Strategy for Board Decisions & Remediation Maryann Alexander, NCSBN Kathleen Russell, NCSBN

Patient Safety

§  Over 200,000 deaths annually due to error

§  NCSBN data from other studies indicate high rates of recidivism by nurses who are disciplined by employers and/or boards of nursing.

§  Staff fear repercussions of error and do not report

§  Many errors “system-related”

Data from the U.S. Criminal Justice System

§  Punishment does not necessarily improve behavior

§  Emphasis is needed on examining what happened and how can we prevent you from doing this again.

§  Support and resources lessen the chance of recidivating.

Consequences of Discipline

§  Nurses tend to hide errors §  Prevents fixing the system §  Risk to patient

§  Focus is often negative

§  Sometimes necessary and effective under the right circumstances.

What does all this mean?

§  Regulation and health care facilities need to work together.

§  We need to effectively prevent errors.

§  Examine environment/system as well as individual errors.

What does all this mean?

§  Punishment may not be the best option for preventing future errors or poor performance.

§  Remediation, counseling, supervision are tools that need to be considered as part of disciplinary action.

Nurse Discipline

§  Need for greater consistency

§  Need to reduce the rate of recidivism

§  Need to reduce error and place emphasis on remediation.

§  Need to tie the process to the patient safety movement.

Focus of evaluation

System error §  May be due to a deficit in

the facilities policies and/or procedures

§  May be due to other providers in the health care system

§  Often a combination of factors

§  remediation

Nurse’s role in error §  concealment/falsification

of records §  substantial or

unjustifiable risk §  reasonably prudent

nurse §  mitigating factors §  history of similar error §  previous facility

Strategy: review the system & behavioral factors for all practice error & professional misconduct cases.

Regulatory Decision Pathway

Goals §  protect the public §  incorporate just culture principles §  increase consistency in discipline

Designed for §  Board of Nursing discipline decisions §  cases of practice errors or unprofessional conduct

Focuses on §  patient safety §  whether system failure and/or behavioral choices by the nurse contributed to the error §  remediation of nurses

Regulatory Decision Pathway (RDP)

Initial development

§  NCSBN team drafted the pathway, summer 2012

§  Presented at Annual Meeting 2012

BONs Review & Revision

§  Solicited 18 BONs to review & pilot the tool, Winter 2012

§  Received feedback from 13 BONs

§  Incorporated feedback into tool, Spring 2013

BON Evaluation results

§  13 BONs reviewed the tool

§  183 cases were used in reviews

§  Majority of BONs thought the tool was §  Clear §  Useful to BON discussions §  Effective in leading to consensus in BON decisions §  Led to conclusions the BON agreed with

§  50% of BONS are considering changing current process as a result of RDP

Revisions Spring 2013 Issues identified by BONs §  concealing/falsifying

records §  contributing or mitigating

factors §  counseling & coaching §  responsibility for action

plans §  unprofessional conduct

cases §  definitions §  directions for tool

Revisions §  moved concealing/falsifying records

from deliberate harm §  added contributing or mitigating

factors to pathway §  added counseling & coaching to

Human Error §  changed responsibility for action

plans to nurse §  included a description of tool &

cases designed for at top of tool §  expanded definitions §  explicit directions

   

The  Regulatory  Decision  Pathway  (RDP)  was  designed  for  Board  of  Nursing  discipline  decisions  in  cases  of  prac5ce  errors  or  unprofessional  conduct.        

With  the  use  of  the  RDP,  the  board’s  discussion  is  focused  on  whether  system  failure  and/or  behavioral  choices  by  the  nurse  contributed  to  the  error.        

Through  the  use  of  RDP  the  board  will  determine  the  type  of  behavior  exhibited  and  whether  disciplinary  ac5on  or  other  ac5on  would  assist  in  protec5ng  the  

public.    

Next  steps  

§  Distribute to Nursing Boards

§  Larger scale data collection

§  Send us your feedback!

Thank you