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Rene Cronquist, J.D., RNMinnesota Board of Nursing
Director of Practice and Policy
The Investigatory Process2013 NCSBN IRE Conference
Tools in the Regulation tool box
Regulation uses a variety of mechanisms – tools, if you will, to carry out is mission of public protection
What’s in your tool box?
Statutes, Rules, Regulations, Case Law, Policies, Advisory Opinions
Program approval/AccreditationCredentialing
LicensureRegistrationCertification
Information/Data
What’s in your tool box?
Big tools: Enforcement, compliance, discipline, investigation, remediation
The right tool for the jobKnowing which tool to use depends on what
you are trying to do. In the context of investigation, are you:
Deciding if the complaint/report is within the authority of your agency?
Gathering factual information to determine whether the complaint has merit?
Gathering information for another group or agency to make decisions?
Determining what action is most appropriate based on the available information?
Complaint process
Complaint process – another view
Details
Intake
Intake toolsSources of complaints
Mandatory and permissive reportBoard as a source of complaints; self reports;
Nursys
Methods of submitting complaints
Screen for jurisdiction
Thresholds, triage, prioritizing, codingTracking mechanisms
Investigation toolsAn effort to learn the who, what, where, why,
when and how of the allegations
Methods:Record gathering
EmploymentMedical records of nurse or patientPharmacy and Prescription drug monitoring program
recordsControlled substance inventory logsCourt records and police reportsSchool recordsReports from other agencies Bank records
Investigation toolsForensics
Evaluation of licensee (CD, mental health, neuropsych)Drug testingComputers (home & work PCs, cell phone, EHR access)Drugs (assay of syringe contents, analysis of
automated dispensing machine history)
Interviews/Written statementsLicenseePatient/victimWitnessesSupervisor and coworkersCollateral contacts
Investigation toolsWritten statements/affidavits
RecordingsSurveillance videosAudio recordings as evidenceAudio recordings of interviews
Site visits
Other recordsEmployer policies and proceduresDatabanks (Nursys, HIPDB/NPDB)
Investigation results
ReportsFormats, templatesKnow your intended audience and all
possible readers
Recommendations; Determining next steps
ChallengesCoordinating investigation with other
agenciesPeer review protection of recordsOut-of-state recordsDestroyed recordsUncooperative witnessesUnreliable or incompetent witnessesUncooperative or unlocatable licensees
Your favorite tools
Board proceedings & actions
Informal processesStipulated agreements
Formal processContested case hearings; administrative hearingsStandard of proof must be met (clear and
convincing vs. preponderance); Board typically has burden of proof
Appeals of Board decisionsEmergency/temporary proceedings
Authority -- usually limited – to take action against a license before a hearing on the merits
Miscellaneous
Board proceedings & actions
Conclude the complaint without action (dismissal)Referral to a non-disciplinary monitoring programNon-disciplinary action (letters of concern,
admonishment, reprimand, Agreements for Corrective Action)
Disciplinary Action
To Report or Not to ReportIs the action public?Is the action reportable?NursysHIPDB/NPDBOIG
Compliance monitoringTerms and Conditions
Probationary termsReports from the nurseReports from the nurse’s supervisorAudits – documentation, med administrationAdditional educationMaintain sobriety, attend support groupsDrug screens
Restrictions/LimitationsSupervision requiredRestricted access to controlled substancesLimitation on work hours or locations
Compliance monitoringNon-compliance
Failure to comply, violations of the order; new allegations
Process used to address non-compliance depends on terms and conditions of the order and individual state laws
More toolsChecklistsTracking mechanismsReport formsAuditsRandomizing drug screens
Challenges and policy questionsHow much information is enough?
How to manage sometimes competing priorities? Efficiency, cost containment, timely resolution of cases, appropriate resolution of cases.
How do we measure quality and effectiveness?
ResourcesNCSBN
Networking opportunitiesConferencesWebsite materialsCE offerings
CLEARFARBNADDIInterviewing technique training
Dean Benard, Benard & AssociatesThe Reid Technique
Thank you!
Rene Cronquist, J.D., RNMinnesota Board of Nursing
2829 University Ave SE #200Minneapolis MN 55414
(612) [email protected]
www.NursingBoard.state.mn.us
