If you're a nurse in Washington State facing a substance abuse-related investigation launched by the Board of Nursing. You might be considering submitting to the “voluntary” rehabilitative program stipulated in a consent agreement with the state. Although consent agreements may seem like an obvious choice, they can come with unforeseen expenses, time commitments, and personal restraints, all under the purview of the stringent oversight of the Board of Nursing.
Before signing a consent agreement, contact the Lento Law Firm's Professional License Defense Team. Our Team assists medical professionals throughout Washington who are facing misconduct allegations. Contact a member of our Team today by calling us at 888-535-3686 or by filling out a brief contact form.
What is Nursing Substance Abuse Disorder?
The National Council of State Boards of Nursing (NCSBN, 2014) defines Substance Use Disorder (SUD) as behaviors ranging from misuse to addiction, encompassing the use of substances like alcohol, as well as legal and illegal drugs. SUD is acknowledged as a multifaceted and evolving issue, particularly for nurses. Nurses dealing with SUD frequently face physical, emotional, financial, and legal consequences. Some critical signs and symptoms of SUD in the nursing profession are noted below.
Behavioral Signs
- Preferring to give the highest dose of medication to patients.
- Frequently volunteering to be the one who administers medication.
- Frequently wasting or breaking medication.
- Having issues with managing medications that are strictly controlled.
- Receiving complaints from patients that their pain medication isn't working well.
- Liking to work shifts when there's less supervision.
- Showing sudden changes in mood, being anxious, or having emotional outbursts.
- Struggling to get along with colleagues and bosses.
- Being forgetful or having trouble remembering things.
- Taking many breaks or being away without explanation.
- Often being late, not showing up for work, or calling in sick, especially after days off.
- Keeping messy or confusing records.
Physical Signs
- Trembling or shaking hands.
- Slurred speech.
- Falling asleep suddenly.
- Watery eyes with unusual pupil size.
- Sweating a lot.
- Walking unsteadily.
- Having a runny nose.
- Feeling sick to the stomach, throwing up, or having diarrhea.
- Notable changes in weight.
- Wearing long sleeves or lab coats often to cover up.
The Washington State Board of Nursing
The Washington State Board of Nursing, formerly known as the Washington State Commission on Nursing, oversees the state's nursing profession by setting minimum licensure standards and monitoring licensed nurses throughout the state. Under Washington State's Nurse Practice Act, the Board is granted authority contained in Title 18 Chapter 18.79 of the state's Revised Code (addressed thoroughly below). Under the Act, the Board sets and enforces standards for competent patient care as well as rules of professional and ethical practice.
Pursuant to Title 18, Chapter 18.130.055 of the state's Uniform Disciplinary Act, the Board is authorized to deny, suspend, restrict, or revoke a nurse's license in instances of professional or ethical misconduct. The Board's disciplinary authority also enables it to initiate disciplinary consequences when nurses are subject to current prosecution or pending charges, including charges related to substance abuse, sale, and distribution.
Substance Abuse Violations Under the Nurse Practice Act
Section 18.130.180 of the state's Revised Code notes the various misconduct allegations that can trigger disciplinary proceedings in Washington. In addition to misconduct issues such as negligence, practicing beyond scope, and documentation issues, the Board is authorized to pursue disciplinary actions for the following substance-abuse-related misconduct:
- “The possession, use, prescription for use, or distribution of controlled substances or legend drugs in any way other than for legitimate or therapeutic purposes.
- The diversion of controlled substances, the violation of any drug law, or prescribing controlled substances for oneself.
- The current misuse of alcohol, controlled substances, or prescription drugs.”
What Instances Prompt Substance Abuse Referrals to the Nursing Board?
Sometimes, substance abuse investigations are triggered by occurrences outside the workplace, like a DUI or a substance abuse-related arrest. Most other times, they are initiated due to alleged misconduct at the workplace that is lodged by a variety of people, such as colleagues, supervisors, or even patients. While each complaint will vary, many substance abuse-related complaints can stem from the concern that you were under the influence during work hours or showed up to a shift hungover. Some other things that can trigger a complaint include:
- Positive drug tests during pre-employment screenings or when conducted for specific reasons.
- Indications of alcohol consumption, such as noticeable odor or behaviors linked to impairment.
- Unlawful consumption, improper disposal, or non-adherence when managing medications or administering them to patients.
- Inconsistencies in documentation or the manipulation of medication tracking systems.
What Happens After Being Reported for Possible Substance Abuse?
Investigation
After the Board receives a complaint, it will launch a formal investigation into the matter. As part of the investigation, you will likely be asked to respond via a written or oral statement. Failure to comply with this, as well as other investigatory requests, can trigger additional disciplinary complaints from the Board.
Throughout the investigation, investigators will use a variety of investigative methods, including interviewing witnesses, collecting evidence, and reviewing documents. At the close of the investigation, the investigator will either close the matter if they determine there isn't enough evidence to support the allegations against you, or they will continue to advance through the disciplinary proceedings.
Formal Consent Agreements
A consent agreement, also called a settlement agreement, is a legally enforceable contract that exists between a nurse facing disciplinary charges and the Board of Nursing. Consent agreements typically include terms and conditions that nurses are obligated to fulfill over a designated timeframe as a trade-off for resolving their pending disciplinary issues. In substance abuse-related cases, consent agreements may require nurses to participate in “voluntary” rehabilitation programs, submit to routine drug screenings, and comply with supervision requirements at their place of employment.
Administrative Hearings and Appeals
If the parties cannot agree to the terms of the settlement agreement, the matter proceeds to an evidentiary hearing consisting of evidence, testimony, and argument. These hearings operate like a small trial and take place in front of a neutral decision-maker. If a nurse is not satisfied with the decision issued after the hearing, they can opt to pursue an appeal.
If you have already turned down a consent agreement and are facing an administrative hearing or an appeal, our Professional License Defense Team can help. Do not feel like your chances of succeeding are gone because you were not able to reach a settlement agreement with the Board of Nursing. Contact a member of our Team today by calling us at 888-535-3686 or by filling out a brief contact form.
Why Consider a Consent Agreement?
Nurses may be motivated to sign a consent agreement for several persuasive reasons. First and foremost, consent agreements can be appealing as they allow for the avoidance of a formal disciplinary proceeding. The Board of Nursing may also tell nurses that they will be permitted to continue to work if they sign the consent agreement and participate in the state's rehabilitative program, something that may not be guaranteed if they wait for the results from a disciplinary hearing. For nurses motivated to address substance abuse issues, they may see signing the agreement as a commitment to their sobriety and rehabilitation.
It's essential to recognize that while the immediate advantages of entering into a consent agreement might appear favorable, they can bring long-term consequences. Consulting with our Professional License Defense Team can provide you with valuable insights and help you explore alternative options.
Potential Drawbacks to Signing a Consent Agreement
The reality is that consent agreements can be misleadingly advantageous. Washington state nurses should deeply consider all of the possible extensive consequences of these agreements before relinquishing their independence, incurring debt, or even admitting to a substance abuse violation that did not occur. Some of the potential drawbacks of consent agreements are explored below.
Professional Repercussions
Although consent agreements are typically “confidential,” many nurses with active agreements will have a hard time hiding the agreement from their colleagues and supervisors. Frequent drug tests, support groups, and professional monitoring forms that must be filled out by supervisors can all create noticeable distractions in the workplace.
Restrictions and Monitoring Burdens
Many nurses are unaware of the significant restrictions, time constraints, and monitoring burdens that often accompany consent agreements. Drug testing, group therapy, and frequent performance monitoring can significantly interfere with a nurse's professional commitments and personal responsibilities. Although nurses may think that peer support groups, drug testing companies, and rehabilitative programs may be willing to work with their schedule, this may not be the case.
Legal Implications
Consent orders are legal agreements that, if violated, can automatically result in the suspension or revocation of a nurse's license. Even when suspensions or revocations do not occur, the Board of Nursing usually keeps a record of any failure to comply. As a result, any subsequent allegations of misconduct can bring harsher repercussions since the nurse's history of non-compliance may influence the decision.
Financial Consequences
Many nurses also may not understand that by accepting a consent agreement, which includes enrollment in rehabilitation programs, they are agreeing to pay for the program's costs themselves. The financial burden of these programs can vary widely based on their duration and type, potentially leading to significant expenses. Moreover, the fees for routine drug testing can increase cumulatively based on the required frequency of the tests.
Alternative-To-Discipline Programs
Many states provide alternative-to-discipline programs as rehabilitative options for nurses grappling with substance abuse challenges. These initiatives are frequently a component of consent order agreements, including a wide range of stipulations, depending on the allegations and substance abuse violations involved. Typical features of these programs include enrollment in a structured treatment program, ongoing professional oversight, counseling sessions, routine drug screening, and assistance to tackle the underlying factors contributing to substance abuse. As a rule, these programs permit nurses to remain employed while they fulfill the requirements specified in their consent order agreements. In Washington, this alternative-to-discipline program is known as "c," which is addressed further below.
Washington's Health Professional Services
Washington's alternative-to-discipline program, known as the Washington Health Professional Services program, operates alongside the state's Nursing Care Quality Assurance Commission (NCQAC). The NCQAC is the state's approved monitoring program that assists nurses with substance abuse disorder by providing them with a program that safely monitors their substance abuse recovery.
NCQAC's “philosophy governing voluntary substance abuse monitoring programs” aims to provide early recognition and treatment options for nurses who may have become chemically dependent on alcohol or drugs. The commission further states that its goal is to ensure that nurses can be treated in a rehabilitative manner and allows the system to continue to practice in their profession.
Services Offered by NCQAC
After a nurse is identified or referred for treatment, the program provides structured monitoring services administered by a team of case managers trained in substance abuse disorder. Throughout the program, each nurse receives a case manager who monitors their program participation throughout the entirety of their treatment plan.
As part of the program, nurses must also find and participate in a peer support group comprised of other nurses who are also struggling with substance abuse issues. Peer support programs take place on a weekly basis, and attendance is required. The meetings are led by medical professionals who are trained in substance abuse knowledge.
NCQAC's Peer Assistance Screening Tool
In order to determine whether the program may be an appropriate fit for nurses, NCQAC offers a Peer Assistance Screening Tool, which helps nurses identify early alcohol or drug use symptoms that may be an indication of substance abuse disorder. The various screen tools offered include:
- The alcohol, smoking, and substance abuse screening test.
- The involvement screen test evaluates substance use across a nurse's lifetime and then, especially in the past three months.
- The Alcohol Use Disorder Identification Test
- The Drug Abuse Screening Tool
- The Cannabis Use Disorder Identification Test
- The “Car, Relax, Alone Forget, Friends, Trouble” Test that screens adolescents for alcohol and drug use within the past 12 months.
- The Screening to Brief Intervention Tool, a test designed to screen adolescents for tobacco, alcohol, and drug use.
Program Requirements
Evaluators
As part of the intake process, nurses must submit to a substance use disorder evaluation and adhere to a recommended treatment plan. The Board will only accept evaluations that are performed by a Substance Use Disorder Professional or other qualified professional such as a psychiatrist, psychologist, or advanced nurse practitioner. Although nurses are free to choose any qualified provider that is certified in Washington State, they must be fully responsible for all the costs associated with the evaluation.
Evaluations are only accepted if they provide a thorough assessment and diagnosis. Evaluations must also reflect the nurses' ability to provide safe care and offer treatment recommendations. After approved by WHPS, nurses must adhere to the program's treatment plan. Depending on the case, a treatment plan may also address additional behavioral health concerns by a thorough mental health evaluation and treatment plan.
In instances where the plan is a condition of a nurse's consent agreement, it must be perfectly adhered to, or nurses can face the risk of further disciplinary consequences.
Intake Evaluation Requirements include:
- A completed bio-psychosocial history.
- The use of two chemical dependency tools.
- A written verification of the nurse's license history provided by the Washington Department of Health.
- A reviewing driving abstract provided by the nurse at the time of the evaluation.
- A criminal history report provided by the nurse at the time of the evaluation.
- An “observed” baseline urine drug screening.
- A current diagnostic that discusses the diagnoses as per the Statistical Manual of Mental Disorders (DSM 5) diagnosis and justification.
- Patient Placement criteria and recommendations, including pain management evaluations per the Six Dimensions of ASAM Criteria.
- A professional opinion regarding the safety of practice
- A list of collateral information
- Any other additional information that may be relevant to the nurse's unique situation.
Treatment Providers
Following the evaluation and drafting of the treatment plan, treatment providers must maintain frequent and ongoing contact with the WHPS in the form of monthly treatment progress reports. Although the providers must submit these to WHPS, it is the nurse's responsibility to ensure that their providers send these to WHPS. Once again, failure to perfectly adhere to this requirement can result in additional disciplinary concerns. Treatment providers must also ensure that they provide WHPS with a written notice prior to discharging the nurse. The notice must specify a discharge strategy as well as plans for aftercare.
Intake Procedures
After a nurse has been appropriately evaluated and selected as an approved treatment provider, the NCQAC conducts an intake process designed by WHPS. The purpose of this intake is to establish the “contract terms” that will be in place. Although case managers offer guidance and recommendations that can be woven into a nurse's contract terms, NCQAC notes that terms may be dependent upon the nurse's “circumstances and needs.” The following items will generally be discussed at this intake conference:
- A discussion of the nurse's history and current situation.
- Confirmation of the nurses' verified willingness to take part in the program voluntarily.
- Identification of contact information, referral circumstances, substance use, treatment history, and any applicable mental health and medical history.
- A discussion of the nurse's program eligibility, referral type, license status, and demographic information.
- A description of the WHPS services the nurse will receive.
- The Stipulation to Informal Disposition, Agreed Order, and Final Order.
- A discussion of the Intake Interview, with a review of the nurse's demographic assessment, employment, health, psychiatric, and family/social histories.
- A review of any legal orders, the complaint, and prescription monitoring program reports.
- Release of Information authorizations.
- SUD evaluation.
Employment Agreements
As a condition for the ability to continue in the nursing profession, WHPS requires nurses to communicate their participation in the program to employers as well as future employers. Throughout employment, WHPS continues to stay in contact with the nurse's employer and may request or provide information about the nurse's participation status, readiness to resume work, and any necessary worksite monitoring in place.
If a nurse is interviewing with a new employer, they must have their new employer sign an “Employment Agreement” that details all of their practice restrictions from the WHPS. The nurse's WHPS Case Manager will then discuss the details of the limits with the potential employer to ensure job approval, as well as the employer's plan to appoint a worksite monitor and direct clinical supervisor.
Consult Our Professional License Defense Team Before Agreeing to a Consent Order
Before considering a consent agreement with the Washington Board of Nursing to resolve substance abuse misconduct, you must consult with our Professional License Defense Team to ensure that you have a comprehensive understanding of any potential consequences you may face. Although you may believe you have no choice but to accept a presented consent agreement, this is not true, and the Washington Board of Nursing will not help you consider the various strategic defenses or alternative routes. This is especially true when considering the fact that consent agreements are often cheaper and more accessible for the Board of Nursing to manage when compared to a costly and time-consuming administrative hearing. Our Professional License Defense Team can also propose alternative solutions or compromises you may be unaware of.
Contact The Professional License Defense Team Today
Our Team has successfully navigated nursing misconduct allegations nationwide and especially within Washington state. Our Team is ready to help you consider whether a consent agreement with the Washington Board of Nursing is the best route for your unique circumstances. Don't hesitate to fight for your future and protect your reputation! Contact a member of our Professional License Defense Team today by calling us at 888-535-3686 or by filling out a brief contact form.
