Recovering employees should be encouraged not to rush back to work, but to allow time to develop a new lifestyle and new coping mechanisms. The longer the employee is substance free, the greater the chance of learning the new behaviors.

Prior to the recovering employee's return to work, a meeting with the nurse executive and/or nurse manager and the employee should take place for the purpose of establishing a return to work agreement. This agreement outlines the expectations of the employee and provides recovery guidelines and work standards. As the return to work contract is being considered, it is important to remember that all recovering employees are different and require an individual approach to their situation. The contract should be done in collaboration with the employee's counselor and in cooperation with the Kentucky Board of Nursing disciplinary orders, if these apply. A nurse executive may always increase the restriction in the KBN order depending on the needs of the employee and the facility but shall not be more lenient on restrictions than the KBN order mandates.

Reentry to the workplace may put the employee in contact with some relapse triggers, for example, increased access by carrying the narcotic keys. It is often recommended that there be a minimum of six months without access to controlled substances after the employee returns to work. During this six month period, it is advisable for the employee to work the day shift and not to float to other units. Sometimes, it is recommended that the employee change units if the former unit has a high stress environment, the patients on the unit require frequent administrations of controlled substances, if the former unit was a chemical dependency treatment unit, or if the staff have negative feelings toward the recovering employee.

Prior to reentry, it is essential that the manager have a meeting with the staff. It is during this meeting that the nurse manager can discuss with the staff the facility's approach to chemical dependency, the disease and the recovery process, the individual nurse's needs, and the support and assistance that will be needed from the staff in order to foster successful reentry. This meeting is also a good opportunity for staff to ask questions and express concerns or opinions about the reentry. It is often helpful to also have the recovering employee meet with the staff prior to reentry.

The staff need to be supportive of the recovering nurse and often they also need to provide direct assistance. In most instances, they will need to administer the controlled drugs for a period of time that are required by the recovering nurse's patients. This process can be facilitated if the recovering nurse performs a reciprocal patient care task for the assisting nurse.

The nurse manager will need to monitor the reentry and keep in close contact with the recovering employee. Throughout this initial period, evaluations need to be performed as spelled out in the return to work contract. These include sessions with the manager, reports from the counselor, and random drug and/or alcohol screenings. The manager will also need to be available for staff concerns in the adjustment phase of the reentry.

It is helpful if the recovering employee has frequent contact with another recovering employee who is at least three years out from his/her initial treatment program. This person can be of tremendous support to the employee as he/she returns to work.

Only those employees who need to know or will be working directly with the employee should be informed of the employee's illness and recovery process. However, many recovering employees will be comfortable in initiating discussions with staff. Other recovering employees will experience anxiety in deciding who to tell, who to turn to in time of need, how to handle social events where alcohol is served and negative comments from staff. Sensitivity is needed by all staff members to help the recovering employee adjust to this initial return to work phase.

Following an established period of time, the nurse manager, another nurse administrator, and the employee need to meet to evaluate progress. It is helpful to have the treatment counselor present at this session. If this is not feasible, a phone report and recommendations from the counselor are essential. Depending on the progress of the recovering nurse, the assessment from the facility staff and the counselor, and the desires of the employee, restrictions on drug administration may be modified or maintained. This is also a time to evaluate all aspects of the return to work contract and make any adjustments that are needed.

An atmosphere of friendly support, carefully planned reentry, close monitoring and availability, along with structured guidelines all help to facilitate a successful reentry.