Patient Safety and Nursing Regulation in the United States

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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

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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
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Regulation

• By the Profession

• By the Government

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What is the NCSBN?

• National
• Council of
• State
• Boards of
• Nursing

www.ncsbn.org
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U.S.A. Authority to Regulate

• 10th 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)

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Why do we regulate professions?

• Potential for harm
• Forum for complaints
• Patient safety
• Protection of the public

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Need for Regulation

• Information Asymmetry
• Bundling of Services
• Forum for Complaints

Patient Safety
Public Protection
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Why license nurses?

• Because nursing requires specialized knowledge,
  skill and independent decision making.
• Because harm could result
• Because it matters

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We protect the public safety by

• Regulating nursing education
• Carrying out laws governing nursing
• Setting licensing requirements
• Taking disciplinary action on the license

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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

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

• Case studies/Examples

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Disciplinary Authority

• Reprimand
• Probation
• Suspension
• Revocation
• Voluntary Surrender

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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

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Most discipline issues involve drugdiversion and
abuse.
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Discipline has also been issued for

• Theft of patients property
• Fraudulent billing for services
• Sexual, physical or verbal abuse
• Failure to follow a prescribers order

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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
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Scope of Practice Decision Making Model
www.arsbn.org
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Importance of Patient Safety with regard to
Nursing Regulation in the U.S.A.
Just Culture
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CORE

• Commitment to Ongoing Regulatory Excellence
• Education
• Practice
• Discipline

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Trends

• Shortage of qualified nurses
• Continued competence
• Unlicensed assistive personnel
• Advanced certification
• Disaster preparedness
• Mobility of nurses

www.ncsbn.org
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Questions?
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Compact States