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."