Quarterly Report to the Texas Board of Nursing (BON) For the period 12/1/2017 through 2/28/2018 (BON Q2 2018) March 26, 2018 Texas Peer Assistance Program for Nurses www.tpapn.org 800 288 5528 512 467 7027 Fax: 512 467 2620 A program of the Texas Nurses Foundation
INTRODUCTION TPAPN is a voluntary program that helps nurses whose practice may be impaired by substance use or mental illness return to safe practice through monitored rehabilitation and recovery. Three types of nurses are served by TPAPN: 1) Licensed Vocational Nurses (LVNs), 2) Registered Nurses (RNs), and 3) Advanced Practice Registered Nurses (APRNs) who are also RNs but who are not included in the RN nurse type. Referrals to TPAPN are received from three sources: 1) Self referrals, 2) 3 rd party referrals (primarily employers, coworkers, friends, family, healthcare providers, etc.), and 3) Board of Nursing (BON) referrals (ordered and non ordered). Eligible and appropriate referrals are considered cases, and are assigned a case manager within a few days of receipt of the referral. Cases include nurses who have signed a participation agreement and those who have not. All cases, with the possible exception of BON (indefinite) enforced suspensions, are eventually discharged. There are two types of discharges: 1) Completions: nurses who have completed the program, and 2) Closures: nurses who did not respond, did not enroll or did not complete the program. Nurses participate in TPAPN in any one of five tracks depending on a number of factors including circumstances, assessment findings, BON direction, etc.: 1) Substance Use Disorder (SUD) track which has two subtracks: a. SUD Only: for nurses with only a substance use disorder, and b. Dual: for nurse with both a SUD and mental health diagnosis. 2) Mental Health Monitoring (MHM) track: for nurses with either a mental health diagnosis or a history of a mental health disorder, and who require monitoring of their nursing practice. 3) Extended Evaluation (EE) track: for nurses who have had a one time substance related incident and have a negative evaluation for SUD. Nurses in this track usually do not have a nursing practice violation or a criminal history. Participation in this track requires BON approval. 4) Mental Health Support (MHS) track: for nurses who have disclosed a mental health diagnosis, are stable and do not have a nursing practice violation or a criminal history, and do not require monitoring of their nursing practice. 5) Interim Monitoring (IM) track: for nurses who have been non adherent with TPAPN track requirements, and become disqualified from continued participation in that track. With BON approval, these nurses may continue to be monitored by TPAPN in the IM track while the BON makes their determination. REFERRAL and CASE ACTIVITY Referrals Received Figure 1 and Table 1 presents data on referrals received by TPAPN by nurse type and referral source. Figure 2 and Table 2 presents data on nurses by referral source and nurse type. TPAPN referrals increased by 31 vs. the previous quarter Average Number of Cases Figure 3 presents data on the average number of cases per quarter by nurse type. TPAPN average number of cases decreased by 14 vs. the previous quarter TPAPN average number of cases increased by 110 since fiscal year Q1 2013 2
Statistical Information Table 3 presents data on participation agreements signed Participation agreements signed decreased by 14 vs. the previous quarter Table 4 presents data on participants employed in nursing (As of the last day of the quarter) Participants employed in nursing increased by 21 vs. the previous quarter Table 5 presents data on completions Participant completions decreased by 4 vs. the previous quarter Table 6 presents information on drug test monitoring activities Requested drug tests decreased by 223 vs. the previous quarter Conducted drug tests decreased by 206 vs. the previous quarter Abnormal drug tests decreased by 37 vs. the previous quarter Excused drug tests decreased by 28 vs. the previous quarter OUTREACH ACTIVITIES TPAPN Overview presentations: 2/9/2018: Meeting with Attorneys who represent Nurses, BON and TPAPN (Austin) ADMINISTRATIVE ACTIVITIES TPAPN Advisory Committee meeting minutes 12/1/2017, (Attachment A, pg. 7 8) STATUS REPORT 2/26/2018 3/1/2018: BON TPAPN Audit Citizens of Advocacy Center, on site TPAPN continues to work with the BON to implement the Sunset Commission s recommendations FISCAL Financial statements included, (Attachment B, pg. 9 17) 3
180 Figure 1: Referrals by Nurse Type and Referral Source Q2 2018 (12/1/2017 2/28/2018) 180 Figure 2: Nurses by Referral Source and Nurse Type Q2 2018 (12/1/2017 2/28/2018) 163 163 160 160 140 140 120 121 BON EEP 120 121 Self Number of Referral 100 80 60 60 BON Ordered 3rd Party BON Non Ordered TOTAL Number of Nurses 100 80 60 60 APRN RN LVN TOTAL 40 20 0 0 3 46 42 40 35 29 26 19 18 16 9 7 6 4 2 2 2 2 0 0 APRN RN LVN TOTAL Nurse Type 40 20 0 46 40 42 35 29 26 19 18 16 9 6 7 2 3 4 2 2 2 0 0 0 BON EEP Self BON Ordered 3rd Party BON Non Ordered TOTAL Nurse Type Table 1 Table 2 Referrals by Nurse Type and Referral Source Referral Source Nurses by Referral Source and Nurse Type Nurse Type Nurse Type Self 3rd Party BON Non Ordered BON Ordered BON EEP TOTAL Referral Source APRN RN LVN TOTAL APRN 3 2 2 0 0 7 BON EEP 0 2 0 2 RN 19 18 42 40 2 121 Self 3 19 4 26 LVN 4 9 16 6 0 35 BON Ordered 0 40 6 46 TOTAL 26 29 60 46 2 163 3rd Party 2 18 9 29 previous quarter 22 17 61 28 4 132 BON Non Ordered 2 42 16 60 change 4 12 1 18 2 31 TOTAL 7 121 35 163 previous quarter 7 99 26 132 change 0 22 9 31 4
Figure 3: Average Cases by Nurse Type Q1 2013 to Q2 2018 (9/1/2012 2/28/2018) 800 700 600 588 600 594 604 589 550 591 635 634 639 696 704 694 697 537 548 549 555 714 580 738 746 751 752 604 592 593 590 737 578 712 698 557 548 Number of Nurses 500 400 300 439 442 440 452 442 411 432 479 486 485 APRN* RN LVN 200 TOTAL 119 128 123 120 113 105 124 122 116 125 136 135 126 127 120 120 130 126 125 125 119 115 100 30 30 31 32 34 34 35 34 32 29 23 21 19 15 14 14 24 32 37 34 36 35 0 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1* Q2 Q3 Q4 Q1 Q2 Q3 Q4 2012 2013 9/1/2012 8/31/2013 2013 2014 9/1/2013 8/31/2014 2014 2015 9/1/2014 8/31/2015 2015 2016 9/1/2015 8/31/2016 2016 2017 9/1/2016 8/31/2017 APRN* 30 30 31 32 34 34 35 34 32 29 23 21 19 15 14 14 24 32 37 34 36 35 RN 439 442 440 452 442 411 432 479 486 485 537 548 549 555 580 604 592 593 590 578 557 548 LVN 119 128 123 120 113 105 124 122 116 125 136 135 126 127 120 120 130 126 125 125 119 115 TOTAL 588 600 594 604 589 550 591 635 634 639 696 704 694 697 714 738 746 751 752 737 712 698 2017 2018 9/1/2017 8/31/2018 5
STATISTICAL INFORMATION Q2 2018 (12/1/2017 2/28/2018) Table 3: PARTICIPATION AGREEMENTS SIGNED TPAPN Tracks APRN RN LVN TOTAL Substance Use Disorder only (SUD) 0 24 7 31 Dual (SUD & Mental Health) 0 16 0 16 Mental Health Monitoring (MHM) 0 8 2 10 Mental Health Support (MHS) 0 1 0 1 Extended Evaluation (EE) 0 3 0 3 Interim Monitoring (IM) 0 7 0 7 TOTAL 0 59 9 68 PREVIOUS Quarter 4 59 19 82 Change 4 0 10 14 Table 4: PARTICIPANTS EMPLOYED IN NURSING* (As of the last day of this quarter) APRN RN LVN TOTAL TOTAL 29 378 65 472 PREVIOUS Quarter 25 364 62 451 Change 4 14 3 21 * This figure is now based on employment end date. It had previously been based on employment start date. Table 5: COMPLETIONS BY NURSE TYPE AND TRACK TPAPN Tracks APRN RN LVN TOTAL Substance Use Disorder only (SUD) 0 19 5 24 Dual (SUD & Mental Health) 0 5 2 7 Mental Health Monitoring (MHM) 0 5 1 6 Mental Health Support (MHS) 0 4 0 4 Extended Evaluation (EE) 0 2 1 3 Interim Monitoring (IM)* TOTAL 0 35 9 44 PREVIOUS Quarter 1 38 9 48 Change 1 3 0 4 *Nurses in IM will not complete the track. After the BON completes their investigation, the nurse will be referred to TPAPN or the case is closed. Table 6: DRUG TEST MONITORING ACTIVITIES REQUESTED CONDUCTED NOT CONDUCTED TOTAL = 3283 TOTAL = 3111 TOTAL = 172 TPAPN Tracks Positive Negative Abnormal Dilute Invalid Rejected Missed Excused Substance Use Disorder only (SUD) 2201 79 1891 104 15 10 2 51 49 Dual (SUD & Mental Health) 870 48 728 38 2 2 1 25 26 Mental Health Monitoring (MHM) 70 25 34 4 0 0 0 4 3 Mental Health Support (MHS) 1 0 0 0 0 0 0 0 1 Extended Evaluation (EE) 54 4 44 2 0 0 0 2 2 Interim Monitoring (IM) 87 3 63 11 0 1 0 4 5 TOTAL 3283 159 2760 159 17 13 3 86 86 PREVIOUS Quarter 3506 153 2915 196 30 10 13 74 114 Change 223 6 155 37 13 3 10 12 28 6
Texas Peer Assistance Program for Nurses TPAPN Advisory Committee December 1, 2017 MEETING MINUTES Page 1 Attachment A I. Call to Order 10:05 a.m. A regular Advisory Committee meeting was held at TNA Offices Dietrich Training Conference Room, Austin, Texas on December 1,2017. The meeting convened at 10:05am, presided by, Program Director, Jonathan Wolfarth. II. Roll Call Advisory Committee MEMBERS PRESENT: Allison Bell, Proxy for Brent LoCaste Wilken, EAP; Denise Benbow, BON; Stephanie Espinosa, Long Term Care Representative; Leonard Keesee, Advocate Committee; Kathie Rickman, Recovering Nurse; T Anya Carter, TxANA representative; Sally Gilliam, TONE (Chair); Shakyryn Napier, Texas Nurses Foundation; Alexandra Olivarri, TNSA; Melanie Wiseman, Treatment Provider Advisory Committee MEMBERS ABSENT: Tammy Wolff, LVNAT; Cindy Zolnierek, Texas Nurses Association Executive Director; Sara Bishop, TOBOGNE STAFF PRESENT: Jonathan Wolfarth, Program Director; Katy Davila, Program Operations Coordinator III. Discussion Item: Today s agenda (for acceptance) Comments: All members approved agenda IV. Action Item: 9/15/2017 Advisory Committee Minutes: Old Business JW MOTION #1: One correction to the minutes: II Roll Call: Semicolon added after Brent LoCaste Wilken, EAP Moved, Motion to approve 9/15/2017 Advisory Committee minutes. Moved by: All APPROVED V. Information Item: New Business A. TPAPN Overview: Jonathan Wolfarth presented TPAPN Overview to the Advisory Committee. VI. Information Item: New Business A. Committee accomplishments (discussion) Committee a) Bring knowledge, skill brought? b) Advocates recruited? Leonard Keesee: Two nurses, who plan to attend the 2018 Spring Advocate Workshop c) Community outreach & education delivered? Leonard Keesee: Provided TPAPN education at HCA (KD spell out HCA) Hospitals, Baylor University, Midwestern State University, Texas Christian University, Trinity Valley Community College and University of Texas at Arlington. Alexandria Olivarri: Presented at TNSA convention. d) Other? B. Roundtable: Feedback from the communities represented (discussion) Committee C. Program Update (informational) JW a) BON TPAPN Audit: Citizens Advocacy Center Jonathan Wolfarth reviewed material that will be provided to the Citizens Advocacy Center for BON TPAPN audit. b) Participant Portal/Case Management Software System i. Ongoing Updates ii. Advocate Access c) Advocate Update i. Summary ii. Upcoming Change a. Advocate Access to Affinity s Spectrum b. Role Focus: Support 7
Texas Peer Assistance Program for Nurses TPAPN Advisory Committee December 1, 2017 MEETING MINUTES Page 2 Attachment A d) Research Study: i. Nursing and Substance Abuse, Tim Cranfill, DMin, Bcc, Director of Pastoral Care, MTB/NBH San Antonio e) TNA/TPAPN Website Upgraded, New Content Coming Soon f) TPAPN Staff Education Material Distributed: Jonathan Wolfarth reviewed material distributed 1. Committee Roster & Contact Information 2. 9/15/2017 Advisory Committee Minutes 3. BON TPAPN Audit a) BON TPAPN Audit RFP b) Audit Material Request c) Audit Materials Table of Contents 4. Advocate Update: Summary 5. Research Study: Nursing and Substance Abuse 6. TPAPN Draft Website Text & Track Descriptions 7. TPAPN Activities 8. Weekly Report to the BON a) New Addition: Board Order Referral Report 9. TPAPN Financial Statements 10. TPAPN Staff Directory Material in Binder Pocket: 1. Advocate Application 2. TPAPN Referral Form D. Committee goals for upcoming quarter (discussion) Committee Advisory Committee Member suggestions: Kathie Rickman: A small Committee be formed to work on the Participant Handbook. Shakyryn Napier: TPAPN presents at the TNA District meetings. T Anya Carter: TPAPN record the TPAPN Advocate Workshop presentations to help facilitate recruiting Advocates. Alexandria Olivarri: Place Meet TPAPN Staff and Success Stories on the TPAPN website. Jonathan Wolfarth requested that Committee members recruit Advocates and request education for TPAPN. Jonathan Wolfarth plans to do more outreach for TPAPN soon. E. Roundtable: What else? (discussion) All VII. Announcements: A. Upcoming Activities: Advocate Workshop 1 Day format 4/6/2018 at TNA s Office VIII. Information Item: Upcoming Committee meetings: B. 3/16/2018; 6/1/2018; 9/7/2018; 12/7/2018 (scheduled from 10:00a.m. 3:00p.m. at TNA office) IX. Adjourned 12:55 p.m. Minutes respectfully submitted by: Katy Davila, TPAPN Program Operations Coordinator December 1, 2017 8
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