1. Remediation Outcome Study Elizabeth H. Zhong, PhD Kevin Kenward, PhD

2. Participating States Arizona Maryland Massachusetts Minnesota Nebraska North Carolina

3. 1996 Probation Issued during 2001 2005 Prior discipline history Recidivism

4. Discipline Record and Recidivism Rates 60 147 60 58 23 Prior Probationary Action Between 1996-2001(N=60) Probationary Action During 2001 (N=207) Post Probationary Action Between 2001-2005 (N=81) 38.3% Rate of Recidivism(39.1%) 39.5%

5. Profile of Disciplined Nurses Gender About 15% of the disciplined nurses were male, the number of disciplined male nurses was disproportionate in the nursing workforce. 2004 National Sample Survey of Registered Nurses 16.9% 10.7% 6.0% 5.3% RNs LPN/VNs 2001 Probation Statistics (Six States) % of Male Nurses

6. Profile of Disciplined Nurses Type of License Probation Statistics State License Statistics RN s LPNs/VN s APNs % Composition 59.0% 37.5% 77.6% 18.3%

7. Years Licensed in 2001

8. Profile of Disciplined Nurses Education

9. Profile of Disciplined Nurses Type of Facility

10. Profile of Disciplined Nurses Board Actions Number of Board Actions Number of Nurses Percent 1 Action8943.0 2 Actions7234.8 3 Actions2512.1 4 Actions31.4 5 Actions146.8 6 Actions10.5 7 Actions10.5 8 Actions10.5 9 Actions10.5 Total207100.1

11. About 35% of the disciplined nurses had a prior legal history (arrest or conviction)

12. About 33% percent of the disciplined nurses changed employers during their probation period.

13. Disciplinary Grounds for 2001 Probation Percent Drug/alcohol impairment/substance abuse21% Intentional misconduct or criminal behavior19% Inappropriate clinical reasoning17% Multiple violations (Different types of violations addressed under a single disciplinary action)14% Breakdown in professional responsibility9% Medication errors7% Documentation errors7%

14. 2001 Probationary Requirements (N=778) Probationary Requirements FrequencyPercent Reports from employer17322.2 Practice only under supervision 14118.1 Restricted setting9912.7

15. Remediation Outcomes FrequencyPercent Completed full probation and returned to practice 7335.3 Completed full probation with no follow-up on practice status 4521.7 Completed full probation and did not return to practice 31.4 Completed probation and charged with a new offense 136.3 Failed to complete probation 6832.9 Early termination of probation due to significant improvements 52.4 Total 207100.0 65% Completed Probation 35% Failed to Complete Probation

16. Recidivism Rate for the 2001 Probation Non-recidivism: Completed the 2001 probationary term and were not reported to the board of nursing for additional offenses within a four-year period from 2001 to 2005. Recidivism: Failed the 2001 probation by having additional offenses during or after the probation. 39% 61% Non-recidivism Recidivism

17. No statistical significance was identified in the actual time spent on probation in regards to the remediation outcome Length of Probation Term by Outcome Non-recidivism Recidivism Yrs

18. Gender by Recidivism Statistically significant relationship between the gender of disciplined nurses and the recidivism rate Non-recidivism Recidivism MaleFemale 56.7% 43.3% 63.8% 36.2%

19. Age by Recidivism Disciplined nurses who recidivated were about three years younger than those who successfully completed the 2001 remediation. Those who were under the age of 40 years old were more likely to recidivate Non-recidivismRecidivism 40 Yrs Old > 40 Yrs Old 50.7% 49.3% 66.4% 33.6%

20. Logistic Regression Analysis There is a negative correlation between age and recidivism, every unit increase in age decreases the odds of being a recidivist to 0.95. For a 10 year age increase, 40% decrease in the odds that the older individual recidivated If a disciplined nurse changed employers during their 2001 probation period, she/he will be 2.55 times more likely to recidivate compared to those who remained with the same employers.

21. License by Recidivism There was a higher percentage of LPN/VNs than RNs that recidivated LPNs/VNs RNs 68.0% 32.0% 50.7% 49.3% Non-recidivism Recidivism

22. Prior Legal History by Recidivism Significant relationship between the disciplined nurses prior legal history (arrest or conviction) and the remediation outcome Non-recidivism Recidivism Without Legal History With Legal History 56.4% 43.6% 67.1% 32.9%

23. The disciplined nurses who committed different types of violations between 1996 and 2001 were more likely to recidivate again during or after the 2001 probation Types of Violations and Recidivism 21.2% 78.8% 68.4% 31.6% Non-recidivism Recidivism Different Same

24. Change of Employers by Recidivism Those disciplined nurses who changed employers during probation were more likely to fail the 2001 remediation program Non-recidivism Recidivism Change of Employer No Change 47.2% 52.8% 76.6% 23.4%

25. Conclusions Male nurses, LPNs/VNs, and nurses who had prior legal histories were at higher risk for recidivism. Changing employers during probation, committing different types of violations were positively related with recidivism. Age of the disciplined nurses was negatively related with recidivism.

26. Recommendations Carefully screen the prior legal histories of the disciplined nurses. Focus on male nurses, LPNs/VNs, as well as those nurses at a younger age (under 40 years old). Pay more attention to those who commit different types of offenses. Whenever possible, encourage disciplined nurses to remain working with the same employer.