INTERVENTIONS
Board Investigation and Disciplinary Action
If a report of impaired practice is determined to fall under the authority of that jurisdiction’s board of nursing, then the board will take action. The BON’s goal is to investigate the complaint, handle the issue in a fair and just manner, take the best course of action to protect the public, and ultimately prevent further incidents.
The details of the process depend on the seriousness of the allegations and the timeliness of the complaint. Proceedings range from informal conferences (a meeting with board members or staff) to full formal hearings (similar to a trial). The nurse will be given an opportunity to respond to the allegations and present their side of the story.
If disciplinary action is warranted, the BON can take various actions, with public safety as a priority. These may include additional education or courses, assisting the nurse with obtaining help for alcohol or chemical dependency, restricting practice, or removal of a license (NCSBN, 2018).
Alternative-to-Discipline Process
Available in many states, “alternative-to-discipline” programs enhance a BON’s ability to quickly assure public protection by promoting earlier identification, requiring immediate removal from the workplace, and providing evidence-based treatment for nurses with substance use disorder. Such programs provide nurses the opportunity to demonstrate to the BON in a nondisciplinary and nonpublic manner that they can become safe and sober, and remain so, while retaining their license (NCSBN, 2023).
When a nurse is reported (or self-reports) as being impaired as a result of the misuse or abuse of alcohol or drugs, or both, or due to a mental or physical condition which could affect the nurse’s ability to practice with skill and safety, the nurse can avoid disciplinary action by:
- Acknowledging the impairment problem
- Enrolling in an appropriate, approved treatment program
- Withdrawing from practice or limiting the scope of practice as required by law
Generally, a state’s alternative to discipline program evaluates all referrals, determines the proper course of action, monitors the nurse’s progress in treatment, and provides case management for all nurses who return to work. If the nurse refuses to participate or fails to progress in the program, a report is made to the BON, which will lead to an investigation and possible disciplinary action against the nurse.
(See also “Resources” at the end of this course.)
Treatment Programs
Treatment programs for impaired health professionals generally must be approved by the state’s board of nursing or designated impaired practitioner program. Approved treatment programs and providers include addiction counselors, psychiatrists, addictionologists, and treatment centers that have a specific focus on healthcare professionals.
Treatment programs for nurses may include state-licensed residential, intensive outpatient, partial hospitalization, or other programs with a multidisciplinary team approach. Approved treatment programs may also be accredited through the Joint Commission or CARF International (formerly Commission on Accreditation of Rehabilitation Facilities). Treatment professionals, including addiction counselors, therapists, psychiatrists, and addictionologists, must also be state-licensed.
RESIDENTIAL TREATMENT PROGRAMS
These programs are provided in a specialized substance abuse facility or in a designated unit within a hospital system. They focus on helping individuals change behavior in a highly structured therapeutic setting. Short-term residential treatment is most common and focuses on detoxification as well as providing intensive treatment and preparation for the participant’s return to a community-based setting.
PARTIAL HOSPITALIZATION PROGRAMS (PHPs)
PHPs provide a structured treatment program as an alternative to inpatient residential treatment. This generally includes intensive and regular treatment sessions in a therapeutic environment five days per week. PHPs do not require the participant to stay overnight, but some PHPs offer a residential option that gives the participant an opportunity to live and work in such a therapeutic environment.
INTENSIVE OUTPATIENT PROGRAMS (IOPs)
Treatment sessions are provided regularly but less frequently than with PHPs. IOPs aim to provide intense treatment with less disruption to work, school, or family schedules. (Nurses must stop practicing as a nurse until they complete treatment, but they may still have to work in another work environment in order to meet their financial obligations; cases are individualized.) IOPs generally consists of a range of services for a minimum of 9 hours per week (SAMHSA, 2021).
CASE
Devon, a registered nurse in the intensive care unit, has worked at Regions Medical Center for over five years. She has always been reliable, well-liked by coworkers, and respected for her high level of skill in dealing with complicated cases. Devon has recently been faced with an unanticipated divorce that has left her anxious and depressed. Fighting for custody of her four young children has caused her a tremendous amount of stress and emotional turmoil.
Colleagues have recognized a significant change in Devon since the divorce. She frequently comes to work late and has called in sick much more than usual. A few weeks ago, a colleague reported to the charge nurse that she thought Devon was impaired because her eyes were red and she was nodding off at work. When the clinical manager spoke to Devon about the situation, she became very defensive, blaming her exhaustion on the stress in her life.
Two weeks later Devon arrived to work 30 minutes late. She was anxious and her behavior seemed erratic. The charge nurse approached her to discuss her assignment and noted the smell of alcohol coming from her breath. The charge nurse was familiar with the hospital policy and procedure regarding potential impairment in the workplace and immediately notified the clinical manager.
The charge nurse and clinical manager met with Devon in a private office to discuss their concerns. After much coaxing, Devon admitted that her drinking had become out of control since her divorce, but she believed she could stop on her own and did not feel a need to get outside help.
The clinical manager explained to Devon that impairment must be reported to the board of nursing or the nurse must be referred to the designated treatment provider for an evaluation and determination of the best course of action. Devon realized then that she couldn’t hide from her substance abuse problem any longer. She decided it would be in her best interests to willingly seek help.
Devon immediately contacted the state’s intervention program and scheduled an evaluation. Devon was informed that her license would be inactivated until the evaluation was complete and treatment recommendations were satisfied. Arrangements were made for Devon’s sister to pick her up from the hospital that day so that she would not be driving. The clinical manager made it clear to Devon that she would be welcomed back to work once she got the help she needed.