Few options are available to nursing regulatory boards for the evaluation of nursing competency in registered nurses who are reported for practice breakdown. To address this deficiency, the authors conducted funded research through collaboration between their respective institutions: a state nursing regulatory board, a community college nursing program, and a state university nursing program. Through this collaboration, a competency evaluation process that used high-fidelity simulation was developed and was called the nursing performance profile (NPP). The NPP process consisted of evaluation of videotaped performances of registered nurses providing simulated patient care in three successive situations. Nurses who were experienced in both practice and supervision rated the performances according to scoring guidelines developed by the authors. Findings showed that the NPP process has the potential to (1) provide regulators, educators, and employers with a quantitative picture of nurse performance across nine areas essential to safe practice, and (2) establish a basis for recommending a specific remediation plan or continuing professional development.

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In times of fiscal constraints, nursing homes are seeking to maximize use of licensed staff through delegation of low-risk tasks to unlicensed personnel. Between 2004 and 2008, the Arizona State Board of Nursing developed and conducted a pilot program to determine the impact on patient health and safety of licensed nurses delegating medication administration to trained certified nursing assistants. There were no differences in patterns of medication errors before and after the introduction of medication technicians, and structured interviews revealed that participants viewed the role favorably, with reported increased role satisfaction on the part of delegating nurses. Efforts are underway to extend the program statewide.

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