The Texas Peer Assistance Program for Nurses (TPAPN) has a long history of helping Texas nurses suffering from chemical dependency regain control over their lives and keep their license in the process. Nurses referred to TPAPN are able to confidentially undergo treatment and later return to nursing practice. Texas nurses should be aware of two new changes regarding the TPAPN program, one positive and one negative. For a description of TPAPN please see my law firm’s web site or blog post from July 2007 entitled "What is TPAPN"

On the positive front, the TPAPN program has developed a new category of treatment named the Extended Evaluation Participation (EEP). To be eligible for the EEP program, the nurse must be involved in an isolated drug incident with no other history of substance abuse and, after professional evaluation, be found to have a low probability of chemical dependency. Participants are subject to one year of drug screening, with a minimum of 18 screens, and are allowed to continue work without any restrictions during this period. If there are no positive screens at the end of the year, the nurse is discharged from the program and their participation and the initial incident remain confidential. Yet, if there is a positive screen or the nurse fails to adhere to the screening program, the participant will be referred to the Texas Board of Nurse Examiners. This new category of treatment program should prove beneficial to the class of nurses who become involved in an isolated incident involving a chemical substance, maybe even inadvertently, and also are not actively abusing that substance and show a low risk of doing so in the future.

Unfortunately, this step in the right direction is undermined by a change in the confidentiality provisions of the standard TPAPN treatment program. Traditionally, nurses whose practice was impaired by substance abuse or mental illness could be either referred by a third party or self-referred directly to TPAPN without the involvement of the Board of Nurse Examiners. Under the new regime, however, the Board must be notified of any referral that involves a practice violation, such as diverting medication or practicing while impaired.

While it is understandable that the Nursing Board would want to be apprised of instances of impaired practice, I fear this change could have an overall negative impact on Texas nursing. Nurses suffering from mental illness or a chemical dependency will likely be more reluctant to self-refer to TPAPN once they know that the Nursing Board and their license will be involved. This may lead to more nurses putting off seeking help until their situation and the potential well-being of their patients become much worse. The old confidentiality provision was specifically, and wisely I think, designed to promote self-referrals to treatment. Now, nurses will have to be more careful in deciding whether to report. Unless they qualify for the new Extended Evaluation Program, the threat to their license will be much more serious.