220 nurses showed up

[pickledpepperRN]

http://sacramento.bizjournals.com/sacramento/stories/2004/01/19/story6.html

EXCLUSIVE REPORTS

From the January 16, 2004 print edition

Agency bogs down as nurses rush to register

Kathy Robertson

Staff Writer

With hospitals across the state scrambling to find enough workers to meet new nurse-to-patient ratios, a record 220 nurses showed up at the Bureau of Registered Nursing in the first week of January to get state approval.

Most were out-of-state nurses seeking temporary licenses. If appropriate credentials were sent ahead of time, most got what they wanted in a few hours.

Permanent licensing is another matter.

The wait time for that has grown to six weeks or more. Budget cuts at the state agency that licenses registered nurses reduced staff by 15 percent last year, creating a backlog of work at a time when demand for its services is at an all-time high.

"We don't want to be a bottleneck in the process, that's for sure, but we are having to do things a little different," said assistant executive officer Susan Brank. "Licenses are not issued as quickly as we'd like."

In October 2003 -- the last time the backlog was reviewed -- there were 2,100 applications pending. The oldest dated back five months.

The board's goal is to issue most permanent licenses in 10 days to two weeks, although complex cases can run three or four months, Brank said. Due to the backlog, the work now takes four to five weeks longer than usual.

A 60 percent increase in applications: Staff cuts are partly responsible for the delay. A big jump in demand is another.

A state agency within the California Department of Consumer Affairs, the board is charged with protecting the public by regulating the practice of almost 300,000 registered nurses in California. The board enforces laws relating to nursing education, licensure, practice and discipline.

There's been a 60.4 percent increase in applications in the last three years. The numbers swelled to 35,887 in the fiscal year ended June 2003, up from 22,372 in fiscal 1999, the year the nurse-to-patient ratio law was signed by former Gov. Gray Davis. Experienced out-of-state nurses can use temporary licenses for six months, but then they, too, have to get permanent certification.

The new staffing law, the first in the nation, kicked in Jan. 1 and affects all general acute-care hospitals in the state. When fully implemented in 2008, ratios will range from one nurse per patient in trauma units to one to every five patients in medical/surgery units.

It's a good problem, union says: The mandate comes amid a national nursing shortage, prompting hospitals to start new nursing programs, beat the bushes for temps or go outside the state -- and nation -- to find them.

Meanwhile, the state budget crisis prompted a staff reduction at the Bureau of Registered Nursing last year from 97 to 82. It remains unclear whether 2004 will bring more cuts.

"This affects hospitals across the state," said Dorel Harms, vice president for professional services at the California Healthcare Association, a hospital trade group. "It's a sign of the times, these budget cuts, but it's coming at a time when we need as many nurses as possible."

"Frankly, we think this is a good problem to have," countered Donna Gerber, legislative director for the California Nurses Association, the union that sponsored the new ratio law.

The union has argued for years that the nursing shortage stems from poor working conditions in California hospitals and that improved conditions will attract nurses back to the market.

"The nurse-patient ratios are a critical vehicle in bringing more nurses to California," Gerber said. "We are aware of the budget cuts last year, but the executive director assured us that staff was working overtime and other changes were made to help reduce the backlog."

The licensing unit, which typically responds to 1,500 phone calls a week, cut back its phone hours to spend more time processing back applications.

The board lost three of its 10 nursing education consultant positions. These nurses respond to nurse practice questions, analyze complaints, regulate nursing school programs and evaluate proposals for new programs.

To cope with rising demand and fewer staff, the board gives top priority to enforcement and now refers more calls to the "frequently asked questions" section at http://www.rn.ca.gov, its Web site.

The agency also suspended its quarterly newsletter, which costs $75,000 to $100,000 to print and mail.

State borrows from agency: Ironically, the Board of Registered Nursing is self-supporting. Funding for its $16.7 million budget this year comes from license and other application fees, but the state budget crisis is so bad that all state agencies have been hit.

The state has dipped into the coffers of many "special fund" agencies to offset the budget deficit. It "borrowed" $12 million from the board last year. Repayment is promised; when remains unclear. The reserve fund is projected to be down to $6.49 million by June, for a 4.7-month operating reserve, Brank said.

Meanwhile, demand on the agency is up in all areas, not just applications.

Complaints rose 41 percent in fiscal 2003, while formal enforcement accusations jumped 77 percent. Total licensee discipline declined 44 percent, but much of that was due to cuts and delays at the state Attorney General's office, the agency that investigates the cases, Brank said.

Efforts to reduce the backlog there spurred a jump in action late last year. Overall, discipline (disciplinary actions?) is projected to rise 166 percent this year.

"We recognize it's important for the public and consumers to do these things in a timely way," Brank said. "We can contribute to the economic recovery of the state because nurses are needed, most make at least $45,000 a year and we typically process 1,600 licenses a month."

At that rate, one month's delay in licensing translates into $6 million in lost wages.