As a nurse in Hawaii facing substance abuse allegations, you may be considering signing a settlement agreement, sometimes called a consent agreement, with the nursing board to resolve your misconduct allegations. Although consent agreements may seem more accessible, they often have hidden consequences. The terms of most agreements can be challenging to maintain while working as a nurse. Regular drug screenings, performance assessments, and participation in therapy must often be completed outside of regular hours and at your own financial expense.
Before signing a consent agreement with the Hawaii Board of Nursing, contact the Lento Law Firm's Professional License Defense Team. Our Team assists medical professionals throughout Hawaii 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.
Contributors to Substance Use in the Nursing Field
Demanding Work Schedules
Aside from erratic schedules and heavy workloads, nurses are expected to maintain a high level of empathy and understanding towards their patients. The intense demands of their job can lead to burnout, with some nurses turning to substances to handle the physical and emotional weariness. Initially, a glass of wine to relax after a shift or an extra cup of coffee to stay alert might seem harmless, but these habits can soon evolve into substance abuse.
Compassion Fatigue
Compassion fatigue, identified by psychologists as a form of vicarious trauma, can also be a contributing factor to substance abuse in the nursing profession. Nurses spend a considerable amount of their time attending to the emotional needs of their patients, sometimes depleting their own along the way. This exhaustion can lead nurses to seek out unhealthy coping mechanisms, such as substance use, to take their minds off of their patients' troubles.
The Hawaii Board of Nursing
The Hawaii Board of Nursing operates under the direction of Hawaii's Department of Commerce and Consumer Affairs Division. The Board is instrumental in regulating the nursing profession within the state, achieving so by overseeing nursing standards in the education, licensure, and practice of Hawaii nurses. The Board's authority and operating procedures are established in Hawaii's Nursing Practice Act, a series of statutes and regulations that govern the state's nursing profession.
In instances of misconduct, the Board is also empowered to investigate complaints and impose a spectrum of disciplinary actions that range from warnings to license suspensions and revocation. In instances of substance abuse, the board may also recommend rehabilitative programs.
Substance Abuse Violations Under Hawaii's Nurse Practice Act
Section 12-457 of Hawaii's Nurse Practice Act establishes various grounds for discipline, such as fraud and negligence. The Act also zeroes in on substance abuse violations by condemning the “Habitual intemperance, addiction to, or dependency on alcohol or other habit-forming substances.” In instances where nurses continue to use habit-forming substances, they may also violate the Act's other sections, such as the section prohibiting any “willful or repeated violation of any of the provisions . . . adopted by the board.”
Hawaii further adopts the scope and standards of the NCSBN Model Nursing Practice Act and Model Nursing Administrative Rules, which requires nurses struggling with substance abuse to:
- Report any condition or impairment (including but not limited to substance abuse or a mental, emotional, or nervous disorder or condition) which in any way currently affects or limits your ability to practice safely, competently, and professionally.
When the Board has reason to believe that a nurse has committed substance abuse-misconduct, §457-5 permits them to “conduct hearings upon request of a denied applicant or charges calling for discipline of a licensee.”
What is Nursing Substance Abuse Disorder?
The National Council of State Boards of Nursing (NCSBN, 2014) characterizes Substance Use Disorder (SUD) in the nursing profession as a range of behaviors, from misuse to dependency, that involve alcohol, legal medications, and illicit drugs. Acknowledged as a multifaceted issue with significant impacts, SUD poses physical, emotional, financial, and legal challenges, particularly prevalent among nurses. Below are some of the behavioral and physical indicators of SUD in nursing professionals:
Behavioral Indicators
- Opting to administer the maximum dosage of medications.
- Regularly volunteering for medication administration duties.
- Everyday incidents of medication wastage or breakage.
- Challenges in managing strictly controlled medications.
- Patient complaints about ineffective pain management.
- Preference for working during less supervised shifts.
- Experiencing mood swings, anxiety, or emotional instability.
- Difficulty in maintaining professional relationships.
- Exhibiting forgetfulness or memory issues.
- Unexplained absences or excessive breaks.
- Habitual tardiness, absenteeism, or frequent sick calls, particularly following days off.
- Disorderly or confusing documentation practices.
Physical Indicators
- Noticeable hand tremors.
- Difficulty in speech clarity.
- Episodes of sudden sleepiness.
- Eye irritation and abnormal pupil size.
- Excessive perspiration.
- Impaired coordination.
- Persistent nasal discharge.
- Symptoms of nausea, vomiting, or diarrhea.
- Significant weight fluctuations.
- Frequent wearing of long-sleeved garments or lab coats to conceal marks.
Circumstances Triggering Substance Abuse Referrals to the Nursing Board
When you first learn that the Hawaii Board of Nursing is investigating you for substance abuse misconduct, you are likely wondering, “Who reported me and for what reason?” Investigations can be sparked by events outside of work, such as receiving a DUI or being arrested. They commonly begin with alleged workplace misconduct after someone files a complaint. The Board of Nursing receives complaints from various sources, including coworkers, supervisors, or patients who might suspect impairment. These formal complaints can be submitted by contacting the Board directly or using the complaint form offered through the state's online portal.
The reasons for being reported can vary, but many stem from a third party believing you were hungover or under the influence while on duty or arriving for a shift. Additional issues that may prompt a complaint include:
- Testing positive for substances in pre-employment screenings or during tests administered under specific circumstances.
- Signs of alcohol use, such as a discernible smell or behavior that suggests impairment.
- Illegal drug use, mishandling, or failing to follow proper procedures in medication management or patient administration.
- Discrepancies in record-keeping or tampering with medication distribution systems.
What Happens After Being Reported for Possible Substance Abuse?
Investigation
You will initially be notified via a formal letter that outlines the complaint, details the allegations, and explains the investigation process. Typically, you will be asked to respond to the claims in writing or verbally during the investigation. It's critical to understand that not participating in the investigation can be considered an additional form of misconduct, potentially leading to further disciplinary actions.
An investigation's scope can vary depending on the specifics of each case. Still, investigators typically use a variety of methods to uncover the details of your alleged substance use at work. Some investigative methods investigators may use include speaking to witnesses such as coworkers or patients, gathering evidence, examining documents, and possibly engaging other professionals like assistants and consultants to assist in the investigation.
Once the investigation concludes, the investigator will assess whether there is enough evidence to proceed with disciplinary actions or, conversely, determine whether there is insufficient evidence to support the allegations and close the case.
Formal Consent Agreements
A consent agreement a legally is a legally enforceable contract between the nurse and the Board of Nursing. In instances concerning substance abuse, consent agreements typically stipulate a set of terms and conditions that the nurse agrees to fulfill over a designated timeframe as a means of settling their disciplinary issues. These stipulations often include participation in a “voluntary” rehabilitation program, submission to frequent drug screenings, and compliance with protocols for supervision at the workplace.
Administrative Hearings and Appeals
Should the parties fail to reach a consensus on the settlement agreement, the matter will escalate to an evidentiary hearing, which includes the presentation of evidence, witness testimonies, and legal arguments. Evidentiary hearings resemble a mini-trial and take place before an impartial hearing office. At the close of the hearing, the hearing officer can issue various decisions such as fines, penalties such as mandatory education courses, and license suspension or revocation.
If you've declined a consent agreement and are now navigating an administrative hearing or considering an appeal, our Professional License Defense Team can assist you by developing a strategic defense, negotiating on your behalf, and representing you throughout the hearing. Contact our Team by calling 888-535-3686 or completing our online contact form to get your needed support.
Why Consider a Consent Agreement?
Nurses may be drawn to consent agreements for several persuasive reasons. Foremost, these agreements present an appealing shortcut to avoid formal disciplinary proceedings. Additionally, many nurses with financial struggles may hope that a consent agreement allows them to continue working in contrast to more extended investigatory periods, which can sometimes prevent a nurse from working while their license is suspended. Some nurses may even feel that consent agreements represent their commitment to their sobriety journey and professional goals.
However, it's crucial to recognize that the short-term relief offered by consent agreements might mask their potential long-term impacts on a nurse's career and reputation. Seeking advice from our Professional License Defense Team can provide critical insights and uncover alternative pathways, ensuring that you can decide what is best for you.
Potential Drawbacks to Signing a Consent Agreement
Consent agreements often present deceptively favorable terms. Nurses in Hawaii are urged to thoroughly evaluate the potentially far-reaching impacts of entering into these agreements, which might involve sacrificing their autonomy and accumulating debt. It's also important to note that the Board of Nursing will not take the time to explain the many potential consequences of signing a consent agreement, as state governments are often motivated to settle matters due to time and financial resources. Some of the possible disadvantages of consent agreements are detailed further below.
Professional Repercussions
While consent agreements are intended to be "confidential," it may be hard to hide the fact that you are under substance abuse treatment. Regular drug screenings, support group participation, work schedule changes, and the paperwork that employers must sign may not go unobserved.
Consent agreements may also affect your ability to advance at work, particularly when positions require an unblemished disciplinary record. Moreover, nurses looking to practice in different states with a multi-state compact license may encounter challenges when their disciplinary record isn't clean.
Legal Implications
Because consent orders constitute legal contracts that, upon breach, can lead to automatic license suspension or revocation, they require perfect adherence. Even in cases where a suspension or revocation is not immediately pursued, the Hawaii Board of Nurses typically maintains a record of any non-compliance. Therefore, future instances of alleged misconduct might incur more severe consequences, as the nurse's record of non-adherence could weigh heavily on the outcome.
Consent orders constitute legal contracts that, upon breach, could lead to the automatic suspension or revocation of a nursing license. Even in cases where a suspension or revocation is not immediately enacted, the Nursing Board typically maintains a record of any non-compliance. Therefore, future instances of alleged misconduct might incur more severe consequences, as the nurse's record of non-adherence could weigh heavily on the outcome.Consent orders constitute legal contracts that, upon breach, could lead to the automatic suspension or revocation of a nursing license. Even in cases where a suspension or revocation is not immediately enacted, the Nursing Board typically maintains a record of any non-compliance. Therefore, future instances of alleged misconduct might incur more severe consequences, as the nurse's record of non-adherence could weigh heavily on the outcome.Consent orders constitute legal contracts that, upon breach, could lead to the automatic suspension or revocation of a nursing license. Even in cases where a suspension or revocation is not immediately enacted, the Nursing Board typically maintains a record of any non-compliance. Therefore, future instances of alleged misconduct might incur more severe consequences, as the nurse's record of non-adherence could weigh heavily on the outcome.Consent orders constitute legal contracts that, upon breach, could lead to the automatic suspension or revocation of a nursing license. Even in cases where a suspension or revocation is not immediately enacted, the Nursing Board typically maintains a record of any non-compliance. Therefore, future instances of alleged misconduct might incur more severe consequences, as the nurse's record of non-adherence could weigh heavily on the outcome.Consent orders constitute legal contracts that, upon breach, could lead to the automatic suspension or revocation of a nursing license. Even in cases where a suspension or revocation is not immediately enacted, the Nursing Board typically maintains a record of any non-compliance. Therefore, future instances of alleged misconduct might incur more severe consequences, as the nurse's record of non-adherence could weigh heavily on the outcome.Consent orders are legal agreements that, if violated, may automatically result in the suspension or revocation of a nurse's license. Even when suspensions or revocations do not occur, the Board of Nursing usually keeps a record of any failure to comply. As a result, any subsequent allegations of misconduct could face harsher repercussions, influenced by this history of non-compliance.Top of Form
Financial Consequences
Many nurses may not realize that by agreeing to a consent agreement, they are committing to cover the costs of these programs on their own. The financial impact of these programs can differ significantly, depending on their length and nature, and may result in considerable expenses. Additionally, the costs for regular drug testing can accumulate over time, depending on how frequently these tests are required.
Stress
The anxiety associated with undergoing a misconduct investigation is undeniable, yet it typically diminishes once the investigation is resolved, sparing nurses the uncertainty of what the future holds. In other words, once an investigation and hearing are over, the nurse can face the consequences and plan for the future, knowing what to expect. Conversely, the stress linked to consent agreements may linger without end. Despite the technically " resolved disciplinary issue," nurses must suffer through loss of autonomy, heightened oversight, and ongoing professional monitoring. Moreover, during their time in rehabilitative programs, nurses are constantly aware of the stipulation that failing to adhere to the program's terms ideally could result in more severe repercussions.
Alternative-To-Discipline Programs
Many states provide alternative-to-discipline programs as a form of rehabilitation for nurses facing substance abuse challenges. Typically incorporated into consent order agreements, these programs feature several vital components, such as “voluntary” enrollment in an official treatment program, ongoing professional supervision, counseling sessions, routine drug testing, and assistance in tackling the underlying factors of substance abuse. Usually, these arrangements permit nurses to maintain their employment during participation, as specified in their individual consent order agreements. In Hawaii, this program's version is called the "Nurses' Diversion Program."
Hawaii's Department of Commerce and Consumer Affairs Diversion Program
Hawaii's Department of Consumer Affairs offers a Diversion Program specifically designed for nurses who are struggling with substance use disorders or mental health issues that could impair their ability to practice safely. These diversion programs typically serve as confidential, non-disciplinary pathways for healthcare professionals to seek help without the immediate threat of losing their licenses.
The main goal of Hawaii's Diversion Program is to protect public safety by ensuring nurses receive the appropriate treatment and support to overcome their challenges. If deemed safe, the program also allows them to continue their professional practice or return to practice once they have completed the program. Participants in the program are usually required to undergo evaluation and engage in recommended treatment plans. They may be subject to monitoring to ensure compliance and recovery progress.
It's important to note that non-compliance with the program's terms must be reported to the board and the regulated industries complaints office. Participants must demonstrate successful completion and rehabilitation through evidence verified by healthcare providers. Completing the program as per the board's rules exempts nurses from further disciplinary actions for related issues. However, failure to meet the program or chapter requirements could lead to additional consequences.
Program Requirements
Before nurses are allowed to enroll in a substance abuse program officially, it must be approved by the Board of Nursing. This ensures that the program is not only actual but also meets the various requirements for monitoring and compliance that the board may have in mind for a given time frame. All requests for approval must be submitted well in advance to provide the board with sufficient time for a thorough evaluation. The Board reviews requests for authorization under the National Council of State Boards of Nursing Non-disciplinary Alternative Program Model Guidelines, which can be seen as optimal standards for nursing substance abuse programs across the country. These model guidelines require program sponsors to provide a detailed manual of policies and procedures within a set timeframe, covering aspects such as:
- What assessment method will be used to establish criteria and thresholds.
- The details of a pre-admission agreement between the nurse, board, and program sponsor.
- The program's admission criteria include grounds of refusal and participation termination.
- The program's care plan and treatment methods to be used.
- A detailed description of the program's monitoring requirements, including details on the frequency, personnel selection, reporting deviations, breach consequences, and quarterly progress reports.
- The program's reporting methods, including deviations from care plans, discharge notifications, relapse incidents, and sponsor program changes or terminations to the board.
- Conditions in a return-to-work agreement for a nurse's return to practice.
- Protocols for readmitting nurses who relapse.
- Copies of the program's annual reports, including summaries of nurses under treatment and those with active return-to-work agreements.
- The program's management system, including information on reporting the sponsor's inability to maintain program aspects or intentions to terminate the program.
If programs deviate from these requirements, they must provide the Board with a written explanation that might justify any deviations from these guidelines. The Board then has the sole discretion to determine whether the justifications are sufficient. A board majority vote can adopt policy amendments.
Can a Substance Abuse-Related Crime Affect My License?
Yes. Substance abuse-related crimes can significantly affect your Hawaii nursing license. At the onset, substance abuse-related misdemeanors and convictions can cause the Board of Nursing to deny an application for licensure. After licensure, the Board of Nursing continues to view these crimes as very serious; their strict guidelines and regulations stay in effect to ensure that nurses under their jurisdiction continue to provide safe and effective care for Hawaii residents.
Although not every substance abuse-related misdemeanor or conviction can cause license suspension or revocation, this is not a guarantee. The severity of the action typically depends on the nature of the crime, the nurse's history, and the potential risk to patient safety.
Under Hawaii's nursing laws, nurses must also report any substance-abuse-related arrests, misdemeanors, or felony convictions to the Board. Failure to do so can trigger automatic disciplinary investigations. Self-reporting also extends to misdemeanors or convictions in other jurisdictions, such as a different state.
Consult Our Professional License Defense Team Before Agreeing to a Consent Order
Before entering into a consent agreement with the Hawaii Board of Nursing to address allegations of substance abuse, you should contact the Lento Law Firm's Professional License Defense Team to ensure you understand the agreement's consequences and future implications.
If you fear that signing the consent agreement offered by the Board of Nursing is your only option, think again. The Board of Nursing will not take the time to sit down and explain all the available defenses and strategies that may be helpful in your case. They don't represent you or have your best interests in mind.
There may be numerous defense strategies or alternative paths you have yet to consider that could circumvent a burdensome agreement. Our Professional License Defense Team is skilled at identifying and negotiating alternative options with the Board—options you might not be initially presented with. These alternatives could include more manageable, more lenient program requirements from a financial and time management perspective.
Facing Misconduct Allegations From the Hawaii Board of Nursing? Contact The Lento Law Firm's Professional License Defense Team Today
Our Professional License Defense Team
Our Team has successfully navigated nursing misconduct allegations nationwide, especially within Hawaii. Our Team is ready to help you consider whether a settlement agreement with the Hawaii 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 filling out a brief contact form.
