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Crisis in New Jersey Highlights Problems for Many State Boards of Nursing

Stockwell, Serena

AJN The American Journal of Nursing: November 2017 - Volume 117 - Issue 11 - p 12–13
doi: 10.1097/01.NAJ.0000526729.52786.70
In the News

Bureaucracy and lack of resources challenge licensing and oversight.

Serena Stockwell

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In what the New Jersey State Nurses Association (NJSNA) and lawmakers call a crisis, the underfunded New Jersey Board of Nursing has become mired in a backlog of licensing applications and complaint investigations that nurse advocates say is detrimental to health care in the state.

The board's executive director recently resigned and the deputy director position has been vacant for months. “The situation is appalling,” said State Senate Majority Leader Loretta Weinberg (D), speaking at a news conference organized by the NJSNA.

“Clearly, we have a crisis of neglect… that has severe ramifications for those entering or currently serving in the nursing and home health care professions, for those people who depend on their services, and on the quality of health care in New Jersey,” added Sen. Bob Gordon (D), who said he has been raising alarms about the problems for three years.

NJSNA president Benjamin Evans detailed the concerns in an essay (http://njsna.org/njbon-oped) and in a telephone interview:

  • limited budgetary control by the executive director
  • long-vacant volunteer positions on the 13-member board (These were recently filled by the governor just days before a Senate Oversight Committee hearing.)
  • tensions with the New Jersey Division of Consumer Affairs, which oversees the board
  • a hiring freeze for staff positions
  • an outsourced call center that operates inefficiently and sometimes misinforms

Evans and the NJSNA's chief executive officer, Judith Schmidt, noted that there would be more than enough money—$13 million in license and other fees were collected last year—if it were not bottled up in the state's general fund. By legislative mandate, the revenue goes directly into the state's general fund, as it does for about half of the state and territorial boards of nursing in the United States, according to the National Council of State Boards of Nursing.

Georgia, for example, has the same “umbrella” structure for its board of nursing as New Jersey, with “no influence, no control,” over decisions and budgets, said Janice Izlar, the Georgia board's president. In contrast, boards in states that are “administratively attached” or “independent,” have more control, although just how much varies—the specifics are set by each state.

“Boards function more effectively when administratively attached,” Izlar told AJN. “And although Georgia does not have as bad a problem as New Jersey, we definitely see opportunities for improvement.”

The biggest problem in Georgia, according to Izlar, is a backlog in investigations of complaints. They typically take 437 days from receipt to resolution. “Obviously, all those under review deserve due process, but just think if you have a nurse who is impaired and taking care of patients and still has a license to work, and is not being monitored—that is not acceptable.” Conversely, an innocent nurse has to wait more than a year to be exonerated.

A 2016 study in the Journal of Nursing Regulation comparing umbrella and independent boards found that although the latter communicate better and have more autonomy, the extra review needed for umbrella boards can be beneficial since external critiques can result in valuable recommendations for improvement.

In Texas, the nursing board is on a two-year funding cycle. “The legislature decides how much money the board can have, and then we have to raise the money through fees, increasing or decreasing them based on what we are allocated,” said Texas Board of Nursing executive director Katherine Thomas, a coauthor of the 2016 study. Thomas spoke to AJN in a telephone interview along with Mark Majek, the Texas board's director of operations.

Even so, the Texas board's budget is not always secure. State officials can summarily request return of funds, and the board lacks the autonomy and budget flexibility, for example, to divert money to an emergency need. Moreover, allocated funds are restricted to the budget period. “If we don't spend it by the end of the fiscal year, it's gone, swept automatically to the state's general revenue for other spending,” Majek said.

Still, the board functions relatively well, according to Thomas. As AJN went to press, the Texas board was able to respond to the extreme emergency of Hurricane Harvey by granting more than 600 temporary licenses to out-of-state nurses seeking to help with the disaster. Whether this will affect future board budgets is unknown, Thomas said.

The situation in New Jersey remains tense and unresolved. Before leaving for a private sector job, the director of the division of consumer affairs, Steve C. Lee, wrote a letter disputing many of the complaints by the NJSNA and lawmakers. Sens. Weinberg and Gordon said they plan to hold hearings on the matter.—Serena Stockwell

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