Keeping nurses in the workforce

With a national shortage of registered nurses (RNs) to care for an aging population, it’s important to keep as many nurses practicing safely and competently as possible. That’s why remediation programs exist as a disciplinary option for nurses who meet certain eligibility requirements. These programs help retain safe nurses in the workforce by increasing their knowledge, skill and competency to prevent future practice breakdown.

The first remediation program of its kind in the United States, the A&M Rural and Community Health Institute’s Knowledge, Skills, Training, Assessment and Research (KSTAR) Nursing Program was approved by the Texas Board of Nursing as a permanent disciplinary option on July 20, 2017.

“We’re all going to be a patient one day,” said Tammy Wagner, BBA, RN, CPHQ, IQCI, chief nursing officer and director of quality and patient safety at the A&M Rural and Community Health Institute. “We all want our nurses to have the most up-to-date standards of care and make sure they’re practicing safely.”

KSTAR Nursing, which started as a pilot project in 2013, is designed to perform individualized competency assessment and provide targeted remediation to ensure nurse competency and make recommendations back to the board on whether the necessary benchmarks are met.

“Nurses faced with licensure discipline for practice errors are going through a challenging time,” said Kristin Benton, DNP, RN, director of nursing for the Texas Board of Nursing. “Having the KSTAR Nursing program as an option provides the nurse with the ability to choose what they believe will work best for them. The individualized nature of the KSTAR Nursing program provides the board with assurance that each nurse’s practice competency is assessed objectively and that a remediation plan designed to target any gaps is implemented followed by an evaluation of whether or not the nurse was able to close those gaps and able to continue practicing safely.”

Traditional remediation of nursing practice breakdown often requires remedial education coursework that is best matched to the nurse’s practice breakdown with supervised clinical practice in the nurse’s employment setting. KSTAR Nursing is a more individualized option. A KSTAR Nursing coach from the A&M Rural and Community Health Institute and the Texas A&M College of Nursing guide the nurse through the entire program. Additionally, nurses who go through the KSTAR program complete clinical practice exercises with standardized patients, who are professional actors, in the Texas A&M University Health Science Center Clinical Learning Resource Center, a simulated health care environment that utilizes highly specialized instructional technology, rather than working with actual patients.

Now, in a  recent article published in the Journal of Nursing Regulation, the KSTAR Nursing team presents two case studies of nurses who went through the program, as well as overall data on pilot program participants. They report that 92 percent successfully completed the pilot program, and none of them were found to have been disciplined for subsequent practice errors two years later. Although this study follows the nurses for 12, 24 and 36 months, the researchers suggest that they should be followed for up to five years to be better able to compare the KSTAR Nursing participants to those who went through traditional remediation orders.

Nurses who are eligible for the program as determined by criteria set by the Texas Board of Nursing are offered the option to enter into an agreed disciplinary order to either complete the KSTAR Nursing program or a traditional warning order. The types of nursing practice violations leading to this type of discipline include errors involving medication administration, documentation and assessment. They are not being disciplined for practice errors involving severe harm to a patient, or for criminal or substance use related board rule violations.

“The College of Nursing faculty bring expertise in simulation development, evaluation of nursing competencies using standard measures and the development of teaching/learning activities appropriate to individual learning needs and learning styles,” said Debra Wise Matthews, PhD, RN, associate dean for academic affairs at the Texas A&M College of Nursing and co-author of the research article. “This makes them a valuable and integral part of the KSTAR Nursing team involved in the individualized assessment of each nurse’s needs, in the development of the individualized remediation plans and in the assessment of the successful completion of the remediation program.”

Wagner and the team are presenting their program and the results to nursing boards in states around the country. “We hope something similar to KSTAR could be replicated elsewhere, or we could arrange for their nurses to be sent to Texas to participate in our program,” she said. “Our ultimate goal is to help the maximum number nurses correct their deficiencies and get back to practicing safe patient care.”