In the March issue, Diana Mason asks who's watching nurses to ensure the public's safety ("Who's Watching?" Editorial). Boards of nursing are "watching" licensees, and outside groups and agencies "watch" these boards, which, as state government agencies, are open to evaluation and review by the public and the designated government agencies that regularly audit their performance. All boards' actions and final decisions related to discipline are public information. It's important that all nurses understand nursing boards' work and mission to protect the public.
Mason also discusses another article in the March issue, "Probation and Recidivism: Remediation Among Disciplined Nurses in Six States," in which Zhong and colleagues at the National Council of State Boards of Nursing (NCSBN) report on data from only six state boards of nursing. This was not due to disciplinary data from all other states being inaccessible to the researchers, as Mason suggests. These data are public information in all U.S. jurisdictions and are available to everyone, including the NCSBN. Rather, it was due to the study's research protocol. Boards were required to complete a 29-item questionnaire on every case that met the study criteria. Knowing that boards have limited time and resources, the investigators did not anticipate that many would participate. This is recognized as a limitation of the study. We commend the boards that did participate and recognize them for their contributions to this important work.
Regarding Mason's statement that "Some boards punish nurses when they shouldn't" in reference to nurses who are disciplined for "systems errors," the evidence from Zhong and colleagues' study demonstrates that the majority of nurses are not disciplined for this reason. Seventy percent of the cases reported in the study (N = 207) were unrelated to systems errors. Instead, they resulted from misjudgment, misconduct, or incompetence. These violations threaten the public safety, and nurses who commit them must be held accountable.
It's unknown whether any of the remaining 30% of cases were connected to systems errors; but when practice errors occur, boards take mitigating factors into account and often employ measures that go beyond conventional discipline.Many boards are developing programs that focus on remediation for nurses with identifiable competency problems and are adopting the Just Culture model, which examines medical errors in relation to the behavior that led to the event and evaluates the system and context in which the error occurred (see http://www.justculture.org). When a system error is noted, many boards inform the employer of the problem.
The good news is that boards of nursing are watching. Even better news is that this can lead to increased authority and financial resources being given to boards, so that they can better protect the public, as is the case in California.
Laura Rhodes, MSN, RN
President, NCSBN
Executive Officer, West Virginia Board of Examiners for Registered Professional Nurses
Charleston, WV