1. The Investigatory Process 2013 NCSBN IRE Conference
Rene Cronquist, J.D., RN
Minnesota Board of Nursing
Director of Practice and Policy

2. Tools in the Regulation tool box
Regulation uses a variety of mechanisms – tools, if you will, to carry out is mission of public protection

3. What’s in your tool box?
Statutes, Rules, Regulations, Case Law, Policies, Advisory Opinions
Program approval/Accreditation
Credentialing
Licensure
Registration
Certification
Information/Data
Other mechanisms, components?

4. What’s in your tool box?
Big tools: Enforcement, compliance, discipline, investigation, remediation

5. 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?
Knowing which tool to use depends on what you are trying to do.
Have any of you ever used a wrench, or other handy, heavy tool for a hammer? Or tried to use a regular screwdriver when you really need a Phillips head? How did it turn out? Ever try to open a bottle with a crimped top without a bottle opener? Yeah, you can do it but it can be frustrating and the results may not be what you intended.

6. Reporting and Enforcement
Complaint process
Intake
Investigation
Board Proceedings
Board Actions
Reporting and Enforcement

7. Complaint process – another view
Intake
Investigation
Board Proceedings
Board Actions
Reporting and Enforcement

8. Details

9. Complaint receipt Initial review Intake
Complaint receipt – paper (mail), fax, , on-line form
Other state agencies, law enforcement
Internal complaints – Application forms, identified in course of investigating another complaints, Nursys reports, newspaper articles
Are there mandated complaints?
Are there statutory requirements for complaints such as time deadlines or format requirements?

10. Intake tools Sources of complaints Methods of submitting 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 – complaint receipt and initial review
Purpose: determine whether complaint is jurisdictional to the board and where the complaint fits in scheme of priorities and processes.

11. Intake
Investigation
Results of Investigation

12. 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
Subpoenas
HIPPA and other privacy and data practices limitations
Federal protection of CD records

13. Investigation tools Forensics Interviews/Written statements
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
Screen cast
Captures the look, the words, the images, the interactivity and inter-relationships from one page and link to the next
Captures webcam narration by witness – which can be compelling to judge and jury
Free, open-source tool: screencast-o-matic.com
Other products like Camtasia

14. 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)

15. Investigation results
Reports
Formats, templates
Know your intended audience and all possible readers
Recommendations; Determining next steps

16. 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
Coordinating with law enforcement
Coordinating with other state boards and agencies or other Boards of Nursing

17. Your favorite tools

18. Results of Investigation
Board proceeding & action

19. 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
Informal
Staff may be authorized to propose stipulated agreements
May be based on pre-determined range of actions
May or may not need board ratification
Misc.
Stips to cease; cease and desist
Administrative suspensions for tax delinquency

20. 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

21. Board proceeding & action
Reporting and Enforcement (Compliance monitoring)

22. To Report or Not to Report
Is the action public?
Is the action reportable?
Nursys
HIPDB/NPDB
OIG

23. 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

24. 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
Checklists
Tracking mechanisms
Report forms
Audits
Randomizing drug screens

25. 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?

26. Resources NCSBN CLEAR FARB NADDI Interviewing technique training
Networking opportunities
Conferences
Website materials
CE offerings
CLEAR
FARB
NADDI
Interviewing technique training
Dean Benard, Benard & Associates
The Reid Technique

27. Thank you!
Rene Cronquist, J.D., RN Minnesota Board of Nursing 2829 University Ave SE #200 Minneapolis MN (612)