Boards of Nursing-Who Do They Stand Up For?

February 14th, 2012

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By , BSN, RN

How often do you think about your state’s board of nursing (BON)? I know I almost never do. I’m betting, for the most part, nurses think about their respective BONs once or twice every two to three years when their license renewals are due. We write a check, or send a credit card payment online and the BON drifts to the back of our brains for another couple of years.

This may be a big mistake.

Boards of Nursing have a lot of power. They regulate how — and if — we can practice as nurses; provide the licensing that allows us to do so and sets the standards for our education. And, to be honest, I don’t know who the people are on my state BON or how they get their jobs. And yes, I do get the newsletter. I skim it, read the headlines and look to see if they have added or changed any of my mandatory continuing education credits and then toss it in the trash. I am only talking about the newsletter I get from the Texas BON. I am currently licensed in two other states but they never send me anything: no newsletters, no emails—just a notice every couple of years to re-up.

So, maybe we should take a little look at what is a BON, where do the members come from and what do they have the power to do?

It was more than 100 years ago that North Carolina established the first board of nursing in the United States. Since them every state has followed suit. The mission of each BON is to protect the public’s health and welfare by overseeing and ensuring the safe practice of nursing. They achieve their mission by outlining the standards for safe nursing care and issuing licenses to practice. Once a license is issued, the board's job continues by monitoring licensees' compliance to state laws and taking action against the licenses of those nurses who have exhibited unsafe nursing practice.

Who Is on a BON?

The individuals who serve on a board of nursing are appointed officials. State law dictates the membership structure of the BON but they usually include a mix of:

  • Registered Nurses
  • Licensed Practical/Vocational Nurses
  • Consumers

Each individual state determines the responsibilities and oversights of their BON. In most cases, boards of nursing report to either the governor of the state, a state agency, a combination of the two or sometimes a separate state official or organization. As North Carolina was a trendsetter in forming the first BON they are equally progressive in how they choose their BON members. North Carolina is the only state that elects the majority of nurses to its BON. In North Carolina 11 of the 14 members are elected by nurses holding valid N.C. nursing licenses. Each year the Board conducts an election to fill the open seats.

Standard powers and duties of a BON are:

  • Enforcing the Nurse Practice Act and nurse licensure.
  • Accrediting or approving nurse education programs in schools and universities
  • Developing practice standards
  • Developing policies, administrative rules and regulations.

Since scope of practice and nursing responsibilities vary state-to-state nurses in the U.S. are responsible for knowing the regulatory requirements for nursing and the nurse practice act in every state in which they are licensed and practicing.

The Nurse Practice Act

Each state has a law called the Nurse Practice Act. Nurses must comply with the law and related rules in order to maintain their licenses. The law describes:

  • Qualifications for licensure.
  • Nursing titles that are allowed to be used.
  • Scope of practice.
  • Actions that can or will happen if the nurse does not follow the nursing law.

The National Council of State Boards of Nursing

The National Council of State Boards of Nursing (NCSBN) is a not-for-profit organization through which boards of nursing act and counsel together on matters of common interest and concern affecting the public health, safety and welfare, including the development of licensing examinations in nursing. There are 60 member boards in the NCSBN including all 50 state boards of nursing, the District of Columbia, and four U.S. territories: American Samoa, Guam, Northern Mariana Islands, and the Virgin Islands. Four states have two boards of nursing, one for registered nurses (RNs) and one for licensed practical/vocational nurses (LPN/VNs): California, Georgia, Louisiana and West Virginia. One state, Nebraska, has both the board of nursing and the board for advanced practice nurses (APRNs) represented.

The NCSBN counts among its duties developing the nursing licensing exams, like the NCLEX-RN, and others. They also maintain the Nursys database, which coordinates national publicly available nurse licensure information and monitor trends in public policy, nursing practice and education.

What Can a BON Do to You?

As nurses, we are cautioned from early on to protect our license. Don’t do anything that might jeopardize that hard earned RN credential. The practice areas that cause the most problems for nurses are documentation, assessment, intervention, bypassing checks and balances, and not knowing policies and procedures. These are the basics of nursing practice and where we fall down the most.

Anyone can report a nurse to the BON. It can be a patient or patient’s family member, a peer, a boss or an institution. Once the board is set in motion, it is up to the nurse to try and keep up, and once that nursing license is marked as under investigation that nurse becomes almost unhireable. You’ve been hit in the pocketbook.

A BON can revoke a license, or force a nurse to surrender their license or impose restrictions that can inhibit employment. Most of us think this will never happen. Most of us are good nurses. But, good nurses sometimes make mistakes, sometimes fail to write something down or miss something when assessing their patient. It happens. And again, anyone can file a complaint and then it must be followed up by the BON. Good nurses have lost their licenses, innocent nurses have become unhireable simply because they were investigated.

The one thing to remember is that boards of nursing are not in place to protect nurses, they are in place to protect the public. BONs are like nurse police.

And, like the police, BONs are not infallible. These boards get very little scrutiny, some provide very little public information, and facing facts, they are government entities that suffer the same bureaucratic setbacks as every other form of government.

In 2009, reporters Charles Ornstein and Tracy Weber, both with Pro Publica, filed a story in conjunction with the Los Angeles Times that “uncovered broad breakdowns in California’s regulation of registered nurses.” They “found that the board took more than three years, on average, to investigate and discipline errant nurses. Positive drug tests, criminal convictions, and discipline by other states didn’t trigger immediate consequences. An attempted murderer renewed his license for years while he was in prison. In some cases, even when nurses were convicted of sex offenses, the board never acted at all.”

It only follows suit that if a BON is taking that long to discipline “errant” nurses, they are also taking that long to clear innocent nurses against whom complaints have been filed. BONs are powerful and often the final voice in how each of us is allowed to practice. I believe they should be held to same standards as the courts, as found in the Sixth Amendment to the US Constitution. A nurse, brought before the board “shall enjoy the right to a speedy and public,” in this case, hearing.

Final Thoughts

Like many of my fellow nurse/bloggers I am disturbed by the case of Amanda Trujillo, RN. There are a lot of conversations to be had about her dismissal and the complaint filed against her with the Arizona BON. In the case of the BON I can find no justification for it being almost a year since the complaint was filed and no action has been taken. This woman, this nurse, deserves to move on with her life. She cannot do this with the Arizona board’s stalling. After 10 months they asked her for a psych evaluation, seemingly after she started garnering attention from the aforementioned writers. I don’t even know how they justify that and they have not seen fit to tell her.

One of the problems I see here is the lack of standardization of what is a nurse’s scope of practice, and a lack of standardization in nurse practice acts. Carol Gino, nurse, writer, and activist, addresses these questions to the Arizona Nurses Association on their Facebook page. She says, “…can we have an example or two of what the professional body does so that the nurses who have no clue can understand what it does for all of us? To have a non-standardized scope of practice, to have nurses as professionals be part of a hospital’s budget puts all nurses in the position of non-professionals. We need a clear statement in non-legalese about what our organizations do for us or when we move into expanded practice, we can get thrown under the bus and no one is watching our back. How can any of us wait for the decree without a salary for a year or so? A bridge has to be made between the nurses in the trenches and the policy makers representing us. This is not only Amanda's story, it's a story that has happened to enough of us to back her. It's just time now. How long can we claim we're professionals without autonomy…?”

State boards of nursing were put in play to protect the public; I get that. However, shouldn’t they be responsible to us, as well?

6 Responses to “Boards of Nursing-Who Do They Stand Up For?”

  1. Greg Mercer, MSN Says:

    Regardless of individual good intentions, BONs, at least in AZ, represent a powerful group of political appointees given discretion and deference in excess of most judges – they operate in relative secrecy, with no legal mandate to conclude any given case, ever. With little effort or time, we have found multiple clear conflicts of interest in the Trujillo case, in which Board members have strong financial ties with the source of the complaint against her, Banner Corp. It seems this BON may well represent a distressed entity, with heavy demands and limited resources.
    There seem to be no standards or restrictions on filing a complaint, and no culpability for misuse of the system by those filing them, unlike a typical Judicial system, in which cases may be accepted or rejected on their merits, and public access to proceeding is the general rule. Perhaps as a result, with a tiny budget and little time, this group of impressive professionals face nearly a thousand new cases annually, to which an average case, after a mere 17 hours of total investigation, nevertheless requires 7 months to come to any conclusion. I draw these numbers from public official State data Amanda Trujillo has waited a year, her future in limbo, and her efforts to seek support have been criticized – is it reasonable for anyone to expect a conscientious unemployed professional to wait 7 to 12 months without seeking any support? No such standard is placed on criminal suspects or those subject to civil litigation – why in the world would a system with less allowance for due process require more of those who stand accused? For more information, see wp.me/s278fi-535
    As with most Nurses today, it seems likely that AZ BON suffers from challenging systems issues – an inadequate budget, and no protection I’ve been able to find against employers’ or others’ abuse of this system for retaliatory purposes. For this reason, I have file an open letter to the office of the AZ Governor , as a concerned citizen and Nurse – see wp.me/p278fi-9v

  2. Caryl J Carver, RN, BSN Says:

    Thank you for clarifying the role of the BON; in general; in the US, they were created to protect the public. Many people did not understand that point. That being said, the Arizona BON is going way beyond the scope of protecting the public and appears to be on a witch hunt against Amanda Trujillio. This infuriates me. Nursing is becoming increasingly harder. Yes, we are told from day one of nursing school to protect our licenses. How many doctors have I heard jeering when a nurse makes that statement? If there isn’t some positive intervention in this case I fear for the future of nursing anywhere in the US.

  3. David Hammond Says:

    We are our own worst enemies.

  4. Richard Willner Says:

    Nurses,
    When in trouble with the state board, run to find a competent experienced peer review or state board lawyer

    If you want, we could point you to the right people.

    Richard Willner
    The Center For Peer Review Justice
    http://www.PeerReview.org

    info@PeerReview.org

    “No Nurse Left Behind”

  5. Andrew Lopez, RN Says:

    Thank you Jennifer Olin for covering Amanda’s case, here is the latest:

    The War Against Amanda Trujillo, April 25, 2012, Mother Jones, RN, Nurse Ratched’s Place:”I still support Amanda Trujillo and some people who have read the allegations against Amanda have questioned my judgment. Frankly, I don’t believe these allegations because I personally know two other nurses who have been reported to their nursing boards by their former employers. One of my friends was reported to the BON after she spoke up about unsafe nursing practices at a shady nursing home, and the other was reported after he chastised hospital administration for placing psychiatric patients and staff in an unsafe environment. Their former employers cooked up all kinds of false allegations against my friends who are both stellar nurses. Their former employers crucified their character, but in the end they were both cleared of any wrongdoing by their respective state nursing boards. There is an escalating pattern of abuse as more unscrupulous employers are using nursing boards as the ultimate scare tactic to keep nurses “in their place. ” Amanda is just another victim of this ploy.”
    http://www.nurseratchedsplace.com/2012/04/the-war-against-amanda-trujillo/

  6. L.Tresvalles Says:

    Please anyone who can help me respecting nursing license endorsement application problem.I passed the NCLEX RN in the state of California in 2010 but without license due to lacking US Social Security Number.I am residing in the Philippines.NCLEX RN qualification inclusive of EILTS have been visa screened by CGFNS International valid until 2015 .It is important that i transfer NCLEX RN to another state due to the three yrs period within which to secure SSN in original licensing state..kindly help

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