In previous blogs, I’ve discussed how state nursing board disciplinary actions can impact a nurse’s career.
In the following case, a nurse faces these challenges even after completing substance use treatment and securing a new job.
How nurse’s substance use disorder was discovered
Shortly after graduating from nursing school, an RN began working as a staff nurse. However, she struggled with a substance use disorder and misused morphine and hydromorphone from her workplace.
Although she administered the correct doses to patients, she kept residue from the vials for personal use. To conceal her actions, she refilled the vials with saline, showed them to another nurse to verify the amount, and discarded them.
She also retrieved discarded vials containing leftover medication from medical waste containers for her use.
About a year into her role, the nurse was seen attempting to take items from a medical waste container. Her employer suspended her and requested a urine specimen for drug testing.
While awaiting the test results, she was seen handling medical waste containers in the hospital. After other incidents were revealed, security searched her locker and found syringes, medication vials, and other items.
Her drug test was positive for morphine, for which she did not have a prescription. Her employment was subsequently terminated.
The RN entered a six-month, comprehensive outpatient substance abuse treatment program. After completing the program, she obtained another nursing position. Her employment was quite successful, and she was promoted.
She attended group therapy every week and continued with her recovery regimen.
A year after her termination from her previous position, she was notified that the board of nursing “had cause” to terminate her nursing license. Attempts to reach a settlement with the board were unsuccessful. However, a stipulation was reached between the board and the RN two years later in which she voluntarily agreed to the facts surrounding her diversion of opioids and subsequent termination of employment at the hospital.
Facing the nursing board
Before the formal hearing, the RN tested negative for several controlled substances, including opioids.
Two witnesses — her substance abuse counselor and her work supervisor — provided positive testimony about the RN, highlighting the following:
- She was honest about her drug diversion and use during treatment.
- She had a strong support system.
- During her hiring interview, she openly disclosed her history of substance use and treatment.
- She excelled in her current nursing role and was described as high-performing and a leader.
A letter from the RN’s psychiatrist was submitted as evidence, stating that she had achieved full abstinence and long-term recovery. The psychiatrist also affirmed that her past substance abuse would not compromise her ability to deliver competent clinical care.
The RN testified on her own behalf, explaining that she began using narcotics after a personal tragedy led to depression. She acknowledged her conduct at the hospital, including diverting narcotics and being dishonest with both her employer and family.
She emphasized that she never sold or shared the diverted medications and always ensured patients received the full prescribed doses.
She said she would be willing to submit to ongoing drug testing and have her current treatment team continue to monitor her recovery.
The board presented no evidence at the hearing. Even so, it revoked her nursing license due to her failure to be honest, including her dishonesty in her handling of narcotic medications.
RN files a judicial review case in circuit court
The court postponed the board's order while deliberating the case. About a year later, it overturned the board's decision to revoke the RN’s license, citing a lack of evidence to refute the RN’s testimony.
The court ruled that the board’s decision was arbitrary and inconsistent, particularly given the initial settlement allowing the RN to practice until a hearing was held. It ordered the board to reinstate the RN’s license with a three-year probationary period.
While the board complied with the court’s order and reinstated the license, it also filed an appeal against the court’s decision.
The appellate court’s decision
The appellate court reviewed relevant state law and emphasized that a board’s authority to discipline is intended to protect the public, not to punish misconduct.
The court highlighted that disciplinary decisions should consider evidence of a licensee’s rehabilitation and mitigating circumstances, with a focus on the licensee’s fitness at the time of the hearing.
In affirming the circuit court’s judgment, the appellate court ruled that the board’s decision to revoke the RN’s license was arbitrary, capricious, and lacked substantial evidence.
Highlights of this case
It’s unclear who reported the RN to the board of nursing or why the report came long after her termination for substance use disorder.
Despite the delay, the board initiated disciplinary proceedings, as such actions can begin after an alleged violation of the nurse practice act, provided they fall within the state’s statute of limitations.
At the disciplinary hearing, the RN presented clear evidence of her recovery journey, which was important to meeting her burden of proof. Notably, the board did not present any evidence against her.
If you are struggling with a substance use disorder, promptly seek treatment through a reputable inpatient or outpatient program. Voluntarily entering into treatment is the best course of action for both your professional and personal well-being.
While this RN’s recovery is a remarkable success, it is an ongoing process that will continue throughout her life. Accountability and honesty — core values of professional nursing — were instrumental in her journey to sobriety.
Remember that even if you successfully counter disciplinary action, as this RN did, the process can take years to resolve. Her story is a testament to resilience, recovery, and the importance of seeking help and maintaining integrity.
