You've Been Asked to Give a Urine Screen

 Your manager asks you to come to his office and tells you he has received a report you smell like alcohol and look impaired so they would like you to give a urine screen. Or maybe you were in an accident while working and a screen is part of the policy.  Or there are drugs missing so everyone is required to provide  a drug screen. There are various possible outcomes and below are helpful hints other nurses have utilized that you may want to.  ***This is not legal advice and I am not working as your attorney in any capacity, these are just an accounting of steps other nurses have used when they were in the same situation and are intended to be for information only***:

You give the screen:  even if you know the screen should be negative does not mean that a mistake may  not be made and the negative screen is now a positive and now evidence against you. So, make sure you then obtain your own screen as well.  There have been nurses who did this and had a screen that showed negative while the one obtained at work showed up as positive. Getting your own screen can help you have evidence to prove  your innocence.  

You refuse to provide a screen:  the biggest problem with this choice is the assumption that if you had obtained the screen it would have been positive. So it becomes an automatic assumption that the screen is positive and any argument is countered by "You would have given the screen unless you knew it was going to be positive, so we believe it to be positive."  It doesn't matter if it is not true, you do not have the proof to show the screen was negative.  So, if you refuse a screen at work for any reason, immediately obtain your own screen so you have something to support your assertion that the screen would have been negative. A nurse has obtained their own screen by use of a private physician or even a walk-in screening site.  Be sure the drug in question or alcohol is included in the screen or else the screen is useless.

Type of screen to get: Make sure the screen covers the drugs in question or get a minimum of a 10 panel screen (tests for 10 different substances).

What to watch for:   When providing a screen make sure the person obtaining the screen handles it correctly.  They should wash their hands.  The sample should be sealed in front of you with a strip across the specimen jar and this strip is signed by the nurse. The sample is then sealed in a sample bag that is signed.  If the sample is poured into another specimen container it must be done in front of you prior to the sealing of the specimen.  DO NOT sign the paperwork unless the sample is sealed in front of you.  DO NOT LEAVE AN UNSEALED SPECIMEN!!   When you sign the paperwork, you are confirming all fo this was completed.

Make sure you let the collector know any medications, prescribed and OTC, that  you have taken and make sure it is all documented on the form. If the test is positive, the Medical Review Officer (MRO) will contact you to go over any medications you may have ingested.

Sometimes, the collector tries to take the position that no, you cannot write on or list anything of the requisition form.  Insist on the ability to list medications and OTC substances you have taken because that is part of the collection policies.  As an alternative, make a notation of any substances you have taken on the a piece of paper and get the collector to sign it confirming that you showed it to them for your records.  

 ***This blog provides general information and a general understanding of the law, but does not provide specific legal advice. By using this site, commenting on posts, or sending inquiries through the site or contact email, you confirm that there is no attorney-client relationship between you and the Blog/Web Site publisher/author. The Blog/Web Site should not be used as a substitute for competent legal advice from a licensed attorney in your jurisdiction.***

TPAPN Board Orders are now Confidential

As of September 1, 2013, TPAPN Board Orders are now confidential.  This is a vast improvement since the statute was changed a few sessions ago requiring the Board to be involved anytime there was a practice issue associated with a substance abuse/addiction issue.  This corrects situations where nurses had sensitive personal information available online for all to see.  Nurses who were referred to TPAPN by the Board and had a mental health  diagnosis or who had an evaluation detailing sensitive personal information had limited choices when they were referred to the Board.  It appears there will be further changes or polishing of the TPAPN process in the near future, so be sure to watch for information and remember it may be in your best interests to consult with an attorney who knows the Board and TPAPN.

To Clarify:  only new TPAPN Board Orders are confidential; the Board is not going back and changing previous Board TPAPN Orders from public to non-public orders.  Since the TPAPN orders are confidential they are not reported to the databank/NURSYS.

Nurses and Addiction

I still continue to find bias against nurses battling addiction. There continues to be a misconception that addiction is a personality defect or a choice. A recent article on Addiction Nursing was published in Advance for Nurses. This article discusses the specialty field of addiction nursing. I thought the article also contained a good description of addiction.

Berthilde Dufrene, MSN, RN, CARN, PRI-C writes, "Addiction is a chronic, incurable, but treatable brain disease. Patients with this disease undergo recurrent cycles of relapse and recovery. Much like other chronic diseases, such as diabetes, hypertension and heart disease, patients usually receive care during an acute phase of the illness and are stabilized with the aid of medication. Pharmacotherapy during the acute care stage aims at interrupting the addictive process through medically supervised detoxification and relieving withdrawal symptoms and discomfort.

Continuing care involves counseling and behavior modification with hope of guiding the patient toward a recovery lifestyle."

So, since addiction is a disease, why does it continue to be treated as a crime or a choice. Why are we so supportive of co-workers that are diabetic or have cancer, but we turn on nurses with drug or alcohol issues. Why are we not fighting to get a non-public rehabilitation order to help nurses with addiction (it also applies to mental illness). In Texas, physicians, physician assistants and acupuncturists all have the ability to be put under a rehabilitation order, which is a non-public, non-disciplinary monitoring of a practitioner's practice. Why is there such a push to punish addiction rather than support people on their recovery road? Some of this push comes from public advocacy groups, so why are we not educating them so that they see that the steps they have instilled have only resulted in health care providers not seeking help for fear of retaliation.

TPAPN, the BON and the future

The BON is meeting July 17-18, 2008. One of the agenda items involves the Board's Legislative Appropriations Request. This is how the Board asks for money from the state to fund their activities. There were several issues brought up by the Board that I found interesting (and that also confirm what I have been telling nurses):

1. More nurses are finding themselves before the Board. The number of complaints is increasing and the Board expects 9200 complaints this year. Just two years ago in 2006 there were approximately 5185 complaints and two years before that in 2004, there were approximately 3690 complaints.

2. More nurses are choosing to fight the Board in front of a judge.

3. The cases that are going before a Judge are more complex. This means that there are more nurses challenging the Board rather than choosing not to show up at a hearing and losing by default.

4. More nurses are hiring attorneys to represent them before the Board. After hearing from prior employees of the Board that nurses should never represent themselves before the Board, I am glad to see that more nurses are seeking help when dealing with the Board.

5. The Board is getting tougher on nurses and nursing licensure applicants.

As part of the request, the Board is asking for funding for 3 attorneys, 2 legal assistants and 4 investigators. Below is part of this draft document involving the need for more money to hire more staff:


New Personnel Needed for Enforcement, Legal and Operation Processes -
The agency’s enforcement workload and expenses for its contested cases have steadily and rapidly increased and must be addressed in order for the Board to maintain its mission to protect the public and timely resolve its complaints. The Board needs appropriations to cover the increase in litigation related costs for its expert fees and witness fees. Additionally, the Board will need approximately eleven (11) additional FTEs for FY 2010 and FY 2011 for its Enforcement, Legal and Operation Departments in order to meet the growing demands. Six (6) FTEs are needed for an increased workload due to growing complaints and litigation. This number would include two (2) investigators; two (2) litigation attorneys; one (1)legal assistant; and one (1) administrative assistant. The agency will begin to process criminal background checks for students. The Board will need an additional five (5) FTEs, including one (1) administrative assistant, two (2) investigators, one (1) Attorney and one (1) legal assistant. Although this number appears to be significant, the rise in the number of investigations, plus the complexity of the Board’s disciplinary cases, supports the need to add enforcement, legal and operation staff in order to meet the agency’s mission and timely resolve cases. The Board in FY 2008 will likely receive 9,200 complaints leading to 2,400 disciplinary actions. By comparison, the Texas Department of Licensing and Regulation (TDLR) will have approximately 8,000 complaints in FY 2008 and will likely take approximately 1,240 disciplinary actions (TDLR Statistical Questionnaire, May 2008). TDLR employs thirty-five (35)investigators and ten (10) prosecuting attorneys. Other than the increase in volume of complaints, there are several other reasons why the Board’s enforcement cases will require more resources for the agency to meet its mission effectively and timely:

1. Complaints are increasing by approximately 15% annually;
2. Formal charges statistics and unresolved complaints statistics are increasing;
3. The Board’s policies have tightened with regard to enforcement and
eligibility;
4. Attorney representation has increased significantly; and
5. Proceedings before the State Office of Administrative Hearings (SOAH)
have become more complex.

We project that cost of adding eleven FTEs as follows: four (4) Investigator
IIIs - $167,576; three (3) attorney IIIs - $189,291; two (2) legal assistants -
$88,962; and two (2) administrative assistants - $62,156. Costs of computer
hardware (one time only) - $11,000. Costs of telephones (one time only) $2,750. Costs of Remodeling (one time only) - $11,000. Costs of Furniture (one-time only) $5,500. Costs of annual phone and internet connections - $1,100. Litigation and expert witness fees - $25,000. This will impact the Enforcement and Licensing Strategies.

Can TPAPN Help?

Frequently, I get inquires from nurses that have been referred to TPAPN (Texas Peer Assistance Program for Nurses) and the nurse was wondering if they should go to TPAPN. If a nurse has substance abuse/addiction issue or mental health issues, TPAPN can be a beneficial rung on the ladder to recovery or health and the nurse should definitely consider entering the program. TPAPN offers not only recovery support, but also the ability to avoid a disciplinary action by the Board.

But, if a nurse is thinking of going to TPAPN solely to avoid being reported to the Board, the nurse should know this is risky and frequently backfires. Several steps in the TPAPN process require a nurse to admit to being an addict or alcoholic and to continue to do this when a nurse is not; it begins to wear on the nurse (especially with the emphasis on truth and accountability in the recovery process). Also, once a nurse admits to a problem it is very difficult to back track and declare there is now no problem. I have heard from nurses that have come close to completion of the TPAPN contract and then decided they can’t “live the lie” anymore and they announce they are not an addict and don’t belong in TPAPN. If this nurse was a third-party referral, TPAPN must report the nurse to the Board, which puts the nurse right back where they started.