Evaluating the Operational Efficiency of Nursing Regulatory Boards’ Discipline Case Management

Background

In the United States and across the globe, differences in staffing, operations, terminology, and other critical measures have historically made it difficult for nursing regulatory bodies (NRBs) to create a standardized method for objectively evaluating nurse performance.

Purpose

To identify indicators of operational efficiency that transcend individual jurisdictions for the disciplinary process.

Methods

Investigative staff at 10 U.S. NRBs entered detailed de-identified discipline case management information into a secure online database between June 2018 and June 2020. Generalized estimating equation models, receiver operating characteristic curves, and natural language processing techniques were then used to assess the efficiency of case resolution.

Results

A total of 55 cases from 10 states in various regions of the United States were submitted. Nearly three-quarters of all cases (73%) were resolved, and the median closure time was 177 calendar days. On multivariable analysis, the volume of open caseloads (adjusted OR = 1.12, 95% CI = 1.06, 1.19, p < .001), number of case steps (adjusted OR = 1.08, 95% CI = 1.03, 1.13, p < .001), and umbrella agency type (adjusted OR = 1.71, 95% CI = 1.06, 2.78, p = .02) had the strongest associations with inefficient case resolution.

Conclusion

To achieve their mandate of ensuring public safety, NRBs must remain agile and utilize evidence-based approaches to manage disciplinary cases. In the United States and internationally, NRBs that efficiently and effectively execute the disciplinary process facilitate the appropriate and safe return to practice of effective nurses.