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The North Carolina Story

The North Carolina Story. Practitioner Remediation and Enhancement Partnership. Mary P. “Polly” Johnson, RN, MSN Executive Director North Carolina Board of Nursing. North Carolina’s PREP Story. Consistent with NCBN Mandate & Vision for The 21 st Century:

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The North Carolina Story

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  1. The North Carolina Story Practitioner Remediation and Enhancement Partnership 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

  2. North Carolina’s PREP Story • Consistent with NCBN Mandate & Vision for The 21st 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

  3. 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

  4. 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

  5. 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

  6. 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

  7. 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

  8. Steps in the PREP Process 1st: Identification of incident/pattern - Incident -usually an error involving established employee OR - Pattern of competency deficit(s) becomes apparent- often new or reassigned employee 2nd: 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

  9. Steps…… 3rd: 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 4th: 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

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

  11. 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 04 • 45 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

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

  13. 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

  14. 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

  15. 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

  16. 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 Keys to Success Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri

  17. 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

  18. NC Board of Nursing: Expanding PREP Statewide in 2004 Practitioner Remediation and Enhancement Partnership ; Presented at the 2004 CLEAR Annual Conference September 30 – October 2 Kansas City, Missouri

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