Drug Monitoring Programs
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Alternative Program (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. 

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. 

AP Enrollment

An eligible Licensee may enroll in the AP by signing a Consent Order prepared by the North Carolina Board of Nursing, agreeing to the facts of the case and terms for participation.  Any cost incurred through participation in the AP is the responsibility of the participant including, but not limited to substance abuse treatment, addictionologist evaluation and random body fluid screening. 

Upon entry into the Consent Order, participant is required to: 

  • Not work in a licensed nursing period for a minimum three (3) month license abeyance (a state of temporary activity). 
  • Submit records from a Board participating treatment facility verifying initial assessment, treatment plan, full compliance with recommendations and treatment start date.   
  • Attend (1) year of weekly aftercare following the initial phase of treatment.   
  • Following receipt of treatment information, attend an AP orientation interview. 
  • Register with and submit random body fluid screens as requested by FSSolutions, the North Carolina Board of Nursing and any nursing employer for the duration of participation.  
  • Attend a minimum of three (3) in-person 12-step meetings each week for the duration of participation. 

Re-Entry to Practice Process

Participants are eligible to petition to re-enter restricted nursing practice following compliance with the AP conditions for a minimum of three (3) months of treatment and two (2) months of random body fluid screening with FSSolutions.  Prior to petitioning, an evaluation by a Board participating addictionologist and evidence of compliance with all recommendations is required. 

Once approved to return to restricted nursing practice, the participant signs a Return to Licensed Practice Agreement.  All nursing positions must be pre-approved by the Board based on the employer’s ability to support the employment conditions.

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 shall not work more than eighty (80) hours within two (2) weeks or more than forty-eight (48) hours within 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. Shall not work in specialty care areas including, but not limited to, the Emergency Department, Intensive Care Unit (ICU), Cardiac Catheterization Lab, Labor and Delivery, Operating Room (OR), and Post-Operative Anesthesia Care Unit (PACU); 
    5. Shall not float from unit to unit within a facility; 
    6. Shall work under the direction of an on-site RN or, with prior approval from the Coordinator, under the direction of an on-site work monitor who is a licensed healthcare provider; and 
    7. APRNs with prescriptive authority shall not prescribe controlled substances. 

    For a minimum of two (2) years:

    1. Shall not work as a Certified Registered Nurse Anesthetist (“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; and 
    5. Shall not make home visits. 

    For the duration of participation:

    • No more than one (1) employer and one (1) site will be approved at a time. 
    • May not volunteer in any capacity providing direct or indirect nursing care or services in any setting. 
    • Work an average of sixty-four (64) hours per month with satisfactory quarterly performance evaluations in a licensed nursing position for employment to accrue toward the three (3) years of licensed nursing employment. 
    • Supervisory nursing employment including, but not be limited to, supervisor, manager and director will not be approved. 
    • Nurse Practitioners are required to update the Collaborative Practice Agreement to reflect any modification of the conditions of the AP and provide the Board with a copy. 

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


    Any failure to comply with the AP conditions may result in termination of participation and suspension of the license 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) continuous years of drug screening. 

    Following successful completion, 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. 

    Chemical Dependency Discipline Program (CDDP)

    The Chemical Dependency Discipline Program is a disciplinary program for a nurse whose competency may be impaired because of the use of drugs and/or alcohol and is not eligible for the Alternative Program for Chemical Dependency. Participation in the Chemical Dependency Discipline Program is public information. Documents are posted on the Board of Nursing's licensure verification system which further describes the specific case.

    Objectives of Chemical Dependency Discipline Program include the following:
      • To ensure the health, safety and welfare of the public through a program that closely monitors nurses impaired by drugs and/or alcohol.
      • Provide a process for nurses to recover from impairment and become safe practitioners.

    Intervention Program (IP)

    The Intervention Program is a voluntary alternative to disciplinary action for a nurse who:
    • Tests positive for an illicit substance on a random or pre-employment screen. An illicit substance is defined as any drug contained in Schedule I or Schedule VI of the Controlled Substances Act of North Carolina, or any drug for which the nurse cannot provide a legitimate prescription of their own.
    • Has convictions for Driving While Impaired (DWI).
    Objectives of the Intervention Program include the following:
    • Early recognition and intervention for nurses who may abuse drugs or alcohol.
    • To ensure the health, safety and welfare of the public through a program that monitors nurses testing positive or convicted of DWI.

    Manager Handbook

    This handbook serves as a resource for Nurse Administrators employing nurses participating in Drug Monitoring Programs (Alternative Program (AP), Chemical Dependency Discipline Program (CDDP)) with the North Carolina Board of Nursing.

    Last Changed 4-Nov-2021

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