Drug Monitoring Programs
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Alternative Program (AP)

The mission of the North Carolina Board of Nursing Drug Monitoring Programs is to protect the public by providing a structured approach to monitoring and returning the recovering chemically dependent nurse to safe nursing practice.

The Alternative Program 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 Alternative Program 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.

Objectives of the Alternative Program 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 Alternative Program Works

To be considered for the Alternative Program, the Licensee must speak with North Carolina Board of Nursing staff. If licensee is eligible for the Alternative Program, they will submit a signed Consent Order prepared by the North Carolina Board of Nursing agreeing to a period of abeyance (a state of temporary inactivity), where they 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 Alternative Program 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 North Carolina Board of Nursing, 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, they are 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 North Carolina Board of Nursing 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 FirstSource Solutions or the Alternative Program 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 Alternative Program 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 Alternative Program 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.
  • Licensees will not be approved for employment by more than one (1) employer and one (1) site at a time.
  • Licensees will not be approved to work in any supervisory capacity to include, but not be limited to, supervisor, manager and director.

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

For a minimum of one (1) year:

  1. Shall not work 11:00 p.m. - 7:00 a.m. and shall 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 Coordinator. 
  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. Advanced Practice Registered Nurses with prescriptive authority shall not prescribe controlled substances.
  5. Shall not work in critical care specialty areas including, but not limited to, the:
    1. Emergency Department
    2. Intensive Care Unit (ICU)
    3. Cardiac Catheterization Lab
    4. Labor and Delivery
    5. Operating Room (OR) and Post Operative Anesthesia Care Unit (PACU)
  6. Shall not work in a substance abuse treatment facility.
  7. Shall not float from unit to unit within a facility.
  8. Shall work under the direction of an on-site Registered Nurse or, with approval from the Coordinator, 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 Certified Registered Nurse Anesthetist
  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 Alternative Program 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 Alternative Program

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.

Questions? Contact Jessica Tracey, Regulatory Compliance Coordinator, at (919) 782-3211 ext. 274 .

  • Write us:

    Alternative Program
    North Carolina Board of Nursing
    P.O. Box 2129
    Raleigh, NC 27602-2129
Last Changed 26-Jul-2019

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