For Employers of TPAPN Nurses Thank you for taking the time to view this short presentation about TPAPN, the Texas Peer Assistance Program for Nurses. We’ll cover what you need to know if you employ or are considering employing a nurse who is participating in the program. So let’s get started. Texas Peer Assistance Program (TPAPN): Ensuring a Good Fit

What is TPAPN? Board of Nursing (BON) approved Alternative, voluntary program for LVNs & RNs Offers recovery Returns nurses back to practice 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.

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.

TPAPN Program Overview Approved 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 Let’s 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.

TPAPN Case Managers Provide 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 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.

TPAPN Advocates: Nurses Helping Nurses Educate nurse participants about TPAPN and recovery Provide 1:1 peer support Assist participants with enrollment and work processes, as needed Provide education to nursing supervisors and coworkers 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.

TPAPN Testimonials “With 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 These are just a couple of the many comments we’ve received about the program. TPAPN graduates over 150 nurses annually, helping employers retain valuable nurses and avoid turnover costs.

Steps for Employer Review employer slide show Confirm nurse submitted employer consent Contact TPAPN Case Manager for job approval Hold Work Agreement meeting with nurse to complete forms Fax completed forms to TPAPN (512-467-2620) and allow nurse to begin work 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.

Steps for Employer Assign a nurse/coworker to administer participants abusable medications and discuss exchange of duties Develop plan to accommodate participants drug testing TPAPN recommends accommodations be discussed during the work agreement meeting. An informational slide show is available for nursing coworkers on TPAPN’s 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.

Restrictions on Practice During the first six months participants agree not to: Take on call duty Administer, count, witness wastage, receive abusable or controlled substances from pharmacy or authorize prescriptions for controlled substances These 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.

Restrictions on Practice TPAPN participants agree NOT to: Function in an autonomous or unsupervised role Work shifts longer than 12 hours Work for multiple employers or be self-employed Work in short-term staffing or work as a traveler Float outside of assigned area Work over 96 hours in two week pay period Work at various practice sites, unless approved 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).

Work Agreement Meeting Review job duties/concerns Read and understand Work Agreement terms/restrictions Determine accommodations for submitting drug test specimen TPAPN will mail drug testing kits to employer (Continued) Let’s 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.

Work Agreement Meeting (continued) Discuss any modifications to Work Agreement with TPAPN Case Manager for approval Understand TPAPN nurse is held to Nurse Practice Act, BON rules and employer’s 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) 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 participant’s job duties and are able to intervene if concerns arise about the participant’s 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 nurse’s 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.

TPAPN: An Important Part of a “Just Culture” Learning and accountability Openness and fairness Systems to enhance patient safety Proactive incentives to decrease at-risk behaviors Coach or counsel as appropriate A punitive system creates barriers to reporting and keeps impaired nurses from getting help Now that we’ve talked about some of the details, let’s 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.

Why should you hire (or rehire) a TPAPN nurse? Civil immunity is afforded those who employ a TPAPN nurse and adhere to the terms of the TPAPN Work Agreement The cost of recruiting and training new staff outweighs the cost of retention Dismissing a nurse without charges of misconduct leaves the nurse free to seek work elsewhere and risks harm to patients or themselves 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 nurse’s 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.

Texas Peer Assistance Program for Nurses (TPAPN) Contact us! Texas Peer Assistance Program for Nurses (TPAPN) www.tpapn.org tpapn@texasnurses.org 1-800-288-5528 Thank you!