TPAPN:a Four Letter Word?

[1964RNfromTX]

I'm having to go through TPAPN for a past hoistory of 4 DWI's. The last one was in 1991. I have been sober for for ten years, but that doesn't seem to count. My alcohol dependancy assessment that I had performed for the boards revealed that I didn't have a problem (and was verified with a polygraph), but the BNE required me to go through TPAPN anyway. TPAPN, wanted a new assessment done stating "the other one was too far in the past"(the previous one was done in Oct. '05). After finishing this new assessment, the counselor told me that he "didn't see a problem" and he "wasn't going to recommend any treatment". However, after talking to the TPAPN case manager the following day, he changed his assessment to read that I need Intensive Outpatient Treatment, 3 nights a week for 20 sessions.

I was allowed 45 days from my initial licensure date to enroll in TPAPN. In the mean time, I obtained a job and have been working. I made my employer aware of my TPAPN stipulation before I was hired, and thus far, they haven't had a problem with any of this. This past week I was told by my case manager that I could not work until I got my assessment done and started the treatment that I need (she has never even met me and has only spoken to me on the telephone twice, but she can tell I have a seriuos problem???).I have a case manager that can only be reached maybe once a week. She will not respond to messages that I have left, nor will she answer her telephone. I have all of my paperwork completed, and have complied with everything I am supposed to do, and I'm ready to go back to work. Now I have to play the waiting game with the case manager, trying to get her to answer her telephone, or at least return my call.

Thanks for letting me vent. Have a nice Labor Day Weekend!

:monkeydance: (Walking the Tightrope Here)

[Magsulfate, BSN, RN]

Of course I do not like it the way it is, but I am very grateful for a second chance at life and at nursing. I can only imagine where I would be right now had I been booted out of nursing, like you suggested, and had lost my career, something that I love. And like I said in a previous post, you must be dedicated to life, yourself, your family and nursing to the greatest degree to bounce back and go through the first few months of tpapn. Thanks for your opinion. That is mine.

[the bull]

Been there Done tthat. I know exactly what you mean. What it really is. Once you mention tpapn they look confused because they have no idea what it is, and while your explainin and then mention the board it scares the hell out of them and they dont know what to think then.

All I know is that i feel i have met the Devil twice and do not want to meet him again

[RNRutRO]

i never claimed to be a subject matter expert on tpapn. based on what i do know of it, i do not like the program. that's all. from reading these posts, it doesn't seem that you think much of it either. rnrutro, don't let me get to you. the anger ain't healthy. to all concerned, please don't fret. i am not a threat to any of you. i am not a manager and have no interest in being one. bne is not going to ask me my opinion and i have nothing against any of you.

knoodsen:

sorry to let the anger boil up. i guess it's my addict in me to get defensive! you have every right to your opinions! however wrong they may or may not be;)

what you said is right. tpapn allowed me, to be a theif and protected. but i didn't do what i did with that in mind. it wasn't like a "get out of jail card fee" if you can understand that. but, for the second chance, i am thankful. i don't think that will happen again. it's not an easy progrm until you get your head on straight. and before you make judgements, there are people that i'm sure you would agree, do not belong in the program. but other's that really do and some that in my judgemental mind, never should have been given a second chance. that said, i'm sure there are those out there that feel the same freaken way about me.

glad to hear you aren't in the position to hire one of us. rejection is probably the hardest part of the process. take another look at the program and possibly you can see that, yes, there are those that make mistakes. and instead of taking their income, life, etc away, there is a second chance. you never know, you may need a second chance one day---i don't think any of us would have thought that we'd be here when we started out as nurses.

hope you had a great 4th of july!

[Knoodsen]

I understand that this is an emotionally charged subject since it affects one's ability to make a living. Personally, I believe that we should be judged by the quality of our work, but that isn't how things operate anymore. Our culture is what it is and I have to accept that or pay a price. I am simply looking for a conversation regarding what the standards should be. Who is entitled to a second chance ( or a chance, for that matter)? If nursing is truly a profession, then we should be deciding who gets to belong to the profession. Does anyone want to think and talk about that? I think we all believe that there are those who deserve another chance as nurses. The tricky part is deciding who doesn't. I would think that a TPAPN nurse would want to talk about this. TPAPN is for "impaired" nurses, right? Nowdays, one is not "impaired" if they have a prescription for the drug(s) they use. Think about it.

[littlehoot]

I wentthrough the same thing. During a difficult divorce a got a DWI in 1996. I was a licensed LVN with TX for 3 years. Every 2 yrs my license was renewed without question. In 2003 I graduated RN school and we were the first to do FBI fingerprints. I did the honest thing and told the board about my 1996 conviction to which I went to intensive 90 in-patient tx. I completed all my community service. Paid all restitution and completed 2 years of Probation with the Criminal System. Then 10 years later I have to hire an attorney and pay out $28,000.00 in attorney fees and expert witness fees. I faced the board of nursing in an informal conference, only to get referred to TPAPN. This is double jeopardy. I paid my time in 1996 and now I have to pay for the crime all over again with this TPAPN. I call the # everyday and see if I have to test. I test when I have to. Then I get a letter from TPAPN that my urine creatinine level was "low" and that increased random testing maybe ordered and that if I test low again that could be resulted as positive and then they will send it to the BNE. TPAPN is not a bad thing, for the people who need it. Get the nurses who now give their patient saline and inject the demerol or morphine into themselves. Not a mere DWI in 1996. Spending $28,000.00 saved my license, but really, this is toooooooooooo old. There needs to be a statue of limitations on this.

Oh, I was board ordered to TPAPN in Aug 2006, it took until Nov 2006 to get my work set up with TPAPN, because my case manager never called back. They had my paperwork for over 3 months. Then when I switched jobs, it took 2 months for my case manager to set up with my new employer. I wonder when the 2 year program really starts. Aug 2006, Nov 2006, or Jan 2007. My case manager was on vacation for two weeks, then had a death in the family, it took 2 months of me having a job but not being able to work...my case maanager was not avaiable. This is BULL****!

Then when she is in contact once, it is for a "low urine creatinine level". Are they just out to rid TX of damn good nurses' or what? Let's get the girl who has a 10 yr old case, leave the one using drugs that belong to patients alone.

Can anyone relate? How can we WE WE the nurses' going through TPAPN stand up for ourselves? Either we do as were told (like communist countries) or we lose our license. I do not know about you, but I have been a nurse ALL my career. Since I was 21 yrs old, nursing is ALL I know. So TPAPN can just shake a magic wand, and "puff" kiss your career and everything you know good-bye. This is unfair and unrealistic. This is causing me to want to drink, hell, get drunk. Instead of helping me this is only hurting. My life has been sailing smooth for over 10 years, now I have to fight to keep my license, that TPAPN can instantly take away.

Anyone out there relating?????????

[Magsulfate, BSN, RN]

Just to put it in perspective.... in the TPAPN "bulletin" that I got in the mail, it stated that there were 600 something TPAPN participants right now, and only 5 case managers. So, that is the reason why the case managers are not available. Only if you do something wrong, THEN all of a sudden they are available. Your advocate should be available to you everyday. My advocate is a nice lady,,,, they are all volunteers, so they really WANT to be there for you.

I think that with the case load being so high, they can't individualize the cases. Everyone has to be treated the same. It would be too hard to decide who would get this treatment, and who would get that. Then you'd have nurses crying foul because of "unfair" treatment. I have heard of a few cases like yours, where it has been years since it happened and you have been working just fine and then all of a sudden,,, you have to go to tpapn for a dwi you got 10 years ago. I don't think it is right that you have to do that because in a sense, the board of nursing is saying you've been drunk all these years. Right? Then,,, that would be saying they are wrong because they let you work drunk all these years. It is absolutly rediculous. I know.

[littlehoot]

Thanks for the input, it just does not make these 2 years go any faster.

[txspadequeenRN, BSN, RN]

just curious do other states have a program similar. i have carried the narc keys for many tpapn nurses so they could have a second chance. but , this whole program seems like a mess .they should have some sort of statute of limitations for nurses.

[latrink]

I know that other states have similar programs like california and I think Penn. But I don't know if all do. I tested in NY and they gave me license without a problem. It wasn't until we moved here that I even heard of a program like this (btw, didn't know til I was on it what it really was!!)

[nurseandlawyertoo]

No surprise there. Many believe that the Board has a bias against nurses with drug and alcohol problems. You may want to go to the Board's website and look at the chemical dependency policy and rules that go along with it. Sure seems like you have plenty of "objective verifiable sobriety" and are past the 5 year rule for criminal convictions/deferreds and can show 5 years sober. While you are doing that research, you may also want to look at the State Office of Administrative Hearings website under Proposals for decision for the BNE to see what the administrative law judges have been doing with these cases--you will be surprised that there are many opinions out there that say that "DWI" is not related to the practice of nursing...unless of course you were driving while you were working.

Yes, the BNE is protecting the public from bad nurses--and from good nurses too, who have made mistakes in their past that the BNE won't let them recover from.

[1964RNfromTX]

I have recently found that I was sent to TPAPN illegally. According to my Declaratory Order.

Texas Administrative Code RULE 213.29.

(a) A person desiring to obtain or retain a license to practice professional or vocational nursing shall provide evidence of current sobriety and fitness consistent with this rule.

(b) Such person shall provide a sworn certificate to the Board stating that he/she has read and understands the requirements for licensure as a registered or vocational nurse and that he/she has not:

(1) within the past five years, become addicted to or treated for the use of alcohol or any other drug; or

(2) within the past five years, been diagnosed with, treated or hospitalized for schizophrenia and/or other psychotic disorders, bi-polar disorder, paranoid personality disorder, antisocial personality disorder or borderline personality disorder.

© If a registered or vocational nurse is reported to the Board for intemperate use, abuse of drugs or alcohol, or diagnosis of or treatment for chemical dependency; or if a person is unable to sign the certification in subsection (b) of this section, the following restrictions and requirements apply:

(1) Any matter before the Board that involves an allegation of chemical dependency, or misuse or abuse of drugs or alcohol, will require at a minimum that such person obtain for Board review a chemical dependency evaluation performed by a licensed chemical dependency evaluator or other professional approved by the executive director;

(2) Those persons who have become addicted to or treated for alcohol or chemical dependency will not be eligible to obtain or retain a license to practice as a nurse unless such person can demonstrate sobriety and abstinence for the preceding twelve consecutive months through verifiable and reliable evidence, or can establish eligibility to participate in a peer assistance program created pursuant to Chapter 467 of the Health and Safety Code;

(3) Those persons who have become addicted to or treated for alcohol or chemical dependency will not be eligible to obtain or retain an unencumbered license to practice nursing until the individual has attained a five-year term of sobriety and abstinence or until such person has successfully completed participation in a board-approved peer assistance program created pursuant to Chapter 467 of the Health and Safety Code.

(4) Those persons who have been diagnosed with, treated, or hospitalized for the disorders mentioned in subsection (b) of this section shall execute an authorization for release of medical, psychiatric, and treatment records.

(d) It shall be the responsibility of those persons subject to this rule to submit to and pay for an evaluation by a professional approved by the executive director to determine current sobriety and fitness. The evaluation shall be limited to the conditions mentioned in subsection (b) of this section.

(e) Prior intemperate use or mental illness is relevant only so far as it may indicate current intemperate use or lack of fitness.

(f) With respect to chemical dependency in eligibility and disciplinary matters, the executive director is authorized to:

(1) review submissions from a movant, materials and information gathered or prepared by staff, and identify any deficiencies in file information necessary to determine the movant's request;

(2) close any eligibility file in which the movant has failed to respond to a request for information or to a proposal for denial of eligibility within 60 days thereof;

(3) approve eligibility, enter eligibility orders and approve renewals, without Board ratification, when the evidence is clearly insufficient to prove a ground for denial of licensure; and

(4) propose conditional orders in eligibility, disciplinary and renewal matters for individuals who have experienced chemical/alcohol dependency within the past five years provided:

(A) the individual presents reliable and verifiable evidence of having functioned in a sober/abstinent manner for the previous twelve consecutive months; and

(B) licensure limitations/stipulations and/or peer assistance program participation can be implemented which will ensure that patients and the public are protected until the individual has attained a five-year term of sobriety/abstinence.

(g) With respect to mental illness in eligibility, disciplinary, and renewal matters, the executive director is authorized to propose conditional orders for individuals who have experienced mental illness within the past five years provided:

(1) the individual presents reliable and verifiable evidence of having functioned in a manner consistent with the behaviors required of nurses under the Nursing Practice Act and Board rules for at least the previous twelve consecutive months; and

(2) licensure limitations/stipulations and/or peer assistance program participation can be implemented which will ensure that patients and the public are protected until the individual has attained a five-year term of controlled behavior and consistent compliance with the requirements of the Nursing Practice Act and Board rules.

(h) In renewal matters involving chemical dependency or mental illness, the executive director shall consider the following information from the preceding renewal period:

(1) evidence of the licensee's safe practice;

(2) compliance with the NPA and Board rules; and

(3) written verification of compliance with any treatment.

(i) Upon receipt of items (h)(1)-(3) of this section, the executive director may renew the license.

Also, from my Declaratory Order:

The Board may, in it's discretion, order a Petitioner, upon initial licensure as a Registered nurse, to participate in a Peer Assistance Program approved by the Board if the nurse would otherwise been eligible for referral to peer assistance persuant to section 301.410, Texas occupation Code.

Texas Occupations Code 301.410

301.410. REPORT REGARDING IMPAIRMENT BY CHEMICAL

DEPENDENCY OR MENTAL ILLNESS. A person who is required to report a nurse under this subchapter because the nurse is impaired or

suspected of being impaired by chemical dependency or mental

illness may report to a peer assistance program approved by the

board under Chapter 467, Health and Safety Code, instead of

reporting to the board or requesting review by a nursing peer review

committee.

1. The law works for you when the government requires you to attend AA, since a series of cases at the State Supreme Court and Federal Appeals Court levels (with no diverging opinions) have held that a government body cannot require a person to attend AA because of its religious content (this violates the 1st Amendment's separation of church and state, called the "establishment"--no establishment of religion by the government--clause). The same does not apply with private employers, since the idea is you can go to another employer. A state agency with sole power for medical licensure parallels the government enacting requirements.

TPAPN requires you to attend AA to remain in compliance, so it seems to be unconstitutional for the boards to make you join TPAPN, since by doing so is making you attend AA.

I am currently working as a Home Health RN. I intend to take this fight to the highest court possible. I am even considering a civil suit.

Good Luck to all of you TPAPers,

David

P.S. Maybe we need to form our own program to fight the injustice of TPAPN and the BNE making them rich.

[latrink]

I think we should!! Does this mean that I'm not supposed to be on this either. I can not prove to anyone that I've been sober but I haven't been arrested (for anything....no law problems here anymore) 6 years and they had me join TPAPN just a few months shy of my 5 yrs since conviction. I went to a rehab but that was 6 yrs ago. Hmm..... I know I shouldn't be on it but when I asked about still going before the board they said that I signed a binding agreement and could not. I'm all for a fight it's paying for it that doesn't sound feasible for me, especially with some of the posts I've read!