Describe the history of alternative to discipline programs. Identify key components of an effective alternative to discipline program



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  • Describe the history of alternative to discipline programs.

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

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





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

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



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



In the 1980’s the Florida Board of Nursing utilized

  • In the 1980’s the Florida Board of Nursing utilized

  • a “discipline only” model.

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

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

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



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

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

  • NCSBN - Set early guidelines for programs that assisted

    • nurses with substance use problems
  • AANA Wellness Committee- promoted education and peer assistance with CRNA’s.

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

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



This new legislation altered Florida’s Mandatory Reporting Law

  • This new legislation altered Florida’s Mandatory Reporting Law





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

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



IPN

  • IPN

  • Department of Health (DOH), the administrative investigative body of the FBON





Earlier Identification and Swifter Intervention

  • Earlier Identification and Swifter Intervention

  • IPN Refrains the Nurse from Practice within 1-3 days

  • (The disciplinary process on average is 9-12 months before action is taken)

  • Standardized, Comprehensive Fitness to Practice Evaluations

  • Approved Providers and Treatment Programs



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

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

  • Quicker Identification of Relapse Behaviors Resulting in Intervention



Appropriate treatment referral (approved provider network)

  • Appropriate treatment referral (approved provider network)

  • Execution of IPN Advocacy Contract

  • Quarterly Progress Evaluations

  • Structured Nurse Support Groups

  • Practice-setting Reports

  • Relapse Prevention Groups

  • Random Urine Drug Screens



Criteria:

  • Criteria:

  • Stability in recovery

  • Support systems

  • Problem-solving ability

  • Cognitive functioning

  • Judgment

  • Ability to cope with stressful situations

  • Decision-making ability in a crisis



Signed Advocacy Contract is received

  • Signed Advocacy Contract is received

  • Treatment is completed or the nurse is well engaged

  • Once practice restrictions are understood: no overtime, floating, multiple employers, agency, home health, hospice employment.

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

  • Random UDS assignment is set up.

  • A workplace monitor who can offer feedback on performance is established.

  • Engagement in weekly nurse support group

  • Relapse prevention workbook is received



Compliance with Advocacy Contract

    • Compliance with Advocacy Contract
    • Negative Random Urine Drug Screens
    • Consistent Attendance at Support/Monitoring Groups
    • Favorable Monitoring Reports
  • - Employer

  • - Primary Treatment Provider

  • - Nurse Support Group Facilitator

  • - Self-Report



CRITERION:



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

    • Should a nurse fail to satisfactorily progress, discontinue treatment, and/or fail to comply with program stipulations, the IPN immediately provides this information to the DOH to initiate swift action to ensure the health, safety and welfare of the citizens of Florida.
    • (Florida Statute 455)


SAMSHA

  • SAMSHA

  • NIDA

  • NCSBN

  • FBON

  • ASAM

  • (Evidence based practice)

  • *****Multistate Research outcomes in the future.



Support by all key shareholders

  • Support by all key shareholders

  • Passage of Legislation

  • Knowledgeable and qualified staff

  • Well researched and though-out Policies/Procedures

  • Network of knowledgeable evaluators and treatment providers



Facilitated nurse support groups

  • Facilitated nurse support groups

  • Worksite monitors communication and education

  • Clearly stated Relapse policy

  • Established program evaluation parameters and performance measures (ACCOUNTABILITY)





  • Linda L. Smith, ARNP, MN, M.Div., CARN-AP

  • Intervention Project for Nurses (IPN)

  • Po Box 49130

  • Jacksonville Beach, Florida 32240-9130

  • lsmith@ipnfl.org

  • 904-270-1620 x 118

  • www.ipnfl.org



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