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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.