Alternative to Discipline Alternative to Discipline Programs: The Florida Programs: The Florida Intervention ProjectIntervention Project

Linda L. Smith, ARNP, MN, M.Div., CAP, CARN-APLinda L. Smith, ARNP, MN, M.Div., CAP, CARN-APChief Executive OfficerChief Executive Officer

Florida Intervention ProjectFlorida Intervention Project

Presented for NCSBN-IREPresented for NCSBN-IRE January 16, 2013January 16, 2013

ObjectivesObjectives

Describe the history of alternative to Describe the history of alternative to discipline programs.discipline programs.

Identify key components of an Identify key components of an effective alternative to discipline effective alternative to discipline program.program.

Recognize the strengths and benefits Recognize the strengths and benefits of the Florida Intervention Project for of the Florida Intervention Project for Nurses.Nurses.

Multiple studies in the early 1980s

revealed that:

67% of nurses reported and/or disciplined 67% of nurses reported and/or disciplined by Boards of Nursing throughout the USA by Boards of Nursing throughout the USA were due to drug, alcohol or psychiatric were due to drug, alcohol or psychiatric

disorders.disorders.

Estimates of Incidence

6-10 % of nurses are thought to have substance abuse problems significant enough to impair practice at sometime in their career..

The Florida ExperienceThe Florida Experience

In the 1980’s the Florida Board of Nursing utilized In the 1980’s the Florida Board of Nursing utilized a “discipline only” model.a “discipline only” model.

The Board began to recognize substance related The Board began to recognize substance related cases were significant in number and recurring.cases were significant in number and recurring.

The only option available for the Board was to The only option available for the Board was to discipline and remove nurses from practice, discipline and remove nurses from practice, however, the Board recognized that often following however, the Board recognized that often following the nurse’s license reinstatement further problems the nurse’s license reinstatement further problems ensued.ensued.

Another concern at the time related to Another concern at the time related to evaluations evaluations presented by nurses during reinstatement presented by nurses during reinstatement hearings. The evaluation(s) presented often lacked hearings. The evaluation(s) presented often lacked sufficient uniformity in credentials, areas sufficient uniformity in credentials, areas addressed and quality.addressed and quality.

History of Alternative to History of Alternative to Discipline (ATD) Program EvolutionDiscipline (ATD) Program Evolution

ANA 1982 Resolution. Call to states to do something ANA 1982 Resolution. Call to states to do something different related to substance abuse among nurses.different related to substance abuse among nurses.

NCSBN - Set early guidelines for programs that assisted NCSBN - Set early guidelines for programs that assisted nurses with substance use problems nurses with substance use problems

AANA Wellness Committee- promoted education and AANA Wellness Committee- promoted education and peer assistance with CRNA’s.peer assistance with CRNA’s.

NOAP - Formed by early ATD program leaders as an NOAP - Formed by early ATD program leaders as an offshoot of a NCSBN committee.offshoot of a NCSBN committee.

IntNSA - Worked to expand the peer assistance model IntNSA - Worked to expand the peer assistance model and made efforts in education and research.and made efforts in education and research.

Legislation was passed in Florida on Legislation was passed in Florida on October 1, 1983 allowing a new avenue October 1, 1983 allowing a new avenue

for addressing impairment in health for addressing impairment in health practitioners.practitioners.

This new legislation altered Florida’s This new legislation altered Florida’s Mandatory Reporting LawMandatory Reporting Law

Reporting Requirements:Reporting Requirements: Licensed Nurses Licensed Nurses

FS 464.018 (Nurse Practice Act)FS 464.018 (Nurse Practice Act)

(k) Failing to report to the department any person who the licensee knows is in violation of this part of the rules of the department or the Board; however, if however, if the licensee verifies that such person is actively the licensee verifies that such person is actively participating in a board-approved program for the participating in a board-approved program for the treatment of a physical or mental condition, the treatment of a physical or mental condition, the licensee is required to report such person only to an licensee is required to report such person only to an impaired professionals consultant.impaired professionals consultant.

An “alternative to discipline” (aka diversion) An “alternative to discipline” (aka diversion) system was now approved in Florida thus system was now approved in Florida thus providing a new option for employers, providing a new option for employers, treatment centers, nursing schools, and treatment centers, nursing schools, and nurses to refer and assist nurses who nurses to refer and assist nurses who demonstrated signs of impairment.demonstrated signs of impairment.

The Florida “Impaired Nurse Program” was The Florida “Impaired Nurse Program” was established in 1983 which later became the established in 1983 which later became the Florida Intervention Project for Nurses.Florida Intervention Project for Nurses.

Now there are two reporting mechanisms for impaired practitioners in Florida:

IPNIPN Department of Health (DOH), Department of Health (DOH),

the administrative the administrative investigative body of the FBONinvestigative body of the FBON

Refusal to Participate/ Failure to progress

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Referral Process

How do Alternative Programs How do Alternative Programs Protect the Public?Protect the Public?

Earlier Identification and Swifter InterventionEarlier Identification and Swifter Intervention

IPN Refrains the Nurse from Practice within 1-3 daysIPN Refrains the Nurse from Practice within 1-3 days (The disciplinary process on average is(The disciplinary process on average is 9-12 months 9-12 months

before action is taken)

Standardized, Comprehensive Fitness to Practice Standardized, Comprehensive Fitness to Practice EvaluationsEvaluations

Approved Providers and Treatment Programs Approved Providers and Treatment Programs

Alternative programs Alternative programs Protect the Public? (continued)Protect the Public? (continued)

Comprehensive Monitoring (NSG, Mtgs., Toxicology etc.)Comprehensive Monitoring (NSG, Mtgs., Toxicology etc.)

Collaborative Effort and Involvement by Employers (Double Collaborative Effort and Involvement by Employers (Double Safety Net)Safety Net)

Quicker Identification of Relapse Behaviors Resulting Quicker Identification of Relapse Behaviors Resulting in Interventionin Intervention

Monitoring and Recovery Support

Appropriate treatment referral (approved Appropriate treatment referral (approved provider network)provider network)

Execution of IPN Advocacy ContractExecution of IPN Advocacy Contract Quarterly Progress EvaluationsQuarterly Progress Evaluations Structured Nurse Support GroupsStructured Nurse Support Groups Practice-setting ReportsPractice-setting Reports Relapse Prevention GroupsRelapse Prevention Groups Random Urine Drug Screens Random Urine Drug Screens

How does IPN Determine Fitness to Practice?

Criteria: Stability in recovery Support systems Problem-solving ability Cognitive functioning Judgment Ability to cope with stressful situations Decision-making ability in a crisis

When can a Nurse Return to PracticeWhen can a Nurse Return to Practice

Signed Advocacy Contract is receivedSigned Advocacy Contract is received Treatment is completed or the nurse is well engagedTreatment is completed or the nurse is well engaged Once practice restrictions are understood: no Once practice restrictions are understood: no

overtime, floating, multiple employers, agency, home overtime, floating, multiple employers, agency, home health, hospice employment.health, hospice employment.

When there is a narcotic When there is a narcotic restriction—we encourage a labor exchange buddy be secured.bor exchange buddy be secured.

Random UDS assignment is set up.Random UDS assignment is set up. A workplace monitor who can offer feedback on A workplace monitor who can offer feedback on

performance is established.performance is established. Engagement in weekly nurse support groupEngagement in weekly nurse support group Relapse prevention workbook is receivedRelapse prevention workbook is received

Indicators of Satisfactory Progress in Recovery and Safety to Practice

– Compliance with Advocacy ContractCompliance with Advocacy Contract– Negative Random Urine Drug ScreensNegative Random Urine Drug Screens– Consistent Attendance at Support/Monitoring Consistent Attendance at Support/Monitoring

GroupsGroups– Favorable Monitoring ReportsFavorable Monitoring Reports

- Employer- Employer

- Primary Treatment Provider- Primary Treatment Provider

- Nurse Support Group Facilitator- Nurse Support Group Facilitator

- Self-Report - Self-Report

Successful Completion

CRITERION:CRITERION: Fitness to practice establishedFitness to practice established Progress and stability in recovery validatedProgress and stability in recovery validated Record sealedRecord sealed

What happens when a nurse fails to comply with program conditions

of participation?

Should a nurse fail to satisfactorily progress, Should a nurse fail to satisfactorily progress, discontinue treatment, and/or fail to comply with discontinue treatment, and/or fail to comply with program stipulations, the IPN immediately program stipulations, the IPN immediately provides this information to the DOH to initiate provides this information to the DOH to initiate swift action to ensure the health, safety and swift action to ensure the health, safety and welfare of the citizens of Florida. welfare of the citizens of Florida.

(Florida Statute 455)(Florida Statute 455)

What drives IPN policies and What drives IPN policies and procedures?procedures?

SAMSHASAMSHA NIDANIDA NCSBNNCSBN FBONFBON ASAMASAM

(Evidence based practice)(Evidence based practice)*****Multistate Research outcomes in the future.*****Multistate Research outcomes in the future.

Components of an Effective ATD Components of an Effective ATD ProgramProgram

Support by all key shareholders Support by all key shareholders

Passage of LegislationPassage of Legislation

Knowledgeable and qualified staffKnowledgeable and qualified staff

Well researched and though-out Well researched and though-out Policies/ProceduresPolicies/Procedures

Network of knowledgeable evaluators and Network of knowledgeable evaluators and treatment providerstreatment providers

Facilitated nurse support groupsFacilitated nurse support groups

Worksite monitors communication and Worksite monitors communication and educationeducation

Clearly stated Relapse policyClearly stated Relapse policy

Established program evaluation Established program evaluation parameters and performance measures parameters and performance measures (ACCOUNTABILITY(ACCOUNTABILITY))

Components of an Effective ATD Program (continued)

Florida ChallengesFlorida Challenges

Thank you for ListeningThank you for Listening

QUESTIONS?QUESTIONS?

Linda L. Smith, ARNP, MN, M.Div., CARN-APLinda L. Smith, ARNP, MN, M.Div., CARN-APIntervention Project for Nurses (IPN)Intervention Project for Nurses (IPN)Po Box 49130Po Box 49130Jacksonville Beach, Florida 32240-9130Jacksonville Beach, Florida 32240-9130lsmith@ipnfl.orglsmith@ipnfl.org904-270-1620 x 118904-270-1620 x 118

www.ipnfl.org