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Does Schwarzenegger care about nursing care?

The governor voices concern about the state nursing board's failure to act on complaints, but he and lawmakers keep denying it the resources necessary to do the job.

July 29, 2009|Kathy J. Sackman | Kathy J. Sackman is a registered nurse and president of the United Nurses Assns. of California/Union of Health Care Professionals.

Gov. Arnold Schwarzenegger made a necessary political move earlier this month when he replaced most of the members of the California Board of Registered Nursing. His action came after a Times article (done in conjunction with ProPublica) exposing how the board repeatedly failed to act on complaints involving abusive, substance-abusing and incompetent nurses.

But is the governor really committed to fixing the problem?

This is the same governor, let's remember, who four years ago tried to completely eliminate the nursing board, the Department of Consumer Affairs division responsible for ensuring the quality of nurses in California and the safety of the patients they serve. The union I head, the United Nurses Assns. of California/Union of Health Care Professionals, led the charge against the proposal, joining together with patient-rights organizations and other healthcare professionals throughout the state to fight this plan that threatened patient protections. We succeeded.

It was a hollow victory, though. The governor and Sacramento lawmakers continued to squeeze the Department of Consumer Affairs, leaving the nursing board without the resources it needed to promptly and fairly investigate and resolve complaints. The nursing board is funded entirely from annual fees paid by nurses to renew their licenses. But in recent years, the governor has diverted more than 10% of these fees to the state's general fund. Meanwhile, the nursing board has had to share a too-small investigative staff with other boards, leading to a large backlog. Cases before the board take an average of three years to be heard.

Until now, the governor has seemed so unconcerned about the situation that he failed to promptly fill empty board positions when they came up. It's quite a contrast with the governor's new stance. Last week, he called the board's process "unconscionable."

I agree. But instead of changing the process, the governor went on to insist that additional resources are unnecessary, that simply "the will" to change the process would be enough. Unfortunately, this typical Schwarzenegger rhetoric fails to provide clear direction or necessary resources for meeting the challenges the board faces, and it sends the clear message that nothing will actually change.

The Department of Consumer Affairs is responsible for overseeing the nursing board -- which manages more than 350,000 nurses statewide -- plus two dozen other professional boards. But the department has only 30 full-time investigators to manage the complaints. That's just not enough, and it leads to a denial of due process for everyone -- those who file complaints and nurses alike. By comparison, the Medical Board of California has 76 investigative personnel for 125,000 licensed physicians.

In order to regain the public's trust and to begin reforming this dysfunctional process, our union is calling on Schwarzenegger and the Legislature to conduct a series of public hearings that will fully address the problems. On Monday, the nursing board requested permission to triple the size of its enforcement staff. Schwarzenegger should support this move.

In addition, furloughs for nursing board staff members and investigators must be halted, and complaints should be better managed so that the most serious accusations are addressed rapidly. The board should implement a better tracking system so that comprehensive records of allegations against individual nurses are maintained (both in-state and out-of-state) and compared against any new claims. And finally, the board should recruit enforcement monitors to guarantee that action recommended by the board against individual nurses is completed and that any required oversight during a probationary period is fulfilled.

It is unusual for a union to call for increased clout and resources for the board that provides oversight of its members. But we are a profession that values its reputation. As nurses, we take an oath to abstain from deleterious and mischievous actions, to do all in our power to maintain and elevate the standard of our profession and to promote the welfare of those committed to our care. It is crucial to the well-trained and highly competent majority of nurses that those who do not meet the rigorous standards of the profession are removed --and that the wrongly accused get a timely opportunity to answer the complaints against them. We believe that our patients and our nurses deserve better oversight.

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