Nurse Recovery Group List
RecoveryTrek Enrollment Instructions
Common Reporting Forms
- RecoveryTrek (Self-Report Form and Attendance Tracker)
- Aftercare Form
- Individual / Group Counseling Report Letter
- Letter to the Nursing Employer
- Letter to the Rehabilitation Program
- Medical Provider Instructions
- Notification of Address / Phone Changes
- Nurse Recovery Group Attendance Fill-In
- Performance Evaluation Report
Online Submission Forms
- Medical Report
- Medical Release of Information
- ATD Evaluation Agreement
- Nursing Supervisor Acknowledgement
- Nursing Supervisor Performance Report
- Counseling Report Form
- Evaluator Release of Information
Please find some available resources on treatment, prevention, and recovery by following these links:
http://substanceabuse.az.gov/substance-abuse/resources and https://www.samhsa.gov/find-treatment
The Alternative to Discipline (ATD) Program is the Arizona State Board of Nursing's non-disciplinary, confidential monitoring program for Registered Nurses, Licensed Practical Nurses, and Advanced Practice Registered Nurses.
The ATD Program is designed for nurses with substance use disorders, medical, or mental health conditions, nurses at risk for these disorders/conditions, or nurses with a combination of these disorders/conditions. Nurses who are interested in the ATD Program must voluntarily request entry into the ATD Program and meet the Program’s eligibility criteria.
How are nurses referred to the ATD program?
- Board Staff Referral based upon Complaint or Application/Renewal Information
- Employer Referral
- Legal Agencies/Regulatory Referral
- Other Community Referral
What is the purpose/intent of the ATD program?
The purpose of the ATD program is to: 1) ensure the public's safety through the early detection, treatment, and monitoring of nurses who have or are at risk for any of the listed conditions that could potentially impact nursing practice; and 2) provide the opportunity for rehabilitation for nurses who acknowledge they have, or are at risk for, a condition that may impact their nursing practice, and wish to obtain the treatment and/or support needed to maintain safe nursing practice.
What are the components of the ATD Agreement?
All individuals are required to obtain an evaluation or provide proof of a current condition or diagnosis, to be eligible for the ATD Program. Some nurses may be required to obtain additional evaluations, as determined by Board staff. The appropriate ATD Program track (substance use disorder, co-occurring, mental health, or medical conditions or those deemed at risk) will be determined by ATD Program staff based on Program criteria and the evaluation(s).
ATD Program stipulated agreements are most commonly three years in length, but some agreements may be less. The agreements will include terms based upon the need of the participant, and may include:
- Substance Use Disorder Treatment
- Medical Treatment
- Mental Health Treatment
- AA/NA Attendance
- Nurse Recovery Group Attendance
- Random Drug Screening
- Abstain from all potentially addicting substances, including alcohol
- Designated RN/MD supervisor/direct supervision of nursing practice
- Work Restrictions
- Medical/Mental Health Care Provider Involvement
Eligibility requirements to participate in the Alternative to Discipline Program include the following criteria:
The ATD Program Applicant:
- Voluntarily requests admission into the ATD Program.
- Agrees, in writing, to comply with all elements of the ATD Program Stipulated Agreement.
- Acknowledges having a substance use disorder, or a mental health or medical condition that may affect his/her ability to practice safely, and in compliance with the Nurse Practice Act, or being at risk for these conditions.
- Has not been terminated due to noncompliance from any alternative to discipline by any state board or state board-approved program.
- Has no history of nursing practice involving significant harm or death to a patient.
- Has not engaged in the diversion of drugs or other substances for the purpose of sale or distribution to others.
- Has not engaged in behavior that has high potential to cause patient harm such as diverting drugs by substituting patient medications.
- If under investigation by another state board, unrelated to his/her entry into the ATD Program, and which results in probation, suspension, surrender or revocation of licensure in another state.
- Is otherwise eligible for continued Arizona licensure.
- Is able to abstain or limit controlled substances or mind-altering medications, as recommended by the evaluator
- Agrees to limit his/her nursing practice to Arizona only and will be issued a single state license while in an ATD program.
- May have previously participated one time in an alternative to discipline program without relapse.
- May be required to temporarily stop nursing practice while completing treatment or other requirements.
- Does not have a previous history of disciplinary action involving probation, suspension, revocation, surrender or denial of a license by any state board.
Has not fraudulently written a prescription for a third party.
Has not engaged in high-risk criminal behavior that includes crimes involving sexual misconduct or crimes involving violence or threatening behavior which can impact safety to practice.