BRIDGE TO RECOVERY: TPAPN STRIVES TO RETURN NURSES TO SAFE PRACTICE

BRIDGE TO RECOVERY:

TPAPN STRIVES TO RETURN NURSES TO SAFE PRACTICE

By Nadia Tamez-Robledo, Texas Nurses Association

For nurses facing substance use or mental health issues, the Texas Peer Assistance Program for Nurses (TPAPN) can help them successfully return to safe practice.

“We save lives,” said TPAPN interim director Leanne Bunch, MSN, RN, LCDC, who has been on staff with TPAPN for 18 years. “But the bigger picture is that when one nurse finds recovery, her family begins to heal, then the nurse returns to practice and provides excellent nursing care for the citizens of that community.”

TPAPN is non-punitive, voluntary, and confidential for APRNs, RNs, and LVNs with mental health and substance use concerns. A program of the Texas Nurses Foundation, TPAPN was created in 1987 and represents a change in attitude about how nurses struggling with these issues should be treated.

“In the past when nurses became sick, we just threw them out,” Bunch said, “or they were terminated and went to work for another facility in the community. This is so much safer.”

While 71 percent of TPAPN’s participants are facing substance use issues, the remainder are being treated for mental health concerns or both. TPAPN nurses receive support for diagnoses across the mental health spectrum, from depression and anxiety to bipolar disorder and schizophrenia. TPAPN’s eligibility requirements were recently broadened to from accepting only nurses with major depressive disorder, PTSD, schizophrenia, schizoaffective disorder, anxiety disorder, or bi-polar disorder to accepting eligible nurses who may benefit from participation in a peer assistance program.

When nurses enter TPAPN, Bunch said, they’re fearful at first. “Nurses come in fighting. They come in tears,” she said. “They’ve worked very hard for their nursing licenses, and we would like for them to see us as here to support them as they stabilize.

“This is not about being a good nurse or a bad nurse. This is about having a behavioral health issue and/or an alleged violation of the Nursing Practice Act. TPAPN provides nurses an opportunity to find recovery.”

Nurses come to TPAPN in one of three ways. They can self-refer, be referred by a concerned third party, or be referred by the Texas Board of Nursing. TPAPN participants are assigned case managers and volunteer advocates, some of whom are former TPAPN participants, for support throughout the program. TPAPN offers several programs for substance use issues and two mental health tracks for nurses with mental health concerns.

Nurses with mental health concerns and without substance use issues may participate in the year-long Mental Health Support Program, which offers support for nurses when safe practice is not in question. Program requirements include documentation of adherence to prescribed psychotherapy, medication, and possibly drug testing as indicated.

The second option, the TPAPN Mental Health Track is for nurses with practice issues. It is also one year, carries the same requirements, and includes six months of nursing practice monitoring. Nurses sign a work agreement with their employer, their job is approved by TPAPN, and they adhere to several work restrictions considered appropriate under ADA.

TPAPN also offers a Dual Track Program for nurses coping with both substance use and mental health issues. RNs and LVNs are required to complete three years in the program while APRNs complete five years.

TPAPN Case Manager Madeleine Lamarche, BS-CJ, RN, said that participants can feel overwhelmed by information when first entering the program, but case managers are there to walk them through every aspect of their program.

“We’re here to help them prove to the Board [of Nursing] that they’re quite capable of practicing safe nursing,” Lamarche said. “Nurses are like anyone else who has either a substance use or mental health disorder. They make the same mistakes, and we help them as they discover new ways of making choices.”

TPAPN participants are assigned an advocate — a nurse volunteer who offers support and guidance to participants throughout their involvement with the program. (For more information on advocates, please see page 12.)

Nurses in recovery learn coping skills, such as how to read subtle changes in their mental health and when to call their therapist or psychiatrist, who can advise them on determining fitness for duty.

“We wouldn’t want that nurse going to work knowing she’s not 100 percent,” Bunch said. “Our mission is twofold. We want nurses to return to practice, but we want to make sure patient safety is first and foremost.”

Even within the nursing world, stigma against mental health and substance use disorders remain. Bunch said that while progress has been made, more awareness and understanding is needed.

“We need to do more education with nurse recruiters and employers so they know a TPAPN nurse is closely monitored and very safe,” she said.