Report 2016-046 Recommendation 17 Responses

Report 2016-046: Board of Registered Nursing: Significant Delays and Inadequate Oversight of the Complaint Resolution Process Have Allowed Some Nurses Who May Pose a Risk to Patient Safety to Continue Practicing (Release Date: December 2016)

Recommendation #17 To: Registered Nursing, Board of

To ensure that BRN and DOI consistently conduct adequate investigations and obtain sufficient and appropriate evidence to discipline nurses accused of violating the Nursing Act if warranted, BRN in collaboration with Consumer Affairs should coordinate with the Attorney General to develop a biennial training program that includes techniques for gathering appropriate evidence and ensure that all investigators, including DOI's investigators, participate in this training.

Annual Follow-Up Agency Response From October 2018

To ensure BRN and DOI consistently conduct adequate investigations and obtain sufficient and appropriate evidence to discipline nurses accused of violating the Nursing Practice Act, the BRN has collaborated with DCA, the AGO, and DOI to develop and provide biennial training that includes techniques for gathering appropriate evidence and ensures all investigators, including DOI's investigators have participated in the training.

California State Auditor's Assessment of Annual Follow-Up Status: Fully Implemented

BRN provided documentation demonstrating it coordinated with the Attorney General in developing training for all investigators and provided evidence of both DOI and BRN investigators attendance records at the training. It also provided the training manual, which includes techniques for gathering appropriate evidence.

1-Year Agency Response

To ensure BRN and DOI consistently conduct adequate investigations and obtain sufficient and appropriate evidence to discipline nurses accused of violating the Nursing Practice Act, the BRN has collaborated with DCA, the AGO, and DOI to develop and provide biennial training that includes techniques for gathering appropriate evidence and ensures all investigators, including DOI's investigators have participated in the training.

California State Auditor's Assessment of 1-Year Status: Pending

Although BRN claims it has fully implemented this recommendation, it did not provide evidence demonstrating that it has. Until it does so, we will continue to assess the status of this recommendation as pending.

6-Month Agency Response

With the coordination of the AGO and participation of DCA's SOLID Training Solutions, DOI, and BRN staff; the BRN implemented a formal training curriculum developed by the AGO for DOI and BRN investigation staff.

The training was designed to educate BRN and DOI investigators in case development and evidentiary issues related to BRN complaints, as well as a description of what constitutes sufficient evidence when investigating BRN complaints.

As of March 22, 2017, all BRN and DOI investigators completed this training.

The training session on March 22nd was recorded and provided to BRN and DOI to make available to future new investigators as part of their required training.

This training requirement has been added to the BRN Investigator training plan in the Investigation Unit Procedure manual.

California State Auditor's Assessment of 6-Month Status: Pending

BRN did not provide documentation demonstrating it coordinated with the Attorney General in developing the training, evidence demonstrating that the training occurred, or documentation indicating the training is required. Until it provides such evidence, we will continue to report this recommendation as not fully implemented.

60-Day Agency Response

With the coordination of the Attorney General's Office and participation of DCA's SOLID Training Solutions, DOI, and BRN staff; the BRN has worked aggressively over the past six weeks to develop a formal training curriculum for DOI and BRN investigation staff. This training is designed to educate BRN and DOI investigators in case development and evidentiary issues related to BRN complaints, as well as a description of what constitutes sufficient evidence when investigating BRN complaints.

The outline of the training curriculum has been developed. The final curriculum, training materials, and training presentation are being developed by the AG's office. Training for all investigative staff is scheduled to be complete March 22, 2017. The BRN will record one of the sessions which will be used as an exemplar in the future for newly hired investigative staff. Staff will be required to attend biennial training sessions. This requirement has been added to the investigator training plan in the policy and procedure manual.

California State Auditor's Assessment of 60-Day Status: Pending

BRN did not provide any documentation demonstrating that the actions they have claimed to take thus far, were indeed taken. As a result, we are assessing the status of this recommendation as pending, given BRN indicates it will fully implement the recommendation.

All Recommendations in 2016-046

Agency responses received are posted verbatim.