EXCELLENCE in nursing practice is important in all venues. Hospital nursing services design and implement care delivery systems to positively benefit and safeguard patients and that promote excellence in nursing practice. Hospital chief nursing officers (CNOs) have the advantage of many measures that demonstrate excellent nursing practice and outcomes. Contemporary measurements and compliance with nationally vetted standards are posted on public Web sites. When expectations are met or exceeded, public relations departments do not fail to use these outcomes as marketing strategies. Thus, through a variety of mechanisms, we have opportunities to showcase nursing's excellent outcomes.
Boards of nursing (boards) monitor regulatory practices that benefit and safeguard the public. A basic regulatory principle is that regulation should not be more restrictive than is necessary for public protection and regulation should not hamper the growth of the nursing profession. Boards fulfill their public protection mission by establishing, endorsing, and monitoring nursing education standards in programs leading to licensure and licensing qualified candidates who complete education programs and successfully pass a licensing examination that measures entry-level competency. Boards also monitor practice changes that impact scopes of practice and issue policy statements or support legislative passage of statutes or rules that support current practice needs. Finally, boards discipline or remove from practice those nurses who fail to meet standards.
The public and agencies that educate, represent, or employ nurses are all considered customers of boards of nursing, and it is important that boards are responsive to their needs. Being responsive to public needs and to others who rely on boards also helps sustain positive relationships that boards in turn rely on for reporting of violations to Nurse Practice Acts.
How do boards of nursing monitor their own operations and outcomes in terms of excellent service? In 2002, the National Council of State Boards of Nursing (NCSBN) established a committee for the commitment to ongoing regulatory excellence (CORE). Prior to this effort, initial work by the NCSBN committee for the commitment to public protection through excellence in nursing regulation established the foundation for an ongoing performance measurement system. Representatives from state boards were charged with implementing these measures specific to nursing regulation. The committee continues to identify issues that pose the greatest risk to negatively impact the public protection function of boards and also identifies areas where professionals and other groups commonly rely on boards for information about and resolution of professional issues. By promoting excellence in regulatory practices and establishing benchmarks, boards better manage regulatory efforts to safeguard the public.
The CORE committee identified and refined best regulatory practices during the ensuing 6 years and intermittently measured those practices, using a survey process. Groups that were directly impacted by board practices provided their perspective on the responsiveness and outcomes of board operations. Surveyed groups included employers, education programs, nurses, nurses who were the subject of complaints, and persons who reported Nurse Practice Act violations to boards. The focus of best practice markers was separated into 5 functional areas common to all boards: discipline, practice, education program approval, licensure, and governance.
Best practices related to discipline are vetted in guiding principles for nursing regulation: public protection, practitioner competence, ethical decision making, and due process based on our national standard that all who are accused have a right to a speedy hearing, shared accountability, strategic collaboration, evidence-based regulation, environment and marketplace responses in forming regulations, and ethical interactions within the global nursing arena.
Through the CORE measurement evaluation process, boards report data on numbers of overall complaints, numbers of complaints that actually progress to discipline, numbers of cases assigned per investigator, and the usual time length of investigations and dispositions of cases. Individual nurses are surveyed to determine their understanding of and engagement with regulations, timeliness of interactions and responses by nursing boards, satisfaction with the licensure process, and their assessment of help provided by the board staff. Employers and educators are surveyed to seek assessments of board responsiveness to changes in practice, ease of communication and information flow, timely communication of relevant information about changes in policies, rules or statutes, and the clarity and accessibility of information.
Outcomes for this work serve as evidence of best practice among boards. While the NCSBN does not have authority to mandate compliance by individual state boards, these boards work collectively and collaboratively to share resources and support best practice efforts so that all constituencies benefit from this shared experience.
What has been learned is that an increasing number of boards utilize the resources of state government to develop Web sites that serve as an access for reports, minutes, licensure verification, newsletters, and copies of statutes and rules. Timely, accurate, and confidential communication with those who make complaints is important both in terms of providing feedback and for sustaining future reporting sources for Nurse Practice Act violations. Oftentimes these complaints are made by nursing administrators or CNOs who have already gathered information based on investigations within their own facilities. When boards fail to act on complaints in a timely manner or fail to provide feedback to the person who makes the complaint initially, then there is a lack of satisfaction with board action and thus a threat to future reporting is created.
Boards of nursing have a vested interest in embracing best practice standards. These standards help meet the public's expectation of how boards effectively serve to protect the public and also serve to protect the rights of individual nurses as guaranteed under the US Constitution for due process. Chief nursing officers need to be aware of these performance measures as they interact with the boards in their states. They can expect the board to engage with CORE measures and promote excellence in regulation in the state.