Nurses and Substance Abuse Issues

Dubbed “heroes” by the general public, nurses play a critical—often underappreciated—role in society. They keep us healthy, laboring to prevent illness, treat diseases, and promote healthy living, regularly providing emotional support that goes above and beyond their basic job description.

Unfortunately, it's a life calling that comes with a fair amount of stress, and nurses are not immune to substance abuse issues. In fact, in the wake of the COVID-19 pandemic, substance abuse numbers have made a sharp uptick nationwide, putting many nursing heroes in a precarious legal position, with licenses and livelihoods on the line for misconduct.

If someone has reported you to the nursing board for substance abuse misconduct, a qualified attorney can help. Call the Lento Law Firm Team today at (888) 535-3686 or contact us online, and let us help protect your rights and your hard-earned professional license.

Understanding the Connection Between Substance Abuse and Nursing

Healthcare professionals play a vital role in our society. Nurses are on the front lines of medicine, working long hours in facilities that are often understaffed and regularly dealing with sick patients whose lives can depend on their decisions.

Many nurses cope with this unrelenting fatigue and emotional strain by reaching for mood-altering substances—a habit that can be particularly problematic, considering their easy access to controlled medication. According to studies, around ten percent of healthcare workers abuse drugs, with one in five nurses struggling with an undisclosed substance use disorder (SUD).

If you are a nurse struggling with substance abuse, a qualified attorney can help protect your license and guide you toward the best possible resolution.

Identifying Substance Use Disorder

According to the Nursing Council of State Boards of Nursing (NCSBN), a substance use disorder (SUD) is defined as any pattern of behavior that misuses a substance—be it alcohol, illegal drugs, or the misuse of legal medication.

Nursing boards are more likely to be lenient with a nurse who recognizes their problem and takes steps to fix it independently. Unfortunately, denial often goes hand in hand with SUD, so most of the time, these issues are not self-diagnosed.

That being said, someone struggling with addiction is likely displaying a few of these common symptoms:

• Increased isolation from friends and co-workers.
• Rapid weight loss or weight gain.
• A marked change in appearance.
• Dilated pupils.
• Slurred, rapid, or pressured speech.
• Defensive behavior.
• A change in job performance.
• Changes in drug ordering patterns.
• Excessive absences from work.
• Arriving late or leaving early.
• Verbal and physical aggression.
• Abnormally lethargic or extreme energy.
• Excessive sweating and seizures.

Unidentified, unreported substance abuse can seriously endanger patients. It can also significantly impact your professional nursing license and open you to civil and criminal liability. If you know you have a problem, it's essential to act now—don't wait until someone gets hurt.

A qualified licensing attorney can help you navigate these legal challenges and protect your rights during this process.

How Substance Abuse Misconduct Affects Your Professional License

Nurses are required to live and work at a certain level of conduct. This prohibits a wide range of behaviors, including criminal activity, inappropriate relations with a patient, fraud, abuse, practice-related mistakes, and, of course, substance abuse.

Failure to abide by these standards can result in several different problems, including:

• Suspension or termination from employment.
• License restrictions.
• License terminations.
• Reprimands and fines.
• Mandatory rehabilitation or treatment programs.
• Loss of certifications and credentials.
• Restrictions on future employment.
• Civil damages and criminal liability.

Each state has its system for handling substance abuse, and the exact scope of a nurse's punishment will depend on several different factors (including whether or not a patient was harmed, previous complaints, and remorse).

Getting your license back after it has been revoked isn't always easy. It can also be expensive and time-consuming, and—where substance abuse is concerned—will likely require proof of rehabilitation, education, and sobriety. In some cases, you might be required to retake your nursing exams.

Unfortunately, despite these deterrents, addiction remains one of the leading causes of disciplinary action against nursing licenses—particularly in light of the COVID-19 pandemic.

COVID's Impact on Substance Abuse in Nursing

Healthcare workers were struck hard by the COVID-19 pandemic. Suddenly, the stress of an already difficult job spiked, leaving many drowning in long work hours, outside pressures, and a rapidly changing disease. Considering the circumstances, it's almost not even surprising that substance abuse among nurses also increased.

In a recent Florida study, researchers examined the effects of COVID-19 on substance abuse among first responders (i.e., law enforcement, firefighters, physicians, and nurses). Among those surveyed, 40% reported using substances to relieve emotional discomfort during the pandemic. A startling 21% were unable to stop and are now struggling with addictions that threaten their professional licenses and livelihoods.

Unfortunately, social stigmas surrounding drug use—even when legal, such as alcohol consumption—often keep many from seeking help until it's too late. Nursing boards are in charge of policing this behavior and shielding patients from professional misconduct. However, considering the extraordinary sacrifices nurses make to keep society healthy, many states are adopting a more rehabilitative approach to SUD misconduct rather than a punitive one.

The Disciplinary Process for Substance Abuse Misconduct

There is no national nursing board. Instead, nursing licenses are handled at the state level. Each has its own rules and regulations, meaning that disciplinary proceedings may vary slightly according to your jurisdiction.

Generally speaking, however, there are six main phases of a misconduct investigation:

1. Receiving a complaint.
2. Reviewing the complaint.
3. Opening an investigation.
4. Discussing the investigation's findings.
5. Taking disciplinary action based on the findings.
6. Appealing the board's decision.
7. Enforcing any disciplinary action.

Disciplinary proceedings for professional licensing can be stressful and overwhelming. Luckily, they're not something you have to do alone. Here's a closer look at each phase of the disciplinary process and how an experienced attorney can help protect your nursing license.

Phase 1: Receiving a Complaint

The disciplinary process begins when someone files a complaint against you. In most states, anyone who knows of the misconduct—be it a friend, co-worker, employer, or patient—can file a complaint. Many of these complaints are filed by mandated reporters.

A mandated reporter is someone who is required by law to report any suspicions of abuse, neglect, or misconduct to the appropriate regulatory body. Where substance abuse is concerned, this may involve reporting suspicious symptoms of SUD to the state nursing board.

You have the right to know when someone has filed a complaint against you. This information is generally relayed in writing. Before you respond to anything, it's essential to speak with an attorney about your situation.

Phase 2: Reviewing the Complaint

After receiving a complaint, the state nursing board will review its content for relevancy and credibility, ensuring it falls under the scope of its authority.

Boards do not have the power to review things like customer complaints, work-related scuffles, or billing issues. Instead, they can only review complaints that relate to licensing issues. For example:

• A breach in standard practice procedures.
• Substance abuse.
• Boundary violations.
• Sexual misconduct.
• Abuse or neglect.
• Fraud.
• Criminal conviction.

If the complaint meets the requirements, the board will open an official investigation into the matter.

Phase 3: Opening an Investigation

A misconduct investigation is not proof of guilt. This process is designed to get to the bottom of things and may involve interviewing witnesses and collecting documents. Investigators may also want to talk to you personally.

While a misconduct investigation is not an official legal proceeding, you still have the right to representation. Anything you say can and will be used to help the board make its decision, so it's critical to discuss your situation with an attorney before speaking with investigators.

Remember, the board's primary goal is keeping patients safe—not protecting your rights and interests. Your best chance of success is to hire an attorney experienced in defending nurses accused of misconduct. Your lawyer will help you gather evidence, protect your rights, and guide you around common disciplinary action pitfalls.

Phase 4: Discussing the Findings

Once evidence and interviews are complete, the investigatory team will reconvene to review their findings. These meetings will discuss the information gathered and how they relate to the complaint. Some of these topics might include:

• Your patients, their history of care, and what (if any) complaints you've received.
• Your patient records, including accuracy, completeness, and adherence to legal and professional standards.
• Your professional conduct and any allegations of inappropriate behavior.
• Your compliance with laws, regulations, and institutional nursing policies.
• Your communication with patients, colleagues, and other healthcare professionals.
• Any previous disciplinary actions—especially instances involving possible substance abuse.

Rather than reviewing information in isolated chunks, the board will consider the picture painted when all the facts are viewed together. If substance abuse is involved, they'll likely pay particular attention to how your actions impacted patient safety and whether or not it's likely to happen again.

Most of these discussions occur behind closed doors, so you and your attorney will not be present. Your opportunity to defend yourself before the board comes after these discussions, during a disciplinary settlement meeting, or a formal hearing.

Phase 5: Taking Disciplinary Action

There is no set formula for calculating punishments. Jurisdiction, offense severity, level of remorse, and other factors all play a role in determining what—if any—disciplinary actions the board will take.

That being said, substance abuse often results in one or more of the following punishments:

• Fines.
• Public censure and reprimand.
• Temporary suspension of practice.
• Alternative-to-discipline program for recovery.
• Required monitoring, education, and remediation.
• Limitations on practice and employment.
• Temporary suspension of all practice.
• Voluntary surrender of license.

Regardless of its action, the board must inform you of its decision in writing. This notification usually comes in the form of a letter outlining the claim, its findings, and whatever action the board has chosen to take.

It's important to note that this disciplinary action does not relieve you from outside litigation. Depending on the circumstances, you might also face civil and criminal repercussions, making it even more critical to have quality representation you trust.

Phase 6: Appealing the Board's Decision

If you disagree with the board's decision, you can request a hearing to present your case. While each state has its own process, disciplinary disagreements are typically settled in one of two ways:

1. Disciplinary Settlement Conference. An informal meeting with the board where you and your attorney have the opportunity to present arguments in your defense.
2. Formal Hearing. A formal proceeding where you will have the chance to present evidence and witnesses.

If the board remains firm in its decision, you may need to file an additional appeal through a court of law. This can be incredibly time-consuming, expensive, and stressful. However, your nursing license is your livelihood and might be worth it in some situations.

Phase 7: Enforcing the Disciplinary Action

Once all hearings and settlement meetings are over, you must abide by the board's decision. While the board cannot force you to do anything, it can revoke or suspend your license. And these problems won't go away just by moving to a different jurisdiction.

State nursing boards are required to update the disciplinary status of all nursing licenses to specific national tracking systems. These track pending disciplinary investigations, license inhibitions, license statuses, and all pending lawsuits against healthcare professionals.

Once your license has been added to these sites, future employers in any state can see all past and pending disciplinary actions against your license. You cannot outrun these issues, so it's important to resolve them through appropriate channels.

While the process may seem overwhelming, it's important to remember that you have options. An experienced attorney can advise you on the best action while defending your rights and hard-earned license.

As an Accused Nurse, You Have Rights

A nursing board is not the same as a formal court. However, because these committees are created by a state's legislative body, they guarantee certain due process rights and safeguards.

One of these rights is the right to speak in your defense and have your side of the story heard. Other procedural rights include:

• The right to know the charges against you.
• The right to be informed about how to request a hearing.
• The right to know the details of any hearings taking place.
• The right to legal counsel.
• The right to present documents in your support.
• The right to present your own witnesses.
• The right to cross-examine the board's witnesses.
• The right to appeal the board's decision in court.

You have the right to a written transcript of all settlement proceedings and hearings, whether formal or informal. You also have a right to a written summary of the board's decision and any disciplinary action they are taking against you.

Substance Abuse May Also Lead to Legal Liability

In some cases, substance abuse can affect more than just your license. Depending on the severity of the circumstances, you may be at risk for civil and criminal liability.

Substance abuse misconduct leads to legal liability when it harms a patient. This harm can be intentional or negligent, though it's usually the latter (after all, most nurses don't intentionally harm their patients). Instead, impaired cognitive functioning leads to mistakes that result in personal injury to the patient. These injuries could result in civil charges, criminal charges, or both.

Where criminal charges are concerned, this may include:

• Assault
• Battery
• Negligence
• Reckless endangerment of human life
• Manslaughter

If the patient or surviving family members pursue damages in civil court, you might also be on the line for:

• Medical bills
• Lost wages
• Pain and suffering
• Wrongful death

If you injured a patient while under the influence and are now facing legal charges, it's crucial to seek representation immediately. A lawyer practicing in these areas can help you navigate the legal process, protect your rights, and potentially mitigate the consequences.

A Shifting Approach to Addiction Misconduct

Late nineteenth-century nursing boards had a severe outlook on substance abuse and misconduct. Theirs was a punitive, “sacrificial lamb” approach designed to punish the accused so severely that it scared others away from similar behavior.

Unfortunately, it wasn't that effective. Fortunately, we're evolving.

With a greater understanding of chemical dependency, many boards are developing rehabilitation, prevention, and support programs designed to guide nurses through recovery rather than brutalizing them with debilitating punishments. One of these substitute measures for tackling substance abuse is an alternative-to-discipline program.

Alternative-to-Discipline Programs for Nurses

Alternative-to-discipline programs (ADPs) are designed to help healthcare professional overcome substance abuse while also keeping their licenses unencumbered. These programs give nurses addiction treatment and aftercare support, helping them develop tools for long-term success.

ADP programs are structured and monitored. They are also completely confidential, allowing a recovering nurse to re-enter the workforce at a gradual, supervised pace.

Nurses who complete an ADP show the board that they are committed to being safe and sober and should be allowed to maintain their licenses in good standing. They are a great alternative to harsh, punitive discipline and have the highest rate of success for long-term recovery from addiction.

An experienced attorney in your jurisdiction can help you figure out if an ADP program is right for you.

Help! I've Received a Complaint from My Nursing Board. Now What?

Your nursing license is a big deal. It represents countless hours of study and years of your life—not to mention a substantial financial investment. A misconduct complaint jeopardizes all those years of hard work and threatens future employment opportunities and earning potential.

If you've been accused of substance abuse misconduct, here are a few crucial steps to finding a successful resolution:

1. Talk to an Attorney. You do not have to do this alone. Exercise your right to representation and find an experienced attorney to help protect your rights and interests during this process.
2. Review the Allegations. Knowledge is power, and it's important to arm yourself with understanding. If you don't understand something about the allegations, research until you do. This might mean reviewing formal complaints, reports, or communications from your employer or licensing board. When in doubt, ask your attorney where to start.
3. Cooperate with the Investigation. It's important to take all communications and investigation requests seriously. However, that doesn't mean sacrificing your own rights and interests. An attorney can guide you around common pitfalls and protect your interests as you cooperate with the investigation.
4. Consider Seeking Treatment. If substance abuse is an issue, you may want to consider seeking voluntary treatment. This initiative demonstrates that you are committed to addressing the problem and may help sway the board toward more favorable disciplinary actions.
5. Documentation. Keep a detailed record of all communications, meetings, and interactions related to the allegations. This includes emails, letters, texts, and notes from conversations, which could be critical evidence during a formal hearing or eventual court case.
6. Prepare for Legal Proceedings. In the event of a formal hearing or court case, it's important to listen to your lawyer's counsel. Be prepared to tell your story and present evidence to support your case.
7. Maintain Professionalism. While this process is stressful and emotional, try to be respectful when interacting with colleagues, patients, board members, and legal authorities. Failure to do so will only hurt your chances of achieving an amicable resolution.

As an accused nurse, this is one journey you don't have to do alone. An experienced attorney can safeguard your interest during this process and help you navigate the complex landscape of substance abuse and professional licensing issues.

Are You a Nurse Accused of Substance Abuse Misconduct?

Misconduct complaints can be stressful and scary. If you've received a complaint from your nursing board and are wondering if it will affect your license, we want to hear from you. Call the Lento Law Firm Team today at (888) 535-3686 or contact us online, and let our experienced professional licensing team help defend your rights during this important process.