is a strong advocate of wellness in the workplace. With 40 years of experience in peer assistance and wellness within our organization, AANA continues to support and promote initiatives to help safeguard our members. The outline for today's webinar is as follows. In Section 1, we will be discussing the AANA's dedication to wellness and their evolution of support throughout the years. As the timing conditions in which we provide care to patients changes, so must we as providers and as a professional organization. In Section 2, we will be discussing the rRNA's perspective as it relates to supporting an impaired colleague. Oftentimes, the student is faced with difficult situations concerning a fellow classmate. We will be discussing some tips and suggestions that you can apply if you were ever faced with this unfortunate and challenging situation. In Section 3, we will be discussing the educator's considerations. Program administrators, faculty, and educators are often placed in a difficult position to protect the school, advocate for the patient, maintain the integrity of the student body, all while providing support and resources for the struggling rRNA. In addition, consideration is also placed on mandatory legal and licensing reporting requirements. In Section 4, we will be discussing employing the risk. We will discuss what the employer should expect when working with an rRNA or cRNA with a suspected impairment. We will also discuss tips on how to effectively manage the rRNA and how to provide a conducive and safe place for employment for the provider attempting to reenter the field. In Section 5, we will be discussing what to do if and when you need help. How do you know if you need help? When is the right time to ask for help and where should you turn to ask for help? In Section 6, we will be discussing the power of self-advocacy. We will discuss how to take charge of your license and to advocate for yourself while navigating those crucial initial steps towards wellness. We will also discuss how to be proactive and take care of your license and the career that you work so hard for. AANA's dedication to wellness. Since 1983, the AANA has been dedicated to providing wellness and substance use disorder resources to its members in the following ways. Peer assistance panel. This dedicated group of volunteers continues to share their experiences, expertise, time, and support to rRNAs and cRNAs across the country who are suffering with substance use disorder or mental health issues. What started out as one to two people has grown into a nationwide network of like-minded individuals dedicated and committed to the wellness of our members. The health and wellness committee. The health and wellness committee consists of both rRNAs and cRNAs and are charged with the task of promoting and supporting overall wellness within the AANA. Their volunteer efforts continue to have a positive impact on our profession and will continue to do so well into the future. The AANA helpline. The AANA continues to support and evolve this confidential helpline. Available to all cRNAs, rRNAs, employers, and family members, the AANA helpline is designed to provide current resources, support, advocacy, assistance with access to care, and oftentimes a shared experience. Calls are answered 24 hours a day, seven days a week by trained individuals who are dedicated and committed to helping those providers who are currently struggling with substance use disorder, mental health issues, employment, or licensing issues. I'd also like to draw your attention to this phone number as you will see it several times during this webinar. To order your free version of these business cards, please visit store.aana.com and utilize code anesthesia experts. Section two, the rRNA perspective. Over the course of training, the rRNA may encounter a fellow rRNA or a cRNA suspected of impairment. At times, it may even be the preceptor or someone in a position of authority. Knowing what to do and just as importantly, what not to do in these situations can profoundly affect the outcome. Keep in mind that mandatory reporting requirements may vary from state to state. Likewise, facility policies on substance use disorder may vary between organizations and sometimes even between departments under the same organization. It will be important for you to familiarize yourself with both your mandatory reporting obligations as a healthcare provider and the policies which dictate the course of action at your organization. Keep in mind that these situations are never easy. Addressing impairment concerning a fellow rRNA or a cRNA can sometimes be stressful and unpleasant. It will be really important to maintain self-awareness and self-care for your overall well-being and mental health. A typical situation may arise with an rRNA who just seems a little different. They seem a little off. Maybe they're presenting as slightly more tired, isolating, irritable, change in demeanor. Keep in mind also that this is oftentimes signs and symptoms of a normal progression through the rRNA clinical and didactic experience. The best thing that we can do during these situations when we are not certain if their actions warrant impairment or if they're indicative of their normal progression is to both consider the landscape of the current rRNA and maintain objectivity when assessing the situation. The rRNA landscape. The traditional experience of the rRNA can be both indicative of foundational precursors to a potential future impairment or it could be a mere reflection of their experience as a resident. Without maintaining consistent objectivity when evaluating the situation, it may be easy to explain away the suspicious actions as a symptom of the didactic and clinical experience and accompanying stressors. The stressors often begin long before the first day of class. A competitive admission process and years of preparation to be enrolled into a program is often the first experience of stress and anxiety. This is followed by three years of long hours, poor sleep, and deadlines that never seem to end. The high stress, increasing workload, and the occupational responsibilities also play a factor. Additional financial concerns and maintenance of the household while reducing employment during the program may also play a factor. Oftentimes relationships and families will be strained and will be forever changed because of the time-consuming and challenging nature of the program. And lastly, the time constraints of the program often result in the avoidance or the minimization of those activities which are designed to promote wellness and overall balance. Oftentimes healthy activities such as hobbies, exercise, mindfulness and meditation, sleep, volunteerism, and vacations need to be reduced or eliminated in the interest of finishing the program. It is for these reasons why it is sometimes difficult to discern whether the changes in the behaviors that have been experienced are patterns of concern or if they're indicative of a potential impairment or if they're just merely an experience of the rRNA. That begs to ask the question, when is the right time to ask for help? Reporting the impaired rRNA. First, let's talk about what not to do. Do not confront the provider directly as this often results in the opposite of the intended outcome. Confronting the provider will heighten their sense of awareness and put them face to face with the realization that people are on to them. This is a very potentially dangerous time for the impaired provider. This is a very potentially dangerous time for the impaired provider. Along that same line of thinking, do not tip off the provider. By providing them with insider knowledge or information in the interest of trying to help them, you could potentially scare the provider into doing something that could be harmful to themselves. Do not investigate the situation by yourself. By utilizing your local resources or by contacting the AANA 24-7 helpline, you will be guided through the situation by providers who have navigated the potentially dangerous situation many, many times. Do not keep quiet. Keeping quiet will sometimes have a dual effect, neither of which are favorable. First, remaining silent will miss an opportunity to intervene with a successful result. Second, the burden and the anxiety of remaining silent, especially if there is an adverse outcome, could potentially be a stressor on your mental health. Do not spread rumors or suspicions. Addiction and mental health are both primary diseases, and we should always keep in mind to protect the privacy of those that are suffering or potentially suffering from the impairment. And lastly, do not feel bad. Although the situation is indeed difficult, always keep in mind that your actions could save someone's life, and very likely their careers. As you can see, without the proper support and guidance, these situations can often be challenging. Here are a few tips that you can follow if you are an RRNA or if you are dealt with a situation with an RRNA struggling with impairment or substance use disorder. Be sure to write down your concerns and observations. This will facilitate the reporting to your program administrator. Also, be sure to review your school's policy on substance use disorder and follow those mandates. Again, notify your program administrator sooner than later. Be sure to also contact the confidential AANA helpline. This is geared to have additional support and resources to help you navigate this very challenging situation. It's also a good idea to familiarize yourself with the Board of Nursing's position statement on impaired provider in addition to mandatory reporting requirements and your obligations, therefore. And do say something while being mindful of confidentiality and the right to privacy. To further illustrate these points, let's now take a look at an actual case study that occurred a few months ago and involves an RRNA who was experiencing substance use disorder. This particular case involves a second year RRNA who had just barely three months of clinical experience. This RRNA is married with two children and their spouse is also a practicing CRNA. The RRNA works at a large teaching facility with many residents. There is a high volume of cases and staff and therefore a lot of turnover in high flow areas. Sometimes that may cause an additional challenge when trying to identify impairment in the workplace. Several classmates suspected the impairment and they noticed that there were behavioral changes, some practice changes, some irritability, and generally speaking some observations and behaviors that were just out of character for this RRNA. After watching the situation progress and the RRNA apparently getting worse, it became evident to the classmates that this provider was not fit for duty. As a result, an intervention was planned amongst all of the classmates which were involved. Their plan included an appeal of support and additional insight from his spouse, the CRNA. They first called the spouse and let her know what their concerns were and what their observations were. They asked if she would be available by phone and that the following day they would be confronting the RRNA with their concerns and their observations. As planned, the intervention was initiated the following day. Shortly thereafter, an urgent call came into the AANA peer assistance helpline after the intervention was completed. Let's now take a look at the outcome from case study number one, the RRNA experiencing substance use disorder. The suspected RRNA was confronted and since the spouse was contacted beforehand, she did feel compelled to let her husband know the situation. She identified the classmates by name who had the concerns and out of fear for his license, she warned him of the impending intervention. As a result, he approached the meeting highly guarded and defensive. The end result was that the RRNA The end result was that the RRNA denied all accusations. He subsequently filed a complaint with the program administration for harassment and he procured the services of an attorney. The end result was that the classmates were instructed to bring all further concerns directly to the program administrator and they were also reprimanded for their failed intervention and for handling this situation outside of the identified school policy. Ten months later, the RRNA was indeed caught diverting propofol from the facility. He was dismissed from the program. He was reported to the Board of Nursing. He was mandated into the treatment program and an impending legal investigation continued. Let's take a moment now and review case study number two, the RRNA experiencing substance use disorder. In this example, all recommendations were followed and the outcome is quite different from the first case study we reviewed. This situation involves a third year RRNA who suspects a CRNA clinical instruction for the RRNA. The RRNA was found to be subject to a drug-inducing who suspects a CRNA clinical instruction to be impaired, possibly diverting. This is a small surgical center with only five anesthesia providers to cover the entire facility. The residents and the staff of the anesthesia providers are all very familiar with each other. This also happens to be the RRNA's last clinical rotation as he will be graduating in a few weeks. As a result of that, he is considerably concerned about his confidentiality as he does not want to put himself in an awkward position as he tries to finish his clinical rotation. The program administrator has recently been notified and all of the observations reported were objectively detailed and consistent. The RRNA reports having high levels of stress and anxiety related to this particular situation. He called the AA&A Peer Assistance Helpline for additional guidance and support. This was done with the encouragement of his program administrator. Let's now take a look at the outcomes for case study number two, the RRNA experiencing substance use disorder. All information was kept confidential between the RRNA, the program administrator, and the AA&A Helpline team. The program administrator was contacted directly by the Helpline team and updated on the evolving situation. Together, they reviewed the school policies and procedures as well as the state reporting requirements in regards to an impaired healthcare provider. The AA&A Helpline team then facilitated a call with both the program administrator and the facility of question. With direction and guidance, an investigation commenced and an intervention was planned on the CRNA suspected of impairment. The CRNA almost immediately admitted to diversion and immediately agreed to enter into a treatment program. Subsequently, he entered into the state monitoring program and into their re-entry program to work his way back into practice. Lastly, the RRNA was also provided resources for self-care and counseling to further process his involvement in the situation. Several months later, the CRNA reached back out to the Helpline to thank all of those who were involved in his situation. He was grateful for the opportunity he was presented with to get the help that he so desperately needed. Whether you're a CRNA, an RRNA, or a colleague or co-worker, one of the questions most commonly asked is, when should I speak up? When should I say something? The answer is, do it early. As you can see, a lot of the early signs of impairment are also reflective of the situation and the experience of being an RRNA or a practicing CRNA. Some of the early signs of impairment could be some of the early signs of impairment could be changes in mood, irritability, inappropriate clothing like long sleeves in the summertime, isolation, changes in practice. Changes in practice could be reflective of a change in their practice. Maybe their practice was changed over the course of years, or maybe their practice is a big change compared to the rest of their colleagues. Frequent medication waste or accidental broken vials that often need to be returned. Increasing call-offs, usually as a result of being hungover or going through withdrawal symptoms. Frequently, they feel sick for the same reasons. They start to experience some relationship discord with their family and their friends, and their performance at work sometimes starts to change. As you can see, there is no quote-unquote smoking gun in any of these early signs, but it is best left to the experts to discern whether this is an appropriate or considerable impairment, or if this is just a reflection of their experiences as a provider. If we take a look at the late signs of impairments, you can see they're quite obvious. They're at work during off hours and in questionable times, coming in hours early and often staying hours late. Sometimes they show up on the weekends or when there's no cases available. Questionable needle marks or track marks, repetitive and consistent charting errors, an accidental overdose, visibly intoxicated, which could look like nodding off, passing out, changes in the pupils, increasing hours of break coverage, coming in early, staying late, offering to give several breaks, physical manifestations and changes in weight loss, continued increasing use and changes in practice. If you start to see a pattern of their increasing controlled substance use over a period of time, refusing to take drug tests and having three or four or five excuses on why they don't want to do the drug test, and walking around with drugs and syringes in their pocket. As you can see, these late signs of impairments don't always tell the entire story, but it's the combination of these signs that are best left to the experts to discern whether this is a significant finding or if this is just once again a reflection of their situation that they're in. If you have a concern, if you have a suspicion, speak up early. Let your program administrator know, let your human resources department know, your department chair, your chief CRNA, let somebody know, call the ANA Peer Assistance Helpline. And of course, it's a confidential call with support and resources available for you to help you through the situation. And finally, one last thought on reporting the impaired or RNA. It is okay to say something and be wrong, but it is not okay to say something and be right. In other words, a great outcome would be that this was just a misunderstanding. An investigation would result in a favorable outcome for the rRNA and both the patient and the rRNA would be safe. Conversely speaking, an unfortunate outcome would be that nothing was done because nothing was said. This could result in a missed opportunity to avoid a poor outcome. In summary, if you suspect something, say something. Section 3, the educator's considerations. The program administrator has a very difficult role sometimes. The administrators must consider all vested parties in relation to the impaired rRNA. This often poses challenges which must be handled delicately and may include the following. A legal duty to protect the school. The duty of the program administrator and the program's legal counsel often work together to protect the integrity of the institution. As a result, they are often obligated to not only consider the recommendations on how to intervene on an rRNA, but also keep the institution legally compliant. They are also tasked with an ethical duty to protect the public from an impaired health care provider. These obligations are outlined clearly in the Nurse Practice Act and they are defined in terms of their role and their expectations. There is also a moral duty to provide access and treatment and or support for the impaired rRNA. These rRNAs may need intervention, they may need treatment, or they may need both. There is also a professional obligation to the clinical site. Sometimes the obligation is contractual and often it is in the best interest of maintaining a good partnership within the community. There is a mandatory duty also to satisfy any reporting requirements at the local, state, and sometimes the federal level. If the indiscretion warrants such reporting, the administrator must balance remaining compliant with reporting while providing support to the rRNA. Lastly, there's also a duty to promote a sense of safety and well-being, physical and mental, to all other rRNAs and staff that are affected. Keep in mind that sometimes these are rather traumatic experiences for both the faculty and the rRNA. It is the educator's duty to promote that sense of safety and well-being to everyone who has been affected. Confronting the rRNA. Confronting or conducting a safe intervention is a very delicate procedure that should only be done by trained and skilled personnel. By utilizing local resources and the expertise of those who work with Peer Assistance Helpline, a positive outcome is much more likely. Confronting or intervening on the rRNA starts long before the actual physical meeting or intervention. First, it is important to collect all pertinent information. Subjective information and objective information will all be integral into determining any indiscretions. This may include pharmacy reports, staff interview, reviews of charts, and general observations of practice. The intervention and interview itself should be held in a safe space. Additional staff members should be present to coordinate efforts and provide additional safety. When determining appropriate drug testing, keep in mind that not all medications are accessible by anesthesia providers are included in a basic panel. It will be important to include all medications which are accessible by the provider. In the situation where the rRNA admits to an issue and requests assistance, it is crucially important to predetermine treatment providers who can immediately assume care and responsibility of the provider. One of the most crucial steps in the process and one of the most important pieces of information to share here is to never leave the rRNA alone and never send them home alone. Be sure to include and involve their families or their support systems as quickly as possible. Also, familiarize yourself with any state or federal mandatory reporting requirements. Obligations to report vary from state to state, but federal obligations will apply to every institution when controlled substances are involved. And finally, consider contacting the AANA helpline for additional resources and support. Calling the helpline before the intervention is conducted will provide you with support, resources, and trained personnel to help you through the process. Section 4, employing the risk. The risk associated with an impaired rRNA is a significance to the clinical site. In the case of a confirmed or suspected impairment of the rRNA, the clinical site should consider the following. Promote collaboration and open communication with the school. This will allow for the free flow of information from the clinical site back to the school. Timeliness of the intervention in close proximity to the initial suspicion will be crucial for a successful outcome. By maintaining these open lines of communication between the school and the clinical site, actions can be taken immediately, thus mitigating any potential consequences. Follow institutional policies on managing the impaired provider while keeping the school informed. In addition to the considerations of the school's policies, the clinical site must also adhere to their facility's policies and procedures. As a result, and in the interest of the clinical site remaining compliant with this reporting obligation, it is often the case that additional reporting occurs outside of the school's reporting. Review mandatory reporting obligations and share all reporting decisions with the school. In the interest of promoting a positive resolution, continue to share information on reporting and interventions with the school. Consider the development of a program which supports a safe re-entry for the provider. A well-crafted re-entry program will likely enhance the culture of the organization by proving to be supportive and encouraging of those wishing to re-enter the profession safely. In regards to the re-entry program, keep in mind that not everyone will be Keep in mind that not everyone will be suitable for re-entry back into the profession after an incident with substance use disorder. Those who are eligible, however, should be carefully selected and, at very minimum, meet the following criteria. They should have successfully completed a treatment program specializing in treating the impaired healthcare provider. When appropriate, the provider should be involved with their state monitoring program. These alternative to discipline programs are designed to provide safeguards, reassurances, and support as the provider attempts to re-enter the field. The provider should have satisfied any investigative, legal, or licensure considerations. That may include, but not be limited to, boards of nursing investigations, office of the attorney general, DEA, state, local, or federal investigations. The provider should also be agreeable to random or forecaused drug testing, as well as possible limitations of work hours or restrictions on certain medications. And lastly, all cases should be considered on an individual basis. By using a collective team of experts who are familiar with re-entry of the impaired healthcare provider, successful outcomes can be expected. We would now like to share with you two actual case studies which highlights the differences of asking for help as opposed to being discovered to have a problem with diversion or impairment. Case study number three, when we don't ask for help. This will highlight the potential outcome of what happens when we don't ask for help. This CRNA was in practice for 12 years. He is a chief CRNA under a high stress, high workflow environment. He works at a trauma center. There have been traditionally understaffed, which has caused him to work long hours. He reports having increasing pressure from management and the facility's owners, which expect him to continue to produce despite the lack of resources and personnel. On the personal side, he has a history of anxiety, a recent surgery, and a new prescription for opiates. He recently began diverting opiate waste medication to self-treat his anxiety and supplement his post-operative pain medication. After several months of falling into that routine, he now diverts and uses daily while at work. He is well aware that he needs help, but he is unable to stop on his own. And he does not want anyone to know. His family is not aware of his indiscretions, and he continues to experience an increase in shame, guilt, depression, and anxiety. Let us now review the unfortunate and all too familiar outcome of case study number three, when we don't ask for help. The unfortunate outcome is as follows. After increasing usage and several charting errors, the CRNA was required to submit to a four-cause comprehensive drug screening test. The results were positive for fentanyl. The CRNA was terminated from his employment, reported to the Board of Nursing, and mandated to be reported to the DEA for theft of a controlled substance. His hospital credentials were revoked, and he was reported also to the National Practitioners Data Bank. He has currently faced pending legal charges and was also required to enter treatment and monitoring. Reentry to anesthesia at the time of his indiscretions were questionable. Upon admission into the treatment center, the CRNA stated that he felt his only option was to try to take care of it on his own. He was embarrassed to reach out for help, but grateful for the opportunity to get the help that he needed. Subsequently, he was able to return back to practice in anesthesia nearly two years after all of the investigative, treatment, and licensure requirements were satisfied. Let's now take a look at case study number four, self-advocacy at work. This case study will illustrate the power of self-advocacy. This CRNA has been in practice for nearly eight years. She has a history of depression and chronic pain. She currently works full-time in a high-stress environment and is married with three children. Her alcohol use has been increasing over the past two years, and she is currently drinking daily. She has a history of one DUI nearly six years ago. Due to her daily and increasing use, mild alcohol withdrawal symptoms begin to present themselves around 12 hours after her last alcohol consumption. The symptoms usually start in the middle of her shift while she's providing anesthesia. Understanding that she met the definition of impairment at work due to the withdrawal symptoms, she begins diverting benzodiazepines at work to alleviate her symptoms. She realized quickly that her situation had become unmanageable, and she has contacted the AANA helpline for information, support, and resources. The outcome for case study number four is as follows. Self-advocacy at work. First, she was reassured of confidentiality when calling the AANA peer assistance helpline. She was then guided through the process of family medical leave and was able to secure that family medical leave in addition to short-term disability. She was also provided with access to local providers She was also provided with access to local providers who have experiences in managing the impaired CRNA. She was also provided with access and support for her family. She immediately entered and successfully completed an inpatient treatment program designed to work on the mental health and the alcohol use disorder that she was experiencing. She also voluntarily entered the state's alternative to discipline program which further protected her license. Three months later, she returned to work without incidents. Her license is currently unencumbered, she has no legal or licensing concerns, and she remains sober, healthy, and grateful to this day. Section five. What to do when you need help. Asking for help for yourself may be one of the hardest yet most important things that you can do over the course of your career. Many reasons have been identified and exist which serves as barriers to health care providers asking for mental health or substance use disorder help when needed. This includes the following. Societal stigma and shame. It's often very stigmatizing to raise your hand and admit to a substance use disorder or a mental health problems. Societal stigma is often reported as one of the leading indicators of why health care providers don't raise their hand and ask for help. Oftentimes, there are professional obligations. You're in charge of the department. Your patients are counting on you. Cases are scheduled for the next couple weeks. You're the only one that can do your job. This overwhelming sense of professional obligations often hinders health care professionals from raising their hand and asking for help. The fear of the unknown. What's going to happen to my license? What's going to happen to my position? What's going to happen to me? What kind of treatment do I have to go into? Why can't I just take care of this on my own? What does this mean for my family? The fear of the unknown is often a limiting factor for health care providers who are suffering from mental health or substance use disorder raising their hand and asking for help. Fear of a punitive response from multiple vested parties. What's going to happen to my nursing license? If diversion was involved, what's going to happen with the legal side of things or the licensure side of things? The punitive responses are often very prohibitive from health care providers raising their hand and asking for help. Cultural barriers, both personal and professional. Sometimes cultural or learned behaviors through culture and upbringing are barriers to asking for help and admitting when you need help. This can happen both personal and professionally. Sometimes financial obligations play a large consideration in asking for help or not. If you're the sole breadwinner, for example, of your family, you're less than likely to raise your hand and ask for help for fear of the financial obligations that you have to your family. One of the most significant barriers for health care professionals not asking for help is denial. Sometimes it's embarrassing, sometimes it's shame, but oftentimes there's an element of denial. They may not think that they are as sick as they are. They may not think it's as significant as it really is. They may not think it's as out of control as it apparently is. Denial is a very big driving motivating force to not ask for help and to continue down the path of substance use disorder and mental health considerations. If you do need help or if you think you might need help, do something today. Contact the AANA helpline for support and resources. Also, review your institutional policies on substance use disorder. Your facility may have additional resources available to you through their employee assistance program, their human resource program, their reentry program, or a variety of other programs that may be available to you. Also, contact your state's alternative to discipline program for additional resources. You can make this call anonymously and protect your anonymity while you procure additional resources. Contact your state's alternative to discipline program for additional resources. The state's alternative to discipline program works in conjunction with the Board of Nursing to provide you the resources and access to care or treatment that is pre-approved by the Board of Nursing. Although the initial call or contact to the alternative to discipline program is confidential, the resources that they provide you will be specific and will be appropriate for your situation. And finally, share your thoughts and feelings with a trusted family member or friend. Make the call together. By contacting the AANA helpline, you'll be put in contact with one of your peers who have been through this before and can help you navigate the next steps. Section six, the power of self-advocacy. The best way to get out of the situation that you found yourself in is to self-advocate. First, know your employer. If you got caught at a facility where your indiscretions surfaced at the top, know your employer. Are they recovery friendly? Will they provide you with assistance? Do they have a reentry program? And ask yourself the question, is this the type of facility that you want to reenter back into the profession with? Many times, one of the most difficult decisions that you will make would be the best decision and that would be changing employers if it's conducive for a healthy lifestyle. Next, know your worth and remember your worth. You deserve to take the time off that you need. You deserve treatment. You deserve the best care that you can get. You deserve to put yourself first and take care of yourself first. Next on the list, proactive is preemptive. Being proactive with your wellness and your care is oftentimes preemptive to any adverse consequences that may arise due to your indiscretions. Proactively take care of yourself and prioritize your mental and physical well-being and by doing so, you will preempt a lot of consequences. Next, work with the state. Most states have what they call an alternative to discipline program, which according to its namesake is just that. It's an alternative to discipline program. So, proactively contact your state monitoring program, your alternative to discipline program and follow their recommendations. That will oftentimes preempt any adverse consequences with the Board of Nursing. Follow the plan and stick with it. Far too many times we have seen healthcare providers get things back on track, life is going good, the job is going good and they deviate from the plan. Follow the plan and stick with it. Sometimes the plan is a little bit long, three years, four years, five years and includes monitoring, treatment, accountability, time off work. Follow the plan and stick with it. Get connected and stay connected. Get connected to yourself. Get connected to your family. Get connected to other like-minded individuals. Get connected to those who are in recovery and have been through the program before. When it's appropriate, tell your story. Help put a spotlight on this occupational hazard. Tell your story. And finally, help a colleague. Erode away the stigma of mental health and substance use disorder. There's nothing to be ashamed of. There are people that have come before us and there will be people that come after us who have fallen down the same traps that we have. Help a colleague. The power of self-advocacy, taking care of yourself, taking care of your license, taking care of your career. Make yourself the priority and be proactive in your actions. And keep in mind, we're here for you. We're here for you as an organization. We're here for you as individuals. We're here for you as your peers. Find resources to support all aspects of personal and professional well-being. Be sure to ask for help. Help navigate through adverse events. Help find healthy routines in terms of sleep and emotional and mental health, stress and burnout, substance use disorder. We're here for you. You can find more information at aanawellness.com.

impaired healthcare providers

early intervention

AANA helpline

self-advocacy

reporting impairment

legal obligations

re-entry programs

mental health destigmatization