About one year ago I wrote about a series of embarrassing newspaper articles about the California Board of Registered Nursing, that described how nurses incarcerated in prison retained their licenses due to the sheer ineptitude of the Board of Registered Nursing. The picture painted was nurses running amok while the Board was asleep at the wheel. Meanwhile, in my practice we were received numerous complaints from our nurse clients about how strict and even punitive the Board of Registered Nursing was acting. Which of these views was right? And what is this controversy all about?  In July 2009, we saw another round of revelations, leading to the sacking of three members of the Board of Registered Nursing and apparently the resignation of the longstanding executive officer of the RN Board.  What are the factors behind this focus on, of all the professions, registered nursing, and why was the Governor so quick to move in response to criticism?

The first and most important factor in our view, which is often not well understood by the public, is that the medical treatment you receive in hospitals is largely from nurses and their supervised LVNs and aides, not doctors. Doctors make their rounds, usually spending as little time in the hospital as possible, doctors perform surgeries, and doctors prescribe medicines and treatments. But for the hospitalized patient, almost all care comes from their registered nurse and those supervised by the RN. The registered nurse is the primary advocate for the patient, the individual charged with calling up the doctor and even demanding treatment if a patient is in neglected by their M.D. In fact, in the face of a recalcitrant doctor, the RN is responsible to even go above the head of the doctor to hospital officials if the situation warrants. Therefore, the registered nurse is the key link in the chain of care from hospital and doctor to patient.  Public concerns about the competency of registered nurses are well founded.

A second factor in this debate is the love/hate relationship that California (its people and the rest of its government) has with its regulatory boards.  In early 2005 there was an effort by the Governor to abolish 88 state boards, including the nursing board, citing waste and inefficiency.  The effort died after about one month.  Nevertheless, nearly five years later state boards understandably feel the need to zealously protect the public in carrying out their mission.  The image of board members as political cronies earning six figure salaries to jet around the state to attend a handful of meetings each year makes a popular punching bag for some politicians, the press and advocacy groups.

To the extent the criticism of the Board of Registered Nursing focuses on lengthy delays in investigations and administrative cases, that criticism seems to have merit.  It is also true that many years ago the Board of Registered Nursing exercised lax oversight in the screening of the backgrounds of nursing license applicants.  In requiring livescans and asking simple background information questions at application and renewal the Board has brought itself in line with the common practices of other California licensing boards.

However, it is most unfortunate that the regulatory pendulum seems to be swinging to the other extreme.  The Board of Registered Nursing may be becoming quick to judge, quick to condemn, and unnecessarily punitive in its approach to the oversight of its licensees.  The purpose of independent licensing boards is that they can be relatively free of the political pressures from other segments of the government.  Unfortunately, actions such as the governor’s undermine that independence and risk seriously damaging the nursing profession in terms of difficulty in attracting sufficient numbers of new nurses and the declining morale among existing nurses.

The image of a “soft on discipline” nursing board is misleading and inaccurate.  I have found the Board of Registered Nursing to be firm in discipline and quite strict in probation oversight.  The Board has exhibited, in my view, a fairness towards its licensees, willing to give a second chance if the licensee is willing to earn it.  Regrettably, second chances may now become a lot harder to come by in Sacramento.