As a nurse in the District of Columbia facing substance abuse allegations, you may be considering signing a settlement agreement, sometimes called a consent agreement, with the nursing board that requires you to complete a rehabilitative program. While signing this agreement may seem straightforward, signing one of these agreements too quickly can come with repercussions.
Before signing a consent agreement, contact the Lento Law Firm's Professional License Defense Team. Our Team assists medical professionals throughout the District of Columbia who are facing misconduct allegations. Contact a member of our Team today by calling us at 888-535-3686 or by filling out a brief contact form.
Factors Contributing to Substance Abuse in the Nursing Profession
Demanding Schedules
The nursing profession is known for its challenging demands, often characterized by high levels of stress, changes in schedules, long hours, and physical demands. Substance issues typically develop gradually, with nurses often failing to recognize their increasing reliance on caffeine, nicotine, alcohol, and eventually controlled substances. Fueled by a profound sense of duty and the constant pressure of handling their responsibilities, numerous nurses may resort to substance use as a coping mechanism.
Compassion Fatigue
An additional element leading to substance abuse in the nursing field is compassion fatigue, a term psychologists have coined for medical providers who take on the suffering of patients who have experienced extreme stress or trauma. As nurses devote much of their time to caring for patients with complex needs, their ongoing commitment can drain their physical, mental, and emotional reserves. Looking to take their mind off of the trauma when they get home, nurses may embrace less-than-healthy coping mechanisms like substance use.
The District of Columbia Board of Nursing
The District of Columbia Board of Nursing oversees the District's nursing profession by setting minimum licensure standards, investigating misconduct instances, and providing nurses with professional development and continuing education opportunities. The Board of Nursing is granted authority in The District of Columbia Nurse Practice Act, which, as referenced below, outlines the legal requirements of the nursing profession, including substance abuse violations that warrant the Board's pursuit of disciplinary consequences such as license denial, suspension, and revocation. Although the Board has the discretion to pursue license suspension or revocation in instances of substance abuse, a large majority of nurses can also take advantage of the District's rehabilitation programs that often mitigate disciplinary consequences.
Substance Abuse Violations Under the Nurse Practice Act That Can Trigger Rehabilitative Programs
Under §3-1205.14 of the Act, the Board of Nursing may pursue civil penalties and/or deny, suspend, or revoke nursing licenses if a nurse commits an act of misconduct. The Act further allows for the Board to pursue disciplinary actions in substance-abuse-related misconduct such as:
- The addiction to or habitual use of any narcotic as defined within the District's Controlled Substance Act.
- Providing or attempting to provide professional services under the use of narcotics in the instance of prescribed medication while in “excess of therapeutic amounts.”
- Providing or attempting to provide professional services while under the use of alcohol or any other controlled substances.
- Substance-related arrests, misdemeanors, and felony convictions.
While each of these acts can trigger disciplinary investigations, each case is different. If the District's Board of Nursing is investigating you, you must act swiftly and educate yourself on available rehabilitation programs, their cost, time commitment, etc. Contact our Professional License Defense Team today for additional information on how to proceed in your unique circumstances.
What is Nursing Substance Abuse Disorder?
The Nursing Council of State Boards of Nursing (NCSBN, 2014) describes Substance Use Disorder (SUD) as a spectrum of behaviors, ranging from misuse to addiction, involving substances such as alcohol and both legal and illegal drugs. They are acknowledged as a multifaceted and evolving issue. Substance Use Disorder (can lead to a range of challenges for nurses, resulting in physical, emotional, financial, and legal consequences. SUD further acknowledges that nurses face a particularly heightened susceptibility to substance abuse, mainly stemming from their easy access to controlled substances within healthcare environments. Some of the signs and symptoms of SUD in the nursing profession are addressed below.
Behavioral Signs
- Preferring to give the highest dose of medication to patients.
- Frequently volunteering to be the one who administers medication.
- Frequently wasting or breaking medication.
- Having issues with managing medications that are strictly controlled.
- Receiving complaints from patients that their pain medication isn't working well.
- Liking to work shifts when there's less supervision.
- Showing sudden changes in mood, being anxious, or having emotional outbursts.
- Struggling to get along with colleagues and bosses.
- Being forgetful or having trouble remembering things.
- Taking many breaks or being away without explanation.
- Often being late, not showing up for work, or calling in sick, especially after days off.
- Keeping messy or confusing records.
Physical Signs
- Trembling or shaking hands.
- Slurred speech.
- Falling asleep suddenly.
- Watery eyes with unusual pupil size.
- Sweating a lot.
- Walking unsteadily.
- Having a runny nose.
- Feeling sick to the stomach, throwing up, or having diarrhea.
- Notable changes in weight.
- Wearing long sleeves or lab coats often to cover up.
Alternative-To-Discipline Programs
Alternative-to-discipline programs serve as rehabilitation options that several states implement for nurses struggling with substance abuse. These programs are usually mandated through consent order agreements and vary in their range of obligations. Some typical components of an alternative-to-discipline program include involvement in a structured treatment program, ongoing professional supervision, counseling, periodic drug testing, and assistance aimed at tackling the underlying causes of substance abuse. Typically, nurses are permitted to maintain their employment while undergoing the program as specified in the relevant consent order agreements. In the District of Columbia, the alternative-to-discipline program is called the "Nurse Rehabilitation Program," which we will explore further below.
District of Columbia's Nurse Rehabilitation Program
The Nurse Rehabilitation Program is a voluntary program administered by the D.C. Board of Health's Committee on Impaired Nurses. The program offers support to nurses struggling with alcohol and substance abuse rehabilitative support through treatment, counseling, and ongoing check-ins. Although the program is “voluntary,” the Board of Nursing typically requires nurses to agree to the program as part of a consent agreement.
Although nurses are encouraged to participate in the program, some may be barred from participation if their substance-related misconduct is more serious. Some instances that may bar a nurse from participating include:
- Having caused injury to a patient while practicing nursing.
- Having had or currently have a pending malpractice litigation alleging patient injury.
- Prior arrests for the diversion of controlled substances or sale of controlled substances.
Participation in the Program
Because participation in the rehabilitation program is voluntary, each nurse must apply. Once accepted, nurses will be provided with written information that details the program's procedures, including the nurse's rights and responsibilities and potential consequences for non-compliance. During their involvement in the program, nurses are essentially under "probation." If they do not fulfill the program's requirements, the Board can pursue punitive measures, including potential license suspension or revocation.
Approval of Treatment Facilities
As part of the program, nurses must meet an ongoing list of criteria, which may differ from case to case. Criteria may include frequent drug testing, performance evaluations at work, and treatment in an approved treatment facility. As summarized under the Act, to qualify, the following criteria must be met:
- The treatment facility must designate a specific contact person for nurses seeking assistance.
- The facility should operate during hours that accommodate various schedules.
- The Committee will outline all treatment costs, ensuring transparency and clarity.
- Accessible treatment services should include both individual and group therapy, among other appropriate treatment methods.
- An available provider at the center must be able to perform timely assessments and evaluations either onsite or nearby.
- The provider must send detailed reports of these assessments to the Committee within an agreed-upon period.
- With the nurse's consent, the provider should be ready to disclose any relevant information about the nurse's condition and treatment participation to the Committee.
- The facility must provide regular updates on the nurse's progress, quarterly or sooner, if significant incidents related to the nurse's condition occur.
- Random drug testing must be conducted under supervision, and the results must be shared with the nursing committee.
What Instances Prompt Substance Abuse Program Referrals to the Nursing Board?
If you learn that you are being investigated for possible substance abuse issues, you are probably curious about the specific incident that prompted the Board's investigations. Investigations can sometimes be set in motion by events outside the workplace, such as a DUI or an arrest. Within the context of the work environment, investigations can be triggered when colleagues, supervisors, or even patients suspect that you are impaired and make a formal complaint.
While every report will vary depending on the circumstances, you may have been reported if others suspect that you were under the influence of drugs or alcohol during your work hours or if you arrived for your shift visibly affected by a hangover. Some of the other types of issues that may trigger a complaint include:
- Positive drug tests during pre-employment screenings or when conducted for specific reasons.
- Indications of alcohol consumption, such as noticeable odor or behaviors linked to impairment.
- Unlawful consumption, improper disposal, or non-adherence when managing or administering medications to patients.
- Inconsistencies in documentation or the manipulation of medication tracking systems.
What Happens After Being Reported for Possible Substance Abuse?
Investigation
Once a written complaint has been filed, an investigator carefully evaluates whether the Board should proceed with additional investigative reviews of the complaint.
Sometimes, the investigator may determine that there isn't enough evidence to pursue a claim against you and close the matter. However, in other situations, the Board may launch a formal investigation, typically requiring you to provide either a written or oral statement. Investigators may also conduct interviews, go on-site visits to medical facilities, and review relevant documents.
Although the District may offer an accused nurse the option to enroll in a rehabilitative program at this juncture, this is not guaranteed. Often, the Board will wait until the investigation is completely closed to determine whether a rehabilitative option is most appropriate given the circumstances.
Settlement Conferences or Administrative Hearings
After the investigation, the Board may offer the nurse a settlement conference to discuss a settlement agreement, sometimes also called a “consent order” (discussed more below). If the Board does not offer the nurse a settlement conference or the parties cannot agree to the terms of an agreement, the matter proceeds to an Administrative Hearing.
Section 3-1205.19 of the Act lays out the various policies and procedures that govern these hearings, which are operated akin to a small trial. While no “jury” is present, the hearings occur before a neutral decision-maker who can review arguments from both parties, as well as evidence and testimony from witnesses. The Board may also subpoena witnesses to testify, such as a nurse's colleagues, patients, supervisors, etc. The nurse will be notified of the decision after the hearing within 90 days. Under §3-12-5.20 of the Act, nurses who are not satisfied with the hearing officer's decision can appeal the decision to the District of Columbia Court of Appeals.
What Is a Consent Order and How Do They Relate to Rehabilitative Programs?
A consent order is a legally binding agreement signed between the nurse and the Board of Nursing. In substance abuse-related cases, consent orders typically include precise terms and conditions that nurses must continue to meet for a specified period. These conditions may require nurses to enroll in a rehabilitation program, undergo regular drug testing, and adhere to workplace supervision protocols. Nurses who fail to meet the terms of the consent order can face further disciplinary investigations by the Board.
Consent Orders and Rehabilitative Options Under the D.C. Nurse Practice Act
Consent orders are addressed in §3-1205.19(b) of the Act, where the Board notes, at its discretion, they may “request the applicant or licensee to attend a settlement conference before holding a hearing under this section and may enter into negotiated settlement agreements and consent decrees to carry out its functions.”
In other words, the Board does not have to present a settlement offer to the nurse. Still, rather than proceed straight to a hearing, they may use their discretion to invite a nurse to a settlement conference to discuss the terms of a possible consent order. Although settlement conferences seem unguaranteed in the District of Columbia, the Board is likely motivated to offer consent orders in most cases because they require fewer resources and funds than a formal administrative hearing would. If you are considering participating in a rehabilitative program, the Board will address your request to participate in a program at these conferences.
Why Consider Settlement?
Nurses may be tempted to sign a consent order agreement for several reasons. First and foremost, consent orders can avoid formal, time-consuming, and anxiety-inducing disciplinary hearings. Nurses may also be motivated to sign the order, assuming they can continue to work without license suspension issues. This makes it an attractive option for those facing financial constraints or concerned about supporting their families. For some nurses, accepting a consent order may even be viewed as a demonstration of their commitment to upholding professional standards or a significant step in their sobriety journey.
Take Caution Before Signing Up For Mandated Substance Abuse Treatment
Just like any decision, consent orders may seem enticing. However, they may be too good to be true. District of Columbia nurses should thoroughly educate themselves about the potential far-reaching implications before signing away their autonomy and peace of mind. Below are some of the several reasons why caution is warranted.
Professional Repercussions
Consent orders may become part of a nurse's professional history, potentially influencing their future employment prospects and professional reputation. Even if nurses manage to retain their current positions, their aspirations for career advancement may be hindered, especially when pursuing senior roles that may depend on a clean disciplinary record. Nurses aiming to work in other states under a multi-state compact license or as agency nurses might also encounter obstacles in these career paths due to consent orders in their records.
Restrictions and Monitoring Burdens
Consent agreements can usher in substantial limitations and monitoring responsibilities, aspects that many nurses may not fully understand at the time of signing the agreement. The District's Alternative-To-Discipline Programs can demand significant time and disrupt their professional and personal routines. Furthermore, additional monitoring can require ongoing regular drug tests and workplace supervision, which may result in workplace rumors and heightened scrutiny.
Legal Implications
Consent orders represent legally binding settlements. Any breach of the agreement can trigger an automatic suspension or revocation of the nurse's license. Even in cases where suspensions or revocations are not imposed, the District's Board of Nursing typically maintains a record of non-compliance. In fact, under the District's laws, non-compliance with a program's terms can trigger the automatic release of a nurse's confidential substance abuse record. Consequently, any future misconduct allegations could lead to even more severe consequences due to this prior non-compliance history.
Financial Consequences
Numerous nurses in the District of Columbia may not be aware that when they agree to a consent order mandating their participation in rehabilitative programs, they are personally responsible for covering the associated expenses. Depending on the duration and nature of the required program, these costs can vary significantly and may become quite substantial. Fees for regular drug testing can also accumulate over time, depending on the frequency required.
Stress
While the stress associated with a misconduct investigation is evident, it may become more manageable once investigations conclude with favorable outcomes. In contrast, stress stemming from consent orders can continue on and on, mainly when fueled by the loss of autonomy, heightened monitoring, and ongoing damage to a nurse's professional reputation.
How Is My Nursing License Affected While Completing the District's Substance Abuse Program?
It depends. Sometimes, the Board may determine that a nurse can safely continue to practice while participating in a rehabilitation program. In other instances, a nurse may feel like it is best to suspend practice temporarily while completing a substance abuse program.
Sections 3-1205.7-8 of the Act address the procedures involved for nurses who may wish to voluntarily limit or surrender their license while they pursue substance abuse treatment. Surrenders can range from permanent to a definite period that the nurse and Board agree to or an indefinite period subject to the review of the Board. Licenses can only be voluntarily limited or surrounded if the nurse submits an affidavit to the Board stating that they are doing so freely and willingly and are not under coercion or duress. As a condition for accepting the voluntary surrender, the Board can still require the nurse to do one or more of the following:
- Receive care, counseling, or treatment from approved healthcare providers.
- Engage in an education program mandated by the board.
- Practice under the supervision of an approved healthcare professional for a set duration.
While a nurse may feel like surrendering their license is the appropriate and courageous thing to do, doing so without consulting our Professional License Defense Team can have drastic consequences. Surrounding a license may be considered an admission of guilt or fault, carrying other legal ramifications. Professionally, it may also be difficult for nurses to apply for nursing licenses in another jurisdiction, such as one of the states.
Consult Our Professional License Defense Team Before Agreeing to a Consent Order
Before considering a consent agreement with the District of Columbia Board of Nursing to resolve substance abuse misconduct, it's essential to consult with our Professional License Defense Team. You deserve to have a comprehensive understanding of the potential ramifications that may ensue and what life after a consent agreement can look like.
Although nurses may believe they have no choice but to accept the presented consent order, they may need to be made aware that legal counsel can assist in negotiating the agreement's terms. This negotiation can lead to a more favorable outcome with less restrictive conditions. Our Professional License Defense Team can also propose alternative solutions or compromises that the Board might not initially offer. These terms may encompass less rigorous program participation requirements or an understanding that the agreement will remain confidential if signed, thereby minimizing its impact on future career opportunities.
Contact Our Professional License Defense Team Today
Our Team has successfully navigated nursing misconduct allegations nationwide, especially within the District of Columbia. We are standing by to help you consider whether a settlement agreement with the District of Columbia Board of Nursing suits your unique circumstances. Contact a member of our Professional License Defense Team today by calling us at 888-535-3686 or by filling out a brief contact form.
