The Ohio Board of Nursing’s Practice Intervention and Improvement Program

The Ohio Board of Nursing is the state agency that regulates the practice of nursing in Ohio. The mission of the Nursing Board is to protect the public by ensuring that nurses have the skills to provide care to patients. In instances where a nurse has violated the Ohio Nurse Practice Act, the Nursing Board has the authority to take a disciplinary action, such as to suspend or revoke a nurse’s license to practice in Ohio. However, in instances where the Nursing Board has reason to believe that a nurse has a deficiency in their practice that may be corrected, the Board may require the nurse to seek additional education and/or training.

The Nursing Board’s Practice Intervention and Improvement Program (“PIIP”) permits the Nursing Board to offer a nurse an opportunity to seek remedial education and training in a specific area instead of taking disciplinary action against a nurse who has a practice deficiency. The PIIP program is considered non-disciplinary and does not constitute a restriction or limitation on a nurse’s license. Participation in PIIP is confidential.

The criteria the Nursing Board uses to identify an individual’s practice deficiency includes, but is not limited to:

(1) Whether the public will be adequately protected from unsafe practice if the individual enters PIIP;
(2) Whether the individual’s practice deficiency resulted in harm to the patient;
(3) The likelihood that the identified practice deficiency can be corrected through remediation;
(4) The frequency of the occurrence of the practice deficiency;
(5) Whether the individual is eligible for participation in PIIP under 4723-18-03 of the Administrative Code; and
(6) Whether the individual has a mental or physical impairment that contributed to the practice deficiency.

If the supervising member believes, after investigation and review, that the individual’s practice deficiency can be successfully corrected through participation in PIIP, the Nursing Board may choose to take no disciplinary action. This decision is generally reached, if the individual enters into a Participatory Agreement with PIIP, complies with the terms and conditions of PIIP, and successfully completes PIIP.

The PIIP Participatory Agreement includes, but is not limited to, provisions that:

(1) Identify the practice deficiencies and the specific remediation (including educational interventions) the participant must complete;
(2) Require the participant to pay all expenses for the required remediation;
(3) Require the participant to provide the Participatory Agreement to a manager of the participant’s employers;
(4) Require the participant to participate in workplace monitoring;
(5) Require the participant to cause all workplace monitors to provide remediation and to send written progress reports regarding the participant’s progress to PIIP at specified intervals;
(6) Require the participant to submit a written personal progress report containing the information required by PIIP to PIIP at specified intervals; and
(7) Specify the terms and conditions the participant must meet to successfully complete the remediation, including the time frames for successfully completing both the educational intervention and workplace monitoring components of the remediation.

Generally, to comply with PIIP, the nurse will identify a nurse educator who will prepare an individualized course of study for the nurse. The course may include a series of written materials to review or a list of on-line continuing education courses that must be completed. The course of study is almost always tailored to the individual need of the nurse and generally does not require the nurse to return to complete coursework in a nursing school setting or to repeat an entire nursing course. The educator will generally meet individually with the nurse to evaluate their skills to determine if the deficiency in their practice has been remediated. In most instances, the nurse can complete the remedial education in a matter of weeks.

A PIIP participant can be terminated from PIIP for reasons including, but not limited to, the failure to: 1) comply with the Participatory Agreement; 2) progress through or successfully complete the educational intervention in the manner and time frame required; or 3) incorporate learned knowledge and skills into practice.

In addition to avoiding public discipline, a participant who successfully completes PIIP will not be reported to the National Council of State Boards of Nursing disciplinary data bank or the National Practitioner Data Bank (NPDB) unless the Nursing Board imposes disciplinary action against the participant.

As always, if you have a question about this post or the Ohio Board of Nursing in general, please feel free to contact one of the attorneys at the Collis Law Group LLC at 614-486-3909 or email me at



In our private practice of representing nurses before the Ohio Board of Nursing, we are often contacted by nurses who have entered into a Consent Agreement with the Nursing Board and who want to change the terms after the Consent Agreement has already been approved by the nurse and the Nursing Board.  Typically, however, a Consent Agreement which has been approved by the nurse and the Nursing Board is final and will not be renegotiated.

A Consent Agreement is a legally binding contract that a nurse may enter into with the Nursing Board to resolve a pending disciplinary matter.  For example, in some instances, a nurse will agree in the Consent Agreement to allow their license to be placed on suspension or on probation, and to be subject to various conditions, such as random drug screens or completion of CEUs in addition to CEUs required for license renewal.  The time to propose and negotiate changes to the Consent Agreement is before the Consent Agreement has been signed by the nurse and the Nursing Board.

While certain provisions in the Consent Agreement are considered by the Nursing Board to be non-negotiable, there are certain sections of the Consent Agreement which may be negotiated.  For example, information pertaining to completed treatment for impairment or other relevant evidence in support of the nurse’s defense may be negotiated to be included in the Consent Agreement.  Additionally, there are certain instances where the Board will negotiate the duration of a suspension or probation based on the evidence in the matter.

We are also contacted by nurses who have violated their Consent Agreement and want to attempt to negotiate more favorable or different terms with the Nursing Board.  Although there is a “standard” provision in most Consent Agreements permitting modification of the Consent Agreement upon the written agreement of the nurse and the Board, it is our general experience that the Nursing Board does not re-negotiate Consent Agreements.  For example, if a nurse is required to pay a $500 fine within 6 months of the Consent Agreement taking effect and the nurse fails to do so, it is our general experience that the Nursing Board will not agree to modify the terms of the Consent Agreement to require the nurse to pay a $250 fine instead. Similarly, if a nurse is required to submit to random drug screens for 1 year and tests positive for drugs – even on 1 screen – the Board will not modify the Consent Agreement to eliminate the random drug screening requirement.

Additionally, failure of a nurse to comply with the terms of the Consent Agreement generally results in the Nursing Board suspending the nurse’s license based on a violation of the Consent Agreement.  If the Board suspends the nurse’s license based on the nurse’s failure to comply with the terms of the Consent Agreement, the earliest the nurse could have their license reinstated would be at the Board meeting subsequent to the suspension, and, in certain instances, it can take longer.  In this regard, please note that the Nursing Board meets every other month.

Prior to entering into a Consent Agreement with the Nursing Board, it is important that you fully understand and agree to all terms and conditions of the Consent Agreement.  After the Consent Agreement is signed by the nurse and by the Nursing Board, the Consent Agreement is a legally binding contract between the nurse and the Nursing Board which is, generally, considered by the Nursing Board to be final and not subject to modification.

As always, if you have any questions about this post or about the Ohio Board of Nursing in general, please feel free to contact one of the attorneys at the Collis Law Group LLC at 614-486-3909 or email me at


Death and dying, from a nurse’s perspective

Since a close relative of mine passed away a little over a year ago, I have been fascinated with reading stories and articles related to end of life issues. So often in America, death and dying is a taboo subject that everyone dances around and which no one seems to be willing to openly and honestly discuss. As we are all going to die one day, I find it rather amazing that people really don’t want to discuss it.

Because I regularly represent nurses who are seeking initial licensure or are the subject of an investigation by the Ohio Board of Nursing, I was curious to see what type of training nurses receive related to end of life issues and how nurses deal with the death of their patients.

I recently came upon two books by a nurse, Theresa Brown, who is an oncology nurse from Pittsburgh, who addresses death and dying from a nurse’s perspective. In her recent book, The Shift, Brown follows the lives of four cancer patients over a 12 hour shift. Brown raises many important issues related to providing nursing care to patients in their homes, listening to patients and family members deal with their fears, and helping her patients deal with the inevitable future.

In her previous book, Critical Care, A New Nurse faces Death, Life and Everything in Between, Brown highlights her first year as a nurse. This book has been used by many nursing schools as part of their curriculum.

A story highlighting Brown and her books can be found on NPR at:

I highly encourage all nurses (and others interested in end of life issues) to listen to the NPR story and consider reading Brown’s books or other literature on end of life issues.

As always, if you have any questions about this post or the Ohio Board of Nursing in general, please feel free contact one of the attorneys at the Collis Law Group at 614-486-3909 or contact me at