North Carolina Board of Nursing

Discipline & Compliance

Drug Monitoring Programs

Alternative Program (AP)

About the Alternative Program for Chemical Dependency (AP)

The AP is a voluntary alternative to traditional discipline action for a nurse whose competency may be impaired because of a substance use disorder. Participation in the AP is not published unless disclosure is necessary to protect the health, safety and welfare of the public or as ordered by a court of competent jurisdiction.

The objectives of the AP include:

  • Ensure the health and safety of the public by closely monitoring nurses impaired by drugs and/or alcohol.
  • Achieve earlier intervention with intent to decrease the time between the nurse’s acknowledgement of chemical dependency and entry into the recovery process.
  • Return the nurse to safe and effective practice in a more efficient manner while minimizing financial impact.
  • Provide an opportunity for nurses to recovery from impairment in a therapeutic, non-punitive and non-published process.

How the AP Works

To be considered for the AP, the Licensee must speak with NCBON staff. If Licensee is eligible for the AP, he/she will submit a signed Consent Order prepared by the NCBON agreeing to a period of abeyance (a state of temporary inactivity), where he/she will not work in a licensed nursing position until approved to do so by the Board. Licensee is eligible to petition to re-enter practice a minimum of three (3) months from the date treatment is initiated.

Any cost incurred through participation in the AP is the responsibility of the participant. Expenses include, but may not be limited to, substance abuse treatment, addictionologist evaluation and random body fluid screening.

Within two (2) weeks of the date the Consent Order is received at the NCBON, Licensee must submit the following evidence from a participating treatment facility:

  1. Initial assessment
  2. Confirmation of treatment start date
  3. Treatment plan

Licensee is required to follow all recommendations of the treatment facility. Once Licensee has completed the initial phase of treatment, he/she is required to participate in Aftercare for one (1) year, which is a minimum of one (1) treatment meeting per week.

Upon receipt of treatment information, licensee will come to the NCBON for an orientation interview.

Within three (3) business days of the orientation interview, Licensee is required to submit to random body fluid screens, as requested by FirstLab or the AP and to continue to do so for the duration of participation. Licensee is required to attend a minimum of three (3) in-person 12-step meetings each week for the duration of participation.

Re-Entry to Practice Process

After Licensee has been enrolled in treatment for three (3) months and shown evidence of compliance with AP requirements, Licensee is eligible to petition to re-enter practice.

Licensee is required to meet with an addictionologist and comply with all recommendations prior to petitioning to re-enter nursing practice.

Once approved to return to nursing practice, the Licensee will sign a Return to Licensed Practice Agreement.

  • All nursing positions held during participation in the AP must be pre-approved by the Board and the employer agrees to submit work performance evaluations as scheduled.
  • Licensees must work an average of sixty-four (64) hours per month in a licensed nursing position for employment to apply to the three (3) years of licensed nursing employment.

Upon return to licensed nursing practice, the following conditions are in place:

For a minimum of one (1) year:

  1. Shall not work 11 p.m. - 7 a.m. and may not work more than eighty (80) hours per two (2) weeks or more than forty-eight (48) hours in a seven (7) day interval unless approved by the AP.
  2. Shall not work more than twelve (12) hours in a twenty-four (24) hour period.
  3. Shall not have access to or be accountable for controlled substances.
  4. Shall not work in critical care specialty areas including but not limited to the Emergency Department, Intensive Care Unit (ICU), Cardiac Catheterization Lab, Labor and Delivery, Operating Room (OR)/Post Operative Anesthesia Care Unit (PACU).
  5. Shall not work in a substance abuse treatment facility.
  6. Shall not work for more than one (1) nursing employer at a time.
  7. Shall not float from unit to unit within a facility.
  8. Shall work under the direction of an on-site RN or, with approval, under the direction of an on-site work monitor who is a licensed health care provider.

For a minimum of two (2) years:

  1. Shall not work as a CRNA.
  2. Shall not work for a staffing agency or as a traveler.
  3. Shall not work in home health or in home care.
  4. Shall not work in home hospice.
  5. Shall not make home visits.

Conditions may be extended in accordance with an addictionologist’s recommendation(s) or incidents of noncompliance.


Any failure to comply with the AP requirements may result in termination of the order. If the order is terminated, the nursing license is voluntarily surrendered for a minimum of one (1) year. Licensee must submit evidence of a minimum of one (1) year of sobriety prior to petitioning for reinstatement.

Successful Completion of the AP

Participants must be successfully monitored by the Board for three (3) years of satisfactory employment in a licensed nursing position in North Carolina or after five (5) years of drug screening.

Once successfully completed, the Licensee is no longer required to submit random drug screens or report to the Board of Nursing and there are no longer conditions on the practice of nursing.