Credentialing bodies exist in a unique place between professionals, employers, government/regulators, consumers and the public. The trust from these interested parties requires a commitment to set and maintain the highest standards for their programs. This includes an obligation to hold certificants accountable to requirements, professional conduct codes and other expectations for holding a given credential (Certification: The I.C.E. Handbook, 3^rd Ed, pgs 71-80).

The Oncology Nursing Certification Corporation (ONCC) has more than 45,000 active certifications and 56,000 certificates of added qualification in high stakes oncology nursing and related subspecialty practice. Our organization has observed a growing number of disciplinary cases arising from individuals seeking exceptions to established policies and certification requirements and/or experiencing increasingly complex professional and personal life events with potential impact on their credential. While acknowledging that unique circumstances occur, it was important that we explore ways to consistently apply standards and provide accountability with grace to maintain the integrity, fairness, and credibility of ONCC credentials.  

Both the National Commission for Certifying Agencies (NCCA) and the International Organization for Standardization (ISO) have requirements that address discipline, sanctions and appeals, with disciplinary actions in particular addressing a wide range of behaviors. When developing a disciplinary policy, the consequences should be considerate of the candidate population, profession and risk of harming the public with sanctions ranging from a simple notification of errant behavior to revocation of the credential. All policies, processes and means for appeal must ensure fairness, be legally defensible and be publicly available (Certification: The I.C.E. Handbook, 3^rd Ed, pgs 128-129, 151-152).

Revisiting Philosophy, Policies and Procedures

ONCC’s policies and procedures have been developed and refined over its 40-year history with the evolution of both its eight certification programs and the NCCA standards. In recent years, a philosophical rationale and decision rubric were created to guide consistency — but not predetermination — of sanctioning. The Discipline and Appeals Committees have increasingly encountered cases that aren’t addressed by the rubric, leaving the committees without adequate guidance. At the same time, ONCC anticipated an increase in cases related to expired licensure as a result of integrating with a national nurse licensure database. With these factors in mind, it was time for an in-depth review and overhaul of the discipline and sanction procedures.

As such, a year-long discovery process was undertaken that included the review of policies from seven sister certification boards, CLEAR publications and conferences, and information from I.C.E along with working groups of the ONCC Board of Directors, legal counsel, the Citizens Advocacy Center, ONCC staff and multiple generative discussions at the board level.

The intention was to update and expand ONCC policies and procedures to:

1. Create more flexibility in the system and sanctions to address myriad new disciplinary situations.
2. Allow greater efficiency in managing discipline cases providing better service to candidates/certificants while properly leveraging staff and volunteer resources.
3. Revise policies and our guidance rubric as needed.

Based on board discussions, we first sought to create a “Just Culture” environment (The Just Culture Company – www.justculture.com). A Just Culture environment balances accountability and learning by distinguishing between human error, at-risk behavior, and reckless behavior—encouraging reporting and improvement while holding individuals and organizations appropriately responsible for their choices.

We used the following guidelines to reframe our approach to sanctions:

• Avoid a risk management or negative outcome approach: Judge the quality of choices and decisions versus the triumph or tragedy of the outcomes.
• Remove severity bias and double jeopardy: Evaluate each case on its own merits, ensure fairness and consistency without being too harsh or too lenient, and safeguard against unnecessarily sanctioning when sanction has already been delivered by another authority
• Avoid disciplinary sanction as de facto response to human errors: People make mistakes. Where can you provide grace? Where must you “hold the line” to ensure fairness and consistency for all certificants, ensure accountability to program expectations, and safeguard patient care and the public?

We then developed new policies, procedures and sanction options to achieve our desired goals:

1. Transitioning from sending “allegation letters” to sending “notifications” to de-escalate from the start.
2. Adding a succinct summary of the adjudication process to our policies for greater clarity and understanding of applicants/candidates.
3. Including a new policy to ensure unique evaluation of each instance and to prevent double-jeopardy between ONCC and state licensing board action.
4. Creating new sanction types for greater flexibility to address a variety of situations, including “letter of private reprimand,” “letter of censure,” and “other actions” (e.g., required continuing education on a specific topic).
5. Adding new procedures on grounds for action, including staff-implemented automatic suspension in specific situations (such as RN/APRN licensure encumbrance which immediately suspends ONCC certification).
6. Clarifying policies on sanctions duration, allowing for sanctions termination once the issue has been remedied, after a specific period, and/or until the certification expires.

Next Steps and Lessons Learned

The new policies have been approved by the ONCC Board of Directors pending the completion of internal steps to operationalize them. Next steps for our effort include:

• Update rubric: This guidance document must be expanded to include the new discipline situation types, the new sanction options and related past cases.
• Legal review: Counsel will again review all new policies, rubric and related documentation.
• Operationalize: Put new procedures into action with staff and the Discipline Committee.

This project resulted in several scenarios that may be worth consideration by other credentialing boards and the industry:

1. Expectations for disciplinary activities and policies have changed. If your organization’s policies and procedures have not been reviewed thoroughly in the last few years, it’s likely time for a deep dive.
2. There is a fair amount of content in our profession on discipline, appeals, and sanctions but it is broadly disbursed. You must review many different chapters/sources and request samples from peers to get robust information. However, a single source might be helpful initallly to those engaging in this type of project in the future.

Striking the right balance between accountability, fairness, consistency, and grace is a delicate dance that requires continuous monitoring of trends and changes in legal and regulatory requirements, candidate and certificant expectations, and public interests. Credentialing bodies must practice and perform this dance with precision to meet the obligations we have with and to our candidates, certificants, employers, and the public.

References

Certification: The I.C.E. Handbook, 3^rd Ed

Franco, M., Professional and Ethical Codes of Conduct, pgs 71-80

Moore, J., Allen, C., and Gueorguieva, J., Policy and Procedures, pgs 127-157

The Just Culture Company – www.justculture.com

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