Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri The North Carolina Story Mary P. “Polly” Johnson, RN, MSN Executive Director North Carolina Board of Nursing

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri North Carolina’s PREP Story Consistent with NCBN Mandate & Vision for The 21 st Century: –To ensure minimum standards of competency and provide the public safe nursing care –To promote safe nursing care through:  achieving excellence in nursing regulation  being primary source of regulatory information  collaborating with other health care organizations in a changing healthcare environment

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Essential Elements Voluntary, non-public, non-punitive Collaborative approach Motivation to improve practice Opportunity to learn from mistakes and upgrade knowledge, skills and abilities

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Eligibility Criteria Concern/Incident primarily related to the individual, not the system Root cause related to practice, not misconduct Individual’s licensure status in good standing Licensee eligible for continued employment

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Exclusionary Criteria Drug related Abuse Fraud/Deceit Serious harm or death Pending criminal charges

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Safety Net for Public Protection Explicit guidelines to distinguish PREP eligibility versus disciplinary review Serves as additional tool for boards to allow earlier intervention with focus on performance improvement Gives boards proactive/non-punitive opportunity to impact safety issues

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Groundwork for PREP Pilot Approached receptive agencies Solicited support from NCHA and NCNA Agencies participated in project development: Chief nurse administrators, attorneys and risk managers Conducted on-site education with key agency personnel prior to implementation

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Steps in the PREP Process 1 st : Identification of incident/pattern - Incident -usually an error involving established employee OR - Pattern of competency deficit(s) becomes apparent- often new or reassigned employee 2 nd : Referral to PREP –Designated agency person initiates referral –Basic information is shared with PREP Coordinator –Employee is told of PREP contact

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Steps…… 3 rd : Determination of eligibility –Facility must determine that employee is eligible for continued employment –Both must agree that employee appears to be viable candidate for PREP –BON must review licensure history 4 th : Assessment/Interview –Assessment of needs/learning opportunities-usually done by agency, if appropriate –Interview licensee-done by BON

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Steps…. 5 th Remediation plan –Agency and BON confer to formulate plan for remediation/enhancement –Proposed to licensee in terms of formal agreement 6 th Contractual agreement - Signed by all 3 parties –Individual/system bears the cost 7 th Successful completion 8 th Survey participants 3 mos. later

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Project Growth and Development Pilot began 6/01 with 7 hospitals Expanded to nursing homes 7/02 15 pilot agencies 7/02-6/04 51 referrals June 01 – June licensees eligible – 6 ineligible 35 licensees successfully completed remediation as of May 04

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Types of Referrals to PREP

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Responses to PREP Improved communication and trust between hospitals and BON Collaborative relationships Positive reception from nursing community for proactive, non-punitive approach by BON Positive response from individuals referred to PREP

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Responses…. Opportunity for boards to impact safe patient care by addressing individual and systems issues Survey of agencies and licensees:  desire for program expansion  perception of fairness and effectiveness of non-disciplinary approach to public protection  key person = program coordinator

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Possibilities for PREP Provide data related to human factors that contribute to practice deficiencies and/or minor incidents Serve as a model to assist regulatory boards to redefine individual accountability in more productive manner Focus on improving performance, rather than expecting perfect performance Facilitate the shift from culture of blame to quality improvement

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Keys to Success Individual Open-minded Learn from mistakes of self or others Actively participate in developing remediation plan System Open-minded Promote non-blaming culture Commitment to support employee in continued employment and remediation

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri Keys…. Regulatory Board Proactive Focused on Quality Improvement Available Resources Collaborative and Approachable Image in healthcare community

Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri NC Board of Nursing: Expanding PREP Statewide in 2004 ;