For more than a century, the US nursing profession has been aware of substance abuse problems among its practitioners and student nurses but has generally dealt with the issue by taking disciplinary action rather than pursuing nonpunitive options. The latter course would allow more healthcare providers, following successful rehabilitation, to remain in the profession. Since the early 1980s, the American Nurses Association (ANA), National Council of State Boards of Nursing (NCSBN), American Association of Colleges of Nursing (AACN), and the International Nurses Society on Addictions (IntNSA) have actively promoted nonpunitive substance abuse policies, and many states have adopted alternative-to-discipline programs that have achieved good outcomes. At the same time, very little is known about the success rates of alternative-to-dismissal programs in nursing schools. After reviewing policies for both practicing nurses and those still in training, the authors recommend that all states adopt nonpunitive policies and that nursing schools develop alternative approaches for students that parallel and expand upon the procedures applied to practicing nurses who have a chemical dependency.