The Value of Peer Support Groups to Recovery with Carrie Kappel, RN System Manager of Operations, Addiction at Alina Health.
Today’s interview focuses on peer support groups and the essential role they fill for those in recovery. We talk specifically about Nurses Peer Support Network in Minnesota as this is where Carrie volunteers, and it gives us a nice look into a peer support group and the value they provide. We need to incorporate next steps resources for those we confront in our hospitals. Have a list of phone numbers on hand to provide or better yet, someone from a peer support group on standby to assist the healthcare professional who has just had their life turned upside down after being questioned about diversion and a substance use disorder.
Terri: Welcome back everybody, my guest today is Carrie Kappel. She is the Operations and Addiction Manager for Alina Health. Carrie has done a lot of work around peer support and reducing shame for those in recovery from a substance use disorder, and that will be the focus of today’s discussion. As we get started Carrie, please give us a little bit of your background and tell us specifically about the peer support group that you’re involved with and what the purpose and the goal of the peer support group is.
Carrie: I’m happy to, thanks Terry for inviting me to join your podcast to bring more attention and awareness. As you said, my name is Carrie Kappel, I currently work as an Addiction Operations Manager for Allina Health in the Twin Cities. I support primarily our outpatient services. I have previous experience working for Hazelden Betty Ford Foundation in their Center City location, and my primary role there was as an Associate Director of their Healthcare Professional Program, so working directly with nurses providers and other Health Care Professionals with substance use disorder issues that likely affected their ability to practice and their need for treatment and then to return to work, as well as monitoring resources that are needed or should have been in place as far as peer support. I currently am a coach chair of the board of directors for a non-profit here in Minnesota which is called Nurses Peer Support Network or NPSN for short – so if I accidentally go back into acronyms which I’m known to do – that’s what I’m referencing. Nurses Peer Support Network is a 501-c3 non-profit here in Minnesota, which has a couple of missions: one is a mission to provide peer support for nurses specifically related to substance use disorder and recovery, and two: to provide education for organizations that employ nursing students in formal training in Minnesota organizations advocate on behalf of nursing, whether it be licensing or monitoring organizations as well as the general population of individuals in Minnesota, to understand the prevalence of addiction in nurses and other health care providers, so there’s a couple of missions for Nurses Peer Support Network, in that peer support was sorely missing prior to the inception of NPSN. We’re a relatively young organization, we’ve been around since 2014 and so a handful of years but we’ve done a lot of hard work in Minnesota to provide peer support for nurses with substance use disorder – and not only around return to work but the stigma that you referenced, in that healthcare professional nurses, in general, can often feel an additional layer of shame – professional shame related to their substance use boundaries that may they may have crossed in active addiction. None of them ever intended to cross – you know they weren’t goals that they set out for – but nonetheless, their disease might have moved them forward and how to come to terms with that, how to accept them themselves and process that and move forward, as well as face any issues they might have moving forward in their career licensing right now.
Terri: You said professional shame, I hadn’t thought about that. Are we talking about the shame specifically surrounding the fact that they were working impaired or diverting medications, putting patients at risk, or does that mean something different, like what is professional shame versus shame in general?
Carrie: That’s a really great question. The reality is that healthcare professionals I think can often feel that because of having an educational background in medicine, that they should have been able to protect themselves from this disease, they should have known better. They have some general understanding of addiction. The reality is that healthcare professional nurses providers don’t have any lower rates of addiction – in some realms they have higher rates of addiction because of access to substances and so understanding that level of professional shame – professional shame related to the fact that they may have crossed boundaries in their active addiction, you know, coming to work not in the best shape, working under the influence, diverting of substances, and then the general areas of shame that many people with addiction have regarding the rule, the boundaries that they’ve violated with their own families or crossing things that they said they would never do. The disease of addiction marches up right over those.
Terri: Sure okay, that makes sense. So all the same types of shame issues that people have to address in addition to “I should have known better, I am educated in this field and I should have known better.” Okay that makes perfect sense. Now, these peer support groups, what do they look like? Do they begin at the moment of entering a recovery program? Do they come into play later down the line? Do you have people in a peer support group that maybe the employer has no idea that they’re struggling, and they’ve decided to go themselves to get help and try to work through it quietly?
Carrie: What does it look like – let me try to take that one step at a time. Peer support in Minnesota is not treatment, so we do not begin to subscribe to being that. In Minnesota, we are exactly what we describe, peer support, so we are a separate entity from treating providers that actually treat the disease of addiction. We’re also different in Minnesota in that our peer supports are not wrapped into either monitoring or alternative discipline programs that many states have and or licensing say with the Board of Nursing in Minnesota. In some states peer support can actually be connected to either of those entities and I think in Minnesota we have a little unique perspective in that we are entirely separate from both of those entities, but we have really collegial relationships with both our monitoring agency Health Professional Services Program of Minnesota and the Minnesota Board of Nursing as well and they’re highly supportive of the work that we’re doing. What does peer support look like? We have both in-person and virtual peer support that happens multiple times a month that allows individuals to either come to meetings – either in person or virtual – and connect with other nurses that are also in recovery. Many of them are in monitoring programs and so working through the requirements that the monitoring program has them navigating; some of them are returning to work, some of them are unemployed, some might have restrictions on their license that prevent them from returning to work or a suspended license, for example, so it could be all. Some might still be engaged in some treatment or ongoing continuing care, so it could vary. We have one virtual support that happens through a collaborative relationship with rooms.com, and it is actually a virtual meeting that we started as a pilot. We gave it a six-month window and rooms is actually gracious to us and joining that pilot and helping us navigate it. What we’ve learned with that platform is that we reached not only nurses in Minnesota, not only nurses nationally that were looking for connection, but we have nurses from around the world that attend, that connect with us who are in England or in France or in Australia and looking for peer connection and are attending that meeting and so that meeting has somewhere between 80 and 100 nurses that attend on a regular basis.
Terri: Wow, so that’s called the room?
Carrie: Yeah it’s through rooms.com. That’s the platform that we use and then we have a nurse’s meeting on that platform that is listed and then, you know, what they do ask that all of the individuals that attend the meetings be nurses – don’t have any ability to guarantee that or guarantee their confidentiality on that meeting because of of the platform, you know, so we support that folks navigate sharing what they’re comfortable with the attendees.
Terri: Okay, well with 80 to 100 people I suspect there’s a lot that don’t participate verbally, it’s more listening or maybe they form their own little connections, start there, and then kind of meet their peers that they take offline?
Carrie: Perhaps, and I think it’s probably a mixture of all the above, you know I think many folks may come to to see what it’s all about, and then as you get more comfortable potentially sharing especially if there’s a topic, and we have pretty skilled navigators – we call them conveners because our leaders are not really facilitators, quote-unquote, they’re not treating providers, they’re not therapists, they are our trained conveners who are experienced at leading these groups and helping engage conversation around the topics of discussion, around shame, around returning to work, around whatever is coming up for the individuals at large, and I think they always come with a couple of topics in their back pocket in case all they hear is chirp chirp.
Terri: Right, well I think it’s probably just the fact that a lot of it is for people to log on and to see that they’re certainly not alone, I mean that’s a lot of people in that peer support group and that right there tells them that they’re not the only ones struggling with it, so I’m sure that’s a good beginning for them.
Carrie: One of the major things that we hear – in fact in my own work at Allina what I’ve heard is I supplied our resource of the nurse’s peer support at work to one of our coordinator staff who does assessments and connections with patients coming into programs or determining what level of care they need, and when I did that you know she didn’t think too much of it but she actually connected with me at a recent holiday celebration that we had from staff and she said I can’t tell you how many times I’ve actually used that resource with patients or people that have connected, and she said I just went to your website and I showed part of one of the videos that are on your website page and she said, you know when it’s a former nurse or they’ve lost their license to their disease or they’re just seeking care at that point and they connect with that, she said, I’ve seen them actually have tears rolling down their cheek, understanding that they aren’t alone, they aren’t the only one, and there might be people to connect with.
Terri: Right, absolutely. Okay, I want to come back to that, I’m hoping you can maybe give us a couple of examples – no names of course – of how it really made a difference in somebody’s recovery and in their life – I do want to ask, though, you had mentioned it’s not peer support, I think you said, is not required, not mandatory in your state. There are other states then I’m assuming do have mandatory peer support groups as part of the licensing board or recovery program, is that correct?
Carrie: So every state has – well, almost every state – Minnesota has what are called alternative to discipline programs which are basically monitoring programs that support individuals that are healthcare providers in returning to work and what requirements need to be in place, what protective measures are there going to be, monitoring to make sure that the individual is following the treatment requirements, maintaining their sobriety, so really for healthcare professionals, there’s a higher standard and in that returning to work there’s an issue of Public Safety and so most states have some sort of alternative to discipline program, they’re all run a little bit differently in each state. In Minnesota, our actual monitoring program and our boards are very are separate entities and the monitoring agency in Minnesota actually monitors almost all licensed healthcare professionals throughout disciplines, so not specifically related to nurses – most healthcare providers in Minnesota have a separate non-profit that provides peer support for pharmacists. We have a pharmacist recovery Network or PRN I don’t know if that rings a bell there, and for Physicians it’s Physicians serving Physicians is the non-profit or Dentists concerned for Dentists. Like I said, we’re late to the game really, I don’t think we missed seeing that we needed the support, we just didn’t really have somebody who stood up and helped us get organized and what we found was Diane Nos, who has now passed – but she and Marie Manthey were actually our key leaders in helping us get organized and build and launch the non-profit of nurses peer support network which has continued to thrive in Minnesota, so like I said we are a little bit different. I think it also allows us a little bit more autonomy. The nursing boards also highly support our work and look for ongoing reports from us on our participation – what’s working well, how many nurses are we reaching on average in Minnesota, so we really try to keep as much data around that as possible. Second, our monitoring program – Health Professional Services Program, Minnesota, is regularly referring individuals to connect with peer support because they understand the vital nature of having that peer support around individuals who likely have a multitude of feelings about their disease, about monitoring, about a return to work around license restrictions or suspensions, or so on and so forth, that they may need to navigate and just having some nurses that have navigated those to help you walk that journey is invaluable.
Terri: Yeah, now you’re a non-profit so are these peer support groups at no charge to these people in Minnesota?
Carrie: We provide them at no charge. We don’t charge our individuals to attend, we don’t take offerings. We welcome donations, our website is up, and we are always looking for donors. We have also partnered with the largest Union, Minnesota Nurses Facilitation in Minnesota. We partner with many of our large Hospital employers across Minnesota to see the value that nurses’ peer support network provides in service to the nurses that they may have working for them. We also regularly, um in this last fall in November we held a CE event that talked about nurse suicide and how closely some of that is related to nurses who have either substance use disorder or are facing some type of board action and often that can be a triggering point for suicide, but you know, wanting to connect those dots and you know then encouraging folks to get involved, understand what we do, we’re always looking for volunteers as well as any donations.
Terri: So okay, yeah I know that’s great. Do your volunteers need to be part of the recovery system themselves or just Health Care Professionals that have a desire to help?
Carrie: So they can be any and all. Most of our conveners are nurses who are recovering themselves – not all of them, but many of them are – some have a fairly good understanding of the disease of addiction, might be working in an area where they have direct knowledge and understanding of that. We have other opportunities with our Organization for folks to serve on say an education committee or like a peer support committee or we were just forming an Outreach committee, so there are a lot of opportunities that even if you’re not a nurse you can volunteer to offer your resources. Our board of directors is not only diverse in ethnicity, age, and discipline, but background. We want to have an addiction provider on our board. We have other individuals who bring certain value values to that organization to support the work we want to move forward.
Terri: You talk about nurse suicide; what would be your message to hospitals out there that have diversion monitoring programs and if they’re doing it right there’s going to come a time that they’re going to have to confront somebody with their suspicions. So what does that look like to you in terms of a healthy confrontation? What advice would you give a hospital that needs to sit down and have that hard conversation with somebody?
Carrie: Certainly I support the challenging conversations that need to happen not only for patient safety but for that nurse’s safety and that nurse’s life, and I want to continue to raise that bar for looking at what kind of supports might be beneficial to have for that nurse if that nurse is in a union she likely has a union representation that should be at that meeting with him or her. I should assume it’s a nurse as a female but you know nursing is primarily female but not entirely, they also should have, you know is there peer support like nurses’ peer support network. If they can’t be available in that room because of the confidential nature of the discussion, could they at minimum give them a contact number could they reach out and say we have this event we have an event and we could use support – would you be able to have somebody here on site in case someone wanted to speak to somebody, you know having some additional supports for that individual as they continue to do the work that they need to do.
Terri: Right yeah that all makes sense. I think we get focused on the investigation itself, making sure we have all the data to have that conversation. We know what questions we’re going to ask but we kind of – I know from my experience – forget about the, “okay we’ve confronted, maybe they’ve admitted, maybe they haven’t admitted, but we think they still have an issue and that is a moment where they’re very vulnerable but we don’t go past that. It’s like okay you know, bye, we’ll let you know our decision within 48 hours or what have you, but there’s a lot more that needs to be done to really take care of them because they are very vulnerable at that point. Yeah okay can you share with us any things that any couple of cases maybe that stick out in your mind that you really felt the peer support group really saved a life or I mean they’re changing lots of people’s lives, I’m sure, but anything that really sticks out for you?
Carrie: So the messages that I have seen or that my conveners have seen is that a nurse may come to a meeting and they’ve now gotten involved with the monitoring program they’re probably either in treatment or completing treatment or completed it, and so they’re at varying levels of understanding of their own disease acceptance, they’re at a varying level of where they’re at with engagement and monitoring – it sets a pretty high bar in what they need to follow in order to successfully return to work. The ongoing stringent requirements around that and most of us understand why that needs to be in place and for that individual with the disease
of addiction who’s trying to navigate following their continuing care and doing all of that and focusing on getting well and staying well, it can feel like just additional things they have to do that other people with this disease don’t have to do, and helping them understand. For example, a nurse comes in and she’s angry – she’s angry about these additional requirements, you know, why do I have to do these things other people who I get in treatment with don’t, there seems to be a double standard for a nurse like me and then being able to process through why that double standard might be there and coming to terms with it and accepting that what they see and what they’re being asked to do for their monitoring really is not much different than what their treating providers are asking them to do for their care – maintain their sobriety, follow their training recommendations, get peer support – whether it’s in 12-step or Celebrate Recovery or smart recovery or nurses peer support network, but getting that peer support to continue to support their recovery moving forward really align well. I think the only – at least for Minnesota I can’t speak to other states specifically – one of the additional requirements in Minnesota is some type of random screening. In Minnesota I believe that they use urine drug screening for the most part and then escalate it based on any concerns with that. Nurses are required to complete in Minnesota – and I would guess this is most standard across other states – is that when you’re engaged in monitoring anything that additionally that is required to complete while you’re in monitoring, the nurse has to pay for, the health care professional has to pay for, so the urine drug screens and in our state most of the times the monitoring program is not asking the treatment it would be recommended for anyone with a disease of addiction. The co-pays, and out-of-pockets would be the same for anyone else but the monitoring would have the additional requirements around the urine drug screening um that needs to be paid for and likely gets handed to the nurse to figure out how to pay for. In other states, I do know that peer support that is tied with a monitor program or a licensing board may actually have a charge for that so you’ve got a nurse that now needs to pay for peer support as well and there may be a fee to be in the monitoring program so there may be an additional fee on top of that
Terri: Wow okay I guess everybody needs to get paid for everything they’re doing but it sure puts these people in a really tough spot because they probably don’t have a job.
Carrie: Well yeah it really depends you know some individuals may not be working you know they may have taken time off to get well, they may have a job that they’re returning to, maybe they have or they’re returning even at a part-time status and you’re right some people will have been terminated from their place of employment so now they’re entirely unemployed and so you’re asking them to figure out and not that the burden maybe shouldn’t be there but I think we need to protect Public Safety and should have an understanding of what the requirements then bounce back to the nurse or other healthcare provider with the disease of addiction.
Terri: Yeah because if they’re going to go through the whole program and come out on the other side in terms of reintegration in their field, they’ve got to do all these things – it’s not an option and if they don’t, it doesn’t mean that they can’t come to full recovery but if they don’t they probably won’t be re-licensed and put back in so it’s kind of a big decision for them that they have. It’s just like it’s like paying rent, I mean I have to pay my rent and I have to pay for all these requirements and I think we as Healthcare Providers and those that that engage in public safety, we all know that there’s a health care crisis in health care workers across across the country and perhaps even if this nurse is not able to provide direct patient care especially working in a site where they have direct access to substances could they provide safe patient care in a application where they don’t have the access and and can still be employed and I think those are all really tough conversations but I do hear more word of nursing monitoring programs beginning to grapple with that question because we might be shooting ourselves in the foot basically with some of these individuals that many of these individuals nurses included that can continue to provide care safely under proper monitoring and be part of our solution and help them get well, get them back in faster which in some cases if they don’t have access it might be a bit of a healing for them too perhaps. Okay, these are great. Well, Carrie thank you for all of your volunteer services, I’m sure you do a lot that is voluntary and all the people that work with you and that make a difference for these people that do need it and you’re giving them an opportunity to get one piece of that puzzle that they don’t have to pay for and makes a big difference for them. I’m sure in your state so thank you for your services.
Carrie: You’re very welcome, it’s a real pleasure. We are entirely volunteer-run; we have one executive director who’s a part-time paid position and everyone else for the organization or committee members, our board members, our conveners, are all volunteers and they passionately believe in this work.
Terri: I think it’s great, so all of you in Minnesota or other states that have these programs and you’re looking to get involved in some way whether it’s financially or time, check these groups out because they sound like a very worthy cause. Maybe somebody should set up a scholarship fund for people that need monitoring or something and can’t afford it that would be a nice thing too for all of you philanthropists out there that are listening. All right well thank you, Carrie, for your time I know you’ve had a really busy day and you’re probably going from your day job to your evening job. I really appreciate all of your time today to do this interview. Some great information for people.
Carrie: You’re welcome, thank you very much.