TPA compliance is necessary to keep your probated nursing license valid. Most nurses in my practice who are on probation to the Missouri State Board of Nursing, are monitored by a Third-Party Administrator (TPA) due to substance abuse issues. TPA compliance requires a nurse’s determination. There are many other probation requirements, however TPA is the most difficult in my opinion.
What does Third-Party Administration require?
The nurse must check in with the TPA daily, including vacation and off days. Here is the link to the Missouri State Board of Nursing TPA information. Usually this is done online, unless the nurse is in an area where there is no internet, which is rare these days. You log-on to the TPA website between 5:00 a.m. and 4:00 p.m., and are notified whether today is the day you must submit to a random drug screen. If so, you have until the close of the testing center’s business, usually 4:30 p.m. to report, give a urine sample, allow for collection and retrieval by the testing center. In Missouri, nursing probation can be up to a maximum of 5 years. 5 years is more common than 1 or 2 years for substance abuse.
6 chances to violate TPM Compliance.
- First, the nurse must check in everyday. Even while on vacation, or not working. If you fail to check in daily, that is a violation of the Compliance contract.
- Second, the nurse must check in on time, between 5:00 a.m. and 4:00 p.m. A late check-in is a violation.
- Third, a missed check-in is a violation.
- Fourth, a positive drug screen is a violation. (The nurse’s doctors will have reported their prescriptions to the Board’s Compliance Officer. Testing positive for an approved substance will not count as a violation.) It is important to note that while marijuana may be legal, the probation agreement normally holds that a positive THC test is a violation. The Board may consider whether a medical prescription for THC is acceptable.
- Fifth, a dilute urine specimen is the same as a positive urine specimen. What is dilute? A sample that contains a creatinine level below 20mg/dl. A low creatinine reading means the sample has been watered down, as in, “I had some wine with my spouse on Valentine’s Day and got notice for a UDS the next day, I better drink a ton of water to flush it out”.
- Sixth, a failure to produce a sample on time is a violation.
Suggestions for successful TPA compliance
I have represented many nurses in Jefferson City before the Board of Nursing, including those who have received a Probation Violation Complaint. To avoid paying me defend your probated license, I suggest:
- Set your alarm early in the a.m., and check in with the TPA early. Otherwise, you may get too caught up in your daily activities and forget.
- Set multiple alarms in case you sleep through the first one.
- Be honest with yourself. You cannot fool the Board by stating you took a sip from someone else’s cup that contained cocaine; or you applied CBD oil and tested positive from that; or you handled a fentanyl patch and tested positive.
- You actually can get a false positive if you ingest poppy seed pastry. Pay attention to what you eat.
My final thought.
TPA compliance is hard, and you may think the Board of Nursing is punishing you. It is true that probation has many effects on the probationer’s nursing practice. The Board is actually giving you a break, allowing you to stay in your field, even though there were 10 vials of Dilaudid missing from the Omnicell that were not documented as wasted or administered, but has your fingerprint accessing the drawer. For information on Disciplinary Hearings before the Board, see my blog.
