Help for Missouri Nurses Facing License Issues Due to Substance Abuse Problems

Being a nurse is an incredibly difficult job, and that was before the COVID-19 pandemic permanently altered the healthcare industry. Hospitals have since had trouble filling their staff, leading to healthcare professionals being overworked to the point of exhaustion — enough that some nurses have turned to substance abuse as a coping mechanism. This should come as no surprise; high-stress jobs frequently lead to substance abuse, and no one has had it harder than healthcare professionals over the past few years. Studies have shown that nurses, in particular, have seen a rise in the rate of substance abuse among their ranks.

In addition to stress, nurses are more prone to substance abuse for the simple fact of proximity. Handling, storing, and administering medication all day can create a massive opportunity for someone looking for relief. For some, the temptation is difficult to overcome.

All things considered, nurses who are facing these challenges should not feel embarrassed. You are not alone in this. Many other nurses have gone through the same issues and made it to the other side, continuing their careers free of problems.

The key, of course, is whether you can retain your nursing license throughout your recovery. That is where the Lento Law Firm comes in. Our Professional License Defense Team helps nurses in Missouri protect their ability to stay in the industry after facing substance abuse problems. The consequences of a disciplinary investigation can be disastrous. Do not attempt to go through the process alone. Contact the Lento Law Firm by calling 888-535-3686 or online via our automated form.

Missouri Alternative Intervention Program for Nurses

Missouri Statute 335.067 establishes two types of programs for nurses in the state: an intervention program and an alternative program. The programs serve different purposes depending upon the stage of substance abuse the nurse in question finds themself in. More specifically, the intervention program is designed for nursing license applicants and existing licensees in the following situations:

  • Self-referral
  • Tested positive in a pre-employment drug or alcohol screening
  • Tested positive in a for-cause drug or alcohol screening after employment has begun
  • Pled guilty to or found guilty of a felony or misdemeanor drug offense
  • Pled guilty to or found guilty of three or more felonies or misdemeanors that occurred as a result of the use of drugs or alcohol (e.g., indecent exposure while drunk)

Missouri's intervention program for nurses lasts a minimum of one year and requires random drug and alcohol testing along the way — all of which is at the nurse's expense.

On the other hand, the state's alternative program is available to licensees who have admitted to having a substance use disorder. This program lasts between three and five years and, like the intervention program, requires successfully clearing random drug and alcohol tests at the nurse's expense.

While both of these programs exist in accordance with Missouri law, they are only made available to nurses at the discretion of the state's nursing board.

The Missouri State Board of Nursing

The regulatory agency that oversees all professional licensing matters in the state of Missouri is the Missouri Division of Professional Registration. Their duties encompass the licensing and discipline of 41 different professions in the state that require a professional license, including medical professionals, real estate brokers, private investigators, and even tattoo artists.

Under this larger framework, the Missouri Board of Nursing is a smaller board specifically responsible for regulating the nursing profession. They provide oversight of nurses with the following classifications:

  • Registered Professional Nurse (RN)
  • Licensed Practical Nurse (LPN)
  • Advanced Practice Registered Nurse (APRN)
  • Certified Nurse Anesthetist (CRNA)
  • Certified Nurse Midwife (CNM)
  • Certified Clinical Nurse Specialist (CNS)
  • Certified Nurse Practitioner (NP)

Travel nurses (also known as agency nurses) of any designation are also under the purview of the Missouri Board of Nursing while they are working at a facility within the boundaries of the state.

The board is comprised of nine total members: at minimum there must be five RNs, one LPN, one APRN, and one non-nurse public member. These board members are appointed by the Missouri governor. In addition to licensing, investigating, and disciplining nurses, the board is also responsible for making and enforcing nursing-related rules and policies. For nurses with substance abuse problems, this means that your enrollment in the state's intervention or alternative programs must first be approved by the board.

How Is Missouri's Board of Nursing Notified About Substance Abuse Issues

Many people with substance abuse problems think they have their issues under wraps, but the reality is that, in most cases, the truth eventually comes to light. One of the most common ways this happens is for a colleague, usually a fellow nurse, to report you to the Board of Nursing. This might feel like a betrayal, but rest assured that it's unlikely the nurse is harboring any malicious intent toward you.

Nursing is one of several mandatory reporting professions in Missouri. If a nurse discovers that another nurse has a substance abuse issue, they have an obligation to report it. Missouri's Code for Nurses instructs those in the profession to first report the inappropriate practice to an authority within their facility or health care system. Each facility should have an official channel designed for claims to be filed without fear of repercussion.

According to the state's guidelines, the issue should be escalated to the Missouri Board of Nursing if the “incompetent, unethical or illegal activity is not corrected within the employment setting and continues to jeopardize the client's welfare and safety.” It should be noted that this obligatory reporting is not limited to substance abuse. It applies to any sort of behavior that would be subject to discipline by the nursing board, including fraud, assault, elder abuse, medical incompetence, and more.

It is also possible that a complaint is filed by a patient or someone advocating on their behalf. If a nurse's substance abuse becomes noticeable enough that it interferes with or negatively affects a patient's healthcare experience, this becomes more likely to occur.

Perhaps the most advantageous way the nursing board can find out about substance abuse is from the nurses themselves — we'll discuss the pros and cons of self-reporting below.

For most Missouri nurses with substance abuse issues, it's not if you'll be reported to the Board of Nurses; it's when. How it happens can be a determining factor in whether the board attempts to discipline you or allows you to enter an intervention or alternative program. If you think you may have been reported to the nursing board for substance abuse — even if you're not sure — it's a good idea to contact the Lento Law Firm. Our Professional License Defense Team can help lay out the options and find the best path to take to save your career.

When Should a Nurse Self-Report?

It may seem like self-sabotage for a nurse to report themselves to the Missouri Board of Nursing for an alcohol or substance abuse addiction. On one hand, the nurse is instigating a serious process with potential career-ending consequences. On the other hand, it may inspire the nursing board to be lenient when determining discipline. It also makes it more likely that the board allows the nurse to attend the state's intervention or alternative program in lieu of an investigation.

To be clear, nurses suffering from substance abuse issues typically do not self-report unless an event or situation makes it a more palatable option. For example, a nurse might take a drug test the day after indulging in illegal substances. Rather than wait for the test to come back positive, they get ahead of it by reporting it to the Board of Nursing directly. Another instance that could prompt a self-referral may be a near-accident in the workplace involving a patient (i.e., almost giving a patient a dangerously high sedative dose before another nurse caught the error). Self-reports can even sometimes be made in response to a colleague's threat — if you don't tell the board yourself, they'll do it for you.

No matter the reason, nurses should never self-report without first consulting with an experienced attorney. The Professional License Defense Team at the Lento Law Firm deals with nursing boards all over the country and is familiar with the alternative pathways available to chemically dependent nurses in Missouri. While self-reporting seems like the simplest way forward, it is not without its drawbacks.

For starters, self-reporting means that you are admitting to guilt — not unlike a plea deal in a criminal trial. It's also not a guarantee that the nursing board will allow you to enroll in an intervention or alternative program. If disciplinary action is brought against you instead, the fact that you already admitted your guilt could put your nursing license in jeopardy. Save yourself the stress. Trust that you are taking the best path forward by contacting the Lento Law Firm before you contact the Board of Nursing.

Missouri's Nurse Intervention and Alternative Programs: Pros and Cons

When determining whether Missouri's intervention or alternative substance abuse programs are right for you, there are a number of things to consider. An attorney from the Lento Law Firm's Professional License Defense Team can better answer questions about your specific case, but here is a general idea of the pros and cons.


An intervention or alternative problem can be a great option for nurses — as long as you are serious about your recovery. Oftentimes, these programs include addiction treatment or rehabilitation. If you truly need to get help, these programs can make that a reality without you having to lose your license. Ideally, once you complete the program, you should be in a much better place to function day-to-day at your job without the need for substances.

Entering into a written agreement for Missouri's intervention or alternative program does equate to an admission of guilt. That being said, it is usually preferable to the headache that comes with being found guilty after a lengthy board investigation. For one, these agreements are confidential; the fact that you are facing issues won't be public knowledge. Fair or not, there is a stigma around being forced out of your job (versus leaving willingly).

Of course, the most obvious advantage for nurses is that completing the program keeps your nursing license in good standing. Without disciplinary action on your record, you should have the same job opportunities as you would have had otherwise.


While Missouri's intervention and alternative programs do allow you to keep your nursing license, it almost always comes with a lot of strings attached. There will likely be some sort of monitoring system that you will be beholden to as long as the nursing board deems necessary. This can include things like frequent check-ins with the board to mandated Alcoholics or Narcotics Anonymous meetings.

Part of your return to work may also include restrictions that limit the tasks you are able to perform at your job. You may want to keep your past struggles to yourself, but it could very well raise questions with co-workers when you are unable to administer certain medications due to restrictions placed by the board.

Another thing to consider is that your current place of employment is under no obligation to keep you on their nursing roster throughout the (often lengthy) duration of any intervention or alternative program. Sure, completion of the program allows you to retain your nursing license — but it says nothing about retaining your job. It's possible that your facility is willing to hold your position open while you go through the treatment process, but it is no guarantee.

Your financial and insurance situation also plays a huge role when deciding whether an intervention or alternative program is the right move for you. Treatment and rehabilitation programs can cost thousands upon thousands of dollars. The Missouri Board of Nursing might require these to complete your program, but they will not cover the costs of a nurse to attend. Insurance, on the other hand, is notoriously inconsistent about which programs they will cover. If your insurance company has any way to get away with not paying for your treatment, you can believe they will try. Either way, agreeing to an intervention or alternative program is a big financial burden that many nurses would not be able to cover without significant savings.

What If You Don't Have an Alcohol or Substance Abuse Disorder?

Missouri's intervention and alternative programs certainly present some benefits for nurses with alcoholism or substance abuse disorders, but what about the nurses who don't? While chemical dependency is more common among nurses, that doesn't mean that every nurse who gets reported for an alcohol or drug-related offense is an addict. On the contrary, since one-off actions like DUIs and failed drug tests get reported to the Board of Nursing, it stands to reason that a good portion of those nurses simply made a singular questionable decision. Drinking a glass of wine or two after work is perfectly normal behavior, especially for those in stressful jobs. Even cannabis use — which is legal in Missouri — might be enough to trigger a Board of Nursing report if it's found during a drug test. But that doesn't make you an addict, and that's the real purpose of these programs.

In situations like these, it may actually be more advantageous for a nurse to go through the nursing board's formal disciplinary process. This makes sense for a few reasons: first, in order to enroll in the state's intervention or alternative program, you must admit guilt. After you've signed the agreement, there is no going back; you are now at the mercy of the nursing board. In order to guarantee your license is not revoked, you will have to complete the program the state assigns you. For someone who is not actually an addict, going through a potential years-long rehabilitation process seems like a waste of your valuable time.

Another reason it might make sense to roll the dice on a disciplinary proceeding is that you have a chance to emerge from it with no disciplinary action taken against you at all. Compared to the possibility of years and years of oversight, probation, and restrictions, this seems like a pretty attractive path to take. It's not without its drawbacks, however. You may have to endure a formal hearing (which functions much like a trial), and there is a chance that you end up losing your case. Even still, some disciplinary action against your license might be preferable to an extensive, time-consuming intervention program.

Regardless of which direction you ultimately decide to go, the important thing is that you do it under the guidance of an experienced attorney. The Professional License Defense Team at the Lento Law Firm helps nurses in need across the country. We are well-versed in Missouri's nursing procedures and have spent plenty of time negotiating with licensing boards on behalf of our clients. Given the opportunity to look over the details surrounding your case, we are confident that we can find the path that offers you the best situation going forward.

Other Available Resources

The last thing anybody wants is to feel like they have been backed into a corner, devoid of options. Missouri nurses with alcohol or substance addiction issues may feel like they don't have any say in what happens next. It's true, to a certain degree; once the Board of Nursing gets word of a nurse's dependency, the nurse in question is stuck in the disciplinary process until there is some sort of resolution. That could mean disciplinary action or board-sanctioned enrollment in an intervention or alternative program. However, before the nursing board finds out, there may be other resources at a nurse's disposal.

One of these can be found via the Missouri Nurses Association. Their Chemical Dependency Peer Assistance Program is made explicitly for nurses who struggle with alcohol or substance abuse. The program acknowledges that nurses are more prone to chemical addiction than other professions because the nature of the job exposes them to drugs. As such, they have created this resource to allow nurses in need to seek help from their peers.

While confiding in fellow chemically dependent nurses may sound like a great option, there are a few question marks that should be addressed before enrolling. For example, is the program totally confidential? Working through your substance abuse before it becomes a Board of Nursing problem would be ideal, but is it realistic? Can you be sure that your participation in such a program won't get back to the nursing board?

Before you rush into any decision, reach out to the Lento Law Firm for a consultation. Our Professional License Defense Team can take a measured look at your situation and help you take the right path to preserve your future.

The Lento Law Firm Helps Nurses in Their Time of Need

If you are a Missouri nurse struggling with substance or alcohol dependency, you may feel like you have nowhere to turn. But you are not alone. Countless other nurses have been in the same place you are and have gone on to have fulfilling careers. The common denominator in those success stories? An experienced, dedicated, and understanding legal team will be on their side for the entire process.

The Professional License Defense Team at the Lento Law Firm can help you navigate the state's complicated nursing laws, weigh your options, and ensure you come out of this in the best position available to you. Our passionate attorneys are familiar with the expectations placed on healthcare workers in Missouri and know how to work alongside the Board of Nurses to make your case as easy as possible. Time is of the essence in these cases, so reach out to our lawyers as soon as you have admitted to yourself that you have a substance abuse problem. For a consultation, contact the Lento Law Firm via our online form or by calling 888-535-3686.


Attorney Joseph D. Lento and the Lento Law Firm are committed to answering your questions about Physician License Defense, Nursing License Defense, Pharmacist License Defense, Psychologist and Psychiatrist License Defense, Dental License Defense, Chiropractic License Defense, Real Estate License Defense, Professional Counseling License Defense, and Other Professional Licenses law issues nationwide.
The Lento Law Firm will gladly discuss your case with you at your convenience. Contact us today to schedule an appointment.

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