Texas Peer AssistanceProgram for Nurses (TPAPN)Helping nurses Safeguarding patientsDawn Webb, MSN, RNProgram Director, Texas PeerAssistance Program for Nurses

Introduction TPAPN Overview Substance use among nurses Reporting and Self – Referral Participation Peer Support

Meet the new TPAPN!TPAPN empowers Texasnurses with substance usedisorders, mental healthconditions or both to makehealthy changes and beproactive in their recoveryjourney so they canpractice nursing safely.

TPAPN MissionTPAPN safeguards patients by providing early identification,support, monitoring, accountability and advocacy to Texasnurses who have an identified substance use and/or mentalhealth condition or related incident, so the individual maypractice nursing safely.

Helping nurses Safeguarding patientsTPAPN is a person-centeredprogram supporting nurses inrecovery from substance use,mental health concerns or both.Our evidence-based approachstrives to help nurses improve theirhealth and wellness, live a selfdirected life and reach their fullpotential.We are devoted to keeping nursesemployed and encourage earlyintervention in the workplace aswell as self-referrals to help nursesavoid practice violations beforethey occur.

TPAPN HELPS NURSES600 nurses participating: 90% substance use ordual 10% mental healthconditions 13,000 drug tests/year 4% positive tests/year

Participant substance use 41% Opioid/Narcotic analgesic40% Alcohol8% Stimulants5% Anti-anxiety4% Marijuana1% Non-narcotic analgesic1% Hypnotics

National Council of StateBoards of NursingSubstance Use Disorder in Nursing Video (12:39 minutes) Identification and reportingInterventionDiagnosis and treatmentMonitoring

SUBSTANCE USE DISORDER*CHANGESPhysical changes: Behavioral changes: Attendance and performanceSecretive, suspicious behaviorAppetite, sleep patternPersonality or attitudeMood swings, irritability, angerLack of motivationFearful, anxious, paranoidBloodshot eyes, abnormal sized pupilsSudden weight loss or gainDeterioration of physical appearanceUnusual smells on breath, body, clothesSocial changes: Sudden change in friends, hangouts,hobbies Legal problems related to substance useUnexplained need for money orfinancial stance-abuse


HELP NURSES GET HELPWhat couldhappen if youdon’t?Who should yoube concernedabout?

Reporting is RequiredTo TPAPN or Nursing Peer Review if: A nurse is impaired or suspected ofbeing impaired by chemicaldependency or mental illness.AND there is NO Nursing Practice Actviolation.TX BON Nursing Practice Act (NPA): Sec. 301.410, and Sec 301.402(e)

Reporting is RequiredTo the Texas Board of Nursing if: Nurse’s practice is, or is suspected of,being impaired by chemicaldependency or diminished mentalcapacityAND the person believes or suspects thatthe nurse committed a practiceviolation.TX BON Nursing Practice Act (NPA): Sec. 301.410

How to Choose?TPAPNHelping nurses Safeguarding patients Guidance, support & monitoring May be an alternative to discipline Social peer support provided byvolunteer nursesBONProtecting the Public Investigations Monitoring Discipline

TPAPN REFERRALReferrals are: Written Confidential Non-anonymousTPAPN referrals come from: Oneself 3rd Parties Board of Nursing

SELF REFERRALThere are numerousadvantages to self-referringbefore a practice violationoccurs, making this the bestway for nurses to engagewith TPAPN.


* BON: Texas Board of Nursing

PARTICIPATION EvaluationRandom drug testingDetermination of fitness to practiceTreatment: current and ongoingPeer supportMonitoring with/without drug testingReturning/continuing to practicenursing Provider release to return to work TPAPN authorization to return towork Employer & Participant WorkAgreement Possible practice restrictions Regular communication withTPAPN Re-evaluation/updated evaluation Discharge: completion or closure

PARTICIPANT FOCUS Recovery from substance use and/ormental health conditions Self Care to maintain long term recovery Maintenance and demonstration of sobriety and/ormental fitness

ABSTINENCE REQUIREDAbstinence from all abusabledrugs including alcohol, ingeneral, is a requirement forparticipation in TPAPN.


Peer Support Partners Provide person centered support Maintain regular supportivecommunication Inspire hope Quarterly Reporting

DISCHARGECompleteDid not completereferred to theBON


Thank s.orgHerman Siu

REFERENCES National Council of State Boards of Nursing (NCSBN). (2011). Substance usedisorder in nursing: A resource manual and guidelines for alternative anddisciplinary monitoring programs. Chicago, IL: NCSBN NCSBN (Producer). (n.d.) Substance use disorder in nursing. Video retrieved from Recovery. (2015). Substance Abuse and Mental Health Services Administration(SAMHSA). Retrieved from