Investigation Uncovers Serious Delays, Lapses in Calif. Nursing Board

California's Board of Registered Nursing often takes years to respond to complaints of misconduct among nurses, according to a recent investigation by the Los Angeles Times and not-for-profit news group ProPublica.

For the report, investigators examined more than 2,000 disciplinary cases filed against nurses from 2002 to 2008. They also conducted interviews and analyzed court records, personnel files and regulatory reports.

The investigation found that the board:

• Did not further punish nurses who received new misconduct charges while on probation;
• Did not use its authority to immediately prevent potentially dangerous nurses from practicing;
• Failed to initiate action against nurses who already had been disciplined by employers or other parties; and
• Took an average of more than three years to investigate and discipline nurses accused of misconduct.

In addition, investigators identified more than 60 nurses who received misconduct charges from at least three health facilities before the board initiated action.

Limitations of Nursing Board

The nursing board has fewer than 40 field investigators whom it shares with as many as 25 other state licensing boards. Some investigators manage up to 100 cases simultaneously.

In addition, California's board does not participate in a national consortium of 23 state nursing boards that share information about nurses under investigation.

Therefore, the board might not identify potentially dangerous nurses who received misconduct charges in other states. In addition, the board does not systematically notify other states of disciplinary action filed against California nurses.

Nursing Shortage Amplifies Challenges

California's ongoing nursing shortage makes the Board of Registered Nursing a particularly crucial agency, the Times reports.

California currently has about 654 working nurses per 100,000 residents, compared with a national average of 836 nurses per 100,000 people.

Therefore, health care facilities looking to fill a high nursing demand often rely on the Board of Registered Nursing to ensure that potential hires meet certain standards.

State Pledges Improvements

In response to the recent investigation, California's Department of Consumer Affairs sent reporters a three-page list of proposed improvements to the nursing board.

The proposals include:

• Adding more staff;
• Conducting expert witness trainings;
• Discussing stalled cases with investigators;
• Implementing computer systems to improve case tracking; and
• Revising disciplinary guidelines.

Ruth Ann Terry, executive officer of the board, said her staff also has begun working with Consumer Affairs investigators to prioritize and accelerate responses to complaints (Ornstein et al., Los Angeles Times, 7/12).