The Iowa Board of Nursing's Nurse Assistance Program (INAP) offers one way for nurses who may have substance abuse or mental health issues to receive intensive, long-term, monitored testing and recovery services. One significant benefit of enrolling in INAP is that any pending disciplinary matters related to the nurse's enrollment – such as discipline for working while under the influence of drugs or alcohol – are postponed during the nurse's enrollment in INAP and will be dismissed if the nurse successfully completes the program. INAP is not the only treatment option available to nurses in Iowa, however, and if you're facing Board of Nursing (BON) discipline for alleged substance abuse, you should contact the Lento Law Firm Professional License Defense Team to discuss your situation and learn how we can help. We can be reached at 888.535.3686 or by setting up a confidential consultation with one of our team members.
What is INAP?
INAP is an alternative-to-discipline program designed to help nurses “impaired as a result of a substance abuse disorder” or “mental or physical condition” receive confidential monitoring and treatment appropriate for their particular disorder or condition. Nurses enrolled in INAP will be able to keep their licenses throughout their treatment period, and if they successfully complete their treatment, any pending disciplinary matters related to their diagnosed condition will be dismissed.
While each nurse who enrolls in INAP receives their own personalized treatment contract, most contracts for nurses diagnosed with substance abuse disorders will include a number of requirements. The nurse must agree to frequent random drug tests, to regularly attend AA or NA meetings, to have and meet with a counselor, and to accept a number of workplace restrictions and monitoring requirements. INAP is not available for every nurse in every kind of misconduct situation; nurses accused of diverting drugs to third parties or of tampering with drugs administered to a patient, for example, may not be permitted to enroll in INAP.
Enrolling in INAP
To enroll in INAP, you must first submit an INAP Nurse Self Report Form to the program. You'll also need to complete and submit several other forms that provide additional needed information for INAP to review your situation. Alternatively, your employer or the BON may contact INAP and refer you to the program.
The next step in the enrollment process, no matter how you've been referred, is to receive a professional evaluation from a licensed “dual diagnosis evaluator,” meaning someone who is trained to identify both substance abuse disorders and mental health disorders. The evaluator needs to be someone that the BON has approved. INAP will review your evaluation to confirm that you are eligible to participate in the program. If so, your evaluation will be used to help INAP create your monitoring contract.
The final step in the INAP enrollment process is for you to receive, review, and sign your monitoring contract. Contracts typically have a three-year term, though that can vary depending on the situation. Once you've signed the contract, you'll be expected to follow its requirements or potentially find yourself removed from the INAP program. If that happens, INAP will notify the BON that you are no longer in the program and did not complete it successfully, and any suspended disciplinary matters against you may be revived.
The intensive nature of INAP and the severe consequences for failing to complete your monitoring contract means that it makes sense for you to carefully consider all of your options before deciding to enroll in the program. The Lento Law Firm Professional License Defense Team can help you with that. Our experienced attorneys can review the misconduct allegations against you and your particular situation and can advise you on whether there may be other treatment and legal options that may be a better way to resolve the issues you're facing.
Participating in the INAP Program
Once you've signed your monitoring contract, you'll officially be enrolled in INAP and will have to follow the program requirements that INAP has included in your agreement. If you fail to do so, particularly if you fail on a regular basis, you may be expelled from the program. Typical INAP monitoring contract requirements include:
- Daily check-ins with INAP's drug testing provider and daily availability for drug tests as directed by the provider
- Frequent attendance at AA or NA meetings, as appropriate; generally at least 5 to 7 meetings per week at first
- Additional attendance at community-based recovery-oriented meetings that may include 12-step, non-faith-based, or other types of recovery-focused groups
- Designation of a licensed professional approved by INAP who will act as your Recovery Program Monitor and will meet with you regularly and submit quarterly reports to INAP about your progress
- Abstinence from alcohol and certain drugs
- Employment restrictions depending on the situation; these may include stopping work until approved to return by INAP and then having conditions placed on your work hours, job assignment, and access to medications; you'll also need a designated Worksite Monitor who will submit regular reports to INAP about your work progress
- You will need to submit periodic reports to INAP about your progress
- All prescribed medications, particularly those with the potential for misuse, must be reported to INAP
The Lento Law Firm Professional License Defense Team is able to help you review the requirements of your proposed monitoring contract and decide whether INAP is your best option. In many cases where nurses are concerned about their licenses and may consider programs such as INAP a way out of having to go through the disciplinary process, our experienced attorneys can provide some valuable perspective based on having defended other professionals in similar situations. We may be able to suggest alternatives that you might not have considered and that might be better for you both personally and professionally.
The best time to contact the Lento Law Firm Professional License Defense Team is before you send any enrollment information to INAP or before you sign any agreement with INAP. That is when you have the most flexibility about how to approach your situation.
Employment While Participating in the INAP Program
You will almost certainly face employment restrictions if you enroll in INAP. Many nurses who enroll may be required to stop working until INAP approves their return to practice. This can create difficulties for many nurses who find themselves having to bear the costs of complying with their INAP monitoring contract, and at the same time, they're prevented from being employed as nurses. This is obviously a consequence that requires advance planning and is one significant downside of the program.
On the other hand, overcoming a serious substance abuse disorder is something that may require so much attention and work that it's simply not practical to be employed while in the early stages of the recovery process. The Lento Law Firm Professional License Defense Team can help you balance these considerations and, in some cases, can suggest alternative forms of treatment that, combined with a strong defense against disciplinary allegations, may work better for you.
The Employment Process While Participating in INAP
Once INAP approves your return to work, there will likely be conditions put in place that are designed to help you as you transition back to working as a nurse and to protect the patients you come in contact with. These are likely to include:
- Designation of a Worksite Monitor (WSM). This is a requirement for all nurses enrolled in INAP who are working in a nursing environment. The WSM must be approved by INAP; they must directly supervise you; they must provide quarterly reports to INAP of your work progress and notify INAP immediately if you exhibit any behavioral change that causes them to be concerned for you or your patients.
- Work Restrictions. Your work hours, shifts you're allowed to work, and work environments may be restricted. For example, you may not be allowed to work in emergency rooms, intensive care, or operating or recovery rooms. You may also be prohibited from working as a travel nurse, for a temp agency, as a home health care nurse, or in hospice care.
The conditions that INAP imposes on your work are likely to change as you progress through your monitoring contract. The goal of the program is to allow you to return to unrestricted work as a nurse, so from time to time the restrictions you face at work may change if you continue to show that you are succeeding with your recovery efforts.
Finding a job while enrolled in INAP is obviously going to be more challenging than if you were not in a program that imposes employment restrictions. You will need to notify any potential employer of your enrollment, and the employer will need to approve the WSM and will have to communicate with INAP about your situation and your progress. This is another factor to consider before enrolling in INAP, and one that the Lento Law Firm Professional License Defense Team can help you weigh along with any other programs that you may be considering.
Travel While Participating in INAP
INAP's daily check-in requirement, frequent group meetings, and personal therapy obligations can make traveling away from home a challenge. INAP suggests providing both the drug testing provider and your INAP contact at least two weeks advance notice before any travel that will take you away from your usual drug testing sites. You must secure INAP approval for your travel plans or risk being considered in default of your monitoring contract obligations.
In some cases, INAP may exempt you from having to call in and test during your travel. In other cases, you'll be required to continue to check in, and if selected for drug testing, you will be expected to have the testing done at an approved test site close to where you are staying. You may also be required to attend AA/NA meetings while you're away. In situations where your planned travel will take you to a place that does not have an approved testing lab, INAP may not approve your travel request.
Medical Waivers
From time to time, you may have to undergo medical or dental procedures that may include the administration of various prescription drugs, including pain medications. You will need to notify INAP staff in advance and, in many cases, will need to submit a statement from the physician or dentist that explains what the procedure is and why the medications are necessary.
Prescription Waivers
As part of your enrollment in INAP, you're required to identify all medications – prescription and otherwise – that you're taking at the time of enrollment. After that, if you are prescribed any medication on an ongoing basis – including pain or anxiety medications – you will need to notify INAP about them, and the physician who prescribed them will need to provide INAP with a statement explaining the need for the prescribed drugs. You will also be required to notify INAP when you've finished taking the prescribed medication.
Because INAP is an “abstinence-based” program, taking certain prescription medications without advance INAP approval may be considered a breach of your monitoring contract obligations.
Exiting the INAP Program
Most INAP monitoring contracts have a three-year term. As you approach the end of that period, at about the one-month point before the term is up, you will need to submit a written request to INAP to review your file. You will also need to create and submit a Relapse Prevention Plan to INAP, which your Recovery Program Monitor can typically help you with. Your enrollment in INAP ends only when INAP notifies you in writing that you have met your monitoring contract requirements and your enrollment is closed. Until you receive that notification – even if you have passed the three-year mark (or whatever your term is) – you need to continue to follow the requirements of your monitoring contract, including daily check-ins and submission of random drug tests when notified that one is needed.
Leaving INAP without completing your monitoring contract term, for whatever reason, will result in INAP notifying the BON that you have failed to complete the program. This will likely trigger the resumption of any pending disciplinary proceedings that the BON has paused during your INAP enrollment.
Challenges of the INAP Program
As with any substance abuse treatment program, there are challenges to participating in INAP. While not necessarily a reason to avoid INAP, you should be aware of them before you enroll so that you understand what they are and can take into account how they may affect your personal situation. These include:
- Cost of the program. You will be expected to pay for your drug testing, counseling fees, costs associated with group meetings (if any), and medical care related to your monitoring program. These can easily run into the thousands of dollars per year.
- Time challenges. In addition to having to be available for a random drug test any day of the week, you will likely have at least one group meeting a day at first and three per week after a period of time. You'll also be expected to meet regularly with your sponsor, as well as with your Recovery Program Monitor. Depending on where these are all located in Iowa, you may find yourself traveling a lot just to be able to make your required meetings.
- Employment challenges. Having to stop working at the beginning of your INAP program and then having to find an employer willing to accept INAP's restrictions on your practice and requirement for a WSM can make it more difficult to find employment while you're still enrolled in the program. This can be frustrating because returning to work on a monitored basis is an essential component of most INAP recovery plans.
- Travel restrictions. Travel will require more planning and may include interruptions for required drug testing while away, as well as attendance at AA/NA meetings at your destination. In some cases, INAP may not approve your travel plans at all.
These challenges may be one reason why relatively few nurses take advantage of INAP; according to the BON's 2022 annual report, there were only 41 active INAP cases as of June 30, 2022, out of roughly 46,000 licensed nurses working in the state.
Of course, every recovery program comes with its own challenges that you should consider, no matter what your choice is. The Lento Law Firm Professional License Defense Team can help you evaluate various programs and decide whether you may be better off with another program, even if that means defending against BON disciplinary charges.
Reasons to Enroll in INAP
As noted, one of the main reasons to enroll in INAP is that any pending disciplinary charges against you that relate to your reasons for enrolling will be suspended while you are in the program and, if you successfully complete it, will be dismissed. On top of this, the intense monitoring, group meetings, and counseling aspects of INAP are designed to provide enrolled nurses with a path to recovery. Depending on your situation, INAP may work well for you.
Alternatives to INAP
There are, of course, many substance abuse treatment options available all across Iowa. Many employers will provide access to confidential treatment programs, and others are available from health care providers and not-for-profit organizations. There is no one-size-fits-all program out there; each program has its own pros and cons, and what's important is that you select one that you believe will be best for you.
The Lento Law Firm Professional License Defense Team can help you make that choice. Having enough information so that you are making an informed choice about your own future is important because that can help you have the proper mindset to complete whatever treatment program you select. Where your concerns relate to any disciplinary allegations made against you, the Lento Law Firm Professional License Defense Team has the experience and understanding of the BON's disciplinary standards and procedures to help you defend and protect your rights and your license.
How the Lento Law Firm Professional License Defense Team Can Help
The experienced attorneys from the Lento Law Firm Professional License Defense Team have helped nurses all across the US – including in Iowa – face disciplinary allegations. We understand the laws and procedures that apply when the Iowa Board of Nursing pursues disciplinary charges against a nurse, and we can help you from the point at which you learn about the allegations.
During the investigation phase, we can represent you when you meet with the BON's investigator and make sure that you only answer fair questions that are clear and understandable. We can help you gather information in your own defense and can negotiate on your behalf with BON staff to arrive at a fair agreement that will conclude the disciplinary matter against you. In cases where such an agreement can't be reached, we'll aggressively defend you, your rights, and your license in any disciplinary hearing.
We also understand that your personal health and well-being is important. If you need treatment for a substance abuse or mental health disorder, we can help you evaluate not only INAP but other programs that may work as well or better for your particular situation, keeping in mind, of course, that you may also need to defend yourself against disciplinary charges.
If you have questions about your situation, or want to learn more about how the Lento Law Firm Professional License Defense Team can help you, call us today at 888.535.3686 or use our contact form to schedule a confidential consultation. We understand how important your nursing license is to you, and we are here to listen and to help.
