Nurses with Substance Use Disorder and Peer Support

Picture of By: Kristin Waite-Labott BSN, RN, CARN, CPRC
By: Kristin Waite-Labott BSN, RN, CARN, CPRC
November 2, 2022

Nurses with Substance Use Disorder and Peer Support

Kristin’s Story

I have been a nurse since 1991. There was never anything else I wanted to do. But in 2004, I lost nearly everything when I was caught diverting drugs from the hospital I worked for. It started with a prescription after a surgical procedure in 1997. Life was stressful and those pills made it better. In the years following, I found reasons to get more pills and one day, when working in an emergency room, I started taking wasted controlled substances. My use escalated after a divorce. Around 2003 I tried fentanyl and found myself unable to stop. I eventually started stealing it from the stock. After that it didn’t take them too long to discover what I was doing. By 2004, I was fired, had lost my nursing license, and ended up spending 4 months in jail after a re-offense.

Once released from incarceration, I threw myself into building a recovery community and lifestyle because I never wanted to return to substance use. Life with substance use disorder (SUD) was too painful to contemplate, and I vowed to continue to develop the skills I needed to stay clean and sober. I have done that since January 17, 2005, with no return to the use of substances.

I was, and am, an excellent nurse. I excelled in my practice and was looked at as a role model by my peers, I had exemplary yearly evaluations. But it still happened to me. I am certainly not the only nurse to go through this. SUD can happen to anyone, to any nurse. The American Nurses Association says that 10-15% of nurses suffer from some form of SUD and 6-8% of them are working impaired. Most experts agree that the pandemic has made it even more prevalent as nurses try to cope with a demanding, emotionally stressful, and at times overwhelming job, leaving them vulnerable.

When I was diverting, I wanted to stop so badly, but I could not. I didn’t know there was a monitoring program with the Wisconsin Board of Nursing (BON) called the Professional Assistance Procedure (Professional Assistance Procedure), that I could join that would help me find treatment, enable me to keep my nursing license, and ensure I practice safely. Most states have similar programs. But, even today, not many nurses know these programs exist.

Once in recovery for a couple of years, and with encouragement from my therapist, I applied to join the monitoring program through the Wisconsin BON. I was accepted into the program, but it was hard, and I wondered if I could make it through. I knew the rules and followed them, but there was no peer support at the time, and no one to guide me through. Many nurses quit the program, they just couldn’t afford it, or they couldn’t manage the strict rules. I didn’t know what to expect in the program and I was often fearful that I would do something wrong and lose everything again. I didn’t know that there were about 300 other nurses also going through the monitoring program, we had no way to connect with one another. I did complete the program and have my full licensure again, but it was more difficult than it needed to be.

Life in Recovery

Today I work with other nurses going through similar circumstances. I work as a certified recovery coach through a telehealth intensive outpatient program at Veritus (https://www.veritussolutions.com/). As a recovery coach, I work with nurses that are going through the same things I did. I know how it feels and how to navigate the ups and downs of recovery. I guide the nurses new to recovery and monitoring programs on what to expect and suggest different avenues to explore. I may not have all the answers, but I have been through it, and I understand. The emotions can be overwhelming: guilt, shame, remorse. It is a roller coaster that is different for everyone. But there are similarities and being able to talk with someone who has been through it, who understands what it entails, and who has returned to safe nursing practice, can be an invaluable resource. A resource I needed. A resource I can now be. 

I also realized Wisconsin needed a peer support program for nurses with SUD, so I started one.

What Can Nurses and Leaders Do? Read on to Learn About Wisconsin Peer Alliance for Nurses

As I think back to my time in the Wisconsin BON’s monitoring program, I am amazed that I was able to complete the program. I was beyond grateful to be able to work as a nurse again, but I was also overwhelmed. The monitoring program was expensive and time consuming. I had a lot of anxiety and wondered if I would be able to complete all the components of the program while working a full-time job and raising 2 daughters on my own. I wanted to talk to someone about it, but I didn’t know anyone that was in or had gone through the program. It would have been immensely helpful to know what to expect, and to have someone to talk to about my anxieties, frustrations, and fear.

Fast forward to 2020, the COVID-19 pandemic was in full swing, and I started working with Veritus. It was in doing this work that I was introduced to nursing peer support organizations in other states. Programs like Statewide Peer Assistance for Nurses (SPAN) in New York (https://www.statewidepeerassistance.org/), Nurses Peer Support Network of Minnesota (https://www.npsnetwork-mn.org/), and the Intervention Project for Nurses in Florida (https://www.ipnfl.org/). These programs offer peer support to help nurses navigate early recovery, including working with monitoring programs. This was a revelation to me; I had no idea that such programs existed. It was then that I decided to start a similar program here in Wisconsin, and the Wisconsin Peer Alliance for Nurses (WisPAN) was born.

The first arm of WisPAN is peer support for nurses with a substance use issue and/or those going through monitoring programs. We are based in Wisconsin, but meetings are virtual and open to any nurse. That includes student nurses, LPNs, RNs, advanced practice nurses, and retired nurses. We hold twice weekly virtual meetings that are free, confidential, and anonymous. Each meeting is facilitated by a nurse in recovery.

The second arm of WisPAN is education. We believe all nurses, nurse leaders, and those working alongside nurses, need to have awareness of the issue of SUD in nurses. It is important that people know how to recognize it, what to do if they recognize it, and be willing to act if they do recognize it. We also believe it is imperative that nurses know about monitoring programs and peer support programs that are available to them. If a nurse develops a substance use issue, they need to know they have an option and a place to turn for help. The hope is that, through education, nurses with a substance use issue will seek help before it affects their nursing practice. To that end, we offer presentations on substance use disorder in nursing and we share our stories of recovery. We do this at colleges and universities, healthcare facilities and clinics, and healthcare conferences around the country. No group is too small or too large. Do you know someone who would benefit from this education? If so, please share our information with them.

There are many benefits to the type of peer support offered through programs such as WisPAN. First and foremost, nurses find that they are not alone. They find that there are others that have gone through, or are going through, similar circumstances. They can talk openly, and they find the support they need. The peer support offered by WisPAN is a bit different than other support type programs. Groups such as 12-step (AA or NA for example) and their meetings are incredibly valuable in teaching people how to live a life free of substances. WisPAN addresses additional issues specific to nurses such as: legal consequences, loss of licensure, working with a monitoring program, or regaining trust in the healthcare community. WisPAN does not offer professional counselors, but rather peers who have been through similar experiences and who use those experiences to help others navigate the ups and downs of being a nurse in recovery. They find guidance, acceptance, and understanding that they didn’t know existed. When nurses hear the stories of other nurses that have successfully completed a monitoring program and safely returned to nursing, it gives them newfound hope that they too can return to safe nursing practice.

Kristin Waite-Labott
Picture of Kristin Waite-Labott BSN, RN, CARN, CPRC

Kristin Waite-Labott BSN, RN, CARN, CPRC

Kristin has been an RN since 1991. After losing much to alcohol and opioid use disorders, she found recovery in 2005. She now works as Director of Client Care and Head Nurse Coach with Veritus, a virtual treatment program for nurses with substance use and mental health disorders; founded and serves as chair of WisPAN (Wisconsin Peer Alliance for Nurses), a non-profit organization providing peer support for nurses with substance use issues; and is an emergency department nurse. She has published a book called, “An Unlikely Addict”, about her story of recovery and a textbook called “Substance Use Disorder in Healthcare Professionals, When Caregivers Need Care and Treatment.” She is a Certified Addictions Registered Nurse, CARN, and a Certified Professional Recovery Coach, CPRC.

Examples of What We Offer

Here are some specific examples of what partnership with us can look like. Every plan is customized — this is just a starting point.

PD Workshop Examples

Classroom wellbeing audit 

Classroom teachers assess their current wellbeing supports, identify specific strengths and gaps, and actively engage with research-based strategies to create an action plan for supporting student wellbeing in the classroom. This audit is more than a checklist—it’s a mirror that reflects how your everyday choices shape the mental health and wellbeing of everyone in your classroom. By pausing to rate, reflect, and plan, you will:

  1. Surface hidden stress points and strengths in your routines, environment, and relationships
  2. Connect concrete teaching practices (pacing, feedback, space design) to student and educator wellbeing
  3. Build shared language and data‐driven insights to guide micro‐interventions and systemic change
  4. Empower yourself and colleagues to co‐design evidence-based strategies that boost resilience, engagement, and trust
  5. Establish a continuous improvement cycle: audit → act → measure → refine

Specialized mental health skill-building workshops 

This goes beyond basic literacy to provide staff with practical skills and techniques for managing specific situations and promoting positive mental health within the school. 

Examples

  1. “De-escalation Strategies for School Staff.” A hands-on workshop teaching verbal and non-verbal techniques for safely de-escalating agitated or distressed students. 
  2. “Building Resilience and Coping Skills in the Classroom.” A training focused on equipping teachers with activities and strategies they can directly implement with students to foster resilience, teach coping mechanisms for stress, and promote emotional regulation. 
  3. “Creating Trauma-Informed Classrooms.” A workshop series exploring the impact of trauma on learning and behavior, and providing practical strategies for creating a safe, predictable, and supportive classroom environment that promotes healing and learning.
  4. “Mental Health & Wellbeing First Operational Mindset for Administrators”: When school leaders shift from a purely operational mindset to a mental‑health‑first mindset, the entire culture changes—students feel safer, staff feel supported, and families feel more connected. This workshop provides high‑impact, administrator‑friendly strategies. They’re concrete, actionable, and designed to fit into the real world of school leadership.

Adult SEL development 

Just as students benefit from developing social-emotional skills, so do adults. Adult SEL focuses on educators understanding their own emotions, managing impulses, setting goals, showing empathy, building healthy relationships, and making responsible decisions. 

Examples

  1. Interactive Workshops: Conduct workshops exploring each of the core SEL competencies (self-awareness, self-management, social awareness, relationship skills, responsible decision-making) through activities, group discussions, and reflection exercises.  
  2. SEL Integration Training: Train staff on how to weave SEL into their daily interactions, curriculum, and classroom management strategies. This includes explicit instruction on SEL concepts for students, creating opportunities for students to practice SEL skills, and integrating SEL into academic content.
  3. Emotion Regulation Strategies: Provide specific training on recognizing and managing challenging emotions in the workplace, including strategies for de-escalation and maintaining composure during stressful situations.

Integration of mental health into curriculum 

Embedding mental health education within the regular curriculum normalizes these topics, reduces stigma, and equips all students with foundational knowledge and skills related to their emotional well-being. Rogers’ understanding of key mental health concepts can inform curriculum development.

Examples

  1. Developing SEL Lessons with Mental Health Components: Collaborate with teachers to integrate lessons on topics like emotional regulation, empathy, and conflict resolution into existing Social-Emotional Learning (SEL) curricula, drawing on Rogers’ therapeutic approaches.
  2. Incorporating Mental Health Themes into English Language Arts: Suggest age-appropriate literature that explores themes of mental health, resilience, and seeking help, and provide teachers with discussion guides developed with input from mental health professionals.
  3. Creating Interactive Activities for Health Class: Develop engaging activities and projects for health classes that teach students about common mental health conditions, coping strategies, and how to access support.

PD Training Examples

Mental health literacy training 

This partnership focuses on equipping school staff with a foundational understanding of mental health concepts, common disorders in children and adolescents, and the importance of early identification and intervention.

Examples

  1. Elementary School Workshop: “Understanding Childhood Anxiety.” Topics could include:
    1. Different types of anxiety in elementary-aged children (separation anxiety, social anxiety, generalized anxiety).
    2. Observable signs and symptoms in the classroom (e.g., avoidance behaviors, physical complaints, difficulty concentrating).
    3. Strategies teachers can use to create a more supportive and less anxiety-provoking classroom environment (e.g., predictable routines, clear expectations, calming techniques).
  2. High School Professional Development Day: “Recognizing and Responding to Teen Depression and Suicidal Ideation.” Topics could include:
    1. Distinguishing between typical adolescent moodiness and signs of depression.
    2. Understanding risk factors and warning signs for suicide.
    3. Evidence-based strategies for talking to students who may be struggling.
    4. School protocols for reporting concerns and accessing support services.
  3. Customized Training for Special Education Staff: “Mental Health Considerations for Students with Learning Differences.” A tailored workshop addressing the unique mental health challenges that students with IEPs may face and strategies for integrating mental health support into their educational plans.

Trauma-Informed practices 

Trauma-informed practice recognizes the widespread impact of trauma and understands potential paths for recovery. In a school setting, this means understanding that students (and staff) may have experienced trauma and that these experiences can affect behavior, relationships, and learning. Training helps staff recognize the signs of trauma, respond in a way that avoids re-traumatization, and create a safe and supportive environment. It also includes understanding secondary trauma or compassion fatigue that educators may experience when working with individuals who have experienced trauma.

Examples

  1. Introductory Workshop: A foundational training on the prevalence and impact of trauma, the principles of trauma-informed care (safety, trustworthiness, peer support, collaboration, empowerment, cultural humility), and recognizing signs of trauma in students and colleagues.
  2. Skill-Building Sessions: Workshops focused on specific trauma-informed strategies, such as creating predictable routines, using de-escalation techniques, fostering a sense of safety and control, and promoting student voice and choice.
  3. Addressing Secondary Trauma: Training specifically addressing the impact of working with traumatized individuals on the helper, providing strategies for self-care and seeking support to prevent compassion fatigue and burnout.

Educator Resilience-Building Workshop Examples

Mindfulness and stress reduction workshops for staff 

Mindfulness involves paying attention to the present moment without judgment. Stress reduction techniques are practical strategies designed to lower physiological and psychological responses to stress. Training in these areas equips educators with tools to manage the inherent demands and pressures of their job, cultivate a sense of calm, and increase their capacity to be present and responsive.

Examples

  1. Workshop Series: A series of workshops (30-60 minutes each) delivered after school or during professional development time. 
  2. Short, Practical Sessions: Offer 15-minute guided mindfulness or breathing exercises before staff meetings or during designated breaks.
  3. Online Modules: Provide access to self-paced online modules on stress management and mindfulness techniques.

Building resilience (CLE)

Resilience is the ability to adapt well in the face of adversity, trauma, tragedy, threats, or significant sources of stress. Training in resilience helps educators identify their strengths, develop positive coping mechanisms, cultivate optimism, and build strong support networks. 

Examples

  1. Interactive Workshops: Sessions exploring the key components of resilience (e.g., self-awareness, self-regulation, optimism, connection, purpose). Activities could include identifying personal strengths, developing positive self-talk strategies, and practicing problem-solving skills.
  2. Goal Setting and Action Planning: Training on setting realistic goals and developing action plans to navigate challenges and achieve a sense of accomplishment.
  3. Building Support Networks: Facilitating discussions and activities that encourage staff to build strong relationships with colleagues and identify external sources of support.

Enhancing school climate – for the staff

School climate refers to the quality and character of school life. A positive school climate for staff is characterized by trust, respect, collegiality, collaboration, and a sense of belonging. Consultation focuses on identifying areas for improvement and implementing strategies to foster a more supportive and positive environment.

Examples

  1. Team-Building Activities: Recommending and facilitating team-building activities that promote positive relationships and a sense of community among staff.
  2. Recognition and Appreciation Programs: Consulting on developing formal or informal programs to recognize and appreciate staff contributions and efforts.
  3. Creating Opportunities for Social Connection: Advising on creating spaces and opportunities for informal social interaction among staff.

Systemic Examples

Needs assessment and strategic planning (CLE)

A systematic process of gathering information about the current state of staff wellbeing within the school, identifying key stressors, and understanding the needs and preferences of the staff. This data then informs the development of a targeted and effective plan for implementing wellbeing initiatives.

Examples

  1. Administering Surveys: Using anonymous surveys to gather data on staff stress levels, workload perceptions, access to resources, and interest in different types of wellbeing support.
  2. Conducting Focus Groups: Facilitating small group discussions with staff from different roles (teachers, administrators, support staff) to gain deeper qualitative insights into their experiences and needs.
  3. Reviewing Existing Data: Analyzing existing school data such as attendance records (staff absences), staff turnover rates, and incident reports (if relevant to stress/conflict).
  4. Collaborative Goal Setting: Working with the school leadership team and wellbeing committee to set specific, measurable, achievable, relevant, and time-bound (SMART) goals for improving staff wellbeing.

Developing supportive policies and practices 

Examining existing school policies, procedures, and unwritten norms to identify those that may contribute to staff stress or hinder wellbeing. Consulting on modifications or new policies that actively promote a healthy work environment.

Examples

  1. Communication Protocols: Advising on establishing clear and efficient communication protocols to reduce ambiguity and information overload.
  2. Meeting Structures: Consulting on making meetings more efficient and purposeful, perhaps by designating some meetings specifically for collaboration or wellbeing check-ins rather than just information dissemination.
  3. Establishing Boundaries: Providing guidance on establishing and respecting professional boundaries regarding work emails and communication outside of school hours.

Consultation on school mental health systems 

This involves leveraging Rogers’ understanding of best practices in mental health care to advise schools on the development and implementation of comprehensive systems that support student and staff well-being.

Examples

  1. Developing a School-Wide Mental Health Protocol: Consulting with a school district to create a clear and consistent protocol for identifying students in need of mental health support, conducting initial assessments, making referrals, and collaborating with external providers (including Rogers, if appropriate).
  2. Implementing a Multi-Tiered System of Supports (MTSS) for Mental Health: Advising a school on integrating mental health supports within their existing MTSS framework, ensuring that all students receive appropriate levels of support based on their needs.
  3. Conducting a Mental Health Needs Assessment: Partnering with a school to administer surveys and conduct focus groups with students, staff, and parents to identify key mental health needs and inform the development of targeted interventions and supports.

Integrating wellbeing into existing structures 

Embedding wellbeing initiatives within the school’s existing operational framework rather than treating them as separate, add-on programs. This ensures long-term sustainability and demonstrates that wellbeing is a priority.

Examples

  1. Professional Development Alignment: Integrating wellbeing topics into regular professional development days or staff training sessions.
  2. Staff Meeting Agendas: Including a dedicated agenda item for staff wellbeing check-ins or sharing wellbeing tips during weekly staff meetings.
  3. School Improvement Plans: Incorporating goals related to staff wellbeing into the school’s overall improvement plan.

 

Coaching Examples

Leadership coaching

Coaching specifically designed for school administrators and team leaders. This focuses on developing their leadership skills related to supporting staff wellbeing, creating a positive team culture, and effectively managing workplace dynamics that can impact stress levels.

Examples

  1. Promoting Work-Life Balance: Coaching leaders on modeling healthy work-life boundaries and encouraging their staff to do the same.
  2. Building Team Cohesion: Working with leaders on strategies to foster a sense of teamwork, trust, and psychological safety within their teams.
  3. Mentor Coaching for New School Administrators on Fostering a Positive School Climate: Pairing experienced administrators with new leaders and providing coaching focused on creating a supportive and mentally healthy environment for both students and staff.

Individual wellbeing coaching

A confidential and supportive partnership between a trained coach and an individual staff member. The coach helps the staff member identify their wellbeing goals, explore challenges, develop strategies, and build self-awareness and resilience. This is particularly helpful for staff experiencing high levels of stress, burnout, or those seeking to proactively enhance their wellbeing.

Examples

  1. Goal Setting Sessions: Initial coaching sessions focused on helping the staff member clarify their wellbeing goals (e.g., reducing stress, improving work-life balance, developing better coping skills).
  2. Strategy Development: Working with the staff member to identify and practice specific strategies for managing stressors and improving wellbeing (e.g., time management techniques, communication skills, boundary setting).
  3. Reflection and Problem-Solving: Providing a space for the staff member to reflect on their experiences, process challenges, and problem-solve difficult situations.

Instructional coaching with a wellbeing lens 

Integrating conversations and support around wellbeing into existing instructional coaching cycles. This recognizes that teacher wellbeing is intertwined with their classroom practice and provides a holistic approach to support.

Examples

  1. Managing Classroom Stressors: Coaches can work with teachers to develop strategies for managing challenging student behaviors, reducing classroom disruptions, and creating a more calm and predictable learning environment.
  2. Building Positive Student Relationships: Coaching on techniques for building strong, positive relationships with students, which can be a source of both joy and stress for teachers.
  3. Workload Management within Instruction: Helping teachers prioritize tasks related to planning, grading, and differentiation in a way that feels manageable.
  4. Reflecting on Emotional Responses: Coaching teachers to reflect on their emotional responses to classroom situations and develop strategies for managing those emotions constructively.

Peer coaching programs 

Training selected staff members to serve as peer coaches for their colleagues. This leverages internal expertise and fosters a culture of mutual support within the school. Peer coaches can provide a confidential and relatable source of support, sharing strategies and offering encouragement.

Examples

  1. Coach Training: Training peer coaches in basic coaching skills, active listening, confidentiality, and boundary setting.
  2. Structured Check-ins: Establishing a structure for peer coaching interactions, such as regular informal check-ins or more formal scheduled conversations.
  3. Providing Resources: Peer coaches can share relevant wellbeing resources with their colleagues.