Jerry Kopel

KOPEL: GUILTY UNTIL PROVEN INNOCENT

Registered, practical nurses must prove they’re not intemperate to gain licensure

In Colorado, nurses are guilty until proven innocent.

For at least the past 30 years, this has been the standard to decide whether a registered nurse or a licensed practical nurse is qualified for a new or renewed license to practice in Colorado.

This folly was discovered by researchers at the Department of Regulatory Agencies in their Sunset review of state regulations governing the nursing profession. The language in CRS 12-38-111 (1) (c) and 112 (1) (c) requires:

“... proof ... to show that the applicant presently is not and, for the 12-month period immediately preceding the date of the application, was not addicted to any controlled substance ... or is not a regular user of the same without a prescription ... and that the applicant is not habitually intemperate in the use of intoxicating liquor.”

How many readers, especially from the Legislature, can prove they are not “habitually intemperate?”

As DORA correctly summarizes:

“If taken literally, every applicant (the vast majority of whom presumably do not have an addiction) would have to produce medical records, letters of reference or an assessment from an addictionologist to meet this requirement.

“... rather than requiring applicants to disclose any current or recent addictions to drugs or alcohol, the wording of the provision requires applicants to affirmatively prove they are not addicted at the time of application.

“It is difficult, if not impossible, to prove a negative.”

However, the requirement has been in the statute for at least 30 years — and who knows how many applicants were unable to prove a negative? In 2003, language in the form of responses to questions was added as subsection (3) in applications for both RN and LPN licenses. It allows a future nurse to provide the same information affirmatively or negatively for original licensure or renewal.

“The provisions requiring applicants to submit proof they are not addicted should be eliminated,” DORA asserts in its Sunset audit.

DORA also found wording that favors errant applicants, noting that “a licensee could be convicted of a crime one month after sending in a renewal questionnaire and not be compelled to disclose it until the next renewal period 23 months later.”

“This poses a clear threat to public safety, and the board should be able to pursue disciplinary action against those who withhold this information from the board.”

According to DORA staff research for fiscal year 2006-’07, there were 10,091 licensed practical nurses and 56,918 registered nurses in Colorado. Yet, during the five years between July 1, 2002, and June 30, 2007, only 197 RNs surrendered their licenses or had them revoked, and only 58 LPNs. During that period, the Nursing Board meted out lesser disciplinary actions in nearly 800 cases.

RNs have been regulated in Colorado since 1905 and LPNs since 1957. They renew their licenses every two years based, in part, on their answers to the questionnaires added in 2003.

In fiscal year 2006-’07, 4,976 LPNs and 1,233 RNs were newly licensed. Nearly 2,000 registered nurses have prescriptive authority.

RNs and LPNs are by no means the only the health-care professionals regulated by the Nursing Board. The board also certifies registered nursing assistants and licensed psychiatric technicians, bringing the total regulated to 91,422 in July 2008, according to DORA.

Do we have enough nurses? DORA points out “a shortage of clinical resources and qualified nursing faculty prevents nursing education programs from accepting more nursing students.”

The agency suggests qualifying medical personnel through clinical laboratory experience in order to open the bottleneck, noting, “... the more opportunity they have to practice a nursing task, such as venipuncture, in a clinical simulation setting, the more effectively and confidently they are able to perform the task on real patients during their clinical rotation.”

“Nursing education programs can only admit as many students as there are available clinical resources ... (this) can result in long waiting lists.”

DORA focused on two sites. One had 140 slots in its RN program, with 300 students on the waiting list. The other has 50 slots, with 400 students on the waiting list.

Presently, requirements for training say no more than 15 percent of a trainee’s hours can be accrued through clinical simulation.

DORA suggests “increasing the number of clinical hours performed in clinical ... simulation (to 25 percent) could help move students through the nursing education system more effectively.”

Jerry Kopel served 22 years in the Colorado House.