North Dakota Board of Nursing Home North Dakota Board of Nursing
Home About the Board Contact Us FAQ Related Links
Nurse Practices Act
Administrative Rules & Regulations
CNA Testing
Discipline
Education
Forms
Practice Statements
Practice
Unlicensed Assistive Person & Medication Assistant
Workplace Impairment Program

PURPOSE

The North Dakota Board of Nursing acknowledges a primary concern for public safety and supports a nurse monitoring program for nurses who would otherwise be charged with violating the Nurse Practices Act or may otherwise go undetected due to:

* Chemical Dependency
* Physical Disorders
* Psychiatric Impairments
* Practice Deficiencies


OBJECTIVES

1. To ensure public health and safety.
2. To provide assistance and support to the nurse.
3. To provide an alternative to the traditional disciplinary process.
4. To provide education and guidance to individuals and organizations on workplace impairment issues.

STATEMENT OF INTENT

It is the intent of the North Dakota Board of Nursing that any nurse with an identified impairment may have the opportunity to enter the Workplace Impairment Program.

ADMISSION CRITERIA
GUIDELINES

* A nurse who meets the eligibility requirements set forth in NDAC 54-09.
* A nurse who admits to an identified impairment, who demonstrates a willingness to comply with a treatment plan and contract.
* A nurse with an identified impairment whose continued licensure would not pose a danger to the public’s health, safety, and welfare.
* A nurse with an identified impairment for whom a structured monitoring program would appear effective.
* An individual who is eligible for and in the process of applying for licensure.
* $30/month program fee, drug testing fees and associated costs shall be the responsibility of the nurse.

CONTACT

Workplace ImpairmentProgram Coordinator
North Dakota Board of Nursing
919 South 7th Street Suite 504
Bismarck, ND 58504-5881
Phone: (701) 328-9783
Fax: (701) 328-9785
www.ndbon.org
e-mail: kbitz@ndbon.org



Related Forms

Application for WIP
file size: 49 kb

Authorization to Return to Practice
file size: 82 kb

Employer Disclosure
file size: 37 kb

Employer Work Performance Evaluation
file size: 43 kb

Identified Health Care Practitioner/Pharmacy
file size: 30 kb

Medication Log
file size: 29 kb

Medication Report
file size: 31 kb

Referral Form
file size: 81 kb

Relapse Plan
file size: 30 kb

Self Assessment Report
file size: 47 kb

Summary of Sponsor Contact
file size: 35 kb

Support Group Attendance Verification
file size: 21 kb

Treatment Professional Evaluation Report
file size: 43 kb

Written Plan of Supervision Monitoring
file size: 37 kb