Anyone can suffer from alcohol and substance use disorders, and nurses are no exception. Being a nurse is a physically and emotionally stressful job. As a nurse, you might think that medical professionals are held to a higher standard and that you are meant to handle more than others, but that is not true. Alcohol and substance use disorders can happen to anyone, and unfortunately. Studies have shown there was an increase in alcohol and substance use disorders in nurses during the COVID-19 pandemic, which made an already stressful professional nearly unmanageable.
If you are an Arizona nurse dealing with alcohol or substance use disorder, there is nothing to be ashamed of. The Lento Law Firm Professional License Defense Team understands how hard you worked to become a nurse, how much your career means to you, and the need to protect your Arizona nursing license. Our Team is here to help you without judgment. At the Lento Law Firm, our goal is to help you get the treatment you need while minimizing any negative impacts on your Arizona nursing license. If you're facing a threat to your Arizona nursing license due to alcohol or substance use, the Lento Law Firm can guide you in weighing your options and potentially pursuing a non-disciplinary alternative. Call the Lento Law Firm Professional License Defense Team today at 888-535-3686 or schedule your consultation online.
Arizona Nurse Regulatory Body
The Arizona State Board of Nursing regulates all things related to nursing in the state of Arizona. The Board of Nursing's mission is to protect and promote the public's welfare by ensuring that each certified or licensed nurse is competent to practice safely. The Board of Nursing accomplishes this goal by providing nurses with education and guidance documents and establishing requirements for certifications and licensures. Additionally, the Board of Nursing fields all complaints and disciplinary actions against Arizona nurses who have violated the Arizona Nurse Practice Act or other nursing regulations and rules. When dealing with disciplinary matters related to alcohol and substance use disorders, the Board of Nursing has the authority to allow nurses in specific situations to avoid disciplinary action through the Alternative to Discipline Program.
What is the Alternative to Discipline Program?
The Alternative to Discipline Program is the Board of Nursing's non-disciplinary monitoring program for registered nurses, licensed practical nurses, and advanced practice registered nurses. Alternative to Discipline is available to nurses with substance use disorders, medical or mental health conditions, nurses who are at risk for these disorders or conditions, or nurses with a combination of these disorders or conditions.
The Board of Nursing details two purposes for the development and implementation of the Alternative to Discipline program: “(1) [to] ensure the public's safety through early detection, treatment, and monitoring of nurses who have or are at risk for any of the listed conditions that could potentially impact nursing practice; and (2) [to] provide the opportunity for rehabilitation for nurses who acknowledge they have, or are at risk for, a condition that may impact their nursing practice, and wish to obtain the treatment and/or support needed to maintain safe nursing practice.”
Nurses with drug or alcohol use disorders have the option of participation in the Alternative to Discipline's Chemically Addicted Nurse Diversion Option (CANDO) Pathway (also referred to as the CANDO Track). Nurses participating in the Program will agree to and sign a stipulated agreement allowing for the confidential treatment, rehabilitation, and monitoring of a nurse's chemical dependency. The Agreement will remain confidential and not be released into the public record so long the nurse complies with the following conditions:
- The nurse participates in the Alternative to Discipline Program CANDO Track
- The nurse complies with all treatment requirements or recommendations
- The nurse refrains from the practice of nursing until the return to nursing has been approved by the treatment program and the executive director
- The nurse complies with all monitoring requirements of the stipulated Agreement, including random drug testing
- The nurse's employer is notified of the nurse's chemical dependency and participation in the confidential Program and is provided with a copy of the stipulated Agreement
Eligibility for the Alternative to Discipline Program
There are many requirements a nurse must meet to be eligible for the Alternative to Discipline Program CANDO Track. For starters, the Alternative to Discipline Program is only accessible to registered nurses and licensed practical nurses overall.
Interestingly, it isn't only nurses with active Arizona nursing licenses who can apply for the Program. If a nurse is practicing in another state and currently participating in that state's version of the Alternative to Discipline Program and is currently seeking approval for an Arizona nursing license application can also apply. The caveat is that nurse must get the written approval of their respective state's board of nursing to apply for Arizona's Alternative to Discipline Program.
The additional requirements for the Alternative to Discipline CANDO Track are as follows:
- Voluntarily request admission to the Alternative to Discipline CANDO Track program
- Sign a written document agreeing to comply with all elements of the Alternative to Discipline Program Stipulated Agreement
- Acknowledge the use of drugs or alcohol in a manner that may affect their ability to practice safely and in compliance with the Arizona Nursing Practice Act
- Has not been terminated by their employer for noncompliance with any Alternative to Discipline equivalent program by any other state board or state board program
- Their nursing practice problems have not caused significant harm or death to a patient
- Has not engaged in the diversion of drugs or other substances for the purpose of sale or distribution to others
- Has not engaged in behavior that has night potential to cause patient harm, such as diverting drugs by replacing the drug with another or with an unsterile solution
- Is under investigation by another state board of nursing, whether it is related or unrelated to their entry into the Alternative to Discipline Program, and which results in probation, suspension, surrender of or revocation of their nursing license in that state
- Is otherwise eligible for continued Arizona licensure
- Agrees to abstain from the use of alcohol and other potentially addictive drugs
- Agrees to abstain from long-term chronic use of controlled substances and potentially impairing medications
- Has not fraudulently written a prescription for a third party
- Has not engaged in high-risk criminal behavior, including crimes involving sexual misconduct or crimes involving violence or threatening behavior, which can impact safety to practice
- Agrees to limit their nursing practice to only Arizona and hold only an Arizona nursing license within the Alternative to Discipline Program
- Agrees, if required, to temporarily stop practicing nursing while completing treatments or other requirements
Additionally, and unlike many other state programs, a nurse may have previously, although only one time, participated in an alternative to the Discipline Program without relapse and remain eligible for the Arizona program.
How Can I Enter the Alternative to Discipline Program?
Entering the Alternative to Discipline Program is a multi-step and complicated process. You must be careful to follow every part of the process, or you can expect your application for the Program to turn into an investigation by the Board of Nursing that will have drastically different consequences. If you decide to pursue an application to the Alternative to Discipline Program, your Lento Law Firm attorney can help ensure your application is completed correctly and within the appropriate time frame.
The process will begin with the Board of Nursing receiving a complaint or self-report about the alcohol or substance use concerns. The nurse will then receive an Alternative to Discipline Program Contact Letter informing the nurse of the complaint and their potential eligibility. The letter will include contact information for an Alternative to Discipline Consultant. The nurse must respond to the consultant within ten days; this is important because if the nurse does not respond within this timeframe, the complaint is sent to the Board of Nursing for a disciplinary investigation.
If the nurse responds within the appropriate time, acknowledges their alcohol or substance use disorder, and requests entry into the Program, the process for determining eligibility and approval will begin. The process begins with the Alternative to Discipline Director, or someone they designate, conducting an interview and assessment with the nurse. During this interview, the nurse will sign consent forms to release relevant information to the Alternative to Discipline Program personnel. This information can include medical records, pharmacy records, psychiatric and psychological treatment records, substance abuse treatment records, and employment records, among other information.
The nurse must also submit the Alternative to Discipline Program Confidential Evaluation Agreement form. This form requires the nurse to obtain any evaluations the Board of Nursing and the Alternative to Discipline Program staff deem necessary. There are very strict guidelines for when the nurse must schedule and attend these evaluation appointments and deadlines for when the evaluator must submit their reports to the Board of Nursing. One type of evaluation the nurse may be required to complete is an alcohol or substance abuse assessment, which will be discussed in greater detail below.
After reviewing this information, the Program Consultant will decide what restrictions would be imposed for the nurse to participate in the CANDO Track. These restrictions are memorialized in an Alternative to Discipline Stipulation Agreement. If the nurse agrees to these terms, they will sign the document, which will be sent to the Alternative to Discipline Program Director or Consultant for approval. The Stipulated Agreement and entry into the Alternative to Discipline Program become effective on the approval date.
What is an Alcohol or Substance Abuse Assessment?
A nurse applying for the Alternative to Discipline CANDO Track may be required to complete an alcohol or substance abuse assessment by a qualified provider. States differ in their requirements for what makes a provider qualified to conduct these assessments. These assessments are typically done by a physician or advanced practice registered nurse specializing in addiction. Your Alternative to Discipline Program Consultant will let you know if a provider with any specific certification needs to complete your evaluations.
Some primary care physicians will have this certification, but not all, so confirm before making an appointment. As mentioned above, there are strict and specific rules and timelines for making appointments and completing evaluations and steep consequences for failing to comply with these requirements.
There are a few certification programs for providers specializing in addiction. One of the most common certification programs is through the Addictions Nursing Certification Board. If you need assistance finding a provider that meets the certification requirements for your alcohol or substance abuse evaluation, the American Academy of Addiction Psychiatry and the American Board of Addiction Medicine have resources available to assist you in locating a qualified provider in your area.
These assessments generally cost between $250 to $500. Unfortunately, the Alternative to Discipline Program does not cover any costs related to applying to or participating in the Program. Some insurance companies may cover the cost. You may want to contact your insurance provider before scheduling your evaluation to see if this service is covered and if they have any providers to suggest that are in network with your plan.
Components of an Alternative to Discipline Program Stipulated Agreement
An Alternative to Discipline Program Stipulated Agreement will remain confidential as long as the nurse complies with the Agreement. The nurse's information and Stipulated Agreement will only be released to other nursing regulatory boards where the nurse holds or is seeking licensure. Each Stipulated Agreement will be case-specific, and the requirements will differ to meet both the nurse's medical needs and public health and safety. There are many requirements and treatments the Alternative to Discipline Program Consultant may include in the Stipulated Agreement; some of these include:
- Medical treatment
- Mental health treatment
- Substance use disorder treatment
- Alcoholics Anonymous or Narcotics Anonymous attendance
- Nurse Recovery Group Attendance
- Random drug screening
- Abstaining from all potentially addictive substances, including alcohol and prescription drugs
- Direct supervision of the nurse by a registered nurse or medical doctor while practicing
- Medical or mental health care provider involvement
The duration of the Stipulated Agreement and participation in the Alternative to Discipline CANDO Track can vary; most are three years.
What are the Pros and Cons of Entering the Alternative to Discipline Program?
The Alternative to Discipline Program CANDO Track can be a good path for a nurse facing addiction. Still, it is important that any nurse considering participating in the Program weigh all the pros and cons before making the years-long commitment. After reviewing your case, your Lento Law Firm attorney will help you compile a comprehensive list of the benefits and risks of entering the Alternative to Discipline Program and help you make the best decision for your help and your Arizona nursing license. Of course, the risks and benefits of participation in the Alternative to Discipline Program are case-specific; we will discuss a few of the general pros and cons of the Program below.
Pros
By participating in the Alternative to Discipline Program CANDO Track, you will be able to focus all your energy on your alcohol and substance use disorder treatment and recovery. If you are truly ready to embark on this difficult journey, participation in the CANDO Track allows for limited distraction and holds you accountable for fully participating in both physical and emotional treatment programs and frequent drug testing. Participation in the CANDO Track is often the only way to address alcohol and substance use disorder without having your addiction impact your license. When participating in the CANDO Track, your Arizona nursing license should have no long-term impacts so long as you do not violate the requirements of your Stipulated Agreement.
There are also reputational benefits to the Alternative to Discipline Program CANDO Track. Participation is proactive as opposed to reactive. This means that you are entering voluntarily as a means of preventing harm instead of as a result of harming a patient, as is common with disciplinary actions against your license. Taking a proactive step is noble and responsible, and hopefully, your friends, family, and colleagues will be more supportive in response. That being said, the Alternative to Discipline Program keeps your information confidential; it is completely up to you to whom you share your alcohol and substance use disorder information. The confidential nature of the Alternative to Discipline Program allows you to keep control over the narrative.
Cons
The Alternative to Discipline Program CANDO Track looks like the best of both worlds, confidentially dealing with your alcohol and substance use disorder while having minimal, if any, impact on your Arizona nursing license, but that is an oversimplification of how it all works. While on paper, the Alternative to Discipline Program CANDO Track is great, it overlooks the realities of alcohol and substance use disorders. It is incredibly difficult, even with support, to fight off addiction, and this fight is an ongoing, life-long journey. Completing treatment programs doesn't guarantee life-long success, and the CANDO Track does not allow room for relapse, a normal but unfortunately common occurrence in addiction treatment. The consequences of a relapse in the Program are significant; relapses can be viewed as noncompliance and can result in the nurse being kicked out of the Program and immediately put before the Board of Nursing for disciplinary action.
Because of the long-term nature of addiction, participation in the CANDO Track is long. As discussed previously, generally, the Program lasts three years. That is a long time to have the Board of Nursing carefully monitoring every move you make. While this may hold you accountable for your sobriety, it can be difficult to deal with limitations or restrictions placed on your license for the duration of the Program. Even once the Program is over, your employer and the Board of Nursing may keep a closer eye on you than they would on others in the general nursing population, which can feel suffocating and unfair.
Additionally, suppose you have had a one-off incident with drugs or alcohol that has you in a bit of trouble. In that case, the Alternative to Discipline Program should also not be viewed as an easy way to get out of disciplinary action by the Board of Nursing. As stated above, participation in the CANDO Track is extensive and long-term. If you have an isolated incident, you could be better off having your Lento Law Firm attorney negotiate directly with the Board of Nursing to come to an appropriate resolution, ideally a warning or reprimand, as opposed to navigating a multi-year program that is a waste of time and money for both you and the Board of Nursing.
Retain the Lento Law Firm Today
If you are an Arizona nurse suffering from alcohol or substance use disorder, the Lento Law Firm's Professional License Defense Team can help. Deciding whether to pursue the Alternative to Discipline Program CANDO Track or take your chances in the disciplinary process is challenging. Our Team will walk you through all the risks and benefits and potential long-term consequences of all options so you can make the decision that is best for you. Let us help you; call us today at 888-535-3686 or contact us online.
