Dennis Corrigan, RN Ohio Board of Nursing Compliance Agent

1. Dennis Corrigan, RN Ohio Board of NursingCompliance Agent

2. COMPLIANCE AND THE OHIO BOARD OF NURSING • INVESTIGATIONS • DISCIPLINARY ISSUES • LAWS AND RULES

3. Board Mission The mission of the Ohio Board of Nursing is to actively promote and protect the health of the citizens of Ohio through the safe and effective practice of nursing as defined by law.

4. Measurable Ends WHAT DO WE WANT TO ACCOMPLISH? • Competent Practitioners • Informed Public • Public Safety • Law Which Reflects the Dynamic Practice of Nursing

5. Board Jurisdiction • Board has jurisdiction over: • RNs, LPNs, nurses in advanced practice such as NPs, CNMs, CRNAs & CNSs, and dialysis technicians and Community Health Workers • Board has no jurisdiction over • Unlicensed individuals • Employers

6. Complaints to the Board • Anyone can file a complaint • Written preferred • Use form--available on the web www.nursing.ohio.gov • Confidential • Compliance Unit Manager reviews to see if complaint indicates a violation of the nurse practice act

7. REGULATIONS • THE BOARD MUST INVESTIGATE ALL COMPLAINTS • ALL COMPLAINTS ARE CONFIDENTIAL • ANY FELONIOUS ACTIVITY MUST BE REPORTED TO LAW ENFORCEMENT (ORC 2921..22) • Falsification of required records (MAR, Pyxis) can be a felony • Theft of any dangerous drug is a felony (not only narcotics) • Administration of medication or treatments without an order can be considered a felony

8. Duty to report misconduct(SECTION 4723.34 ORC) • Every employer of nurses or dialysis technicians must report the name of any current or former nurse or dialysis technician who has engaged in conduct that would be grounds for disciplinary action by the Board • Prosecutors & nursing associations must also report

9. WHISTLEBLOWER PROTECTION 4723.33 • Any person who in good faith makes a report or participates in any investigation, administrative proceeding or judicial proceeding has full protection by law against retaliatory action

10. Types of cases • Drugs/alcohol • Patient abuse • Imposters/unlicensed practice • Medication/documentation errors • Mental health and physical health impairment • Social Media • Criminal actions • Disciplinary action by other states

11. DRUG THEFT • MOST THEFT IS PRN OR WASTE • IF SOMEONE WANTS TO STEAL THEY WILL • AS PROFESSIONALS IT IS OUR DUTY TO PUT AN END TO DIVERSION • WE MUST BE RESPONSIBLE FOR ADVANCING THE RESPECT AND PROFESSIONALISM NURSING DESERVES

12. WHAT CAN WE DO AS NURSES? • CHECK CHECK CHECK (USE OUR SENSES) • DO RANDOM COUNTS • TALK TO OUR PATIENTS • LOOK FOR RED FLAGS

13. WHAT CAN THE BOARD INVESTIGATOR DO? • ASK TO HAVE PATIENTS DRUG TESTED • ASK THAT LICENSEE BE DRUG TESTED • CHECK WORK HISTORY • GET COVERT (WITH HELP) • BACKROUND CHECKS • PHARMACY PROFILES • CAMERAS • FINGERPRINTS • ALL MEANS OF INVESTIGATORY SURVEILLANCE

14. Process • Complaint received • Possible violation determined • Investigation conducted • Board liaison (supervising member for disciplinary matters) oversees and reviews investigation • Closure of the case • Non-disciplinary monitoring • Consent agreement • Hearing • Full Board determines whether to charge

15. BOARD DISCIPLINARY ACTION • The law sets out specific instances when the Board can take disciplinary action • If the action is not included in the law, the Board has no authority to act • The law does not require the Board to act on minor violations if the Board feels that the public is adequately protected.

16. Section 4723.28 ORC Offenses • Fraud, misrepresentation or deception in obtaining a license • Disciplinary action elsewhere • Practicing without a license • Conviction, plea of guilty to, judicial finding of no contest or treatment in lieu of conviction in Ohio or elsewhere involving: • A misdemeanor in course of practice • A felony • any crime involving moral turpitude • A violation of a drug law

17. Section 4723.28 ORC Offenses • Self administering a drug not in accordance with a valid prescription • Habitual indulgence in the use of a controlled substance to the extent that practice is impaired • Impairment of the ability to practice due to a physical or mental disability • Assaulting or causing harm to a patient or depriving someone of the means to summon assistance

18. Section 4723.28 ORC Offenses • Obtaining or attempting to obtain money or anything of value by intentional misrepresentation or material deception in the course of practice • Adjudication as mentally ill or incompetent • Practicing beyond one’s scope • Failure to comply with terms of the Alternative program for chemical dependency or PIIP

19. Section 4723.28 ORC Offenses • Failure to establish & maintain professional boundaries with a patient • Regardless of whether the contact or verbal behavior is consensual, engaging with a patient (other than a spouse) in: • Sexual contact • Verbal behavior that is sexually demeaning to the patient or may reasonably be interpreted by the patient as demeaning

20. Section 4723.28 ORC Offenses (B) 19 • Failure to practice in accordance with acceptable & prevailing standards of safe care

21. STANDARDS RULES(CHAPTER 4723-4 OAC) • Demonstrate competence & accountability in all areas of practice in which the nurse is engaged • Appropriate recognition, referral, or consultation & intervention when a complication arises during or after the performance of a specific function or procedure

22. STANDARDS RULES(CHAPTER 4723-4 OAC) • Timely implement prescribed regimen, direction or treatment regimen unless • Nurse believes or should have reason to believe the regimen etc. is inaccurate, not properly authorized, not current or valid, harmful or potentially harmful or contraindicated • Clarify a prescribed regimen etc • Document efforts to clarify & protect the client

23. STANDARDS RULES(CHAPTER 4723-4 OAC) • Promotion of client safety • Display appropriate title or initials when providing direct care • Delegate a nursing in accordance with Board standards • Completely, accurately & timely report & document nursing assessments, observations, care & the client’s response to the care

24. STANDARDS RULES(CHAPTER 4723-4 OAC) • Promotion of client safety • Accurately & timely report errors or deviations • No falsification of client records or any document prepared in conjunction with practice • Implement measures to promote a safe environment • Maintain professional boundaries • Assure appropriate licensure • Only an RN supervises & evaluates the practice of nursing

25. 4723-4-06 (P) A licensed nurse shall not submit or cause to be submitted and false, misleading, or deceptive statements, information, or documentation to the board, to current employers, or to any future employers for positions requiring a nursing license.

26. 4723-4-06 (Q) For purposes of paragraphs (I, (J), (K), (L), and (M), of this rule, a nurse shall not use social media, texting, emailing, or other forms of communication with, or about a patient, for non-health care purposes or for purposes other than fulfilling the nurse’s assigned job responsibilities.

27. SOCIAL MEDIA “When a rhythm goes from this…..to this…...” #intensivecarenurse #nurseoftheyear #anothersaturdaynight #Ihavenoclue

28. PROHIBITIONS(SECTION 4723.03 ORC) • Title protection (we earned our titles) • Cannot engage in the practice of nursing or represent self as being licensed even in a volunteer capacity • Cannot employ a person not licensed as an RN or LPN to engage in the practice of nursing • Cannot sell or fraudulently obtain a license, certificate etc.

29. PROHIBITIONS(SECTION 4723.151 ORC) • Prohibited practices include • Medical diagnosis • Prescription of medical measures • Practice of medicine or surgery or any of its branches • Does not prohibit CRNA, CNM, CNP. CNS from practicing within scope of practice defined in section 4723.01

30. Disciplinary Action • Only if violation is addressed in the nurse practice act (Section 4723.28 ORC) • Not without due process

31. Disciplinary Action • Board may take no action • Reprimand (Fine) • Restrictions • No overtime, no night shifts, no medication administration, no narcotic administration • Other • Additional CE, presentations, repeat educational program, repeat NCLEX • Suspend • Permanent revocation

32. NON-DISCIPLINARY OPTIONS • PIIP (Practice Improvement and Intervention Program) • AP (Alternative Program for chemical dependency)

33. PIIP • Program Concepts • Identified Practice Deficiency • Appropriateness of Remediation • Eligibility of Individual for PIIP • Participatory Agreement • Educational Providers • Workplace Monitor • Participant Success vs Failure

34. Alternative Program for Chemical Dependency: • Referral to the Board • By employer via complaint • By nurse independently Email the Board at disciplinary@nursing.ohio.gov

35. If you have an employee that has a substance abuse problem that impairs their ability to practice in any way, is self-administering medications not in accordance with a valid prescription, or you have missing drugs or inconsistent records you MUST file a complaint with the Board.

36. Admission process • Nurse obtains application by calling, or emailing the Board • Nurse submits application packet, assessment and licensure surrender to the Board • Case is reviewed by Alternative Program Manager and Board liaison for appropriateness and eligibility • If accepted into program, Monitoring agent is assigned and meets with the nurse to discuss terms of agreement and monitoring • If not accepted into program, case is referred to Compliance Unit for potential disciplinary action.

37. Due Process Rights for potential disciplinary action • Notice of Opportunity sent • Hearing conducted before attorney hearing examiner • May be represented by legal counsel • Witnesses • Opportunity to question witnesses

38. Process • Hearing examiner issues report & recommendations • Full Board reviews hearing transcripts, evidence/exhibits & hearing examiner report • Full Board determines disciplinary action

39. Myths • Can lose a license with a phone call • No action without due process • Can lose a license for abandonment • Refusal to work overtime generally is not abandonment • May face employer sanctions

40. Myths • Filing a complaint will cause a nurse to lose their license • Only a nurse can cause themselves to lose their license

41. WE ARE A BETTER BOARD! • MORE EFFICIENT • BETTER RECOGNITION • DILIGENT IN DISCIPLINE • BETTER MONITORING • BETTER RELATIONSHIPS WITH OTHER AGENCIES INCLUDING INVESTIGATORS WITH OTHER AGENCIES AND PROSECUTORS

42. YOU CAN’T MAKE THIS STUFF UP!! • THERE ARE HORROR STORIES OUT THERE. • BE AWARE! • KEEP NURSING THE RESPECTED PROFESSION THAT IT IS. • CREATE THE CORRECT CULTURE

43. QUESTIONS? • DENNIS CORRIGAN, RN • Nursing Compliance Agent dcorrigan@nursing.ohio.gov 614-995-5423