Texas Peer Assistance Program for Nurses (TPAPN)

As a nurse of any level, receiving a letter from the Texas Peer Assistance Program for Nurses can be alarming, especially if that letter says that you have been referred to their program for allegations of impairment, substance use/abuse, or mental health concerns. Most nurses are only familiar with TPAPN based on what they learned in nursing school or from working with another nurse who is participating in the program. Having the advice of an attorney familiar with TPAPN is vital to understanding your options and reaching the best possible outcome. If you receive a referral letter from TPAPN, it is highly recommended that you promptly consult with an experienced nursing license defense lawyer like the attorneys at Lype, Dest & Smith.

What TPAPN is

The Texas Peer Assistance Program for Nurses, or “TPAPN” as it’s familiarly called, is an alternative to discipline program established by the Texas Nurses Foundation (a nonprofit organization whose mission “is to improve the health of Texans through charitable initiatives including those that advance nursing practice, education, research and leadership”). TPAPN provides monitoring, support, and accountability for Texas nurses who have a substance use or mental health condition so that the public and the BON can be assured that the nurses are practicing safely.

What TPAPN is NOT

Although nurses enrolled in the Texas Peer Assistance Program for Nurses may participate, or even be required to participate, in a treatment program or rehab, TPAPN is not itself a treatment or rehabilitation program. It does not operate its own treatment center and its employees do not provide treatment, counseling, or support services to nurses.

TPAPN is also not a part of the Texas Board of Nursing. Although TPAPN has a contract with the Board, it is its own entity.

 

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How does a nurse end up in TPAPN?

Nurses participate in TPAPN through two routes: referrals and Board Orders. Referrals are voluntary, confidential, and non-disciplinary. Board Orders are settlement agreements between a nurse and the Board of Nursing whereby the nurse agrees to participate in TPAPN. Board Orders for TPAPN are sometimes confidential, but not always. While not technically considered to be discipline by the BON, TPAPN Orders do have some of the same hallmarks of disciplinary Board Orders.

TPAPN receives participation referrals from different sources. Some nurses voluntarily self-refer themselves to TPAPN, while others are referred by a third party such as an employer or the BON. Most TPAPN referrals are initiated by one or more incidents that lead the referring party to believe that the nurse may not be practicing safely due to a substance use or mental health issue. Examples of these types of incidents include narcotics diversion, narcotics discrepancies, impaired behavior, and criminal offenses involving drugs or alcohol. 

A nurse who is Board-Ordered to participate in TPAPN, typically does so to settle a Board investigation into the precipitating incident(s) at issue instead of having to go through a trial, which can be a very time-consuming and expensive process. 

What are the requirements for TPAPN

TPAPN participation can last anywhere from 1-5 years with various requirements. Participation conditions vary from case to case, but some of the standard requirements are:

• Randomized drug testing
• Support group meetings
• Supervised practice/workplace monitor
• Periodic employer reports
• Narcotics restrictions
• Individual psychotherapy
• Inpatient/outpatient treatment

Not all of these requirements will necessarily last the entire 1-5 years. For example, TPAPN’s standard narcotics restrictions are generally only in place for the first 6 months of working as a nurse, and drug testing usually decreases in frequency over time. Part of TPAPN’s intake process is to have the nurse submit to a psychological evaluation to determine the relevant substance use/mental health diagnoses. The evaluator then recommends appropriate participation parameters to ensure the nurse can continue to practice without placing patient safety at risk.

Board of Nursing

In some circumstances, employers have the option to refer a nurse to TPAPN instead of the Board of Nursing if they believe a nurse is impaired. In this case, if the nurse enrolls in and participates in TPAPN, the Board may never know about the referring incident. However, if a nurse receives a TPAPN referral letter but declines to participate in the program, TPAPN will send the referral to the Board of Nursing for investigation and resolution.

Sometimes though, the employer will refer the nurse to both the BON and TPAPN. In such instances the nurse may have enrolled in TPAPN only to receive an investigation letter from the Board of Nursing about the same incident. This means that the nurse will be allowed to participate in TPAPN while the Board of Nursing investigation is pending. Nursing Board investigations can end in a variety of ways. This can include closing the nurse’s case as long as they remain compliant with TPAPN. In other cases the Board may want to convert the nurse’s initial TPAPN referral to a Board Order.

Any kind of noncompliance with TPAPN’s requirements is grounds for TPAPN to close your case and refer it back to the Board of Nursing. If the Board of Nursing deems it appropriate (generally in more severe cases or incidents involving a positive drug test while in TPAPN), they have the option to temporarily (i.e. immediately) suspend the nurse’s license. The Nursing Board does this because if the nurse is no longer being monitored by TPAPN, the Board feels it does not have the active monitoring to assure that the nurse is safe to practice. Not all closed TPAPN cases result in a temporary suspension and many resolve normally after a Board investigation.

In any of these situations, it is important to consult with an attorney well-versed in the ins and outs of TPAPN and the Board of Nursing to give yourself and your career the best path forward. Many nurses referred to TPAPN may not be appropriate for the program. This is a recurrent problem as TPAPN is primarily structured for nurses with legitimate substance abuse or serious mental health diagnoses. Many nurses are referred to TPAPN based on only a suspicion they may have a problem. If they do not, it may make more sense for the nurse to decline TPAPN participation and go through a Board investigation that could end up simply being dismissed.

Which option is best is highly fact specific and is also dependent on an individual nurse’s preferences. If you have been referred to TPAPN, or are considering self-referring, it is highly recommended to speak with an attorney first. A Texas nursing license attorney at Lype, Dest & Smith can help answer your questions and understand your options before you make a decision. 

Contact us online or call (737) 257-6598 to speak to one of our attorneys.

Dan Lype

Not afraid to go to court when necessary, Dan has successfully litigated cases all the way to the Supreme Court of Texas. Dan also prides himself on being readily available to clients throughout their cases. He strongly believes effective representation should be a collaborative effort between a client and their attorney.

Years of experience: 15 years
Bar number: 24065658
Location: Austin, TX

Dan Lype

Not afraid to go to court when necessary, Dan has successfully litigated cases all the way to the Supreme Court of Texas. Dan also prides himself on being readily available to clients throughout their cases. He strongly believes effective representation should be a collaborative effort between a client and their attorney.

Years of experience: 15 years
Justia Profile: Dan Lype
Bar number: 24065658
Location: Austin, TX