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 1 st Quarter 2010 New and improved Shorter Terms defined
Your State Aggregate CORE Helps Identify Potential Problem Areas
Tangible Evidence: Improve Productivity & Efficiency Expense Calculation Per Licensee Aggregate My State Variance
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
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
Compare patient outcomes for Nurse Practitioners (NP) based on their degree of physician supervision: 1. Those who have on-site physician supervision 2. 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.
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 Questions What 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 TimeFrequencyPercent One month – Twelve months 12232.11 One - Two years7319.21 More than five years7218.95 Three - Five years5414.21 Two - Three years318.16 Less than one month153.95 Unknown133.42 Length of Time Worked for Organization Where Practice Breakdown Occurred
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
Use simulation to determine optimal training background of medication aides
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 states 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 everyones 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 Service Decentralize Investigation
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. FrequencyJurisdiction 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 15 AK, AR, DE, GA, HI, IA, ME, MO, MS, NE, WY, AS, GU, MP, VI No response4KY, MD, MI, RI
Survey Results Who manages and staffs (administers) the alternative to discipline program FrequencyPercent Board of Nursing Staff1847.37 An outside agency/entity (not another governmental or state agency). 1334.21 State Agency other than the Board of Nursing410.53 Other25.26 No Response12.63
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
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.