OKLAHOMA BOARD OF NURSING PERFORMANCE AUDIT FOR THE PERIOD JANUARY 1, 2007 THROUGH JUNE 30, Oklahoma State Auditor & Inspector

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1 OKLAHOMA BOARD OF NURSING FOR THE PERIOD JANUARY 1, 2007 THROUGH JUNE 30, 2009 PERFORMANCE AUDIT Oklahma State Auditr & Inspectr

2 Audit Reprt f the Oklahma Bard f Nursing Fr the Perid January 1, 2007 thrugh June 30, 2009 This publicatin is printed and issued by the State Auditr and Inspectr, as required by 74 O.S Pursuant t 74 O.S. 3105, 14 cpies have been prepared and distributed at a cst f $ Cpies have been depsited with the Publicatins Clearinghuse f the Oklahma Department f Libraries.

3 January 19, 2010 TO THE OKLAHOMA BOARD OF NURSING This is the audit reprt f the Oklahma Bard f Nursing fr the perid January 1, 2007 thrugh June 30, The Office f the State Auditr and Inspectr is cmmitted t serving the public interest by prviding independent versight and by issuing reprts that serve as a management tl t the State. Our gal is t ensure a gvernment that is accuntable t the peple f the State f Oklahma. We wish t take this pprtunity t express ur appreciatin t the agency s staff fr the assistance and cperatin extended t ur ffice during the curse f ur engagement. Sincerely, STEVE BURRAGE, CPA STATE AUDITOR & INSPECTOR

4 Oklahma Bard f Nursing Perfrmance Audit Agency Backgrund The Oklahma Bard f Nursing (Agency) was established t safeguard the public health and welfare f the residents f Oklahma by ensuring that any persn wh practices r ffers t practice registered nursing, practical nursing, r advanced practice nursing in this state is cmpetent t d s. This is accmplished thrugh the regulatin f nursing licensure, unlicensed assistance certificatin, nursing practice and nursing educatin. Oversight is prvided by 11 bard members (Bard) appinted by the gvernr serving five-year terms (the tw public members serve the same term as the gvernr). Bard members are: Francene Weatherby, RN, PhD, CNE... President Elizabeth Schultz, RN, CRNA... Vice-President Linda Cyer, LPN... Secretary- Treasurer Lauri Jnes, RN... Member Nettie Seale, RN, M.Ed.... Member Liz Michael, RN, MS, NEA-BC... Member Jni Jeter, RN, MS... Member Linda Martin, LPN... Member Jean Winter, LPN... Member June Cash, M.Ed.,... Public Member MaryJac Rauh, MPH... Public Member Table 1 summarizes the Agency s surces and uses f funds fr fiscal years 2008 and 2009 (July 1, 2007 thrugh June 30, 2009). Table 1 - Surces and Uses f Funds fr FY 2008 and FY Surces: Nurse License Fee $ 2,536,198 $ 2,705,861 Other Fines, Frfeits, and Penalties 194, ,294 Ttal Surces $ 2,730,625 $ 2,908,155 Uses: Persnnel Services $ 1,744,355 $ 1,702,714 Prfessinal Services 229, ,474 Travel 56,058 58,534 Miscellaneus Administrative Expenses 172, ,425 Rent Expense 64,340 67,278 Maintenance Repair and Expense 53,691 37,200 General Operating Expenses 25,556 27,199 Office Furniture and Equipment 86, ,298 Other 4,907 5,393 Ttal Uses $ 2,438,647 $ 2,607,515 Surce: Oklahma PepleSft accunting system (unaudited, fr infrmatinal purpses nly) 1

5 Oklahma Bard f Nursing Perfrmance Audit Purpse, Scpe, and Sample Methdlgy This audit was cnducted in respnse t 74 O.S. 212, which requires the State Auditr and Inspectr s Office t audit the bks and accunts f state fficers whse duty it is t cllect, disburse r manage funds f the state and 74 O.S B. regarding a request frm an executive directr t cnduct a perfrmance audit. The audit perid cvered fr bjective 1 was January 1, 2007 thrugh June 30, 2009 while bjectives 2, 3, and 4 addressed July 1, 2008 thrugh June 30, We selected ur samples in such a way that whenever pssible, the samples are representative f the ppulatins and prvide sufficient evidential matter. Sample methdlgies can vary and are selected based n the audit bjective and whether the ttal ppulatin f data was available. Randm sampling is the preferred methd; hwever, we may als use haphazard sampling (a methdlgy that prduces a representative selectin fr nn-statistical sampling), r judgmental selectin when data limitatin prevents the use f the ther tw methds. We identified specific attributes fr testing each f the samples. When apprpriate, we prjected ur results t that ppulatin. We cnducted this perfrmance audit in accrdance with generally accepted gvernment auditing standards. Thse standards require that we plan and perfrm the audit t btain sufficient, apprpriate evidence t prvide a reasnable basis fr ur findings and cnclusins based n ur audit bjectives. We believe that the evidence btained prvides a reasnable basis fr ur findings and cnclusins based n ur audit bjectives. This reprt is a public dcument pursuant t the Oklahma Open Recrds Act (51 O.S. 24A.1 et seq.), and shall be pen t any persn fr inspectin and cpying. Objective 1 - Determine if the Agency s internal cntrls prvide reasnable assurance that revenues and expenditures were accurately reprted in the accunting recrds and if financial peratins cmplied with 62 O.S. 211 and 74 O.S Cnclusin The Agency s internal cntrls prvide reasnable assurance that revenues and expenditures were accurately reprted in the accunting recrds. Cmpliance prcedures were perfrmed with regards t tw laws: With respect t the mnths tested, the Agency appears t be in cmpliance with 74 O.S limitatin f the executive directr s salary; The Agency appears t be in cmpliance with 62 O.S % transfer f all fees charged, cllected, and received t the state general revenue fund. Methdlgy T accmplish ur bjective, we perfrmed the fllwing: Dcumented internal cntrls related t the receipting and expenditure prcesses which included discussins with Agency persnnel, bservatin, and review f dcuments; Tested cntrls which included: Discussing with persnnel and bserving the lcatin where funds are retained prir t depsit t ensure they are adequately safeguarded as required by 62 O.S. 7.1.C.2.a; 1 Since prcedures in the peer assistance prgram have been mdified ver time, it was determined that fiscal year 2009 wuld be the mst apprpriate time perid t review fr bjectives 2, 3, and 4. 2

6 Oklahma Bard f Nursing Perfrmance Audit Determining if the persn preparing the depsit is independent f the receipting prcess. This included randmly selecting 25 depsits t ensure the incme reprt and daily depsit reprt ttals frm the Agency s internal system agreed with the depsit slip amunt, the business manager s initials were present n the depsit slip, and the amunt n the depsit slip agreed with the amunt depsited n the State Treasurer s (OST) agency mnthly statement; Determining the Agency s clearing accunt was recnciled n a mnthly basis t the OST by smene independent f the cash receipting prcess; Reviewing a randm sample f three Office f State Finance (OSF) frm 011 recnciliatins t ensure the recnciliatins were reviewed by smene independent f the preparer, were mathematically accurate, agreed t supprting dcumentatin, and the recnciling items appeared reasnable; Reviewing a randm sample f three recnciliatins between the Agency s depsit recrds and OSF PepleSft depsit recrds t ensure the Agency s recrds were crrectly psted; Reviewing a randm sample f 25 expenditure claims frm the perid t determine if the purchase requisitin (as applicable), the purchase rder (as applicable), the packing slip (as applicable) and the invice were prperly apprved. Additinally, we ensured the invice supprted the payment, the invice was mathematically accurate, the crrect accunt cde was used, and the expenditure appeared reasnable given the Agency s missin; Determining if the persn receiving the warrants was independent f the psting and apprval prcess; and Reviewing three randmly selected mnths Peplesft six-digit expenditure reprts" fr vendr names which appeared unusual 2. Reviewed a PepleSft accunting system depsit reprt fr the audit perid t ensure funds are transferred frm the Agency s clearing accunt at least nce per mnth as required by 62 O.S E; Reviewed a randm selectin f six mnths payrll infrmatin in the PepleSft accunting system t ensure the executive directr s annual salary did nt exceed the maximum limit set frth in 74 O.S ; and Recalculated the amunt transferred t the state s general revenue fund during the audit perid t ensure 10% f all fees charged, cllected, and received by the Agency were transferred as required by 62 O.S Unusual was defined as a vendr name that was unfamiliar t the auditr r strange given the missin f the Agency. 3

7 Oklahma Bard f Nursing Perfrmance Audit Objective 2 - Determine whether the Agency s dcumentatin related t a nurse s participatin in the peer assistance prgram demnstrates the nurse cmplied with their prgram cntract and the Agency s plicies and prcedures. Objective Backgrund Under the guidance f 59 O.S , the Agency administers the peer assistance prgram (prgram). Nurses can vluntarily enter the prgram r can be required entry thrugh bard actin. Once accepted, the participant signs a cntract detailing specific requirements that must be met. The requirements include but are nt limited t: Attending a specified number f supprt grup meetings (alchlics annymus, narctics annymus, etc., and nurse supprt grups which include discussins with ther nurses in a similar situatin). Specific dcumentatin f attendance at these meetings is required mnthly as well as dcumentatin frm the participant s 12-step spnsr and nurse supprt grup facilitatr quarterly; Being randmly tested fr drugs and alchl. In rder t cmplete the prgram, the participant must have 24 cnsecutive mnths f negative drug tests; Attending cunseling sessins. The cunselr is required t submit a mnthly reprt t the Agency regarding the participant s prgress; Cmpleting self assessment reprts addressing hw the participant is prgressing in the prgram frm their perspective; and Wrking in the practice f nursing, as apprpriate. Supervised practice reprts are cmpleted by the participant s supervisr nce they have been allwed t resume wrking as a nurse. The participant s prgress is mnitred by a case manager, the prgram manager, and a peer assistance cmmittee 4. Nncmpliance with the cntract can result in additinal requirements being placed n the participant as well as terminatin frm the prgram. Cnclusin Methdlgy With respect t files tested, it appears the Agency has a mnitring system designed and perating t ensure the nurse cmplied with their prgram cntract and the Agency s plicies and prcedures. T accmplish ur bjective, we perfrmed the fllwing: Dcumented internal cntrls related t the bjective which included discussins with Agency persnnel, bservatin, and review f dcuments; Reviewed a randm sample f 25 participants files fr: A prgram applicatin; The initial interview frm; A signed cntract; The applicable number f supprt grup attendance recrds; 3 A. There is hereby established a peer assistance prgram t rehabilitate nurses whse cmpetency may be cmprmised because f the abuse f drugs r alchl, s that such nurses can be treated and can return t r cntinue the practice f nursing in a manner which will benefit the public... 4 Each vlunteer cmmittee must have at least three members, at least ne member wh is currently certified thrugh the Addictins Nursing Certificatin Bard, the Natinal Assciatin f Alchl and Drug Abuse Cunselr Certificatin Bard r the Oklahma Drug and Alchl Prfessinal Cunselr Certificatin Bard, at least ne recvering persn, and the majrity must be currently licensed nurses. 4

8 Oklahma Bard f Nursing Perfrmance Audit The applicable number f drug test results; Cunselr s reprts; The applicable number f self-assessment reprts; The applicable number f supervised practice reprts; and Evidence the case manager mnitred the participants prgress while in the prgram. Objective 3 Determine whether the Agency s plicies and prcedures (PAP-08 and Investigative Department Prcedures #Ip-08) ensure cmpliance with 59 O.S I. when a participant defaults frm the prgram. Cnclusin Methdlgy With respect t files tested, it appears the Agency s plicies and prcedures ensure cmpliance with 59 O.S I 5. T accmplish ur bjective, we perfrmed the fllwing: Dcumented internal cntrls related t the bjective which included discussins with Agency persnnel, bservatin, and review f dcuments; Reviewed a randm sample f 15 participants files wh terminated during the perid July 1, 2008 thrugh June 30, 2009 fr the fllwing: A ntificatin letter was sent t the participant stating they are terminated frm the prgram; If terminated by the peer assistance cmmittee, we determined the cntract was mdified and the letter prvided t the participant was sent t the investigatins divisin f the Agency, the executive directr (vlunteer entry nly), emplyer (if applicable), nurse supprt grup facilitatr (if applicable), and cunselr (if applicable); A letter frm the executive directr t the participant stating the license was suspended (vlunteer entry) r a letter frm the investigatins divisin stating the license was revked (Bard actin) as a result f defaulting frm the prgram; and The license was revked/suspended n the Agency s website. Determined the number f wrkdays between the participant terminatin date and the license suspensin/revked date n the Agency s website. This was determined t be an average f three days. Objective 4 Determine whether the Bard f Nursing is satisfied with the quality and quantity f prgram related infrmatin prvided t them by the Agency. Cnclusin Based n review f survey respnses frm Bard members, bservatins made at the September 23, 2009 Bard meeting, and review f Bard meeting minutes frm fiscal year 2009, it appears the Bard is satisfied with the quality and quantity f prgram related infrmatin prvided t them by the Agency O.S I states, The Executive Directr f the Bard shall suspend the license immediately upn ntificatin that the licensee has defaulted frm the peer assistance prgram, and shall assign a hearing date fr the matter t be presented t the Bard. On average, three wrkdays passed between when the participant was terminated frm the prgram and when their license was suspended/revked n the Agency s website. Based n prfessinal judgment and discussins with management, this time perid appears reasnable given the intent f this law. 5

9 Oklahma Bard f Nursing Perfrmance Audit Methdlgy T accmplish ur bjective, we perfrmed the fllwing: Interviewed the prgram manager and executive directr; Reviewed the Bard s meeting minutes fr fiscal year 2009 t determine what, if any, infrmatin related t the prgram is discussed by the Bard and acted upn, if applicable; Sent a survey t Bard members asking them questins related t the quantity and quality f prgram related infrmatin prvided t them by the Agency; and Attended the September 23, 2009 Bard meeting. 6

10 OFFICE OF THE STATE AUDITOR AND INSPECTOR 2300 N. LINCOLN BOULEVARD, ROOM 100 OKLAHOMA CITY, OK

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