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Weigh nursing errors in their full context
- Article by: Teresa J. Ayling
- October 10, 2013 - 7:15 PM
Sunday’s article about the Minnesota Board of Nursing was informative (“Nurses in trouble get second chances,” Oct. 6). However, as an attorney who represents nurses before the board, I would like to suggest another perspective.
Almost all of us make mistakes on the job. Some mistakes have negative consequences for our customers or employers; others do not. They can be caused by carelessness, understaffing, lack of sleep, defective equipment, distraction caused by illness in the family, poor training, health problems, lack of supervision, a bad day, weather problems, or a combination of these and other factors. The point is that the mistake may or may not be the employee’s fault alone. When mitigating factors exist, such as lack of training or understaffing, those issues may not be fully reflected in the document setting forth the consequences of the licensee’s action.
Many matters come before the board as a result of a nurse losing his or her job. By the time the matter makes its way through the system to a conference, the nurse may be reemployed. He or she may have learned from the mistake and become a better nurse as a result. The board rightly considers the comments of supervisors, old and new, in evaluating whether the nurse is capable of safely practicing despite a mistake or even a series of mistakes.
I realize that the mistake of a health care provider can be serious and sometimes fatal. As a consumer of health care services, I want my doctors and nurses to be perfect all the time. But that is not how the world is. Mistakes happen, even when we try our hardest. I wonder if people would want to go to college and study for years to get a nursing degree if they knew that their license could be taken away because of one mistake — one bad day.
The purpose of the Board of Nursing, like other licensing boards, is to protect the public, not to punish mistakes. The Nurse Practice Act requires a showing of a “Failure to or inability to perform professional or practical nursing … with reasonable skill and safety” in order to take licensing action for a practice error. One mistake typically does not meet that criteria.
In my opinion, the board effectively and efficiently uses its conferences with nurses to investigate complaints and to educate nurses about practice issues, and sometimes appropriately refers a nurse for additional education as an alternative to suspending or revoking the nurse’s license.
I also believe that the diversion program for nurses with chemical dependence is a good program. The Health Professionals Service Program, known as HPSP, has been used by 17 health licensing boards in Minnesota since 1994 to monitor licensed health professionals with chemical dependence, physical illness and mental health problems, so that they can continue to work safely in their chosen professions. According to its website, the program currently monitors 600 professionals.
According to the U.S. Department of Health & Human Services, “approximately 10 percent of the general population experiences alcoholism, while another 5 percent are addicted to drugs.” Nurses are not immune from the disease. Persons who have chemical dependence can safely practice nursing if they have had treatment and are not using alcohol and other chemicals. The HPSP program monitors health professionals to ensure that they are in remission.
Participation in HPSP is no picnic. The professionals typically have to agree to years of random drug and alcohol tests, calling in each day to see if they must go to a clinic to be tested at their own expense. They cannot leave town for vacation or even for a funeral without first arranging a clinic where they can be tested if they come up for a random test. They typically have to provide quarterly reports from psychologists or psychiatrists to attest that they are compliant with therapy; logs of required attendance at AA or NA, and quarterly reports from supervisors confirming that there are no problems on the job.
These stringent requirements are designed to quickly detect and report any relapses to the board overseeing the licensee. One drawback is that there can be a time lag between HPSP’s report to the board and the board’s action. Perhaps the lag is due to staffing levels at the board, a common issue in government agencies in this no-new-taxes era.
Good people sometimes make mistakes. Before judging the decisions of the Board of Nursing too harshly, it might be worthwhile to look at all of the nurses who have picked up their lives after struggling with chemical dependence or who have gone back to successful careers after an error on the job. In many instances I think we would be happy to have those nurses at our bedside.
Teresa J. Ayling is a labor lawyer at Hellmuth & Johnson in Edina and a former registered nurse.
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