Patient Safety and Nursing Regulation in the United States Faith A. Fields, MSN, RN President National Council of State Boards of Nursing United States of America

Topics: 1. Importance of patient safety with regard to nursing regulation in the U.S. 2. How regulation ensures public protection 3. Share practice cases which resulted in disciplinary action 4. US perspective on public protection

Regulation By the Profession By the Government

What is the NCSBN? National Council of State Boards of Nursing

U.S.A. Authority to Regulate 10 th Amendment of the US Constitution –Gives to states all powers not delegated to federal government –States have power to enact laws to protect its citizens –Regulatory authority derived from legislative authority –State legislatures delegate enforcement activities to state administrative agencies (e.g. Boards of Nursing)

Why do we regulate professions? Potential for harm Forum for complaints Patient safety Protection of the public

Need for Regulation Information Asymmetry Bundling of Services Forum for Complaints

Why license nurses? Because nursing requires specialized knowledge, skill and independent decision making. Because harm could result Because it matters

We protect the public safety by: Regulating nursing education Carrying out laws governing nursing Setting licensing requirements Taking disciplinary action on the license

Board Authority Fraud or deceit in procuring a license Guilty of a crime or gross immorality Is unfit or incompetent Is habitually intemperate or is addicted Is mentally incompetent Guilty of unprofessional conduct Action in other jurisdictions Willfully or repeatedly violated NPA

Importance of Patient Safety with regard to Nursing Regulation in the U.S.A. Case studies/Examples

Disciplinary Authority Reprimand Probation Suspension Revocation Voluntary Surrender

Case Review – Practice Issue Nurse Did What? –Terminated from employment due to patient abuse Attempted to use force to cause a patient to swallow their medication Witness statements Review of work history –License revoked

Most discipline issues involve drug diversion and abuse.

Discipline has also been issued for: Theft of patient’s property Fraudulent billing for services Sexual, physical or verbal abuse Failure to follow a prescriber’s order

Avoiding Disciplinary Action Know and follow the Laws and Rules Know your scope of practice and limit actions to scope of practice Know and follow the facility policies and procedures Check and double check when action/inaction may cause harm to a patient.

Scope of Practice Decision Making Model

Importance of Patient Safety with regard to Nursing Regulation in the U.S.A.

CORE Commitment to Ongoing Regulatory Excellence Education Practice Discipline

Trends Shortage of qualified nurses Continued competence Unlicensed assistive personnel Advanced certification Disaster preparedness Mobility of nurses

Questions?

Compact States