Board vacancies and a lack of resources for the entity that oversees nurses and home health aides in New Jersey are now eroding this critical healthcare workforce and putting patients at risk, according to critics of its current operations.
Senate Democratic Leader Loretta Weinberg and her colleague Robert Gordon, both of Bergen County, joined a half-dozen nursing advocates Monday to urge Gov. Chris Christie to immediately fill six vacant seats on the 13-member New Jersey Board of Nursing, beef up support staffing, and make other changes.
The critics claimed the board’s function is suffering, leaving thousands of potential providers in limbo as they await licensure, and contributing to a lack of care for vulnerable patients. The senators pledged to schedule legislative hearings to assess the full scope of the problems. (The governor’s office referred questions to the division.)
But the Division of Consumer Affairs, which oversees the board, insisted that it is operating as needed: licenses are now approved in days, not weeks; the panel has more resources than similar licensing entities; and two of the six board vacancies are the result of a law that took effect just weeks ago, expanding its public membership. The division released a letter from DCA director Steven Lee, drafted in response to previous requests from lawmakers, that refuted the accusations point by point.
A very busy board
The board, one of 47 overseen by the DCA to regulate more than 100 professions, is responsible for licensing nurses and certifying home health aides; approving professional education programs; overseeing regulations; and investigating and prosecuting practitioners who violate those codes. New Jersey now has licensed some 143,500 nurses — including registered nurses (RNs), licensed practical nurses (LPNs), and advanced practice nurses (APNs) — and more than 80,000 home health aides.
In recent years, the panel has been criticized for delays in processing licensing applications, particularly for home health aides, typically low-wage workers who help patients with personal care and household chores. Gordon said he met with the division three years ago to raise the issue and sponsored a bill last year to expedite temporary permits for these professionals, who he said were waiting months for board approval.
Last year, state officials said the processing for home health-aide certification had already been reduced to less than two weeks, on average — a challenge since the vast majority of submissions were incomplete. On Monday, the DCA said, as of mid-2015, nursing applicants who have passed their exams now wait less than five days for board action, down from three to five weeks. The turnaround time is expected to decline further now that the state implemented an electronic application system for nurses, making it the first DCA board to get this technical upgrade.
Empty seats on the panel
But Weinberg and Gordon said these improvements were not enough and blamed Christie for failing to appoint new members to the panel. “Clearly, we have a crisis of neglect at the New Jersey Board of Nursing that has severe ramifications for those entering or now serving in the profession,” Gordon said during a press conference in Trenton, “and for those who depend on them for quality healthcare.”
Weinberg called the situation “troubling and appalling” and said it was magnified by the pending departure of the current executive director, a lack of a deputy director, and what critics said was limited funding for the board’s operations. “The inability of this vital state board to carry out its mission is affecting families and the strength of the state’s healthcare system. This situation must be remedied immediately,” she said.
Concerns about board operations re-emerged publicly last week, when Avery Hart, a social worker who serves as the panel’s only public member, shared worries raised by board president Patricia Murphy, an RN and APN, in letters to lawmakers and nursing advocates. This prompted Gordon to write to the attorney general’s office, which oversees consumer affairs, and had suggested at budget hearings earlier this year that staffing at the board was sufficient.
“It’s come to such a position now that the frog has to jump out of the pot before we can see New Jersey’s nursing system going down the tubes,” Hart said, joining other advocates at Monday’s press conference.
4,000 applicants on line?
The advocates asserted that as many as 4,000 applicants are now awaiting nursing licenses and, since months may lapse between their education and the time of the test, half fail the necessary exam when the time comes. The impact of these delays is particularly acute in fields where nurses are filling gaps in patient care, including family medicine and certain addiction and mental health specialties, they said.
“This is deplorable,” said Benjamin Evans, an APN with a nursing doctorate who heads the New Jersey State Nurses Association. “New Jersey has to fix this. We have to get this on track.”
Ann Twomey, president of the Health Professional and Allied Employees, which represents 13,000 nurses and other healthcare workers in New Jersey, said it was a dangerous time to have a backlog of nurses waiting for licensing. “We’re on the cusp of one of the largest nursing shortages that we’ve had in a long time,” she said, adding that such delays are “not fair to the citizens of this state.”
But state officials defended the board’s work and said, while there is always room for improvement, the criticisms are inaccurate and misleading. In his letter to lawmakers, Lee said the board has not failed the public: The panel still has a quorum of members and the day-to-day work is handled by staff, which has remained at a consistently high level since 2010. A new senior staff member is also scheduled to start work in the coming weeks, he said.
Lee also stressed there is no backlog of license requests awaiting state action. The board is typically flooded with 2,000 to 4,000 applications in the late spring, when nursing schools finish classes, and hundreds of files may be awaiting additional submissions at any time, but these are generally processed within a week.
The panel also has plenty of financial resources, Lee said. The nursing board took in some $13 million last year in licensing fees and fines for violations, and a budget change in 2015 allows DCA officials to use this revenue to support the work of other licensing entities, if the needs of the nursing panel are met first.
“The commitment of significant resources and the hard work of Division staff led to unprecedented improvements in the licensure process for nurses and the certification process for (home health aides), which have benefitted all members of the nursing and (home health aide) professions and those who employ them and utilize their services,” Lee wrote.