North Carolina Board of Nursing

Discipline & Compliance

Chemical Dependency Resources

When to Refer

What to Consider

If a nurse’s performance is suggestive of a Substance Use Disorder consider the following information:

  • Review your facility’s policies and procedures before initiating action unless patients and/or staff are in imminent danger*
  • Use your facility chain of command in addressing the issue
  • If drug screening is requested, assure adherence to strict chain of custody protocols
  • Use the 5 W’s Test in organizing your thoughts
    • Who made the complaint? ie patient, family, peers, colleagues
    • What is the nature of the complaint? under medicating, documentation discrepancies, excessive wasting patterns, impaired on duty
    • Where is the location of the incident?
    • When did the event occur?
    • Why did the events occur? (possible motivations, causes)

Referrals should be made to the Board of Nursing when any one of the following situations arise:

  • Positive pre-employment drug screens
  • Positive results on a “for-cause” drug screen
  • Signs and symptoms of impairment including the smell of alcohol on the breath, regardless of whether or not the impairment is alleged to be as a result of the nurse’s own prescription meds
  • Reports of excessive use of controlled substances, increased wastage, sloppy or careless wasting, consistent failure to follow facility policies for wasting controlled substances, documentation discrepancies, manipulation of medication dispensing systems
  • Any time there is a violation of the Nursing Practice Act

*If patient safety is an immediate concern, the staff should intervene immediately to protect the patient and remove the nurse from the situation until the chain of command can be activated to assist in the management of the situation.

When in doubt, you may call the Board at (919) 782-3211 ext. 271 for further consultation.