Fellowship Experiences and Lessons Learned…

ResearchingAdvanced Practice Registered

Nurse Discipline for 2003 and 2004

2008 Institute of Regulatory Excellenceby

Randall Hudspeth, MS, APRN-CNS/NP, FREVice-Chairman, Idaho State Board of Nursing

Objectives for Presentation

1. Demonstrate the ethics of regulation as evidenced through consistent disciplinary outcomes of APRNs in the study.

2. Discuss technology use strategies to better and more easily communicate information.

3. Discuss the processes and outcomes of one study conducted through the IRE that contributed to the body of knowledge.

Inspiration for a Worthwhile Topic• Selected as a

member of the APRN Committee that was task to draft the “Vision Paper.”

• Questioned where was the evidence that there was or was not a problem with Advanced Practice Nurses?

Purpose of StudyProfessional organizations for APRNs site the low incidence of litigation as evidence that APRN practice is essentially problem free. The literature is void of issues related to APRN regulation and discipline. This survey is intended to compile data over two years related to discipline of APRNs to validate whether or not problems, outside of the small number of litigation cases, do exist in any significant number.

Research Question

What is the number of APRN discipline cases in each of four discipline subject (data) categories during 2003 and 2004?

(This time interval chosen because data collection time was fall 2005 and spring 2006, which allowed sufficient time for cases to be resolved and to have the most data to report.)

Tool Development• Tool constructed and tested spring 2005• Issues identified with data collection

– Lack of consistent disciplinary definitions.– States vary in what is considered unprofessional

conduct.– Felony and misdemeanor convictions handled

differently.– Not all states discipline APRN license when the RN

license is disciplined.

Objective of the Tool

The objective of this tool was to develop a universal instrument to survey all APRN discipline for all states, including the District of Columbia, in a way which would capture as many discipline actions as possible considering the state-to-state variability which exists. Hence, definitions of discipline categories were crafted in this survey to include as many state-specific variations as possible and the tool provided specific definitions and examples of the four discipline categories.

Definition--Discipline

Defined as a formal action taken by a board of nursing or a court, whereby an APRN received a formal letter of reprimand, a restriction placed on an active license or certification, such as a prohibition against narcotic access, restriction from participating in the multi-state licensure compact, suspension with or without a stay, a suspension or probation with remedial conditions which might include civil penalties, or a revocation which might

include civil penalties.

Definition—Chemical Impairment

• Generally accepted to be discipline based on conviction or admission and negotiated settlement of some form of inappropriate controlled substance use, diversion, or alcohol use.

• Voluntary surrender licenses were not included because they are not consistently disciplined.

Definition– Exceeding Scope of Practice

Exceeding scope of practice discipline included participating in those activities not generally recognized to be acceptable or customarily performed by others within the same licensure or authorization role and category and who had similar educational preparation and experience. Specifics for this disciplinary category differed from state-to-state, depending on individual state statute.

Definition--Unprofessional Conduct

Encompasses a wide variety of activities from fraud, falsification of records, boundary issues, general behavior unbecoming to the profession and not supported by society. This category also includes non-professional issues where statute requires action be taken for felony conviction or other legal issues.

Definition– Abuse, Neglect and Unsafe Acts

Included any activity that would place a patient in danger or demonstrate blatant disregard for patient safety and wellbeing. Examples are abandonment, boundary violations, sexual misconduct, and improper dispensing or prescribing of medications.

Data Summary

• N= 125,882

• NP= 86,940

• CRNA= 23,994

• CNM= 5,741

• CNS= 9,257

DisciplineCategory

→

APRN ↓

Total number

APRN by role and %

of total sample

Total numbe

r actions and % by role

Chemical Impairment

Exceed scope of Practice

Unprofessional Conduct

Patient Abuse or

Safety Neglect

CRNA 23,944 (19.02%)

125(0.52%)

63(0.260%)

14(0.06%)

44(0.18%)

4(0.02%)

NP 86,940(69.06%)

512(0.59%)

79(0.090%)

106(0.12%)

128(0.14%)

199(0.29%)

CNM 5,741(4.56%)

27(0.47%)

2(0.034%)

9(0.015%)

14(0.024%)

2(0.03%)

CNS 9,257(7.35%)

24(0.25%)

3(0.032%)

8(0.09%)

8(0.09%)

5(0.05%)

Total 125,882(100.0%)

688(0.54%)

147(0.21%)

137(0.20%)

194(0.28%)

210(0.30%)

Noteworthy Summary of Findings

1. Exceeding scope of practice was the least problematic for APRNs at 137 cases (20%) of all discipline.

2. Sample had good geographic representation for across the US.

3. States of all sizes participated.

Issues for Boards of Nursing Resulting from

Data Collection Experience

1. Separate RN and APRN discipline. 1. Some states just discipline RN license even if offense was

APRN related.

2. Post annual statistical reports on websites so researchers can collect their own data.

3. Strive for commonly defined categories of discipline.

4. Work to achieve some accounting of the CNS population in the country.

Issues for Fellows

1. Boards of Nursing have multiple requests for survey data and requests place a burden on staff to gather data.

2. Multiple tools work best with multiple mailings (i.e. both paper and electronic).

3. No matter how many experts you have read a manuscript, it will be re-written!

Choosing the Publication for Submission

1. Who is your target readership?

2. Is the topic sufficiently broad and of interest across practice types that a general journal is better than a specialty?

3. Do you already have a contact at a journal?

Publication AbstractThe nursing profession continues to struggle to find the most appropriate approach to credentialing Advanced Practice Registered Nurses (APRNs). One early step in addressing this struggle is determining the incidence of APRN disciplinary actions by boards of nursing. This article presents data from 2003 and 2004 describing the incidence of APRN disciplinary actions by United States boards of nursing. Fifty-one boards of nursing, all members of the National Council of State Boards of Nursing, were asked to report the numbers of APRN discipline cases for 2003 and 2004 which had been resolved, using a tool that differentiated disciplinary cases into four data categories: chemical impairment, exceeding scope of practice, unprofessional conduct, and safety or abuse of patients. Thirty-eight (74.5%) of 51 boards of nursing reported discipline data for a total of 125,882 APRNs showing 688 disciplinary actions were taken during 2003 and 2004. This indicates that APRNs experience a low incidence of discipline related to chemical impairment, exceeding scope of practice, unprofessional conduct, and safety or abuse of patients.

Objective. To present data from a two-year time period, 2003 and 2004, on the incidence of Advanced Practice Registered Nurses (APRN) being disciplined by boards of nursing.

Method. 51 Boards of Nursing, all members of the National Council of State Boards of Nursing, were surveyed and reported numbers of resolved APRN discipline cases for 2003 and 2004 using a tool that differentiated and defined disciplinary cases into four subject matters: chemical impairment, exceeding scope of practice, unprofessional conduct, and safety or abuse of patients.

Conclusion. 38 boards reported findings that support the notion that APRN experience a low incidence of discipline by regulatory boards related to chemical impairment, exceeding scope of practice, unprofessional conduct, and safety or abuse of patients

Poster Abstract

Hudspeth, R. (April 2, 2007). "Survey of Advanced Practice Registered Nurses Disciplinary Action". Online Journal of Issues in Nursing. Vol#12, No. 2

Available: www.nursingworld.org/ojin

Publication Citation

Thank you.