Chapter 4723-18 | Practice Intervention and Improvement Program (PIIP)

Rule 4723-18-01 | Definitions.

• Effective: February 1, 2019
• Promulgated Under: 119.03

As used in this chapter:

(A) "Certificate holder" means an individual holding a current, valid certificate issued by the board to provide dialysis care as a dialysis technician or dialysis technician intern.

(B) "Educational intervention" means the following:

(1) One or more learning activities that meet the requirements of rule 4723-18-06 of the Administrative Code, with content and objectives that address a participant's prescribed learning needs;

(2) An activity with content and objectives that meet a participant's prescribed learning needs provided by the participant's employer through a registered nurse who meets the qualifications set forth in rule 4723-18-06 of the Administrative Code.

(C) "Employer" means any person for whom a participant works, or may work in the future, or any institution that grants practice privileges enabling an individual to practice at the institution, while participating in the practice intervention and improvement program.

(D) "Licensee" means any individual holding a current valid license issued by the board to practice nursing as an advanced practice registered nurse, registered nurse or licensed practical nurse.

(E) "Participant" means a licensee or certificate holder undergoing a remedial process in the practice intervention and improvement program.

(F) "Participatory agreement" means a voluntary, written contract between an individual and the board's practice intervention and improvement program (PIIP) in which the board abstains from taking disciplinary action against the individual for violation of Chapter 4723. of the Revised Code and the individual agrees to be monitored by the board and remediated according to the terms and conditions of the program. The participatory agreement includes, but is not limited to, the following:

(1) Stipulation by the individual to one of more identified practice deficiencies;

(2) Agreement of the individual to completion of the remediation process required by the board;

(3) Authorization by the individual to the release of records and information to PIIP by employers, workplace monitors and other parties involved in the individual's remediation process; and

(4) Acknowledgment by the individual that their failure to comply with the terms and conditions of the participatory agreement will result in disciplinary action by the board.

(G) "Practice intervention and improvement program" or "PIIP" means the program authorized by section 4723.282 of the Revised Code that allows the board to abstain from taking disciplinary action against a licensee or certificate holder, who has a practice deficiency that has been identified by the board through an investigation conducted under section 4723.28 of the Revised Code.

(H) "Practice deficiency" means a practice activity that does not meet acceptable and prevailing standards of safe nursing care as set forth in Chapter 4723-4 of the Administrative Code, Chapter 4723-8 of the Administrative Code, Chapter 4723-9 of the Administrative Code, or the acceptable and prevailing standards of safe dialysis care set forth in Chapter 4723-23 of the Administrative Code.

(I) "Remediation" means a prescribed educational intervention that is designed to correct an individual's identified practice deficiency. Remediation includes, but is not limited to, successful demonstration by the individual that the learned knowledge and skills have been incorporated into the individual's practice.

(J) "Supervising member" means the board member elected to serve as the supervising member for disciplinary matters in accordance with section 4723.02 of the Revised Code.

(K) "Workplace monitor" means the individual who observes and evaluates, for a specified time period, the practice of a participant in PIIP to determine whether the participant has incorporated applicable learned knowledge and skills into workplace practice.

Last updated October 2, 2023 at 1:52 PM

Supplemental Information

Authorized By: 4723.282, ORC 4723.07
Amplifies: ORC 4723.282
Five Year Review Date: 10/2/2028
Prior Effective Dates: 2/1/2009

Rule 4723-18-02 | Process and criteria to use when identifying an individual's practice deficiency.

• Effective: February 1, 2014
• Promulgated Under: 119.03

(A) The board shall investigate, according to section 4723.28 of the Revised Code, evidence that appears to show that a licensee or certificate holder has failed to practice in accordance with acceptable and prevailing standards of safe care as set forth in Chapter 4723-4 of the Administrative Code, Chapter 4723-8 of the Administrative Code, Chapter 4723-9 of the Administrative Code, or Chapter 4723-23 of the Administrative Code.

(B) The supervising member shall review the evidence obtained during the investigation to determine whether the individual's identified practice deficiency can be corrected through participation in the practice intervention and improvement program (PIIP) rather than through formal disciplinary action. Criteria to use when making this determination include, but are not limited to, the following:

(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 or other untoward outcome for the patient;

(3) The likelihood that the identified practice deficiency at issue is a deficiency that can be corrected through remediation;

(4) The extent of the individual's cooperation with the board during the investigation;

(5) Whether the individual's identified practice deficiency represented an intentional or willful commission or omission by the individual;

(6) The frequency of the occurrence of the identified practice deficiency;

(7) The adverse impact of the identified practice deficiency on others;

(8) Whether the identified practice deficiency affected a particularly vulnerable patient;

(9) Whether the individual is eligible for participation in PIIP as specified in rule 4723-18-03 of the Administrative Code; and

(10) Whether the individual has a mental or physical impairment that contributed to the practice deficiency.

(C) When the supervising member has reason to believe, after an investigation and review of evidence, that the individual's identified practice deficiency can be successfully corrected through participation in PIIP, the board may abstain from taking disciplinary action provided the individual enters into an agreement with PIIP according to rule 4723-18-04 of the Administrative Code, complies with the terms and conditions of PIIP, and successfully completes PIIP.

Last updated October 2, 2023 at 1:52 PM

Supplemental Information

Authorized By: 4723.07, 4723.282
Amplifies: 4723.282
Five Year Review Date: 10/2/2028
Prior Effective Dates: 2/1/2001, 2/1/2007

Rule 4723-18-03 | Eligibility requirements for participation in the practice intervention and improvement program (PIIP).

• Effective: February 1, 2019
• Promulgated Under: 119.03

An individual may participate in the practice intervention and improvement program if the supervising member determines that the public will be adequately protected from unsafe practice if the individual enters PIIP, and:

(A) The individual has not been the subject of formal disciplinary action by any regulatory board or entity located in Ohio or in another jurisdiction, unless the supervising member determines that the previous disciplinary action was for a violation that should not preclude participation in PIIP;

(B) The individual is not concurrently under investigation by the board for a violation of Chapter 4723. of the Revised Code or the rules of the board that does not constitute a practice deficiency;

(C) The supervising member determines that the nature of the individual's identified practice deficiency is such that it may be corrected through remediation;

(D) The individual holds a current valid, license or certificate issued by the board;

(E) The individual is otherwise eligible to renew the license or certificate issued by the board;

(F) At the time of PIIP eligibility determination by the supervising member, the individual is working in a position in the state of Ohio, whether as an employee or contractor, that requires a nursing license, if the individual is a licensed nurse, or a dialysis technician certificate, if the individual is a dialysis technician; and

(G) The individual does not have any impairment as defined in rule 4723-3-02 of the Administrative Code.

Last updated October 2, 2023 at 1:52 PM

Supplemental Information

Authorized By: 4723.282, ORC 4723.07
Amplifies: ORC 4723.282
Five Year Review Date: 10/2/2028
Prior Effective Dates: 2/1/2001, 2/1/2002

Rule 4723-18-04 | Provisions of the participatory agreement for the practice intervention and improvement program (PIIP).

• Effective: February 1, 2024
• Promulgated Under: 119.03

(A) When an individual has been determined by the supervising member to be eligible for the practice intervention and improvement program, the individual shall execute a participatory agreement with PIIP that includes, but is not limited to, provisions that:

(1) Set forth the identified practice deficiencies;

(2) Identify the specific remediation including educational interventions the participant must complete;

(3) Specify the time frame for the participant to submit to PIIP copies of the educational intervention content and objectives that demonstrate it fulfills the prescribed education intervention requirements;

(4) Require the participant to pay all expenses the participant incurs as a result of the required remediation;

(5) Require the participant to provide the participatory agreement to a manager, or a person with administrative responsibilities equivalent to or higher than a manager, for all of the participant's employers or contracting entities with respect to which the participant provides nursing or dialysis care, and provide documentation to the board of the manager's receipt of the participatory agreement;

(6) Require a participant who is an advanced practice registered nurse to provide a copy of the participatory agreement to the following, and submit documentation to the board of their receipt:

(a) The credentialing body of each institution at which the licensee provides advanced practice registered nursing services or nursing care;

(b) Each collaborating physician with whom the licensee works as a clinical nurse specialist, certified nurse practitioner, or certified nurse midwife;

(7) Require the participant to participate in workplace monitoring;

(8) Require the participant to cooperate with any entity, including the educational provider and workplace monitor;

(9) Require the participant to cause all workplace monitors, selected according to paragraph (B) of rule 4723-18-08 of the Administrative Code, and educational providers, selected according to rule 4723-18-06 of the Administrative Code, to provide remediation and to send written progress reports regarding the participant's progress in remediation to PIIP at specified intervals;

(10) Require the participant to sign all waivers necessary to secure all reports required by PIIP;

(11) Require the participant to meet with a PIIP representative at specified intervals;

(12) Require the participant to obey all federal, state, and local laws, including all laws and rules regulating nursing practice or dialysis care in Ohio;

(13) Specify that the prescribed educational intervention cannot be used to satisfy the continuing education requirements set forth in Chapter 4723. of the Revised Code and the rules of the board;

(14) 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; and

(15) Set forth the grounds for termination from PIIP.

(B) An individual determined by the supervising member to be eligible for PIIP who refuses to enter into the participatory agreement set forth in this rule within the time frame specified by PIIP may be subject to disciplinary action according to section 4723.28 of the Revised Code.

Last updated February 1, 2024 at 9:34 AM

Supplemental Information

Authorized By: 4723.282, 4723.07
Amplifies: 4723.282
Five Year Review Date: 2/1/2029
Prior Effective Dates: 2/1/2001

Rule 4723-18-05 | Grounds for termination from the practice intervention and improvement program (PIIP).

• Effective: February 1, 2014
• Promulgated Under: 119.03

(A) A participant may be terminated from PIIP for any of the following:

(1) Failure to comply with any term of the participatory agreement entered into by the participant;

(2) Receipt of evidence from an employer educational intervention provider indicating that the participant has failed to progress through or to successfully complete the prescribed educational intervention in the manner and during the time frame prescribed by the supervising member;

(3) Receipt of evidence from the workplace monitor indicating that the participant has failed to incorporate learned knowledge and skills into practice or has continued to demonstrate the practice deficiency;

(4) Failure to complete the remediation including the educational intervention; or

(5) Failure to maintain eligibility for PIIP.

(B) When a licensee or certificate holder is terminated from PIIP for one of the reasons specified in paragraph (A) of this rule, the board shall proceed with disciplinary action according to section 4723.28 of the Revised Code. The board may consider an individual's termination from PIIP when determining the sanction to be imposed.

Last updated October 2, 2023 at 1:52 PM

Supplemental Information

Authorized By: 4723.07, 4723.282
Amplifies: 4723.282
Five Year Review Date: 10/2/2028
Prior Effective Dates: 2/1/2001

Rule 4723-18-06 | Requirements for educational intervention.

• Effective: February 1, 2019
• Promulgated Under: 119.03

(A) The practice intervention and improvement program shall utilize educational interventions that contain content and objectives that meet the participant's learning needs as prescribed by the supervising member.

(B) An educational intervention shall be one of the following:

(1) A continuing education activity that meets the requirements of Chapter 4723-14 of the Administrative Code;

(2) An activity conducted by a national certifying organization approved by the board according to section 4723.46 of the Revised Code;

(3) A course provided by a post-secondary educational institution that is approved, authorized or registered by the board, the Ohio department of higher education, the state board of career colleges and schools, or a substantially similar authorizing body in another jurisdiction, for which academic credit is awarded to the participant; or

(4) An activity that is provided by the participant's employer through an employed or contracted registered nurse who holds a master's degree and has at least two years experience in nursing education or adult education.

(C) According to section 4723.021 of the Revised Code, an entity that provides services related to remediation, including but not limited to a participant's educational intervention shall not be held liable in damages to any person as the result of any act, omission, proceeding, conduct, or decision related to official duties undertaken or performed pursuant to this chapter.

(D) Educational intervention shall not be used for purposes of satisfying the participant's continuing education requirements.

Last updated October 2, 2023 at 1:52 PM

Supplemental Information

Authorized By: 4723.282, ORC 4723.07
Amplifies: ORC 4723.282
Five Year Review Date: 10/2/2028
Prior Effective Dates: 2/1/2001

Rule 4723-18-07 | Standards and procedures for remediation.

• Effective: February 1, 2014
• Promulgated Under: 119.03

(A) An individual shall be notified in writing of a determination by the supervising member that their identified practice deficiency may be remediated through participation in the practice intervention and improvement program.

(B) In order to participate in PIIP, an eligible licensee or certificate holder shall enter into the participatory agreement set forth in rule 4723-18-04 of the Administrative Code.

(C) The participant shall notify PIIP in writing of the educational intervention selected within the time frame specified in the participatory agreement. The written notification shall include a copy of the learning activity's content and objectives that demonstrate it meets the prescribed educational intervention requirements.

(D) When the participant's educational intervention is provided by an employer through an employed or contracted registered nurse, the participant shall provide the registered nurse with a copy of the participatory agreement and provide PIIP with documentation of the registered nurse's receipt of the agreement.

(E) The participant shall provide documentation acceptable to PIIP that all educational interventions have been successfully completed within the specified timeframe.

(F) According to rule 4723-18-08 of the Administrative Code, PIIP shall establish workplace monitoring requirements that a participant must meet in order to demonstrate that the learned knowledge and skills have been incorporated into the participant's practice and shall notify the participant and the participant's workplace monitor in writing of these requirements.

(G) Upon receipt of evidence that the participant has failed to successfully complete the remediation, PIIP shall immediately notify the supervising member.

Last updated October 2, 2023 at 1:52 PM

Supplemental Information

Authorized By: 4723.07, 4723.282
Amplifies: 4723.282
Five Year Review Date: 10/2/2028
Prior Effective Dates: 2/1/2001

Rule 4723-18-08 | Standards and procedures for workplace monitoring.

• Effective: February 1, 2024
• Promulgated Under: 119.03

(A) A PIIP participant shall be monitored by PIIP to determine whether the participant satisfactorily demonstrates that the learned knowledge and skills have been incorporated into the participant's practice.

(B) A participant, in collaboration with his or her employer, shall identify one or more individuals who meet the requirements of paragraph (D) of this rule who will act as a workplace monitor of the participant's nursing or dialysis care.

(C) The workplace monitor shall:

(1) As directed by PIIP, observe specific aspects of the participant's practice at the intervals identified by PIIP;

(2) Evaluate specific aspects of the participant's practice and report to PIIP whether that practice, with respect to the identified practice deficiency, meets acceptable and prevailing standards of safe nursing care set forth in Chapter 4723-4 of the Administrative Code, Chapter 4723-8 of the Administrative Code or Chapter 4723-9 of the Administrative Code, or the acceptable and prevailing standards of safe dialysis care set forth in Chapter 4723-23 of the Administrative Code;

(3) Report the participant's progress in remediation to PIIP at the intervals required by PIIP; and

(4) Maintain the confidentiality of the participant's participation in PIIP and of all records associated with the participant's remediation.

(D) A workplace monitor shall meet the following requirements:

(1) When monitoring a licensed nurse the workplace monitor shall be a registered nurse with a current, valid license;

(2) When monitoring an advanced practice registered nurse, the workplace monitor shall be an advanced practice registered nurse with a current, valid license issued under section 4723.41 of the Revised Code, or a holder of a current, valid license issued under Chapter 4731. of the Revised Code to practice medicine and surgery or osteopathic medicine and surgery, or podiatric medicine and surgery;

(3) When monitoring a dialysis technician, the workplace monitor shall be a registered nurse with a current, valid license or a holder of a current, valid license issued under Chapter 4731. of the Revised Code to practice medicine and surgery or osteopathic medicine and surgery.

(E) In addition to meeting the requirements of paragraph (D) of this rule, a workplace monitor shall:

(1) Have no disciplinary action imposed on their license or certificate, or any disciplinary action with respect to a similar license or certificate issued by another jurisdiction;

(2) Be in a position that enables the monitor to directly observe the participant's clinical performance;

(3) Have a minimum of five years experience or less as approved by the Supervising Member as a registered nurse, advanced practice registered nurse, physician, or podiatrist; and

(4) Cooperate with the participant and PIIP to meet the requirements set forth in the participatory agreement entered into by the participant and PIIP.

(F) When the individual to be monitored is a licensed practical nurse, the workplace monitor may direct a licensed practical nurse to observe specific tasks related to the identified practice deficiency and to report those observations to the monitor.

(G) When the individual to be monitored is a dialysis technician or dialysis technician intern, the workplace monitor may direct an Ohio certified dialysis technician or licensed practical nurse to observe specific tasks related to the identified practice deficiency and to report those observations to the monitor.

(H) For purposes of providing the remediation directed by the supervising member, a workplace monitor shall be considered a representative of the board and, according to section 4723.021 of the Revised Code, shall not be held liable in damages to any person as the result of any act, omission, proceeding, conduct, or decision related to official duties undertaken or performed pursuant to this chapter.

Last updated February 8, 2024 at 1:24 PM

Supplemental Information

Authorized By: 4723.282, 4723.07
Amplifies: 4723.282
Five Year Review Date: 2/1/2029
Prior Effective Dates: 2/1/2001

Rule 4723-18-09 | Terms and conditions a participant must meet to successfully complete the practice intervention and improvement program (PIIP).

• Effective: February 1, 2019
• Promulgated Under: 119.03

(A) An individual eligible for the practice intervention and improvement program shall enter into a participatory agreement, as set forth in rule 4723-18-04 of the Administrative Code, and shall comply with all of the terms and conditions set forth in the agreement.

(B) A participant shall provide or cause to be provided all of the following to PIIP:

(1) Written verification acceptable to PIIP that the participant has successfully completed the educational intervention prescribed by the supervising member; and

(2) Written verification from a workplace monitor who meets the requirements set forth in rule 4723-18-08 of the Administrative Code that, at the time of verification with respect to the identified practice deficiency, the participant's practice meets the acceptable and prevailing standards of safe nursing care set forth in Chapter 4723-4 of the Administrative Code, Chapter 4723-8 of the Administrative Code, or Chapter 4723-9 of the Administrative Code, or the acceptable and prevailing standards of safe dialysis care set forth in Chapter 4723-23 of the Administrative Code.

(C) Upon receipt of the documents required by paragraph (B) of this rule, the supervising member shall review all information relevant to the participant's remediation to determine whether the participant's practice as a licensed nurse or dialysis technician meets the acceptable and prevailing standards of safe nursing care set forth in Chapter 4723-4 of the Administrative Code, Chapter 4723-8 of the Administrative Code, or Chapter 4723-9 of the Administrative Code, or the acceptable and prevailing standards of safe dialysis care set forth in Chapter 4723-23 of the Administrative Code.

(D) When the supervising member determines that the participant's identified practice deficiency has been sufficiently corrected so as to meet the acceptable and prevailing standards of safe care, the supervising member shall notify the participant in writing that remediation has been successfully completed and participation in PIIP is completed.

(E) When making a decision regarding disciplinary action for violations of Chapter 4723. of the Revised Code or the rules of the board, the board will be notified by written communication from board staff, marked as confidential according to division (D) of section 4723.282 of the Revised Code if the individual who is the subject of proposed board action previously successfully completed PIIP.

(F) A participant who successfully completes PIIP shall not be reported to the national council of state boards of nursing's disciplinary data bank or the federally mandated national practitioner database unless the board imposes disciplinary action against the participant.

(G) When the supervising member determines that remediation has not occurred or the participant has otherwise violated the terms and conditions of the participatory agreement, the board shall proceed with disciplinary action in accordance with section 4723.28 of the Revised Code.

Last updated October 2, 2023 at 1:52 PM

Supplemental Information

Authorized By: 4723.282, ORC 4723.07
Amplifies: ORC 4723.282
Five Year Review Date: 10/2/2028
Prior Effective Dates: 2/1/2004

Rule 4723-18-10 | Confidentiality of records for the practice intervention and improvement program (PIIP).

• Effective: February 1, 2014
• Promulgated Under: 119.03

(A) Information and records obtained by the practice intervention and improvement program pursuant to an investigation conducted in accordance with section 4723.28 of the Revised Code shall be confidential and are not public records pursuant to division (I) of section 4723.28 of the Revised Code.

(B) All records regarding an individual's participation in PIIP are confidential and are not public records pursuant to division (I) of section 4723.28 of the Revised Code and division (D) of section 4723.282 of the Revised Code.

(C) All employers providing educational intervention and workplace monitors selected to provide remediation by a participant in PIIP shall, as representatives of the board, maintain the confidentiality of all records regarding the participant's remediation.

(D) All PIIP records maintained by the board shall be kept in a secure storage area according to the board's record retention schedule.

(E) Notwithstanding paragraphs (A) and (B) of this rule, PIIP may prepare public reports setting forth in general terms statistical information regarding the program as requested by the board.

Last updated October 2, 2023 at 1:52 PM

Supplemental Information

Authorized By: 4723.07, 4723.282
Amplifies: 4723.282
Five Year Review Date: 10/2/2028
Prior Effective Dates: 2/1/2002