to of q1 - texas board of nursing · 2018-01-02 · quarterly report to the texas board of nursing...

Quarterly Report

to the

Texas Board of Nursing

(BON)

For the period 9/1/2017 through 11/30/2017 (BON Q1 2018)

December 15, 2017

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

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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 decreased by 29 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 25 vs. the previous quarter

TPAPN average number of cases increased by 124 since fiscal year Q1 2013

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Statistical Information

Table 3 presents data on participation agreements signed

Participation agreements signed increased by 24 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 100 vs. the previous quarter* *This figure is now based on employment end date. It had previously been based on employment start date.

Table 5 presents data on completions

Participant completions decreased by 26 vs. the previous quarter

Table 6 presents information on drug test monitoring activities*

Requested drug tests increased by 573 vs. the previous quarter**

Conducted drug tests increased by 425 vs. the previous quarter**

Abnormal drug tests increased by 166 vs. the previous quarter

Excused drug tests are 114 (not previously reported) *** *Three new categories have been added to this table: Excused, Invalid and Rejected. **Drug test frequency variance due to migration of new software system. ***Some drug tests were excused because of collection site closures and limited hours due to Hurricane Harvey and the Thanksgiving holiday. OUTREACH ACTIVITIES TPAPN Overview presentations:

10/4/2017: Texas Board of Nursing

10/24/2017: National Association of Hispanic Nurses Association meeting (San Antonio)

10/28/2017: Licensed Vocational Nurses Association of Texas (LVNAT) Annual Convention (Round Rock)

11/1/2017: Texas Surgical Care Affiliates (Dallas)

TPAPN Bi‐annual Advocate Workshop:

11/3/2017: Texas Nurses Association Headquarters (Austin)

ADMINISTRATIVE ACTIVITIES

TPAPN Advisory Committee meeting minutes 6/2/2017, (Attachment A, pg. 7 – 8) STATUS REPORT

TPAPN is being audited by the Citizens Advocacy Center

TPAPN continues to work with the BON to implement the Sunset Commission’s recommendations FISCAL

Financial statements included, (Attachment B, pg. 9 – 18)

Table 1 Table 2

Referrals by Nurse Type and Referral Source Nurses by Referral Source and Nurse Type

Nurse

Type Self 3rd Party

BON

Non‐Ordered

BON

Ordered BON EEP TOTAL Referral Source APRN RN LVN TOTAL

APRN 4 0 3 0 0 7 BON EEP 0 3 1 4

RN 15 15 49 17 3 99 Self 4 15 3 22

LVN 3 2 9 11 1 26 BON Ordered 0 17 11 28

TOTAL 22 17 61 28 4 132 3rd Party 0 15 2 17

previous

quarter 22 34 69 35 1 161 BON Non‐Ordered 3 49 9 61

change 0 ‐17 ‐8 ‐7 3 ‐29 TOTAL 7 99 26 132

previous

quarter 5 132 24 161

change 2 ‐33 2 ‐29

Referral Source Nurse Type

03

144

15

3

22

0

17

11

28

0

15

2

17

3

49

9

61

7

99

26

132

0

20

40

60

80

100

120

140

APRN RN LVN TOTAL

Number of Referral

Nurse Type

Figure 1: Referrals by Nurse Type and Referral SourceQ1 2018

(9/1/2017 ‐ 11/30/2017)

BON EEP

Self

BONOrdered

3rd Party

BONNon‐Ordered

TOTAL

0

4

0 03

7

3

1517

15

49

99

13

11

2

9

26

4

22

28

17

61

132

0

20

40

60

80

100

120

140

BON EEP Self BON Ordered 3rd Party BON Non‐Ordered TOTAL

Number of Nurses

Nurse Type

Figure 2: Nurses by Referral Source and Nurse TypeQ1 2018

(9/1/2017 ‐ 11/30/2017)

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 Q4

2012‐20139/1/2012‐8/31/2013

2013‐20149/1/2013‐8/31/2014

2014‐20159/1/2014‐8/31/2015

2015‐20169/1/2015‐8/31/2016

2016‐20179/1/2016‐8/31/2017

2017‐20189/1/2017‐8/31/2018

APRN* 30 30 31 32 34 34 35 34 32 29 23 21 19 15 14 14 24 32 37 34 36

RN 439 442 440 452 442 411 432 479 486 485 537 548 549 555 580 604 592 593 590 578 557

LVN 119 128 123 120 113 105 124 122 116 125 136 135 126 127 120 120 130 126 125 125 119

TOTAL 588 600 594 604 589 550 591 635 634 639 696 704 694 697 714 738 746 751 752 737 712

30 30 31 32 34 34 35 34 32 29 23 21 19 15 14 14 24 32 37 34 36

439 442 440452 442

411432

479 486 485

537 548 549 555580

604592 593 590

578557

119 128 123 120 113 105124 122 116 125 136 135 126 127 120 120 130 126 125 125 119

588600 594 604

589

550

591

635 634 639

696 704 694 697714

738 746 751 752737

712

0

100

200

300

400

500

600

700

800

Number of Nurses

Figure 3: Average Cases by Nurse TypeQ1 2013 to Q1 2018(9/1/2012‐11/30/2017)

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.

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STATISTICAL INFORMATION

Q1 2018

(9/1/2017 ‐ 11/30/2017)

Table 3: PARTICIPATION AGREEMENTS SIGNED

TPAPN Tracks APRN RN LVN TOTAL

Substance Use Disorder (SUD)

SUD Only 3 35 10 48

Dual (SUD & Mental Health) 1 12 3 16

Mental Health Monitoring (MHM) 0 6 3 9

Mental Health Support (MHS) 0 0 1 1

Extended Evaluation (EE) 0 3 2 5

Interim Monitoring (IM) 0 3 0 3

TOTAL 4 59 19 82

PREVIOUS Quarter 2 44 12 58

Change 2 15 7 24

Table 4: PARTICIPANTS EMPLOYED IN NURSING* (As of the last day of this quarter)

APRN RN LVN TOTAL

TOTAL 25 364 62 451


Change 0 ‐75 ‐25 ‐100* 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 (SUD)

SUD Only 0 22 3 25

Dual (SUD & Mental Health) 0 5 3 8

Mental Health Monitoring (MHM) 0 4 3 7

Mental Health Support (MHS) 1 3 0 4

Extended Evaluation (EE) 0 4 0 4

Interim Monitoring (IM)*

TOTAL 1 38 9 48


Change 0 ‐25 ‐1 ‐26*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** Positive Negative Abnormal Dilute Missed Excused*** Invalid Rejected

TPAPN Tracks

Substance Use Disorder (SUD) SUD Only 2374 2230 76 2004 128 22 48 76 8 12 Dual (SUD & Mental Health) 908 868 45 766 52 5 17 20 2 1Mental Health Monitoring (MHM) 76 60 21 39 2 3 4 7 0 0Mental Health Support (MHS) 0 0 0 0 0 0 0 0 0 0Extended Evaluation (EE) 62 53 8 45 2 0 1 6 0 0Interim Monitoring (IM) 86 77 4 61 12 0 4 5 0 0

TOTAL 3506 3288 154 2915 196 30 74 114 10 13PREVIOUS Quarter 2933 2863 144 2661 30 27 69 – – –

Change 573 425 10 254 166 3 5 – – –*Three new categories have been added to this table: Excused, Invalid and Rejected.

**Drug test frequency variance due to migration of new software system.

***Some drug tests were excused because of collection site closures and limited hours due to Hurricane Harvey and the Thanksgiving holiday.

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Texas Peer Assistance Program for Nurses TPAPN Advisory Committee

September 15, 2017 – MEETING MINUTES P a g e | 1

I. Call to Order 10:08 a.m. A regular Advisory Committee meeting was held at TNA Offices Dietrich Training Conference Room, Austin, Texas on September 15, 2017. The meeting convened at 10:15am, presided by, Program Director, Jonathan Wolfarth

II. Roll Call Advisory Committee MEMBERS PRESENT: Denise Benbow, BON; Stephanie Espinosa, Long Term Care Representative (teleconference); Leonard Keesee, Advocate Committee; Brent LoCaste‐Wilken, EAP; Sara Bishop, TOBOGNE (teleconference); Kathie Rickman, Recovering Nurse Advisory Committee MEMBERS ABSENT: T’Anya Carter, TxANA representative; Sally Gilliam, TONE (Chair); Shakyryn Napier, Texas Nurses Foundation; Melanie Wiseman, Treatment Provider (teleconference); Tammy Wolff, LVNAT; Cindy Zolnierek, Texas Nurses Association Executive Director 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: 3/3/2017 Advisory Committee Minutes: Old Business – JW MOTION #1: Moved, Motion to approve 6/2/2017 Advisory Committee minutes. Moved by: All APPROVED

V. Information Item: New Business A. Committee accomplishments (discussion) – Committee a) Bring knowledge, skill…brought? b) Advocates recruited?

c) Community outreach & education delivered? Leonard Keesee provided TPAPN education at Baylor University, Midwestern State University, Texas Christian University, Trinity Valley Community College and University of Texas at Arlington. d) Other? The following participant concerns were addressed: Participant evaluation cost and participant drug testing. Jonathan Wolfarth discussed the challenges of nurses obtaining an evaluation completed by mastered prepared or doctorial prepared evaluators. In January 2017 TPAPN started requiring evaluations be completed by master prepared or doctorally prepared evaluators, which is more consistent with BON evaluator requirements. The intent is to be fair and equitable for everyone. TPAPN works closely with the BON, and TPAPN’s job is to help the nurse, thereby protecting the public. B. Roundtable: Feedback from the communities represented (discussion) – Committee

C. Program Update (informational) – JW TPAPN was monitoring focused, but is now guidance, support and monitoring. TPAPN is working to achieve a more individualized approach in response to Sunset recommendations. Jonathan Wolfarth reviewed TPAPN activities from June through August 2017. TPAPN would like to train Case Managers on motivational interviewing. Denise Benbow reviewed the process of SOAH Hearings. Jonathan Wolfarth must appear in person or by phone as well and be available to answer questions about nonadherence. The BON is having discussions about possibly requiring the Case Manager to attend SOAH Hearings, rather than requiring Jonathan Wolfarth to appear. TPAPN upgraded to the new Participant Portal/Case Management software system (Affinity’s Spectrum) in September 2017 and feedback from TPAPN staff and participants has been well received. Jonathan reviewed the new process for letters and forms which is significantly simplified and different. The TPAPN forms book has been deconstructed by each program track and are currently available in the participant portal/case management software system.

ATTACHMENT A

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Texas Peer Assistance Program for Nurses TPAPN Advisory Committee

September 15, 2017 – MEETING MINUTES P a g e | 2

i. Participant Portal/Case Management Software System (Affinity’s Spectrum) Update NCSBN & Affinity Research ii. Participant Enrollment Process Redesign iii. Staff Update iiii. TNA/TPAPN Website Upgrade Coming Soon

Material Distributed: Jonathan Wolfarth reviewed material distributed

1. TPAPN Activities 2016‐2017 (non‐inclusive)

2. TPAPN Program Tracks Overview & Detail Table

3. Weekly Report to the BON

4. Advocate Update: Summary

i. New Optional Step‐down Year Process Jonathan Wolfarth informed the Advisory Committee that many participants if it’s appropriate, have a step‐down year, which means some requirements are less for the last year of participation. If Case Manager Participant and Advocate agree, the Advocate isn’t required in the last year of participation. Advocate’s primary role is support. Denise Benbow suggested reaching nurses for Advocacy at the TNA District meetings. Jonathan Wolfarth presented at TNA District 9 in Houston on 6/9/2017 and at the TxANA Annual Fall Convention in San Antonio on 8/6/2017. TPAPN will attend the TNA Leadership Conference this month and will have an exhibit table with TPAPN material available, including Advocate Applications. ii. Advocate Email 8/9/2017 5. TPAPN Financial Statements: July 2017 Jonathan Wolfarth reviewed TPAPN financials. 6. New Participant Portal/Case Management Software System: Affinity’s Spectrum 7. TPAPN Staff Update (roster) 8. Board of Nursing Invitation for Consultants to Provide Offers of Auditing Services for TPAPN

Material Circulated: 9. Quarterly Report to the BON June 15, 2017 i. http://www.bon.texas.gov/pdfs/board_meetings_pdfs/2017/July/7‐1‐1.pdf

10. TPAPN Initial Letters, Welcome Package & Track Documents Material in Binder Pocket: 11. Advocate Application 12. TPAPN Referral Form

D. Committee goals for upcoming quarter (discussion) – Committee

E. Roundtable: What else? (discussion) – All

VI. Announcements: A. Upcoming Activities: Advocate Workshop 1‐Day format 11/3/2017 at TNA’s Office

VII. Information Item: Upcoming Committee meetings: B. 12/1/2017; 3/2/2018; 6/1/2018; 9/7/2018; 12/7/2018 (scheduled from 10:00a.m. – 3:00p.m. at TNA office)

VIII. Adjourned 12:55 p.m. Minutes respectfully submitted by: Katy Davila, TPAPN Program Operations Coordinator September 15, 2017

ATTACHMENT A

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ATTACHMENT B

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