The Investigatory Process
2013 NCSBN IRE Conference
Rene Cronquist, J.D., RN
Minnesota Board of Nursing
Director of Practice and Policy
Tools in the Regulation
tool box
Regulation uses a variety of mechanisms – tools,
if you will, to carry out is mission of public
protection
What’s in your tool box?
 Statutes, Rules, Regulations, Case Law, Policies, Advisory
Opinions
 Program approval/Accreditation
 Credentialing
 Licensure
 Registration
 Certification
 Information/Data
What’s in your tool box?
 Big tools: Enforcement, compliance, discipline, investigation,
remediation
The right tool for the job
 Knowing which tool to use depends on what you are trying
to do.
 In the context of investigation, are you:
 Deciding if the complaint/report is within the authority of your agency?
 Gathering factual information to determine whether the complaint has
merit?
 Gathering information for another group or agency to make decisions?
 Determining what action is most appropriate based on the available
information?
Complaint process
Intake
Investigation
Board
Proceedings
Board
Actions
Reporting
and
Enforcement
Complaint process – another view
Intake
Investigation
Board
Proceedings
Board
Actions
Reporting
and
Enforcement
Details
Intake
Complaint
receipt
Initial review
Intake tools
 Sources of complaints
 Mandatory and permissive report
 Board as a source of complaints; self reports; Nursys
 Methods of submitting complaints
 Screen for jurisdiction
 Thresholds, triage, prioritizing, coding
 Tracking mechanisms
Intake
Investigation
Results of Investigation
Investigation tools
An effort to learn the who, what, where, why,
when and how of the allegations
Methods:
 Record gathering
 Employment
 Medical records of nurse or patient
 Pharmacy and Prescription drug monitoring program records
 Controlled substance inventory logs
 Court records and police reports
 School records
 Reports from other agencies
 Bank records
Investigation tools
 Forensics
 Evaluation of licensee (CD, mental health, neuropsych)
 Drug testing
 Computers (home & work PCs, cell phone, EHR access)
 Drugs (assay of syringe contents, analysis of automated dispensing
machine history)
 Interviews/Written statements
 Licensee
 Patient/victim
 Witnesses
 Supervisor and coworkers
 Collateral contacts
Investigation tools
 Written statements/affidavits
 Recordings
 Surveillance videos
 Audio recordings as evidence
 Audio recordings of interviews
 Site visits
 Other records
 Employer policies and procedures
 Databanks (Nursys, HIPDB/NPDB)
Investigation results
 Reports
 Formats, templates
 Know your intended audience and all possible readers
 Recommendations; Determining next steps
Challenges
 Coordinating investigation with other agencies
 Peer review protection of records
 Out-of-state records
 Destroyed records
 Uncooperative witnesses
 Unreliable or incompetent witnesses
 Uncooperative or unlocatable licensees
Your favorite tools
Results of
Investigation
Board proceeding
& action
Board proceedings & actions
 Informal processes
 Stipulated agreements
 Formal process
 Contested case hearings; administrative hearings
 Standard of proof must be met (clear and convincing vs.
preponderance); Board typically has burden of proof
 Appeals of Board decisions
 Emergency/temporary proceedings
 Authority -- usually limited – to take action against a license before a
hearing on the merits
 Miscellaneous
Board proceedings & actions
 Conclude the complaint without action (dismissal)
 Referral to a non-disciplinary monitoring program
 Non-disciplinary action (letters of concern,
admonishment, reprimand, Agreements for Corrective
Action)
 Disciplinary Action
Board proceeding &
action
Reporting and
Enforcement
(Compliance monitoring)
To Report or Not to Report
 Is the action public?
 Is the action reportable?
 Nursys
 HIPDB/NPDB
 OIG
Compliance monitoring
 Terms and Conditions
 Probationary terms
 Reports from the nurse
 Reports from the nurse’s supervisor
 Audits – documentation, med administration
 Additional education
 Maintain sobriety, attend support groups
 Drug screens
 Restrictions/Limitations
 Supervision required
 Restricted access to controlled substances
 Limitation on work hours or locations
Compliance monitoring
 Non-compliance
 Failure to comply, violations of the order; new allegations
 Process used to address non-compliance depends on terms and
conditions of the order and individual state laws
 More tools
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Checklists
Tracking mechanisms
Report forms
Audits
Randomizing drug screens
Challenges and policy questions
 How much information is enough?
 How to manage sometimes competing priorities?
Efficiency, cost containment, timely resolution of cases,
appropriate resolution of cases.
 How do we measure quality and effectiveness?
Resources
 NCSBN
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Networking opportunities
Conferences
Website materials
CE offerings
 CLEAR
 FARB
 NADDI
 Interviewing technique training
 Dean Benard, Benard & Associates
 The Reid Technique
Thank you!
Rene Cronquist, J.D., RN
Minnesota Board of Nursing
2829 University Ave SE #200
Minneapolis MN 55414
(612) 617-2198
Rene.Cronquist@State.mn.us
www.NursingBoard.state.mn.us