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?"