None of us is that shiny ideal prettied up nurse we see in those fluffy commercials on TV that tempt people into our profession….In fact, I’m kind of tired of seeing the same lame title given to nurses every year: “the most trusted profession in America.” Seriously? We all know why we shouldn’t be named that, or why we don’t deserve that honor. Florence Nightingale, may she rest in peace, would be scoffing and rolling her eyes in her grave right now. Because she knows better. In fact, Florence was quite the hell raiser herself. Never one to be silenced or disregarded. She had her “things” and we all have ours. It didn’t make her any less of a nurse, and one hell of a pioneer at that—but she made mistakes like the rest of us have, and will. The difference between then and now is fact she could learn from the mistakes made, study them, find ways to prevent them, and continue on with her mission, her calling—caring for people. None of us is perfect, especially now at a time where the practice of nurses and our control over it is rapidly unraveling…and our foundation—growing weak. Not only must we monitor those patients in our charge, keeping them alive another 12 hours, but we also have been forced to split our minds and souls in half because we ourselves have to be wary about the landmines all around us, or the quick sand ready to suck is down into the netherworld, everywhere we practice. It could be a doctor, another colleague, a nurse manager, an administrator, or even a patient who gets angry—that ends your career. I always wondered if this was the reason Florence Nightingale didn’t like the idea of hospitals or sequestering the ill and injured in one place like that. Perhaps she knew it wasn’t good for either the nurses or the ill. Im sure she wouldn’t have liked what Boards of Nursing have evolved into either.
Can anyone tell me why Arizona TV reporters seem more interested in putting a spotlight on just one regulatory board and not the others?
…..Especially because the very people who are hurting their colleagues and failing to put patients before politics have an RN after their name too. I did a little research into the Arizona Sunset Clause and the most recent Auditor General’s report (2011) on the Arizona Board of Nursing as I watched my favorite show “Criminal Minds” tonight, and I found some pretty interesting stuff that made me want to call up the Auditor General and say “Are we talking about the same board here?” Ever since I caught the quote made by then Board Member Kathy Malloch about 40% of all complaints received by the board never being opened it really bothered me, it stuck with me. From what I read in the Auditor General’s report it seems that the Board has the power to determine which complaints have no merit or do not meet criteria to follow up with an investigation. I disagree. Who makes that determination and what criteria must be met? Because, as per the Auditor general’s report, it states that complaints are opened when there is the presence of a violation of the nurse practice act. I gotta tell ya Mr. Auditor General, they pulled one over on you. Because that certainly isn’t happening here. The following are some of the findings and recommendations of the Arizona Auditor General pertaining to the overall performance of the Arizona Board of Nursing and his recommendations (you may see a link to the recommendations and a rise in the dismissals of cases and letters of concern……makes you think…..) I mean, it made me stop and ponder, why I read in the Board minutes that the investigation times are shrinking and more cases are being processed……Someone’s got some splainin’ to do—to the PUBLIC!
But first, some history on the Sunrise and Sunset Process in Arizona: “Established by Laws 1978, Chapter 210 Arizona’s sunset review process requires the Legislature to periodically review the purpose and functions of state agencies to determine whether continuation, revision, consolidation or termination is warranted. Sunset reviews are based on audits conducted by either the Office of the Auditor General (OAG) or a Committee of Reference (COR). Following the audit, a public hearing is held by the COR to discuss the audit and receive testimony from agency officials and the public.
Established by Laws 1985, Chapter 352, and expanded by Laws 2008, Chapter 132, Arizona’s sunrise process provides a mechanism for both health professions and nonhealth professions to request regulation and, for health professions, an expansion in scope of practice. The sunrise process begins when an applicant group presents the Joint Legislative Audit Committee (JLAC) with a report defining the need for regulation or scope of practice expansion. JLAC assigns the report to a COR for review and recommendation. The Joint Legislative Audit Committee “JLAC” is a 12-member committee consisting of 6 members from each chamber of the Legislature. Five members each are appointed by the President of the Senate and the Speaker of the House of Representatives based on the members’ understanding and interest in agency audits. JLAC membership includes an Appropriations Committee member from each chamber, and no more than three appointees from each chamber may be members of the same political party. Additionally, the President of the Senate and Speaker of the House of Representatives serve as ex-officio members. JLAC chairmanship alternates each year between the House and Senate. oversees all legislative and agency audit functions. Subject to legislative approval, JLAC appoints the Auditor General and directs all sunset, performance, special and financial audits and special research requests. JLAC is required to ensure that agencies comply with audit findings and recommendations and has legislative subpoena power.
In order to facilitate the sunrise and sunset process JLAC:
1) assigns agencies subject to sunset review to a COR; 2) assigns sunrise review applicants to a COR; 3) determines whether the OAG or a COR will conduct an agency’s sunset audit; 4) directs the OAG or a COR to conduct audits; 5) oversees the preparation and introduction of legislation to delay a sunset review if the OAG or a COR is unable to complete the review according to schedule; 6) directs the OAG or a COR to conduct performance audit follow-up reviews; 7) assigns COR chairmen (JLAC has the statutory authority to appoint COR chairmen, but traditionally the chairs are selected by standing committee chairmen when appointing the members); and 8) meets quarterly or on the call of the chairman.”
The May 2011 Auditor General’s Report Concerning the Arizona State Board of Nursing
“Complaint processing delays allow unsafe nurses to continue practicing—Delays in resolving complaints may permit unsafe nurses to continue to practice without needed oversight or limits on what they are allowed to do. In one substance abuse- related case, where a nurse allegedly used a patient’s medication and removed a patient’s emergency kit containing narcotics, it took the Board more than a year to resolve the case. The delay was attributed to difficulty contacting and getting responses back from the nurse, extending the investigation 2 months for a substance abuse evaluation, and waiting 5 months for the nurse to sign a consent agreement”
Rapid processing allows unsafe nurses to keep practicing! I can think of half a dozen instances over the past few years where nurses did worse than this and were given “Letters of Concern.” And yep, Mr. Auditor General, it could be your next nurse….
“Addressing three factors could improve investigation timeliness: (1) Substance abuse, psychological, and other board-ordered evaluations can prolong complaint investigations for 2 months or longer. If the Legislature gave the Board authority to allow its Executive Director to order such evaluations, as is the case with the Arizona Medical Board’s executive director, evaluations could be conducted earlier so the results could be considered when the Board first reviews the complaint investigation”
Oh she’s ordering them alright, but somehow all the right people aren’t getting them! Review the past board minutes Mr. Auditor General, and you’ll see what I mean. They get Letters of Concern too…..yup, right again, that could be YOUR next nurse. In fact, board ordered evaluations are actually on the rise and are taking up more investigative time. But somehow, the people who seem to really need them, are walking away back into the nursing world without them. Neat right?
“The Board investigates and resolves complaints involving violations of board statutes and rules, such as any conduct or practice that is or might be harmful or dangerous to the health of a patient or the public. The Board has an approved policy and guidelines used by board staff to determine whether to open a complaint upon receiving an allegation that a nurse or CNA violated a provision of the board statutes or rules, when a criminal background check or review of discipline history in another state indicates that such a violation occurred, or when an applicant for licensure or renewal self-reports such an act. After board staff determine that the allegations meet criteria to open a complaint, the complaint is sent through the Board’s triage process. Triage includes assessing the risk of the complaint allegation and determining priority based on concern for public safety (see textbox); subpoenaing initial information such as employment records, the involved patient’s medical records, and other documents; sending notification to the subject of the complaint; and assigning an investigator. In fiscal year 2010, the Board opened more than 1,600 complaints.
Following triage, board staff investigate the complaint allegations and prepare an investigative report that is used by the Board to deteremine whether to dismiss the complaint or issue a nondisciplinary letter of concern, or whether there is sufficient evidence of a violation that warrants disciplinary action. Board investigators obtain information regarding the complaint allegations by subpoenaing or requesting additional documents and by interviewing involved parties such as the complainant(s), witnesses, and the licensee/ certificate holder.
The Board’s Executive Director can resolve some complaints. Specifically, A.R.S. §32-1605.01 authorizes the Executive Director or designee to close complaints that meet criteria for dismissing the complaint or issuing a nondisciplinary letter of concern. For example, if the complainant does not wish to address the Board and there is no evidence substantiating the complaint allegations or demonstrating that a statute or rule violation occurred, the Executive Director or designee may dismiss the complaint. Complaints resolved by the Executive Director are collectively presented for the Board’s information on a board meeting consent agenda.”
I think it would be nice if we as a profession knew what that process was, as well as the public. It goes to the issue of Transparency once more, but then again, the Auditor General has cited them on this issue in the past as well…….and if we are talking actual violations of the nurse practice act then for Gods sake why have the practitioners I have highlighted on my past few blogs walked away without a single flake of ash on them from the Arizona Board of Nursing? Why do we have a nurse practice act? To decide who to use it on and who not to use it on???
Perhaps they should take another read at the Auditor General’s recommendation: “When complaint resolution is delayed, patient safety may be affected. Specifically, licensees and certificate holders alleged to have violated board statutes and rules may continue practicing when they are unfit to do so, or may not quickly receive needed supervision.” (Yes this goes for all those Letters of No Concern issued to people who actually grossly violated the nurse practice act, abandoned their patients, used drugs in the workplace, abused elders, stole drugs, and had multiple DUI’s—not to mention falsifying medical records and forgery)
The Arizona Board of Nursing LOVES TO GO OVERBOARD ON USING SUBPOENAS……
According to the Auditor General: “In addition, the Board should also clarify its guidance for investigative staff that specifies when motor vehicle and law enforcement records should be subpoenaed. Board guidelines state that investigators should subpoena documents pertinent to the complaint and obtain relevant law enforcement and court records as applicable. However, in a review of 26 complaint cases, auditors found 3 cases where staff subpoenaed more information than necessary or relevant to determine whether there was probable cause of a violation to refer a complaint for a formal hearing or to offer the licensee/ certificate holder a consent agreement.1 Specifically, motor vehicle and/or law enforcement records were subpoenaed for complaint allegations related to practicing beyond the appropriate scope, making medication errors, and/or arguing with a patient. For these cases, motor vehicle or law enforcement records would not help determine if the alleged violations occurred. Therefore, the Board should clarify its guidance for investigative staff to specify when motor vehicle and law enforcement records should and should not be subpoenaed, based on the nature of the allegations, to help prevent board staff from obtaining unnecessary or irrelevant information.”
The Board currently subpoenas: Any and all medical records of nurses under investigation from any and all physicians. They also access any psychiatric records you may have out there. They also subpoena pharmacy records. Many of these actions are tactics that go way overboard into violating a nurse’s privacy. These actions should be reserved for prior drug offenders, abuse or neglect allegations, nurses involved with repeated sentinel events, or frequent DUI’s. Not every nurse needs to have his or her privacy violated by a state agency in this manner.
The Auditor General: “The extent to which the level of regulation exercised by the Board is appropriate and whether less or more stringent levels of regulation would be appropriate. This audit found that the current level of regulation exercised by the Board is generally appropriate.”
The Auditor General has obviously not read my blogs….
Here are some rough statistics from my research tonight:
70 nursing licenses revoked
61 nursing licenses surrendered
43 nurses placed on various forms of probation (keep in mind a nurse on probation in Arizona CANNOT get a job to save her life)
So lets add that up: That is 174 nurses taken out of or opting out of the nursing workforce here in Arizona for whatever reason…..How many nursing classes is that? The average nursing class is between 15-20 students? Now, multiply that by 10 years……Its roughly 1,740 nurses practicing at all levels of the profession who have literally disappeared from our midst.
I have yet to read the case files.
While we’re at it, let’s discuss the Auditor General’s recommendation regarding having evaluations done by the time the nurse presents before the Board and his/her case is considered. Well, its usually at the board meeting that the evaluation is ordered and the usual time frame for completion is 45 days. Which sets back the investigation times even further. While we are on the subject, giving Joey Ridenour free reign to personally decide what complaints get past the 10 mile high brick wall of the AZBON and which are bounced back never to be seen again was clearly a mistake (again, reference my past blogs) and allowing more latitude to order evaluations? NOT EVERY SINGLE NURSE NEEDS A DAMN PSYCH EVAL. (however, just about every nurse who has to deal with this Board needs a shot of tequila now and then)
Between 2013-2014: 117 Various Psychiatric Evaluations were ordered.
Now lets talk about all those lucky duckies who managed to float on out to the middle of the lake, far away from the grasp of Val Smith or Kathy Malloch or Joey Ridenour. The same lucky duckies, whom, according to the Auditor General, should have been disciplined……
Between 2013-2014: 234 cases were issued either a “Letter of No Concern” despite gross violations of the state’s nurse practice act, or cases were “Dismissed” for unknown reasons not stated in the board minutes.
Ironically, toward the end of the March 2014 Board of Nursing Minutes, it was decided to no longer publish the dismissed cases in the meeting minutes. Transparency at its best, yet again.
So, lets go back to former Board Member Kathy Malloch’s quote in one of the recent Nursing Regulatory Journals….. “40% of complaints are never opened or don’t meet criteria for investigation.” According to whom? And what is the criteria? I argue that the public, again, has the “right to know.” (I know you’re sick of hearing that Val Smith but its true.) So if we combine all of those Letters of No Concern, with those case Dismissals with the 40% that never get opened…….Just how many is the Board looking at, and what exactly is the criteria for their elusive, secret “eenie meanie monnie moe” method for choosing who gets dragged through “Dante’s Nine Circles of Hell” and who doesn’t?
So, Mr. Auditor General, Mr.. Ombudsman, any questions?