Nursing and Substance Abuse in Maryland

Nurses provide a crucial set of skills to society. They assist people at their most vulnerable. As was seen during the COVID-19 pandemic, many put their lives and well-being on the line for their community's health and safety. 

For over 20 years, nurses have been ranked as the most trusted profession in the United States. Despite the vital role nurses play in society, staffing shortages are growing. Nursing professionals are overburdened and dealing with increasing levels of burnout. Female nurses have a significantly higher suicide rate than the general population. 

Substance abuse accounts for over 40 percent of disciplinary action as a result of these stressors. The problem is that addressing substance abuse among nurses continues to focus on punishment rather than treatment. 

Substance abuse does increase the risk of mistakes, including jeopardizing patient safety and care. Keeping patients safe should be a top concern, but that doesn't mean anyone benefits from ineffective methods to address substance abuse among healthcare professionals.    

Despite working in a high-stress job that can sometimes mean putting their health and safety at risk, nurses are given minimal support. They're expected to work long hours and cover staffing shortages while providing the same level of care. That some nurses are turning to alcohol and drugs to cope isn't ideal but understandable. 

The current system fails nurses. Medical professionals dealing with substance abuse hesitate to admit to a problem out of fear of damaging their career or reputation. When a problem does arise, rather than move to help and treat, the system often first focuses on punishment. 

While Maryland has an alternative-to-discipline treatment program, nurses risk being expelled from the program if they relapse or struggle with their recovery. They may still face disciplinary action and may be unable to work even as they pay for treatment. 

If you're a nurse who's facing disciplinary action due to substance abuse issues, you deserve to have an advocate on your side. The Professional License Defense Team at the Lento Law Firm knows that substance abuse issues tie into larger problems in how nurses are treated and supported. You shouldn't be punished when what you need is support and treatment. Call us at 888-535-3686 or fill out our online form

Lack of Support 

Even before the 2020 pandemic, nurses faced multiple challenges to their profession. Twenty percent of nurses reported substance abuse issues, and Maryland, along with the rest of the United States, faced staffing shortages. 

In 2017, the American Nurses Association (ADA), the Emergency Nurses Association (ENA), and the International Nurses Society on Addictions (IntNSA) endorsed a joint statement calling for shifting how the medical industry responds to substance abuse issues. The statement called for prevention, treatment, and recovery rather than punishment. 

The statement highlighted that how organizations and states handle substance abuse issues affects long-term outcomes and recovery. When substance abuse was viewed as a chronic medical illness in need of treatment rather than behavior to be punished, short- and long-term outcomes improved. 

The COVID-19 pandemic worsened these problems. A 2022 report from the Maryland Hospital Association found that 25 percent of hospital nursing positions were vacant, and over 60 percent of licensed nurses have considered leaving the profession.  

A May 2020 study found that even just two months into the pandemic, medical staff reported dealing with:  

  • Depression 
  • Anxiety 
  • Insomnia 
  • Psychological distress 
  • Post-traumatic stress 
  • Burnout 

A 2022 report built on this research found that half of medical personnel reported feeling burnt out. Nurses were generally found to have the highest rates of both burnout and suicidal thoughts.  

Burnout is more than just needing a vacation. It can have profound impacts on an individual's mental and physical health. It can also increase the risk of mistakes made at work, including cognitive issues. Approximately 50 percent of medical staff reported dealing with PTSD related to the COVID-19 pandemic, and 75 percent of nurses report cognitive issues due to work-related stress. Separate research has shown that up to 25 percent of PTSD cases are delayed onset, occurring at least six months after the traumatic events. 

Lack of support is one reason why nurses are burnt out, looking to leave the profession, and dealing with substance issues. They were on the frontlines during the early days of a new disease and had a lack of institutional and mental health support. Staffing shortages and cost-focused health care mean they're expected to do more during their shifts while still providing the same level of care. Nontraditional work schedules mean it can be difficult to get help. 

Yet nurses, rather than receive support and assistance to deal with these problems, risk disciplinary action if they admit that they have a problem. They're also on the hook financially to pay for treatment and recovery. 

The current situation creates a vicious cycle: When the risk of punishment looms, the stigma surrounding substance abuse heightens. With the added stigma, those dealing with substance addiction and abuse are less likely to seek help. Feeling unable to seek help, substance issues may worsen.  

Treatment, Not Punishment 

Even if a nurse knows they need help, finding that support can be difficult. They're often responsible for the cost of therapy and other services. They may have to try and find treatment options outside of traditional business hours. 

Concerns about whether they can seek therapy or other support services in private can make nurses also hesitate to reach out. Even if an employer provides support, nurses who don't trust their employer's leadership are less likely to use those services

The recent concerns about mental health apps highlight why nurses may hesitate to seek help. These apps and companies, often not bound by HIPAA, have been found to violate patient privacy. They've shared patient data with third-party advertisers, and the lack of federal laws protecting data privacy means that individuals have few ways to address these violations. Maryland also doesn't have any data privacy laws. 

For nurses, fear of being discovered can result in a nurse not seeking help early. They may have to confront the problem only when it affects their work performance or results in disciplinary action.  

Maryland Disciplinary Proceedings 

Disciplinary proceedings against a nurse begin when someone files a complaint with the Maryland Board of Nursing. While anyone can file a complaint, Maryland doesn't allow anonymous complaints. 

Upon receiving a complaint, the Board will assign an investigator to the case. Investigations generally follow these steps

  • Complaint 
  • Initial Review 
  • Investigation 
  • Boarding proceedings 
  • Board action 
  • Reporting and Enforcement 

Board proceedings occur if the investigation finds that there's merit to the initial complaint. When a nurse receives a “notice of agency action” from the Board of Nursing, they may request a hearing. 

You should always request a hearing. Even if you did commit the alleged actions, you will want to mitigate the disciplinary action, such as by showing events in context. You should do everything you can to defend your license and your career. 

An informal option for resolving an investigation is through a settlement conference. These informal meetings focus on compiling facts and resolving a case without a formal evidentiary hearing.  

Some of the disciplinary actions the Board of Nursing can take: 

  • Deny a license 
  • Grant a probationary license 
  • Issue a reprimand 
  • Place a nurse on probation 
  • Restrict a nurse's ability to practice 
  • Suspend a license 
  • Revoke a license 

The Board of Nursing will mail its final decision to you as an order. Orders may include conditions you must satisfy to end some disciplinary actions. 

You will have to meet with a compliance officer as part of a disciplinary action. A compliance officer for disciplinary actions is different from rehabilitation program staff. 

That disciplinary action was taken against you also enters the public record. These records go back 15 years. Long after you've completed the terms and conditions of your order, these records may still be affecting your professional reputation.  

What the board recommends may not be in a nurse's best interests for their recovery or their career. Nurses who face disciplinary issues on the basis of substance abuse should contact the Professional License Defense Team at the Lento Law Firm to ensure they have someone on their side who can explain the pros and cons of each option as well as the long-term repercussions. Don't assume that anyone affiliated with the Board of Nursing or your employer will be focused on protecting your life and career.

Requesting Release from a Board Order 

After the board takes disciplinary action against you, you can petition, in writing, to terminate the order. A compliance coordinator will summarize your compliance with the conditions of your order. Both your written petition and the compliance summary will be submitted to the Board of Nursing. 

If the Board agrees with the petition, they'll send you written notification that you've satisfied the terms of the Order. Nurses should be careful not to act in a way that violates any terms of their Order – or makes it appear that they believe the Board will grant their petition – until they receive that written response. Until you have written proof of the Board's decision, you're still under the Order. Failure to abide by its terms could be considered noncompliance. 

Noncompliance can make it more difficult for you to return to work as it may negatively influence the Board's decision. Any noncompliance may cause the Board to believe that you're not ready to return to work or not yet eligible for release.  

Terms and Conditions 

Nurses facing disciplinary action, especially those related to substance abuse, should take every available avenue to mitigate the charges against them. This is especially true when determining what terms and conditions the Board includes in an order. 

The more serious the disciplinary action, the longer it may take you to satisfy conditions and return to practicing nursing without restrictions. A condition that can be satisfied in six months will have less of an impact on your career than one that takes years to resolve. 

One of the challenges with substance abuse is that it might be indirectly related to any disciplinary action. You should be prepared to show a connection between a complaint and your substance abuse issues and how your substance abuse issues should be a mitigating factor in any disciplinary action.  

The Professional License Defense Team at the Lento Law Firm can help you. The goal is to build a case that lessens any disciplinary actions against you and creates manageable conditions for resuming your nursing career without conditions or restrictions.  

Nursing Rehabilitation Program 

As an alternative to discipline, nurses may request admission to the Maryland Board of Nursing's Rehabilitation Program. The program is confidential and accepts both self-referrals and referrals from others. Whether the rehabilitation program is in a nurse's best interests for their recovery or career may not be considered during the referral or screening process. Nurses are responsible for advocating for themselves.  

Once referred to the program, nurses will be screened to see if they meet the eligibility requirements. The following actions make a nurse ineligible for the rehabilitation program: 

  • Behaved in a way that did or could have resulted in patient harm or injury 
  • Been arrested or convicted of the sale or distribution of controlled substances 
  • Been unsuccessful or discharged from an alternative to-discipline program 

If a nurse is eligible, they must enter into a consent agreement. The Rehabilitation Program doesn't provide any treatment, consultative, or educational services. The purpose of the program is to monitor a nurse's recovery.  

Consent Agreements 

As part of the rehabilitation program, nurses must sign a consent agreement. These agreements must be valid for at least five years. Once signed, a consent agreement is legally binding and must include: 

  • The individual recovery plan, such as therapy, toxicology screening, support groups, and other assessments of recovery 
  • Stipulations for employment 
  • Allowed medications, both prescribed and OTC 

If a nurse fails to comply with the terms of the consent agreement, they may be expelled from the rehabilitation program and referred to the Board of Nursing for disciplinary action.  

While a nurse is under a consent agreement, the Monitoring Coordinator or Committee must approve all potential employment before the nurse begins the new position.  

Maryland Resources 

Center for Substance Use, Addiction and Health Research (CESAR) at the University of Maryland. Focused on research, CESAR partners with organizations throughout Maryland on how to improve treatment for substance abuse. CESAR can be a potential resource for nurses seeking the newest research on treating substance abuse issues. 

In Fall 2021, the University of Maryland School of Nursing (UMSON) launched the United States's first post-bachelor's certificate in Substance Use and Addictions Nursing. The goal of the program is training that enables nurses to provide better care to patients suffering from substance abuse.  

For nurses dealing with substance abuse issues, this course provides another avenue of support. Medical professionals who go through the certificate program will not only be better trained to assist in treatment and recovery, but they'll also be more likely to appreciate the workplace challenges that nurses face.  


Nurses dealing with substance abuse assume all costs for their treatment, even those required in their consent agreement. This can include toxicology screens, substance abuse evaluations, psychological and medical assessments, and individual and group therapy. A nurse is responsible for any costs not covered by their employer or health insurance. 

These financial burdens can create an added source of stress, especially for those struggling with and attempting to overcome substance abuse and addiction. Costs can vary and depend on a variety of factors, such as the drugs or alcohol involved, the severity of the abuse, and an individual's overall health. 

By one estimate, addiction treatment costs between $15,000 and $27,000. As of 2022, the average salary for an RN in Maryland is $78,000. If a nurse is on unpaid leave or not allowed to work, the financial burden can become even more significant. 

Depending on how long they're unable to work, financial stress could hinder their treatment and recovery. This is another reason why minimizing disciplinary actions and restrictions on working is so important. 


Family Medical Leave Act may cover nurses who seek treatment for substance abuse issues. FMLA protects employees' jobs when they need to take unpaid medical leave.  

FMLA will apply to you when: 

  • Your employer has more than 50 employees or is a government agency 
  • You've worked for your employer for at least one year 
  • You've worked at least 1250 hours in the past year (or the equivalent of 24 hours a week) for that employer 
  • Your employer has at least 50 employees within 75 miles of your workplace 

If you're eligible for FMLA, you have to receive treatment through a healthcare provider or a referral from a healthcare provider.  

While the purpose of FMLA is to prevent people from losing their jobs due to medical issues, the law does have exceptions. An employer may not have to follow FMLA when they have a policy on substance abuse, up to and including firing employees for violating that policy. To meet this exception, an employer's policy must be: 

  • Established 
  • Enforced in a non-discriminatory manner 
  • Communicated to all employees  

If an employee isn't abiding by FMLA or otherwise ignoring laws when a nurse attempts to receive treatment for substance abuse, the Professional License Defense Team at the Lento Law Firm can help you protect your rights. 

Long-Term Support 

One of the challenges of recovering from substance abuse is that it isn't just completing a course or undergoing a prescribed treatment plan to get back to normal. Maintaining sobriety is a lifelong process, and that's one reason why up to 50 percent of people relapse during their first year of recovery. 

Part of your recovery program should be determining how to avoid high-risk situations and minimize the chance of relapse. You also need long-term support systems in place, but all these decisions should be yours. 

Employers and others may be unsure how to treat you as you recover from substance abuse. Some may put too many restrictions on you in the name of not wanting to cause you stress. These individuals are often well-meaning, but they're still attempting to dictate your recovery and your life. 

Others, especially some employers, may be less well-meaning. They may create unreasonable goals for you to meet or place restrictions on you that make it difficult for you to do your job. Reasons such as protecting patient safety may be given, but such restrictions may damage your career and be designed to attempt to force you out of your job.  

Some medical personnel may need to take time away from work as part of their recovery process. Even once they return to work, they may find that switching to a different department or position is the best choice for their recovery journey. The key here is that it should be your decision. 

Some nurses, once they have better support systems in place and healthier outlets for stress, may return to their old jobs. Some may find they're in a better place mentally and better able to perform. The important thing is that you're the one making these decisions, not your employer. 

No one should use your substance abuse issues to limit your career. If an employer or anyone else is using your previous issues or recovery to limit your ability to work and reach your full potential in your career, the Professional License Defense Team at the Lento Law Firm can help. 

Treatment, Not Punishment 

The issue of substance abuse within the medical profession isn't just a problem for nurses. It's a problem for society when nurses aren't given the support and assistance that they require to do their jobs at the highest level. 

Patient care and safety is important. Patient safety should include providing support for the people who help them. Unfortunately, our current system expects nurses to be their own support systems, pay for their treatment, and risk their careers if they admit to a problem.  

The continued stigma around substance abuse means too many people still consider it a choice rather than a disease. Alternatives to discipline are a good start, but treatment costs still fall on a nurse's shoulders even when they're unable to work. 

Disciplinary action may fail to consider the challenges of treatment and the risk of relapse. Recovering from substance abuse isn't as simple as finishing a course of antibiotics.  

If you're facing disciplinary action due to substance abuse, the Professional License Defense Team at the Lento Law Firm can assist you. We know the challenges that nurses face, and we work to find settlements and solutions that allow you to get the help you need with minimal impact on your career. Call us at 888-535-3686 or fill out our online form


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