Substance Abuse Defense for Nurses - Virginia's Health Practitioners’ Health Monitoring Program (HPMP)

As a certified or registered nurse in Virginia, you undoubtedly worked hard to get where you are. Nursing is not an easy profession by any means, and simply doing the job can take a mental and emotional toll on you. If you happen to have other things going on in your life, such as starting a family, the loss of a loved one, or another life-altering event, the stress can pile on. But if you let that stress affect your work and start to make careless mistakes, the consequences are severe. 

Nurses in Virginia and around the country deal with substance abuse accusations on a frequent basis. Having access to drugs puts heavy scrutiny on nurses, and a small mistake or misunderstanding can lead to disaster. Nurses and healthcare professionals also have to adhere to higher standards than most other professions. You might be blamed for medications that go missing, or your boss might interpret your frequent tardiness for work as a sign of alcoholism.   

If you do make a mistake related to substance use, such as getting a DUI or showing up to work hungover, you also face much harsher punishments than people who don't work in healthcare. Most states have some sort of substance abuse recovery and monitoring program, which allows healthcare professionals to get help and avoid disciplinary action. However, these programs aren't always the right answer if you do have an incident involving substance abuse as a nurse. 

At the Lento Law Firm, we understand that you work hard and that you don't want to throw your entire nursing career away over a substance abuse accusation. If you're considering joining Viriginia's substance abuse recovery program for healthcare providers, or you've been referred to it, you should contact our Professional License Defense Team first. We can help you assess your situation and guide you to make the right choice for you. Call our team today at 888-535-3686 or submit our contact form, and we'll get back to you. 

Virginia Board of Nursing Rules 

In Virginia, the Board of Nursing keeps a close eye on all licensed nursing professionals, including licensed practical nurses (LPNs), registered nurses (RNs), nurse practitioners (like nurse anesthetists and midwives), nurse aides, advanced nurse aides, clinical nurse specialists, and even medication aides. All of these professions fall under the Virginia Nurse Practice Act, which sets the rules for nursing licenses in the state. This Act, especially Section 54.1-3007, gives the board the power to suspend or revoke licenses, give out warnings, or put nurses on probation if they don't meet the standards. 

The Board goes beyond just setting basic standards; they have a comprehensive set of rules that every nurse in Virginia must adhere to. It's a strictly regulated environment with constant oversight. The Virginia Department of Health Professions even puts out reports every three months listing all the nursing licenses they've had to suspend or take away. If you're a nurse in Virginia and you get accused of wrongdoing or are suspected of being impaired, it's a big deal. Your job and entire career could be on the line. 

How HPMP Works 

The Virginia Department of Health Professions (DHP) has a recovery program for impaired healthcare providers in the state called the Health Practitioners' Health Monitoring Program (HPMP). This program is supposed to provide assistance to nurses and other healthcare professionals in the state who are deemed unable to practice safely. Essentially, HPMP is an alternative to disciplinary action for healthcare providers who have either a substance abuse diagnosis or a mental or physical health diagnosis that may alter their ability to practice their profession safely. 

The goal of the program is “to provide each practitioner with the identification and monitoring of the treatment recovery process to achieve and maintain optimal physical, mental, and emotional health in order to promote self and patient safety.” If you enroll in HPMP, you'll work with their team members to recover and return to safe and productive clinical practice. 

Nurses Are the Most Represented Group in HPMP 

In 2021, HPMP had 349 total participants, and Board of Nursing providers made up the largest chunk of participants at 57% and the largest number of new enrollees in 2021 at 33%. The majority of those new nursing participants were RNs. In addition to having the largest number of new participants, the Board of Nursing also had the largest number of enrollees who joined while an investigation was ongoing—and the largest number who were board-ordered to join. 

As you can see from these statistics, nurses are, by far, the most frequent participants in HPMP in Virginia. Maybe it's not surprising, given how much pressure nurses are under or how much scrutiny they face while doing their jobs. It also puts nurses under even more pressure as they're more closely watched. 

Alternative to Disciplinary Action 

The Virginia Nurse Practice Act gives the board powers to refuse, revoke, suspend, censure, or put on probation licenses of nurses who use alcohol or drugs to an extent that renders them unsafe to practice or have any mental or physical illness that renders them unsafe to practice. However, the board may offer enrollment in HPMP as an alternative option if a nurse doesn't want to face this kind of disciplinary action. 

It's important to keep in mind, though, that opting for HPMP when you've been accused of being unfit for practice isn't necessarily a “get out of jail free card.” You might avoid formal discipline from the board, but there are also significant consequences to joining HPMP. These consequences still have a bearing on your license and ability to practice. They could even make it difficult for you to practice in the future. 

At the Lento Law Firm, we understand that HPMP might seem like an attractive option when you're facing severe disciplinary action from the Virginia Board of Nursing. But it might not be the best for your particular situation. Our Professional License Defense Team can help you make this decision and even liaise with the board so you can explore other options. 

What to Expect When Enrolling in HPMP 

Virginia DHP contracts with the Virginia Commonwealth University Health System (VCUHS) to provide monitoring and clinical services to nurses and healthcare providers enrolled in HPMP. These services typically include: 

  • Intake to determine if you're eligible for the program 
  • Referrals to specific treatment providers who can assess your progress 
  • Monitoring of treatment 
  • Maintaining the alcohol and drug toxicology screening process 
  • Support and documentation you can use at board hearings 

Enrolling in HPMP is completely voluntary; however, some nurses are given no other choice by the board or their employers if they've been accused of a substance abuse offense. Also, HPMP enrollment is free, but you will have to pay for the treatments and screenings that are required for your monitoring. 

What Actions Can Lead to an HPMP Referral? 

The HPMP website lists four categories of behavior or issues that suggest a healthcare professional might need to join HPMP. These categories are substance abuse and chemical dependency, psychiatric conditions, disruptive behavior, and physical limitations. 

Substance Abuse and Chemical Dependency Issues 

Some signs that might get a nurse referred to the board for HPMP include: 

  • Smell of alcohol on the breath at work 
  • Red-faced or prominent capillaries on the cheeks and nose 
  • Bloodshot or glassy eyes and excessive use of eyedrops or wearing sunglasses indoors to conceal it 
  • Constricted or dilated pupils 
  • Sweating when otherwise comfortable 
  • Self-medicating for medical problems without seeking help 
  • Memory lapses and being unable to account for whereabouts 
  • Slow, slurred, or pressured speech 
  • Avoiding close contact or interaction with others 
  • Avoiding eye contact with others 
  • Lying 
  • Erratic behavior patterns, mood swings, or inappropriate responses (such as laughing when someone is crying) 
  • Tremors and shaking hands 
  • Not answering when on call or not returning pages 
  • Missing work infrequently or frequently late for work 
  • Defensive or in denial about drug or alcohol consumption when confronted 
  • Persistent financial, marital, or familial problems 
  • History of alcohol or substance abuse in the family 
  • Excessive use of fragrance or breath spray to conceal substance abuse 
  • Possessing alcohol or drugs at work 
  • Possessing alcohol or empty alcohol containers in the car on a regular basis 
  • Being known to frequent bars or clubs 
  • Frequently associating with known alcohol or substance users/abusers 
  • Low or elevated self-esteem 
  • Poor impulse control, hasty, impatient 
  • Easily agitated, irritable 

There are also “warning signs” linked to psychiatric conditions, disruptive behavior, and physical disorders. Some of these signs overlap with the substance abuse warning signs, like increased irritability or isolation. Although HPMP is for mental and physical health disorders as well as substance abuse disorders, 98% of new participants in the program in 2021 were monitored primarily for substance use disorders. The most frequent drugs of choice reported were alcohol at 56% and opioids at 29%. 

This list of “warning signs” on the HPMP website can either be used by you if you're considering joining HPMP of your own accord or by coworkers and employers if they've noticed a problem with you. Reading over the list, you can see that some things are quite serious and clear signs of a substance abuse problem, such as alcohol on the breath or possessing drugs and/or alcohol at work. 

However, many of these “warning signs” are much more nuanced and could be interpreted in several ways. Having persistent financial, marital, or familial problems could have absolutely nothing to do with substance abuse and might instead be the result of a traumatic event in your life. Having low self-esteem might not be related to substance abuse but could be because you have a boss who regularly belittles or criticizes you in front of your coworkers. If your boss knows that you like to go out on the weekends, they might use it as justification that you have a drinking problem when you don't. 

Misunderstandings are common when it comes to substance abuse accusations against nurses in Virginia. If medications are found out of place or not properly logged, a nurse is accused of diverting or stealing the medication. Accusations against nurses can also quickly get out of hand, but the Professional License Defense Team at the Lento Law Firm is ready to defend you. We can help you decide if HPMP is the right option for you and liaise with the board concerning your situation. 

How Long Does HPMP Placement Last? 

There's no set duration for HPMP; it's determined on a case-by-case basis. Depending on the severity of the offense that got you referred to HPMP, program completion could take longer. For some nurses, monitoring lasts for a few months, and then they're ready to return to work without constraints. For others, the process can drag on for years, with continuing requirements to get tested for drugs or alcohol, seek treatment with expensive specialists, or provide the proof the board requires to give you the all-clear. 

Before you agree to do HPMP as a Virginia nurse, think about how it might upend your professional and personal life. You may have to take time out of your busy schedule to get treatment, which either reduces your work hours or the time you can spend with family. Are you willing to put up with these kinds of restrictions for months or years on end? You might end up avoiding disciplinary action by enrolling in HPMP, but the consequences may ultimately not be worth it. 

At the Lento Law Firm, our Professional License Defense Team can help you decide what the best course of action is. We can evaluate the accusation against you and the board's position on the matter and help you predict what your duration in the program might be. Our goal is to provide you with as much information as you need to make a sound decision concerning HPMP. 

What Requirements Do You Have to Fill to Complete the Program? 

The requirements for HPMP are different for each participant and based on the issues they're dealing with. Some examples of requirements nurses have had to fill while participating in substance abuse monitoring programs are: 

  • Random urine samples 
  • Taking a breathalyzer test multiple times per day 
  • Attending a 12-step group substance abuse program, such as Alcoholics Anonymous (AA) 
  • Regular medical visits to an addiction counselor 
  • Mandated abstinence from all substances including alcohol, some over-the-counter-painkillers, and prescribed medication-assisted treatments such as methadone 

In addition to the services required concerning treatment—which nurses have to pay for out of pocket—prolonged participation in the program can lead to financial insecurity. In Virginia, nurses are allowed to continue working while participating in HPMP, and their licenses remain active. But they might have restrictions placed on where they're allowed to work, limiting their employment opportunities and posing a potential risk to their ability to earn income and support themselves or their families. 

In some cases, nurses' employers require them to join HPMP after an incident in order to keep their jobs. Once they're in the program, they're closely scrutinized. One relapse or small error could terminate their employment and result in the forfeiture of the nursing license. These errors could be significant, like getting caught diverting medications, or they could be minimal, like complaining to your support group about the restrictions you face. Often, getting flagged once during the program is enough to get your license immediately suspended and prevent you from working. 

All of this scrutiny and the requirements of the program don't account for the mental and emotional toll participation takes. Having to submit to regular checks that disrupt your work day, taking time out of your personal schedule to attend appointments with healthcare providers, and the constant fear that one small mistake could get your license taken away immediately can all severely impact your mental health—which is a little ironic, given that HPMP in Virginia is also for healthcare professionals who have diagnosed mental health problems too.  

If you're a devoted nurse, you'll probably put up with a lot to keep your job and your license. But you shouldn't have to let your health suffer because of the strict monitoring requirements. Our Professional License Defense Team can help you find alternatives. We can negotiate with the board on your behalf and work toward a solution that doesn't include months or years of monitoring just so you can keep your nursing license. 

Can You Still Practice While Participating in HPMP? 

One of the primary goals of HPMP is to allow healthcare professionals to keep working while completing the program. Unless you pose a clear and immediate threat to public safety, you can hold onto your license and continue to practice as a nurse while enrolled in HPMP. You might be placed in a different working environment, however, to minimize your chances of relapse. 

In addition, your employer will know that you're in HPMP, and they may have to complete paperwork or other monitoring requirements concerning your performance on the job. Although you can keep practicing while participating in the substance abuse monitoring program, your work will almost certainly look different than it did before. 

Why You Need a Lawyer's Help with HPMP 

If joining HPMP is a board matter, why do you need an attorney? A team of lawyers that knows how to defend licensed nurses can be instrumental to your case for several reasons: 

  • The board has more resources, including lawyers and experts, in licensing issues than you do. Hiring an attorney gives you some resources as well. 
  • The law isn't on your side. Since it's not a legal matter, you may not be “innocent until proven guilty.” The board can follow its own rules when deciding what to do with your case. 
  • You likely have little experience dealing with the Virginia Board of Nursing. Our team can negotiate with the board on your behalf and ensure things go smoothly. 

What Are Professional License Defense Team Can Do for You 

By hiring our firm to assist you with your substance abuse accusation, you benefit from our services, which include: 

  • Identifying the ideal outcome for your case based on your situation 
  • Obtaining relevant evidence and testimony concerning the accusation or incident in question 
  • Guidance in the disciplinary process if you choose to have a hearing 
  • Taking further legal steps, such as filing a lawsuit against the board, if necessary 

Our legal team is experienced in negotiating with nursing boards, and we'll press for the best possible outcome for your case. 

We Help Nurses Throughout Virginia 

Our Professional License Defense Team can help you no matter where in Virginia you're practicing, including: 

  • Chesapeake 
  • Norfolk 
  • Richmond 
  • Newport News 
  • Alexandria 
  • Hampton 
  • Roanoke 
  • Portsmouth 
  • Suffolk 
  • Lynchburg 
  • Centreville 
  • Dale City 
  • Reston 
  • Leesburg 
  • Harrisonburg 
  • McLean 
  • Charlottesville 
  • Blacksburg 
  • Ashburn 

Even if you don't see your city listed, reach out to our team. We'd be happy to discuss your case with you and help you see what your options are. 

Contact the Lento Law Firm for Help with Your License  

If you have been accused of being involved in a substance abuse incident that threatens your nursing job or license, you shouldn't try to handle it on your own. Call our team so we can help you navigate this tricky situation and find a solution that doesn't end up ruining your life or your career. Call now at 888-535-3686 or fill in our online form and a member of our team will get back to you. 


Attorney Joseph D. Lento and the Lento Law Firm are committed to answering your questions about Physician License Defense, Nursing License Defense, Pharmacist License Defense, Psychologist and Psychiatrist License Defense, Dental License Defense, Chiropractic License Defense, Real Estate License Defense, Professional Counseling License Defense, and Other Professional Licenses law issues nationwide.
The Lento Law Firm will gladly discuss your case with you at your convenience. Contact us today to schedule an appointment.

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