ProPublica storyBy Shawn Kennedy, AJN editor-in-chief

New York does not require applicants for nursing licenses to undergo simple background checks or submit fingerprints, tools that can identify those with criminal histories and flag subsequent legal problems. And it often takes years for New York to discipline nurses who provide inept care, steal drugs or physically abuse patients.

That’s from a recent ProPublica story on lax oversight of New York State nurses. Back in 2008, the same independent investigative journalism organization, in partnership with the Los Angeles Times, investigated lax policies of the California Board of Nursing that allowed nurses (both RNs and LPNs) with serious criminal convictions to continue to be licensed. (See our report on this and the editorial by then-editor-in-chief Diana Mason in the March 2009 issue.)

In this month’s story, ProPublica reporters Daniela Porat and colleagues turn their sights on New York State’s nurses. They detail the policy issues and systemic gaps that lead to poor oversight by the state education department’s Office of Health Professions, such as lack of background checks, relying on self-report of infractions, and no requirement for fingerprinting. Many other states have adopted more rigorous approaches. The report offers several compelling cases to drive home the point that investigations are often inadequate and disciplinary action often not taken, allowing many nurses who should not be practicing to continue to do so.

One important caveat has been raised by Edie Brous—a nurse, attorney, and AJN’s contributing editor for our legal column—about this report:

“The report is singularly focused on how nursing boards are not protecting the public from dangerous nurses, but . . . ignores the other half of that equation—that these boards can also be overly punitive and harsh with other nurses and fail to distinguish between unintentional (and inevitable) human error and actual misconduct/negligence.”

She notes that investigations can take overly long, potentially harming the careers of nurses who are ultimately cleared of any wrongdoing. She also questions the application of some rulings, citing a case of a nurse who was disciplined with a six-month suspension of her license for a medication error that had occurred five years earlier:

“She has been in safe practice and accurately administering medications for five years, so why separate her from practice now? It’s a harsh penalty, to begin with—but if they think she is such a danger to the public that they have to suspend her license for half a year now, why were they letting her practice for all this time? It’s punishment for the sake of punishment, and not really in the interests of ‘protecting the public’ to suspend her today.”

Nurses are human and will make mistakes, especially in systems that make it easy to do so because of poorly designed systems and inadequate staffing. The system should be fair and allow them due process. But we must also be held accountable if we are to deserve the public’s trust. Those who engage in criminal or abusive activity or make egregious errors because of incompetence or negligence that results in harm to patients shouldn’t be licensed, and we should all support that.