Alternative Program for Chemically Dependent Nurses

Alternative Program for Chemically Dependent Nurses

Board Approved Providers
Substance Use Disorder Guidelines
Substance Use Disorder Courses

An Alternative To Impairment can cost you your job and your license.

Don't wait to be reported.
Ask for help.
Ask the Nevada State Board of Nursing about its Alternative Program for Chemically Dependent Nurses.
We help heal the healers.

If you or someone you know has an addiction, the Nevada State Board of Nursing can help. It runs a successful program for nurses and nursing assistants whose practice may be impaired due to chemical dependency.

The goal of the Alternative Program for Chemically Dependent Nurses is to protect the public by identifying impaired individuals, providing intervention and education, and requiring treatment.

It helps heal the healers, giving them the opportunity to take personal responsibility for recovery while being closely monitored through a nonpublic agreement.


How do people get into the program?
STEP 1. Self report --Nurses and nursing assistants who are willing to admit that their impairment has led to a violation of the Nurse Practice Act and who are willing to go into treatment may enter the program by reporting their problem directly to the Nevada State Board of Nursing.


STEP 2. Temporary surrender of license --Nurses and nursing assistants must agree to temporarily surrender their licenses or certificates until they have established stable recovery and met their treatment requirements of 180 hours of treatment in a Board-approved chemical dependency program, and 90 Alcoholics Anonymous/Narcotics Anonymous meetings in 90 days.


STEP 3. Monitoring --After they complete their treatment requirements, participants must agree to abide by the terms of a nonpublic monitoring agreement, which includes working under an unmarked, conditional license while complying with an agreement designed to closely monitor their practice while in recovery.


Who is eligible?

Nurses or nursing assistants who:

  • report themselves to the nursing board before, rather than after, a complaint is filed ,

  • are licensed or certified in Nevada,

  • abuse alcohol or drugs to the extent their nursing practice has been affected,

  • have had no more than one previous treatment episode, and

  • who sign a voluntary agreement to follow all components of the program.


Who is not eligible?

A nurse or nursing assistant:

  • who has had previous disciplinary action related to impairment from chemical dependency,

  • who, evidence shows, has a long history of diverting drugs, or

  • who has a complaint pending against him or her regarding diversion or impaired practice.


Who runs the Alternative Program?

The Board's compliance coordinator chairs the Board’s Disability Advisory Committee, which administers the Alternative Program for Chemically Dependent Nurses. Committee members include professional substance abuse and mental health nurses and nurses who have recovered from alcohol or drug addiction or have had other life experiences around addictions. The committee:

  • evaluates whether chemical dependence is impairing a person’s nursing practice

  • submits recommendations to the Nevada State Board of Nursing, which may be accepted, amended, or rejected

  • monitors recovery progress through scheduled interviews with the nurse or nursing assistant and regular reports from employers, treatment providers, and the nurses themselves.

What services does the program provide?



For the public:

  • immediate intervention to protect the public as an alternative to a longer disciplinary process

  • coordination and consultation with employers to assure patient safety


For the nurse or nursing assistant:

  • the ability to continue to work as a nurse or nursing assistant

  • consultation about entering the program

  • monitoring and ongoing assessment of their personal recovery

  • random drug and alcohol testing

  • information regarding local professional and support services

  • encouragement, support and guidance in recovery as an effective alternative to disciplinary action

  • removal from monitoring when the program is successfully completed



Is the program successful?

Yes! The majority of participants successfully complete the program. To do so, they must follow all of the stipulations contained in a signed agreement/decree, complete treatment in a Board-approved program, and demonstrate a change in lifestyle that supports continuing recovery. Participants who violate their agreements are subject to disciplinary action by the Board.




How do people get more information?

  • Call toll free 888-590-6726

  • Write 5011 Meadowood Mall Way, Suite 300, Reno, NV 89502-6547

  • Refer to NRS 632.307 of the Nevada Nurse Practice Act


Chemical Dependency in Nurses and Nursing Assistants


Under Nevada law, nurses and CNAs must report potential violations of the Nurse Practice Act. Practicing while impaired is a violation of NRS 632.320 (5) and NAC 632.890 (9).


Chemical dependency is one cause of impairment. The Board’s Disability Advisory Committee has put together this fact sheet to help you identify impairment on the job. If you suspect someone is impaired, urge the individual to seek help. If they refuse, report your suspicions to your supervisors. It may be a difficult decision, but if you do not make it, you will be endangering the health of the patients and the impaired nurse or CNA.




Possible indications of nurse or CNA impairment on the job include:

  • Absent or late for work, especially following several days off. However, the drug-addicted nurse or CNA may never be absent and may “hang around” when not on duty. Because the hospital is the source of supply, the nurse or CNA may volunteer to work double shifts, overtime, holidays, days off, etc.

  • Odor of alcohol on the breath. Any nurse or CNA who would report for duty after drinking is assuming a terrible risk and in doing so is evidencing his/her loss of control and need for the drug.

  • Odor of mouthwash and breath mints. These may be used to mask the odor of alcohol.

  • Fine tremors of the hands. This symptom occurs with withdrawal from the drug. The alcoholic nurse or CNA will sometimes begin to use tranquilizers to mask signs of withdrawal and thus may develop cross dependency.

  • Emotional instability. The nurse or CNA may change from being irritable and tense to being mellow and calm. There may be inappropriate anger or crying.

  • Returns late from lunch break.

  • May be sleepy or may doze off while on duty.

  • Shuns interaction with others and tends to withdraw.

  • Makes frequent trips to the bathroom. The female alcoholic/drug addict may carry a purse with her.

  • Deterioration in personal appearance.

  • Frequent bruises or cigarette burns. Bruises over antecubital fossa and on wrists or hands. These injuries are the result of crashing into furniture, falling while intoxicated, dozing off with a lighted cigarette, or the recent injection of a drug.

  • Job performance may be affected with sloppy or illegible handwriting, errors in charting, and errors in patient care.

  • Lapses in memory or confusion. There may be euphoric recall of events.

  • Shunning of job assignment or job shrinkage. The nurse or CNA is apt to drop out of professional activities.



The nurse who is diverting drugs from the unit may:

  • always volunteer to give medications.

  • medicate another nurse’s patient.

  • use the maximum PRN dosage when other nurses use less, or the maximum PRN dosage may always be used on one shift but not on another (the PRN medications afford the greatest opportunity for the nurse to supply his/her habit).

  • have responsibility for patients who complain that medication given on one shift is not as effective as on others, or that they did not receive medication when the record shows they did.

  • have frequent wastage, such as spillage of drugs or drawing blood in the syringe.

  • work on a unit where drugs are disappearing or seals have been tampered with.

  • always offer to count narcotics to make sure the count is correct.

  • have pinpoint pupils, shaky hands, could be sleepy or hyper while on duty.



Keep in mind that no indicator, or group of indicators, is unique to chemical dependency.


However, if there is a drop off in the work performance of a previously good employee, the supervisor should consider the possibility of a problem if several indicators are present.