A celebrated Japanese proverb compels those who will listen to “Fall seven times, stand up eight.” Those who struggle with alcohol dependence or any other kind of substance abuse may find hope in this sentiment, as it is rare that anyone effectively manages their dependence issues after only saying once that they're going to stop using. Oftentimes, it takes several serious stumbles that may put one's relationships, financial stability, and even one's entire career on the line before an alternative pathway forward becomes both clear and sustainable.
If you're grappling with a substance dependence issue, it's important to know that while you may feel unbearably lonely, you're not alone. In 2022, the federal Substance Abuse and Mental Health Services Administration reported that 48.7 million Americans were navigating the ups and downs of substance abuse disorders. One of the only silver linings of the opioid crisis and the tumultuous years of the Covid pandemic is that the American press, state and federal regulators, medical professionals, and the public as a whole seemed to truly wake up to the reality that anyone – of any age, profession, educational level, and economic status – can find themselves struggling with substance abuse. No one is immune.
When the Stress of Nursing Becomes Too Much
While anyone can struggle with dependence on alcohol, illicit drugs, or prescription medications, there is little doubt that individuals who pursue certain professions are more likely than the average adult to develop substance abuse issues. According to The Substance Abuse and Mental Health Services Administration, workers in the mining and construction industries are among those professionals most likely to abuse alcohol, for example. However, healthcare workers are giving those traditionally stressful occupations a run for their money. While nursing has always been a high-stress profession, the uniquely taxing years of the COVID-19 pandemic helped to inspire skyrocketing rates of substance abuse among nurses in the U.S.
If you are serving the needs of the public as a nurse in North Carolina, and the stress of the job, the challenges of daily life, or any other issue has caused you to start abusing substances, you have no reason to be ashamed. Yet, you are likely going to need help to safeguard your relationships, your finances, and whatever you hold dear from the destruction that substance abuse tends to inspire.
Your situation may have already become so dire that your career is on the line as a result of your substance abuse. Or, perhaps you're scared that someone will report their concerns about your substance abuse to your employer or the state's nurse licensing board, even if they haven't yet. Either way, in addition to seeking help to manage your substance abuse itself, you may need legal assistance to safeguard your career and professional interests at this time. As such, it may benefit you to speak with the Lento Law Firm's Professional License Defense Team about proactively pursuing the North Carolina Board of Nursing's alternative program or disciplinary program.
Each of these options can potentially help you to protect your professional interests, although there are both pros and cons to participation in each opportunity. As such, when you connect with our team, we'll help you to evaluate each option independently after learning about your personal circumstances, needs, and goals. At that time, you'll be empowered to make a truly informed decision in your best interests. Call us today at 888-535-3686 or submit information online to learn more. With your career, health, and well-being on the line, it's important to be as proactive as possible. We are here to help.
North Carolina Nursing Regulatory Body
The North Carolina Board of Nursing (NCBN) is the state agency that is primarily responsible for licensing and certifying nursing professionals who work in the Tar Heel State. It is also empowered to discipline nurses if they violate state law and/or Board regulations concerning the professional conduct standards that apply to the nursing field. The NCBN approves – and has the authority to suspend or revoke – licenses and certificates for positions including the following:
- Certified Nurse Midwife
- Certified Registered Nurse Anesthetist
- Clinical Nurse Specialist
- Licensed Practical Nurse
- Nurse Aide II
- Nurse Practitioner
- Registered Nurse
The NCBN is comprised of 14 board members, of which eight are registered nurses, three are licensed practical nurses, and three are public members. One appointment apiece to the public member roster is made by the House Speaker, the Senate's President Pro-Tem, and the Governor. All members serve 4-year terms and may not serve more than eight years on the Board consecutively.
The Board identifies six primary purposes for its operations. They include:
- Administering the Nurse Licensure Compact
- Overseeing the practice of nursing in North Carolina per the terms of the state's Nursing Practice Act
- Regulating the practice of nurse midwives and nurse practitioners, specifically
- Approving and monitoring nursing education programs employed throughout the state that lead to initial licensure
- Issuing, renewing, and reinstating nursing licenses for licensed practical nurses and registered nurses, and maintaining the Nurse Aide II registry
- Investigating complaints against licensed nurses, and engaging in disciplinary actions when warranted
If you are dealing with substance abuse issues, it is the Board's final type of authority that is likely most concerning to you at this time. Yes, it is true that whether you self-report or a complaint is filed against you, the Board can engage in discipline if it finds that your competency to practice nursing has been compromised by your use of alcohol and/or drugs. It is possible that you could be reprimanded, placed on probation, or you could have your license suspended or revoked. This is why it is important to understand your options and to evaluate them carefully. Depending on whether you meet the eligibility criteria for these opportunities, you may be able to take advantage of the NCBN's Alternative Program for Nurses in Recovery (AP) or its Discipline Program for Nurses in Recovery (DP).
North Carolina Nursing Laws
Before exploring your options, it's important to consider the law that you may be unintentionally in violation of as a result of your substance abuse. It is, after all, the legal framework that empowers the Board to take action against you. If you ultimately decide to fight back against allegations of professional wrongdoing, it is this law that the Board will reference when arguing its position and the practical applications of this law that the Lento Law Firm's Professional License Defense Team will utilize to contextualize your situation as well.
Each state passes its own laws and employs its own regulations and guidelines that govern the profession and practice of nursing within its borders. The North Carolina Nursing Practice Act serves as this primary legal reference in the Tar Heel State. The NCBN also employs Administrative Code Rules in order to exercise its authority as defined in the Nursing Practice Act. As a result, all professional, ethical, and license-related legal concerns associated with the nursing profession in North Carolina are scrutinized through these lenses.
Notification of Substance Abuse to the North Carolina Board of Nursing
You may have recently been notified that the Board is aware of your struggles. Alternatively, you may be concerned that it is only a matter of time before it finds out that you're having difficulty managing a substance abuse issue. As North Carolina is a mandatory reporting state, you have reason to be concerned.
On the Board's webpage, which specifically concerns reporting, it explains that “The Board evaluates all complaints to ensure public protection. All allegations are evaluated with respect to jurisdiction, risk to the public, and the circumstances leading to the reported incident/event.” Due to the state's mandatory reporting laws, employers and healthcare professional colleagues who witness certain behaviors are bound to report them. In addition, patients, their loved ones, and general members of the public are empowered to file complaints with the Board as well.
Recognizing that the practice of nursing is a complex undertaking that is subject to misinterpretation and blurred lines, the Board outlines a number of behaviors that are non-reportable or are only “potentially” reportable. For example, a refusal to accept an assignment is not reportable, and sleeping on duty is only potentially reportable. With that said, of the 11 “definitely reportable conduct events” outlined by the Board, five of them relate to substance abuse concerns. They are:
- Drug abuse
- Impairment on duty
- Drug diversion
- Positive drug screen
- Fraudulent prescription for controlled or abusable substances
Clearly, the NCBN feels that it is very important to be alerted to the substance abuse challenges of a practicing nurse professional. As such, it is often in the interests of nurses to self-report, if the Board hasn't already been notified of their challenges. Self-reporting can be perceived as a willingness to accept responsibility for one's personal circumstances and a willingness to pursue treatment. When one's nursing license is potentially on the line, earning the goodwill of the Board in this way can be a positive first step toward both health-related and professional recovery.
The North Carolina Board of Nursing's Programs for Substance Use Disorders
Unlike most state boards of nursing, the NCBN does not highlight its alternative-to-discipline program (AP) over its discipline-based program (DP) related to substance abuse. It explains the objectives of these programs, their enrollment procedures, compliance concerns, and consequences for non-compliance simultaneously on its website. This is notable primarily because it serves as a clear indication that its alternative program is not the best approach for every nursing professional and that pursuing one option over the other is often up to the individual. Certainly, there are those who are not eligible for the AP and must either enter into a DP or potentially forgo nursing in North Carolina as a result. But, for many, there is a genuine choice to be made between the Board's AP and DP opportunities.
The Alternative Program serves as a voluntary alternative to being subjected to traditional forms of discipline for alleged professional misconduct. Participation in the AP is confidential and subject to exceptions related to the protection of public health, safety, and welfare. By contrast, the Discipline Program is not confidential. Participation is noted in the state's licensure verification system, which is made readily available to both the North Carolina public and prospective employers around the country.
In either case, nurses who are struggling with substance abuse challenges can enroll in these programs to benefit from structured monitoring. Once a participant in either program is cleared to return to their profession without restrictions, their license will no longer be in jeopardy.
Requirements of the NCBN's Alternative Program and Discipline Program
Once the Board has been alerted to a nurse's alleged compromised professional competency due to substance abuse issues, it will start investigating the situation at hand. To participate in either the AP or the DP, an eligible nurse is required to sign a consent order that has been prepared by the Board. Signing this order means that the nurse agrees both to the terms of participation and the facts of their case, effectively negating any chance for appeal or additional pushback against the allegations in question.
If a nurse enters the AP, their license will be rendered temporarily inactive, also referred to as “held in abeyance.” If a nurse enters the DP, their license will be – on a temporary basis – formally suspended. This inactivity/suspension will continue for a minimum of three months. During that time, the nurse participant will be expected to seek substance use disorder treatment, submit to random drug screening, and attend mutual support group meetings. Upon successful completion of the terms of the AP or DP – including a successful addictionologist evaluation – a nurse participant may return to the practice of nursing subject to restrictions, the nature and timeline of which are at the discretion of the Board and program administrators.
Overall, participants in both the AP and DP must be monitored to some degree over the course of several years. If a participant returns to active nursing, they must be monitored for at least three years after achieving “satisfactory employment in a licensed nursing position.” If a participant does not return to nursing right away or there are gaps in this satisfactory employment requirement, they must be monitored for a minimum of five years via random drug screening.
If a participant does not meet the terms of their program, termination of their participation will result in a suspension of their nursing license for a minimum of one year. At that time, they may not be considered for licensure reinstatement until they've achieved a minimum period of continuous sobriety as characterized by the Board's Sobriety Notebook.
Weighing the Pros and Cons of Participation in the Alternative Program
If you are eligible to enter into the Alternative Program, the process of assessing your options can be overwhelming. Know that you don't have to do this alone. You can call the Lento Law Firm's Professional License Defense Team to discuss the particulars of your situation and how your options may ultimately affect your professional, health-related, and overall well-being. The following are a few considerations worth mulling over as you prepare for this conversation.
Pros
Oftentimes, it takes a significant level of support to achieve sustainable management of a substance abuse disorder. By entering into the AP, you'll benefit from a program that was designed to facilitate the treatment of nurses, specifically, which few other programs are structured to do. You'll also benefit from continuous check-ins and random screenings that will help hold you accountable and deter you from slip-ups. The knowledge that you will be able to return to nursing sooner than you otherwise might and that your participation will be kept confidential – unlike the public notifications made for DP participants – can also be powerful motivators to regain your health.
Additionally, successful participation in the AP will allow you to avoid formal discipline and a disciplinary record to match. This will help to ensure that you remain able to advance in your chosen career in whatever ways you want to if/until you decide to stop nursing. One of the toughest realities associated with substance abuse is that it tends to limit one's choices and future opportunities. By proactively participating in the AP, you can minimize this concern to the greatest possible extent.
Cons
With the exception of gaining a formal disciplinary record, there are few distinctions between participation in the AP and the DP. Meaning if you choose to roll the dice and fight the allegations that you're facing, the likely worst-case scenario – unless your situation is particularly egregious – is that you'll end up ineligible for the AP and will need to choose between the DP and whatever alternative consequence the Board chooses to impose for non-participation in either program. If you don't feel confident in your ability to comply with the AP's requirements, you are filled with anxiety at the idea of being monitored by the Board for years on end, or you simply aren't ready to enter into sustainable recovery, agreeing to participate in the AP may not be the best choice for you.
Additionally, it's worth noting that participants in the AP and DP are responsible for all related costs, including substance use disorder treatment, addictionologist evaluations, and random drug screening. The total costs of these services will likely be truly significant. Depending on how good your insurance coverage is, you may or may not be in a position to pay for your participation in this program.
Finally, agreeing to participate in the AP will automatically result in a temporary hold on your license, and that hold will remain in effect until you've met a number of time-intensive requirements. Even then, your license will be subject to restrictions for years. As such, depending on the strength of your case, you may be in a position to better safeguard your earning power by fighting back against the allegations that you're facing than you would if you simply agreed to abide by the terms of the AP.
Challenging the Allegations and/or Participating in the Discipline Program
Participation in the AP is voluntary. Even participation in the DP is technically voluntary. You could choose to accept whatever consequences that the Board imposes for non-participation. You could also potentially fight back and win your case. The best way forward may not necessarily be the most straightforward. If you opt to push back against any complaint that has been filed with the Board against you,
your Lento Law Firm Professional License Defense lawyer will employ their extensive experience and considerable skill on your behalf. You may end up facing no greater challenge than a reprimand, which would allow you to pursue treatment on your own terms.
It's critical to keep in mind that if you don't seek treatment for your substance abuse challenges, you could unintentionally end up harming a patient, incurring liability for that harm, and losing your license forever. With that said, if you're in a position to push back against a complaint and seek treatment in a way that allows you to remain employed and avoid potentially oppressive monitoring, know that we will do everything possible to help you secure a favorable outcome at the end of the Board's investigation and hearing processes.
Connect with the Lento Law Firm Today
After spending years earning your nursing degree and years investing in your career more broadly, you have much at stake as the Board either actively considers a complaint against you or may be alerted to your substance abuse challenges soon. Know that you do not have to navigate the consequential ups and downs of your situation alone. The Lento Law Firm's Professional License Defense Team practices nationwide, and we can help you preserve your interests whether you're currently nursing in North Carolina or you've taken a traveling position elsewhere. Just as we have helped so many other nurses weigh their options and fight for their rights, so can we help you. Call us today at 888-535-3686 or contact us online to learn more. We look forward to hearing your story.
