Nurse-monitoring audit spurs senators concern

Hearings promised as observers say public safety may be compromised

Two national authorities on nurse monitoring programs say that the independent audit of the Oregon Board of Nursing released last week shows the board is allowing potentially dangerous nurses to stay on the job.

Nurse monitoring programs are designed to monitor drug- and alcohol-addicted and mentally ill nurses while allowing them to continue working.

Barbara Taylor, a Florida nurse who for six years held various supervisory positions with Florida's Intervention Project for Nurses, one of the country's most respected monitoring programs, reviewed the findings of independent auditor Brad Rafish and told the Portland Tribune that Oregon's program lacks basic support for addicted nurses and public protections that other such programs have had in place for years.

'They (patients) are in danger unless the monitoring is adequate, and in my opinion this monitoring is inadequate at this point,' Taylor said. 'This looks to me like a program that is in its very infancy. It might not be, but that is what it looks like. It has not grown with what is being done as a standard in other places.'

The audit, conducted over two and a half months, made 10 recommendations to improve the nurse-monitoring program, ranging from hiring more staff to supervise nurses to developing specific guidelines and standards for nurses participating in the program.

The Oregon nurse-monitoring program has been operating for 15 years.

'I would be concerned that the nurses are not getting what they need,' Taylor said. 'You need a lot of structure and support in order to do well. The relapse percentage (in Oregon) is probably higher, and that impacts the safety of the public.'

Taylor's analysis of the audit contrasts with comments made last week by Joan Bouchard, executive director of the Board of Nursing. Bouchard told the board, 'I think the audit shows there are no emergencies or huge fires here.' Bouchard also said the board's staff would look at implementing changes suggested by the audit.

Senator sees problems

State Sen. Vicki Walker, D-Eugene, had a different reaction to the audit. 'I'm not sure I agree with the executive director,' Walker said. 'I think there are some serious concerns here.'

Walker said she was especially concerned to read that nearly one in five nurses in Oregon's monitoring program work in long-term care facilities such as nursing homes.

Nurses in the monitoring program are supposed to be supervised at all times, yet Oregon law allows nursing homes to have just one nurse on duty at a time.

'I think that is an emergency, and it requires immediate attention by the board,' Walker said. She added that she would like to see the program move nurses to jobs in which they had greater supervision if more thorough monitoring could not quickly be put in place.

Laura Clarkson, program coordinator of Oklahoma's Peer Assistance Program and, until recently, president of the national organization for nurse monitoring programs, said she thought the audit was well done.

'They've made a good start by having this audit done,' Clarkson said. 'They now know that they're not doing a good job.'

The audit makes clear that understaffing is leaving addicted nurses in Oregon's program at work but without adequate monitoring. But Clarkson said not all the changes that need to be made in the Oregon program would require more money.

'The one thing that really flew out at me was that they didn't have specific guidelines and criteria (for participating in the program),' Clarkson said. 'That's a must. That establishes continuity and procedure.'

Lack of staff, guidelines cited

Clarkson said guidelines allow case managers to make clear to nurses what they must do to stay in the program, and what will happen to them if they don't. 'If you haven't told them what's going to happen, you can't expect them to comply,' Clarkson said.

The audit said Oregon's program lacked the most basic guidelines for case managers and that case managers were left to rely on their own judgment in dealing with nurses who relapse or fail to comply with their monitoring agreements. Clarkson said such guidelines are readily accessible from the National Council of State Boards of Nursing.

'You don't have to reinvent the wheel,' Clarkson said.

Taylor called the size of the Oregon program's staff 'pitiful.' According to the audit, each of two case managers has about 150 nurses to monitor, and the support staff is equivalent to less than one full-time worker.

As a result, according to the audit, 'minimal monitoring' of nurses in the program was taking place. Staff members often are unable to keep track of such monitoring activities as making sure participating nurses have taken and passed required drug tests.

Taylor said that when she left the Florida program in 2001 there were 20 staff members working to monitor approximately 1,000 nurses.

'They're trying to do a lot with very few resources (in Oregon),' Taylor said. 'And it's going to hurt everybody. It's going to endanger the public, and the nurses are getting sicker instead of getting better. It's just too lax.'

Hearings set for next month

Sen. Bill Morrisette, D-Springfield, chairman of the Oregon Senate Committee on Public Health, said his committee will begin holding hearings on the nursing board Oct. 10.

Morrisette said auditor Rafish will be invited to the hearings, and that he expects presentations also will be made by Board of Nursing staff and Department of Justice Deputy Attorney General Pete Shepherd, who has been looking into the board's activities since the Portland Tribune ran a series of stories revealing problems with the board last spring.

'There are a number of things that need to be fixed, and we will deal with them as we hear them,' Morrisette said.

Morrisette has said that he would like to see a change made in the composition of the nursing board. Currently, seven of nine members are nurses, and Morrisette has said he would like a greater percentage of non-nurse members.

Board of Nursing members had no immediate reaction to the audit when it was presented last Thursday, saying they had received copies the night before. None of the board members whom the Tribune has attempted to contact for comment since then has returned calls.

Lonn Hoklin, spokesman for Gov. Ted Kulongoski, who appoints all nursing board members and can ask for their resignations, said the governor had no comment as to whether the audit revealed that public safety has been compromised.