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How does this protect me as a patient?
Licensing boards are in place to protect the public by regulating the professions. The medical boards regulate physicians; the pharmacy boards regulate pharmacists; the nursing boards regulate nurses. Their mission is to prevent harm to patients by enforcing professional practice acts. Because the mission is identical across licensing boards, the response to complaints should be comparable. It is not.
In a Delaware case last fall, a nurse accidentally spilled 12 tablets of an expensive medication on the floor. She then wasted them in a sharps container and notified the pharmacy. The pharmacist contacted her boss, who notified the physician. The pharmacist asked the doctor to retrieve those wasted pills. The doctor then ordered the nurse to do so. The nurse and her manager shook the sharps container and retrieved the pills. At the physician’s request, the pills were inspected by the pharmacist and the pharmacist’s supervisor. Both the pharmacists and the physician decided that the pills did not show signs of contamination or damage and could be returned to the bottle.
Another nurse in the facility filed a complaint against the nurse and her supervisor with the nursing board. The state also filed claims against both pharmacists and the doctor. No disciplinary action was taken against the pharmacists by the pharmacy board. No discipline was taken against the physician by the medical board. But the nurses, although relying on the expertise of the doctor and following his orders, were disciplined by the nursing board. There you go.
In an episode where all three professions are involved, it would be reasonable to assume that the respective licensing boards would take a similar approach. In investigating a complaint, the licensing boards would first determine if the issue falls within their jurisdiction. Next, the board would investigate the issue to determine if the provider had engaged in professional misconduct. Lastly, the board would decide if the misconduct required discipline to protect the public. Unfortunately, nursing boards seem more likely to decide that actual discipline is necessary when other boards find that correction, education, warnings, or no action whatsoever are indicated. Nursing boards are more likely to punish nurses than medical boards are to punish doctors. Nursing boards are more likely to punish nurses than pharmacy boards are to punish pharmacists.
Nurses are the last dominoes to fall but they should not disproportionally carry the weight of adverse events. In a situation where the physician has given an improper order or a pharmacist has assumed responsibility for the safety of a medication, it should not be the nurses who are held solely responsible. Nurses should be able to follow the physician’s order or rely on a pharmacist’s opinion without being exposed to licensure discipline. This is particularly true when nurses can also be disciplined for not following a physician’s order.
A doctor can violate standards of practice and not have his license disciplined, as can a pharmacist. But nurses must be punished. Why are nurses alone held to such a standard? Why must nurses alone pay a penalty instead of being corrected or educated? How does such a disproportionate response protect the public?
I don’t dispute a licensing board’s mission to protect the public. And I don’t dispute a nursing board’s authority and responsibility to discipline a nurse if it is necessary to accomplish that mission. But I do have concerns about that discipline being imposed in a disproportionate manner.
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