You've worked hard to establish your career as a nurse. You've gone to school, you've put in the 14+-hour shifts, and now all of that may be threatened by a charge of substance abuse against you.
Substance abuse issues are an increasingly common problem with nurses. A lack of support and a punishment-first mindset compounds the stress that most nurses face as part of the job.
Yet even a single incident of use can potentially end with a nurse labeled as having a substance abuse issue. This could then subject that nurse to years of monitoring.
When faced with disciplinary action, especially action that isn't proportionate to a nurse's behavior or actions, a nurse may decide it's better to leave the profession. For some, what Louisiana requires them to do to maintain their nursing license and career may conflict with what's best for their recovery from substance abuse. Overly restrictive or less-than-useful disciplinary procedures may result in nurses leaving the field.
Often, substance abuse programs do little to safeguard patient safety. Instead, they subject nurses to stressful and onerous requirements that seem designed to punish more than help.
The Professional License Defense Team at the Lento Law Firm works with our clients to find resolutions that help them proactively recover from substance abuse issues and continue their nursing careers. We help our clients understand their options and determine the best choices for their personal lives, health, and careers. Call us at 888-535-3686 or fill out our online form.
Lack of Support
Patients should feel safe when they receive medical care. They should trust that the medical personnel assisting them will be able to perform their jobs without issue.
For nurses, the problem is that they're expected to juggle a variety of responsibilities with minimal support. When nurses struggle with this pressure, rather than get the help they need, they're often punished or blamed.
In short, nurses are the scapegoats for larger problems within the healthcare industry. One of the ways this is most apparent is with substance abuse issues.
Nurses: Overworked and Burnt Out
Reports about burnout and substance abuse among nursing professionals predate the COVID-19 pandemic. A 2019 survey of more than 3.9 million nurses found that over one-third left a job due to burnout. One 2010 report stated that up to 20 percent of nurses reported having a substance abuse problem.
A 2017 joint statement by the American Nurses Association (ANA), the Emergency Nurses Association (ENA), and the International Nurses Society on Addictions (IntNSA) called for changing how the medical industry treats nurses with substance abuse issues. This statement touted replacing disciplinary-based approaches to substance abuse with treatment-based work.
The Covid-19 pandemic only increased the stress that nurses face as part of their jobs. Over half of the nurses reported feeling burnt out. A similar percentage of nurses have PTSD.
Nurses also state that they don't feel supported by their employers. By nature of the profession, nurses work erratic hours, and this schedule can make it more difficult for nurses to get the help they need.
The shortage of qualified nurses compounds these problems. Fewer students are opting for nursing school, and since 2015, one reason for the shortages is due to nurses deciding to switch careers. Staffing shortages can increase work-related stress and burnout, which can, in turn, increase the risk of substance abuse and nurses leaving the profession.
Nurses aren't facing just one problem but several with no easy solution in sight. Society as a whole needs nurses, but our current system fails to support them or give them the support they need.
This lack of support can increase stress and the risk of substance abuse. Even when a nurse knows they need help, they may hesitate to come forward out of fear of losing their career and facing serious financial and professional damage.
Disciplinary Procedures for Nurses in Louisiana
All nursing staff, including students, may be subjected to disciplinary proceedings. This includes nurses licensed through the Nurse Licensure Compact (NLC), often referred to as a multistate license.
Disciplinary issues can arise for any number of reasons. They will usually fall into one of the following groups:
- Professional misconduct
- Criminal offenses
- Standard-of-care violations
- Ethical violations
- Documentation issues
Substance abuse falls under the professional misconduct category. Depending on the circumstances that led to a nurse facing disciplinary actions, they may also face related disciplinary actions under criminal offenses or standard-of-care violations. For example, a nurse who is charged with a DUI or a nurse whose impairment while working threatened or resulted in compromising patient safety.
The disciplinary process in Louisiana:
- Complaint and Investigation
- Hearing and resolution
- Appeal
Louisiana provides a detailed summary of the hearing process. One important note is that nurses do have the right to be represented by legal counsel during hearings.
Before a hearing, a nurse may also settle through a resolution by voluntary agreement. Similar to a plea deal in criminal law, board staff offer a voluntary agreement, also known as a Consent Agreement, to the nurse. Once signed, these agreements are binding, and they require a nurse to agree to the facts as presented by the state board.
Agency nurses follow a similar disciplinary procedure. Nurses will generally be referred to substance abuse treatment, formally known as the Recovering Nurse Program, after the hearing and as part of the resolution.
The Recovering Nurse Program in Louisiana
The Louisiana State Board of Nursing advertises its Recovering Nurse Program (RNP) as a way to protect the public while helping nurses recover from substance abuse and keep their jobs. The details and requirements of the program paint a more nuanced picture.
RNP is billed as a voluntary, confidential program that's an alternative to disciplinary action. While nurses don't have to participate in RNP, many are given limited alternatives to the program.
Nurses may be referred to the program, although a referral isn't required to participate in RNP. A nurse may request to join the program through self-referral.
RNP Eligibility
The RNP program works with nurses who have chemical dependency or abuse issues, mental health problems, or a medical or physical condition that interferes with a nurse's ability to provide safe care to patients. The program works with both registered nurses and nursing students.
The board lists both criteria to establish eligibility and a list of actions that make a nurse or nursing student ineligible for RNP. An important note is that relapsing during or after treatment for substance abuse issues does not automatically bar a nurse from the RNP program, although it depends on the circumstances of the relapse.
To be eligible for RNP, they must:
- Be licensed, be eligible for licensing, or have applied for clinicals
- Be mentally ill or abusing alcohol and drugs in a way that may affect their nursing practice
- Agree to enter the program
- Provide consent for appropriate evaluations, both medical and psychiatric
- Not have any previous disciplinary actions with any licensing board
Nurses and nursing students are ineligible for RNP when:
- They have either a criminal conviction or pending criminal charges
- They've been previously disciplined by the Louisiana State Board of Nursing
- The criteria don't explicitly mention disciplinary actions by other boards, although the eligibility criteria indicate that disciplinary action by any licensing board makes a nurse ineligible for RNP
- They've sold drugs
- They've previously failed to complete, due to non-compliance, any diversion program, including RNP
- They caused significant patient harm and/or death
The Professional License Defense Team at the Lento Law Firm can help nurses determine if they're eligible for RNP and if RNP is the best choice for them.
RNP Steps
Each RNP program will be somewhat different for each nurse. These are some of the general steps that are part of the RNP process:
- Discontinue your work as a Registered Nurse
- Sign an agreement
- At a Board-certified facility, complete an inpatient evaluation
- After you have an evaluation, you will receive recommendations for your treatment plan
- If treatment is recommended, you must first complete treatment
- After completing treatment, a nurse will need to:
- Contact your RNP group facilitator for meeting times and location
- Attend any required groups and/or meetings
- At each group or meeting, you must have your verification calendar signed
- Begin contacting the drug screening service daily
- Contact the facilitator of the RNP group (this information is included in the program agreement packet) for the date, time, and location of meetings.
- Start attending the required groups/meetings (AA/NA, Aftercare, RNP group).
- Have your verification calendar signed at each group/meeting.
Before returning to work, nurses must:
- Complete the recommendations from their evaluation
- Have a release from an addictionist who has been approved by the State Board, approval from State Board staff, and a signed Employer's Agreement
- Once a nurse returns to work, they must follow certain restrictions:
- They cannot administer narcotics for at least six months
- They cannot work 11-7 or overtime for the first year after they complete treatment
- They cannot work in critical care areas for the first year after they complete treatment
- As long as they are participating in the RNP program, they must have direct on-site supervision
Other Facts about Louisiana's RNP Program
The RNP often requires a significant time and financial commitment. Nurses should be aware of the reality of the RNP Program before agreeing to participate.
RNP agreements are for five years. Failure to complete the program may result in a nurse again facing disciplinary action.
If a nurse misses two drug screening appointments, their license will be automatically suspended. They may have to go through another evaluation or sign a new agreement.
Certain medications are prohibited while part of RNP, and nurses should check before beginning any course of treatment, even when prescribed by a doctor or other medical professional. Nurses should submit Medication Report Forms for ALL medications, even those not considered addictive.
Nurses who lost their jobs due to substance issues can look for new employment while part of RNP. They must disclose their involvement with RNP to all potential employers before being hired.
If a nurse relapses while part of the RNP program, they can sign a new five-year agreement and submit to a new evaluation.
Nurses are responsible for all costs affiliated with the RNP program, including paying for any recommended treatment. This last detail can make the RNP program stressful for participants. Nurses are required to pay for treatment and related services at a time when they're earning potential may be significantly limited.
What if Someone Incorrectly Refers Me to RNP?
That a nurse is referred to the RNP program doesn't mean a nurse is required to participate. Neither does it mean they are automatically subjected to disciplinary action. The program is voluntary.
Not all referrals to RNP come from disciplinary proceedings. Any individual, including family members, can refer a nurse to RNP. Louisiana expects nurses to report impaired or potentially impaired nurses to the RNP.
Someone may make a referral in hopes of hurting a nurse's reputation or damaging their career. If a nurse is incorrectly referred to RNP, the question turns to what a nurse can do to remedy this mistake.
The Nurse Practice Act states that a nurse may not pursue a civil action against an individual or organization based on a referral. When a referral is made without malice and under a reasonable belief that the referral and any accompanying information is accurate, the person or organization who made the referral faces no civil liability.
In cases when a referral was made with malice, nurses may have recourse. If a referral was designed to undercut their reputation or position or act as retaliation and the nurse has evidence, a nurse may have a civil action.
Referrals that are malicious and/or unreasonable open up a nurse to potentially disciplinary actions as well as undercutting their professional reputation. Even when a nurse knows a referral wasn't made in good faith, they should contact The Professional License Defense Team at the Lento Law Firm.
One Strike and You're Out
One nurse's recreational use of marijuana highlights the challenges nurses face regarding substance use and the Louisiana State Board of Nursing. The case is a good example of how the state's disciplinary and RNP processes look in action. It also shows the differences between what's legal and what might result in disciplinary charges.
Shonda Broom, a nurse with twelve years of experience, failed a drug test for a new job. She later secured a different job, but when the Louisiana State Board of Nursing learned of her failed drug test, they launched an investigation.
While Louisiana allows for medical marijuana use, the state doesn't permit recreational use, and medical marijuana must be prescribed. Broom didn't have a prescription, and although her use of the drug was outside of work hours and before working for either job, she still faced disciplinary action. At no point did anyone claim she had a substance abuse problem.
Harsh Penalties
When contacted, the Louisiana State Board of Nursing essentially confirmed that Broom's story isn't unusual. Any nurse who fails a drug screen, including for alcohol, marijuana, and other drugs, faces potential disciplinary action. This is the case even when the nurse's use of drugs or alcohol was outside of work hours and had no bearing on their performance.
While the board considers each action on a case-by-case basis, using marijuana off-duty could result in:
- Losing a license for at least six months
- Even once a nurse is eligible for reinstatement and meets all of the stipulations of a consent order, they will remain under probation and will have to submit to drug screens, monitoring, and other terms for five years
- Significant financial expenditures in the form of treatment, fines, and fees
The board emphasized that, while the disciplinary action is strict, they have a success rate of 95 percent for nurses who agree to these terms. What they don't mention is that some of these nurses may not have a substance abuse problem or be a danger to patients.
That a nurse has a medical marijuana prescription doesn't exempt them from potential disciplinary action. If they are reported for showing signs of impairment or failing a drug screen while on duty, they will need to provide a physician's certification stating they are fit for duty. Such an action may allow them to avoid disciplinary action.
The problem is that marijuana stays in a person's body long after they partake. Drug tests can potentially detect marijuana up to 30 days after use. Organizations, including the National Council for State Boards of Nursing (NCSBN), have pointed out that drug tests have their shortcomings and cannot provide “any objective threshold” for establishing impairment.
A Rock and a Hard Place
Despite a nationwide shortage of nurses, Broom's years of experience, and the not-at-all small detail that nothing she'd done related to her performance as a nurse, Broom decided to surrender her professional license rather than accept the board's disciplinary action.
According to the disciplinary records from Broom's case, the disciplinary action from that one failed drug test:
- To keep her license, Broom would have had to accept a temporary suspension of her license with the option to apply for reinstatement
- To be eligible for reinstatement, Broom would have had to complete a drug treatment program defined in a consent order
- When working, Broom would have been limited to restricted environments under direct supervision and would have been banned from dispensing medication to patients
- Broom's supervisors would have been required to submit quarterly evaluation reports to the nursing board
- If Broom took a new job, she would have been required to inform her new employer about her treatment plan
- Broom would have been required to pay more than $1,200 in various fees and fines to the nursing board
The consent order requirements included:
- Completion of a rehabilitation program
- A probationary period with random drug screens
- Professional monitoring
- Periodic psychiatric and substance abuse evaluations
These terms would have been for five years. In addition to the fees mentioned above, Broom would have been responsible for all expenses.
Deciding to surrender her license, however, didn't provide Broom with a clean slate. The disciplinary action shows up on background checks, which limits her employment options.
In short, one woman used marijuana to help with depression and high blood pressure. There's no record of her being high on duty, that her off-duty drug use impacted her work, and that her off-duty drug use impacted patient care or safety. Despite that, she faced years of probation, thousands of dollars in fees, and a permanent mark on her professional reputation.
Legal Or Not?
Broom's case raises several questions about how Louisiana's grounds for disciplinary procedures can be applied to potentially target or harm nurses. For example, a nurse goes on vacation in a state where marijuana is legal and uses the drug. Shortly after arriving home, her employer requires her to submit to a drug test. The marijuana use occurred in a state where the drug is legal and on the nurse's own time, but testing has no way of showing that.
Alternatively, employers may require certain nurses to submit to drug screening as a way to single them out or retaliate. A supervisor could claim a nurse was showing impaired judgment and request a drug test.
Declining to submit to a drug screen can also lead to disciplinary action. A nurse who refuses to submit an employer's requested drug screening may be found guilty of unprofessional conduct.
These hypotheticals raise several questions:
- Does regulating a nurse's behavior on vacation serve a higher purpose or benefit patient safety?
- Do zero-tolerance policies that have little to no relationship to a nurse's on-duty performance serve the public's best interests?
- Or do they risk limiting the pool of qualified nurses, which makes access to care that much more challenging for the average person?
The example of Broom's case also shows why nurses accused of drug or alcohol abuse, even when the behavior in question is use and not abuse, should hire an attorney immediately. No one benefits from an experienced nurse being subject to years of monitoring and evaluations that do little, if anything, for patient care or substance abuse recovery. The Professional License Defense Team at the Lento Law Firm can help a nurse outstand their options and avoid disproportionate discipline.
Protect Your Life
For individuals suffering from substance abuse issues, it's often more than just their career that's affected. Every aspect of their life may be touched by drug or alcohol addiction or abuse. Treatment can be challenging, and relapses are common.
More and more research shows that a punishment-based approach is ineffective compared to a treatment-based approach for substance abuse issues. Despite these studies, nurses in Louisiana face discipline when they have or are accused of having substance abuse issues.
Nurses who don't even have substance abuse issues can also find themselves being referred to the RNP program. One failed drug screening may result in a nurse looking at five years of monitoring, even when patient safety was not at issue.
Louisiana needs nurses. Nurses need support rather than punishment. The Professional License Defense Team at the Lento Law Firm understands not only how to navigate the disciplinary process but also the challenges that nurses face. Call us at 888-535-3686 or fill out our online form.
