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The Investigatory Process 2013 NCSBN IRE Conference

The Investigatory Process 2013 NCSBN IRE Conference. Rene Cronquist, J.D., RN Minnesota Board of Nursing Director of Practice and Policy. Tools in the Regulation tool box. Regulation uses a variety of mechanisms – tools, if you will, to carry out is mission of public protection.

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The Investigatory Process 2013 NCSBN IRE Conference

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  1. The Investigatory Process2013 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

  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?

  6. Complaint process

  7. Complaint process – another view

  8. Details

  9. Intake

  10. Intake tools • Sources of 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

  11. 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

  12. Investigation tools • Forensics • 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

  13. 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)

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

  15. 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

  16. Your favorite tools

  17. 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

  18. 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

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

  20. 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

  21. 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

  22. 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?

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

  24. Thank you! Rene Cronquist, J.D., RN Minnesota Board of Nursing 2829 University Ave SE #200 Minneapolis MN 55414 (612) 617-2198 Rene.Cronquist@State.mn.us www.NursingBoard.state.mn.us

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