Jurisprudence pt. 4: Peer Review

Definition of minor incidents:

- "Conduct that does not indicate that the continuing practice of nursing by an affected nurse poses a risk of harm to the client or other person."

What are nurse's due process rights in incident-based peer review?

- A nurse must receive notice regarding the review - The nurse will have opportunity to respond to that notice - The nurse may hire his or her own attorney, will get feedback after the decision, and will have a chance to respond to the decision

Protections after invoking safe harbor:

- A nurse who has invoked Safe Harbor may not be disciplined or discriminated against by his or her employer - May engage in the requested conduct pending the peer review, - Is not subject to the reporting requirement, and - May not be disciplined by the Board for engaging in that conduct while the peer review is pending - The rules protect a nurse who makes a good faith request for Safe Harbor.

If you are under investigation, you don't have to tell anyone except?

- Fellow employees - Future or current employers

Incident-based peer review

- Incident-Based Peer Review relates to an incident reported after the fact by a nurse or facility. - The Peer Review Committee evaluates the nurse and his or her qualifications and quality of patient care. - The Committee also evaluates the merits of a complaint and makes recommendations regarding the complaint.

What are the 2 kinds of peer review?

- Incident-based peer review - Safe harbor peer review

What are the rules for reporting an incident?

- The rules state that a nurse has the responsibility to submit a *written, signed* *report* to the Board when he or she has cause to suspect violations of the rules and regulations by another nurse. - The nurse making the report must give their name but remains confidential. - *You CAN NOT make an anonymous report to* *the BON.* - If you fail to report, it's a violation of NPA 301.402 (b) and Rule 217.19 (j).

Minimum due process rules permit the nurse requesting Safe Harbor to:

- appear before the committee, - ask questions and respond to questions, and explain why he or she believes the requested conduct or assignment would have violated a nurse's duty to a patient.

When to report minor incidents?

- creates a significant risk of physical, emotional, or financial harm to the patient - indicates a lack of a conscientious approach, - indicates the nurse lacks knowledge or competencies, that can not be easily remidied, or indicates a pattern of multiple minor incidents

Due process rights grant that you will be:

- notified that you are being evaluated, - provided with a description of the events, and - given the opportunity to present testimony and rebut the decision in writing

When does your duty to a patient officially begin?

A nurse's duty is not defined by any single event such as clocking in, or taking report. - From a BON standpoint the focus is on the relationship and responsibility of the nurse to the patient(s), not to the nurse's employer or employment.

What situations are minor incidents and which aren't? A. One medication error with no harm to patient B. A pattern of poor clinical judgement C. Failure to record one set of vital signs on a stable patient D. An error that contributed to a patient death E. Failure to notify a physician of lab results within normal limits F. Criminal conduct

Minor incident: A, C, E Not a minor incident: B, D, F

Why was peer review created?

Nurses wanted the opportunity to monitor themselves, apart from and before the Board's review.

When should the request be made by?

PRIOR TO THE END OF, OR BEFORE LEAVING THE WORK ASSIGNMENT AREA - Keep a copy! - Do not fax or mail this form to the BON

Safe Harbor peer review

Safe Harbor Peer Review relates to an application made by a nurse to seek safe harbor before he or she accepts an assignment.

True or False: Nurses have the right to refuse to engage in conduct related to patient care if they believe the conduct would violate the NPA or any Board rule

True

True or False: Peer review is totally separate from the BON and it's confidential.

True: it's the law

Can the investigation be closed without any action taken against the nurse?

Yes

What does the safe harbor try to balance?

- Safe Harbor tries to balance duty to patient with protection of the nurse's license. - It allows nurses to accept assignments, and do the best patient care they are capable of, without fear of licensure action by the Board if they accidentally commit a practice error.

How to invoke safe harbor:

- The "Quick Request for Safe Harbor" must be made before accepting the assignment and the request must be made in writing. - You don't have to use a form - any written format is acceptable, as long as it contains the required information. - The information required is not complicated, and it won't take you long to write out.

Whistle Blower Protections:

- The NPA and the Board's rules and regulations have several protections in place for nurses who report potential violations. - Ex: You cannot be suspended, terminated, or otherwise disciplined if you properly make a report.

The purpose of safe harbor peer review:

- The general purpose of Safe Harbor Peer Review is to allow a nurse to accept an assignment when the nurse has reason to believe the patient is at risk and the nurse needs protection of her license. - Safe Harbor protects nurses while they care for patients in less-than-ideal circumstances.

A nurse comes to work and learns that two coworkers are at home with the flu. On topof that, there are more patients to care for than on a usual shift. His supervisor says, "You're on duty now and we need you to get started!" But the nurse feels nervous about how much there is for one person to handle. What would you do? What actions are needed? A.Hit the ground running and then file a report at the end of your shift. B. Write notes to yourself so you'll remember the order of events if anything goes wrong. C. Before you start your shift, take 5 minutes to fill out the Safe Harbor Quick Request form

C.

What is an exclusion from minimum process? A. The nurse is a new employee in orientation B. The nurse has been reported more than three Incorrect times in the past 12 months C. The nurse's practice is suspected of being impaired due to chemical dependency

C.

What does the Safe Harbor not protect nurses from?

Civil action

True or False: If the nurse and supervisor collaborate and determine a safe harbor assignment or otherwise resolve this issue, the nurse is required to withdraw the request for Safe Harbor Peer Review.

False