My Guide to TPAPN

  1. Disclaimer: This surrounds my experience in TPAPN, but it should apply to many state monitoring programs with some exceptions.

    Three years and I'm finally finished with a completion letter in my hands.

    I thought it would be nice to share some advice for those still pulling their hair out at the idea of starting and those still exhausting their savings trying to keep up with the testing. Here are a few helpful tips I think many could benefit from in no particular order.

    1. Stay Under the Radar

    I believe I've read a handful of posts on these forums in the last three years from nurses talking about aggressively making phone calls to their advocates, TPAPN, and their case managers. I know the policies and requirements are awful. In fact, they are terrible at times. Unfortunately, most of us have screwed up along the way and TPAPN is our only hope towards a future career in nursing. If you have no chance at escaping TPAPN and you start off like this you're three years in the program will likely be more difficult than the rest of us because you put yourself in the spotlight early on.

    Reading all the posts from nurses screaming, fighting, and shouting "I'M GONNA GET A LAWYER" to me has been like watching a wild animal getting pinned into a corner by a group of hunters. While I encourage people truly innocent to use a lawyer, I think getting a lawyer for the purpose of getting out of the mess you honestly made is worse than the three years you'd have to do in TPAPN. Not dealing with your addiction, for many, has greater implications than a measly 36 months of being in a program that forces you to be clean for once.

    I already put my disclaimer up that if you're innocent, indeed you should seek legal counsel. For the rest, well... You know who you are.

    2. No Excuses for False-Positive Results

    False-positive test results is another popular thread you'll find here. While I am aware of specific things that will cause false-positive results, the most common reason these drugs tests come back is because these nurses used drugs.

    In three years I was tested about seventy-five times (Just Over $4,000) and had zero problems. Here are some things I did that may have helped avoid some problems:

    • I kept a box of gloves in bathroom because it's hard to find chemical components of cologne or perfume for you ladies. Most of them are made with heavily concentrated forms of alcohol. I would always spray cologne onto the gloves and then rub it on my clothes and never my skin.
    • Don't be embarrassed to ask friends or family if there was alcohol used in the food they prepared for you. My oldest sister, who happens to also being a raging alcoholic, uses wine in a lot of the Italian food she cooks. This isn't a problem unless you're someone that gets drug tested. I always believed alcohol cooked out of food if it was well heated up; however, there's a great amount of information available online to suggest that for that to be true the cooking conditions have to be very specific. Don't trust everything served to you - ASK!
    • Enjoy your bakery items. I ate a pint of vanilla ice cream in two nights leading up to a drug test that tested for alcohol consumption and it was negative. I've consumed my own banana bread the night before and morning of a test and had no issue despite having vanilla extract. Unfortunately, once upon a time some nurse before you couldn't admit to their addictions to alcohol and got busted. They got busted and probably cried on these forums looking for people to say "Ohhh get a lawyer girl! It was the vanilla extract. Fight them girlie #hugs!" when really they probably consumed alcohol and said it was the vanilla extract in their pineapple upside down cake. Sorry, no. Stop drinking alcohol and enjoy your bakery items.

    3. Random Testing Isn't So Random

    While most of them will be random, don't bet on it for vacations. Make absolutely sure that you schedule your travel/flights to accommodate testing times. If Quest Diagnostics only allows us drug addicts to get tested from 0900-1500, it's probably not a good idea to pick a flight that lands at 1430. Check where testing locations are prior to booking your hotel to make sure there is a location close to where you'll be staying.

    There were two vacations we took that were about a year apart where I was selected to test on the days of travel. For the first vacation, I was selected to test both the day of arrival and departure. I thought "Surely they wouldn't test me on the day of travel for a vacation I requested three months in advance?" Surely I was wrong. I didn't leave a lot of wiggle room for testing for the arrival day. I was supposed to land at 1400 and the plane was late and came in at 1420. I had to get our rental car and get to the testing center that was twenty minutes away. I walked into the Quest Diagnostics center at 1455. I was so stressed my hands were shaking. Don't put yourself into that position and plan your flights/travel to accommodate delays.

    4. Pay Close Attention To The People At Quest Diagnostics

    One thing that really stinks is that even if you go into test, the test can be invalid and considered non-compliance if the people at Quest screw up. Out of $4,000+ of tests, here are some of the most common issues I ran into that you have to be vigilant about:

    • The online system at Quest says "USE SPLIT SPECIMEN" and the COC form says "USE SPLIT SPECIMEN". I can't tell you how many times I was handed a single specimen container and told "Nah, you don't need a split." Make sure it's split!
    • Pay close attention to testers hands. There was two separate occasions where I had a young lady test me months apart who would soak her hands in ethanol based hand cleaner and then touch all of my testing supplies. If you feel uncomfortable about how your sample is being handled - Speak up!
    • Don't believe what people at Quest tell you. In my last few months of testing, I accidentally pulled an old RecoveryTrek COC form that was sitting in my car for over a year and used it to test. As I was walking out I noticed it and I told the staff I needed to test again because it wasn't an Affinity COC form. They told me, "Oh sorry. You can only drug test once a day. Just come back tomorrow." Come back tomorrow? Ya, ok... I traveled to the other side of town to another Quest and tested with no issues. Remember that in this program if someone is uninformed and gives you bad advice it's not their fault. It will fall on you because TPAPN will not care that someone told you something that wasn't true.
    • Expect at least once screw up with a COC form. There was one test in my first year where RecoveryTrek sent me an e-mail saying that I put the wrong social security number on a COC form and that if I did that again it would be considered non-compliance with the program. I had a copy of the COC form and the social security was perfect. Some things will be out of your control and be quite frustrating.

    5. You Should Never Lie With One Exception

    That one exception is in regards to your COC forms. In case you didn't notice, the DONOR COPY on the back page of the COC packet is the only page that blocks out the receivers signature/date/time so you have no evidence to take home that you actually provided a sample. Why? I couldn't tell you. However, what this means is that the DONOR COPY is a piece of worthless paper if anything ever happens to your sample. And who's problem will that be? Yours.

    What I would always do is tell the collector "Hey, my boss wants their copy today to prove that I actually came here" even though they could care less. The collector would then hand me the second to the last page labeled EMPLOYER COPY which is the same as the DONOR COPY but the receivers signature/date/time is on it. With this copy, you can actually prove you provided a sample if anything were to happen to your sample in transit.

    6. Finding Employment In TPAPN

    This is an interesting subject because it varies from city to city. I'll share my story about job finding and perhaps it might be helpful to some.

    When I first started TPAPN I dedicated 100% of my time off to job hunting. I have children and my wife was already a hard working stay at home mother. I was the only provider, so I had a lot of passion to look for work. Luckily, we were Dave Ramsey fanatics that had over six months of cash to live on and no debt, but I didn't want to chomp all the way through it. And so job hunting began.

    I live in a small town where almost every single facility is owned by HCA or Tenet corporations. HCA would not hire me because it's the facility I was fired from. The CNO's from two other facilities said that I would not be able to work for them for the rest of my life. That sucks. Tenet would be my next best option. I successfully got two jobs from interviews. One was for rehab and another doing scheduling/clinical coordinating of sorts. I waited until after they offered me the job to tell them about TPAPN. Both times they said they would call me back after discussing it, and both times they said they could not hire me simply because of the restrictions. No nights, no overtime, no narcs, quarterly meetings, and sign in sheets from charge nurse or supervisor is an administrative nightmare and I don't blame them for waving goodbye to me.

    I finally established a job about a month after joining TPAPN because the substance abuse counselor would network other TPAPN nurses together. Through his networking, I was able to get in contact with a nurse who was in home health that worked for a company who's director had been through TPAPN. What a find huh? What I found out later is that most home health companies will hire anyone with a nursing license and a pulse. It can be really boring, but it keeps you doing some skills and in our case it kept the lights on and put food on the table.

    Since we had no debt and a low monthly mortgage, I decided to leave nursing after I satisfied TPAPN's 12 months of "safe and effective nursing practice" to work for a sub-company of Albertson's as a driver and part-time at Wing Stop.

    7. Provide Perfect Urine

    This might sound strange. However, in the $4,000+ I did of testing, I had a dilute urine twice. I was never warned about it; however, out of worry I decided I would only provide urine that was concentrated from then on. I started to provide TPAPN my first urine of the day. This ended up back firing. I had two urine samples that TPAPN thought were too concentrated and they actually sent me a letter about it. While most people get warned for dilute urine, my letter said that my urine was too concentrated and that if it continued my urine would be considered positive regardless of results and that I would lose my license. My advice is don't over hydrate yourself, and don't give them your first urine of the day either. Both are bad and can cause you to lose your license.

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    Hopefully some of you find this information helpful. Please don't hesitate to send me any questions. If you're the type that can't be honest publicly for whatever reason, don't hesitate to just send me a private message. Take this one day at a time and sooner or later it will all be over.
  2. Visit Uncle-JoJo profile page

    About Uncle-JoJo, MSN, RN

    Joined: Jul '17; Posts: 27; Likes: 52
    Specialty: 3 year(s) of experience

    12 Comments

  3. by   mimifromtx
    Hi Uncle JoJo,
    Congratulations on being done! I think you have a pretty handy guide here, with a few minor exceptions...

    1) There are A LOT of folks in monitoring because they decided to be honest nurses (Isn't that what we are taught) and landed in monitoring because of depression/bipolar issues. They "fessed up" thinking they were doing the right thing by being honest, thinking that even taking an antidepressant is the equivalent of "treatment"...which they were never placed in a facility or had a run in of any other kind, yet find themselves in a monitoring contract :/
    So I really don't think those nurses screwed up or put themselves in that position (stigmatization of mental health issues is an ongoing problem!) And this doesn't even address the stupid things kids do in their teens and twenty's that make them end up decades later in monitoring

    2) A VERY recent post on this forum shows that we can jump through the flaming hoops, diet and fluid restrict, avoid contact with almost everything including dirt, and still pop a positive UDS that leads to weeks/months/years of HELL! Our comrad popped a positive for ETOH/ETG/ETS, split screen, split actually even turned to "rocket fuel" as she said, so she went for her own PETH, yada..yada..yada.. and was shown to be negative. SOOOO...I really feel like downplaying the acute possibility of positive tests is negligent! Certainty the vast majority of the population in monitoring will not encounter these problems. However, stating that they only result from USING is downright false and harmful, especially considering the fact that these tests are so poorly controlled, and have such poor evidence based science backing the results (again...aren't we taught that EBS makes a test valid?)
  4. by   Uncle-JoJo
    Hey Mimi,

    Thanks for the feedback. For point one, it was simply a matter of not putting a disclaimer that I'm speaking only on the substance abuse side. Putting people with mental health into a monitoring contract simply "because" they have bipolar/depression is one of the saddest BON/TPAPN things I'm aware of. I think most would agree.

    Unfortunately, the forum does not allow me to edit my disclaimer. Hopefully someone will scroll down and read this before posting.

    For point two, I'll approach that by simply stating that most of what you're trying to insert is not applicable if you consider how I presented it. I never said false positives weren't a thing. I said the most common reason for a positive drug screening was for the use of drugs/alcohol. The headline "No Excuses for False-Positive Results" is no joke. Nurses often make every attempt to prove their innocence often can't because of TPAPN's restrictions, lack of interest in resolution, or a limitation to testing windows. It's just the sad reality of what's available to us.

    Please forgive me if it came off harsh. I know false positive tests do exist and it sucks for those affected by them.
  5. by   nurse_girlie
    As a nurse grad facing contract I found the tips related to specimen collections and getting signed copies of the collection document helpful. Thanks.
  6. by   Persephone Paige
    Congratulations on being finished.
  7. by   rn1965
    Congratulations on your completion. I will use some of the tips! Thank you!
  8. by   hppygr8ful
    Good tips here.

    When in comes to the so-called false positive Etgtest I will add that in the five years I was in California's program I had 2 positive Etg tests. I know I did not drink but the way it was explained to me is there is no such thing as a false positive because Etg is a metabolite of ETOH in the system. It only means that some how, some way ETOH got into your system. In both cases mine were ultimately ruled as incidental exposures and excused. I wasn't particularly careful about what I ate but I did use appropriate caution and did not consume anything that had alcohol in the name or ingredient list.

    Hppy
  9. by   Uncle-JoJo
    Five years hppy? I couldn't imagine doing five. Good job getting that over with. Thank you for the feedback.
  10. by   hppygr8ful
    Quote from Uncle-JoJo
    Five years hppy? I couldn't imagine doing five. Good job getting that over with. Thank you for the feedback.
    California's program is five years 4 under direct supervision and 1 year of transition where all requirements are lifted except RUDS. Then you can be let out.

    Hppy
  11. by   GeneralizedConfusion
    Hello. I made a post and was wondering if you could read it. I also wanted to know, when you are done with monitoring will future employers know that your license was once encumbered?

    Also, if I were to complete monitoring and then move states to transfer licenses would I have to go through monitoring again? And also can I go through this type of program and receive an interstate compact license?

    Sorry for the thousand questions and I'm sure you don't have the answer to all of them. But its hard finding anyone who knows anything about this stuff
  12. by   Uncle-JoJo
    If you successfully complete TPAPN your license should appear as though nothing happened.

    If you're still in monitoring TPAPN required you only work in Texas until complete. However, if you're done it has zero implications and you can practice wherever you're compact allows. Also, you don't have to repeat monitoring if you go through reciprocity for another states license that isn't compact. You only have to continue monitoring in another state (or sometimes start over) if you're still in monitoring.
  13. by   cat_lady_jr
    I successfully completed TPAPN and later moved to another state with a compact license. My TPAPN participation was not on my license and I didn't have to go through their monitoring program. I did report my participation when I applied to move my license to another state and sent them a copy of my completion letter just to be safe. It turns out that wasn't necessary. I had no investigation through the Texas BON and self-reported to TPAPN, so YMMV. If your license was formally investigated by the Texas BON, then you will most likely need to report that during your application to move licenses.
  14. by   cat_lady_jr
    Congrats on completing the program! I know how hard you've worked. I also graduated from TPAPN and it was a long road. I did want to add my experience to your comment. You are absolutely right that a split screen is a must. I had a false positive EtG result on an initial screening, but when the other specimen was tested it was negative. I was so afraid and confused when that happened and I thanked the lord that I had provided a split specimen. My case manager was really nasty about it until the negative came back.

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