PPt for Employers of Nurses in TPAPN

Texas Peer Assistance Program (TPAPN): Ensuring a Good FitFor Employers of TPAPN Nurses

Thank you for taking the time to view this short presentation about TPAPN, the Texas Peer Assistance Program for Nurses. Well cover what you need to know if you employ or are considering employing a nurse who is participating in the program. So lets get started.

1Board of Nursing (BON) approvedAlternative, voluntary program for LVNs & RNsOffers recoveryReturns nurses back to practiceWhat is TPAPN?

TPAPN is a Board approved, voluntary program for LVNs and RNs recovering from substance use and psychiatric disorders. It offers nurses one-on-one mentorship and life-renewing opportunities for recovery. The goal is to return participants back to nursing practice, which promotes professional accountability and thus protects the public.

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Objective

To help employers and potential employers of TPAPN nurses understand how TPAPN fosters a positive and safe work environment for participating nurses and enhances patient safety.

After viewing this slideshow, you will have a better understanding of how participating in the program will support nurses and promote a safe work environment.3Approved under Texas Health and Safety Code

Available to eligible nurses who may benefit from Peer Assistance Services

Nurse can self-report or be referred by a third party

Voluntary; may withdraw at any time

TPAPN Program Overview

Lets begin with an overview. Established in 1987 under Chapter 467 of the Health and Safety Code, TPAPN is a state-approved peer assistance program for Texas nurses. TPAPN offers licensed nurses who are impaired by substance use or psychiatric disorder an opportunity to undergo treatment and to safely return back to nursing practice under the protection of confidentiality.

Program participation is an alternative to being reported to the Board of Nursing. A nurse can either self-report or be referred to TPAPN. Completely voluntary, the program allows a nurse who has entered TPAPN to decline participation or withdraw at any time.However, failure to adequately fulfill the TPAPN agreement may result in a referral to Board of Nursing.

The goal of the program is to provide an effective channel for recovery from substance use and/or psychiatric disorder and effective re-integration back into nursing practice, thus protecting the public and providing incentives for professional accountability.

4Provide information and support for referred nurses

Monitor nurse participants work performance, program compliance and progress in recovery

Liaison between nurse participants, treatment providers, employers and Advocates

TPAPN Case Managers

Once in TPAPN, the nurse is assigned a Case Manager with expertise in substance use and/or psychiatric disorders. They offer information, support and monitor nurses performance and progress in recovery. Case Managers also liaison between participants, treatment providers, employers and the TPAPN volunteer Advocates who offer peer support to the nurse.

TPAPN combines the roles of overseeing appropriate treatment, continuing care, support groups, practice restrictions, drug screens and monthly/quarterly reporting to ensure that nurses honor their TPAPN agreements.

5Educate nurse participants about TPAPN and recoveryProvide 1:1 peer supportAssist participants with enrollment and work processes, as neededProvide education to nursing supervisors and coworkers

TPAPN Advocates: Nurses Helping Nurses

TPAPN Advocates are LVNs and RNs who serve as trained volunteers. An Advocate is there to listen to participants, assist them in coping positively with issues, problem-solve, and help them successfully complete the program. Texas is very fortunate to have a state peer program where nurses support other nurses. Advocates may be recovering or non-recovering nurses who have a sincere desire to see their peers succeed by providing one-on-one peer support and education.

6With my new sense of self-worth and improved nursing practice, I am living proof that TPAPN works. Nurse Graduate Becoming an Advocate was never a question for me; it was and continues to be a gift. It is one way I can give back what was so freely given to me. TPAPN Advocate

TPAPN Testimonials

These are just a couple of the many comments weve received about the program. TPAPN graduates over 150 nurses annually, helping employers retain valuable nurses and avoid turnover costs.7Review employer slide showConfirm nurse submitted employer consent Contact TPAPN Case Manager for job approvalHold Work Agreement meeting with nurse to complete formsFax completed forms to TPAPN (512-467-2620) and allow nurse to begin workSteps for Employer

Once the nurse is ready to return to work, and a job offer has been extended, the nurse is required to submit a release of information to allow communication between TPAPN and potential employer. The potential employer must contact the TPAPN Case Manager, via phone or email, to review the position and TPAPN work restrictions to consider job approval.Upon receipt of job approval, employer and participant may schedule work agreement meeting to complete necessary documents. Please review forms to ensure they are completed and fax to TPAPN. 8

Assign a nurse/coworker to administer participants abusable medications and discuss exchange of duties

Develop plan to accommodate participants drug testingSteps for Employer

TPAPN recommends accommodations be discussed during the work agreement meeting. An informational slide show is available for nursing coworkers on TPAPNs website. Please direct the necessary nursing staff to view the slide show. Also arrange for an exchange of duties between TPAPN participant and coworker to accommodate narcotic/abusable medication administration.

9During the first six months participants agree not to:Take on call dutyAdminister, count, witness wastage, receive abusable or controlled substances from pharmacy or authorize prescriptions for controlled substances

Restrictions on Practice

10These restrictions prohibit on-call assignments and access to controlled medications during the first six months after signing the Work Agreement. The narcotic restriction may be waived by TPAPN Case Managers for nurses participating under a psychiatric disorder agreement. Restrictions are enforced to help assure safe nursing practice. Modification of any restriction will occur only when mutually agreed upon by Case Manager and employer. The length of program participation runs for one to five years.

The use of hand sanitizer containing ethyl alcohol is prohibited. Program participants must also abstain from all alcohol and abusable drugs, medications, and substances and agree to provide random drug screens.

TPAPN participants agree NOT to:Function in an autonomous or unsupervised roleWork shifts longer than 12 hours Work for multiple employers or be self-employedWork in short-term staffing or work as a travelerFloat outside of assigned areaWork over 96 hours in two week pay periodWork at various practice sites, unless approved

Restrictions on Practice

Several work restrictions are in effect throughout the entire, one to five year length of TPAPN participation. Unsupervised work is not allowed and shifts are limited to a maximum of twelve hours. Floating to various areas of a hospital can be stressful and is difficult to monitor, therefore floating may be considered to units that are managed by the same supervisor. Overtime limits for TPAPN nurses prohibit participants from working more than 96 hours in two week pay period and lastly, TPAPN Case Managers may consider approving work at multiple practice sites under a distributive practice addendum with TX BON approval. TPAPN considers these restrictions reasonable under the Americans with Disabilities Act (ADA). 11Review job duties/concernsRead and understand Work Agreement terms/restrictionsDetermine accommodations for submitting drug test specimenTPAPN will mail drug testing kits to employer(Continued)

Work Agreement Meeting

Lets review a checklist for the nurse manager or employer to use when working with a TPAPN nurse. This is a tool that will help you decide if the job is a good fit for the nurse. It will also help you to consider what factors might impede or facilitate success.

Employer is to review the job requirements and any concerns with the nurse. Before returning to practice, the nurse will meet with employer to sign documents and discuss accommodation for drug testing and narcotic administration. The employer will want to develop a plan of action to accommodate the nurse should he/she be selected to drug test. Testing is to be done at any available Quest site. Drug testing kits are delivered to designated supervisor or nurse manager and should be stored in secure location. These are for use if a situation indicates the need to collect a drug test for an emergency or for-cause.12Discuss any modifications to Work Agreement with TPAPN Case Manager for approval

Understand TPAPN nurse is held to Nurse Practice Act, BON rules and employers Policies and Procedures

Give nurse opportunity to disclose potential work-related triggers to relapse and signs of possible relapse

Direct coworkers with a need to know to view information on TPAPN website (www.tpapn.org)

Work Agreement Meeting (continued)

Here are some additional steps to consider when preparing for the work agreement meeting.

Discuss any questions or requests for modifications with the TPAPN Case Manager. Remember the nurse is held accountable to her licensure responsibilities as well as the employers policies.

Supervisors monitoring TPAPN nurses cannot be current participants in TPAPN. Supervisors must be familiar with the participants job duties and are able to intervene if concerns arise about the participants practice and/or behaviors.

An informative slide show is available for coworkers of TPAPN nurses. Supervisors may direct nursing coworkers to review the coworker slide show, posted on the TPAPN website at www.tpapn.org.

TPAPN staff must report to the nurses employer as well as the Board if the participant is nonadherent, such as, having a positive drug screen, withdrawal from the program or moves out of state. 13Learning and accountability Openness and fairnessSystems to enhance patient safetyProactive incentives to decrease at-risk behaviorsCoach or counsel as appropriateA punitive system creates barriers to reporting and keeps impaired nurses from getting help

TPAPN: An Important Part of a Just Culture

Now that weve talked about some of the details, lets look at the big picture. In a just culture, individuals are continually learning, designing safe systems and managing behavioral choices. Events are not simply things to be fixed, but opportunities to improve understanding of the system. The focus is not on blame, but transparency. 14Civil immunity is afforded those who employ a TPAPN nurse and adhere to the terms of the TPAPN Work AgreementThe cost of recruiting and training new staff outweighs the cost of retentionDismissing a nurse without charges of misconduct leaves the nurse free to seek work elsewhere and risks harm to patients or themselves

Why should you hire (or rehire) a TPAPN nurse?

Studies show that when individuals receive treatment for substance abuse, significant savings are realized by employers, including greater productivity, decreased medical care and sick leave costs and fewer on the job injuries.

Under 467.008. (c) (6) of the Texas Health & Safety Code, civil immunity is afforded those who employ a TPAPN nurse and adhere to the terms of the Work Agreement.The cost of turnover in nursing, when accounting for both direct and indirect costs, may cost employers anywhere from 60 - 100% of the former nurses salary, plus the salary of the new nurse. In an unpublished study, Baylor University Health System, Dallas, realized over 4 million dollars savings in turnover cost avoidance over a 9-yr. period by retaining nurses participating in TPAPN.

Substance abuse and dependency as well as psychiatric disorders are most prevalent in our society and the health care industry is not immune. When employers have proactive policies and procedures in place that acknowledge the existence of these disorders in the nursing work force, identification and referral of nurses with these conditions is enhanced leading to safer work conditions and improved employee morale.

15Texas Peer Assistance Program for Nurses (TPAPN)

www.tpapn.org tpapn@texasnurses.org1-800-288-5528

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