Disciplinary processes for nurses, from organizational supervision to outcomes: A document analysis of a regulatory authority's decisions

Abstract

Aim: This study aims to explore the disciplinary processes for nurses, from organizational supervision to final decisions by the Finnish regulatory authority.Background: Regulatory authorities are responsible for protecting the public, by ensuring that they receive safe, competent and ethical nursing care, but little is known about the disciplinary processes for nurses.Methods: This is a retrospective document analysis of 296 disciplinary decisions by the Finnish regulatory authority from 2007 to 2016. The data were analysed using a quantitative design with descriptive statistics.Results: We studied 204 disciplined nurses (81.4% female) with a mean age of 43.5 years. The disciplinary process comprised organizational supervision, complaints, investigations and decisions. Nurses with substance abuse issues were more likely to face criminal investigations and receive temporary decisions. The process lasted from under 1 month to years and could have profound effects on nurses, colleagues and nurse managers and compromise patient safety. Conclusion:This study identified key factors that could inform the disciplinary processes for nurses. More knowledge is needed about how organisations ensure patient safety when unprofessional conduct is suspected.Implications for Nursing Management: Retaining nursing professionals is vital due to global shortages, and more attention should be paid to organizational supervision and support for nurses during disciplinary processes.

Developing a Feasible and Credible Method for Analyzing Healthcare Documents as Written Data

“…Information or access may be unavailable before the data collection if highly confidential or sensitive data are involved. This means that the research questions are exploratory during this phase and can only be specified after an overview of the entire data has been obtained ( Häggman-Laitila et al, 2019 , 2020 ; Kangasniemi et al, 2022 ; Papinaho et al, 2021 , 2022 ; Toivonen et al, 2020 ). Determining the research questions and data can be based on previous studies and by consulting responsible authorities ( Appleton & Cowley, 1997 ) who hold relevant data or experts and practitioners engaged in the study topic.…”

“…This phase includes providing reasons to justify the use of selected documents in the analysis, by identifying available and potentially suitable documents and any bias they may have (see phase 6). Justifying the use of documents is also crucial when using highly protected or sensitive data, such as complaints from clients and patients or official investigations ( Bowen, 2009 ; Häggman-Laitila et al, 2019 , 2020 ; Kangasniemi et al, 2022 ; Papinaho et al, 2021 , 2022 ; Toivonen et al, 2020 ).…”

“…Document analysis can have different focuses , depending on the study purpose ( Atkinson & Coffey, 2010 ; Coffey, 2014 ; Finnegan, 2011 ; Gorichanaz & Latham, 2016 ). First, it can be used to understand documents and their content in a specific context, such as an analysis of healthcare steering documents ( Papinaho et al, 2021 , 2022 ). For example, the analysis can focus on how the documents relate to real-life practical healthcare ( Häggman-Laitila, 2003 ; Häggman-Laitila et al, 2010 , 2019 , 2020 ; Toivonen et al, 2020 ).…”

“…A deductive development strategy can be used to develop an extraction matrix that is based on previous knowledge, using either a systematic review method or systematic literature searches. If previous knowledge is limited, or unavailable, experts in the field can be consulted as part of the development process ( Häggman-Laitila et al, 2019 , 2020 ; Hipp et al, 2020 , 2021 ; Papinaho et al, 2021 , 2022 ; Toivonen et al, 2020 ). For example, we consulted relevant authorities when we developed an extraction matrix to study administrative decisions related to unprofessional conduct.…”

“…In addition, we used our experience of carrying out 14 studies using document analysis to examine the feasibility and credibility of the method. These document analyses employed qualitative and quantitative methods and used documents such as patient records or plans ( Häggman-Laitila, 2003 ; Häggman-Laitila et al, 2010 , 2019 , 2020 ; Hipp et al, 2020 , 2021 ; Puustinen et al, 2021 ; Toivonen et al, 2020 ; Turjamaa et al, 2015 ), healthcare steering documents ( Kallio et al, 2018 , 2020 ), clients’ complaints ( Kangasniemi et al, 2022 ), and administrative healthcare decisions ( Papinaho et al, 2021 , 2022 ).…”