If your questions are not answered in the FAQs on the Monitoring page of the Board’s website, you may contact the Probation/Compliance office.

Include your nursing license number AND your case number in all items sent to the Board, whether sent by US Postal Service, fax, or email.

Board staff will communicate in one of 3 ways:

• Telephone
• E-mail
• Letters through the US Postal Service

You are REQUIRED to provide Board staff with the following:

• VALID non-work telephone number.
• VALID e-mail address, preferably one NOT associated with your employer.
• Accurate mailing address.

If any changes occur in these 3 methods of contact, you must provide the Board with these changes as soon as possible. You may update your contact info under My Profile.

Following the Board’s approval of your Order, at a regularly scheduled Board meeting, you will be mailed a copy of your Order. Its effective date is the date of service or attempted service by certified mail.

Yes, the requirements apply for the duration of your Order. This is specifically set forth in your Order.

Once you have met ALL the requirements to complete your monitoring, the Probation/Compliance Director will send you a letter. Please retain this letter in your personal files. Note: Most Orders require the licensee to work a minimum time in a monitored practice setting, prior to completion of the Order. When this is a requirement and the quarterly employer report is not submitted, any time worked in that quarter will not count toward fulfillment of this requirement. Use the “Monitoring” section of My Profile on the ABN website to self-monitor compliance with your Order. You will be able to see which reports have and have not been received. You will not have access to the content in the reports.

Refer to your Order to determine requirements for your release from monitoring. Continue to comply with your Order, until you receive a letter from the Board that you have completed monitoring and have been released from monitoring. Required steps when an Order requires a “release from monitoring evaluation”:

1. Send a written request to Probation/Compliance, stating that you would like to be released from monitoring.
2. Along with the request, send in your original Abstinence-oriented Support Group Meeting Attendance Records from the last 6 months.
3. Probation/Compliance will review your monitoring record, to determine whether you are compliant with all aspects of your Order and have met the MINIMUM requirements for release from monitoring.
4. You will be given EITHER:
   1. Information about scheduling your release from monitoring evaluation OR
   2. Reasons why you should NOT schedule the evaluation at this point.
5. If you are given permission to schedule the evaluation, schedule and complete the evaluation in the appropriate time frame, with the treatment provider to whom you are referred.

Options are:

1. The total amount of the fee may be paid at Services, Fees, & Fines on the ABN website. You may use a credit or debit card. A $3.50 transaction fee will be added to the total.
2. Cashier’s checks, money orders, certified checks, or corporate/business checks (in an amount not to exceed the total fine amount due) may be mailed or hand-delivered to the ABN office.

NOTE: Personal checks are NOT accepted for disciplinary fines. Fines will be available for payment on the Board’s website, once your Order becomes effective. Refer to your Order for information on when payment of the fine is due.

You will receive correspondence with instructions on how to activate your account for participation in drug testing. The Board-recognized program for random drug testing is administered by Affinity eHealth. Affinity eHealth will provide you with access to SPECTRUM for participation in the program. If you require assistance with SPECTRUM, please contact Affinity Care (Help Desk): 1-877-267-4304 M-F 5:30 am CT to 7:00 pm CT Sa-Su 8:00 am CT to 4:00 pm CT

1. Either you (if you are able), or another responsible person, should notify Probation/Compliance staff of your hospitalization, as soon as possible. You should contact Probation/Compliance staff when you are discharged from the hospital.
2. Obtain a copy of the discharge summary and medications administered while hospitalized. Submit this documentation to Probation/Compliance, as soon as it is available. If this documentation is not submitted to Probation/Compliance, any drug screens or monitoring activities that were missed are noncompliant.
3. If you are given activity limitations, or are not allowed to drive when first discharged from the hospital, Probation/Compliance staff MUST receive appropriate documentation clearly specifying the limitations. Monitoring activities after discharge from the hospital are only excused when the appropriate documentation is received.

Any monitored nurse who is hospitalized is not expected to attend meetings, provide specimens for drug screens, etc., for the duration of the hospitalization ONLY.

You will receive correspondence with instructions on how to activate your account for participation in drug testing. The Board-recognized program for random drug testing is administered by Affinity eHealth. Affinity eHealth will provide you with access to SPECTRUM for participation in the Board-recognized program for random drug testing. If you require assistance with SPECTRUM, please contact Affinity Care (Help Desk): 1-877-267-4304 Mon-Fri 5:30 am CT to 7:00 pm CT Sat-Sun 8:00 am CT to 4:00 pm CT

Fee payments are made directly to the Board-recognized program for random drug testing. Payment of the collection site fee is either made through the Board-recognized program for random drug testing, or at the collection site location.

The Board-recognized program for random drug testing maintains a list of collection sites for nurses monitored by the ABN. You need to travel to an approved collection site and provide the specimen on the same day you are selected.

Prior to 12:00 noon on the Saturday you are selected:

1. Notify the Board-recognized program for random drug testing.
2. Telephone the direct number for Probation/Compliance and leave a message.

If you do not check in on a Saturday and you are selected, this screen will be reflected as noncompliant and may have a negative impact on your compliance with monitoring.

Out of state travel requests include two requirements:

1. You must notify the Board-recognized program for random drug testing of OUT OF STATE travel, at least seven (7) days prior to your departure on your trip. A collection site will be identified to you for the out of state travel, should you be selected to test while out of state.
2. Email Probation/Compliance staff of your plans. This notification does NOT satisfy the notification to the Board-recognized program for random drug testing, as required in number 1 above.

The status of a missed screen that occurs during travel out of state, without the minimum required advance notice to the Board-recognized program for random drug testing, is reflected as noncompliant.

If an evacuation plan is in effect, schools are closing due to weather, etc., please DO NOT go to a collection site. The sites probably will be closed. If you are selected to test:

1. Telephone the direct number for Probation/Compliance and leave a message indicating that you were selected to test and the nature of the weather emergency.
2. Notify the Board-recognized program for random drug testing.

To contact Probation/Compliance in these instances, please call the DIRECT number for Probation/Compliance: 334-293-5229 Do NOT call the Board’s toll-free number; you will not be able to leave a message.

• Your drug screen is positive: The Medical Review Officer (MRO) will contact you to discuss your positive result. The MRO will give instructions identifying the documentation to be sent and the deadline for receiving the documentation.
• Your drug screen has an invalid result in some part of the testing. The MRO will discuss this with you, and notify the Board, if there is any reason for concern.

Ensure that the Board-recognized program for random drug testing has your correct contact information.

Many nurses who abuse prescription medications go to multiple healthcare providers to obtain their drugs of choice. While you are monitored, you need to have ONE provider who functions as the “quarterback” for your health care, making referrals to other providers, as deemed necessary. If you do not have a primary healthcare provider, you will be expected to find one, as soon as possible.

• Verification from your primary healthcare provider/dentist of all currently prescribed or authorized medications, to include over the counter medications, is due at the start of monitoring.
• Subsequent verification from the prescribing healthcare provider/dentist is due within 10 days of the issuance of a new prescription.
• Controlled medications require verification from your primary healthcare provider, as to your need for medication.

You will need to identify these providers and their contact information to the Board. The requirement for a primary healthcare provider does not preclude you from seeing some of your specialty providers. However, a specialty provider (e.g.: neurologist, orthopedic surgeon) should not be in charge of your preventive care.

If you are ill, please be seen at an urgent care clinic or emergency department. Immediately report prescribed medication, in writing, to your primary healthcare provider. If you are ill, please do NOT wait to take the medications until someone at the Board “approves” the medications. Prescribing healthcare provider verification of prescribed medication is due within 10 days of the issuance of a prescription. Controlled medications require verification from your primary healthcare provider, as to your need for medication.

The Alabama Board of Nursing uses the Medication Guide Version 1.7, published by Earley Consultancy, for nurses monitored by the Board. You are REQUIRED to download this guide and have it available for your use throughout the program. Over the counter medications and medications which require a prescription are not allowed without verification of prescribed medication from your primary healthcare provider. This applies to ALL nurses whose monitoring includes drug screening

Controlled medications require verification from the primary healthcare provider to the Board. Continued usage requires quarterly verification to the Board from the primary healthcare provider.

Steps to take:

1. Email Probation/Compliance staff of the procedure and the date it will occur.
2. Notify the Board-recognized program for random drug testing of the procedure and the date it will occur.
3. The day of the procedure, obtain documentation of the procedure and any medications given during the procedure (operative report, DC Summary, medical restrictions, etc.). Submit this documentation to Probation/Compliance.
4. If you are discharged with prescriptions, obtain verifications as you would for any other medications.

Any setting where you are expected to function independently, without direct or consistent supervision, is not allowed. Examples of these types of employment are:

• Any position that requires the nurse to enter the home of an individual patient, including, but not limited to, home health, hospice, or house call service
• nursing float pool
• travel nurse agency, nurse staffing agency, nursing registry, or temporary employment agency
• self-employment
• contracting for services
• locum tenens positions
• employed as faculty at a nursing program
• employed as a school nurse, without prior written authorization from the Board

If you have questions about the appropriateness of a work setting, contact Probation/Compliance .

Monitored nurses may not accept supervisory jobs. You may be asked to supply a job description to Probation/Compliance for a position you are considering. For Monitoring purposes, supervising nurse duties include, but are not limited to:

• making employment decisions related to licensed staff;
• evaluating the performance of licensed staff;
• scheduling licensed staff; and
• making patient assignments to licensed staff.

Any change regarding employment must be reported immediately. Print a Notification of Receipt of Order form from the Board’s website. The forms are found under the “Monitoring” tab. This form must be completed by your supervisor and returned to the Board within 10 days of the employment change.

You are not allowed to access or administer any medications classified as Controlled Substances on Schedules II-V by the Drug Enforcement Administration (DEA) or the Alabama Controlled Substances List.

• Your access to controlled substances through any computerized system must be BLOCKED by your employer.
• You are not allowed to carry keys for the narcotics cabinet.
• You are not allowed to COUNT controlled substances.
• You are not allowed to WITNESS waste of controlled substances.
• You are not allowed to CHART any doses of controlled substances given by other nurses.
• You are not allowed to ADMINISTER controlled substances to patients that are signed out by another nurse.
• You are not allowed to CALL IN PRESCRIPTIONS for controlled substances.
• You are not allowed to order, receive, or sign for delivery of controlled substances.

Step 1: You must first send a written request to Probation/Compliance, asking for the restriction to be REVIEWED, and include the originals of your Abstinence-Oriented Support Group Meeting Attendance Records for the six months preceding your request. Step 2: A complete review of your monitoring records will occur. The following information/documents must be in your records:

1. Name and contact information for your primary health care provider.
2. Prescription verifications for all medications.
3. Notification of Receipt of Board/Consent Order from your employer.
4. Six FULL months of reports from
   1. Continuing Care/Aftercare (if required)
   2. Counseling (if required)
   3. Employer
5. All Monthly Self-Reports received ON TIME (by the 5^th of the month)
6. All negative/compliant drug screens

Step 3: Review forms will be e-mailed to:

• Your Continuing Care/Aftercare facilitator
• Your Counselor;
• Your Employer
• YOU: a Self-Assessment is e-mailed and required.

All these forms must be completed and returned to Probation/Compliance. Step 4: Probation/Compliance will review all the materials and determine if the restriction should be lifted. A letter will be sent to you AND your employer notifying you of the decision. You are NOT allowed to access controlled substances until you AND the employer receive the letter of notification. Until this letter is received, you are not allowed access to controlled substances.

• If any of the criteria listed in the section above are not met, the restriction will not be lifted.
• If you no longer are employed or you change jobs just before the restriction review occurs, your restriction will not be lifted. You must be employed in a nursing job and your new employer needs to submit some reports before the restriction will be lifted.
• If any person providing input into the review does NOT believe you are ready to have the restriction lifted, the restriction will not be lifted.

Remember, accessing and administering controlled substances is a serious responsibility. If you cannot be successful in completing the BASIC monitoring requirements that allow you to practice nursing, you will not be allowed to access and administer controlled substances.

Reports must be submitted online from the Board’s website only. Self-reports are DUE by the 5^th of each month [ex: self-report for the month of June becomes available on July 1 and is due June 5^th]. Reports may only be submitted during the month in which they are due. The status of a missed report is noncompliant. A pattern of late submissions may negatively impact your monitoring.

You may download and print forms in the Monitoring Forms section of the ABN website. Take an Abstinence-Oriented Support Group Meeting Attendance Record with you when you attend an abstinence-oriented support group. Obtain a verifying signature at each meeting attended. Be prepared to submit your original Abstinence-Oriented Support Group Meeting Attendance Record forms when requested by Probation/Compliance.

Reports must be submitted on-line from the Board’s website only. If the reports are not submitted within the month due, the employer, Aftercare Counselor, and/or Individual Counselor cannot send anything to the Board to “make up” for this.

1. Reports may be submitted through the LAST day of the month in which the report is due.
2. After the last day of the month, the reports are not available. The status of a missed report is noncompliant
3. If the report is NOT submitted, you will not receive credit for that quarter’s activities (You will not be given credit for 3 months of Continuing Care/Aftercare, Counseling, and/or employment).
4. Missing reports may delay lifting of a controlled substances restriction, re-evaluation for return to advanced practice nursing, release from monitoring, etc.
5. Additional missing reports will cause negative consequences for your monitoring.

Any change must be reported immediately:

• YOU are responsible for obtaining the appropriate Information or Notification form and providing the form to the new facilitator/counselor, employer-supervisor.
• Receipt of the Information/Notification form is required before access to the respective online quarterly report will be granted to a new Aftercare Counselor, Individual/Group Counselor, or Employment supervisor.
• These forms are available on the Board’s website, under Monitoring.

Board staff MUST have the correct names and contact information, in order for your reports to be submitted.

When you click the “SUBMIT” button, you will see confirmation that the report was submitted and the option to PRINT your report. This is the ONLY time you can print your report. You may also check report receipt in the “My Profile” section on the ABN website.

You may wish to refer to the Troubleshooting Tips.

The Order itself does not specifically mandate disclosure of monitoring status during the interview process. However, the Order requires the nurse to provide a copy of his or her Order to the employer, and have the employer submit the Notification of Receipt of Order form within 10 days of the nurse’s hire date. The website of the Alabama Board of Nursing provides License Lookup as primary source verification to allow you to validate a license as of the date that the verification is printed.

An individual whose license status is “Active/Probation” is required to immediately provide all healthcare employers with a complete copy of his or her Order. Documents that MUST be provided to you:

1. A complete copy of the Order (usually 12-20 pages total).
2. Notification of Receipt of Order form.

The practice restrictions are stated in the Order. If a particular stipulation in the Order does NOT apply to a nurse, this will be clearly noted in the Order.

Your role

1. Complete and return the Notice of Receipt of Order to Probation/Compliance. Make sure that your phone number and email address are included. List the healthcare credentials of all monitors.
2. Familiarize yourself with the Order and its requirements in the workplace.
3. Accurately report the nurse’s work performance
4. Timely submit quarterly Employer reports.
5. Immediately notify the Board, should there be a problem involving the monitored nurse.

Nurses on probation need to be monitored by a nurse who works with them. In some instances, this nurse may also be the supervisor. This is to ensure that there are no issues with the monitored nurse, such as odd or suspicious behavior relating to drug usage or appropriation, inappropriate behavior, practice related problems, etc. If the supervisor is NOT onsite when the monitored nurse is working, there must be at least ONE other licensed nurse in good standing with their regulatory body, whose license type is at or above the license type of the monitored nurse, and who is onsite.

• There may be more than one monitor: some nurses have multiple monitors listed. All monitors must be aware of their responsibility as a monitor and be willing to assume such.
• If there is not at least one Monitor besides the supervisor on the Notice of Receipt form, Probation/Compliance will contact you for the name of an appropriate Monitor.

Reports must be submitted on-line from the Board’s website only. For the on-line reports to be set up for you, you must return the Notification of Receipt of Order form to Probation/Compliance. If this form is NOT returned to Probation/Compliance, you will not be able to submit reports for the nurse. Once your information is received and entered, you may access the reports by going directly to the Board’s website: www.abn.alabama.gov .

• Monitoring Reports
• Select “Online Employer Report”. Under this heading you will find
  • Online Employer Report (this is the actual report)
  • Online Employer Reporting Instruction Manual. Please read this manual before you begin completing reports. It contains necessary information about user names, passwords, etc.

The reports are available online throughout the month in which the reports are due (e.g.: reports due July 10 are available July 1-31). After the last day of the month, you will not be able to submit the report.

The information requested in the report is the MINIMUM that should be reported.

The number of hours actually worked (not scheduled) is needed, so staff may calculate whether the monitored nurse has met the work requirements of their respective Order.

Your assistance with monitoring a nurse who has an Active/Probation license status is appreciated.

• You should report any issues that occur during the quarter (was the nurse written up for absences, patient care problems, employment termination or resignation, etc.).
• The act of reporting an issue does not necessarily translate to problems for the nurse with the Board of Nursing.
• Your role is to ACCURATELY report job performance, attendance, and any problems that arise. You may contact Probation/Compliance between reporting periods, should a need arise.

Refer to the Order. A nurse who has this restriction will have the stipulation “Employment-Access to Drugs” or “Employment-Access to Controlled Substances.” In order to have this restriction lifted, the monitored nurse must submit a written request to the Board. A letter will be sent to the nurse, with a copy to the employer, of the decision as to whether or not the restriction is lifted.

It may be inconvenient for a nurse on your staff to be unable to administer controlled substances to patients. The burden of giving controlled substance medications for a monitored nurse is best equally distributed among the other staff members on duty.

• It is helpful to assign which nurse will give controlled substances for each of the monitored nurse’s patients at the beginning of the shift. In this manner, each nurse for whom they may be responsible for medications, and the monitored nurse knows to whom he/she should go for assistance with this.
• The monitored nurse should NOT expect special favors. If others are giving controlled substances for the monitored nurse, the monitored nurse needs to take on some of the other staff members’ duties.

Refer to the Order (stipulation “Employment-Supervision Restriction” or “Employment-Restrictions”). Probation is the monitored practice of nursing which permits the nurse to continue to practice nursing, according to conditions set forth by the Board. The nurse who has a license status of Active/Probation is prohibited from performing supervisory duties.

For monitoring purposes, supervising nurse duties include, but are not limited to:

• making decisions about employment and/or disciplinary action of licensed staff.
• evaluating the performance of licensed staff.
• scheduling licensed staff.
• making patient assignments for licensed staff.

Nurses monitored by the Board who have the controlled substances restriction in effect are not allowed to access or administer any medications classified as Controlled Substances on Schedules II-V by the Drug Enforcement Administration (DEA) or the Alabama Controlled Substances List

• Access to controlled substances through any computerized system must be BLOCKED by the employer.
• Monitored nurses are not allowed to carry keys for the narcotics cabinet.
• Monitored nurses are not allowed to COUNT controlled substances.
• Monitored nurses are not allowed to WITNESS waste of controlled substances.
• Monitored nurses are not allowed to CHART any doses of controlled substances given by other nurses.
• Monitored nurses are not allowed to ADMINISTER controlled substances to patients after being signed out by another nurse.
• Monitored nurses are not allowed to CALL IN PRESCRIPTIONS for controlled substances.
• Monitored nurses are not allowed to order, receive, or sign for delivery/receipt of controlled substances.

The use of the term “controlled substances” is deliberate: “narcotics” refers only to opiate and opiate-like drugs. Many other medications are addicting but are not “narcotics,” and are classified as controlled substances.

You may wish to refer to these Troubleshooting Tips.