Did the comparison of your state data to the aggregate data of other boards allow for meaningful comparisons for where the agency may improve? Survey Question
Critical to know how close or far the agency is in comparison to similar boards The numbers showed where significant process reviews/changes/decisions need to be made. Advantages
Improvements • Want more meaningful comparisons • Reliability of some data (e.g., financial data, low response rates) questionable
What decisions or changes have you made, if any, based on your CORE report? Survey Question
Review and develop the outcome measures in the Board Strategic Plan Used comparative data to change/support an increase in the licensing fee structure Used the data to make changes in the phone system; purchased new reporting system to measure phone outcomes. Uses
Developed a consultative approach to assisting the nursing education programs comply with the rules and prepare for approval surveys Used the comparison information to develop practice statements Used the Core Survey to create a tracking system for gathering discipline data. Uses
What are the critical programs or services that most affect the quality and costs of your regulatory operations that you like to receive best practice information on? Survey Question
Alternative programs disciplinary processes Background checks and international nursing applicants requirements Disciplinary process Licensure process Investigative best practices Hearing department best practices Best Practices?
Summary of State data Continue to refine and narrow the focus of the survey instrument Revise tool to assure that data is being collected consistently Areas of Improvement
2010 CORE Survey 1st Quarter 2010 New and improved Shorter Terms defined
CORE Helps Identify Potential Problem Areas Your State Aggregate
Tangible Evidence: Improve Productivity & EfficiencyExpense Calculation Per Licensee Aggregate My State Variance
Tangible Benefit: Licensing Staff Improved Productivity & Efficiency Verification Cycle Time Improved 57% 2007
INCORPORATING CORE FINDINGS INTO STRATEGIC PLANNING GOAL: TO FACILITATE INFORMATION EXCHANGE BETWEEN THE BOARD AND ITS CONSTITUENTS Objective: Effective communication with the public, including licensees, employers, policy makers, consumers Performance Measure: CORE findings indicate positive communications with constituents
Simulation • Help regulators determine when and how to use simulation in pre-licensure nursing education. • In other words, how much simulation is enough and in what situations?
Clinical Only Simulation Only Clinical + Simulation
Knowledge Confidence Clinical Outcomes
Potential Study Participants • Major Simulation Labs Across the Country • Issues Regarding Sample Criteria
Employer Survey The employer survey is designed to provide insights into the professional and practice issues of nurses in practice settings. The data collected will provide insights into the following: • The nursing workforce (i.e., nurse vacancies, recruitment, hiring, and retention); • Educational preparation (i.e., clinical education, nursing program preferences, degree preference, and general preparation to practice); • Transitioning and professional development, questions related to transition and training newly-hired nurses. • Patient safety (i.e., licensure, errors, discipline, shift length/scheduling, communication, organizational characteristics, and role clarity.
Questions To what extent is there an inadequate supply of nurses? And what negative consequences, if any, have facilities experienced as a result of an inadequate supply of nurses? Do facilities prefer not to hire newly-licensed nurses and if so why? How important is clinical experience? Are most of the nurses hired by facilities prepared (prior to hire) to provide safe, effective care to clients?
Questions What are the types and lengths of transition programs offered to newly-licensed, experienced, and foreign-educated nurses? Are facilities providing medication safety, patient safety, and simulation training and development for nurses?
APRN Compare patient outcomes for Nurse Practitioners (NP) based on their degree of physician supervision: • Those who have on-site physician supervision • Those with professional collaboration • Those who collaborate with agreed upon protocols or delegation • No physician involvement whatsoever
An Assessment of the Safety, Quality, and Effectiveness of Care Provided by Advanced Practice Nurses A sweeping review of the scientific literature on the quality, safety, and effectiveness of care provided by APRNs
Geo Mapping Geo-mapping shows the locations of every actively practicing physician in all 50 states and non-physician providers. Some believe these maps invalidate the argument that expanding the scope of practice of non-physician providers will enable increased access to care for rural patients, demonstrating that physicians and non-physicians are equally accessible in metropolitan and rural areas.
Updates Index Revised format
Why TERCAP? • Sufficient attention must be given to analyzing and understanding the causes of errors in order to create learning systems and improve patient safety. • TERCAP examines adverse events to understand where the system broke down, why the incident occurred, and the circumstances surrounding the incident. • Analyzing critical incidents, whether or not the event actually leads to a bad outcome, provides an understanding of the conditions that produced an actual error or the risk of error as well as the contributing factors.
TERCAP Research Questions What factors are associated with practice breakdown?
Years of Experience at Time of Disciplinary Action Avg. = 14 years
Length of Time Worked for Organization Where Practice Breakdown Occurred
Gender 6 6 18 17
Type of License Percent
Erroneous Conclusions 37% of nurses with criminal convictions committed medication errors Margin of Error = + 35% Range = 2.5% to 72.5%
Medication Aides • Dozens of studies have confirmed that the rate of administration error is low and seems to average about 10% for medication aides as well as RNs.
Expert Panel Amy Vogelsmeier PhD, RN, Assistant Professor, Coordinator for Leadership in Nursing and Health-Care Systems John A. Hartford Geriatric Nursing Scholar, Sinclair School of Nursing University of Missouri. Glenise McKenzie, RN, PhD, Assistant Professor, Rural Health Research Office, Oregon Health and Scieences University School of Nursing Jill Scott-Cawiezell PhD RN FAAN, Professor and Area Chair for Systems and Practice, University of Iowa College of Nursing Suzanne K. Sikma PhD, RN, Professor, Nursing Program, University of Washington Ginette A. Pepper PhD, RN, FAAN, Director, Hartford Center of Geriatric Nursing Excellence, Professor & Helen Bamberger Colby Endowed Chair, Associate Dean for Research & PhD Programs, University of Utah College of Nursing
Medication Aides Gather information on: • Who regulates medication aides • What medication aides can and cannot do • Training • Supervision • Where they work
Medication Aides Meta Analysis Combines the results of several studies that address a set of related research hypotheses
Medication Aides Use simulation to determine optimal training background of medication aides