These Executive Position Papers analyze data regarding current disciplinary and nondisciplinary models for the management of chemically impaired nurses which are used by state boards of nursing that license registered nurses. They also analyze data regarding the method of management under which the majority of nurse managers in acute care facilities in Delaware would be most likely to report a chemically impaired nurse. The results support a set of recommendations and strategies to implement a new nondisciplinary model for management of the chemically impaired nurse in Delaware.

Executive Position Paper One presents a review of the literature pertinent to chemical impairment in nurses, disciplinary and nondisciplinary alternatives used by boards of nursing to manage this problem, and the human and economic costs of the problem. The current disciplinary method used by the Delaware Board of Nursing (DBN) is found lacking in that it hinders identification, treatment, recovery, and reentry of chemically impaired nurses in Delaware. A decision is made to suggest a change to a nondisciplinary model for Delaware.

Executive Position Paper Two describes convenience samples of executive directors (EDs) of state boards of nursing and nurse managers (NMs) of acute care facilities in Delaware, questionnaires used to collect data to determine what models boards of nursing use for their management of chemically impaired nurses, the model under which nurse managers in Delaware would be most likely to report a chemically impaired nurse and their willingness to fund their choice. Twenty-one of the EDs surveyed confirmed a trend toward an increase in the use of nondisciplinary methods, and nurse managers chose a nondisciplinary model which they agreed to fund with licensure surcharge. Paper Two presents the evidence supporting Delaware's needs for a new nondisciplinary model and in a series of eight recommendations describes a plan to implement a nondisciplinary model.

Executive Position Paper Three describes the new nondisciplinary model for the management of the chemically impaired nurse in Delaware in a draft of rules and regulations for Assistance in Lieu of Discipline (ALD).

Change strategies involve the use of a task force, professional nursing groups, and legislators.