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"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."

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Julie Jargon
Contact: Julie Jargon