research department. core did the comparison of your state data to the aggregate data of other...
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Research Department
CORE
Did the comparison of your state data to the aggregate data of other boards allow for meaningful comparisons for where the agency may improve?
Survey Question
Critical to know how close or far the agency is in comparison to similar boards
The numbers showed where significant process reviews/changes/decisions need to be made.
Advantages
Want more meaningful comparisons
• Reliability of some data (e.g., financial data, low response rates) questionable
Improvements
What decisions or changes have you made, if any, based on your CORE report?
Survey Question
Review and develop the outcome measures in the Board Strategic Plan
Used comparative data to change/support an increase in the licensing fee structure
Used the data to make changes in the phone system; purchased new reporting system to measure phone outcomes.
Uses
Developed a consultative approach to assisting the nursing education programs comply with the rules and prepare for approval surveys
Used the comparison information to develop practice statements
Used the Core Survey to create a tracking system for gathering discipline data.
Uses
What are the critical programs or services that most affect the quality and costs of your regulatory operations that you like to receive best practice information on?
Survey Question
Alternative programs disciplinary processes
Background checks and international nursing applicants requirements
Disciplinary process
Licensure process
Investigative best practices
Hearing department best practices
Best Practices?
Summary of State data
Continue to refine and narrow the focus of the survey instrument
Revise tool to assure that data is being collected consistently
Areas of Improvement
2010 CORE Survey
1st Quarter 2010
New and improved
Shorter
Terms defined
0
100
200
300
400
500
600
700
800
900 YourState
Aggregate
CORE HelpsIdentify Potential Problem Areas
Tangible Evidence: Improve Productivity & Efficiency
Expense Calculation Per Licensee
($20.00)
($10.00)
$0.00
$10.00
$20.00
$30.00
$40.00
$50.00
$60.00
2002 2005 2007
$48.80
$38.91
<$9.89>
Aggregate
My State
Variance
Tangible Benefit: Licensing Staff Improved Productivity & Efficiency
0
10
20
30
40
50
60
70
80
2005All
2005State
2007All
2007State
VerificationTimeliness%Web LicensureVerif.
Verification Cycle Time Improved 57% 2007
INCORPORATING CORE FINDINGS INTO STRATEGIC PLANNING
GOAL: TO FACILITATE INFORMATION EXCHANGE BETWEEN THE BOARD AND ITS CONSTITUENTS
Objective: Effective communication with the public, including licensees, employers, policy makers, consumers
Performance Measure: CORE findings indicate positive communications with constituents
Simulation
Simulation
Help regulators determine when and how to use simulation in pre-licensure nursing education.
In other words, how much simulation is enough and in what situations?
Clinical
OnlySimulation
OnlyClinical + Simulation
Knowledge
Confidence
Clinical Outcomes
Potential Study Participants
• Major Simulation Labs Across the Country
• Issues Regarding Sample Criteria
Practice and Professional Issues (PPI)
Employer Survey
Employer Survey
The employer survey is designed to provide insights into the professional and practice issues of nurses in practice settings. The data collected will provide insights into the following:
1.The nursing workforce (i.e., nurse vacancies, recruitment, hiring, and retention);
2.Educational preparation (i.e., clinical education, nursing program preferences, degree preference, and general preparation to
practice);
3.Transitioning and professional development, questions related to transition and training newly-hired nurses.
4.Patient safety (i.e., licensure, errors, discipline, shift length/scheduling, communication, organizational characteristics,
and role clarity.
Questions
To what extent is there an inadequate supply of nurses? And what negative consequences, if any, have facilities experienced as a result of an inadequate supply of nurses?
Do facilities prefer not to hire newly-licensed nurses and if so why?
How important is clinical experience?
Are most of the nurses hired by facilities prepared (prior to hire) to provide safe, effective care to clients?
What are the types and lengths of transition programs offered to newly-licensed, experienced, and foreign-educated nurses?
Are facilities providing medication safety, patient safety, and simulation training and development for nurses?
Questions
APRN
APRN
Compare patient outcomes for Nurse Practitioners (NP) based on their degree of physician supervision:
1. Those who have on-site physician supervision2. Those with professional collaboration 3. Those who collaborate with agreed upon protocols or delegation 4. No physician involvement whatsoever
An Assessment of the Safety, Quality, and Effectiveness of Care Provided by
Advanced Practice Nurses
A sweeping review of the scientific literature on the quality, safety, and effectiveness of care provided by APRNs
Geo Mapping
Geo-mapping shows the locations of every actively practicing physician in all 50 states and non-physician providers.
Some believe these maps invalidate the argument that expanding the scope of practice of non-physician providers will enable increased access to care for rural patients, demonstrating that physicians and non-physicians are equally accessible in metropolitan and rural areas.
Information for legislators
Member Board Profiles
1.Updates
2. Index
3.Revised format
TERCAP
Sufficient attention must be given to analyzing and understanding the causes of errors in order to create learning systems and improve patient safety.
TERCAP examines adverse events to understand where the system broke down, why the incident occurred, and the circumstances surrounding the incident.
Analyzing critical incidents, whether or not the event actually leads to a bad outcome, provides an understanding of the conditions that produced an actual error or the risk of error as well as the contributing factors.
Why TERCAP?
TERCAP Research QuestionsWhat factors are associated with practice breakdown?
Patient characteristics
Nurse characteristics (demographic data)
Nurse practice history factors (scheduling, staffing levels and/or timing of incidents)
Licensure types
Educational characteristics
Setting factors
Healthcare system factors
Healthcare team factors
Clusters of practice breakdown associated with the primary types of error
Types of practice breakdown associated with patient outcome
Types of patient medical record documentation associated with different types of practice breakdown
From Questions to Findings
Work Times
Medication errors occur more often between midnight and 7am
Types of patient
medical record
documentation
More than seventy percent of the practice breakdown occurs with a paper medication record system
Types of healthcare system factors
Frequent interruptions or distractions lead to documentation errors
Years of Experience at Time of Disciplinary Action
Avg. = 14 years
Length of Time Frequency Percent
One month – Twelve months
122 32.11
One - Two years 73 19.21
More than five years 72 18.95
Three - Five years 54 14.21
Two - Three years 31 8.16
Less than one month 15 3.95
Unknown 13 3.42
Length of Time Worked for Organization Where Practice Breakdown Occurred
Gender
6
17
0 2 4 6 8 10 12 14 16 18
Percent
Percent ofDisciplined
Nurses Who AreMale
Percent of Malesin Nurse
Population
6
18
Type of License
7761
23
38
6 10
10
20
30
40
50
60
70
80
RN LPN/VN APRN
Population
TERCAP
Per
cent
Highest Degree Frequency Percent
Associate RN 128 33%
PN/VN 116 30%
Associate LPN 27 7%
Diploma RN 17 4%
BA 2 1%
Other degree 2 1%
Total 292 76%
Education
37% of nurses with criminal convictions committed medication errors
Erroneous Conclusions
37% of nurses with criminal convictions committed medication errors
Margin of Error = + 35%
Range = 2.5% to 72.5%
Medication Aides
Medication Aides
Dozens of studies have confirmed that the rate of administration error is low and seems to average about 10% for medication aides as well as RNs.
Expert Panel
Amy Vogelsmeier PhD, RN, Assistant Professor, Coordinator for Leadership in Nursing and Health-Care Systems John A. Hartford Geriatric Nursing Scholar, Sinclair School of Nursing University of Missouri.
Glenise McKenzie, RN, PhD, Assistant Professor, Rural Health Research Office, Oregon Health and Scieences University School of Nursing
Jill Scott-Cawiezell PhD RN FAAN, Professor and Area Chair for Systems and Practice, University of Iowa College of Nursing
Suzanne K. Sikma PhD, RN, Professor, Nursing Program, University of Washington
Ginette A. Pepper PhD, RN, FAAN, Director, Hartford Center of Geriatric Nursing Excellence, Professor & Helen Bamberger Colby Endowed Chair, Associate Dean for Research & PhD Programs, University of Utah College of Nursing
Medication Aides
Who regulates medication aides What medication aides can and
cannot do Training Supervision Where they work
Gather information on:
Meta Analysis
Combines the results of several studies that address a set of related research hypotheses
Medication Aides
Medication Aides
Use simulation to determine optimal training background of medication aides
Workforce
Boards of
Nursing
Nursing
Workforce
CentersSam
ple
Surve
y
NCSBN will collect data from states who renew licenses on-line
State Boards of Nursing On-line License
Renewal
NCSBN’s WorkforceDatabase
Analyze Data at the National Level
Analyze Data at the Regional Level
Analyze Data at the State Level
Umbrella/Independent Boards
Shared Services
Would consolidation, re-structuring or moving regulatory programs reduce program costs?
Would consolidation, re-structuring or moving regulatory programs increase administrative efficiency?
Would consolidation, re-structuring or moving regulatory programs increase their effectiveness?
Would consolidation, re-structuring or moving regulatory programs increase their ability to fulfill their legislative mandates?
Umbrella/Independent Boards
Shared Services
Consolidation focuses on how state’s organize the delivery of services – taking existing organizations, services or applications and combining them into a single operation; typically mandated by executive order or statute.
Shared services focuses on the delivery of a particular service or services in the most efficient and effective way, as a way of gaining economies of scale and other benefits. The centralization of specific activities that function as everyone’s vendor of choice; usually implies voluntary participation involving service level agreements (SLAs).
1. Autonomous boards;
2. Boards are autonomous but with shared administrative functions;
3. Boards that share authority with a centralized agency;
4. Boards with limited authority.
There are not two organizational models but four major organizational models in use nationally.
You don't need to own your own grocery store to control what you eat.
A shared-services organization gives business units absolute control over what they buy from it. You buy, you pay; you don't buy, you don't pay.
Allocations distribute costs among business units after the fact based on a formula that's roughly based on utilization. Allocations do not give business units control of a checkbook, and in fact serve no economic purpose other than cost accounting. Oh, they do one more thing: They get business units upset about "taxation without representation" and put the shared-services organization on the defensive about its costs
Consolidate
E-mail Services
Shared Services
Customer ServiceDecentralize
Investigation
Alternative to Discipline
Alternative to Discipline Programs
Review discipline and alternative programs and provide recommended regulatory practices for chemically dependent licensees
Survey Results
States with Alternative to Discipline Programs
Currently have an alternative to discipline program for licensees with substance abuse disorders.
Frequency Jurisdiction
Yes, have an alternative to discipline program
36
AL, AZ, CA, CO, CT, DC, FL, ID, IL, IN, KS, LA, MA, MN, MT, NC, ND, NH, NJ NM, NV, NY, OH, OK, OR, PA, SC, SD, TN, TX, UT, VA, VT, WA, WV, WI
No, do not have an alternative to discipline program
15AK, AR, DE, GA, HI, IA, ME, MO, MS, NE, WY, AS, GU, MP, VI
No response 4 KY, MD, MI, RI
Survey Results
Who manages and staffs (administers) the alternative to discipline program
Frequency Percent
Board of Nursing Staff 18 47.37
An outside agency/entity (not another governmental or state agency).
13 34.21
State Agency other than the Board of Nursing 4 10.53
Other 2 5.26
No Response 1 2.63
Whether or not information related to participants in the alternative to discipline program is public information or not?
Whether or not participants in the alternative to discipline program are routinely required to submit to observed random drug screening
Whether or not the nursing employer is notified about the positive confirmed drug screen results of a licensee who tests positive (confirmed positive drug screen results) for an unauthorized drug or alcohol
Whether or not a licensee who tests positive for an unauthorized drug or alcohol is permitted to remain in the alternative to discipline program
Number of drug screens can a licensee can fail (testing positive) before being reported to the Board
Single Clinical Competency Assessment
Programs
Determine whether graduates from single clinical competency programs are able after graduation to practice in a clinical setting at a level substantially equivalent to the graduates of nursing educational programs that require students to complete a required number of supervised clinical learning experiences.
