California’s nursing board has confirmed what fans of Charles Ornstein and Tracy Weber’s disciplined caregivers series for ProPublica and the Los Angeles Times already suspected, that about 3,500 California nurses had clean records there despite being disciplined in other states. You can find Ornstein and Weber’s report on these developments at ProPublica or the LA Times.
After last year’s report by ProPublica and The Times, California ran its list of 376,000 active and inactive nurses against a database maintained by the National Council of State Boards of Nursing, to which nearly all states voluntarily report their disciplinary actions. Among the matches were nurses who had been disciplined by multiple states, sometimes for the same incident.
California officials said they couldn’t disclose the names of any nurses who turned up in the search until a formal disciplinary charge is filed. While those cases are pending, the nurses remain free to practice in California.
Of the 3,500 nurses whose records matched, “as many as 2,000 … will face discipline in California, officials estimate,” Ornstein and Weber write. “That’s more registered nurses than the state has sanctioned in the last four years combined.”
By simply typing a nurse’s name into a national database, state officials can often find out within seconds whether the nurse has been sanctioned anywhere in the country and why. But some states don’t check regularly or at all.
The failure to act quickly in such cases has grave implications: Hospitals and other healthcare employers depend on state nursing boards to vouch for nurses’ fitness to practice.
The reporters found an army of examples, from the disturbing anecdote they lead with to the 117 California nurses whose licenses had been revoked, suspended, denied or surrendered elsewhere or the 10 nurses who were disciplined in Rhode Island, yet operated with clear licenses in neighboring Massachusetts.
Most of these transgressions are recorded in a federal database, as well as in one operated by the National Council of State Boards of Nursing. Both are incomplete, even though states are required to update the federal database within 30 days of a disciplinary action. And the federal database, while more complete, is rarely used, probably because it costs money while the state boards’ database is free. Some states only check these databases when licensing a nurse the first time, others rely on the nurses themselves to disclose their own problems. A handful check their nurse list against the database regularly, but they appear to be in the minority.
Calling it a “free-wheeling, $4-billion industry” fueled by the nation’s chronic nursing shortage, ProPublica reporters Tracy Weber and Charles Ornstein take on the firms that supply temporary nurses to American hospitals (Los Angeles Times version here). In the story, the reporters say they “found dozens of instances in which staffing agencies skimped on background checks or ignored warnings from hospitals about sub-par nurses on their payrolls. Some hired nurses sight unseen, without even conducting an interview.”
Although the healthcare system as a whole is increasingly regulated, the nurse staffing industry remains a Wild West. No one knows how many agencies exist nationwide; estimates range from 3,000 to 6,000.
Ornstein, AHCJ’s president, and Weber found plenty of cases to back up that ‘Wild West’ impression. In some cases, firms shift problem nurses from hospital to hospital as trouble arose and, even when a nurse was tossed from one temp firm, he or she usually had no problem finding work at another. Nurses were hired with criminal backgrounds and licenses that were revoked in other states. They often allow employees to prove their “competency” through online tests, and are sometimes fly-by-night operations run by people with no prior nursing experience.
The state has adopted strict new rules governing drug abusers in the health care industry, requiring that those in the rehab program be tested more than 100 times in the first year, and pulling them from practice immediately should a relapse be detected.
In addition, public Web sites will now list any restrictions to their licenses, “easing the long-standing confidentiality protections that have shielded participants and kept their patients in the dark.”
The 22-year-old database was supposed to be open to hospitals and nursing homes for background check purposes, but has been tied up in layers of bureaucracy. A policy for opening it up was written during the later years of the Bush administration, but the president decided to defer the decision to his successor.
Shapiro writes that the plan for opening the database is now under review by the Obama administration: “A spokeswoman for the Department of Health and Human Services says things are on track. And that maybe by early next year, the department will open the registry of disciplined nurses, aides and pharmacists.”
Public Citizen has posted an open letter to HHS Secretary Kathleen Sebelius requesting that the proposals to open the database be put into effect “immediately.” The letter explains why the database is important, and details the consequences of keeping it under wraps.