loading gif icon


Article Review: An Alternative Approach to Remediation Implemented by the Texas Board of Nursing


  • Personalized nurse remediation plans dramatically decrease the time needed to get a nurse back to safe independent practice compared to traditional remediation.
  • Personalized assessments identified 26% of nurses who met all core competencies and were able to complete the remediation without an individualized education plan.
  • No nurses who completed the personalized nurse remediation had another nursing practice violation within 2 years, similar to the standard approach to remediation.


How can we improve nursing practice breakdown remediation, and get safe, well trained nurses back into the workforce? Recently published in the Journal of Nursing Regulation, the Addressing Nursing Practice Breakdown: An Alternative Approach to Remediation article aims to examine the effectiveness of an alternative approach to traditional nursing practice breakdown remediation.

The article presents the results of a pilot study assessing the Knowledge, Skills, Training, Assessment, and Research (KSTAR) program, as well as two case studies of nurses who successfully completed the program. Although this pilot study is the first presentation of such a remediation program for nurses, preliminary results suggest that it is equally as effective at preventing repeated practice breakdowns as the traditional method and leads to quicker returns to independent practice.

Summary of Findings

  1. Nursing practice breakdowns pose a serious threat to safe healthcare delivery. In order to retain licensure after a violation occurs, nurses are required to take remedial education and supervised practice before return to independent work. The Texas Board of Nursing partnered with Texas A&M Rural and Community Health Institute and College of Nursing to create an alternative approach to nurse remediation known as KSTAR. KSTAR provides an individualized approach for nursing remediation for nurses who have had a nursing practice breakdown. It is different from traditional remediation programs in that it contains a personalized assessment in order to identify gaps in knowledge and develop a specific remediation plan.
  2. The article clearly defines each of the components of the program which includes: a 6-hour nursing jurisprudence and ethics course, an initial assessment of the nurses’ knowledge and skills, an individualized education plan (IEP), a final assessment, and focused remediation. The article also reports case studies for two individual nurses to demonstrate how each component of the program was implemented in practice to create a personalized and effective approach to nurse remediation. The article also reports the overall results of the 53 nurses who chose to participate in the KSTAR program.
  3. Results from the pilot show that 92% of the nurses who participated in the pilot KSTAR program successfully completed it. After the initial assessment 26% of nurses demonstrated competency and did not require an IEP (Individualized Education Plan). A key indicator of the effectiveness of a program is the number of nurses who have a subsequent nursing practice breakdown after completing the program. The 49 nurses who completed the KSTAR program were compared to 82 nurses who completed the traditional remediation. There were no significant differences found between the groups after two years of follow up. No nurses from the KSTAR group had a subsequent nursing practice breakdown and only 1 of the 82 nurses who completed the traditional remediation had a subsequent nursing practice breakdown.


The KSTAR program is innovative in that is uses a personalized approach to remediation compared to traditional approaches. While traditional approaches base each nurse’s remediation on the type of practice breakdown that occurred, the KSTAR program uses assessments to identify gaps in knowledge and skills that may have led to the practice breakdown. This ensures that each nurse’s remediation is specific to the knowledge and skills needed for that individual.

Limitations of the study include a small sample size and lack of randomization, which are common for pilot studies. However, despite these limitations the preliminary results are quite encouraging, and it will be interesting to see if the similarities in recidivism rates between the KSTAR and control group are maintained 5 years later. While this is the first program of its kind in nurses, assessment driven remediation has also been studied in doctors with similar positive effects.1 In combination, these studies suggest that personalized assessment driven remediation is a valid alternative to traditional remediation approaches.

This article advances knowledge in the field in several ways. This pilot program provides evidence that an alternative nurse remediation program is as effective in preventing recidivism as the traditional approach. Further, it suggests that personalized assessments as a part of nurse remediation can dramatically reduce the time needed for a nurse to return to safe independent practice. Finally, personalized assessments can help identify nurses who may not need an individualized education plan, highlighting which nurses may be ready to go back to independent practice sooner than others.

Read the full article here

Role of Relias

Relias Assessments played a vital role in both the initial and final assessment of the nurses’ knowledge and skills. The assessment is assigned based on the nurse’s area of practice and was used to identify competency gaps using benchmarks from national data and provide insight into knowledge gaps and personalize curriculum for each nurse.

Learn more about how Relias Assessments assists healthcare organizations in assessing competencies and personalizing learning.



1. Lillis S, Takai N, Francis S. Long-term outcomes of a remedial education program for doctors with clinical performance deficits. J Contin Educ Health Prof. 2014;34(2):96-101.

Connect with Us

to find out more about our training and resources

Request Demo