WEBVTT
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- [Woman] Dr. Elizabeth Zhong is a
research scientist at NCSBN.
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She specializes in large-scale research surveys and
data analysis, with extensive working experience
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in the discipline-related fields.
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Zhong is an ad hoc member of the dissertation committee
of the Counseling Psychology Department
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at Loyola University.
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- [Dr. Zhong] Hello.
Welcome.
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It's my pleasure to present you to the NCSBN
Criminal Conviction Cohort Study.
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Do nurses disciplined for criminal conviction pose
a risk to public safety?
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How likely are they to recidivate?
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NCSBN has been exploring this topic
in the past few years.
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Since 2015, we initiated a case review study of nurses
and the nurse applicants who received disciplinary
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action for criminal conviction during 2012 and 2015 to
determine the type of crimes they were convicted of and
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the corresponding board actions.
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The findings of the study were published in the
Journal of Nursing Regulation and were presented
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at the 2016 Scientific Symposium.
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The current study, we followed up
on this group of nurses.
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We were to check whether they receive the additional
disciplinary actions during the five-year
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post-disciplinary period of time.
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Before we start, we would like to recap
the 2015 studies.
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Here, we found that driving under the influence and
violation of Controlled Substances Act were the main
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crimes reported to the boards of nursing, and probation
is the most common disciplinary action taken
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by the board.
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In addition, we found that boards tend to impose more
serious board actions, such as license revocation or
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license suspension, in response to more serious crimes,
such as sexual offense or crimes related
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to nursing practice.
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These are the examples of criminal convictions
related to nursing practice.
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Here, we see violation of Controlled Substances Act is
the most common one.
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Here, reported fraud were mainly
related to insurance fraud.
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For the current study,
we followed up with this group of nurses
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and tried to address the following questions.
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First, how frequently did the nurses who were
disciplined by boards of nursing
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for a criminal conviction and
retained an active license
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commit new violation or crimes during the five-year
post-disciplinary time frame?
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Do nurses who are disciplined for the board for a
criminal conviction and retain an active license
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pose a risk to public safety?
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What particular types of criminal conviction or other
factors are associated with elevated or reduced
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risk of recidivism?
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This is a 10-year case review study.
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We evaluated nurses who received disciplinary action
during 2012 to 2013 for criminal conviction.
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Any violations committed five years prior and
post-disciplinary actions were reviewed as well.
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Data were extracted from the Nursys database
with assistance from the IT department.
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To supplement the case reviews,
we also performed a relative risk analysis to explore
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the significance of identified trends.
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For comparison purpose,
we also included a random sample of 2,000 nurses who
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received disciplinary action for violations unrelated
to criminal conviction during the same time period.
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Nurses who committed a crime before being licensed
were excluded from the analysis.
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In addition, for the nurses who received disciplinary
actions such as license revocation or license
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suspension without license reinstatement within the
five-year post-disciplinary period of time were
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excluded from the recidivism analysis.
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In addition, revision actions without identifiable new
violations were excluded from the recidivism analysis.
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In addition, we also excluded reciprocal action taken
by the board based on actions taken from other boards.
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Two legal consultants read all the board orders to
recategorize the type of violations to determine the
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status of recidivism.
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The Western IRB granted NCSBN the IRB
exemption approval for the study.
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Now let's look at the first question.
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How frequently did nurses who were disciplined by the
boards of nursing for criminal conviction and retained
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an active license commit the new violations during
the five-year post-disciplinary time frame?
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Our case review showed that 2,429 nurses
met the case review criteria.
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More than 938 of them were removed from the workforce
as a result of the 2012 and 2013 board actions.
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Among those who retained an active license,
38% of them recidivated during the
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5-year post-disciplinary period.
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Among those who recidivated,
9% of them committed a new crime.
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And for those who committed a new crime,
58% of them were related to substance use disorder.
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The 5-year post-disciplinary case review shows that
38% of the nurses in the cohort group versus 36% of the
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nurses in the control group who retained an active
license recidivated during the 5-year
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post-disciplinary period.
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Now you may want to know,
do the nurses who are disciplined by the boards
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of nursing for a criminal conviction and retain an
active license pose a risk to public safety?
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After being disciplined for a criminal conviction,
38% of the nurses recidivated,
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and 11% of them recidivated with a crime or violation
related to nursing practice.
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The majority of the nurses who recidivated committed a
violation or crime unrelated to nursing practice,
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including animal cruelty,
dropping out of a monitoring program,
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or failing to meet the
licensure board reporting requirements.
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Our case review shows that at the time of the 2012
and 2013 disciplinary action,
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413 nurses were disciplined for
committing practice-related crime.
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Boards of nursing removed 220
of them from the workforce.
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During the 5-year post-disciplinary time,
we found that a total of 62 nurses recidivated
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with practice-related violation or crimes.
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Now, let's take a look at what types of criminal
conviction or other factors are associated
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with elevated or reduced risk for recidivism.
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First, we evaluated the recidivism rate by the types of
initial crimes committed by the 1,071 nurses who
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committed a single crime.
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And we found out that violation of
Controlled Substances Act had
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the highest recidivism rate, that's 53%.
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We found 40% of the nurses who committed a crime
related to substance use disorder recidivated
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versus 30% of the nurses who committed a crime
unrelated to substance use disorder.
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Here, substance use disorders include both violations
of Controlled Substances Act
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and driving under the influence.
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Forty-eight percent of nurses who committed a crime
related to nursing practice recidivated
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versus 37% of them committed a crime
unrelated to a nursing practice.
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In addition, we found 43% of nurses who committed
multiple crimes versus 36% of nurses who committed
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a single crime recidivated.
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In addition, our analysis shows that nurses who
committed violation before the 2012 and 2013
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disciplinary actions tended to more likely to
recidivate compared to those did not have
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such a history.
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However, that difference was
not statistically significant.
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We also conducted a relative risk analysis, and we
found that the following factors associated with
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elevated risk for recidivism.
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The nurse committing a violation or crime related to
SUD or related to a nursing practice,
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and the nurses who committed multiple crimes.
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Finally, we found that the longer the criminal
conviction time before the 2012 and 2013
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disciplinary action,
the lower the risk a nurse will recidivate.
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The current analysis was based on data voluntarily
submitted by board of nursing.
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Not all boards submitted detailed case files.
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NCSBN research department contacted 24 boards directly
to reach over 200 case files.
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In addition, no direct comparison on the efficacy of
disciplinary actions taken by the board is available
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at this time because we do not have detailed
information on the types of remediation opportunities
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taken by the nurses.
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Thirty-eight percent of the nurses disciplined for
criminal convictions versus 36% of nurses disciplined
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for violations unrelated to criminal conviction
recidivated during the five-year
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post-disciplinary time period.
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So here, we can see, with proper discipline and
monitoring, nurses with criminal conviction history did
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not report a significantly higher recidivism
rate than nurses without such a history.
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Our analysis further showed that 11% of nurses
committed a violation related to nursing practice
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during the five-year post-disciplinary period
which may have patient safety implications.
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Among the nurses who were disciplined by boards of
nursing for criminal conviction and retained
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an active license, 4% of them recidivated with a
violation or crime related to nursing practice
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within 5 years.
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According to our analysis, nurses who committed
a crime related to substance use disorders
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and committed a crime related to nursing practice,
and those who committed multiple crimes are
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at a higher risk for recidivism.
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As we all know that substance use disorder is the
leading cause for disciplinary actions in nursing.
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We're very glad to report that NCSBN already initiated
a groundbreaking national study to evaluate the
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outcomes of the substance
use disorder monitoring programs.
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The finding of the study will publish in the
Journal of Nursing Regulation,
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and my colleague, Mr. Richard Smiley,
also presents at this conference.
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Before I finish the talk,
we would like to thank Dr. Maryann Alexander,
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chief officer of nursing regulation, for her support
and contribution to the study.
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Dr. Alexander is the driving force
for the criminal conviction studies.
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In addition, we would like to thank boards of nursing
who generously shared their data with us.
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In addition, the NCSBN IT department has done a great
job on retrieving that data for the current analysis.
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Finally, we would like to thank you
for taking time to join us.
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Here is my contact information.
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Feel free to contact me for any comments or questions.
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In addition, I'll be glad to take
questions at the live Q&A session.
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Thank you.
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- Hello. Welcome back.
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So, first of all, thank you for taking time to join the
presentation, and now I think it's time for us to
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gather information from you,
how these findings reflect your experience.
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We welcome any comments and suggestions.
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So if you have any questions,
please feel free to submit your question
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to the Q&A section.
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So let's take a look.
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Okay. Hi, Kathy.
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So I just saw a note that they
did not see the PowerPoint presentation.
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So don't worry.
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So this presentation will be available online later,
and also, I will be happy to send it to you.
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And we're still waiting for the questions.
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So during this time,
I would like to give you a brief update
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on the current study.
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First, so based on the feedback, we would like to
submit the current findings to the
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Journal of Nursing Regulation, and then meanwhile,
we are conducting analysis on the control group data.
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Oh, this...yeah.
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So the purpose of the control group analysis will
develop a model to predict the risk
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factor for recidivism.
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In addition, NCSBN initiated a 10-year nurses'
discipline case review study to further determine
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the discipline trend.
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So we hope that the new study findings will be
available for you for our next research conferences.
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Okay.
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Now we look at the question from Ann [inaudible].
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So the question is any of the finding surprised me?
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What do we think of the findings?
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I think, in a way, not a big surprise,
but one thing we did find that based on our assumption
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that nurses without criminal conviction history could
have a significantly higher recidivental rate or pose
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harm to patients.
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However, our study shows by proper monitoring and
discipline, we found that the recidivental rate
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for nurses who had a criminal conviction is not
significantly higher compared to the nurses who
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committed a violation without
criminal conviction history.
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It's a little surprising, but however,
I think that's a good sign that it shows the current
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procedures taken by the boards are
useful in reducing the errors.
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But however, we have to say,
even though we do not find a significantly discipline
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rate for the nurses who committed criminal conviction
compared to the nurses without this history.
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But as we all know that in general nursing workforce,
the discipline rate annually is only less than 0.3%.
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For our nurses, the criminal conviction nurses, in 5
years, that discipline rate was 38%, in 5 years, yes.
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Still, they are at risk for public safety.
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But we have to say, we have evidence that the current
remediation and the discipline action taken by the
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boards reduce the risk for harm to patients.
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Yeah, that's something we found.
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And we're still looking for any other questions.
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Okay.
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So since I didn't see any new questions coming up,
so feel free to drop any question to us directly.
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So I will sign off,
and enjoy the rest of the conference.
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And see you next time.
Thank you. Bye.