Patient Safety and Nursing Regulation in the United States

Faith A. Fields, MSN, RNPresident

National Council of State Boards of NursingUnited States of America

Topics:1. Importance of patient safety

with regard to nursing regulation in the U.S.2. How regulation ensures public

protection3. Share practice cases which

resulted in disciplinary action 4. US perspective on public

protection

Regulation

By the Profession

By the Government

What is the NCSBN?

National

Council of

State

Boards of

Nursing

www.ncsbn.org

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)

Why do we regulate professions?

• Potential for harm

• Forum for complaints

• Patient safety

• Protection of the public

Need for Regulation

• Information Asymmetry

• Bundling of Services

• Forum for Complaints

Why license nurses?

• Because nursing requires specialized knowledge, skill and independent decision making.

• Because harm could result

• Because it matters

We protect the public safety by:

• Regulating nursing education

• Carrying out laws governing nursing

• Setting licensing requirements

• Taking disciplinary action on the license

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

Importance of Patient Safety with regard to Nursing

Regulation in the U.S.A.

• Case studies/Examples

Disciplinary Authority

• Reprimand

• Probation

• Suspension

• Revocation

• Voluntary Surrender

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

Most discipline issues involve drugdiversion and abuse.

Discipline has also been issued for:

• Theft of patient’s property• Fraudulent billing for services• Sexual, physical or verbal abuse• Failure to follow a prescriber’s order

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

Scope of Practice

Decision Making Model

www.arsbn.org

Importance of Patient Safety with regard to Nursing

Regulation in the U.S.A.

CORE

Commitment to Ongoing Regulatory Excellence

• Education

• Practice

• Discipline

Trends

• Shortage of qualified nurses

• Continued competence

• Unlicensed assistive personnel

• Advanced certification

• Disaster preparedness

• Mobility of nurses

www.ncsbn.org

Questions?

Compact States