Nurses are among many healthcare professionals who are closely monitored due to their handling of drugs, narcotics, and other controlled substances. As a part of their agreement with the state's licensing authority, nurses must take care to properly label, store, and administer them to patients. However, nurses can become caught up in substance abuse, often caused by a precipitating incident.
Unfortunately, nurses could be accused of diverting medication from patients to their own pockets, being inebriated on the job, having a run-in with law enforcement, or they may be the subject of an anonymous complaint. However, a nurse could become implicated in an investigation into substance abuse by false allegations or actions taken out of context. Regardless of their origin, being accused is not something to take lightly.
Tennessee's governing authorities will launch an exhaustive investigation into a nurse's personal and professional life. With pressure nationwide to halt the advance of substance abuse issues, nurses shouldn't attempt to defend themselves alone, whether or not they believe they've done nothing wrong. Sometimes, licensing boards have zero-tolerance policies related to substance abuse, and even failing to report a colleague can derail a nurse's career. Subsequent disciplinary actions could leave nurses out of work for years and unable to gain a license to practice in other states.
Nurses in Tennessee threatened by licensing board investigations and sanctions need assistance to retain their credentials and keep their good standing intact. The Lento Law Firm Professional License Defense Team is well-known in Tennessee and nationwide for defending nurses from licensing board implications. Nurses are an invaluable part of society, giving life-saving care to patients every day, and it's vital that they can continue to work free from allegations or the consequences of disciplinary actions. If you're a licensed Tennessee nurse dealing with allegations of substance abuse or sanctions from the licensing board, call the Lento Law Firm now at 888-535-3686 or visit us online to schedule a consultation.
Tennessee's Nurse Substance Abuse Protocols
States have rehabilitative programs for nurses who are struggling with substance abuse or dependency, and Tennessee is no different. The term substance abuse may be considered subjective, but the Tennessee Board of Nursing has its own definition to hold licensees accountable. The state agency asserts that it will monitor for nurses "whose practice is impaired, or potentially impaired, due to the use of drugs or alcohol, or psychological or physiological condition."
The Tennessee Board of Nursing lists that some signs of addiction include the following:
- Mood swings
- Inappropriate behavior at work
- Frequent days off for implausible reasons
- Non-compliance with acceptable policies and procedures
- Deteriorating appearance
- Declining job performance
- Illegible charting or errors within
- Alcohol on the breath
- Forgetfulness
- Poor judgment and concentration
- Lying
Yet, there are others the Tennessee Board of Nursing deems as signs of addiction, but may very well be typical behavior for many, such as:
- High achievement as a student and a nurse
- Volunteering for overtime and extra duties
- Volunteering to be the med nurse
- No drug use unless prescribed for a chronic illness or following a medical procedure
- Family history of alcoholism or addiction
The state agency claims that "any of these characteristics may be symptoms of a number of other problems besides addiction." However, there's no guarantee that a nurse won't be investigated for demonstrating such behavior.
With their proximity to narcotics, drugs, and medication, substance abuse is a significant problem among all healthcare professionals in all areas of the country. It is a chronic, progressive illness that can be treated effectively. But considering its implications to a professional license, maintaining your credentials can be challenging. For instance, at any time, a nurse must consent to a drug test if requested by an employer or potential employer, and refusing a test creates the presumption that the test will be positive. Any test refusal or failure is reported to the Tennessee Board of Nursing, which is required to suspend the nurse's license pending an investigation.
However, there are steps nurses can take to manage the situation. Although the licensing board maintains strict guidelines on substance abuse among nurses, it also funds a program to help those in need.
Tennessee Professional Assistance Program
The Tennessee Professional Assistance Program (TNPAP)—sometimes referred to as the Peer Assistance Program—is a confidential and voluntary program designed to assist healthcare professionals, including nurses, who may struggle with substance abuse related to drugs and alcohol or issues arising from psychological or physiological conditions. TNPAP aims to provide support, intervention, and rehabilitation to ensure public safety and help professionals regain their ability to practice safely and effectively.
TNPAP allows nurses to self-refer or be referred by others, such as employers, colleagues, or the Tennessee Board of Nursing itself. Nurses can voluntarily enter the program without facing immediate disciplinary actions; however, there is no guarantee that they won't be levied later. There is no cost for TNPAP services when the individual has an active Tennessee license. Yet, the cost of the TNPAP-approved medical evaluations, support groups, pain management, toxicology reports, and others is the participant's responsibility.
Once in the program, nurses undergo a comprehensive assessment to determine the nature and extent of their impairment. TNPAP collaborates with healthcare professionals, including addiction specialists and mental health professionals, to design an individualized treatment plan. Nurses will also sign a monitoring agreement that may include but is not limited to the following during treatment:
- Attendance at a support group and 12-step meetings (like Alcoholics Anonymous or Narcotics Anonymous)
- Toxicology screening (approximately 20-24 per year)
- Refraining from consuming mood-altering drugs, including alcohol
- Timely submission of reports
- Obtaining a sponsor or accountability partner
While TNPAP operates independently, it communicates with the Tennessee Board of Nursing to ensure public safety. Therefore, once a nurse enters the program, the state agency will know, but specific details are generally kept confidential. Subsequently, admission into TNPAP means that a nurse must refrain from practicing as a healthcare professional in any capacity until the program determines it is safe to allow them to resume. To do so, they must adhere to all the stipulations in the signed monitoring agreement and demonstrate a "change in lifestyle that supports continuing recovery." Participants who violate their agreement are reported to the Office of Investigations within the Tennessee Department of Health (TDH) and are subject to possible disciplinary action.
It's crucial to note that while TNPAP is a voluntary program, nurses may also be subject to disciplinary proceedings by the state board if their impairment poses an immediate risk to public safety. Moreover, it's critical to understand the implications of admitting yourself to a voluntary program under the guise of confidentiality without the advice of an attorney.
The Lento Law Firm Professional License Defense Team is here to counsel Tennessee nurses on navigating issues with substance abuse or allegations thereof. You've worked hard and dedicated an immense amount of time and money into your education, practice experience, and credentials. Even before allegations arise, you must know where to turn for the best possible outcome.
Substance Abuse Complaints and Mandatory Reporting
The Tennessee Board of Nursing takes substance abuse seriously. Nurses should be aware of how the agency handles allegations as a part of their licensing agreement and other state and federal laws. For instance, the Nurse Practice Act compels any nurse who has knowledge of any healthcare provider's "incompetent, unethical, or illegal practice" to report it to the proper authorities—TNPAP or the state board through TDH's Office of Investigations. However, allegations can come from anywhere.
Complaints can be filed by patients, family members, peers, law enforcement, and individuals who request to remain anonymous. While complaint information about a nurse remains confidential, if it leads to formal discipline by the licensing board, then the nurse's information will be public knowledge.
All complaints received within the Office of Investigations are reviewed within three business days. Each complaint will be reviewed by a consultant who is licensed and in good standing with the Tennessee Board of Nursing and a staff attorney assigned by the TDH. Together, they will evaluate if a potential violation of a statute or rule profession exists based on the allegations provided.
Investigation Procedure and Informal Discipline
When the Tennessee Board of Nursing and the TDH determine a violation is likely to have occurred, the file is forwarded to a field investigator to collect witness statements and documentation to prove or disprove the allegations. The accused nurse is usually interviewed to allow them the opportunity to provide an explanation for the allegations.
If it's determined that no violation occurred, the nurse is notified in writing. If a violation is found, the nature, severity, and the position of the board in disciplining similar violations will be considered in determining one of the two following paths:
- The state board's consultant issues an informal letter of correction.
- The nurse receives a formal reprimand with their information posted to a public database.
- The licensee is referred to the TDH legal office for consideration of formal disciplinary charges.
A letter of correction might be issued if there are deficiencies or non-compliance with certain regulations or standards. The content and purpose can vary depending on the specific circumstances, including details about the substantiated claims, a deadline for corrective actions, and information on addressing further issues.
Another means of informal punishment is a formal reprimand, which is nearly identical to a letter of correction. However, whereas the nurse's information remains confidential with the informal letter, when a formal reprimand is levied, their information is published on the Tennessee Licensure Verification Database under the licensee's profile. Even though letters of correction of formal reprimands don't carry with them sanctions, an appeal is not provided.
Consent Orders and Contested Case Hearings
If the state board consultant and TDH attorney determine during the investigation process that formal discipline better suits the allegations, they may refer the matter to the Tennessee Office of General Counsel. Based on prior board actions, the attorney will consider recommended discipline and prepare a Consent Order, which is then sent to the nurse.
Nurses will have the opportunity to review the order and agree to the terms laid out, including any discipline and further stipulations on their license. If accepted, the order is submitted to the National Council of State Boards of Nursing database, where the licensee's information, including the complaint or allegations and the eventual disciplinary measures, is accessible to other states and future employers.
If the nurse does not enter into a consent order, a “Notice of Charges” is filed, formally opening up a contested case hearing between the nurse and the Tennessee Board of Nursing. If the state agency seeks to take action against a license, a copy of the notice of charges—including the time, date, location, and respondent rights—must be sent to the nurse no later than 30 days before the hearing date.
Proceedings are overseen by an administrative law judge (ALJ) from the Office of the Secretary of State's Administrative Procedures Division (APD). Before the hearing, both parties will hold a pre-hearing conference to discuss any settlement possibilities. Then, the nurse and their representation, as well as the state board, will exchange relevant information, documents, and evidence through a discovery process. This allows each party to understand the other's case and to prepare their arguments.
During the contested case hearing, the petitioner—the party who has initiated the proceedings—usually bears the ultimate burden of proof. Tennessee's standards rely on the "preponderance of the evidence" standard, wherein the petitioner must prove that it is at least more true than not true.
Licensees and Tennessee Board of Nursing representatives will present their arguments, witnesses, and evidence. The ALJ ensures a fair and orderly process and may question witnesses and review evidence. But parties will also be given the chance for cross-examination.
The ALJ will issue a final order will be based on the evidence presented and will include one of the following determinations:
- Affirming the Tennessee Board of Nursing's original decision
- Modifying the sanctions imposed
- Reversing the state board's decision.
All final orders must contain a clear and concise statement of the available procedures and time limits for seeking reconsideration, administrative relief, or judicial review. Unless a licensed nurse decides to challenge the ALJ's decision, the sanctions imposed by the board remain in effect.
Sanctions for Substance Abuse
Disciplinary action for Tennessee nurses is imposed immediately upon the board's determination of responsibility for the allegations or the ALJ's final order. The potential sanctions a nurse may face include but are not limited to the following:
- License probation: Nurses must comply with certain conditions and restrictions of their licensure and practice for a specific amount of time. This may include regular drug testing, participation in treatment programs like TNPAP, or other specified requirements.
- License suspension: A temporary removal of the nurse's license for a specified period, during which the nurse cannot practice in Tennessee or any other state.
- License revocation: Permanent exclusion of the nurse's license in Tennessee. Many times, a nurse with a license revoked in one state may not apply for a license in another state.
It's important to note that the specific disciplinary actions taken by the Tennessee Board of Nursing depend on the individual circumstances of each case. Factors influencing the decision include the severity of the substance abuse problem, whether patient safety was compromised, the nurse's cooperation with the board, and any previous disciplinary history.
Even though nurses may want to abide by the will of the board, they must exercise every option of redress available. The Lento Law Firm Professional License Defense Team is an invaluable tool that ensures nurses have multiple opportunities to retain their credentials, including appealing the determinations of licensing or judicial authorities.
Can You Appeal the Tennessee Board of Nursing or ALJ's Decision?
Yes, but it depends on the situation and how a nurse progressed through the disciplinary process. As mentioned before, there is no appeals process for informal discipline like a letter of correction or a formal reprimand. But there is an opportunity when sanctions like license probation, suspension, or revocation are on the table.
If a nurse wants to appeal what was done by the Board of Nursing in the contested case hearing, they may file a petition with the state Chancery Court. A single judge—referred to as a chancellor—will review the entire record from the contested case hearing and not consider any additional information or evidence—unless special circumstances exist—and render a decision on the matter.
A nurse may further contest to the Tennessee Court of Appeals. The initial procedure is for the presiding judge in the district where the petition is filed to determine whether the petitioner meets the criteria for a three-judge panel. Within ten days of receiving notice, the presiding judge will notify the Tennessee Supreme Court, which will agree or disagree on whether the case meets standing requirements. The panel will hear arguments as to why the chancellor's should be reversed.
Critically, one of the reasons why nurses need to retain professional legal assistance is because steps taken before the appeals stage directly affect the ability to contest a decision. For instance, if a nurse accepts the state board's informal disciplinary measures early on, they waive their right to appeal.
How Can the Lento Law Firm Help Tennessee Nurses?
You may think hiring an attorney is a big step to take initially, especially if you know there are avenues of redress and programs geared toward helping nurses struggling with or accused of substance abuse. However, it's a common misconception that could land you in trouble and without the credentials you need to practice.
To promote the best outcome of your case, the Lento Law Firm Professional License Defense Team stands prepared to assert your right to fair proceedings and defend your nursing credentials. Our dedicated attorneys are well-known in Tennessee and nationwide for representing nurses and other healthcare professionals in licensing disputes related to substance abuse issues.
The Lento Law Firm Professional License Defense Team is a value proposition for a multitude of reasons, like the following:
- Self-reporting to TNPAP: While Tennessee's substance abuse program is voluntary, the state board will become aware, and they may seek disciplinary action. Let us advise you on how to proceed with obtaining help while protecting the status of your license.
- Corresponding with the Tennessee Board of Nursing: When the licensing board becomes aware of substance abuse, they may propose a rehabilitation plan or alternative sanctions. Our team will step in to relay how you can approach defense against adverse action on your license.
- Protecting your right to due process: When nurses accept certain forms of discipline, including informal measures, they may waive their right to appeal. We will ensure every option for redress is available to you during every step of the process.
- Negotiating consent orders: Even if a consent order has more informal means of action on a licensee, sometimes the wording of the order can spell trouble with compliance in the future. Let us negotiate with the board to uphold your rights and advocate for a more beneficial resolution.
- Representing you in contested case hearings: Although contested case hearings are administrative, they can have complex procedures to follow. Our attorneys will assist in the required processes—like maintaining a proper record—that promote the best outcome in your case.
You have dedicated your life to becoming a licensed nurse and have a significant responsibility to the public as a healthcare professional. While substance abuse may abridge Tennessee Board of Nursing regulations, it is an on-the-job health risk that requires rehabilitation, not disciplinary action.
The Lento Law Firm Professional License Defense Team is prepared to help any licensed Tennessee nurse navigate complaints, allegations, and discipline surrounding substance abuse issues. You deserve a team that can represent you effectively, understand how the state manages nursing and license regulations, and can broker a resolution with state and judicial authorities. To gain stress-free assistance and keep your nursing credentials intact, get in touch with Lento Law Firm now by calling 888-535-3686 for help or schedule a consultation online.
