Nurses Able to Circumvent System, Keep Working Despite Allegations of Misconduct
TweetAs I mentioned earlier this week on Medicare Solutions Blog, the nursing shortage has created many problems nationwide. One issue which has been exacerbated by the nursing shortage is the problem of nurses censured for misconduct in one state crossing state lines to work elsewhere. Recently a twenty-four state compact meant to help nurses work in the neediest areas has actually opened the door for nurses being investigated for professional irresponsibility and negligence to elude the consequences of their misconduct and keep working. This ten year old interstate compact allows a nurse with a license obtained in their home state to work in any of the other twenty-three states. Nursing licenses obtained in states not in the pact only allow the nurse to work in that home state. While this compact goes a long way toward bringing nurses into the states that need them most, it also creates significant gaps in nationwide regulatory efforts to get bad nurses out of our hospitals by revoking their licenses because states in the compact are allowing nurses to work in their state whom their regulatory boards have never reviewed.
Bad Nurses Able to Circumvent the System
When a nurse is accused of misconduct in a state outside the compact, they are suspended during the investigation and their license is revoked or they are otherwise sanctioned if the allegations are proven true. Within the compact, when a state is slow to act (or fails share information with its fellow compact members) on allegations of misconduct, nurses suspected of crimes remain free to work in any of the other member states. Some nurses in the compact will leave their home state while they are being investigated and set up shop in another compact state, jumping from state to state to elude subsequent allegations and putting patients in jeopardy. Compact officials don’t track which nurses are sanctioned for misconduct elsewhere by their home state nor do they investigate whether states are adequately monitoring visiting nurses.
Because there is no federal licensing system for nurses the compact has been an improvement over the state-by-state method for policing nurses who work in different states, but as evidenced the ability of one state to keep bad nurses out of its hospitals is only as good as the reporting of other states in the compact. As a result, though the compact has been heralded as a success, board officials in non-member states worry it gives compact members a false sense of security. They argue that differing regulations and standards across states make cooperation difficult. For example, laws in most states allow officials to suspend a nurse’s license immediately but some cannot no matter how serious the allegations. Also, some states require criminal background checks before giving a nurse his or her license, while other states don’t.
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