If you are facing a substance abuse investigation led by the Georgia Board of Nursing, you have likely found yourself in a high-pressure situation. While agreeing to a consent order agreement can seem like a straightforward path, signing one too hastily can have drastic consequences. This rush to resolve the allegations might prevent you from considering more favorable options that might have been available.
If you are considering signing a consent order, it's crucial to understand all your legal options before making a final decision. Our experienced Professional License Defense Team takes pride in defending the licenses of healthcare professionals across Georgia. We encourage you to reach out to us to discuss your situation. Our Team will provide you with comprehensive legal advice, ensuring that you are fully informed about your rights and all available options.
Contact a member of our Team today by calling us at 888-535-3686 or by filling out our brief contact form.
Factors Contributing to Substance Abuse in the Nursing Profession
Demanding Schedules
The demanding nature of the nursing profession, marked by its intense stress levels, can sometimes precipitate substance abuse problems in nurses. This issue often evolves slowly, with nurses not immediately recognizing their growing dependency on substances. Nurses are regularly confronted with critical life-and-death situations, endure emotionally and physically taxing tasks, and face long, unpredictable hours. This unrelenting stress can lead to exhaustion and, as a result, to substance abuse. What may begin as a casual glass of wine to unwind after a shift or caffeine consumption to maintain energy can rapidly become a more serious issue.
The phenomenon of burnout, a state of physical, emotional, and mental depletion, is common among nurses. It's hardly surprising that this level of burnout can frequently result in substance abuse, impacting not just the nurses' well-being but also the caliber of care they can provide to their patients. Driven by a deep sense of responsibility and the pressure to manage their workload, many nurses may turn to substance use as a way to cope. However, this can quickly develop into a dependency.
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. Nurses typically operate in settings where staffing is insufficient, and they are regularly immersed in challenging situations. They dedicate a significant amount of time to patients with intricate care requirements. This continuous engagement can deplete their physical, mental, and emotional energies, possibly resulting in the adoption of unhealthy coping strategies such as substance use.
The Georgia Board of Nursing
The Georgia Board of Nursing is integral in overseeing the nursing profession within the state. It is tasked with issuing licenses for various nursing roles, including Registered Nurses (RNs), Licensed Practical Nurses (LPNs), Nurse Practitioners (NPs), Advanced Practice Registered Nurses (APRNs), Certified Registered Nurse Anesthetists (CRNAs), and Certified Nurse Midwives (CNMs). The legislative backbone for nursing practice in Georgia is contained within the state's Nurse Practice Act. The Georgia Nurse Practice Act serves as a legal structure that oversees the nursing profession in the state, outlining the requirements for licensure, the standards for nursing practice, and the ethical conduct expected of nurses.
Disciplinary Authority Under Georgia's Nurse Practice Act
The Georgia Nurse Practice Act empowers the Georgia Board of Nursing to deny, revoke, or impose disciplinary measures on a nurse's license if they breach specific regulations. It emphasizes that nurses in Georgia must hold a valid license to practice legally within the state.
The Board's authority to revoke or refuse a nursing license in Georgia is clear-cut, but its disciplinary powers are more extensive and not fully detailed in its administrative rules. Typical disciplinary measures can range from issuing warnings and reprimands to placing specific restrictions on a nurse's license. These restrictions may confine a nurse's practice to certain facilities or areas or necessitate supervision. Additionally, nurses may be required to undergo evaluations and treatments for substance abuse or mental health conditions.
Substance Abuse Violations Under Georgia's Nurse Practice Act
Under §43-26-11 of the Act, the nursing license can be denied, suspended, or revoked due to the use of alcohol, drugs, or narcotics. Nurses who have been convicted of any substance-abuse-related felonies may also be denied or stripped of licensure pursuant to §46-26-40 of the Act. Finally, nurses can face disciplinary measures if they have displayed an inability to practice nursing skills due to the safe use of substances.
It's essential to recognize that even minor sanctions like warnings or reprimands can affect a nurse's employment, potentially leading to dismissal from staffing agencies. Although opting for these more minor penalties might be a strategic move to avoid harsher outcomes like license suspension or revocation, they can still bring unexpected restrictions that nurses might not fully grasp when agreeing to settlement terms. For nurses in such predicaments, it's vital to thoroughly understand and navigate these resolutions, making it advantageous to seek expert advice for evaluating and negotiating any disciplinary action terms.
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. Recognized as a complex, progressive condition, SUD can cause physical, emotional, financial, and legal difficulties. Nurses are particularly vulnerable to SUD, mainly due to their ready access to controlled substances in healthcare settings. Some of the signs and symptoms of a nursing substance abuse disorder are discussed 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.
What Instances Prompt Substance Abuse Referrals to the Nursing Board?
If you have learned that the Georgia Board of Nursing is investigating you for substance abuse violations, you are likely wondering what incident triggered the investigation. Sometimes, investigations can be triggered by instances outside of the workplace, such as a DUI or criminal investigations relating to illicit substances. Other times, investigations may be triggered if colleagues, supervisors, or patients believed you were under the influence of drugs or alcohol while on the job or showed up to shift hungover. Georgia's Secretary of State directs members of the nursing profession and the public to report instances of suspected substance abuse in the following scenarios:
- Positive pre-employment or for-cause drug test results.
- Signs of alcohol use such as smell or impairment-related behaviors.
- Excessive usage, wastage, or non-compliance while handling medications.
- Documentation discrepancies or manipulation of a medication system.
- Any concerns for patient safety that warrant immediate attention or intervention.
What Happens After Being Reported for Possible Substance Abuse?
After a written complaint is submitted by a member of the public, a colleague, or a supervisor, it is referred to a state investigator who gives serious consideration as to whether the Board should take further investigative action. In some instances, the investigator may not believe further action is warranted, and you will not be contacted. In other scenarios, the Board will initiate a formal investigation, often requiring the nurse in the subject to participate by providing a written or oral statement. Other investigatory methods can include interviewing witnesses, visiting medical facilities, and reviewing documentation.
After the investigation, the Board can take one of several routes. The board can determine that there is insufficient evidence to pursue a disciplinary hearing and close the matter. The Board can also close the complaint with a letter of concern informing the nurse that while no laws were broken, the Board is nevertheless concerned about the events that led to the investigation. On the more severe side, complaints can be closed on the condition that fines are paid, making the investigation public information.
If the complaints are not resolved through one of these methods, the allegations are likely much more severe. At this juncture, the nurse may reach a settlement with the Board, referred to as a Consent Order (discussed more below), or forgo settlement and proceed to a formal hearing before an administrative law judge. The Board can then choose to follow or decline to follow the administrative law judge's disciplinary recommendations, if any.
What Is a Consent Order, and What Are the Implications of Signing One?
A consent order is a voluntary legal agreement made by the nurse in question with the Board of Nursing. Consent orders in substance abuse complaints typically set out specific terms and conditions that nurses must comply with, such as joining a rehabilitation program, undergoing routine drug tests, and following workplace monitoring protocols. Many nurses are tempted to sign consent orders because they are an alternative to going through formal disciplinary actions and enable nurses to retain their licenses. At the same time, they meet the agreed-upon rehabilitation and monitoring obligations.
Private Versus Public Consent Orders
Consent orders can be private or public. A private consent order requires a nurse to admit that there has been a breach of practice laws and rules. In exchange, the nurse participates in a series of alternative-to-discipline programs, and the order remains confidential between the licensee and the board, remaining inaccessible to the public. Public consent orders, on the other hand, require an admission of misconduct and participation in substance abuse programs but nevertheless remain accessible to the public as information related to the nurses' public license information.
Why Consider a Consent Order?
Georgia nurses might opt for a consent order agreement for several vital reasons. Most notably, consent orders avoid the need for a formal, potentially stressful, and public disciplinary hearing, providing a more confidential solution with known results. Secondly, by accepting the consent order's conditions, nurses can usually keep their license while undergoing necessary rehabilitation and monitoring, making it an “obvious” choice for those who are financially strapped or concerned about supporting their families. Some nurses may even feel like accepting a consent order demonstrates their commitment to professional standards and, if guilty of substance abuse, their own personal sobriety process.
Exercising Caution While Considering Consent Orders
As with anything, consent orders may be too good to be true. Georgia nurses should take the time to make sure they are adequately informed about the rippling consequences of signing a consent order before they face ongoing professional and personal repercussions. Some of the various reasons why nurses facing substance abuse allegations should exercise caution when considering whether to sign a consent order are discussed below.
Professional Repercussions
Consent orders are typically recorded in a nurse's professional history, potentially affecting their opportunities for future jobs and how they are perceived professionally. In addition to becoming part of a nurse's permanent professional record, future employment opportunities can be limited as potential employers may feel like the nurse is a liability. Even if nurses are able to maintain their current employment status at their facility, their career advancement plans may be affected, especially in instances where more senior positions may require a clean disciplinary record. Nurses who are interested in working in other states through a multi-state compact license or as an agency nurse may also find that these career opportunities are hindered.
Restrictions and Monitoring Burdens
Consent agreements come with significant restrictions and monitoring burdens that many nurses only come to grasp after it is too late entirely and they have signed the order. In Georgia, nurses must participate in the state's Alternative-To-Discipline Program, which can be highly time-consuming and interfere with their work and personal schedules. Additional monitoring can include frequent drug testing and workplace monitoring, both of which can lead to workplace gossip and scrutiny.
Legal Implications
Consent orders are legally binding settlement agreements. Violating any part of the order, even unintentionally, can trigger automatic license suspension or revocation. Even if suspensions or revocations are not ordered, the Board of Nursing typically keeps a record of non-compliance, meaning that future misconduct allegations could result in even more severe consequences.
Financial Consequences
Many nurses in Georgia may not understand that when they sign a consent order that requires them to participate in mandatory rehabilitative programs, they are responsible for paying for those programs. Depending on the duration and type of the program needed, costs can be pretty extensive. Regular drug testing also comes at a regular cost, which can quickly add up depending on the testing frequency.
Stress
Although the stress of a misconduct investigation is apparent, it can potentially be limited once investigations close and favorable decisions are ordered. Consent-order-related stress, however, can continue in perpetuity, feeding off of the loss of autonomy, increased monitoring, and reputational damage that a nurse continues to suffer.
Alternative-To-Discipline Programs
Alternative-to-discipline programs are programs various states use as a rehabilitation option for nurses accused of substance abuse. These programs are typically required as a result of consent order agreements and include a variety of requirements, such as participation in structured treatment, ongoing professional monitoring, counseling, drug testing, and support to address the root causes of substance abuse. Under applicable consent order agreements, nurses are typically allowed to continue working while they complete the program. Georgia's alternative-to-discipline program, the “Peer Assistance Program,” is discussed more below.
Georgia's Peer Assistance Program
Formerly known as the Georgia Nurses Association Nurse Advocate Program, Georgia's Peer Assistance Program is a volunteer-led substance abuse program granted authority by the Georgia Board of Nursing to offer rehabilitative services to nurses struggling with alcohol, illegal drugs, and prescription drug sobriety.
As part of the program, nurses must participate in weekly peer-support groups, comply with mandatory quarterly reporting requirements regarding their work performance, and participate in frequent and random drug screenings. Nurses are not allowed to miss any of their weekly peer-support group meetings and must be willing to embrace the traditional 12-step meeting format that is utilized.
Throughout participation in the program, nurses are considered to be on “probation,” meaning that if they fail to meet the program's requirements, the Board can pursue penalty-based repercussions such as license suspension or revocation.
Quarterly Report Forms
As part of the Peer Assistance Program, nurses must ensure that they submit completed quarterly report forms to the nursing compliance component of the board of nursing. Depending on the circumstances and the substances involved, nurses must first fill out their own personal reporting form and then arrange for the following individuals to provide the Board with updated information regarding their sobriety progress:
- Treating Addiction Physician
- Continuing Care Support Group Facilitator
- Employer
- Psychotherapist/Professional Counselor
If nurses continue to take prescription medication, they must also submit quarterly medication management forms as well as a quarterly list of all prescription medications. In the event that the nurse is prescribed a new medication, they must submit a copy of the prescription medication form to the Board within ten days. Failure to do so can result in misconduct allegations.
Consult Our Professional License Defense Team Before Signing A Consent Order
If you are considering signing a consent agreement with the Georgia Board of Nursing to settle your substance abuse-related misconduct allegations, you must consult with our Professional License Defense Team first to ensure that you understand all the potential consequences that can follow. Not only are consent agreements legally binding, but they can also be confusing for the average person to know as they are filled with legal terms and policies that have several implications.
Many nurses may also assume that they must “accept” the consent order as presented but are unaware that counsel can help negotiate the terms of the agreement, potentially resulting in a more favorable outcome with less restrictive terms. While negotiating more favorable terms, our Professional License Defense Team can also suggest alternative solutions or compromises that the Board may fail to offer. These terms can include less stringent program participation requirements or even a mutual understanding that the agreement will remain private if the order is signed, minimizing the consequential impact on future career moves.
Contact The Lento Law Firm's Professional License Defense Team Today
If you are facing substance abuse allegations, the Georgia Board of Nursing will not hesitate to ensure that you are swiftly and adequately punished. Even in instances where nurses are innocent or have already reached sobriety, they may nevertheless feel pressured to accept public or private consent agreements with the Board. While these agreements may be the best route in some scenarios, they may be overly stringent and restrictive in other instances where less severe outcomes may be possible.
Protect yourself and your career – contact the Lento Law Firm's Professional License Defense Team Today. Our Team has successfully navigated nursing misconduct allegations all over the state, and we are standing by to consult with you before you sign any consent order agreements with the Georgia Board of Nursing. 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.
