February 12, 2019

Line Dempsey: Welcome to our podcast, Regulation Matters: a CLEAR conversation. I'm your host, Line Dempsey. For those who do not know me, I'm a senior investigator with the North Carolina State Board of Dental Examiners. I'm on the CLEAR board of directors as well as the current chair of the National Certified Investigator Training committee and vice chair of the annual conference program committee with CLEAR. As many of you may know, the Council on Licensure, Enforcement and Regulation, or CLEAR, is an association of individuals, agencies and organizations that comprise the international community of professional and occupational regulation. Our podcast is a chance for you to hear about the latest and greatest in our community, and today, I'm really excited to welcome Deb Elias, director of practice and standards with the College of Registered Nurses in Manitoba. Welcome.

Deb Elias: Hello.

Line: Thanks so much for joining me today. I guess, we'd like to talk about establishing evidence for regulatory policies and this is a CLEAR resource brief that you authored with Jill Tomasson Goodwin at the University of Waterloo and Leanne Worsfold with iComp Consulting, correct? Deb: That's correct. Line: And this was based on a case study involving registered nurses in Canada. And what you've provided in the resource brief is a three-step method for systematically and critically reviewing evidence supporting regulatory policies. I guess my first question is, what precipitated your research on practice hours?

Deb: Well, I was fortunate enough to be in a fellowship program through the National Council of State Boards of Nursing, so I was looking for some subject matter to review as part of that and with work here, we've been working on some new legislation. And as part of any legislation review, as all regulators would know, you kind of start drilling down into the details of what are the definitions of what are the things we're looking for, and why do some of these things exist. And practice hours, or currency hours as some people call them, were something that we've had in place since 1980. And they were really the longest standing continuing competence requirements that we had, but then in 2004, we initiated other learning plans and portfolios as well as a jurisprudence online module. So the question was, is the use of practice hours or currency hours sort of an outdated kind of a concept with all the other components of a continuing competence program.

Line: Excellent... So I guess when you did the research, what methodology did you use to kind of deal with this data, and I guess ultimately, what were you're findings?

Deb: Well, we did look at the literature, just to see if there was anything out there. And, as a lot of regulators will know, sometimes it is difficult to find the evidence to support some of the policies that we have in place. So we took a good hard look at the literature just to see if there's anything there that we could use and looked around the world to see what kind of currency requirements that other people, other regulators (nursing, but also other healthcare professions and other professions as well) - What did they use and was there some consistency with that? And we found there was some evidence regarding a frequency of doing things but there really wasn't a lot directly to do with currency. So we thought, well maybe... Maybe we could take a deeper look at doing some of our own research on that as well.

Line: Right. And I guess when you look at the research like that, and there's very little, you kinda have an open slate as far as getting the material you need. In the end, what were your findings?

Deb: Well, let me just tell you a little bit about the methodology because we had started using a multi-source feedback. So with our continuing competence, every year we take a portion of our nurses and have them also participate with multi-source feedback. So they get feedback from colleagues, and if they have clients, they also include clients as part of that feedback as well. And so we've been doing that for a couple of years when this research all began. And so, the multi-source feedback questionnaire was built based on our entry-level competencies. So I thought, we have this data; we could use the multi-source feedback questionnaires as a proxy for competence because they are looking at some of the aspects of what we're looking for with competence. And specifically it's things like inter-professional skills, communication, ethics, informed consent, those kinds of things. And so we used those, the multi-source feedback results, as a proxy measure of competence and then looked back at the practice hours and ran some statistical analysis to see, was there some correlation between the results of the multi-source feedback and the practice hours as well? So it was really interesting. Our case example unfortunately didn't uncover any causal relationships among the variables.

So there isn't a strong relationship between practice hours, the currency period, years since graduation, age and highest level of education. But there were some findings and we found five things that were of significant interest to us. And in our group, we broke down the population to both clinical nurses as well as non-clinical nurses, and both of them have the same currency requirements and the same continuing competence requirements but they do have interaction with clients on a more frequent basis if you're a clinical nurse for example. And what we found is that for both of them, there was a strong correlational evidence between the total practice hours in the past three and five years, and which really suggests that maybe a five-year currency period is too long.

And we all know that health care, and technology just on its own, is changing at a really rapid rate. So maybe looking at a shorter currency period is worthwhile. For non-clinical RNs, we found that there was strong correlational evidence between the total amount of practice hours in the past three years, as well as higher competence or higher multi-source feedback scores, but the strength when we looked at it a little further and had some discussions with our statistician really found that the strength of the factor is weak. So it only was indicating about 5% of the influence. And it really begs the question as to why is that? And at this point, we really don't have an answer to it, but I think there should be some further analysis of that as well.

Line: Now you mentioned a difference between, I guess, the clinical nurses versus the non-clinical nurses. So with their continued education requirements for continuing competency, how different was it between those two areas, those two groups because of the nature of what they were doing clinically versus non-clinical?

Deb: Well, they tend to focus on different educational opportunities. So our program is set up so you do a self-assessment based on the standards to determine what your goal is for the year, learn towards that goal, and then document the impact of the learning on your practice. So we didn't really find, besides the three and five years, there wasn't anything significant in our statistics with this particular study.

Line: Gotcha, so what, I guess, would be your recommendations for other regulators?

Deb: Well, we weren't able to find - because we were looking too to see, is there a cut score? Is there a minimum amount of practice hours that you have to have in order to maintain competence? And we sliced up the data in a few different ways to try to find that type of information, and we really weren't able to do that. And I think, you know, we really probably need to put our heads together as far as regulators go and think about this and think about the data that we have collectively that we all collect so that we could have larger power in our numbers and also maybe find a different way to get at this kind of information. So I'm thinking collaborative research in the future would be a really beneficial thing to do.

Line: Well, that kinda leads me to the next question. What are your next steps, I guess looking specifically what you're doing - and obviously, collaboration with other individuals and other agencies will be helpful - but, I guess, what are your next steps?

Deb: Well, we're taking a look at the practice hours, because since this study has occurred, we've actually moved to the new legislation which takes the currency hours out of the continuing competence part of the legislation and puts it into the registration renewal requirement. So it's still a currency requirement in order to maintain your registration, but it's slightly different. So we're kind of pausing right now and taking a look. It's still a requirement as of now, but I think we're looking to see, is there other ways to look at that information and are there other data sources that we should be considering? So we're kind of pausing and taking a look at that and then also having some discussions with some of our counterparts both in our province as well as across Canada.

Line: Excellent. Well thank you, Deb, for your time and being a part of the CLEAR podcast. It's wonderful to have the opportunity to share and learn from each other. And CLEAR members can log in to the CLEAR website under publications, resource brief tab to read the full resource brief, and others can purchase a copy online. And thank you for speaking with me today.

And thank you for listening. We'll be back with another episode of Regulation Matters: A CLEAR conversation very soon. Please subscribe to our podcast on Podbean, iTunes, Apple Podcast, Google Podcast, Google Play, Stitcher, Spotify, or TuneIn. We're available in a lot of different avenues now. And if you just enjoyed this podcast, please live a rating or comment in the app. Your reviews are helpful for us in improving our ranking and making it easier for new listeners to find us. Feel free to visit our website at www.clearhq.org for additional resources and a calendar of upcoming training programs and events. Finally, I want to thank our CLEAR staff, specifically, Stephanie Thompson, our content coordinator and editor for this program. I'm Line Dempsey, and I hope to be speaking with you again very soon.

The audio version of this podcast episode is available at https://podcast.clearhq.org/e/research_on_practice_hours/

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