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. 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. 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.
Retrieved December 11, Visit Source. Password recovery. The impaired nurse will often deny their impairment. Alternative diversion programs for nurses with impaired practice: Completers and non-completers. Considerations to weigh carefully Nurses are not immune to drug and alcohol misuse. Health promotion programs are often put on by employers to help motive their employees to change behaviors. Many nurses fear reporting a colleague because they worry about retaliation.
Latest celebrity crotch shots. Is it wise to enter alternative-to-discipline programs for substance use disorders?
Step 4 of 6 Board Proceedings. Board Action. From Complaint to Resolution The graphic below demonstrates the disciplinary process from receipt of complaint to resolution and reporting. Military Connect. Initial Review of Complaint. Treatment of substance use disorder helps keep patients and healthcare professionals safe. Nursing Workforce. How Will You Prepare? While the vast majority of nurses are competent and caring individuals who provide care according to the standard, violations of Discipline and the impaired nurse nurse practice act do happen. If a licensee violates a term of probation, the Board may, after a hearing, impose any further discipline that is authorized to be imposed after the initial discipline, pursuant to Section The position statement Substance Use Among Nurses and Nursing Studentsco-authored by the International Nurses Society of Addictions and the Emergency Nurses Association calls for an alternative-to-discipline approach with the stated goals of:. Step 5 of 6 Board Actions.
She willingly entered into a settlement agreement with the state board of nursing BON , which placed her CNA certificate on a month conditional status.
- Nursing organizations advocate for rehabilitating rather than punishing nurses experiencing substance use disorder.
- Whether or not a nurse is able to continue in the profession depends on the type of discipline administered by the Board.
- While the vast majority of nurses are competent and caring individuals who provide care according to the standard, violations of the nurse practice act do happen.
She willingly entered into a settlement agreement with the state board of nursing BON , which placed her CNA certificate on a month conditional status.
In addition, she entered a guilty plea agreement to the criminal charges and was placed on 5-year supervised probation. Melissa successfully completed a nurse monitoring program NMP and was given a positive evaluation by a physician and a certified addiction professional indicating she required no further treatment. Years later, Melissa completed a nursing program, but she was concerned that her past would prevent her from receiving her RN license, even though her NMP report stated no current concerns related to substance abuse issues.
Her application was referred to an application review committee for further investigation and recommendations. The BON offered Melissa a conditional license through a settlement agreement.
After consulting with her attorney, Melissa waived her right to a hearing and accepted the agreement. The conditions included abstaining from use of all mind-altering drugs or medications, professional monitoring by the NMP for 2 years, and a substance abuse evaluation within 1 year from the effective date of her agreement with the BON. All this was accomplished without a BON hearing.
If Melissa had contested either settlement agreement and had a hearing, she would have provided the BON with grounds for disciplinary action and denial of her application. See Ending throwaway nurse syndrome.
Society frequently perceives anyone including nurses with substance use disorder to be weak, immoral, unable to exert control over their problem, and even criminals. Without treatment, these nurses moved from job to job, and the cycle of misuse and firing continued.
During the late 20th century, many nurses who had a substance use disorder were arrested, charged with a crime applicable to the situation for example, possession of a controlled substance, diversion of controlled substances from the employer , and convicted of state and federal violations.
Because the main goal of BONs is to protect the public, in the late s, they began to focus on substance use disorders and established approaches to meet that goal. Primarily, that meant removing a nurse from practice, which is disciplinary and punitive. Regardless of the defense or circumstances surrounding the allegations, nurses had their licenses suspended. Some professional assistance programs were developed in the late s and s, but the American Nurses Association ANA recommendation that state BONs develop alternative-to-discipline programs prompted the provision of treatment, rehabilitation, and monitoring for nurses with a substance use disorder.
The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition DSM-5 lists several levels of severity of substance use disorder, but all involve recurring use of drugs or alcohol that causes significant clinical and functional impairment, such as health problems and a failure to meet major responsibilities. For nurses, that means a breakdown in professional practice that can lead to a complaint filed against them with the state BON.
Part 1 of this two-part series reviews the BON complaint process, including alternative approaches to discipline. Part 2 will discuss recent developments that aid nurses who are facing BON actions stemming from substance misuse allegations. Each state, through its legislature, establishes a specific procedure for submitting a complaint against a nurse to the BON. Grounds for a complaint vary from state to state but conduct by a nurse that might lead to a complaint include a conviction of driving under the influence, drug diversion, a positive drug screen when no lawful prescription exists, and absent or questionable documentation of administered controlled substances.
When the complaint is submitted, the nurse generally is given the opportunity to respond, either orally through an interview with an investigator or in writing. After a BON receives the complaint and response, it has several options:. BONs also can offer alternatives to discipline.
See Alternative-todiscipline programs. For example, the board may require treatment in a professional assistance program PAP. If this requirement is completed, the case is closed and no disciplinary action occurs. Alternative-to-discipline programs ADPs , in contrast, provide a nonpunitive, nondisciplinary, and usually confidential approach. They offer treatment and after-care monitoring.
ADPs vary from state to state. Some are administered by BON staff, others are administered by a different state agency for example, the department of health or are managed by a professional association or a peer-assistance entity. Eligibility for ADPs also varies.
Note that this is not true in all ADPs. Some, for example, require nurses to surrender their license until they complete the program. After nurses successfully complete the ADP and after-care monitoring, they can return to work without a public disciplinary action and with an unencumbered license. ADPs have a high success rate of long-term recovery for nurses treated successfully.
The result is a win for the nurse, the BON, and the public. If a disciplinary process is initiated, and no settlement occurs between the nurse and the board, a formal hearing may be the next step. A final determination on the allegations can take months to reach due to the unavailability of witnesses, burdens of proof preponderance of the evidence , and difficulty scheduling a hearing. For all these reasons and more, a negotiated consent order or settlement agreement is a better alternative in many instances.
The nurse always has the right to a hearing, even after settlement negotiations or conferences have occurred and are unsuccessful. In these cases, a full hearing may be the only option. In some states, a hearing may not be an initial option. In Pennsylvania, a conviction or a plea of nolo contendere no contest in a criminal matter, or a conviction of a misdemeanor, requires an automatic suspension by the applicable licensing board for 1 year. During that year, the BON has no jurisdiction, and therefore no discretion, to consider the case.
No nurse wants to face BON actions related to substance misuse. American Addiction Centers. Statistics on drug addiction. American Psychiatric Association. Substance use disorders and accessing alternative-to-discipline programs. J Nurs Regul. Darbo N. Alternative diversion programs for nurses with impaired practice: Completers and non-completers. J Addict Nurs. Dismissed without prejudice law and legal definition. US Legal. Erin SM. RN , Docket No. Wyoming State Board of Nursing. September 9, National Council of State Boards of Nursing.
I found it interesting that you state that the BON can require any nurse to attend an investigation hearing to review if they can keep their license. My sister was called to a disciplinary hearing with the review board next week and wants to be as prepared as possible.
I will send her this information so she look into a company that will do a nursing licensing board investigation consultation. Save my name, email, and website in this browser for the next time I comment. No part of this website or publication may be reproduced, stored, or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without permission in writing from the copyright holder.
Sign in. Log into your account. Forgot your password? Create an account. Sign up. Password recovery. Recover your password. Get help. American Nurse Today. Ending throw away nurse syndrome Society frequently perceives anyone including nurses with substance use disorder to be weak, immoral, unable to exert control over their problem, and even criminals.
Punitive approach During the late 20th century, many nurses who had a substance use disorder were arrested, charged with a crime applicable to the situation for example, possession of a controlled substance, diversion of controlled substances from the employer , and convicted of state and federal violations.
The Board may choose suspension, for a period of up to three years, wherein the nurse may not practice nursing until the period of the suspension is completed. Global Regulatory Atlas. Discipline Resources. A return-to-work agreement is created and often involves a reduction in hours, limited shifts, and restrictions in assignments with continued treatment and monitoring for periods of up to three to five years. Restrictions are lifted as the nurse demonstrates he or she is making progress.
Discipline and the impaired nurse. From Complaint to Resolution
When a BON disciplinary process is based on substance use disorder: Part 1 - American Nurse Today
The purpose of this course is to help nurses in the state of Florida identify and support colleagues who may be afflicted with workplace impairment. Impairment occurs when a nurse is unable to provide safe patient care due to using a mood or mind altering substance, having a physical condition or a distorted thought process from a psychological condition Intervention Project for Nurses, Due to one of these conditions the nurse is unable to perform their professional responsibilities and duties consistent with nursing standards.
Nurses need to be aware of the impact impairment has on the patients and the health care system in general because the impaired nurse may not be able to provide safe and appropriate care. It is critical that nurses are aware of signs of impairment and how to report a fellow nurse suspected of substance abuse. Substance abuse has the potential to lead to mental illness, cardiovascular disease, hypertension, liver disease, hepatitis, human immunodeficiency virus, traumatic injuries and possibly death due to over dose.
These activities include:. Substance abuse comes in many forms. It may involve street drugs, alcohol abuse or taking a prescription of either a patient, family member or friend. Nurses may take some injectable medication from a patient to use for themselves and give the patient a diluted down version of the drug or pure saline.
Medications frequently abused by nurses include: alcohol, benzodiazepines, cocaine, methamphetamines, marijuana, narcotics, sleeping pills, heroin, ecstasy, and stimulants. While many nurses have a long history of drug and alcohol abuse, some nurses going through a stressful time may use substances to cope their problems.
The impaired nurse may be difficult to detect, because they often are very careful to avoid being caught. By the time signs or symptoms are noticeable it is often been going on for an extended period of time. Addiction is a compulsive behavior and may stem from abuse, an unstable lifestyle, a family history of addiction, poor choices, thrill seeking or denial. Treatment of addiction should be done for an extended period of time. Often, nurses resist substance abuse treatment; and only enter a program with the encouragement of family, friends, peers, management or a court order.
At times, physical signs may be noticed in an impaired nurse. Some physical signs that should increase the suspicion of impairment include:. There are certain behaviors that should clue the nurse that a co-worker may be impaired and include:. Substance abuse disorders are a major problem in nursing.
Substance abuse disorders lead to more deaths, disabilities and illnesses than any other preventable health condition NIDA, Substance abuse contributes to missing work, injuries, reduced productivity, liability, societal harm, person harms and increased health care costs.
It is beneficial, not only for the employee, but also the employer to assist their workers in managing alcohol and substance abuse. Nurses lack education regarding the addiction process, how to identify those with addiction and how to implement effective interventions. It is important that nurses receive education about substance use disorders. Employers should implement strategies to promote safety and provide assistance.
Guidelines should be developed to promote safety for nurses and their patients and offer assistance to nurses who suffer with substance abuse or other conditions that lead to impairment.
Policy should be a drug free work place and having all nurses fit to practice. Practices that will reduce the risk of impaired nurses on the worksite include: pre-employment drug testing, for cause testing testing when there is logical suspicion that the employee is under the influence of drugs while working and fitness to practice evaluations. The workplace should promote a culture of transparency and consist of clear expectations and consequences.
In addition, it should be clear that there is openness to help the nurse with a substance abuse problem or other condition that leads to impairment. The workplace has significant potential to identify and help workers with drug and alcohol problems.
Workers spend a lot of time at work and co-workers and supervisors may be able to notice signs or symptoms of drug or alcohol problems and assist them in getting the help they need. Employers may influence employees to get help for impairment. Programs may include health promotion, education, and referral to alcohol and other drug abuse treatment if needed.
These programs look to quickly identify problems and intervene early. The primary goal of an EAP is to help employees maintain their job and career. While these programs are not free and may cost the employer significant money, research suggests that EAP provide more savings than it costs.
The U. Department of Labor reports that 5 to16 dollars are saved for every dollar spent in an EAP. While it is not illegal to drink alcohol, the effect of drinking off the job can effect on the job performance.
For example, binge drinking may lead to hangovers the next day which may compromise work performance. Employers do have a reason to attempt to modify employee drinking as this may positively affect work performance. The ideal way to address off the job drinking is through alcohol education programs at work through EAP or another health promotion program with the goal of encouraging behavioral change.
This may even encourage the patient who is impaired to self-refer themselves to treatment programs. Alcohol education programs also have the potential to teach workers to identify an impaired co-worker. A nurse who works alongside another nurse is more likely to identify problem behaviors before a supervisor notices the same problem behaviors.
Health promotion programs are often put on by employers to help motive their employees to change behaviors. Drinking and drug use can affect health; teaching employees about healthy alternatives has the potential to change behaviors.
For example, engaging in exercise, adapting a healthy diet or taking up a stress management program may reduce drug or alcohol use. Chronic work stress, a large number of hours worked, unhealthy work conditions and poor workplace safety is linked to alcohol related problems International Center for Alcohol Policies, The employer has a responsibility to determine if risk factors are present within the work environment and attempt to modify the work environment to reduce the risk of alcohol and drug use.
Addressing alcohol and drug use in the work setting has many similarities to addressing it in primary care. Both the worksite and the primary care office have significant preventative potential. Much variability exists between the content and quality of interventions between health care settings and places of employment.
Unfortunately, there is the potential to hide problem behaviors and unless the health care provider or the worksite finds a problem no intervention will occur. Both the primary care setting and worksite have many roles to fulfill and preventing, identifying and treating substance and alcohol abuse is not the highest priority goal in either setting. EAP assist substance abuse programs within companies. EAP programs are not solely derived to address substance abuse, they also help employees with other issues such as mental health, marital problems, parenting problems, financial problems, legal issues and balancing life and work.
They offer visits to provide assessment or short-term counseling. Employees may be referred to an outside provider for follow up treatment. Employees may not get involved in EAP for a variety of reasons. Employees often do not feel that their problems will be held confidential, but they are confidential. Many employees may also feel shameful for looking for help.
Some employees fear that they need to get permission from their boss, but they can self-refer to an EAP. Lastly, many do not know that they exist.
Some workplaces more strongly promote EAP than other workplaces. Individuals who use a company EAP are more likely to take part in and stay engaged in alcohol and other drug treatment programs. Determining impairment from mental illness is a tricky task. A scale, the Nurses Work Functioning Questionnaire, has been developed to determine if there is impairment from common mental illnesses. It is a 50 question survey that has been determined to be highly reliable and valid.
The first step the nurse must do to be able to report an impaired health care provider is to be able to recognize the signs or symptoms and be educated in substance abuse. Many nurses fear reporting a colleague because they worry about retaliation. Nurses should be familiar with the organizations policy for employee substance abuse and any assistance programs that the organization offers. A fellow nurse should not enable another nurse to continue to abuse substances.
It is the ethical duty of the nurse to report any substance-abusing nurse ANA, While the ANA is not in favor of random drug tests for nurses, if there is concern that drugs or alcohol is affecting work performance it believes that testing is appropriate ANA, In addition, the ANA is against the misuse of prescribed drugs by nurses.
It also is opposed to the misuse of prescribing drugs by nurses who have prescriptive authority. It encourages nurses to have pharmacological education about abuse, misuse and addiction of prescriptive drugs ANA, It is not helpful to make excuses or cover for an impaired nurse. It will not only potentially harm the nurse, but his or her patients.
The nurse should be made to accept the consequences of his or her behaviors and actions. Reporting a colleague can be a positive step as this will protect patients and support their colleagues to enter into treatment programs.
It is critical that nurses guard against behaviors that promote impairment among fellow nurses. The nurse should not ignore signs of impairment or engage in enabling an impaired nurse. The impaired nurse should not just be fired or transferred as this passes the problem on to another department or employer and continues to put patients at risk. The requirements for mandatory reporting of nurses by nurses vary from state to state.
A nurse who cannot practice safely due to impairment is in violation of the Nurse Practice Act. The IPN offers a program for impaired nurses to be rehabilitated in a non-punitive and confidential method.
The goal is to keep nurses practicing instead of allowing them to lose their license. The IPN will allow early intervention to expedite enrollment into a recovery program. The nurse immediately stops practicing and does not return to practice until the IPN assures that they are safe to return to practice. It offers a cost-effective method to the disciplinary process. If the nurse is reported to both the Department of Health and the IPN at the same time then disciplinary action may occur.
Prior to , the only option the Florida Board of Nursing had was to discipline the impaired nurse and stop them from practicing. Despite the punishment, nurses continued to have problems after their license was reinstated. As the number of nurses who were impaired increased, other options were sought to help get nurses back to work while maintaining safety for patients Intervention Project for Nursing,