Linda L. Smith

Florida's Intervention Project for Nurses: A Description of Recovering Nurses' Reentry to Practice

When a nurse misuses or becomes dependent upon alcohol or other drugs (AODs), there is a great likelihood that nursing practice will be adversely affected. The risk of harm by nurses whose skill and judgement is impaired by the use of chemical substances is a concern that must be addressed at both regulatory and professional levels. The nursing profession has both a responsibility to its members and an obligation to preserve public safety. All nurses in the United States must be licensed, and although the regulations and requirements vary among the states, the primary purpose of licensure is to ensure that the public receive safe, competent nursing practice. In 1982, the American Nurses’ Association (ANA) House of Delegates formally recognized the problem of impaired nursing practice by adopting a resolution “to address health problems that compromise nurses’ ability to function within the standards and codes of conduct for professional practice” (ANA, 1982). More specifically, this resolution called for the development of state assistance programs, the encouragement of nurses’ employers to offer appropriate services prior to disciplinary action, and the establishment of mechanisms to collect and disseminate information related to the problem of impairment among nurses. Since the late 1970s and early 1980s, peer assistance programs have been developed in almost every state. Peer assistance programs vary considerably in the range of services offered. Some provide only education and referral services, while others provide more comprehensive services, including assessment, referral, coordination

Florida Intervention Project for Nurses: A National Model for ADP and Nurse Assistance.

INTRODUCTION The problem of impairment among healthcare practitioners and its impact on patient safety has remained a concern since the early 1980s. The American Nurses Association (ANA) estimated that 6%Y8% of nurses use alcohol or drugs to an extent that is sufficient to impair professional performance (ANA, 1984). In 1982, the ANA called out to the state nursing associations to develop ‘‘alternative to discipline’’ (ATD) programs to assist nursing colleagues with substance abuse and mental health conditions, disseminate information about substance abuse and mental health conditions as treatable, and conduct research (ANA, 2002). The ATD programs would also provide a nondisciplinary alternative for nurses, thus allowing impaired nurses to receive help and monitoring without license discipline. The Florida Nurses Association (FNA) was the first state nursing association in the United States to respond to the ANA’s call by initiating and lobbying for the passage of legislation to start an ATD program for Florida nurses. Since its inception in 1983, Florida’s ATD, known as the Intervention Project for Nurses (IPN), has assisted over 23,000 nurses. Most nurses in IPN receive help for substance abuse and/or mental health conditions, whereas a smaller number receive assistance with physical conditions that may impact patient safety. The Florida IPN has evolved into a national model with a reputation for excellence and is often sought out by other state boards of nursing and nursing associations for consultation and assistance in program development and evaluation. IPN’s primary purpose is to protect consumers from unsafe nursing practice while assisting nursing colleagues with evaluation, treatment, referral, and coordination of support services. This approach enhances public safety while providing an avenue for the nurse’s rehabilitation and retention in the nursing profession. This central mission is accomplished by way of strong partnerships with stakeholders, statewide educational (skill building) training, and case management services, along with a network of accredited evaluators/treatment programs and approved nurse support groups throughout Florida. Like most ATD programs, IPN receives calls regarding alleged impairment from nursing employers and other referral sources on a daily basis. IPN provides consultation and evaluates each call to determine appropriateness for program entry. During this intake process, each nurse is oriented to IPN, completes initial paperwork, and undergoes a formal fitness to practice evaluation with an approved evaluator. All licensees who enter IPN execute a formal monitoring agreement after treatment. Monitoring agreements range in length from 2 to 5 years, depending on the primary and secondary diagnoses. During the monitoring process, IPN provides oversight and coordination of services by way of a comprehensive case management/monitoring process. Key components include (a) communication with each participant and with his or her support network, (b) random toxicology screening, (c) weekly attendance at a facilitated support group, (d) mutual support group meetings (such as 12 Step), (e) worksite and safety to practice monitoring, and (f) treatment provider follow-up. All IPN policies are approved annually by the Florida Department of Health (DOH) and parallel many of the National Council of State Boards of Nursing (NSCBN) guidelines for ATD programs. The following article will highlight five areas of the Florida IPN program, which have contributed to its success and longevity. These areas include the following: 1. Maintenance of strong partnerships with stakeholders 2. Standardized accountability reporting 3. Formal approval process for evaluators/treatment programs 4. Oversight of a strong nurse support group network 5. Educational programming for skill building and stigma reduction