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Home Health on TPAPN

I'm just curious how feasible it is to work as an RN with a home health agency when you are in an impaired nurses program? Does anyone have any experience. So far in my quest they seem to want me the most but I don't know if it is really feasible. I would love some input!

jackstem

Specializes in Impaired Nurse Advocate, CRNA, ER,.

Many boards of nursing and/or alternative to disicpline programs do not allow the nurse to work in home care, specialty areas like ICU and ER, Hospice, etc. They also limit hours and shifts in many instances. Check with the program in your state. Have you checked to see if your program has a web site?

Jack

Ohio's program explains possible requirements as part of an agreement here:

Chapter 4723-6 Alternative Program for Chemically Dependent Nurses

Actually, here in Texas it is very possible to do. I know from experience. There is an extra page in the contract you have to agree to along with employer, but I didn't find it too difficult. One thing was, I had to make a face to face contact, and preferably first thing in the morning. Then a call throughout the day.

I was lucky to work with a really great manager, and a field nurse that would always meet up with me. Plus, if I recall correctly, you can only take call once a month and those days you will have to have a face to face with someone. That was kinda a downer on the weekends when you didn't have to see anyone. But, again, I made the bad decisions, so it wasn't horrible.:nurse:

The BEST part for me, was there was really no temptation. In HH you don't really give narcotics. Of course, if you want to find trouble, you can. Right?

Plus, honestly, the pay was much better than the hospital, and more flexible.

Good luck. If you have any questions, please feel free to PM and I will do my best to help you. FYI, I did complete the program with little problems. So, it can be done. Again, best of luck!!

dkalang

Specializes in ICU, CVU, CCU, PCU.

I am also in TPAPN in Texas. I was terminated one month after starting TPAPN and that was in November 2009. I am still unemployed. I was told that I couldn't work Home Health unless someone went with me. I'm confused. Do they decide on a case by case basis. I think I will give my case manager a call tomorrow and ask about this again.

please do check with your cm (i truly hope you don't have the ole bat i had, but apparently, she was what i needed at the time)

i did find that sometimes the "rules" would change while in the program. it also depends on where you are at in the program.

i don't remember all the added stipulations i had, but it was very doable for me. and, like i said, i had a don and case manager in the office that didn't make a big deal when i "checked in daily" plus i used a field nurse that i had become comfortable with to explain my situation to, and she became my "back-up, back-up" so, i'd meet her often, have lunch/coffee for the day. seems to me, i kept a calendar and had whoever initial the days i worked when we met up for the day. that way, no one could say i didn't have my "face to face"

also check with your advocate. he/she may also know something about home health. in fact, when i finished, my cm told me that they had had very "good results" with hh and participants.

hope things haven't changed.

keep me posted and best of luck!!!! you will make it!! promise! how far are you in the program, if you don't mind me asking?

dkalang

Specializes in ICU, CVU, CCU, PCU.

:)Thank you for the info. I will call my cm. I've already talked to my advocate about it and she doesn't know. In fact, she doesn't know a whole lot for an advocate. I'm thinking about requesting a new advocate. The one I have does all of the talking... about herself, and not recovery related. I haven't called her much because she has yet to know the answers to any of my questions. My cm is great. The one I had at first reminded me of nurse managers and supervisors who are very narrow-minded, opinionated, and stiff. She was an RN but the new one I have is an LCDC and she has been great. Takes her time in answering questions and is willing to work with you. She wasn't very good at explaining the home health thing to a potential employer when they talked to her on the phone. And I had a hard time understanding specific stipulations that I would have if I worked home health. I guess she was vague because, being new to the job, she wasn't sure herself but didn't want to admit. I will ask her about it again. Maybe with more experience, she knows more now. Thank you so much. I will post when I find out something.

dkalang

Specializes in ICU, CVU, CCU, PCU.

Sorry I didn't read your last question. I've been in TPAPN since Nov. 4, 2009. I voluntarily admitted substance abuse to my employer on Oct 19, 2009 and asked for help. (I did this voluntarily because I had been clean since 1987 and relapsed and I knew what was going to happen if I did not act. My first experience was in 1983 when TPAPN did not exist. I was caught diverting, fired from my job, report to and lost my license, and arrested and charged with theft. I did get my license back and luckily had many wonderful years of recovery. Needless to say, I stopped doing what I needed to do (meetings, sponsor, literature, steps) I thought I had overcome addiction. The last 2 weeks before asking for help was a nightmare! This disease progresses despite clean time. It was as if I never stopped using. It was very frightening and surprising to me. (This disease is insidious and deadly) I was in outpatient treatment and attending my 90 in 90 when I was terminated from my job on Nov 23, 2009. That's a long story. I did end up qualifying for unemployment, which is about to run out. And I filed a complaint with the EEOC just days ago for wrongful termination due to discrimination based on disability. Like I said it is a very convoluted, twisting, long story. I've been meaning to post it on this forum, just don't feel like doing that much typing. I need to go to bed. I will post more later.

I've been told that most boards do not allow it, but makes no sense to me. Very simple to keep one off cases where controlled meds are being used by the patient. And easy to incorporate a little more supervision also. But each state has their own rules. Good luck no matter how this all turns out. You will get to the other side eventually.

dkalang

Specializes in ICU, CVU, CCU, PCU.

I have no sanctions and am not being monitored by the board of nursing. But you are right. I am under no illusions; home health patients do have alot of meds laying around. That's why I am on TPAPN. It makes me accountable. I have 7 months clean and I need accountability. I had 13 years clean previously and I know that I have a disease that is trying to kill me. I have to work the steps, go to meetings, read the literature, call my sponsor, and most importantly, stay in constant contact with my God. I prefer working in case management, utilization management, but at this point, I am getting pretty anxious to get a job. I do have faith that I will get something soon. Thanks for your reply.

Magsulfate, BSN, RN

Specializes in ICU.

:)Thank you for the info. I will call my cm. I've already talked to my advocate about it and she doesn't know. In fact, she doesn't know a whole lot for an advocate. I'm thinking about requesting a new advocate. The one I have does all of the talking... about herself, and not recovery related. I haven't called her much because she has yet to know the answers to any of my questions. My cm is great. The one I had at first reminded me of nurse managers and supervisors who are very narrow-minded, opinionated, and stiff. She was an RN but the new one I have is an LCDC and she has been great. Takes her time in answering questions and is willing to work with you. She wasn't very good at explaining the home health thing to a potential employer when they talked to her on the phone. And I had a hard time understanding specific stipulations that I would have if I worked home health. I guess she was vague because, being new to the job, she wasn't sure herself but didn't want to admit. I will ask her about it again. Maybe with more experience, she knows more now. Thank you so much. I will post when I find out something.

Call TPAPN and , tell them your concerns about your advocate, I don't know if they will get you a new one, but maybe they can try to figure out what the issues are and resolve them. They may just need to speak with him/her and clarify some things. Also, please remember the advocates are VOLUNTEERS. TPAPN is short on advocates and sometimes it is difficult to even find one that is in your area. Advocates have their own full time jobs to keep up with along with volunteering for TPAPN. This can be very stressful and frustrating at times. Specially when you've got participants who don't want to follow the rules. Your advocate may be very new at this, just be patient. You have to check in with your advocate like your contract says, and your advocate does not need to be your 'friend". Call them, check in, answer their questions. Make sure she knows that you're calling in for drug testing everyday, that you're continuing to go to your meetings as ordered and that there are no other issues.

TPAPN is also very short on money and resources. Remember, they are doing the best with the funds that are given to them. They can close up shop at any time and all the participants would be out of the program, end up face to face with the board. That is not a good thing when you're a nurse with chemical dependency issues. The board is much harsher than TPAPN.

One more thing to remember, the advocate is not your counselor. They are there because your case manager probably has more than 200 other tpapn participants to keep up with and there's no way that a cm alone can manage to give personal attention to all of her participants. The advocate should try and answer your questions and if it is out of her scope then she must refer you to the case manager. SHe is not responsible for any paperwork, communication or stipulation issues that you have with TPAPN. The advocate can stand in for the case manager in the return to work meeting and she can be there to help potential employers understand TPAPN rules, etc. Your advocate will not be making decisions regarding your stipulations, other than how often you will call in and check with him/her.

And please remember, the best advice I can give you, is to just follow TPAPN's rules to the letter. Don't call them unnesseccarily and definitely don't call them when you're upset. As a matter of fact, keep the calls to Austin as limited as possible. Follow the rules, fill in all blanks, and do exactly what you're suppose to do. Then you'll be fine. :)

Magsulfate, BSN, RN

Specializes in ICU.

To answer your questions about home health, yes tpapn will allow it. However, you must be doing very well in your recovery. If they have any reason to suspect that you may not be able to handle home health and stay sober at the same time, then they will not let you do it. Same thing goes with working nights.

Like Rnrutro was saying, there has to be face to face contact with your manager everyday before you go out to the home. Someone has to make sure that you're not impaired. right? lol Well, relapse is very common and you must work hard to not have it. . . . TPAPN will also allow nurses to work night shift if there is good support at work and you have a manager on site at night.

Home health goes along with the tpapn rules that you can't be autonomous. You certainly wouldn't be able to work somewhere that YOU are the manager and there is no other person above you to make sure that you're doing okay.

All of these stipulations are put into place because they want the recovering nurse to have as least amount of stress as possible. It has been proven somewhere that more stress equals greater chance for relapse. Go figure.

Monica,

hey I think I know who you are...pm me you email address, I don't have the upgraded membership.

Lance

Well nevermind my caseworker didn't think the job was appropriate! I'm pretty sure its because the home health agency never dealth with TPAPN and he wasn't familiar with the ins and outs. He thought alot of it fell onto me but it really doesn't it requires alot of an employer and someone new just doesn't want to do that. Maybe if I can find a job with someone familiar with peer assistance it will be better! Any ideas in the Houston area?

Keep trying. Don't give up easily. Have you talked with your advocate to see if they can give you some ideas? It just depends where you interview and who you interview with. Do NOT, I repeat, NOT tell the "HR" person. Wait until you meet your manager and get a good feel for the job. No reason telling someone all your business if it's not the right job for you. Dialysis is a good place and I've heard Herman is tpapn friendly. Good luck. YOu CAN do it!!

@texasgirl.. im a lvn and also in tpapn.. i work in home health but in the quality assurance dept. mon thru friday 8-5... ive been in the program for 17 and a half months.. 6 more months to go... just hang in their...

diva rn, BSN, RN

Specializes in PICU, ICU, Hospice, Mgmt, DON.

Florida's IPN does not allow HH in the field typically but will allow the QA job of course.

They will allow nights on a case by case basis if there is a supervisor in the house.

In my peer group there are 9 out of 12 of us working: here is the run down..maybe it will give you some ideas:

2 in case management

1 in QA for Home Health agency

2 in outpatient surgical centers

1 works at Cleveland Clinic Office for the Doctors

1 works at a Pediatricians office

1 in Fresnius dialysis

1 in Watershed (inpatient alcohol recovery)

and 3 are still looking...I know of 3 more nurses who are also working in CD/alcohol recovery..you must have 2 years of sobriety yourself before they will allow it, but the treatment centers are very IPN friendly..it takes one to know one..

I guess.

anyway, dialysis is also historically recovery friendly here in FL as well and many IPN nurses have started back via DaVita and Fresnius..

don't know if they are out there where you are...

good luck!

Hello, I currently work Home Health and am in the monitoring program, initially they told me I could not work Home Care or night shift and unfortunately my full time job was Nights and my part-time job was with Home Care, with a lot of meeting and a great boss!! We came to an agreement that every morning when I came to the office (Home Care) I would take a breathalyzer and at the end of the day I would do this again. My boss was able to get the breathalyzer from a friend that works for the police dept and that is how I have started and ended my work days for the last 16 months. I am so great full that they allowed me to do this, otherwise I am not sure what I would have done. Good luck to you!!

Dialysis maybe?

catsmeow1972, BSN, RN

Specializes in OR.

Waking up an older thread but reading through it did not quite answer my question. i am just a scoash (is that even a word?) past the 3 year mark, 709 days to go, of a 5 year contract, yeehah, downhill run. My issue was mental health although I've been put through the wringer of substance use disorder stuff. yeah that's been great for the brain health stuff, but anyway i digress.

i've had no notable problems except for the routine difficulty of getting a job. Sadly sometimes the jobs that us contract people can get are in crummy facilities that hire lots of contract people because no one else with any choice would go near them. i did nail down a job at a great facility that did not care about the contract. Unfortunately, i have discovered that i not a floor nurse. Just can't handle the stress.

Having decided that my days of hospital work are over (and after much thought and yes tears, i think i'm okay with that, mostly.) i would like to try my hand at private duty/home health. It sounds very appealing to me. i would be able to concentrate on one patient at a time without getting pulled in 18 directions at once. i live in an area where home health companies abound. It's very snowbird heavy and quite affluent.

Supposedly, the contract will clear me to do home health soon (they review for something they call "transitional monitoring" at the 3 year mark where supposedly they lift the employment restrictions.) I say "supposedly" because no one is really forthcoming about what transitional monitoring actually means. So much of this stuff is left open to interpretation depending on who your case manager is and the direction of the wind.

My concern is that i don't know how difficult it will be to get a HH position even without employment restrictions. I am guessing those reports from the employer still have to be turned in so you still have to discuss the issue with said employer. Once again, i am stuck wondering. I would like to know because if getting HH is going to be a near impossibility then i need to turn my attention elsewhere.

Does anyone out there have recent experience in getting into HH with a contract, even one that is closer to the end the beginning?

I did home health for 8 months at the beginning of my 3 year contract. I didn't love it, but it was a job, and I do know other nurses who do love it so it's worth looking into. For the contract restrictions, I was still on a narc restriction but that didn't really matter because we never administered meds to the patients. The home health nurse was really doing just a weekly checkup on our patients, plus occasionally wound care. No meds. They took their meds on their own or had a caregiver. Some patients did need for me to fill their weekly pill boxes, so they just didn't give me patients who are on any narcs. It wasn't hard to do, there were very few patients on narcs anyway.

As far as the supervision that is required for most monitoring contracts, mine (TPAPN in Texas) required that I check in and check out with my manager every day. One of those could be by phone, the other had to be in person. My manager also assigned 3 other people who were allowed to be my "check in" people since she was not always available in the office or on the phone. The in person check in/out was literally me walking in the door of the office, saying "hey, I'm checking in (out)" and leaving. I wasn't allowed to see patients before I had done the check in, or after the check out.

There really isn't much to the home health visits. Truthfully it was just going in, doing a set of vitals, talking to them about whatever topic related to their main health problem (because you always had to document that you had done some type of teaching, like on meds, diet, nutrition etc) and then leaving and finishing up the paperwork in the car. The paperwork is much more time consuming than the actual visits! Especially on new patients.

The only stressful part about home health for me was calling the doctor's offices. It's hard to talk to a doctor at all, usually you leave a message, and then their nurse calls you back later with the doctor's answer. They rarely leave voicemails, so you really have to answer when they call back, and I don't like to answer calls while I'm driving. I get too distracted. So I tended to make all my visits in the morning so I could get all my phone calls done in the afternoons, with hopefully the doctor's offices finally calling back by the end of the day.

A minor issue I had with home health, and this was totally my ego talking, was that I felt like the check in and check out process was a constant reminder that I was in TPAPN. Twice every day I had to say "hey look, I'm not high". I lived pretty far away from my agency, but my patients were close to my house, so the drive into the office for the in person check in/out was always annoying to me. Knowing I could've driven a few miles to each of my patients and then gone home if I wasn't in TPAPN, but since I was, I had to add the extra twenty five minutes of driving to go to the office. But I was lucky that the agency agreed to do those check ins! I knew that, so I tried to feel gratitude rather than annoyance.

Oh, and the check in and out log was written down by the agency and I faxed it into my case manager quarterly along with my quarterly status updates.

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