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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.

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Julie Jargon
Contact: Julie Jargon