| (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.
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