22 Tex. Admin. Code § 217.13 - Peer Assistance Program
(a) A
peer assistance program for nurses approved by the Board under chapter 467,
Health and Safety Code, will identify, monitor, and assist with locating
appropriate treatment for those nurses whose practice is impaired or suspected
of being impaired by chemical dependency, mental illness or diminished mental
capacity so that they may return to practice safe nursing.
(b) Role of the Board of Nursing and Peer
Assistance Program.
(1) The Board of Nursing
will retain the sole and exclusive authority to discipline a nurse who has
committed a practice violation under §301.452(b) of the Nursing Practice
Act regardless of whether such violation was influenced by chemical dependency,
mental illness, or diminished mental capacity. The Board will balance the need
to protect the public and the need to ensure the nurse seeks treatment in
determining whether the nurse is appropriate for participation in an approved
peer assistance program.
(2) The
program shall report to the board, in accordance with policies adopted by the
board, a nurse reported to the program who is impaired or suspected of being
impaired for chemical dependency, mental illness, or diminished mental capacity
if the nurse was reported to the program by third party. A third party report
is a report concerning a nurse suspected of chemical dependency, mental
illness, or diminished mental capacity that comes to the attention of the
program through any source other than a self report.
(c) General Criteria for Approved Peer
Assistance Program.
(1) The program will
provide statewide peer advocacy services to all nurses licensed to practice in
Texas whose practice may be impaired by chemical dependency, certain mental
illnesses, or diminished mental capacity.
(2) The program shall have a statewide
monitoring system that will be able to track the nurse while preserving
confidentiality.
(3) The program
shall have a network of trained peer volunteer advocates located throughout the
state.
(4) The program shall have a
written plan for the education and training of volunteer advocates and other
program personnel.
(5) The program
shall have a written plan for the education of nurses, other practitioners, and
employers.
(6) The program shall
demonstrate financial stability and funding sufficient to operate the
program.
(7) The program shall have
a mechanism for documenting program compliance and for timely reporting of
noncompliance to the board.
(8) The
program shall be subject to periodic evaluation by the board or its designee in
order for the board to evaluate the success of the program.
(d) Evaluation of Peer Assistance
Program.
(1) The program shall collect and
make available to the board and other appropriate persons data relating to
program operations and participant outcomes. At a minimum, the program shall
submit the following statistical information quarterly to the Board for the
purpose of evaluating the success of the program:
(A) Number and source of referral;
(B) Number of individuals who sign
participation agreements;
(C) Type
of participation agreement signed, i.e., Extended Evaluation Program; substance
abuse or dependency, dual diagnosis, mental illness;
(D) Number of cases referred to program by
Board of Nursing (this number should include all third party referrals that are
reported to the board, but remain in participation pending board
review);
(E) Number of participants
referred to program by Board order;
(F) Number of self referred cases closed and
reason(s) for closure;
(G) Number
of active cases;
(H) Number of
participants employed in nursing;
(I) Number of participants completing
program;
(J) Number of participants
who are reported back for failing to comply with the participation
agreement;
(K) Monitoring
activities, including number of drug screens requested, conducted and results
of these tests;
(L) All applicable
performance measures required by the Legislative Budget Board.
(2) The program shall have a
written plan for a systematic total program evaluation. Such plan shall include
at a minimum monthly reports of the programs activities showing compliance with
this rule, quarterly reports of applicable LBB performance measure data and an
annual report of program activities.
(3) The program shall be subject to periodic
evaluation by the board or its designee in order for the board to evaluate the
success of the program.
(e) Participants entering the approved peer
assistance program for chemical dependency or chemical abuse must agree to the
following minimum conditions:
(1) The nurse
shall undergo, as appropriate, a physical and/or psychosocial evaluation before
entering the approved monitoring program. This evaluation will be performed by
health care professional(s) with expertise in chemical dependency.
(2) The nurse shall enter into a contract
with the approved peer assistance program to comply with the requirements of
the program which shall include, but not be limited to:
(A) The nurse will undergo recommended
substance abuse treatment by an appropriate treatment facility or
provider.
(B) The nurse will agree
to remain free of all mind-altering substances including alcohol except for
medications prescribed by an authorized prescriber for legitimate medical
purposes and approved by the program.
(C) The nurse must complete the prescribed
aftercare, if any, which may include individual and/or group
psychotherapy.
(D) The nurse will
submit to random and "for cause" drug screening as specified by the approved
monitoring program.
(E) The nurse
will attend support groups as specified by the contract.
(F) The nurse will comply with specified
employment conditions and restrictions as defined by the contract.
(G) The nurse shall sign a waiver allowing
the approved peer assistance program to release, to the extent permitted by
federal or state law, information to the Board if the nurse does not comply
with the requirements of this contract.
(3) The nurse may be subject to disciplinary
action by the Board if the nurse does not participate in the approved peer
assistance program, does not comply with specified employment restrictions, or
does not successfully complete the program.
(f) Referral to Board of Noncompliance with
Peer Assistance Program.
(1) A participant
may be terminated from the program for the following causes:
(A) Noncompliance with any aspect of the
program agreement;
(B) Receipt of
information by the board which, after investigation, results in disciplinary
action by the board; or
(C) Being
unable to practice according to acceptable and prevailing standards of safe
nursing care.
(2) The
program shall contact the board in accordance with board policies if a nurse
under contract fails to comply with the terms of the program agreement or
evidences conduct that indicates an inability or unwillingness to comply with
the program.
(g)
Eligibility for Program Participation.
(1) The
program shall contact the board if it receives a third-party referral for a
nurse who may have been impaired or suspected of being impaired and who may
have failed to comply with the minimum standards of nursing (22 TAC §
217.11) and/or committed an act
constituting unprofessional conduct (22 TAC §
217.12). The program shall send
that report to the Board. The Board will balance the need to protect the public
and the need to ensure the impaired nurse seeks treatment in determining
whether the nurse is appropriate for participation in an approved peer
assistance program.
(2) An
individual may not participate in the program if the information reviewed in
conjunction with the report indicates to the board that the individual's
compliance with the program may not be effectively monitored while
participating in the program. This information includes, but is not limited to,
the following:
(A) The individual is not
currently licensed as a registered nurse or licensed vocational
nurse;
(B) The individual is
currently using or being prescribed a drug normally associated with chemical
dependency or abuse;
(C) The
individual has a medical and/or psychiatric condition, diagnosis, or disorder,
other than chemical dependency, in which the manifest symptoms are not
adequately controlled;
(D) The
individual has attempted or completed two or more chemical dependency
monitoring programs as of the date of the application, notwithstanding the
individual's current chemical dependency treatment plan and related treatment
currently submitted for purposes of program eligibility;
(E) The board has taken action against the
individual's license to practice nursing as either a registered nurse or a
licensed practical nurse in Texas within the last 5 years;
(F) The individual has been convicted of a
felony, placed on probation or received deferred adjudication relating to a
felony, or felony charges are currently pending, or is currently being
investigated for a felony; or
(G)
The individual has been convicted or registered as a sex offender.
(h) Successful
Completion of the Program. A participant successfully completes the program
when the participant fully complies with all of the terms of the program
agreement for the period as specified in the agreement. When a participant
successfully completes the program, the program shall notify the participant of
the successful completion in writing. Once the participant receives this
written notification of successful completion of the program, the participant
shall no longer be required to comply with the program agreement. The program
shall notify the board when a nurse who the board has ordered to attend or
referred to the program successfully completes the peer assistance
contract.
(i) Re-evaluation of
Participation in Peer Assistance Program.
(1)
Each individual receiving an eligibility order requiring participation in a
peer assistance program upon initial licensure shall be notified by the Board,
upon the issuance of a nursing license, that he/she may request re-evaluation
of his/her participation in the peer assistance program.
(2) If an individual wishes to have his/her
participation in a peer assistance program re-evaluated by the Board, the
individual must affirmatively request re-evaluation by the Board and provide
the Board with relevant evidence supporting the individual's request.
(3) The following factors shall be considered
when re-evaluating an individuals' required participation in a peer assistance
program:
(A) the individual's criminal history
record information and whether participation in the program is warranted based
upon the time that has elapsed since the individual's conviction or end of
community supervision;
(B) the
individual's participation requirements and the amount of time the individual
is required to participate in the peer assistance program based upon the
individual's individualized needs; and
(C) verifiable and reliable evidence of the
individual's sobriety and abstinence from drugs and alcohol, which may include
evidence of the completion of inpatient, outpatient, or aftercare treatment,
random drug screens, individual or group therapy, letters of support from
sponsors, a substance use disorder evaluation, and evidence of support group
attendance.
(4) An
individual must comply with the terms of his/her eligibility order until the
Board completes its review under this subsection and issues a
decision.
(5) The Executive
Director is authorized to:
(A) review an
individual's request for re-evaluation of his/her participation in a peer
assistance program under this subsection;
(B) amend the participation requirements for
an individual based upon the individual's individualized needs and/or the
amount of time an individual must participate in the peer assistance
program;
(C) require the individual
to comply with terms and conditions issued and monitored by the Board instead
of participating in a peer assistance program; and
(D) execute a waiver of an individual's
participation in a peer assistance program if the individual has achieved a
satisfactory period of treatment or documented sobriety that complies with
Board rules and policies, and it is determined that the individual's continued
participation is not necessary for the protection of the public.
Notes
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