Intervention Project for Nurses (IPN)

Florida’s state designated impaired practitioner program for nurses only is the Intervention Project for Nurses (IPN) with a mission “to ensure public health and safety by providing education, monitoring and support to nurses in the State of Florida.” The Department of Health contracts directly with IPN, which is required to meet specific criteria and standards. Costs are paid for by license renewal fees and are part of the budget of the Florida Board of Nursing (BON) (IPN, 2018; Smith, 2017).

In the early 1980s the nursing profession realized that 67% of nurses reported and/or disciplined by Boards of Nursing in the United States had drug, alcohol, or psychiatric disorders. At the time, the Florida BON, like most, used only a disciplinary model, yet there were a variety of concerns about the results obtained with that model. Beginning in 1982 with a call from the ANA, nursing groups and states began to look for different ways to address the problem of substance abuse among nurses (Smith, 2013).

On October 1, 1983, the Florida Legislature made it possible for an alternative to discipline program in the state and it amended the Mandatory Reporting Law to its current terminology, allowing reporting of a nurse directly to IPN under certain circumstances (Smith, 2017, 2013). IPN was the first such program in the country and has become a model for other states (IPN, 2018).

Treatment Process

The steps a nurse will encounter when entering IPN are:

• Initial referral call
• Consultation/intake
• Intervention/evaluation
• Appropriate treatment
• 2–5 years of monitoring

IPN is not itself a treatment program but a master monitoring program and a resource provider. It refers nurses to an appropriate treatment program based on the specific situation and provides a variety of services including:

• treatment referral (approved provider network)
• IPN Advocacy Contract
• Structured Nurse Support groups
• Mutual Support Groups
• Quarterly Progress Evaluations
• Practice-setting reports
• Relapse prevention groups
• Random toxicology testing

A nurse signs a contract for participation in the program and will be required to attend a variety of meetings and support groups in addition to completing their treatment program. Frequent drug testing and a daily check-in are also part of the program. The ultimate goal is for a nurse to retain his or her license and return to safe practice. Normally there will be restrictions when the nurse first returns to the workplace that will require a worksite monitor and may restrict access to work with controlled substances (Smith, 2017, 2013).

Benefits and Challenges of ATD Programs

The Florida IPN and alternative to discipline programs in general can have benefits for patients, nurses, facilities, and the community. One often cited benefit is the ability to take quick action in removing a potentially unsafe nurse from practice as opposed to the traditional investigation and discipline process that can take months and may only come into play after actual harm has taken place. Regulatory boards report the costs to administer ATD programs are lower as well (NCSBN, 2011).

For nurses the ability to obtain help while retaining their license and preserving the possibility of returning to the workplace provides significant motivation, as does the ability to keep their names from being made public (in most places). Factors typical in ATD programs such as close scrutiny of activities, high quality support situations, 12-step meetings, drug testing, and consistent reviews have been demonstrated to be protective factors supporting a successful recovery (NCSBN, 2011).

Contracts between regulatory boards and program providers need to be spelled out carefully, including how and when information is shared. Issues of confidentiality are often a critical motivator for participation in the program but some critics see this a simply creating a safe haven for nurses from public discipline rather than as timely way to get those with substance use disorders into treatment. Balancing accountability and transparency to the board and the public with the needs of participants and program operators is an ongoing consideration (NCSBN, 2011; Strobbe & Crowley, 2017).