Florida was one of the first states to introduce an intensive counseling program for nurses with substance abuse issues. Its Intervention Project for Nurses (IPN) was started in 1983, and it provides a way for nurses to avoid disciplinary action for substance abuse-related misconduct allegations by enrolling in the IPN's “education, support and monitoring” program. While there are undeniably upsides to the IPN's intense approach to helping nurses combat substance abuse and other type of impairment issues, there are also downsides that you need to consider before enrolling. The Lento Law Firm Professional License Defense Team can help you evaluate your options if you've been referred to IPN or are considering referring yourself. Call us today at 888.535.3686 or use our contact form to schedule a confidential consultation to learn more about how we can help.
What is IPN?
The IPN program is administered by a company called Intervention Project for Nurses, Inc., which contracts with Florida's Department of Health specifically to provide counseling and other services to “nurses with impairing conditions such as substance abuse disorders, psychiatric and physical conditions.” The program is authorized by Florida Law and must meet certain statutory requirements.
The vast majority of nurses enrolled in the IPN program do so because of substance abuse issues. The stated goals of the IPN program include:
- Protecting patient safety
- Providing nurses and employers with educational programs to help identify nurses who have “fitness to practice” issues
- Providing “support and monitoring” of nurses enrolled in the IPN program
- To help nurses avoid professional disciplinary sanctions
- To help keep nurses working in the nursing profession
The IPN program is voluntary in the sense that a nurse cannot be forced to enroll. That said, if the Board of Nursing orders a nurse to contact the IPN program and the nurse refuses to do so, disciplinary action is likely to follow. And while an employer or co-worker may report a nurse to IPN, it is up to the nurse to decide whether the IPN program is right for them. Nurses can also contact IPN directly if they believe the IPN program may help them with substance abuse or other work impairment issues.
It's important to understand that once a nurse is enrolled in the IPN program, it can be very difficult to leave before completing it without there being some serious professional consequences. Failure to complete the IPN program may be treated as a violation of Florida's Nurse Practice Act. That's why it's very important to consider your options before contacting the IPN program; in many cases, you do have other options. Contact the Lento Law Firm Professional License Defense Team to learn more about what those options are for your particular situation.
Enrolling in IPN
In most cases, once you contact the IPN program (or are referred to the program and decide to accept the referral), you will be required to undergo an evaluation – at your expense – by an outside IPN-approved physician. According to the IPN program, this evaluation can include:
- An “extensive interview” with the IPN evaluating physician
- Review of documentation provided to the physician by you and the IPN program
- Personality and other types of so-called Psychometric Testing
- Toxicology tests
- Review of information provided by your employer, colleagues, or family members
- Psychological and neurocognitive testing, if the physician believes it is needed
The IPN evaluator's role is not necessarily to determine whether or not the nurse has a specific substance abuse problem. The focus is instead on whether there is “probable cause” to believe that the nurse is not fit to practice because of one or more issues, including “illness or use of alcohol, drugs, narcotics, chemicals” or “as a result of any mental or physical condition.” Because the “probable cause” standard doesn't require the IPN evaluator to specifically diagnose the nurse with having a particular problem, it's much more likely that a nurse who does not have an actual substance abuse problem may still be required to enroll in the IPN program.
After your evaluation, and assuming the IPN evaluator determines that you should participate in the IPN program, you will sign an agreement with IPN that will spell out what is expected of you for the duration of your enrollment in the IPN program. This is a long-term commitment; while IPN program terms are not fixed and depend heavily on the individual nurse's progress, nurses are typically in the IPN program for anywhere from two to five years. In some cases, nurses may be released from the IPN program sooner, but it's entirely at the discretion of IPN staff.
Participating in the IPN Program
One of the first things that will happen when you begin to move forward with the IPN program is that you'll be expected to sign a “Refrain From Practice” agreement – essentially, you will not be allowed to work as a nurse until you have approval from IPN staff to do so. In addition, your enrollment with the IPN program is likely to include the following:
- Regular and random toxicology testing
- Frequent, likely daily, check-ins with IPN or its toxicology testing provider
- Participation in one or more weekly support groups
- Required psychological or cognitive therapy
- A ban on use of alcohol (IPN is a “complete abstinence” program)
- Restrictions on your use of many prescribed and over-the-counter medications
- Submission of quarterly self-evaluation reports to the IPN program
As with the initial evaluation, you will be responsible for paying any fees associated with your participation in the IPN program, even during periods when you are not permitted to be employed as a nurse.
Employment While Participating in the IPN Program
As noted above, as part of enrolling in the IPN program, you will not be allowed to work as a nurse until you've been approved to do so by IPN staff. Approval will typically depend on your progress with the IPN program and is at the discretion of the IPN staff. The fact that there is no hard and fast rule about when you may be able to return to work as a nurse is one of the most difficult aspects of the IPN program.
Completing the full IPN program can be expensive, running to the tens of thousands of dollars by the time you've paid for toxicology testing, counseling, medical consultations, and the like. Having to meet these necessary expenses of the IPN program while not being able to work as a nurse can be a significant challenge for many IPN participants. What makes this even more difficult is that leaving the IPN program early, before IPN staff approves your exit, can result in an immediate referral to the Board of Nursing for disciplinary proceedings, even if your reason for leaving is that you can't afford the cost of the program.
The Employment Process While Participating in IPN
Returning to employment while you are enrolled in the IPN program can be a challenge. There are a number of steps you need to follow, and your employment must be approved by IPN staff before you can begin.
The first step is to secure approval from IPN staff to return to work. You'll typically have a case manager who you can contact about that. Once you have IPN approval, you need to do the following:
- Let your future employer – in particular, your immediate supervisor – know that you are enrolled in the IPN program and that whether you will be able to accept a position will depend on getting IPN staff approval.
- Refer your potential employer to your IPN case manager, who will verify that you are allowed to return to work and will let the employer know of any restrictions on your ability to perform your nursing duties (for example, you may initially be prohibited from dispensing prescription medication).
- Provide your future employer with a copy of your IPN contract so that the employer is fully aware of the terms of your enrollment in the IPN program.
- Confirm that you will be supervised by another licensed healthcare professional who is aware of your participation in the IPN program, will be working at the same location where you will be working, and who is willing and able to provide you with assistance and to send quarterly work performance evaluations to the IPN program.
- Make sure the IPN program has the contact information for your new place of employment and for your immediate supervisor, and notify IPN if that information changes.
While enrolled in the IPN program, you won't be allowed to work as a self-employed nurse, to work for more than one employer at a time, to work more than 40 hours per week or 84 hours bi-weekly (if working 12-hour shifts), or to work for a staffing agency. You may not work in the fields of chemical dependency, home hospice, or home health. You will also be prohibited from working as a “floater” for your employer outside of areas supervised by your designated manager.
After receiving all of this information from you, your potential employer, and your potential supervisor, it is up to the IPN staff whether you will be allowed to accept the employment offer.
Travel While Participating in IPN
Because of the requirement that you be available for random drug and alcohol tests, travel within and outside of Florida can be a challenge. You will need to notify your IPN case manager of any anticipated travel that will take you out of the immediate area. Travel for more than a few days can mean missing required group meetings and therapy sessions; as a result, you may find that your travel plans will have to be canceled or modified significantly while you're enrolled in the IPN program. You may also be required to submit to enhanced drug and alcohol tests upon your return from approved travel or to make yourself available for testing (assuming testing is available) at your travel destinations.
Because of the zero-tolerance policy that the IPN program is built on, you will need to secure IPN staff approval for any medical procedure that may result in you being prescribed medications that could result in you failing a drug test. This is something you need to plan for well in advance, wherever possible. Be prepared for the IPN to insist on communicating directly with your physician about the planned procedure and for your doctor to be required to modify normal pain management protocols because of your IPN requirements.
If your medical procedure or recovery could result in you missing substantial portions of your IPN-required therapy (such as weekly group meetings and periodic counseling sessions), you may risk being terminated from the IPN program for failure to comply with your IPN contract – even if your medical procedure is not optional.
In these situations, it may be helpful to have the assistance of one of the experienced attorneys from the Lento Law Firm Professional License Defense Team, who can help you discuss your situation with your IPN case manager and try to secure an agreement from IPN staff not to terminate you from the program while you have and recover from your medical procedure.
Here, too, the IPN program's zero-tolerance policy means you will need to contact your IPN case manager before you are prescribed any medication. You do not want to risk taking a prescription medication that will violate your IPN contract, particularly if the terms of your IPN contract require you to have IPN staff approval for any sort of prescribed medication whatsoever, even if it will not cause you to test positive for prohibited drugs.
Exiting the IPN Program
You will not be released from the IPN program simply because you've spent a certain amount of time in the program, even if your IPN contract anticipates that you will be in the program for a certain number of years. You will need to show that you've consistently and successfully complied with each and every one of the requirements set forth in your IPN contract. In certain cases, you may be allowed to exit the program before the stated contract term is complete. In any case, you'll need to show:
- You've complied with all terms of your IPN monitoring contract
- You've had no positive drug or alcohol test results for at least six months in a row before your contract completion date
- At least one year's satisfactory work performance in a clinical nursing position
- Recommendations from your support group facilitator, your work supervisor, and your therapist
- If you will be working in a position where you will be expected to dispense controlled substances (prescription medication), then at least six months working in that capacity with no adverse issues
If you successfully complete your IPN program, then you will not have to face any disciplinary charges based on the alleged misconduct that led to you entering the program to begin with.
Challenges of the IPN Program
As you can see, there are a number of challenges associated with enrolling in Florida's IPN program. This is why you need to carefully consider whether enrolling in the IPN program is for you. The Lento Law Firm Professional License Defense Team can help you with that decision. Our experienced attorneys can provide you with information about the options available to you based on your particular situation so that you can better understand whether or not the IPN program is your best one.
Keep in mind the following challenges you'll face if you enroll in the IPN program:
- You'll immediately have to stop working. Only after completing a number of months of the IPN program will you be allowed to return to work.
- Once you are cleared to return to work, you will have to find an employer willing to work with the restrictions and reporting requirements imposed on you by the IPN program.
- You'll have to pay for your testing and counseling. These fees can accumulate and, over the course of a five-year IPN contract, can easily exceed $25,000.
- Your ability to travel may be restricted, depending on how long you plan to be away and where you are going. If you have close family living outside of Florida, as many residents do, this can make it difficult to see them during your IPN contract.
- You'll have to check in with the drug testing provider on a very regular basis, at least every weekday. You'll also have to regularly participate in group and individual counseling sessions.
The challenges imposed by the IPN program may explain why, according to a recent report, relatively few nurses in Florida have enrolled in the program.
Reasons to Enroll in IPN
While the IPN program is not for everybody, it's definitely for some people. There are many nurses who have entered and successfully completed their IPN program contracts and are back working full-time. They credit much of their recovery to the intense focus the program required them to put on understanding their dependency issues and developing strategies to help them overcome those problems.
Even so, when faced with the possibility of enrolling in IPN, it also makes sense to become informed about your other options. Making a decision because you choose to, rather than doing so because you believe it's the only decision you can make, will help you stick with whatever program you select in the long run.
Alternatives to IPN
The IPN program is far from the only substance abuse treatment program available to nurses in Florida. While it will help with avoiding disciplinary proceedings based on substance abuse issues, in many cases, it may make more sense to seek treatment elsewhere or to contest the disciplinary proceedings (or both).
Many employers have substance abuse referral programs that are available to all employees, including nurses, and there are AA and NA programs all across the state. The Lento Law Firm Professional License Defense Team will help you understand what your options are and whether it may make more sense to fight the disciplinary charge based on your situation. There is no one-size-fits-all answer in these kinds of situations, which is why it can be so helpful to review the facts of your case with one of our experienced professional license defense attorneys.
How the Lento Law Firm Professional License Defense Team Can Help
The Lento Law Firm Professional License Defense Team has years of experience helping nurses and other healthcare license holders defend themselves in professional misconduct situations. If you have been accused of misconduct because your employer or a co-worker believes you have abused alcohol or other substances, contact us as soon as possible. This includes situations where the Board of Nursing directs you to contact the IPN program. We can help in a number of ways.
First, we will let you know what to expect if you do move forward with the IPN program. In many cases, we can discuss your situation with the Board of Nursing and with the IPN program and help you determine whether it makes more sense to address the problem another way.
If you do move forward with the IPN program, we can help you understand the initial evaluation you are given by the physician you're referred to by IPN. In some cases, the IPN evaluator will refer a nurse to the program despite the absence of any evidence that the nurse has used drugs of any kind. In fact, referrals have been made simply based on the nurse disclosing to the IPN evaluator that they drink alcohol on occasion – even if there is no alcohol in the nurse's system at the time of the evaluation. Depending on the situation, we may be able to negotiate the terms of your IPN contract.
In cases where you decide not to move forward with the IPN program and a misconduct charge is filed against you, we will help you defend against the charge. We regularly do this for healthcare professionals across the US, including for nurses in Florida, and our experienced license defense attorneys understand the BON's misconduct investigation and resolution process. Where a negotiated solution is the best option, we will fight for the best option possible for your particular situation. If your case goes to the hearing stage, we are experienced and effective advocates and will be there to support and defend you throughout the process.
If you've been accused of misconduct based on any form of substance abuse, call the Lento Law Firm Today at 888.535.3686 or use our contact form to set up a confidential consultation. Your nursing license and your reputation are important to you; we are here to help you keep them both.