Nursing practice in North Dakota has its advantages, like nursing practice elsewhere. The nursing profession can be enormously rewarding from a compassion and patient relationship standpoint. It can also have substantial financial rewards. Nursing in Fargo, Bismarck, Grand Forks, Minot, and the state's other cities and towns can have its own charm, given the state's rugged beauty. Yet nursing can also be so challenging in North Dakota, as in other states, that a nurse may turn to substance abuse for self-medication relief. Alcohol abuse and addiction are common enough among nurses, but access to prescription medications can also lead to drug abuse and addiction.
When nurses face allegations of substance abuse, North Dakota Board of Nursing disciplinary authorities may offer them the opportunity to participate in an alternative to discipline (ATD) program like the Reach for Resilience program open to nurses and other healthcare professionals in North Dakota. However, those programs may require you to relinquish your nursing license or unduly restrict your nursing practice. They may also impose conditions you cannot meet to retain or regain your license. Let the Lento Law Firm's premier Professional License Defense Team help you evaluate North Dakota Board of Nursing ATD program participation and defend and defeat substance abuse disciplinary charges. Call 888.535.3686 or complete this contact form now to retain our attorneys' skilled and experienced representation to protect your North Dakota nursing license.
Nationwide Nursing Substance Abuse, Dependency, and Addiction Issues
If you are a nurse struggling with substance abuse, dependency, or addiction issues, you are certainly not alone. Those issues are prevalent among nurses nationwide, not just in North Dakota. One of the bigger reasons why nurses show increased rates of substance abuse over the general population is that nurses can have ready access to the prescription medications of their patients. They can also have access to anesthetics and other mood-altering substances used in medical settings. Access creates temptation. The above-cited Journal of Nursing Regulation study indicates that about one out of every five nurses suffer from some level of alcohol or drug abuse, addiction, or dependency. Meet just five of your nursing colleagues, and chances are good that one of them has such an issue.
Access to medications isn't the only reason that nurses face higher-than-average substance abuse rates. Nursing may be a compassionate profession, but it is also a physically, mentally, and emotionally challenging profession. Physical demands and injuries can lead to pain medication and related dependency and addictions. Mental and emotional demands of strictly complying with physician orders while managing severely debilitated, declining, or difficult patients may lead to bad habits of overuse of alcohol and misuse of drugs in attempts to relieve anxiety, stress, and depression. Odd work hours, sleep disruption, and other nursing challenges can increase the risk of dependency. Get our help if dependency issues have led or may soon lead to disciplinary charges.
Discipline Triggers for Nursing Substance Abuse
Disciplinary charges related to substance abuse or dependency are a real risk for nurses. Nurses interact so constantly with patients and so frequently with professional colleagues that concealing an addiction, abuse, or dependency issue can be difficult to impossible. Patients and their family members may closely watch everything a nurse does, quickly reporting suspicions of aberrant, impaired, or intoxicated behavior. Physicians may likewise detect a nurse's mood or behavior disorder, as may other nurses, aides, assistants, and attendants. Healthcare professionals may have the regulatory obligation to promptly report a nurse's suspected impairment when a nurse looks drowsy, distracted, drugged, or unsteady, with glassy eyes, slurred words, and forgetful recall.
Other circumstances can likewise trigger substance abuse disciplinary charges against a nurse with a dependency issue. Medication inventories may lead to investigation and reports of the nurse's medication diversion. Drunk driving charges may lead to employer and licensing board notification. Civil infractions for disorderly conduct, open intoxicants, and similar misbehavior, or even domestic violence allegations and divorce actions, may reveal a lurking dependency or addiction issue. Nurses with substance abuse issues face a substantial risk of discovery and disciplinary charges. Let us help if you face those charges in North Dakota.
North Dakota Nursing Practice Regulation
Under the North Dakota Nurse Practices Act, North Dakota Statutes Sections 43-12.1 et seq., the North Dakota Board of Nursing has the regulatory authority and responsibility to license nurses for practice within the state's borders. Section 43-12.1-08 authorizes the Board of Nursing not only to license nurses but also to set the terms, standards, and conditions for renewing, regulating, and disciplining nursing licenses. You must deal with the Board of Nursing's licensing officials to obtain your North Dakota nursing license, renew it, and protect it against disciplinary charges. Section 43-12.1-14 of the North Dakota Nurse Practices Act expressly grants the Board of Nursing the power to “deny, limit, revoke, encumber, or suspend any license” that the board has issued.
North Dakota Nurse Substance Abuse Discipline
The North Dakota Nurse Practices Act includes substance abuse affecting nursing practice among its grounds for license discipline. Section 43-12.1-14 of the state's Nurse Practices Act authorizes the Board of Nursing to discipline for conduct that “relates adversely to the practice of nursing,” when a nurse “engaged in any practice inconsistent with the standards of nursing practice,” or when a nurse “diverted or attempted to divert supplies, equipment, drugs, or controlled substances for personal use or unauthorized use.” The Board of Nursing further adopted regulations specifically articulating to “practice nursing or assist in the practice of nursing while under the influence of alcohol or unauthorized drugs or while exhibiting impaired behavior” as grounds for discipline. Don't doubt the Board of Nursing's authority to pursue your license for impaired practice and other substance abuse issues raising questions over your fitness for nursing practice.
North Dakota Nurse Disciplinary Actions
If the North Dakota Board of Nursing disciplines you for a substance abuse-related issue, including your inability or unwillingness to comply with terms of your alternative to discipline program, then your discipline will likely be public. The Board of Nursing publishes disciplinary notices on its website, including the disciplined nurse's name, license number, date of discipline, and form of discipline. Interested persons may request more detailed information on the basis for the discipline. You may have to report any discipline to your employer, patients, and other licensing bodies. Even if you do not self-disclose your discipline, others may promptly discover your discipline from the board's online records. Let us help fight your disciplinary charges. Do not consent to an alternative to discipline program with which you cannot or may not comply, resulting in discipline. Get our help.
North Dakota Alternative to Discipline Program
North Dakota nurses have some form of alternative to discipline programs available to them. The state legislature amended the state's Nurse Practices Act, in Sections 43-12.1-02.2 and 43-12.1-14.6, to include provisions requiring the Board of Nursing to offer an alternative to discipline program. The first such section defines an alternative to discipline program as “a voluntary alternative to traditional discipline program designed for nurses with substance use disorders, behavioral health conditions, or medical health conditions.” The second such section requires the Board of Nursing to “adopt and enforce rules to establish an alternative to discipline program.”
The Board of Nursing had a Reach for Resilience alternative to discipline program in place during the pandemic and continues to advertise the availability of that program. Yet under the enacted Senate Bill 2114, the Board of Nursing is enacting new rules for a permanent alternative to discipline program. Your question isn't whether an alternative to discipline program will be available. Your question is whether you should consent to a program and risk failing to complete it, or whether you should instead fight the disciplinary charges and misconduct allegations. We can help you evaluate what may be the most important decision of your nursing career.
North Dakota Alternative to Discipline Program Participation
The North Dakota Board of Nursing does not publish the detailed requirements of its alternative to discipline program. The Board of Nursing repealed the regulations for its prior alternative to discipline program when the legislature removed its authority to offer the program. With the passage of Senate Bill 2114, the Board of Nursing once again has that authority and is enacting new rules for the alternative to discipline program. A primary feature of alternatives to discipline programs is their confidentiality. Your employer and colleagues may not know that you are in an alternative to discipline program. However, under its current statutory authority, the Board of Nursing may disclose your program participation “when disclosure of the records is necessary to protect the health, safety, and welfare of the public.” In short, if you do not comply with every term and condition of your program, the board may use your program participation and non-compliance against you to pursue discipline against your license. Don't jump at the chance to enter the program. Get our help to evaluate the risks of your participation and, if appropriate, negotiate better terms or simply fight the disciplinary charges to avoid the program's risks and burdens.
North Dakota Alternative to Discipline Program Features
While the North Dakota Board of Nursing does not currently publish detailed rules for its alternative to discipline program, that program will very likely require you to comply with your evaluation and treatment plan, whatever the plan's terms and conditions impose. Your failure to do so may result in discipline, even if the disciplinary charges against you would not have been enough for discipline. When entering an alternative to discipline program, you are, in other words, giving disciplinary officials more ammunition with which to catch you. Your program may include any one or all of the following common features:
- substance abuse, dependency, and addiction evaluation by an examiner of the plan's choosing, at your cost;
- a dependency treatment plan by professionals of the plan's choosing, at their locations, on their times and dates, and at your cost;
- daily, weekly, or other frequent monitoring of your strict compliance with the plan;
- frequent drug and alcohol testing at the plan's choice of providers, locations, and times and dates;
- daily, weekly, or other periodic logs and reports that you and your providers must complete, subject to sanction for failure to submit timely;
- your payment for all evaluation, examination, and treatment services, whether those costs fall within your insurance plan or other coverage or not; and
- North Dakota Board of Nursing monitoring to pursue your discipline in the event that you fail to comply with all plan terms and conditions.
Entering North Dakota Substance Abuse Diversion
You may wonder how nurses get into alternative to discipline programs. Some nurses voluntarily enter the program, realizing their need for assistance. Early voluntary admission may forestall later disciplinary charges. However, failure to comply with the voluntary program may trigger disciplinary charges that would otherwise not have resulted. Beware of entering the program on your own. You may be far better off to follow your own program rather than the official alternative to discipline program.
Employers, supervisors, and colleagues may also refer a nurse to the alternative to discipline program. Referrals generally involve the third party's call or other contact with program officials, who may then reach out to the involved nurse, encouraging program participation, perhaps in lieu of a licensing complaint by that third party. Healthcare workers may have a duty to report to disciplinary authorities. If, instead, disciplinary officials have already received complaints, those officials may urge or even require the nurse to enter the program to divert disciplinary charges. Get our help, no matter how you come to the point of considering the North Dakota Board of Nursing alternative to discipline program. Beware the risks.
Negotiating North Dakota Alternative to Discipline Program Terms
Just because you face a referral, offer, or demand that you enter the North Dakota Board of Nursing's alternative to discipline program does not mean that you must accept the first terms and conditions the program offers. Program officials will doubtless have a template of expectations that include things like psychological or substance abuse and addiction evaluation, medical examination, medical treatment including medication, counseling or psychotherapy, drug and alcohol testing, and reporting. Those requirements can be so burdensome as to interfere with your work, schooling, family responsibilities, travel, recreation, and even your physical fitness regimen or other self-care. You need not necessarily accept the program's first offer. We may be able to negotiate far better terms for you, particularly as to program requirements and providers, locations, and schedules. Don't set a trap for yourself. Let us help you gain reasonable terms and conditions if you are convinced that you should participate in the program.
North Dakota Alternative to Discipline Program Accountability
If you determine to participate in the North Dakota Board of Nursing's alternative to discipline program, you should expect to find yourself accountable to your program's terms. You may see officials describe the program as voluntary, but once you are in it, your failure to comply with its terms may mean new disciplinary charges. In that sense, once you are in a program, it is no longer voluntary but compulsive. You may find that its terms are no longer necessary or never were necessary. But you must still complete those terms unless and until formally relieved of them by program officials, who may refuse to alter the plan.
You may also believe that only major departures from your plan would subject you to discipline, such as refusing to show up for drug or alcohol testing or failing those tests. However, relatively minor departures, such as attempting to reschedule evaluation, treatment, counseling, or testing dates, moving locations, or not following through on treatment recommendations, may lead to disciplinary review and charges. You may find yourself jumping through unnecessary hoops, one after another, making your life harder and more stressful, not better. Let us help you evaluate any program offer.
North Dakota Alternative to Discipline Program Duration
The North Dakota Board of Nursing does not publish the duration of its alternative to discipline program. However, other alternatives to discipline programs in other states do indicate how long their programs may last once a nurse enters the program on referral or by agreement or diversion. And those periods are not the thirty to sixty to ninety days that you might reasonably expect to investigate and treat a dependency issue. Typical program periods begin at one full year and may extend to two, three, or even five years. You might find that you must comply with unnecessary evaluation, testing, monitoring, and reporting requirements for years longer than they are reasonably necessary. Beware of entering the program without our review, advice, and representation.
North Dakota Alternative to Discipline Issues
You can see the challenges that North Dakota's alternative to discipline program may present to you, many of which you may not have considered. You might be wisely reconsidering program participation. You might now see that your better option may be to simply fight the substance abuse allegations. Consider one last time the following summary of issues you may face by entering the Board of Nursing's alternative to discipline program.
Procedural Issues with North Dakota's Alternative to Discipline Program
You may have already had North Dakota Board of Nursing disciplinary officials or alternative to discipline program administrators advocating that you enter the program. But those officials are not your advisors. They have very different interests than you have. They also have conflicts of interest when pretending to advise you. They may not disclose the program's risks; instead, they only talk about the program's potential benefits. They may not tell you how many nurses flunk out of the program and how many nurses lose their licenses as a consequence. They may also not tell you how much the program can cost you in financial and other terms. Get our independent advice.
Substantive Issues with North Dakota's Alternative to Discipline Program
Alternative to discipline programs also can create significant issues of real substance in your life that you would be far better off without having to face. Take drug and alcohol testing, for instance. If your program requires testing, then you'll have to show up when and where they say, no matter what else you must accomplish. Your prescription medication or other habits may lead to suspicious or failed tests. If your program requires counseling or other participation, you may have to continue long after you find that service unhelpful or outright harmful, annoying, burdensome, costly, or discouraging. Your program may take away from you all reasonable aspects of choice.
Non-Compliance Issues with North Dakota's Alternative to Discipline Program
The above discussion has already highlighted how small non-compliance issues with your alternative to discipline program may create large disciplinary issues that you would never have otherwise faced. When agreeing to a program that disciplinary officials authorize and approve, the program writing will very likely include a term that your non-compliance may result in additional discipline. You are, in short, potentially putting your own neck in an unnecessary noose. Don't set yourself up to fail by entering a poorly formed alternative to discipline program agreement. Get our help evaluating the terms and conditions, negotiating better terms, or simply fighting substance abuse allegations through disciplinary proceedings.
Premier North Dakota Nursing License Defense
The Lento Law Firm's premier Professional License Defense Team is available across North Dakota to advise and represent you when deciding whether to participate in the Board of Nursing's alternative to discipline program or, alternatively, to fight any associated disciplinary charges if that is your better option. Call 888.535.3686 or complete this contact form now to retain our Professional License Defense Team.
