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The Sick Cycle of Trying to Comply with Probation Ordered by the Missouri State Board of Nursing

By: Jason L. Call, Call & Gentry Law Group

Nurses are some of my favorite people. Hard working, selfless, and dedicated, most nurses are genuinely caring, compassionate, and love what they do. For more than 20 years I have been helping LPN’s, RN’s and APRN’s, avoid or minimize discipline against their professional licenses in cases brought against them by the Missouri State Board of Nursing. The unfortunate reality, however, is that many nurses are getting burned out by the profession, and having their licenses harshly disciplined and being placed on years of probation is not helping. Excessive hours, understaffing, COVID-19, angry/frustrated patients, and unsympathetic state boards of nursing have taken a toll on nurses, and many are rethinking their chosen career. According to a 2022 survey of physicians, registered nurses and advanced practice providers, some 25% of respondents were considering a career change; and of those, 89% cited “burnout” as the primary reason.

Burnout could also contribute to other problems, including the potential to turn to drugs or alcohol. If a perceived chemical dependency issue results in a complaint against the nurse, the Missouri State Board of Nursing will investigate, and will in many cases either file an action against the nurse in the Administrative Hearing Commission (to prove cause to discipline the nurse) or will attempt to convince the nurse to accept a settlement agreement for probation, containing difficult, and in some cases impossible compliance terms.

If you are a nurse with an alleged or admitted chemical dependency issue, you may end up on Board ordered probation for years, which will almost always include mandatory drug testing that requires you to “check in” daily on an app, and if selected, to travel to an approved lab to submit to a urine screen. This drug testing can be onerous, and some nurses have a hard time complying.

Miss checking in? That will get you a phone call from the Director of Compliance at the Missouri Board of Nursing. Miss multiple check-ins or miss a drug screen when you are selected? Or worse, relapse on alcohol or your drug of choice? Then the Board is likely going to file a Probation Violation Complaint against you, and schedule you for a hearing before the Board. If a probation violation is found to have occurred, the Board then has discretion to impose even more discipline upon you, potentially putting you on probation for an even longer period of time than you were originally! This can result in a vicious, sick cycle where you as a nurse are constantly battling to live your life but also try and avoid probation violations, so you can once again have an unencumbered nursing license, but the Board keeps calling you back for probation violation hearings, and extending your probation again, and again.

For any nurse who ends up with a license that is on probation, there are some things you can do to help maintain compliance and hopefully avoid having to appear for a probation violation hearing. First, calendar every single deadline in your settlement agreement or Board order that requires action on your part, and make sure you follow through. The Board is not that forgiving, and missing deadlines for things like employer reports or continuing education is a sure-fire way to get yourself set for a probation violation hearing.

In addition, one of the most difficult parts of compliance is with mandatory drug/alcohol testing. To help make sure that you maintain compliance, always try to check in at the same time every day, regardless of whether you are working a nursing shift. It also helps to put a repeating alarm on your cell phone to make sure you don’t miss a check-in. Furthermore, make sure you have several different collection centers (in case one is closed or there are extended wait times) and that you know the hours of operation, to make certain that you give a urine sample on time if you are selected to do so.

And finally, remember that you are responsible for what goes into your body. You must not consume alcohol in any form! A positive test for alcohol when the Board requires abstinence, will result in a probation violation complaint. The Board’s terms will include a list of foods and substances that you should avoid, and you should take heed to make sure you don’t consume anything on the list (like NyQuil, for example). And one more thing: as a general rule, if you do not prepare the food/drink or you are not 100% sure what is in it, do not consume it. I can recall several instances where my clients ate watermelon, or drank OJ in an unlabeled container, only to find out later that it had been spiked with alcohol by someone. This then resulted in a “surprise” positive urine drug screen for alcohol or metabolites of alcohol called ETG and ETS. And of course, the Board filed a probation violation complaint against the nurse in each case.

In conclusion, the best way to avoid the sick cycle of repeat probation violations is to comply with your probation terms in every way, make sure you never miss a check-in or a drug screen, and successfully complete the terms of probation the first time around, so that you can get out from under the Board’s supervision. From my experience, the longer your probation, or the more times it is extended, the harder it will be to get your license (and your life) back.

Ney et al. (2022) A Treatment for America’s Healthcare Worker Burnout. Accessed October 11, 2022