A reader said she was reported to her board of nursing for an apparent substance use disorder.
After a hearing, the board recommended that to maintain her license, she would need to get into a treatment program sponsored by the board. The reader responded to the board she did not want to voluntarily participate in the treatment program. She wonders what will happen next.
As I discussed in my blog, “Should Nurse Accept Reprimand Offer from Board of Nursing,” boards have the authority to propose professional disciplinary options to nurse licensees. Although it is always best not to be in a situation where you have to make the choice to accept a professional discipline, in most instances the recommendation from the board requires careful, thoughtful consideration.
If an offer is reasonable based on your specific circumstances, and your attorney counsels you that the offer is the best option for you, you should accept your attorney’s advice.
In this instance, it sounds as though participating in a treatment program will allow the reader to keep her license, which is a critical point. By not accepting the offer to get into treatment, she will continue with her substance use disorder and will most likely face a possible suspension of her license and need to petition the board for reinstatement at a future time when she is “clean and sober.”
The reader did not indicate the type of treatment program in which the board was requiring her to participate. Because she would be able to keep her license if she enrolled, it sounds as if it may well be an alternative-to-discipline program.
What are alternative-to-discipline programs?
Alternative-to-discipline programs are used by boards of nursing to help nurse licensees receive needed treatment and maintain an unencumbered professional nursing license. They provide a “non-punitive, nondisciplinary and usually confidential approach” to the nurse licensee. Treatment and aftercare are included in alternative-to-discipline programs.
The “confidential” approach is a crucial benefit of an alternative-to-discipline program that offers this protection. A board of nursing disciplinary action is accessible to the public through the board’s reporting mechanisms and is reported to the National Practitioner Data Bank and other banks.
However, successfully completing an alternative-to-discipline program and its aftercare requirements allows the nurse licensee to obtain treatment confidentially, no (reported) discipline occurs, and the nurse can return to nursing practice and safely provide care to patients.
Alternative-to-discipline programs vary from state to state. Variability includes how the program is administered (e.g., by the state board or another state agency), eligibility and continued nursing practice during treatment.
Alternative-to-discipline programs have been highly successful in treating nurses with substance use disorders. Moreover, the long-term recovery rate for nurse licensees undergoing treatment in these programs is high. Last, but by no means least, the public is protected because the nurse licensee is practicing unimpaired.
Boards of nursing that administer alternative-to-discipline programs include Delaware, Iowa, Maryland, Michigan and North Carolina. To check if your state board offers these programs, click here.
Examples of other nursing board disciplines
The following are a few reported disciplines by state boards where an alternative-to-discipline program was not applicable, was not available or was not requested by the nurse:
- Maine Board of Nursing — Registered professional nurse license revoked due to diversion of scheduled drugs from place of work resulting in criminal conviction and falsifying medical records in diverting the scheduled drugs.
- Illinois Board of Nursing — RN license placed in “refuse to renew” status after a sister-state violation due to drug diversion. An audit found narcotic withdrawals with discrepancies and the nurse admitted to diversion of medications.
- Missouri Board of Nursing — RN license suspended and placed on probation after diverting oxycodone and hydromorphone, and a positive drug screen for amphetamines, marijuana and methamphetamine.
- Connecticut State Board of Nurse Examiners — Registered nurse license revoked because her practice “posed a threat to public safety” after her license was previously suspended for using marijuana, cocaine and heroin for almost two years.
Considerations to weigh carefully
Nurses are not immune to drug and alcohol misuse. If you have been reported to your board of nursing for drug or alcohol problems, you need to seek treatment as soon as possible.
Boards of nursing are well-versed in substance use disorder, and when there is the option of treatment and aftercare in a confidential manner, an offer to participate in such programs is one that should be accepted.
It allows you to get the treatment you need and, more importantly, allows you to continue to practice as a licensed nurse once that treatment is successfully completed. Consider these points:
- Review your state nurse practice act for the possibility of an alternative-to-discipline program.
- Obtain legal counsel to represent you through the board’s process for getting into an alternative-to-discipline program.
- Comply with all requirements for admission into an alternative-to-discipline program and its obligations while in treatment (e.g., group therapy, individual therapy, drug screens).
- When returning to practice, accept any suggested conditions that allow you to practice safely and without impairment (e.g., no night duty, no home healthcare).
- Remember that being “clean and sober” is a lifelong responsibility that benefits your well-being and safe patient care.
- If an alternative-to-discipline program is not an option in your state, seek treatment through alternative programs with the approval of the board of nursing.
- Underscore the importance of working with your board of nursing and don’t consider simply not cooperating with that board or “handing in the towel” in the face of allegations of substance misuse.
Take these courses related to substance use disorder:
Recognizing Signs of the Misuse or Abuse of Controlled Substances
(1 contact hr)
Many state medical licensing boards have already or will require healthcare professionals to complete mandated continuing education that addresses prescribing controlled substances. Misuse and abuse of prescribed controlled substances can lead to serious consequences, such as addiction and overdose. Understanding the signs of abuse of medications such as opioids and sedatives is important to safe prescribing of controlled substances. This module will teach healthcare providers about substance use disorder and how to identify signs and symptoms of misuse and abuse. The module will also discuss a safe and effective approach to managing patients with substance use disorder.
Controlled Substance Prescribing for Chronic Pain Management
(1 contact hr)
Many states now or will in the future require continuing education specifically addressing controlled substances. Chronic pain is a fairly common disorder for which healthcare providers often prescribe controlled substances, such as opioids. Prescription opioids can alleviate pain in certain patients, but the risk of misuse, abuse, addiction, and overdose means that providers need to evaluate the risks and benefits for each patient. This course will educate healthcare providers on the role of prescription controlled substances along with other therapies for chronic pain using recommendations from current national guidelines. Upon completion of this course, providers should be able to identify which patients can benefit from chronic opioid therapy along with ways to evaluate them for misuse during the course of their treatment.
The Nurse With Substance Use Disorder
(1 contact hr)
The American Nurses Association has long estimated that misuse of chemical substances among nurses parallels that of mainstream society; however, recent statistics from the CDC reveal that mainstream society substance abuse of illicit drugs or misused prescription drugs is higher. Research indicates nurses with substance use disorder often begin misusing drugs, including alcohol, before finishing their nursing education and can make an entire work group dysfunctional. Use of labels such as impaired can result in stigmatization of the behaviors, making it more difficult for the nurse to seek help or for peers to report them for intervention. All but 7 states in the U.S. have programs to address substance abuse and impaired practice in nursing stressing alternatives to traditional disciplinary actions and criminal prosecution. This activity will help you to recognize and support colleagues who may be suffering from substance use disorder while protecting patient safety.