Substance abuse and addiction can result in you losing your nursing license or, at the very least, facing disciplinary action against you by the Texas Board of Nursing (BON). However, the BON also recognizes that substance abuse disorders are treatable. Nurses who receive appropriate treatment and reach a stable recovery can provide safe and quality care under specific circumstances. An experienced nursing license defense lawyer can represent your interests in any disciplinary proceedings resulting from addiction or substance abuse. We can also explain your options and work to achieve a reasonable solution with the licensing board that will focus on treatment, recovery, and a return to nursing practice.
BON Policy on Substance Abuse Disorders and Other Alcohol and Drug-Related Conduct
The BON has issued a formal disciplinary sanction policy on substance abuse disorders and other alcohol and drug-related conduct. This policy statement explains BON’s position on these issues by nurses and nursing license applicants and their procedures for reviewing such conduct. Overall, BON strives to balance the need to protect public health, safety, and welfare by ensuring safe and effective nursing care, acknowledging that substance abuse disorders are treatable conditions that can lead to stable recovery, and nurses who can safely treat patients.
As a result, BON has developed various flexible options in evaluating and remedying the unique circumstances of each case involving nurses who have substance abuse disorders or have engaged in drug or alcohol-related behaviors that may impair their ability to provide safe patient care. Not all substance abuse complaints require disciplinary action; if they do, not all require the same degree of intervention.
Options for BON Intervention in Cases Involving Substance Abuse Concerns
Tex. Occ. Code §301.4521 permits BON to require nurses to undergo a physical or psychological evaluation to determine if they can safely provide nursing care. This section also sets forth specific requirements for that evaluation if their fitness is in question due to a substance abuse disorder or drug or alcohol-related conduct.
If the nurse’s substance abuse disorder or conduct creates immediate or severe fitness concerns, the BON may remove a nurse from practice until it deems them safe to return to those duties. The BON will allow the nurse to undergo treatment and return to nursing care when they demonstrate sobriety and stable recovery for a sustained period. This evidence may include negative drug screens, recommendation letters, proof of attendance at support groups or other forms of treatment, and employer evaluations. Once the nurse returns to practice, the BON may require monitoring, including random drug screening, for a specific period.
In less serious cases, the BON may allow the nurse to continue to practice while participating in a BON-approved peer assistance program. Depending on the circumstances, this oversight might occur through a non-public Board order or a more closely monitored disciplinary order involving random drug screens and supervised practice. These options may be more appropriate when the nurse does not have a diagnosed substance abuse disorder but has exhibited conduct involving drugs or alcohol that may raise questions about the nurse’s ability to care for patients safely.
BON-Approved Peer Assistance Program
22 Tex. Admin. Code §217.13 sets forth the criteria for BON-approved peer assistance programs for nurses in Texas. The purpose of peer assistance programs is to “identify, monitor, and assist with locating appropriate treatment for those nurses whose practice is impaired or suspected of impairment by chemical dependency, mental illness or diminished mental capacity so that they may return to practice safe nursing. These programs are subject to periodic evaluation by BON to maintain its approval.
Participants in BON-approved peer assistance programs for chemical dependency or abuse must agree to certain minimum conditions. These conditions include undergoing an appropriate physical and psychosocial evaluation before entering the program, undergoing recommended treatment, and abstaining from alcohol and drugs. The nurse also must agree to submit to random drug screening, attend specified support groups and aftercare, comply with employment conditions, and sign a waiver allowing disclosure of information to the BON if they do not comply with program requirements.
Alcohol or Drug Use as Grounds for Disciplinary Action
Tex. Occ. Code §301.452(b)(9) states that “intemperate use of alcohol or drugs that the board determines endangers or could endanger a patient” is a ground for disciplinary action against a nurse or denial of a nursing license. “Intemperate use” includes “practicing nursing or being on duty or call while under the influence of alcohol or drugs.”
BON’s Disciplinary Matrix provides for various potential sanctions depending on the severity of the violation, as follows:
- First Tier Offense: Misuse of drugs or alcohol without patient interaction and no risk of harm or adverse patient effects. No previous history of misuse and no other aggravating circumstances
- Sanction: Warning with Stipulations that may include remedial education; supervised practice; public service; random drug testing; limit specific nursing activities, and/or periodic board review. Appropriate when an individual declines participation in a peer assistance program or is ineligible.
- Second Tier Offense: Misuse of drugs or alcohol without patient interaction and no risk of patient harm or adverse patient effects; previous history of a peer assistance program participation or previous Board order.
- Sanction Level I: Board-ordered participation in a Board approved peer assistance program. For individuals diagnosed with no chemical dependency and/or substance abuse/misuse, Reprimand with the same Stipulations as listed above for a First Tier Offense.
- Sanction Level II: Suspension of License until treatment and verifiable proof of at least one year of sobriety; after that, a stay of suspension with the same Stipulations as listed above for a Sanction Level I. For individuals receiving a diagnosis of no chemical dependency and/or no substance abuse/misuse, probated Suspension of License, with same Stipulations as listed above for a Sanction Level I. Temporary Suspension of nursing practice if violation may be continuing and imminent threat to public health and safety.
- Third Tier Offense: Misuse of drugs or alcohol with a risk of patient harm or adverse patient effects.
- Sanction Level I: Board-ordered participation in an approved peer assistance program if there is no actual patient harm and no other aggravating circumstances. For individuals receiving a diagnosis of no chemical dependency and/or no substance abuse/misuse, a Warning or Reprimand with the same Stipulations listed above for a Second Tier Offense. Denial of Licensure until treatment and one (1) year of verifiable sobriety, then license with stipulations that include supervision, limited practice, and random drug testing.
- Sanction Level II: Suspension of License until treatment, verifiable proof of at least one year sobriety, thereafter a stay of suspension with same Stipulations as listed above for a Second Tier Offense. For individuals receiving a diagnosis of no chemical dependency and/or no substance abuse/misuse, probated Suspension of License with the same Stipulations as listed above for a Second Tier Offense. Temporary Suspension of nursing practice if violation may be a continuing and imminent threat to public health and safety.
- Fourth Tier Offense: Misuse of drugs or alcohol with serious physical injury or death of a patient or a risk of significant physical injury or death.
- Sanction Level I: Denial of Licensure, Revocation, or Voluntary Surrender.
- Sanction Level II: Temporary Suspension of nursing practice if violation may be a continuing and imminent threat to public health and safety.
Get Assistance Defending Your Nursing License Today
A substance abuse disorder or alcohol or drug abuse may threaten your ability to maintain your nursing license and continue working as a nurse. Fortunately, the BON has made various avenues available to you so that you can get professional help while maintaining your career. Do not hesitate to get legal assistance if you are in this situation. Contact a Texas nursing license defense attorney immediately if you receive or anticipate receiving notice of disciplinary proceedings due to allegations of substance abuse.