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Original Research: Probation and RecidivismRemediation Among Disciplined Nurses in Six States


AJN, American Journal of Nursing: March 2009 - Volume 109 - Issue 3 - p 48–57
doi: 10.1097/01.NAJ.0000346931.36111.e9

OBJECTIVE The researchers sought to determine what factors might affect the outcomes of remediation, including the likelihood of recidivism, among nurses who had been the subject of disciplinary action and had been put on probation by a state board of nursing.

METHODS Boards of nursing in six states, Arizona, Maryland, Massachusetts, Minnesota, Nebraska, and North Carolina, chose to participate in this exploratory study. A 29-item questionnaire was used to investigate the records of 207 RNs, LPNs, and advanced practice RNs (APRNs) who were disciplined and put on probation by a state nursing board in 2001, as well as to collect data on their employment settings, the boards' actions, and remediation outcomes (the presence or absence of recidivism); 491 nurses who had not been disciplined served as controls.

RESULTS Among the disciplined nurses studied, 57% were RNs, 36% were LPNs, 3% held both RN and LPN licenses, and 3% were APRNs. Of the disciplined group, 39% recidivated between 2001 and 2005. Three factors were shown to influence the recidivism rate: having a history of criminal conviction, having committed more than one violation before the 2001 probation, and changing employers during the probationary period.

Data on history of criminal conviction prior to state board disciplinary action were available for 112 (54%) of the 207 nurses. Among those 112, 35% (n = 39) had a history of criminal conviction, whereas only 3% of the control group reported one. The recidivism rate among those with a history of criminal conviction (56%; 22 of 39 nurses) was nearly twice as high as the rate among those without such a history (33%; 24 of 73). Also, 33% of the disciplined nurses changed employers during their probation; the recidivism rate among them was more than twice the rate among the disciplined nurses who stayed with the same employer. The recidivism rate of the 45 disciplined nurses who committed more than one practice-related violation from 1996 through 2001 was twice as high as the rate of those who committed only a single violation.

The proportion of men who had been disciplined was more than twice the proportion of men in the national nursing workforce. Younger nurses (both men and women) were more likely to recidivate.

CONCLUSIONS All health care regulators and nursing employers should be aware of the association between a history of criminal conviction and the likelihood of committing a violation that requires state nursing board disciplinary action.

In studying nurses who had been put on probation by a state board of nursing, the researchers found that 39% committed other violations during or after the probationary period. Supplemental Digital Content is available in the text.

Elizabeth H. Zhong is a research associate; Kevin Kenward is research director; Vickie R. Sheets is director of practice and regulation; Mary E. Doherty is a practice, regulation, and education associate; and Lindsey Gross is a research administrative assistant, all at the National Council of State Boards of Nursing in Chicago. The authors of this article have no significant ties, financial or otherwise, to any company that might have an interest in the publication of this educational activity.

Contact author: Elizabeth H. Zhong,

The authors would like to thank the following staff members of the participating state boards of nursing who generously shared their data and made suggestions that were essential for this study. North Carolina: Carol Walker, MS, RN, and Polly Johnson, MSN, RN, FAAN; Massachusetts: R. Gino Chisari, MSN, RN, and Rula F. Harb, MS, RN; Minnesota: Rene Cronquist, JD, RN, David Jacobsen, Kay Buchanan, MS, RN, Mary Squires, and Shirley Brekken, MS, RN; Arizona: Valerie Smith, MS, RN, FRE, Lila Wiemann, and Joey Ridenour, MN, RN, FAAN; Maryland: Patricia A. Noble, MSN, RN, and Donna Dorsey, MS, RN, FAAN. They would also like to thank Kathy Apple, MS, RN, CAE, Thomas O'Neill, PhD, Richard Smiley, MS, MA, Esther White, MS, and Kristin Hellquist, MS, at the National Council of State Boards of Nursing, and Sandra Evans, MAEd, RN, at the Idaho Board of Nursing for their valuable comments.

© 2009 Lippincott Williams & Wilkins, Inc.