We all might agree that a nurse who's been convicted of sexually assaulting a patient shouldn't hold a nursing license. But what about someone convicted of driving while intoxicated? What about a second offense? Or a third that results in death? Where should the line be drawn?
In some states there is no line. That's the impression I got from the recent work of Charles Ornstein and Tracy Weber, Pulitzer Prize-winning journalists who worked for the Los Angeles Times and who are now with ProPublica, a new nonprofit news organization dedicated to "investigative journalism in the public interest" (http://www.propublica.org). Between October 5 and November 2, 2008, the Los Angeles Times and ProPublica published Ornstein and Weber's series on the large number of California RNs and LPNs with criminal convictions who are continuing to hold and renew their licenses. In one case, a nurse renewed his license while behind bars for attempted murder. The journalists noted that the California boards for registered and vocational nursing
* were inconsistent in mandating that applicants be fingerprinted.
* failed to have a system in place for discovering whether applicants for licenses or renewals had been convicted of a crime that would make them unfit to practice nursing.
* often acted so slowly, even when a nurse disclosed a history of criminal conviction, that a nurse could commit several crimes before the board took action (in one case, the board acted 10 years after a criminal conviction).
And the California Board of Registered Nursing failed to ask nurses to disclose criminal convictions on their license renewal applications.
Ornstein told me that more reports through ProPublica are forthcoming. He and Weber are delving deeply into this topic and looking beyond California. (Other states may not look much better. I'm licensed in New York State and have never been fingerprinted.)
Some nurses have questioned the journalists' motives; one nurse asked me, "Why don't they go after medicine?" The answer: medical boards have long been under scrutiny by journalists. Nursing is seldom in the spotlight.
Ornstein and Weber's reports are causing state nursing boards and governments to examine whether boards have sufficient authority and resources to protect the public from nurses who pose a danger to patients (see "Protecting the Public from Bad Nurses," AJN Reports). After the first article in Ornstein and Weber's series ran, Carrie Lopez, director of the California Department of Consumer Affairs, announced that the California Board of Registered Nursing would require fingerprinting of all nurses-not just new applicants, who had been required to do so since 1990-and Ornstein told me that the board has added staff, too.
In this issue of AJN, Elizabeth H. Zhong and her colleagues at the National Council of State Boards of Nursing (NCSBN) report their findings of an exploratory study of recidivism among nurses on probation in six states for non-drug-or-alcohol-related offenses. The fact that the NCSBN could not access public databases in all states to get this information speaks to how much work needs to be done to even study such issues. Licensure has always been the purview of states, resulting in variation in how boards act. Zhong and colleagues report that almost 40% of nurses on probation in these six states in 2001 committed another act of professional misconduct between 2001 and 2005. Among the related major factors was history of a criminal conviction, suggesting that boards should carefully screen and monitor nurses with a criminal background.
This is a complex issue. Some boards punish nurses when they shouldn't-for example, in cases of health care errors resulting from unsafe systems. And not all nurses who have been convicted of a crime should lose their licenses or even be disciplined. But the determination shouldn't take 10 years. If state boards aren't looking out for nurses who shouldn't be practicing, I hope that journalists like Ornstein and Weber will continue to hold us all accountable.