Remediation Outcome Study Elizabeth H. Zhong, PhD Kevin Kenward, PhD.

Remediation Remediation Outcome StudyOutcome Study

Remediation Remediation Outcome StudyOutcome Study

Elizabeth H. Zhong, PhDElizabeth H. Zhong, PhD

Kevin Kenward, PhDKevin Kenward, PhD

Participating StatesArizona Maryland Massachusetts Minnesota Nebraska North Carolina

1996

Probation Issued during 2001

2005

Prior discipline history

Recidivism

Discipline Record and Recidivism Rates

60

147

60

58

23

Prior Prior Probationary Probationary Action Between Action Between

1996-2001(N=60)1996-2001(N=60)

Probationary Probationary Action During 2001Action During 2001

(N=207)(N=207)

Post Post Probationary Probationary Action Between Action Between

2001-2005 (N=81)2001-2005 (N=81)

38.3%

Rate of Rate of RecidivismRecidivism

(39.1%)(39.1%)

39.5%

Profile of Disciplined NursesGender

About 15% of the About 15% of the disciplined nurses disciplined nurses were male, the number were male, the number of disciplined male of disciplined male nurses was nurses was disproportionate in the disproportionate in the nursing workforce.nursing workforce.

2004 National Sample Survey of Registered Nurses

16.9%

10.7%

6.0%5.3%

RNs

LPN/VNs

2001 Probation Statistics (Six States)

% o

f M

ale

Nu

rses

Profile of Disciplined NursesType of License

Probation Statistics

State License Statistics

RNs

LPNs/VNs

APNs

% C

om

po

siti

on

59.0%

37.5%

77.6%

18.3%

Years Licensed in 2001

Educational Level Frequency PercentDiploma/Certificate 80 43.0

Associate Degree 74 39.8Baccalaureate Degree 26 14.0Master's Degree 3 1.6Doctorate Degree 3 1.6Total 186 100.0

Profile of Disciplined NursesEducation

Profile of Disciplined NursesType of Facility

Frequency PercentLong-term care facility 82 44.1Hospital 65 34.9Home health care 11 5.9Public/community health 4 2.2Ambulatory care 3 1.6More than one setting 1 0.5Other 20 10.8

Profile of Disciplined Nurses Board Actions

Number of Board

Actions

Number of Nurses

Percent

1 Action 89 43.0

2 Actions 72 34.8

3 Actions 25 12.1

4 Actions 3 1.4

5 Actions 14 6.8

6 Actions 1 0.5

7 Actions 1 0.5

8 Actions 1 0.5

9 Actions 1 0.5

Total 207 100.1

About 35% of the About 35% of the disciplined nurses disciplined nurses had a prior legal had a prior legal history (arrest or history (arrest or conviction)conviction)

About 33% percent of the disciplined nurses changed employers during their probation period.

Disciplinary Grounds for 2001 ProbationDisciplinary Grounds for 2001 Probation

  Percent

Drug/alcohol impairment/substance abuse 21%

Intentional misconduct or criminal behavior 19%

Inappropriate clinical reasoning 17%

Multiple violations (Different types of violations addressed under a single disciplinary action) 14%

Breakdown in professional responsibility 9%

Medication errors 7%

Documentation errors 7%

2001 Probationary Requirements

(N=778)Probationary Requirements

Frequency Percent

Reports from employer 173 22.2

Practice only under supervision

141 18.1

Restricted setting 99 12.7

Remediation Outcomes

Remediation Outcomes Frequency Percent

Completed full probation and returned to practice 73 35.3

Completed full probation with no follow-up on practice status

45 21.7

Completed full probation and did not return to practice 3 1.4

Completed probation and charged with a new offense 13 6.3

Failed to complete probation 68 32.9

Early termination of probation due to significant improvements

5 2.4

Total 207 100.0

65% Completed Probation

35% Failed to Complete Probation

Recidivism Rate for the 2001 Probation

Non-recidivism: Completed the 2001 probationary term and were not reported to the board of nursing for additional offenses within a four-year period from 2001 to 2005.

Recidivism: Failed the 2001 probation by having additional offenses during or after the probation.

39%61%

Non-recidivism

Recidivism

No statistical significance was identified in the actual time spent on probation in regards to the remediation outcome

Length of Probation Term by Outcome

Non-recidivism

Recidivism

Yrs Yrs

Gender by Recidivism

Statistically significant relationship between the gender of disciplined nurses and the recidivism rate

Non-recidivism

Recidivism

Male Female

56.7%

43.3%63.8%

36.2%

Age by Recidivism

Disciplined nurses who recidivated were about three years younger than those who successfully completed the 2001 remediation.

Those who were under the age of 40 years old were more likely to recidivate

Non-recidivism Recidivism

≤ 40 Yrs Old > 40 Yrs Old

50.7%

49.3%

66.4%

33.6%

Logistic Regression Analysis

There is a negative correlation between age and recidivism, every unit increase in age decreases the odds of being a recidivist to 0.95. For a 10 year age increase, 40% decrease in the odds that the older individual recidivated

If a disciplined nurse changed employers during their 2001 probation period, she/he will be 2.55 times more likely to recidivate compared to those who remained with the same employers.

License by Recidivism

There was a higher percentage of LPN/VNs than RNs that recidivated

LPNs/VNs RNs

68.0%

32.0%50.7%

49.3%Non-recidivism

Recidivism

Prior Legal History by Recidivism

Significant relationship between the disciplined nurses’ prior legal history (arrest or conviction) and the remediation outcome

Non-recidivism Recidivism

Without Legal History

With Legal History

56.4%

43.6%67.1%

32.9%

The disciplined nurses who committed different types of violations between 1996 and 2001 were more likely to recidivate again during or after the 2001 probation

Types of Violations and Recidivism

21.2%

78.8%

68.4%

31.6%

Non-recidivism Recidivism

Different Same

Change of Employers by Recidivism

Those disciplined nurses who changed employers during probation were more likely to fail the 2001 remediation program

Non-recidivism

Recidivism

Change of Employer

No Change

47.2%

52.8%

76.6%

23.4%

Conclusions

Male nurses, LPNs/VNs, and nurses who had prior legal histories were at higher risk for recidivism.

Changing employers during probation, committing different types of violations were positively related with recidivism.

Age of the disciplined nurses was negatively related with recidivism.

Recommendations

Carefully screen the prior legal histories of the disciplined nurses.

Focus on male nurses, LPNs/VNs, as well as those nurses at a younger age (under 40 years old).

Pay more attention to those who commit different types of offenses.

Whenever possible, encourage disciplined nurses to remain working with the same employer.