Nursing Boards: Protect the Public or Organizations?

[dlatimer]

Purpose of State Boards: Protect the Public or Organizations?

I was recently introduced to a problem a nurse had with their State Board of Nursing and their employer, a hospital. The nurse was placed on probation after self-reporting they had sought and received treatment for alcohol addiction. Since then this nurse has been unable to find work. The conditions of probation exclude many places to work and limited to hospitals, doctor's offices and nursing homes. In several instances the hospital was interested in employing this nurse, but had a policy to not hire nurses on probation. The nurse informed the Nursing Board of this situation and was told 'We don't have any control over the hospitals.'

After pondering the situation, I wondered if that was true. Hospitals are the main source of complaints to the Nursing Boards. Therefore they must have some relationship with them. To reinforce that concern an article in the February, March, April issue of the Nursing Board's Newsletter entitled Reporting Final Disciplinary Actions. Two things caught my attention when reading this article. 1) Hospitals and ambulatory surgical centers were mandated to report. Wouldn't that constitute a working relationship? 2) A list of types of incidents that don't require a report to the board. That list is:

Rudeness

Tardiness

Absenteeism

No call no show

Personality Conflicts

Employees not being a good fit for the organization based on personal beliefs and values.

Time card violations

The stated purpose of the article was to inform the newer mandated reporters and limit the unnecessary complaints.

I don't mean to read too much into this, but does this imply these were 'incidents' that are no longer investigated by the board?

Especially personality conflicts and employees not being a good fit for the organization based on personal beliefs and values. I only mention these because it is well known that many health care institutions are 'for-profit' and their goals are to increase shareholder value which may not be shared by the nurse committed to more humanistic values. Such as 'what is best for the patient' which may not coincide with 'what is best for the organization'.

Recent nurse polls have indicated a majority of nurses are dissatisfied with working conditions. That said, they may not be performing at peak performance. I don't know about you, but when I or my loved one is under the care of a nurse - I would like that nurse to be at peak performance. Pride in workmanship is universally recognized as a good indicator of job performance. If a nurse can have pride in their work, then they do a better job.

As the nursing shortage continues in most parts of the country does this effect the number of nurses who leave nursing? The Nursing Board is mandated in most states to be the public protector. Are they relying too much on organizations for their disciplinary reporting that may not have the public good in mind? If so that would explain why the US health system is ranked lower in quality and higher in cost than many other world health systems. Maybe it is time Nursing Boards review their disciplinary procedures so there is no conflict of interest regarding their stated purpose.

[Bobylon]

Am assuming that by "nursing shortage," you mean in terms of staffing/employed nurses.... there are a LOT of nurses in this country ... the "shortage" in the workplace can only be blamed on the employer...mine included.

[elkpark]

A) It's certainly not clear that there is a "nursing shortage" in the US at this time.

B) The fact that hospitals are "mandated reporters" doesn't imply that there is a "working relationship" between hospitals and the BONs, which regulate nursing practice, not hospitals. I am a mandated reporter of child or elder abuse, as an RN, but that certainly doesn't mean there is any "working relationship" between myself and the local or state DSS.

C) My take on the list of "incidents that don't require a report to the board" listed above is that they are general employee issues/concerns, not issues related specifically to nursing practice. IMO, the BON is supporting nurses (somewhat) by letting employers know that they are not in the business of regulating typical employer/employee conflicts which have nothing to do with public safety, only issues/concerns that specifically involve licensed nursing practice and safety. People post here periodically about employers threatening them that if they call in sick too often, come in late, etc., the employer will report them to the Board. This (list) is one example of a Board going on record as saying they are not concerned with those kind of complaints about nurses, and employers needn't bother bringing those kind of issues to their attention.

Beyond those few observations, I'm not sure I'm understanding what larger point you're trying to make. Are you suggesting that BONs should be in the business of enforcing good employment/working conditions for nurses because that will make the public safer? The idea that nurses would do a better job in situations where they are happy about their working conditions doesn't mean that nurses are necessarily unsafe in a setting where they're not particularly happy about their working conditions (and the BON is in the business of enforcing/regulating safe practice, not "peak performance" -- thank goodness! That's not a standard I would want to be held to every working day ...). We're legally and ethically responsible for providing safe, competent care any time and place that we work, regardless of the working conditions or how happy we are with a particular job. Also, IMO, nurses are independent adults and professionals who are capable of making their own decisions about whether the conditions and compensation offered by a particular employer are acceptable to them, and finding an employer that does offer satisfactory working conditions and compensation.

The BONs are mandated to regulate the practice of nursing in their respective states, and (appropriately, IMO) have no authority to regulate healthcare employers beyond regulating nursing practice. If I'm misunderstanding your point, I apologize and would be happy to hear more about what you're trying to say.

[dlatimer]

Nursing Shortage resources: http://www.aacn.nche.edu/media/FactSheets/NursingShortage.htm

The statements below are from AACN Nursing Shortage Fact Sheet, April 2011.

According to a report released by the American Hospital Association in July 2007, U.S. hospitals need approximately 116,000 RNs to fill vacant positions nationwide. This translates into a national RN vacancy rate of 8.1%. The report, titled The 2007 State of America's Hospitals - Taking the Pulse, also found that 44% of hospital CEOs had more difficulty recruiting RNs in 2006 than in 2005.

In July 2010, the Tri-Council for Nursing released a joint statement on Recent Registered Nurse Supply and Demand Projections, which cautioned stakeholders about declaring an end to the nursing shortage. The downturn in the economy has lead to an easing of the shortage in many parts of the country, a recent development most analysts believe to be temporary. In the joint statement, the Tri-Council raises serious concerns about slowing the production of RNs given the projected demand for nursing services, particularly in light of healthcare reform. See http://www.aacn.nche.edu/Media/NewsReleases/2010/tricouncil.html

The American Association of Colleges of Nursing (AACN) is concerned about the shortage of Registered Nurses (RNs) and is working with schools, policy makers, kindred organizations, and the media to bring attention to this health care crisis. AACN is working to enact legislation, identify strategies, and form collaborations to address the nursing shortage. To keep stakeholders abreast of current statistics related to the shortage, this fact sheet has been developed along with a companion Web resource.

I agree that it the employers who don't hire needed nurses. More on that later.

[dlatimer]

Sorry I wasn't clear. To summarized: Bad staffing conditions result in poor patient outcome. Who regulates that staffing levels are adequate? Nurses risk their jobs when they demand/stand up for better staffing. JCAHO is paid by the hospitals. Is this similar to the financial meltdown? The financial institutions were paying S&P, Moodys for favorable ratings on their products.

[elkpark]

Sorry I wasn't clear. To summarized: Bad staffing conditions result in poor patient outcome. Who regulates that staffing levels are adequate? Nurses risk their jobs when they demand/stand up for better staffing. JCAHO is paid by the hospitals. Is this similar to the financial meltdown? The financial institutions were paying S&P, Moodys for favorable ratings on their products.

CA is the only state that has mandated client:staff ratios through legislation -- which was passed by the state legislature. Joint Commission is an entirely different matter from the state BONs -- is it BONs or Joint Commission with which you have a beef?

There are a bunch of existing threads here kvetching about Joint Commission if you're interested in what's already been discussed.

In my own experience as a hospital surveyor for my state and the Feds, there are no Federal or state (in any state other than CA) rules that mandate specific staff ratios -- however, there are rules that specify that facilities must provide staff sufficient to provide safe, appropriate care to clients, and, if that doesn't happen and there is some kind of bad outcome or complaint, facilities can get cited and penalized for that. But no one comes in in advance and looks at staffing levels. And all the state and Federal healthcare rules are focused on the care provided to clients, not working conditions for the staff. That falls under the aegis of the state and Federal departments of labor and OSHAs.

Just speaking hypothetically, it would make the most sense, IMO, for the state healthcare licensing agencies to regulate/mandate staffing conditions, if anyone is going to, since they regulate agencies/facilities rather than individual healthcare occupations -- however, again, those agencies operate under the direction of the state legislatures, most (all?) of which are v. friendly and agreeable toward big business, inc. healthcare businesses (and the current trend is clearly to become more business-friendly, not less). They're not in a big hurry to make life more difficult for healthcare executives by making life better for individual nurses. God bless free enterprise and the free market, right???????

[CrunchRN, ADN, RN]

You lost me after stating there was a nursing shortage........ I don't care what those references say...there isn't and will not be for a very long time.

[misesguy]

Whenever there are government mandated licenses that one needs to receive in order to work there will always be a surplus of unemployed nurses or really any occupation that is licensed. Its the natural effect of such practices. Employers have direct decision making on hiring in their business, but ends where their sphere of influence ends. Meanwhile, a governmental license blankets the entire market and makes it extremely hard to find productive work if one does not have the "privilege". One may argue that these restrictions and regulations are necessary, but the natural by product is a shortage of workers compared to what would have been.