Quarterly Report
to the
Texas Board of Nursing
(BON)
For the period 3/1/2018 through 5/31/2018 (BON Q3 2018)
June 25, 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
2
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) 3rd – 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 3 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 11 vs. the previous quarter TPAPN average number of cases increased by 99 since fiscal year Q1 2013
3
Statistical Information Table 3 presents data on participation agreements signed
Participation agreements signed increased by 9 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 decreased by 63 vs. the previous quarter
Table 5 presents data on completions
Participant completions increased by 20 vs. the previous quarter
Table 6 presents information on drug test monitoring activities Requested drug tests decreased by 124 vs. the previous quarter Conducted drug tests decreased by 32 vs. the previous quarter Abnormal drug tests decreased by 32 vs. the previous quarter Excused drug tests decreased by 66 vs. the previous quarter
OUTREACH ACTIVITIES
5/9/2018: Program Director participated in a University of Texas Pop‐Up Institute panel discussion (Austin): o Substance Misuse and Addiction Among Young and Emerging Adults
TPAPN Bi‐annual Advocate Workshop:
4/6/2018: Texas Nurses Association Headquarters (Austin): o Attended: 37 Advocates, 1 BON member
Topics Covered: o Advocate role focus: Social Peer Support o TPAPN Program Overview o Motivational Interviewing
ADMINISTRATIVE ACTIVITIES
3/15/2018: TPAPN Advisory Committee meeting minutes (Attachment A, pg. 7 – 8) STATUS REPORT
Sunset Commission’s TPAPN recommendations: o Awaiting BON direction
FISCAL
Financial statements included (Attachment B, pg. 9 – 17)
Table 1 Table 2
Referrals by Nurse Type and Referral Source Nurses by Referral Source and Nurse Type
NurseType Self 3rd Party
BON Non‐Ordered
BON Ordered BON EEP TOTAL Referral Source APRN RN LVN TOTAL
APRN 2 2 4 0 0 8 BON EEP 0 1 0 1RN 22 21 53 22 1 119 Self 2 22 0 24LVN 0 9 24 6 0 39 BON Ordered 0 22 6 28
TOTAL 24 32 81 28 1 166 3rd Party 2 21 9 32previousquarter 26 29 60 46 2 163 BON Non‐Ordered 4 53 24 81change ‐2 3 21 ‐18 ‐1 3 TOTAL 8 119 39 166
previousquarter 7 121 35 163change 1 ‐2 4 3
Referral Source Nurse Type
0 1 0 12
22
0
24
0
22
6
28
2
21
9
32
4
53
24
81
8
119
39
166
0
20
40
60
80
100
120
140
160
180
APRN RN LVN TOTAL
Num
ber o
f Referral
Nurse Type
Figure 1: Referrals by Nurse Type and Referral SourceQ3 2018
(3/1/2018 ‐ 5/31/2018)
BON EEP
Self
BONOrdered
3rd Party
BONNon‐Ordered
2 2 40 0
8
22 21
53
22
1
119
0
9
24
60
39
24
32
81
28
1
166
0
20
40
60
80
100
120
140
160
180
BON EEP Self BON Ordered 3rd Party BON Non‐Ordered TOTAL
Num
ber o
f Nurses
Nurse Type
Figure 2: Nurses by Referral Source and Nurse TypeQ3 2018
(3/1/2018 ‐ 5/31/2018)
APRN
RN
LVN
TOTAL
4
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1** Q2 Q3 Q4 Q1 Q2 Q3 Q42012‐2013
9/1/2012‐8/31/20132013‐2014
9/1/2013‐8/31/20142014‐2015
9/1/2014‐8/31/20152015‐2016
9/1/2015‐8/31/20162016‐2017
9/1/2016‐8/31/20172017‐2018
9/1/2017‐8/31/2018APRN* 30 30 31 32 34 34 35 34 32 29 23 21 19 15 14 14 24 32 37 34 36 35 39RN 439 442 440 452 442 411 432 479 486 485 537 548 549 555 580 604 592 593 590 578 557 548 539LVN 119 128 123 120 113 105 124 122 116 125 136 135 126 127 120 120 130 126 125 125 119 115 109TOTAL 588 600 594 604 589 550 591 635 634 639 696 704 694 697 714 738 746 751 752 737 712 698 687
30 30 31 32 34 34 35 34 32 29 23 21 19 15 14 14 24 32 37 34 36 35 39
439 442 440 452 442411
432
479 486 485
537 548 549 555580
604 592 593 590 578557 548 539
119 128 123 120 113 105124 122 116 125 136 135 126 127 120 120 130 126 125 125 119 115 109
588 600 594 604589
550
591
635 634 639
696 704 694 697714
738 746 751 752737
712 698 687
0
100
200
300
400
500
600
700
800
Num
ber o
f Nurses
Figure 3: Average Cases by Nurse TypeQ1 2013 to Q3 2018(9/1/2012‐5/31/2018)
APRN*
RN
LVN
TOTAL
*In September 2013, the length of TPAPN's SUD track increased from two to three years for RNs and from three to five years for APRNs resulting in an overall increase in TPAPN cases. These increased lengths in required program participation were implemented based on evidence indicating that increased program participation and extended monitoring periods contributed to increased long term recovery. **Some APRNs, starting Q3 2015, were misclassified as RNs. This was corrected Q1 2017.
5
STATISTICAL INFORMATION
Q3 2018 (3/1/2018 ‐ 5/31/2018)
Table 3: PARTICIPATION AGREEMENTS SIGNED TPAPN Tracks APRN RN LVN TOTAL Substance Use Disorder only (SUD) 2 40 10 52 Dual (SUD & Mental Health) 1 7 1 9 Mental Health Monitoring (MHM) 1 5 4 10 Mental Health Support (MHS) 0 1 0 1 Extended Evaluation (EE) 0 1 0 1 Interim Monitoring (IM) 0 2 2 4
TOTAL 4 56 17 77PREVIOUS Quarter 4 59 9 68
Change 0 ‐3 8 9
Table 4: PARTICIPANTS EMPLOYED IN NURSING* (As of the last day of this quarter)
APRN RN LVN TOTALTOTAL 31 326 52 409
PREVIOUS Quarter 29 378 65 472Change 2 ‐52 ‐13 ‐63
Table 5: COMPLETIONS BY NURSE TYPE AND TRACK
TPAPN Tracks APRN RN LVN TOTAL Substance Use Disorder only (SUD) 0 33 7 40 Dual (SUD & Mental Health) 0 9 0 9 Mental Health Monitoring (MHM) 1 5 1 7 Mental Health Support (MHS) 0 3 1 4 Extended Evaluation (EE) 0 4 0 4 Interim Monitoring (IM)*
TOTAL 1 54 9 64PREVIOUS Quarter 0 35 9 44
Change 1 19 0 20*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 = 3159 TOTAL = 3079 TOTAL = 80 TPAPN Tracks Positive Negative Abnormal Dilute Invalid Rejected Missed Excused Substance Use Disorder only (SUD) 2159 84 1913 84 15 11 2 37 13 Dual (SUD & Mental Health) 814 31 711 38 9 5 0 15 5 Mental Health Monitoring (MHM) 64 20 37 1 2 0 0 3 1 Mental Health Support (MHS) 1 1 0 0 0 0 0 0 0 Extended Evaluation (EE) 47 5 39 2 0 0 0 1 0 Interim Monitoring (IM) 74 1 66 2 0 0 0 4 1
TOTAL 3159 142 2766 127 26 16 2 60 20PREVIOUS Quarter 3283 159 2760 159 17 13 3 86 86
Change ‐124 ‐17 6 ‐32 9 3 ‐1 ‐26 ‐66
6
Texas Peer Assistance Program for Nurses TPAPN Advisory Committee
March 16, 2018 – MEETING MINUTES P a g e | 1
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 March 16 ,2018. The meeting convened at 10:08am, presided by, Program Director, Jonathan Wolfarth.
II. Roll Call Advisory Committee MEMBERS PRESENT: Brent LoCaste‐Wilken, EAP; Denise Benbow, BON; Stephanie Espinosa, Long Term Care Representative; Kathie Rickman, Recovering Nurse; Sally Gilliam, TONE (Chair); Melanie Wiseman, Treatment Provider; Cindy Zolnierek, Texas Nurses Association Executive Director; Linda Plank, (Proxy for Sara Bishop, TOBGNE Representative) Advisory Committee MEMBERS ABSENT: T’Anya Carter, TxANA representative; Leonard Keesee, Advocate Committee; Shakyryn Napier, Texas Nurses Foundation; Alexandra Olivarri, TNSA; Tammy Wolff, LVNAT STAFF PRESENT: Katy Davila, Program Operations Coordinator; Jonathan Wolfarth, Program Director
III. Discussion Item: Today’s agenda (for acceptance) Comments: All members approved agenda
IV. Action Item: 12/1/2017 Advisory Committee Minutes: Old Business – JW MOTION #1: Stephanie Espinosa motioned to approve minutes, Kathie Rickman seconded Moved, Motion to approve 12/1/2017 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?
Kathie Rickman Advocate for two nurses completed TPAPN recently. c) Community outreach & education delivered?
Sally Gillam provided an article on TPAPN in the Texas Nursing voice. Linda Plank: Faculty member at Baylor University provides TPAPN information to students.
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 discussed the BON TPAPN Audit Citizen of Advocacy Center findings. On 2/27/2018 Leonard Keesee met telephonically with David Swankin, President and CEO of Citizen Advocacy Center and Becky LeBuhn, Board Chair of Citizen Advocacy Center regarding TPAPN. On 2/28/2018 Sally Gillam met telephonically with David Swankin, President and CEO of Citizen Advocacy Center and Becky LeBuhn, Board Chair of Citizen Advocacy Center regarding TPAPN.
b) 4/4/2018: Jonathan Wolfarth and Cindy Zolnierek meet with Courtney Hulbert, LCSW, PLLC; Previous PRN Program Director to discuss TPAPN Policies and Procedures
c) 4/11/2018: Jonathan Wolfarth, Cindy Zolnierek, Andy Cates meet with BON d) Participant Portal/Case Management Software System
i. Ongoing Updates ii. No Spectrum Advocate Access
e) Advocate Update: Jonathan Wolfarth discussed the value of Social Peer Support and TPAPN’s shift of the Advocates Role
i. Summary ii. Upcoming Change
a. SAMHSA: Core Competencies for Peer Workers b. Role Focus: SAMHSA Peer Support
Attachment A
7
Texas Peer Assistance Program for Nurses TPAPN Advisory Committee
March 16, 2018 – MEETING MINUTES P a g e | 2
f) TNA/TPAPN Website Upgraded, New Content g) TPAPN Staff Education h) Weekly Report to the BON i) TPAPN Financial Statements: Jan 2018 j) TPAPN Staff Directory
D. Committee goals for upcoming quarter (discussion) – Committee
E. Roundtable: What else? (discussion) – All Denise Benbow informed the Advisory Committee that employers may access NURSYS database to see nurses that
are Board Ordered to TPAPN or have upcoming licensure renewal. Denise Benbow discussed the process of Eligibility Board Orders. Denise Benbow recommended updating the TPAPN Advocate Quarterly Report by adding separate comment
boxes for “Support Provided: Emotional, Informational, Instrumental and Affiliational”. Advocates will then have the opportunity to add comments under each type of support provided, instead of combining all types of support provided in one comment box.
Cindy Zolnierek suggested adding the articles in the Texas Nursing Magazine to TPAPN’s website. Jonathan Wolfarth discussed the process of Intake, Enrollment Pending, Enrolled and reporting requirements to
TPAPN and the BON. Jonathan Wolfarth informed the Committee that TPAPN will hire a motivational interviewer to provide training to
TPAPN staff.
Material Distributed: Jonathan Wolfarth reviewed material distributed 1. Committee Roster & Contact Information 2. 12/1/2017 Advisory Committee Minutes 3. BON TPAPN Audit 4. Advocate and Supervisor Quarterly Reporting (old and new form)
Denise Benbow suggested to include a blank box under each “Support provided” rather than one large box after “Support Provided”
5. Advocate update: Summary 6. SAMHSA: Core Competencies for Peer Workers 7. Role Focus: SAMSHA Peer Support 8. TPAPN Activities 2016 ‐ 2018 9. Weekly Report to the BON
a) New Addition: Board Non‐Order, Third Party and Self‐Referral Reports 10. TPAPN Financial Statements: January 2018 11. TPAPN Staff Directory
VII. Announcements: A. Upcoming Activities: Advocate Workshop 1‐Day format 4/6/2018 at TNA’s Office
VIII. Information Item: Upcoming Committee meetings: B. 6/1/2018; 9/7/2018; 12/7/2018 (scheduled from 10:00a.m. – 3:00p.m. at TNA office)
IX. Adjourned 1:55 p.m. Minutes respectfully submitted by: Katy Davila, TPAPN Program Operations Coordinator March 16, 2018
Attachment A
8
Attachment B
9
Attachment B
10
Attachment B
11
Attachment B
12
Attachment B
13
Attachment B
14
Attachment B
15
Attachment B
16
Attachment B
17
