La. Admin. Code tit. 46 § XLVII-3419

Current through Register Vol. 50, No. 6, June 20, 2024

Section XLVII-3419 - Alternative to Disciplinary Proceedings

A. Under the provisions of R.S. 37:911 et seq., as re-enacted and amended, the Louisiana State Board of Nursing (board) has the authority to establish and implement a recovering nurse program as an alternative to the disciplinary process. The RNP is established to assist registered nurses or student nurses who have demonstrated actual or potential inability to practice nursing with reasonable skill and safety to individuals because of use of alcohol or drugs; or who have demonstrated inability to practice nursing with reasonable skill and safety to individuals because of illness or as a result of any mental or physical condition, so that such nurses or student nurses can be treated and return to the practice of nursing in a manner which will not endanger the public health, safety and welfare. Only nurses or student nurses whose conditions have reliable indicators of ability for safe nursing practice will be eligible for participation in the RNP.

1. The purpose of the RNP is to encourage the voluntary participation of such nurses or student nurses in appropriate rehabilitative medical treatment and/or ongoing aftercare and monitoring, and to allow for the deferral of administrative proceedings of such nurses under the Louisiana Nursing Practice Law, R.S. 37:911-933.

2. In addition to being an alternative to disciplinary action, the RNP accepts individuals who have been diagnosed with a physical, and/or mental impairment, or substance use disorder and who have disciplinary action ordered by the board.

B. Objectives. The RNP objectives are as follows.

1. Ensure the health, safety and welfare of the public through a program that closely monitors registered nurses or student nurses whose capacity to practice nursing with reasonable skill and safety to patients has been, or may potentially be, compromised because of use of alcohol or drugs, or because of illness or as a result of any mental or physical condition.

2. Promote safe nursing care by preventing and/or restricting the practice of the chemically, physically, and/or mentally impaired nurse or student nurse.

3. Implement a plan for identification, referral to treatment facilities and monitoring of the chemically, physically and/or mentally impaired nurse or student nurse.

4. Establish criteria for identification of a chemically, physically and/or mentally impaired nurse or student nurse.

5. Develop and maintain criteria for identification of acceptable treatment programs.

6. Provide a structured program for nurses and student nurses seeking recovery from the impairment through a non-punitive process.

7. Provide educational programs to the health care community related to the identification and intervention of chemically, physically and/or mentally impaired nurses or student nurses, subsequent treatment alternatives, and monitoring.

C. Operational Definitions

Board-the Louisiana State Board of Nursing.

Compliance-conformity in fulfilling the Recovering Nurse Program agreement.

Confidentiality-all records of a nurse or student nurse who has successfully completed or is in the non-disciplinary alternative program shall not be subject to public disclosure, and shall not be available for discovery proceedings except as required by federal and state confidentiality laws and regulations. The records of a nurse or student nurse who fails to comply with the program agreement or who leaves the program without enrolling in an alternative program in the state to which the nurse moves, or who subsequently violates the Nurse Practice Act or the rules of the board, shall not be deemed confidential except for those records protected by federal and state confidentiality laws and regulations.

Impaired Nurse-a registered nurse or student nurse who has demonstrated actual or potential inability to practice nursing with reasonable skill and safety to individuals because of use of alcohol or drugs; or has demonstrated inability to practice nursing with reasonable skill and safety to individuals because of illness or as a result of any mental or physical condition.

Impairment-problems associated with the actual or potential inability to practice nursing with reasonable skill and safety to individuals because of the use of alcohol or drugs; or inability to practice nursing with reasonable skill and safety to individuals because of illness or as a result of any mental or physical condition.

Non-Compliance-failure to conform with the stipulations of the RNP agreement.

Recovering Nurse Program (RNP)-a program established by the board to identify and assist registered nurses, registered nurse applicants and student nurses whose capacity to practice nursing with reasonable skill and safety to patients has been, or may potentially be, compromised because of use of alcohol or drugs, or because of illness or as a result of any mental or physical condition.

Relapse-the use of a mind or mood altering chemical when total abstinence from all mind- or mood-altering chemicals has been directed.

Student Nurse-an individual who is enrolled in a Louisiana State Board of Nursing-approved program preparing for licensure as a registered nurse.

D. Admission to RNP as an Alternative to Disciplinary Proceedings

1. Participation in RNP may be a choice for individuals whose capacity to practice nursing with reasonable skill and safety to patients has been, or may potentially be, compromised because of use of alcohol or drugs, or because of illness or as a result of any mental or physical condition and who volunteer for assistance, and who meet admission criteria and enroll in lieu of formal disciplinary action.

2. Involvement by the individual in the non-disciplinary alternative will remain confidential, provided that the individual complies with all stipulations in the RNP agreement.

3. Admission criteria include:

a. licensed registered nurse who resides in the state of Louisiana; or graduate of a school of nursing who is eligible for licensure in Louisiana; or registered nurse currently enrolled in a peer assistance program and who is requesting endorsement from another state; or registered nurse currently enrolled in a peer assistance/alternative program and who is licensed in Louisiana and is requesting transfer back to Louisiana, or a student nurse enrolled in a Louisiana State Board of Nursing approved program;

b. voluntarily requests admission to RNP whether referred by self or other sources;

c. addicted to or uses alcohol and/or other mood altering substances including prescription drugs, or has a physical or mental condition, which impairs or potentially impairs the ability of the nurse or student nurse to perform duties safely;

d. no previous disciplinary action within the past two years. No previous peer assistance/alternative program participation unless first relapse uncomplicated by previous history;

e. has no criminal convictions or pending criminal charge pertaining to any crime of violence or other crime referenced in LAC 46:XLVII.3331.A, any crime that involves the distribution of drugs, and/or any crime that demonstrates a lack of fitness to practice nursing;

f. no diversion of chemicals for the purpose of sale or distribution;

g. no dealing or selling of illicit drugs;

h. no co-existing, untreated physical, emotional or psychiatric problems which would impair nursing competency;

i. no related nursing problems involving death or significant harm to patient;

j. agrees to comply with all RNP stipulations and signs program agreement including statement of admission of substance use disorder or other impairment.

E. Implementation Process

1. All inquiries and complaints regarding problems associated with impairments shall be responded to in a confidential and timely manner. The board's professional staff determines the disposition of the inquiry or complaint, including, but not limited to referral to an interventionist, treatment referral, or referral to the board.

2. A registered nurse or student nurse seeking confidential entry into the Recovering Nurse Program (RNP) is initially interviewed by the board's professional staff, the employer, and/or a qualified clinician to assess the registered nurse or student nurse's immediate needs, to identify and evaluate the nature and extent of the nurse's or student nurse's impairment, and to determine the nurse's or student nurse's motivation for seeking entry into the program. Eligibility for entry into RNP is based upon the criteria in §3419 D

3. The board reserves the right to require participation in RNP of any impaired individual who has disciplinary action on their license or who is seeking licensure or who is enrolled in an approved program preparing for licensure as a registered nurse.

4. Program Criteria

a. Participant must comply with all stipulations of RNP Agreement.

b. Participant agrees to be responsible for all costs of evaluation, treatment, and monitoring.

c. Participant actively participates with treatment plan.

d. All treatment facilities, treatment plans and referrals must meet criteria approved by the board prior to their use by a nurse.

e. When the board orders a comprehensive psychiatric, psychological, and/or substance abuse evaluation(s), and/or physical examination, the board's professional staff may approve the evaluator or treatment facility based on criteria approved by the board.

5. Practice restrictions which support the recovery process shall be imposed. All participants employed in a health care environment shall have a work site monitor who meets the guidelines established by the board and who communicates with the board's professional staff concerning the participant's job performance as stipulated in the program agreement.

6. The Recovering Nurse Program (RNP) shall regularly monitor the compliance of each participant in accord with criteria approved by the board.

a. Program representatives and group facilitators may be utilized to assist the program staff in monitoring the participants.

b. Monitoring specifications in the program agreement for participants who are chemically addicted shall include at least the following:

i. random drug screens;

ii. periodic reports from program representatives and/or group facilitators;

iii. periodic evaluations from employers;

iv. periodic reports from aftercare counselors and/or therapists and/or physicians;

v. verification of attendance at 12-step meetings.

c. Monitoring specifications in the program agreement for participants with other impairments shall be individualized.

d. A participant's failure to comply with the RNP agreement may constitute grounds for disciplinary action.

F. Admission and Progression. The following procedures shall apply to RNP participants.

1. For nurses who have met criteria in §3419. D and have entered the program confidentially with no disciplinary action will upon entry:

a. sign RNP agreement for five years for substance use disorders. Agreements to rule out substance use disorder or medical, mental or physical agreements may be of shorter duration depending on treatment team recommendations;

b. refrain from the practice of nursing until approved by RNP;

c. complete and submit to the board a comprehensive inpatient evaluation and treatment as recommended from a board recognized treatment facility. Admission shall be within 10 days unless otherwise approved by RNP or boards professional staff;

d. submit to the board a "Fitness for Employment" release form completed by a board approved addictionologist prior to approval by RNP to return to work;

e. be granted confidentiality and no disciplinary action will be taken against the license.

2. At first relapse/non-compliance for nurses in the program confidentially, the following steps will be taken.

a. Refrain from the practice of nursing until approved by RNP.

b. complete a relapse evaluation as directed by RNP staff. Participants must follow all treatment recommendations. Admission shall be within 10 days unless otherwise approved by RNP;

c. Sign RNP agreement for length of time to be determined by treatment team.

d. Submit to the board a Fitness for Employment release form completed by a board approved addictionologist prior to approval by RNP to return to work.

3. At second relapse/non-compliance for nurses in the program confidentially, the following steps will be taken:

a. be referred to board's professional staff for disciplinary action against license including automatic indefinite suspension with minimum of six months;

b. be required to take the following steps prior to reinstatement of license:

i. complete and submit to the board a comprehensive inpatient re-evaluation and treatment as recommended by a board approved addictionologist;

ii. sign and adhere to a disciplinary RNP agreement with documented evidence of continuous sobriety for a minimum of six months;

iii. submit to the board a release form completed by a board approved addictionologist at the time reinstatement is requested;

iv. board hearing or consent order will be required prior to reinstatement;

v. submit fine/costs as imposed.

vi. submit fine/costs as imposed.

4. A third relapse/non-compliance will result in an automatic suspension for a minimum of two years and show cause order for revocation.

G. Nurses Leaving the State

1. A participant who moves from Louisiana to another state with an alternative program shall have records transferred to that program.

2. A participant nurse or student nurse who moves to a state where there is no alternative program shall have the nurse's records transferred to the board in the receiving state.

H. Discretionary Authority. The board shall have authority to discipline an impaired individual subject to its jurisdiction and nothing in this Subsection shall limit that authority.

I. Costs of Alternative to Disciplinary Proceedings. The participant agrees to submit payment of $250 per year as an administrative fee.

La. Admin. Code tit. 46, § XLVII-3419

Promulgated by the Department of Health and Hospitals, Board of Nursing, LR 24:1293 (July 1998), amended LR 27:728 (May 2001), LR 31:1586 (July 2005), LR 35:1535 (August 2009), LR 36:1244 (June 2010), LR 37:3025 (October 2011), Amended by the Department of Health, Board of Nursing, LR 44919 (5/1/2018).

AUTHORITY NOTE: Promulgated in accordance with R.S. 37:918.