Amy Pollman's life changed one night in January 1995, when a psychiatric patient at Porter Hospital who was known to be suicidal smothered herself with a plastic bag that had escaped the notice of hospital employees.
Pollman was at home when the call came. It was the first suicide at Porter's twenty-patient psychiatric unit since she had started managing it more than three years earlier. "I went in [to the hospital] to be there for the staff. As manager of the unit, it was my task to investigate what, if anything, had gone wrong and to see if our policies and procedures were followed correctly," says Pollman, who had never even laid eyes on the patient.
The woman had been transferred to Porter for psychiatric treatment after being rushed to another Denver hospital during a failed overdose attempt; she had used the plastic bag to carry her belongings between hospitals, but no one knows whether she intended to use the bag as a weapon all along or whether it merely came in handy when she decided to try to kill herself the day after being admitted.
Before patients can be checked in to the psychiatric unit, they must be searched to make sure they don't have anything -- including plastic bags -- that could be used to harm themselves or others. Pollman discovered that the three nurses and the psychiatric technician who admitted the patient hadn't conducted a thorough search. But on the same day she suspended them, Pollman's supervisors suspended her. "It was quite distressing to me and very much a surprise," she says, adding that she had never been disciplined in her entire career. She has been practicing since 1978, when she graduated from Union College in Lincoln, Nebraska, with a bachelor's degree in nursing. The job at Porter was Pollman's first in Colorado.
An unresolved matter in her personnel file lead to the suspension: A few months back, another Porter patient claimed she had overdosed on pills that she had brought into the hospital after a visit home. Pollman was on vacation when the patient made the allegation; while she was gone, her supervisor placed a memo in her personnel file asking her to find out whether the hospital's search policy had been followed. Soon after, her supervisor's job was eliminated, and Pollman never followed up on the memo with her new boss. But she did investigate the patient's claims; blood tests showed no evidence of medication in her system.
"Because the memo was still in my file, they felt there were some similar issues to this case -- that hospital procedures may not have been followed," Pollman says. "Procedures were followed, but because I had not reported back to my director informing her of what I'd done about the situation, they gave me a three-month severance and career counseling."
During her time off, Pollman decided she'd had enough of working in hospitals, so she moved to California to help a friend start a home health-care program. She got a California nursing license and stayed there for a year. But she missed her family, so in September 1996 she moved back home to Kansas City and took a job as director of psychiatric services at a home health agency. She became licensed to practice nursing in both Kansas and Missouri, since Kansas City nurses often treat patients in both states. Pollman's Colorado license was up for renewal in October of that year, but she decided to let it lapse because she didn't plan to return to Denver.
A month later Pollman got a letter from the Colorado Board of Nursing informing her that she was going to be investigated for her role in the 1995 suicide, along with her direct supervisor, the director of nursing and every nurse who had worked that weekend. One of the nurses, who has since quit nursing and is still battling the board, says, "If you're a criminal, you get arraigned within a certain period of time; if you're a nurse, there's no statute of limitations. Something that happened years ago can come back to haunt you."
The board even scrutinized a nurse who had incorrectly taken the patient's blood pressure. "How did everyone else get thrown in the pot? What did an incorrect blood-pressure reading have to do with the death?" asks Pollman, who immediately retained the help of a Porter Hospital attorney. (The patient's family never sued the hospital or any of its employees.)
Almost a year passed without a word. In October 1997, Pollman received a letter from the Colorado Attorney General's Office stating that the Board of Nursing had forwarded her case to them. "There wasn't anything I could do. The board decided the case warranted turning over to the attorney general's office, even though my lawyer told them they had no jurisdiction over me because I had provided no direct care to the patient," Pollman says.
Pollman was drawn into the investigation because a manager's failure to provide adequate supervision to employees is considered to be a violation of the Nurse Practice Act -- the state law that sets the rules for nurses and the grounds for discipline when they are broken. The Colorado Board of Nursing is an eleven-member group (made up of nine nurses and two members of the public) charged by the state with licensing registered nurses, practical nurses and psychiatric technicians, certifying nurses' aides, and disciplining those who violate the Nurse Practice Act.
"[The Board of Nursing] seemed to feel I was responsible in some way because I didn't educate the staff correctly about the procedures, but I have documents showing that I held regular inservices. I routinely updated the staff at meetings on what the policies were," Pollman says. Many nurses in Colorado are now trying to change the Nurse Practice Act because they say parts of it -- including the part under which Pollman was charged -- are so ambiguous that nurses don't even know when they are in violation of the law.
In January 1999, more than a year after receiving the case, the attorney general's office presented Pollman with three choices: She could fight the board's assertion that she'd violated the Nurse Practice Act; she could agree that she'd violated the act and agree to give up her license ("Which I thought I already had done when I left Colorado and didn't renew it," Pollman says); or she could deny the allegations, voluntarily give up her license and agree never to practice in Colorado again.
"By then it had been four years since the suicide, and I wanted to forget about it," she says. "I knew I didn't have a chance in hell of getting anything decided my way in a hearing and that if I got my license revoked, it would look worse on my record than voluntarily giving it up. I wasn't planning to return to Colorado anyway, and I would have been on my own with no lawyer fees covered by the hospital if I had picked choice number one."
Pollman took option number three.
The nursing board then assured her, she says, that the status of her nursing license, which is available to the public, would show that it had been voluntarily relinquished. Ironically, at around the same time, Pollman received a letter from Porter Hospital saying that its internal investigation had cleared her of any wrongdoing.
Finally, Pollman thought, it was over.
She thought wrong.
In March 1999, Pollman got laid off when the company she worked for started cutting costs. The same friend who had told her about the job in California suggested she seek a management position at Staff Builders Home Health Care, a psychiatric home-health agency in Phoenix. Pollman started there in May 1999. "I told my administrator the whole story about what happened in Colorado, and she had no problem hiring me. The first day on the job, my task was to go to the Arizona Board of Nursing office and apply for my license. The second question on the form asks if you've ever had a disciplinary action from another state. I anticipated that and attached the letter from the Colorado Board of Nursing and the letter from Porter Hospital," she says. "I was told that because I'd answered yes, they couldn't grant me a temporary license. Then I got a call telling me that the Arizona Board of Nursing would have to conduct their own investigation of what happened in Colorado before they'd give me a license. Here I'd moved out to Arizona from Kansas, and I was in limbo because of Colorado!"
Pollman's boss allowed her to work as a consultant, but not to care for patients until her name was cleared. The Arizona Board of Nursing told Pollman that its investigation could take up to three months and that all of her personnel files dating back to 1995 would be subpoenaed. Pollman was allowed to give the board the names of witnesses with whom she'd worked at Porter Hospital, as well as a written statement detailing her recollection of events. The board's investigator also wanted to know how Kansas would have ruled on her case.
As it turned out, Kansas had decided not to renew her license. "The Kansas Board of Nursing never notified me of that, and they didn't ask me any questions or investigate beyond looking at the stipulation letter. They read the stipulation to mean that it had the full force of a revocation, and Kansas law states that a nurse's license can't be renewed if it's been revoked in another state," she says.
Pollman later learned that when the Arizona Board of Nursing heard her case in August, she'd be able to make a five-minute statement -- unlike in Colorado, where nurses are not allowed to testify before the board. In the months preceding that hearing, a friend put Pollman in touch with a lawyer who knew about a similar case in Colorado. An administrator at another Denver-area hospital had been charged by the Colorado Board of Nursing with violating the Nurse Practice Act in two incidents. In one, a patient died after nurses failed to recognize her symptoms and report them to a doctor. In the second, an intravenous needle was improperly inserted into an infant, and the fluid went into the baby's tissue instead of the bloodstream; the baby had had to undergo two surgeries to repair the damaged tissue. Even though the administrator had no contact with either of the patients -- and was even on sick leave when the second incident occurred -- she was issued a letter of admonition.
The administrator appealed the board's action, claiming that she wasn't responsible because the nurses in each of the hospital's seven departments report to their immediate directors, not to her. The Colorado Court of Appeals overturned the board in May. In his ruling, Judge Robert Kapelke wrote, "Respondent contends that the Nurse Practice Act does not authorize the board to discipline her for the conduct at issue here because she was not engaged in the 'practice of professional nursing' within the meaning of the Act. Under the circumstances here, we agree."
According to the Nurse Practice Act, the "practice of professional nursing" includes: "Providing therapy and treatment that is supportive and restorative to life and well-being either directly to the patient or indirectly through consultation with, delegation to, supervision of, or teaching of others."
Judge Kapelke determined: "In her administrative capacity, respondent was not providing evaluation of a patient's treatment. Therefore, we conclude that the Board exceeded its authority in disciplining respondent."
The decision came just in time for Pollman, who sent a copy of it to the Arizona Board of Nursing. She met with the boardmembers on August 19, but before they got to her case, they discussed several others. "The longer I sat there listening to other cases, the angrier I got at the State of Colorado. There were nurses who'd abused children, alcohol and drugs. I did none of those things, and yet I had been punished," Pollman says.
When it was Pollman's turn to testify, she was nervous. "You're sitting before a long table with nine people. It feels like you're on trial," she recalls. "If I'd had any idea of the ramifications that would come from signing that stipulation, I never would have done it. I had no idea it would cause me so much trouble in other states."
When she was done presenting her side, one boardmember asked Pollman if the person who was supposed to search the patient was a nurse. Pollman said yes. The boardmember then asked if the person in charge of the psychiatric unit at the time was a nurse. Again, Pollman answered yes. "She said, 'Those are the people who should have been disciplined,'" Pollman recalls.
The board voted unanimously to dismiss Pollman's case and grant her a license. "The investigator herself came over and hugged me and said, 'I'm glad it went your way,'" Pollman says.
"My family wants me to reopen my case and get it heard on appeal in Colorado, but I don't want to practice in a state that doesn't treat nurses fairly," Pollman says. "If the supervisory nurses in Colorado understood that the Board of Nursing is holding them responsible for anything their nurses might do -- that if their staff ever messes up, the board could go after them -- no one would want to be in a supervisory role in Colorado."
Nurses say having a complaint before the Colorado Board of Nursing is like walking around with a scarlet letter pinned to their chests.
The reason: The Nurse Practice Act requires employers to report nurses to the board for any violation of the Act, no matter how minor.
And a lot of minor mistakes are being made, they say, because of a nursing shortage in Colorado that came about in the mid-1990s. As managed-care companies nationwide looked for ways to cut costs, nurses were among the first casualties. Word of the subsequent shortage in nursing jobs spread and enrollment in nursing schools dropped.
Two years ago, after several nurses noticed that more and more of their colleagues were bemoaning the high number of complaints -- and the slow resolution of those cases by the board -- they formed Nurse Advocates for Safe Practice, a support group of about forty nurses that meets monthly to discuss problems in the nursing industry. These nurses don't expect the board to rectify the downfalls of managed care, but they would like it to do the one thing it has the power to do: lobby the state legislature to change the Nurse Practice Act so that it clarifies which mistakes constitute violations.
In 1980 the act was amended to make it mandatory for employers to turn in nurses for every violation; before that, minor problems could be resolved in the workplace.
According to one member of Nurse Advocates for Safe Practice who has reviewed nurse practice acts in 48 states, only Minnesota, Missouri and New Hampshire require that only employers report complaints; the others also require nurses to report their colleagues to the board.
Anyone can report a nurse to the Colorado Board of Nursing, but because employers are the only ones required to do so, the protocol in the workplace is for nurses to report errors they witness to their employer, who then reports them to the board. The flaw with that, nurses say, is that employers rarely witness the violations they report. In addition, once a nurse reports a complaint to her employer, she is absolved of all responsibility. Nurses here say that if Colorado required nurses to report their peers, there would be fewer frivolous complaints because the complainers would be held accountable. "Some states, like Nebraska, allow nurses to sue an employer or nurse for malicious reporting," the nurse says. "There is nothing to protect nurses from unfair reporting in Colorado's Nurse Practice Act."
The Colorado nursing board's 1981-82 annual report lists only seven disciplinary actions for the year; the number of nurses who have been disciplined by the board has since increased to 235. Although the board doesn't track how many complaints come from employers and how many come from patients, its administrator says the overwhelming majority are generated by employers.
Nurses say the mandatory reporting rule scares employers into reporting every mistake a nurse makes; if they don't, the employer could be accused of violating the Nurse Practice Act. In a December 1997 issue of Colorado Nurse, a monthly newsletter published by the Colorado Nurses Association, the board answered questions about the Nurse Practice Act. To the query, "What are the implications of reporting or not reporting performance issues to the Board?" the board responded, "The greatest implication lies in the need to protect the public. While a facility may believe that its internal investigation and sanction is all that is needed, the nurse may be employed by another facility or agency which is unaware of the performance issues. The only clearinghouse for state-wide protection exists with the Board."
The act states, in part, that a nurse must be disciplined when he or she "has willfully or negligently acted in a manner inconsistent with the health or safety of persons under his care; has negligently or willfully practiced nursing in a manner which fails to meet generally accepted standards for such nursing practice; has negligently or willfully violated any order, rule or regulation of the board pertaining to nursing practice or licensure; has falsified or in a negligent manner made incorrect entries or failed to make essential entries on patient records..."
Members of Nurse Advocates for Safe Practice say that that portion of the act leaves them wide open for disciplinary action; they would like to add the words "grossly" before "negligent" and "willfully" before "falsified."
"A lot of minor cases that don't present a threat to public safety bog down the system, and it wrecks the lives and careers of nurses who have made an isolated error," says Cathy Klein, an attorney and licensed nurse who has been representing nurses in Colorado for twelve years.
A nurse who asks to be identified only as Teresa knows all about the havoc that a frivolous complaint can wreak on a nurse's life.
Teresa didn't win any popularity contests at the neurological care unit of the Denver hospital where she worked between 1992 and 1994. She spoke up when she noticed other nurses doing something wrong.
One day she saw a nurse and a nurse aide bathing an elderly handicapped woman who couldn't control her bowel movements. In front of the patient, she says the two employees said things like, "Ugh. Yuck. Gross." Instead of reporting them to their supervisors, Teresa decided to teach them that their behavior was unacceptable by setting an example. She went up to the patient, patted her on the shoulder and assured her, "It's not your fault. You can't help it."
But when she noticed that nurses were cleaning patients with washcloths that had been sitting in an unsanitized sink, she confronted them and later brought it up in a staff meeting. "I didn't blame anyone; I just asked the nurses not to lay the washcloths in the sink anymore and then use them on patients," she says. "That's when the complaints about me started coming."
Shortly after the washcloth incident, a nurse's aide asked Teresa to help clean a patient while Teresa was busy dispensing medication. "I told her to ask someone else to help her because I couldn't leave what I was doing, and she accused me of saying the patient could lie in his excrement. That complaint ended up in my personnel file!
"There was a lot of immaturity on that unit, and a lot of resentment. It was not a place where you could make suggestions for better patient care without being retaliated against." Teresa, who had had a flawless record since she began her career in 1965, says she ended up being accused of not being a team worker.
In her first several months on the job, sixteen complaints were made against her, but Teresa didn't know about them until January 25, 1993, when she received a memo from the hospital's head nurse. The memo said: "Co-workers frequently think that you do not respect or trust them." The head nurse directed Teresa to act "as an equal member of the team, not the superior; communicate your needs, but do not dictate."
Since the memo didn't cite any specific incidents, Teresa was left to guess. The memo ended with the following admonition: "This is Step II of the disciplinary action, a written warning. Failure to comply with the above expectations will result in further disciplinary action, up to and including termination."
The real reason behind the complaints, Teresa says, is the fact that she "dared to question" things. Teresa requested that more nurses and support staff be assigned to her unit because nurses were getting sidetracked with other duties such as emptying trash cans, staffing nurses for the next shift and answering phones. It seemed that every time she raised an issue, another complaint was added to her personnel file.
The file eventually made its way to the Board of Nursing.
On July 9, 1994, a hospital employee walked into a room and saw that a patient's bed rail had been left down. Teresa was the last nurse to have treated the man, but she couldn't remember whether or not she'd forgotten to raise it -- perhaps the patient had lowered the rail. Either way, he hadn't fallen out of bed or tried to get out.
But on July 15, Teresa was fired.
In October 1994, her employer reported her to the nursing board, beginning a five-year inquiry that would deprive Teresa of the strong sense of job security she'd enjoyed during her long career.
In November Teresa received notice of the complaint from the Board of Nursing and was asked to respond to the bed-rail accusation by December 7. She didn't hear from anyone again until April 1995, when the investigator told her he was expanding the case to include all sixteen charges in her personnel file. In June Teresa submitted her answers and then spent the next few months calling the board office to ask when the investigation would be completed.
She says she was repeatedly told that nurses never attend the board meetings at which their cases are discussed, but because of her persistence, Teresa was able to find out when her case was scheduled. In January 1996, she attended the two-day session during which her case was discussed, but neither she nor her attorney were allowed to speak. "They had multiple cases before them, had short discussions and then made decisions quickly," Teresa says. "The boardmembers don't meet the nurses; they don't even know the nurse is a human being. You feel like a piece of meat."
Several days later she received a letter telling her that her case was being referred to the attorney general's office. At the time, Teresa was working part-time for a home health-care agency where she'd worked before the hospital. "I went to them after I was fired, and they believed in me. But the agency was too small for advancement, and I wanted to get more experience, so I started looking for other jobs," she says.
In May she received an order requiring her to admit to twelve complaints and, as her lawyer later explained in writing to the attorney general's office, "to agree to extremely onerous terms of probation which would preclude her from her present, and possibly any future, employment."
Teresa wrote back saying the stipulation was unacceptable. The status of her nursing license was then updated on the automated licensing information line so that any prospective employer could learn that discipline was pending. "I couldn't get a job. I tried three times, in hospices and home health-care agencies, and two wouldn't even return my calls after checking on my license," she says. So Teresa remained at her part-time job. And for the next twenty months, she waited. And worried. And wondered what her future would hold.
On January 6, 1998, the Colorado Board of Nursing sent Teresa a letter of admonition for five of the twelve complaints against her (four had somehow disappeared; Teresa was never told why). "On January 23 I filed a motion to dismiss and said that if they didn't dismiss the case, I wanted it heard by an administrative law judge," she says.
A month later she received instructions to participate in the Alternative Complaint Resolution Process (a new way for the board to resolve uncomplicated cases), where she would be asked only to respond to the original complaint about the bed-rail incident; the other allegations had been tossed out. In April Teresa was finally able to defend herself before two nurses assigned to hear her case. For two hours, she explained what it was like to work in that unit of the hospital. In a letter dated May 26, 1999, the Colorado Board of Nursing informed Teresa that her case had been dismissed.
Following the dismissal, one of the nurses who heard her case apologized to Teresa and told her she's a good nurse, Teresa recalls. "She said she was sorry the Alternative Complaint Resolution Process hadn't been in place before."
Finally, she was vindicated. But Teresa still fears that if she is ever reported to the nursing board again -- even for something as simple as leaving a bed rail down -- she will have to go through the process all over again.
"I was in the position of having to prove myself innocent. It's really scary," she says. "If you do something a little wrong -- not something grossly negligent -- you're considered a bad nurse. The way it's written now, you can break the Nurse Practice Act every single day."
The number of complaints reported to the Colorado Board of Nursing has almost doubled in the last decade, from 290 in 1991 to 484 last year; the board actually handled far more cases than that last year, though, because some were filed in previous years.
When the board receives a complaint, it sends a letter to the nurse along with a copy of the complaint. The nurse has thirty days to respond. At that point, the board decides whether to dismiss the complaint, turn it over to the Department of Regulatory Agencies' centralized complaints-and-investigation department, which contracts with independent fact-finders to collect information, or pass it along to the new and speedier Alternative Complaint Resolution Process.
After an investigation, the board reviews the findings and decides whether the case should be dismissed or go to the attorney general's office for prosecution before an administrative law judge. Last year, 247 cases were dismissed; 104 nurses and technicians were placed on probation (which means they can still work, but under supervision); 24 had their licenses suspended; 43 had their licenses revoked; and 64 received letters of admonition. Although the number of complaints fluctuates each year, approximately 45 to 50 percent of them are dismissed, according to Patricia Uris, program administrator for the Colorado Board of Nursing.
Even though the volume of complaints has risen considerably in the past decade, Uris says the percentage of nurses who have complaints against them has remained fairly steady. In 1991, there were only 40,612 nurses and psychiatric technicians licensed in Colorado; today there are 55,246. That means the percentage of nurses with complaints against them has increased only by .2 percent.
Still, nurses say the backlog results in years of worry, even for caregivers with minor complaints hanging over their heads. "Most nurses don't know about the discipline part of the Nurse Practice Act until they or someone they know gets caught in the trap," says Anne Scott, a member of Nurse Advocates for Safe Practice. Scott has never had a complaint brought against her in her 36-year nursing career, but she sympathizes with nurses whose careers have been put on hold due to minor complaints. "I can't believe the language in the Nurse Practice Act and how vague it is. A nurse can't even confront her accuser. Why?"
State law does not permit nurses to testify before the Colorado Board of Nursing, and that makes it all the more difficult for them to defend themselves. It is unclear how many states allow nurses to testify before their nursing boards. In some states that allowance is contained in state statutes; in others it is spelled out in nurse practice acts. The nurse practice acts in Alaska, Arizona, Arkansas, Delaware, Georgia, New Hampshire and Rhode Island state that nurses can present their case before the nursing board.
"It's hard to make yourself clear when you go back and forth with the board in letters. It's hard to express what has happened in a case in writing," says one nurse who did not want to be identified. "Every nurse should have the opportunity to speak to the boardmembers face-to-face."
Colorado isn't the only state with a high volume of complaints against nurses. The Arizona Board of Nursing, which requires both employers and nurses to report their colleagues, received 500 complaints in 1995; over the past four years, the number has jumped to 2,000. "We also have a lot of nurses who are unhappy about how long it takes to resolve complaints, but we haven't been able to increase the number of investigators by four times, and we still have to investigate every complaint that comes in," says Janet Walsh, associate director of investigations for the Arizona Board of Nursing.
Scott is concerned about incomplete investigations and says that many times, nurses aren't informed that there's a problem. "Sometimes," she says, "they don't learn about it until an investigation is under way. The seriousness of the situation is that we need nurses in this state, and nurses are having a hard time as it is now because of the heavy workload we carry. And then we have to worry about all the tattletaling that's going on about minor concerns. It's sort of like a witch-hunt. I don't know why nurses are treated this way. Historically, is it because most of the profession [has been made up of] women? They don't treat pharmacists and doctors like this."
Attorney Klein agrees that more is expected of nurses than of other health-care providers: "The way the Nurse Practice Act is written now, nurses are held almost to a standard of perfection. I don't want the act to list all the things that are reportable, because that would get to be too cumbersome, but a change in the wording regarding employer reporting would help the board focus on the egregious errors and allow the good nurses to proceed with their careers."
The nurse who has studied other states' nurse practice acts has found that most other states -- with the exceptions of Connecticut, Minnesota, Oklahoma and South Dakota -- clearly define what constitutes unprofessional conduct, while Colorado's does not. To prove that a nurse violated the acts in most states, the nursing boards must prove that she committed gross negligence or that she acted deliberately or knowingly and that she made repeated mistakes.
So far, the Texas Nursing Practice Act appears to be the most reasonable, the nurse says. Although employers in Texas must also report nurses to their state board, the Texas act requires a nursing peer review committee to evaluate the complaint and then recommend to the board what action should be taken. The Texas act also lays out in much more detail the type of unprofessional conduct that should be reported, and it contains a clause that Colorado nurses especially like: "The [Texas] Board believes protection of the public is not enhanced by the reporting of every minor incident that may be a violation of the Nursing Practice Act. This is particularly true when there are mechanisms in place in the RN's employment setting to take corrective action, remediate deficits and detect patterns of behavior."
The Texas act goes on to define minor incidents as those in which "potential risk of physical, emotional or financial harm to the client due to the incident is very low; the incident is a one time event with no pattern of poor practice; the RN exhibits a conscientious approach to and accountability for his/her practice; and the RN appears to have the knowledge and skill to practice safely."
Despite the wishes of the nurses, however, the Colorado Board of Nursing isn't planning to lobby the state legislature to change the Nurse Practice Act, according to Uris. "I don't see that there's a need for a change in the grounds for discipline. The board already has to prove willfulness and negligence. If it was changed to grossly negligent, it would make it more difficult to protect the public. There's a fine line between giving nurses due process and protecting the public.
"The Board of Medical Examiners doesn't even have to look at willfulness, so for us to change that part of the act would be moving in the extreme opposite direction," Uris adds, referring to the Colorado Medical Practice Act, which lays out the violations for which doctors can be disciplined.
Anyone can find out if a Colorado nurse has been disciplined by calling the Automated License Information System (303-894-7888) or by clicking on a link at the bottom of the Colorado Board of Nursing Web page (www.dora.state.co.us/Nursing/). One nurse, who asked not to be identified, conducted an informal telephone poll of 29 local health-care facilities this summer to determine how many employers would hire a nurse who had been disciplined. Eighteen indicated they wouldn't hire a nurse who had received a letter of admonition from the board; nineteen said they wouldn't hire a nurse who had been placed on probation.
The threat of medical malpractice suits also probably contributes to the rise in reporting -- and to the reluctance of employers to hire nurses who have been disciplined.
"It's unfortunate that employers have decided not to hire nurses who have been disciplined. That is certainly not the intent of the board," Uris says. "A letter of admonition or probation does not mean a nurse is unsafe to practice."
Even though the board has no immediate plans to try to convince legislators to change the Nurse Practice Act, boardmembers are starting to draft new regulations that will help clarify which nursing errors should and should not be reported; by next spring, the rules should be ready for public review and input.
In addition, on July 1, a new state law restructured the board into two panels with five members each who meet once a month (the board president can sit on either panel or on both). Before the changes, the board met only once every two months, which contributed to delays in complaint resolution.
And nurses who had bad experiences with former boardmembers are finding promise in the current group. Four of the eleven members are new; they were appointed by Governor Bill Owens in January and can serve two three-year terms. Uris also is new; before January, she taught nursing at the University of Colorado Health Sciences Center. "By dividing the board in half, people don't have to wait two months anymore. Ours is the only nursing board in the country to be split into panels," she says, explaining that the legislature modeled it after the Board of Medical Examiners.
Complaints should also meet closure more quickly now that the board has instituted the Alternative Complaint Resolution Process. Since 1998, nurses accused of minor mistakes have been able to state their case before nurses who are now employed by the board for just that reason. In one recently resolved case, a nurse who fell asleep while on the night shift explained that he was exhausted because he and his wife had just had a baby. The nurses suggested he switch to a daytime shift. "This new process enables us to speed along cases that aren't that complicated and to get at the real cause behind the error," Uris says. "It's a more personal approach to dealing with nurses."
As a result of the new law, the board now can issue nurses a "letter of concern" as another -- but less serious -- way to warn them that their performance needs improving. Borrowed from the Board of Medical Examiners, the letter of concern is similar to a letter of admonition but is not public record. While employers and patients won't be able to find out whether a nurse has received a letter of concern, it will remain on file with members of the board so that if the same nurse comes before them again, they can identify a pattern of poor practice.
Another change has to do with when a complaint can become public record. It used to be that once a complaint was filed with the Board of Nursing, anyone could find out. Now no one will know whether a nurse has a complaint against her until formal action has been taken and the nurse has signed off on it.
Board of Nursing president Merrilee McDuffie says she doesn't want to comment on the issues Nurse Advocates for Safe Practice members have raised until the entire board has had a chance to discuss them; the board doesn't meet again in full until November 18. But, she says, "The new legislation takes care of a lot of their concerns. I think the board has made great strides in trying to expedite the [complaint] process."
While the Board of Nursing may not try to change the Nurse Practice Act, nurses still have hope that it will be amended. Several members of Nurse Advocates for Safe Practice met recently with the legislative committee of the Colorado Nurses Association, the state's professional organization for registered nurses. The committee wants to study other states' nurse practice acts before deciding whether to revamp the disciplinary section of Colorado's. The CNA could authorize the study at its annual convention this week.
If a task force charged with conducting the study recommends changes to the act by its May 2000 deadline, the CNA will then vote on whether to lobby the state legislature for a bill that incorporates the changes.
Judith Burke, president of the Colorado Nurses Association, wouldn't say whether she thinks the Nurse Practice Act needs changing. "If we knew it needed to be changed, we wouldn't be forming a task force to look into it," she says.
Members of Nurse Advocates for Safe Practice originally went to the CNA with their concerns about the Nurse Practice Act two years ago. "They had valid concerns about the process of investigating complaints and about the length of time it takes to resolve them, so we met with the board, and they heard our concerns," Burke says, adding that the CNA worked with the Board of Nursing to pass the recent law.
"We're pleased that the board heard us and took action to improve their process. We're monitoring the outcomes of the improved process to ensure that they are, in fact, improvements and that they solve the nurses' concerns," Burke says. "We need to give the changes the board has made time to be implemented."
With the board's recent efforts to give nurses a fair shake, it seems nurses would be breathing a collective sigh of relief. But they aren't. And they won't until the Nurse Practice Act is changed.
"Until they take out mandatory reporting for employers," says Teresa, the nurse who was turned in for leaving the bed rail down, "the amount of frivolous complaints that make it to the board won't diminish."
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