Supporting Public Safety by Encouraging Nurses' Use of Alternative-to-Discipline Programs

Alternative-to-discipline (ATD) programs were developed to address substance use disorder (SUD) among licensed health professionals by offering a recovery-oriented monitoring pathway in lieu of public disciplinary action. ATD programs do not provide treatment; they protect the public by facilitating evaluation and treatment engagement, monitoring individualized recovery plans, and, when appropriate, safe return to practice. While ATD programs are applicable for a range of health professions, nursing serves as a useful case because it is a profession in which licensure oversight, employer action, patient safety, and workforce consequences uniquely converge. Relatedly, evidence suggests that substance use in nursing is not rare, that clinician substance use can affect quality of care, and that recovery in nursing is shaped not only by treatment but also by stigma, regulatory burden, financial barriers, communication problems, and return-to-work barriers. However, program availability does not establish that every nurse with SUD should enter regulatory monitoring. Some nurses seek treatment or mutual support independently before professional practice is affected, whereas others may consider voluntary ATD entry to preserve a nonpublic path to licensure and practice. The question for nursing is no longer whether ATD programs should exist. The more pressing question is whether nurses can reach and use these programs in ways that are timely, psychologically safe, and professionally workable enough to support both public protection and personal recovery. This commentary argues that nursing ATD programs should be evaluated not only by whether they exist but also by whether nurses can realistically access, enter, remain in, and safely return to practice through them. Late entry into treatment remains worthwhile and should never be dismissed. Still, a public protection model works best when the benefits, burdens, limits of confidentiality, and potential career implications are described clearly.