Commitment to Excellence in Nursing Regulation Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Kathy Apple, RN, MS, CAE Executive Director National Council of State Boards of Nursing

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri NCSBN Mission The National Council of State Boards of Nursing (NCSBN), composed of member boards, provides leadership to advance regulatory excellence for public protection.

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Need for Study Multiple stakeholders were demanding accountability Lack of clarity among stakeholders about Board roles and responsibilities Trend toward outcome measurement at state level

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Purpose of the Study Incorporating data from internal and external sources Using benchmarking strategies Identifying best practices Establishment of a Performance Measurement System

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Phases of the Project 1.Validation of Board Roles

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Results of Phase 1: Roles Identified –Establish scope of practice for nurses –Issue licenses to qualified nurses –Assure continued competence –Investigate complaints and impose disciplinary sanctions as appropriate

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Phases of the Project 1.Validation of Board Roles 2.Identification of Performance Indicators

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Results of Phase 2: Technical Work Group developed –Performance indicators –Outcome Indicators –Output Indicators –Efficiency Indicators

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Examples Performance Indicator –Timeliness of complaint handling Outcome Indicator –Average time for complaint resolution

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Examples, cont. Output Indicator –Number of complaints resolved in FY Efficiency Indicator –Average cost per completed complaint

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Phases of the Project 1.Validation of Board Roles 2.Identification of Performance Indicators 3.Tool Development

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Tool Development Process Original tools developed and piloted Original tools revised and further tools developed –6 data collection tools for boards of nursing –Surveys to collect data from 6 stakeholder groups

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Board Surveys 1.Discipline 2.Licensure 3.Education Program Approval 4.Practice 5.Governance (Executive Staff) 6.Governance (Board President)

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Board Surveys Included Processes used, e.g.: –Investigator caseloads –Use of site visits or self-reports for education programs Timeliness issues, e.g.: –Days needed to processes license request

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Board Surveys Included Outcomes achieved, e.g.: –Number of discipline cases closed Opinions, e.g.: –From Executive Staff and Board President

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Stakeholder Groups 1.Licensed nurses 2.Health care employers 3.Nurses who had been the subjects of complaints 4.Persons who had lodged complaints 5.Nursing associations 6.Nursing education programs

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Stakeholder Surveys Included Perceptions of board’s –Timeliness, –Fairness, –Adequacy of regulation, etc. Satisfaction with board’s –Communication with stakeholder group, –Nursing program approval process, etc.

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Phases of the Project 1.Validation of Board Roles 2.Identification of Performance Indicators 3.Tool Development 4.Data Collection

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Data Collection Stakeholder contact information submitted by boards –Random samples selected from those submitted 6 data collection tools sent to boards of nursing

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Data Collection Wisdom Not all boards routinely collected the data asked for –Many boards used this as an opportunity to improve/modify amount and types of data collected Language/definitions (i.e., financial data, board processes) differed among boards

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Phases of the Project 1.Validation of Board Roles 2.Identification of Performance Indicators 3.Tool development 4.Data Collections 5.Reports of Findings

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Report Format I.Aggregate findings A.Data results 1.From board surveys 2.From stakeholder surveys B.Relationships among variables II.State-specific findings A.Comparison of state with all states B.Comparison of state with “like” boards

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Example of Comparison with Aggregate Data, i.e., Ed. Program Perceptions Approval ProcessState Rating Aggregate Rating Interval between board visits Preparation time for board visits Feedback/evaluation provided by board

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Comparisons with Similar Boards Boards evidenced a wide variety of resources, structures & processes Boards were compared to other boards similar in a number a variables

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Comparison Variables Size of staff Staff assigned to specific functions Numbers of investigators Whether or not state mandated reporting of errors Processes related to complaint review

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Comparison Variables cont. Board structure Standard of proof Staff autonomy Number of board meeting per year Timeliness of discipline processes Timeliness of licensure processes

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Comparisons of Sample Board with Other Boards with Similar Numbers of Staff

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Phases of the Project 1.Validation of Board Roles 2.Identification of Performance Indicators 3.Tool development 4.Data Collections 5.Reports of Findings 6.Search for “best practices”

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri The Search for Best Practices Data were used to identify boards with consistently high ratings in –Outputs –Effectiveness Ratings were explored in 5 functional areas –Discipline, licensure, education program approval, practice and governance

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri The Search for Best Practices Selected boards were interviewed to discover –Practices common among boards with consistently high ratings –Differences from boards with lower ratings

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Discipline Best Practices Boards with the highest ratings on discipline outcomes –Delegated authority to board staff –Communicated well with stakeholders –Hired investigators and attorneys & actively managed discipline process –Trained and mentored investigative staff –Applied discipline sanctions consistently

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Licensure Best Practices Boards with the highest ratings on licensure outcomes –Secured essential human and other resources –Made an aggressive commitment to customer service

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Education Best Practices Boards with the highest ratings on education outcomes –Provided consultative, as well as evaluative services to education programs –Took a leadership role in establishing congruence between education and regulation

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Practice Best Practices Boards with the highest ratings on practice outcomes –Facilitated understanding of legal scope of practice –Made an aggressive commitment to customer service –Established a high level of involvement with the statewide nursing community –Delegated authority to board staff

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Governance Best Practices Boards with the highest ratings on governance outcomes –Promoted an understanding of the respective roles of staff and board members –Built an effective working relationship and a high level of trust between board and staff –Facilitated an effective working relationship among board members –Demonstrated a commitment to board member development

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Phases of the Project 1.Validation of Board Roles 2.Identification of Performance Indicators 3.Tool development 4.Data Collections 5.Reports of Findings 6.Search for “best practices” 7.Development of Ongoing System of Performance Measurement

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Commitment to Ongoing Regulatory Excellence (CORE)

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri CORE Nursing Boards educated on CORE –Manuals prepared, distributed and explained –Ongoing presentations and publications Best Practice “Tool Kit” –Submissions by boards of systems and processes that have facilitated best practice

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri CORE Ongoing improvement of data collection system –All survey items linked to outcome and/or best practice –Data collection streamlined –Additional tools created and piloted Information Technology Finance Board Member

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Utilization of Data by Boards of Nursing Data has been used to: Support decision-making Develop mandated reports Provide information to legislators Change data management processes Improve stakeholder satisfaction Streamline processes Determine priorities

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Next Steps Identify and remove barriers to participation Support member boards’ adaptations of best practices

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Questions?

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Kathy Apple, RN, MS, CAE National Council of State Boards of Nursing 111 East Wacker Drive, Suite 2900, Chicago, IL Phone: , Fax: Publication Crawford, L. (2004). Evidenced-Based Regulation: A Regulatory Performance Measurement System, Research Brief Volume 8. National Council of State Boards of Nursing: Chicago.