1. Patient Safety and Nursing Regulation in the United States Faith A. Fields, MSN, RN President National Council of State Boards of Nursing United States of America

2. Topics: 1. Importance of patient safety with regard to nursing regulation in the U.S. 2. How regulation ensures public protection 3. Share practice cases which resulted in disciplinary action 4. US perspective on public protection

3. Regulation By the Profession By the Government

4. What is the NCSBN? National Council of State Boards of Nursing www.ncsbn.org

5. U.S.A. Authority to Regulate 10 th Amendment of the US Constitution –Gives to states all powers not delegated to federal government –States have power to enact laws to protect its citizens –Regulatory authority derived from legislative authority –State legislatures delegate enforcement activities to state administrative agencies (e.g. Boards of Nursing)

6. Why do we regulate professions? Potential for harm Forum for complaints Patient safety Protection of the public

7. Need for Regulation Information Asymmetry Bundling of Services Forum for Complaints

8. Why license nurses? Because nursing requires specialized knowledge, skill and independent decision making. Because harm could result Because it matters

9. We protect the public safety by: Regulating nursing education Carrying out laws governing nursing Setting licensing requirements Taking disciplinary action on the license

10. Board Authority Fraud or deceit in procuring a license Guilty of a crime or gross immorality Is unfit or incompetent Is habitually intemperate or is addicted Is mentally incompetent Guilty of unprofessional conduct Action in other jurisdictions Willfully or repeatedly violated NPA

11. Importance of Patient Safety with regard to Nursing Regulation in the U.S.A. Case studies/Examples

12. Disciplinary Authority Reprimand Probation Suspension Revocation Voluntary Surrender

13. Case Review – Practice Issue Nurse Did What? –Terminated from employment due to patient abuse Attempted to use force to cause a patient to swallow their medication Witness statements Review of work history –License revoked

14. Most discipline issues involve drug diversion and abuse.

15. Discipline has also been issued for: Theft of patient’s property Fraudulent billing for services Sexual, physical or verbal abuse Failure to follow a prescriber’s order

16. Avoiding Disciplinary Action Know and follow the Laws and Rules Know your scope of practice and limit actions to scope of practice Know and follow the facility policies and procedures Check and double check when action/inaction may cause harm to a patient. www.learningext.com

17. Scope of Practice Decision Making Model www.arsbn.org

18. Importance of Patient Safety with regard to Nursing Regulation in the U.S.A.

21. CORE Commitment to Ongoing Regulatory Excellence Education Practice Discipline

22. Trends Shortage of qualified nurses Continued competence Unlicensed assistive personnel Advanced certification Disaster preparedness Mobility of nurses www.ncsbn.org

23. Questions?

24. Compact States