Accessibility and Financial Barriers in the Utilization of Alternative to Discipline Programs in the United States

Nurses are facing increased mental health issues, substance use, and even suicide since the novel coronavirus pandemic arrived in the United States. Nurses with substance use disorder (SUD) may enroll in alternative-to-discipline (ATD) programs to retain their license during initial treatment with the goal to return to practice, but this process is not without challenges. For example, previous analyses have shown that the time surrounding disciplinary/regulatory process regarding substance use disorder (SUD) by either employers or licensure boards was a trigger for nurses who died by suicide. Internet searches are a common approach to find information on health-related topics. This limited critical review sought to replicate and evaluate a simple internet search that a nurse seeking information on their state ATD program may complete. Google searches for information on ATD programs were completed on the 50 continental states and Washington, DC between April and September 2022. States with ATD programs were evaluated for evidence-based components and barriers to accessing program information. Publicly available ATD program information ranged from requirements for contact information to obtain details to websites that outline the entire program, including associated costs. While ATD programs offer a significant improvement over traditional disciplinary responses to nurse substance use, a significant barrier is program cost, which can often exclude participation. In this article, we discuss the detailed results of our critical review and offer implications for practice that include opportunities for research and a national database to track ATD program components and target outcomes to support return to practice for nurses with SUDs.