# Are “Alternative to Discipline” Programs for Nurses With Alcohol and Other Drug Challenges Relevant to Global Contexts? A Scoping Review

## TL;DR

This scoping review examines if alternative to discipline programs for nurses with alcohol or drug issues can be applied globally, highlighting challenges like cost and strict abstinence requirements.

## Contribution

The study evaluates the global relevance of alternative to discipline programs for impaired nurses, identifying barriers to their universal implementation.

## Key findings

- Alternative to discipline programs help retain nurses with substance use issues in the profession.
- Programs often require strict abstinence and lack tailored options, limiting their effectiveness.
- Perceptions of punitive measures hinder program acceptance and global adoption.

## Abstract

Alternative to discipline programs, defined as programs for nurses ‘impaired’ by issues such as alcohol and/or drug use, provide treatment and support to return to the profession. This paper aims to explore alternative to discipline programs for nurses to determine whether these programs are relevant to other geographical contexts. A scoping review was conducted in accordance with the JBI methodology. The PRIMSA‐ScR checklist was used in this scoping review. The databases searched included MEDLINE (PubMed), Embase (Elsevier), Cumulative Index to Nursing and Allied Health Literature (EBSCOhost), and ProQuest Dissertations and Theses Global (ProQuest) from 1984 to 2024. Title and abstract screening was conducted on 1622 papers, resulting in 90 papers for full‐text screening. After full‐text screening, 19 papers met the inclusion criteria for this scoping review. Issues related to the cost of programs, strict requirements for abstinence, and a lack of ‘bespoke’ options that address participant needs were identified in this review and need to be addressed prior to global implementation of these programs. Impairment of nurses due to alcohol and/or drug use threatens workforce sustainability, and without ‘alternatives to discipline’, can mean experience nurses are lost to the profession, often without treatment. Exploration of alterative to discipline programs is essential to ensure that nurses with alcohol and other drug challenges are retained in the profession and receive the treatment required to remain safe practitioners. Likewise, the perception that programs were punitive in nature should be addressed to ensure acceptability of these programs as an alternative to the loss of employment.