Wisconsin Substance Abuse Programs: What Nurses Need to Know Before Signing Consent Agreements

If you're a nurse in Wisconsin State facing a substance abuse-related investigation launched by the Board of Nursing, you might be considering submitting to the “voluntary” rehabilitative program in order to settle any disciplinary investigation you are facing. 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 Wisconsin 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 ANA finds that 6-8% of nurses have substance use impacting their job, with rates of misuse (10-15%) mirroring the general population, indicating at least one in ten nurses may struggle with substance use 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

  • Showing a preference for administering the maximum dosage of medications to patients.
  • Regularly offering to administer medications.
  • Often involved in the wastage or breakage of medications.
  • Experiencing difficulties in handling tightly controlled medications.
  • Facing complaints from patients regarding the ineffectiveness of their pain medications.
  • Preferring to work during times of reduced supervision.
  • Experiencing abrupt shifts in mood, including anxiety or emotional outbursts.
  • Finding it challenging to maintain positive relationships with peers and superiors.
  • Exhibiting forgetfulness or memory issues.
  • Frequently taking excessive breaks or disappearing without a clear reason.
  • Habitually arriving late, failing to appear for shifts, or calling in sick, particularly following days off.
  • Maintaining disorganized or unclear records.

Physical Signs

  • Exhibiting hand tremors or shaking.
  • Speaking with a slur.
  • Experiencing episodes of suddenly dozing off.
  • Presenting with watery eyes and abnormal pupil dilation.
  • Sweating excessively.
  • Demonstrating an unsteady gait.
  • Experiencing nasal congestion or a continuous runny nose.
  • Suffering from nausea, vomiting, or diarrhea.
  • Undergoing significant weight fluctuations.
  • Frequently wearing long sleeves or lab coats, potentially to conceal marks.

The Wisconsin State Board of Nursing

The Wisconsin State Board of Nursing, formerly known as the Wisconsin State Commission on Nursing, oversees the state's nursing profession by setting minimum licensure standards and monitoring licensed nurses throughout the state. Under Wisconsin 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.

Wisconsin Nurse's Association

The Wisconsin Nurses Association (WNA) advocates for over 95,000 registered nurses in Wisconsin by creating programs that enhance nursing standards, workplace ethics, and a nurse's overall well-being. Membership is available to registered nurses with an active or eligible license not under suspension or revocation, including those in recovery who have surrendered their license due to impairment.

Under the Association's bylaws, members are assured fair hearing consisting of due process prior to any disciplinary actions. Due process is a legal term that affords someone the right to be notified about the allegations against them and present their side of the story to a neutral decision-maker prior to facing any potential consequences. The WNA's Bylaws further grant the Board the authority to pursue disciplinary charges in instances where a nurse violates any policies or codes issued by the Wisconsin Nursing Association or the American Nursing Association.

Substance Abuse Violations Under the Nurse Practice Act

Wisconsin nurses facing allegations of substance abuse-related misconduct often find themselves in this predicament due to a handful of substance abuse-related misconduct issues. These include: 1) practicing while under the influence, 2) misappropriation or mishandling of illicit medications, particularly prescription medications or opioids, 3) compromised ability to practice safely due to impairment, and 4) arrests and convictions for DUI and other related misdemeanors or felonies. These substance-abuse-related issues are thoroughly discussed in the state's Rules of Conduct (summarized below) for the nursing profession, which address the various misconduct grounds that enable the Wisconsin Board of Nursing to pursue disciplinary action.

Practicing While Under the Influence

Practicing while under the influence occurs when nurses perform their work duties while impaired by alcohol, drugs, or other substances. This misconduct can also extend to practicing while taking prescription medication beyond what may be medically necessary. Some professionals who are using illicit drugs recreationally may not even realize that substances are still in their system days later. AmericanAddictionCenters.org notes that the half-life of drugs can vary significantly from person to person, entirely. Some examples of varying half-lives include:

  • Heroin: 1-3 days.
  • Cocaine: 2-3 days.
  • Marijuana/THC: 1-7 days.
  • Meth: 2-3 days.
  • MDMA: 2-4 days.

Wisconsin's Rules of Conduct prohibit practicing while under the influence in the following sections:

  • Practicing nursing while under the influence of alcohol or illicit drugs or while impaired by the use of legitimately prescribed pharmacological agents or medications.
  • Unable to practice safely because of alcohol or other substance use.

Misappropriation or Mishandling of Illicit Substances

In 2023, a Janesville Nurse was sentenced to 15 months in prison after she was caught stealing fentanyl while on the clock at SSM Health St. Mary's Hospital. Officials also accused the nurse of tampering with the Pyxis machine, an automated machine designed to dispense medication in the hospital. The matter led to further investigations by the Food and Drug Administration and the Drug Enforcement Agency at the hospital.

Misappropriating or mishandling violating can occur when nurses divert controlled substances that they have access to at their job for personal use. Aside from facing misconduct allegations that threaten their nursing license, drug diversion can also result in criminal penalties for theft and substance diversion. Wisconsin prohibits misappropriation by noting the following in the Rules of Conduct:

  • Improper prescribing, dispensing, or administrating medication or drug-related offenses, including any of the following:
    • Prescribing of any drug other than in the course of legitimate practice or as otherwise prohibited by law.
    • Dispensing of any drug other than in the course of legitimate practice or as otherwise prohibited by law.
    • Administering any drug other than in the course of legitimate practice or as otherwise prohibited by law.
    • Error in prescribing, dispensing, or administering medication.
    • Obtaining, possessing, or attempting to obtain or possess a drug without lawful authority.

Impaired Practice Abilities

Nurses who are currently under the influence of substances or show up to work hungover may have impaired practice abilities as their body adjusts to the substances in and leaving their systems. Under these circumstances, they may make poor clinical decisions, interpret patient data, or even fail to recognize critical patient condition changes. Impairment can also affect a nurse's medication administration, making them more likely to administer incorrect dosages or the wrong medication altogether, exposing their patients to harm and liability issues. Wisconsin prohibits impaired practice abilities by noting the following in the Rules of Conduct:

  • Engaging in repeated or significant disruptive behavior or interaction with health care personnel, patients, family members, or others that interfere with patient care or could reasonably be expected to impact the quality of care rendered adversely.
  • Failing to perform nursing with reasonable skill and safety.
  • Departing from or failing to conform to the minimal standards of acceptable nursing practice may create unnecessary risk or danger to a patient's life, health, or safety. Actual injury to a patient need not be established.

Substance-Related Misdemeanors and Convictions

Aside from the criminal consequences that can follow a substance-related misdemeanor or felony conviction, The Wisconsin Board of Nursing has the authority to pursue disciplinary charges against nurses entangled with substance-related criminal matters. Pursuant to the state's Conduct of Conduct, nurses must notify the Board of any felony or misdemeanor in writing within 48 hours after the entry of the judgment of conviction, including the date, place, and nature of the conviction or finding. After considering the relevant information surrounding the event, the Board may determine whether the circumstances of the crime of which the credential holder was convicted are substantially related to nursing practice.

What Instances Prompt Substance Abuse Referrals to the Nursing Board?

When you first learn that the Wisconsin Board of Nursing is investigating you for substance abuse issues at work, you likely are wondering, “Who reported me and why?” Unfortunately, you may never find out whether a supervisor, colleague, or patient reported you. However, the Board should inform you about the nature of the allegations, meaning the alleged misconduct. Sometimes, substance abuse investigations are triggered by occurrences outside the workplace, like a DUI or a substance abuse-related arrest. Other times, 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?


After receiving a complaint for alleged misconduct, the Wisconsin Board of Nursing initiated a detailed investigation into the allegations. At the beginning of the inquiry, you will typically be required to respond in writing or orally. It's important to note that failure to comply with the Board's request for your participation can lead to further disciplinary actions.

Throughout the investigation, the Board's investigators will utilize a range of methods throughout their fact-finding inquiry. Investigators may conduct interviews with witnesses such as supervisors or colleagues, collect relevant evidence, and examine documents. If the investigation concludes with insufficient evidence to substantiate the claims against you, the case may be dismissed. Otherwise, the process may progress to the following stages of disciplinary action.

Formal Consent Agreements, The “Settlement Stage”

A consent agreement, another term for a settlement agreement, is a legally binding agreement between a nurse who is under disciplinary scrutiny and the Wisconsin Board of Nursing. These agreements usually stipulate specific terms and conditions that the nurse must adhere to within a set period as a compromise for setting their ongoing disputes. In disciplinary actions involving substance abuse, consent agreements often stipulate that nurses enter "voluntary" rehabilitation programs, undergo regular drug tests, and follow supervision protocols at their workplace.

Administrative Hearings and Appeals

Should the parties fail to reach a consensus on the settlement agreement's terms, the case advances to an evidentiary hearing, which involves the presentation of evidence, testimonies, and legal arguments. These hearings are very serious and resemble a mini-trial conducted before an impartial decision-maker. Results from the hearing can range from dismissal of the matter to fines, penalties, and license suspension or revocation. If a nurse finds the outcome of this hearing unsatisfactory, they can seek 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 might be inclined to enter into a consent agreement due to several factors. Consent agreements offer the advantage of circumventing a formal disciplinary process, relieving nurses of an “unknown” hearing decision. While nurses may be temporarily barred from practicing in investigations pending an administrative hearing, the Board may also offer them the option to practice on probation in return for their agreement to the Board's proposed consent agreement. Finally, some nurses who recognize needing help in their sobriety journey may see the consent agreement as a responsible and committed step.

It's important to understand that even though signing a consent agreement might seem beneficial initially, it could have hidden consequential terms. Talking to our Professional License Defense Team[AK3] can offer you helpful advice and show you other possible choices.

Potential Drawbacks to Signing a Consent Agreement

While consent agreements might seem reasonable initially, they can have hidden agendas and requirements that become overly burdensome. Nurses in Wisconsin should think about all the significant impacts these agreements could have, like losing their freedom, getting into debt, or admitting to a substance abuse problem they may not be facing.

Professional Repercussions

Even though consent agreements are often labeled as "confidential," nurses under such contracts may find it challenging to keep the arrangement hidden from coworkers and supervisors. Regular drug screenings, participation in support groups, and the requirement for supervisors to complete professional monitoring forms can lead to apparent disruptions in the workplace.

Restrictions and Monitoring Burdens

Consent agreements often come at the expense of extensive limitations, time commitments, and oversight responsibilities of consent agreements. Obligations such as drug testing, group therapy sessions, and constant performance evaluations can significantly disrupt a nurse's work duties and personal life. While there may be an expectation that peer support groups, drug testing services, and rehabilitation programs will accommodate their schedules, this is not always guaranteed.

Legal Implications

Consent orders are legally binding contracts that, upon breach, can lead to an immediate suspension or cancellation of a nurse's license. Even in cases where suspension or revocation is avoided, the Wisconsin Board of Nursing may maintain documentation of non-adherence. If future misconduct is alleged, the repercussions could be more severe.

Financial Consequences

Many nurses might be surprised to learn that many rehabilitation programs required under the terms of their agreement must be self-funding. The financial impact of these programs can differ significantly, depending on how long they last and what kind they are, possibly resulting in considerable expenses. Along the same vein, the costs for regular drug testing can add up over time, depending on how often these tests need to be conducted.

Alternative-To-Discipline Programs

Many states offer “alternative-to-discipline” programs designed as alternatives to disciplinary action. These programs are aimed at helping nurses deal with substance abuse issues within the confines of conditions outlined in consent agreements. Because each consent agreement can vary from case to case, the terms of a nurse's alternative-to-discipline program can differ based on the nature of the allegations. Common elements of these programs typically include enrollment in a formal treatment plan, continuous professional monitoring, counseling sessions, regular drug tests, and support for addressing the root causes of substance abuse. Generally, these programs allow nurses to continue working while they meet the obligations outlined in their consent agreements. In Wisconsin, such an alternative-to-discipline program is called "Wisconsin's Health Professional Services," which we will discuss in more detail later.

Wisconsin's Nurses Caring for Nurses Program

The Wisconsin Nurses Association's Nurses Caring for Nurses Program is a voluntary, confidential rehabilitative program designed to assist chemically dependent nurses who are struggling with substance abuse-related misconduct. The program operates under the Association's Workforce Advocacy Program, which focuses on providing education, awareness, support, and advocacy during recovery. The program can also help nurses find direct mental health or addiction counseling, intervention, treatment, or monitoring services that may be required as part of a nurse's consent agreement.

While the state doesn't have a lot of information available as to the exact monitoring and testing requirements that are required through their alternative-to-discipline programs, the program likely mirrors that of other states, which are all equally motivated to ensure that their nurses lower liability risk to the public by showing up to work substance free.

Consult Our Professional License Defense Team Before Agreeing to a Consent Order

Before agreeing to a consent agreement with the Wisconsin Board of Nursing for substance abuse issues, consult our Professional License Defense Team to ensure that you understand all of the strategic options that may be available to you. Although signing a consent agreement may seem more straightforward, you may not fully comprehend the potential repercussions. While it might seem like accepting the consent agreement is your only option, that's not the case. The Wisconsin Board of Nursing may not guide you through other strategic defenses or alternatives. Often, consent agreements are favored by the Board because they are less expensive and easier to manage than going through a lengthy and costly administrative hearing. Our team can offer other solutions or compromises you might not know exist, providing you with a broader range of options.

Contact The Professional License Defense Team Today

Our Team has successfully navigated nursing misconduct allegations nationwide and especially within Wisconsin. Whether in a large city like Madison or Milwaukee or a more remote area like Appleton or Kenosha, our team is ready to help you consider whether a consent agreement with the Wisconsin 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 the Lento Law Firm's Professional License Defense Team today by calling us at 888-535-3686 or by filling out a brief contact form.


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