Transcript Slide 1 - National Council of State Boards of Nursing

The Investigatory Process
2013 NCSBN IRE Conference
Rene Cronquist, J.D., RN
Minnesota Board of Nursing
Director of Practice and Policy
Tools in the Regulation
tool box
Regulation uses a variety of mechanisms – tools,
if you will, to carry out is mission of public
protection
What’s in your tool box?
 Statutes, Rules, Regulations, Case Law, Policies, Advisory
Opinions
 Program approval/Accreditation
 Credentialing
 Licensure
 Registration
 Certification
 Information/Data
What’s in your tool box?
 Big tools: Enforcement, compliance, discipline, investigation,
remediation
The right tool for the job
 Knowing which tool to use depends on what you are trying
to do.
 In the context of investigation, are you:
 Deciding if the complaint/report is within the authority of your agency?
 Gathering factual information to determine whether the complaint has
merit?
 Gathering information for another group or agency to make decisions?
 Determining what action is most appropriate based on the available
information?
Complaint process
Intake
Investigation
Board
Proceedings
Board
Actions
Reporting
and
Enforcement
Complaint process – another view
Intake
Investigation
Board
Proceedings
Board
Actions
Reporting
and
Enforcement
Details
Intake
Complaint
receipt
Initial review
Intake tools
 Sources of complaints
 Mandatory and permissive report
 Board as a source of complaints; self reports; Nursys
 Methods of submitting complaints
 Screen for jurisdiction
 Thresholds, triage, prioritizing, coding
 Tracking mechanisms
Intake
Investigation
Results of Investigation
Investigation tools
An effort to learn the who, what, where, why,
when and how of the allegations
Methods:
 Record gathering
 Employment
 Medical records of nurse or patient
 Pharmacy and Prescription drug monitoring program records
 Controlled substance inventory logs
 Court records and police reports
 School records
 Reports from other agencies
 Bank records
Investigation tools
 Forensics
 Evaluation of licensee (CD, mental health, neuropsych)
 Drug testing
 Computers (home & work PCs, cell phone, EHR access)
 Drugs (assay of syringe contents, analysis of automated dispensing
machine history)
 Interviews/Written statements
 Licensee
 Patient/victim
 Witnesses
 Supervisor and coworkers
 Collateral contacts
Investigation tools
 Written statements/affidavits
 Recordings
 Surveillance videos
 Audio recordings as evidence
 Audio recordings of interviews
 Site visits
 Other records
 Employer policies and procedures
 Databanks (Nursys, HIPDB/NPDB)
Investigation results
 Reports
 Formats, templates
 Know your intended audience and all possible readers
 Recommendations; Determining next steps
Challenges
 Coordinating investigation with other agencies
 Peer review protection of records
 Out-of-state records
 Destroyed records
 Uncooperative witnesses
 Unreliable or incompetent witnesses
 Uncooperative or unlocatable licensees
Your favorite tools
Results of
Investigation
Board proceeding
& action
Board proceedings & actions
 Informal processes
 Stipulated agreements
 Formal process
 Contested case hearings; administrative hearings
 Standard of proof must be met (clear and convincing vs.
preponderance); Board typically has burden of proof
 Appeals of Board decisions
 Emergency/temporary proceedings
 Authority -- usually limited – to take action against a license before a
hearing on the merits
 Miscellaneous
Board proceedings & actions
 Conclude the complaint without action (dismissal)
 Referral to a non-disciplinary monitoring program
 Non-disciplinary action (letters of concern,
admonishment, reprimand, Agreements for Corrective
Action)
 Disciplinary Action
Board proceeding &
action
Reporting and
Enforcement
(Compliance monitoring)
To Report or Not to Report
 Is the action public?
 Is the action reportable?
 Nursys
 HIPDB/NPDB
 OIG
Compliance monitoring
 Terms and Conditions
 Probationary terms
 Reports from the nurse
 Reports from the nurse’s supervisor
 Audits – documentation, med administration
 Additional education
 Maintain sobriety, attend support groups
 Drug screens
 Restrictions/Limitations
 Supervision required
 Restricted access to controlled substances
 Limitation on work hours or locations
Compliance monitoring
 Non-compliance
 Failure to comply, violations of the order; new allegations
 Process used to address non-compliance depends on terms and
conditions of the order and individual state laws
 More tools
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Checklists
Tracking mechanisms
Report forms
Audits
Randomizing drug screens
Challenges and policy questions
 How much information is enough?
 How to manage sometimes competing priorities?
Efficiency, cost containment, timely resolution of cases,
appropriate resolution of cases.
 How do we measure quality and effectiveness?
Resources
 NCSBN
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Networking opportunities
Conferences
Website materials
CE offerings
 CLEAR
 FARB
 NADDI
 Interviewing technique training
 Dean Benard, Benard & Associates
 The Reid Technique
Thank you!
Rene Cronquist, J.D., RN
Minnesota Board of Nursing
2829 University Ave SE #200
Minneapolis MN 55414
(612) 617-2198
[email protected]
www.NursingBoard.state.mn.us