the investigatory process 2013 ncsbn ire conference

Rene Cronquist, J.D., RNMinnesota Board of Nursing

Director of Practice and Policy

The Investigatory Process2013 NCSBN IRE Conference

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/AccreditationCredentialing

LicensureRegistrationCertification

Information/Data

What’s in your tool box?

Big tools: Enforcement, compliance, discipline, investigation, remediation

The right tool for the jobKnowing 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

Complaint process – another view

Details

Intake

Intake toolsSources of complaints

Mandatory and permissive reportBoard as a source of complaints; self reports;

Nursys

Methods of submitting complaints

Screen for jurisdiction

Thresholds, triage, prioritizing, codingTracking mechanisms

Investigation toolsAn effort to learn the who, what, where, why,

when and how of the allegations

Methods:Record gathering

EmploymentMedical records of nurse or patientPharmacy and Prescription drug monitoring program

recordsControlled substance inventory logsCourt records and police reportsSchool recordsReports from other agencies Bank records

Investigation toolsForensics

Evaluation of licensee (CD, mental health, neuropsych)Drug testingComputers (home & work PCs, cell phone, EHR access)Drugs (assay of syringe contents, analysis of

automated dispensing machine history)

Interviews/Written statementsLicenseePatient/victimWitnessesSupervisor and coworkersCollateral contacts

Investigation toolsWritten statements/affidavits

RecordingsSurveillance videosAudio recordings as evidenceAudio recordings of interviews

Site visits

Other recordsEmployer policies and proceduresDatabanks (Nursys, HIPDB/NPDB)

Investigation results

ReportsFormats, templatesKnow your intended audience and all

possible readers

Recommendations; Determining next steps

ChallengesCoordinating investigation with other

agenciesPeer review protection of recordsOut-of-state recordsDestroyed recordsUncooperative witnessesUnreliable or incompetent witnessesUncooperative or unlocatable licensees

Your favorite tools

Board proceedings & actions

Informal processesStipulated agreements

Formal processContested case hearings; administrative hearingsStandard of proof must be met (clear and

convincing vs. preponderance); Board typically has burden of proof

Appeals of Board decisionsEmergency/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 programNon-disciplinary action (letters of concern,

admonishment, reprimand, Agreements for Corrective Action)

Disciplinary Action

To Report or Not to ReportIs the action public?Is the action reportable?NursysHIPDB/NPDBOIG

Compliance monitoringTerms and Conditions

Probationary termsReports from the nurseReports from the nurse’s supervisorAudits – documentation, med administrationAdditional educationMaintain sobriety, attend support groupsDrug screens

Restrictions/LimitationsSupervision requiredRestricted access to controlled substancesLimitation on work hours or locations

Compliance monitoringNon-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 toolsChecklistsTracking mechanismsReport formsAuditsRandomizing drug screens

Challenges and policy questionsHow 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?

ResourcesNCSBN

Networking opportunitiesConferencesWebsite materialsCE offerings

CLEARFARBNADDIInterviewing technique training

Dean Benard, Benard & AssociatesThe Reid Technique

Thank you!

Rene Cronquist, J.D., RNMinnesota Board of Nursing

2829 University Ave SE #200Minneapolis MN 55414

(612) 617-2198Rene.Cronquist@State.mn.us

www.NursingBoard.state.mn.us