Problems with the program that oversees nursing in New Jersey go beyond vacancies on the licensing board to include a chronic lack of support staff, internal management concerns, and other issues that critics say now put nurses’ profession — and patient health — at risk.
More than a dozen nurses, educators, advocacy organizations, and labor leaders testified yesterday before the Senate Legislative Oversight Committee at a hearing dedicated to fleshing out concerns raised by professionals about the New Jersey Board of Nursing, which licenses and regulates some 220,000 healthcare providers, including home health aides. The hearing led the committee chairman, Sen. Robert Gordon (D-Bergen), to suggest the program needs a “total overhaul.”
In addition to struggling to convene meetings with a board that was until recently short eight of its 15 members, the speakers said a shortage of professional support staff led to serious delays in processing license applications, reviewing disciplinary cases, and monitoring dozens of nurse education programs. (Critics contend nurses must wait months to be approved for exams and thousands of licensing applications are awaiting board review, an issue that exacerbates any care shortages.)
Only one member of the nursing board staff has actual nursing experience, critics said. And many of the staff that are assigned to the board — one of 47 overseen by the Division of Consumer Affairs — report to managers elsewhere, creating inefficiencies and potential conflicts, speakers said.
‘Lack of professional staff’
“So, we have an executive director with lots and lots of responsibilities and no authority over some of the people working for the board,” explained Patricia Murphy, a former board chair. But the “chronic lack of professional staff, that seems to be the core of the problem,” she added.
Gordon and Senate Majority Leader Loretta Weinberg (D-Bergen), the committee’s vice chair, had called the hearing to get to the bottom of issues raised this summer by Murphy and Avery Hart, who is a public representative on the board.
Both Murphy and Hart were replaced on the board last Friday, when Gov. Chris Christie appointed 10 new individuals and re-appointed three current members to the panel. Weinberg and the former members suggested the governor’s action appeared to be retribution for their speaking out.
While the governor’s office declined to address that charge, a spokesman for Christie suggested the senators were playing partisan politics and didn’t have their facts right; some of the vacancies took effect in July, when the governor signed a law expanding the nursing board’s membership. Former Division of Consumer Affairs director Steven Lee, who left the post in September, insisted staffing for the board was sufficient — and more robust than for many other licensing panels — and there was no significant backlog of applications.
Sharon Joyce, who took over as acting DCA director when Lee left, testified that the board was now “staffed appropriately” but will be better served when it hires an additional three or four workers, something that is now in the works. Joyce also launched an internal audit to better understand the challenges involved with the complex licensing system and to see how the board can make improvements.
“I think it’s a question of looking at the process and seeing where we can shore it up,” Joyce said, noting a need for improvement in communicating with applicants — some of which is still done by regular mail, better partnerships with nursing advocates, and improved technology.
But these responses didn’t necessarily satisfy the committee chair. “My sense is that if you were a private sector organization, you would be out of business,” Gordon said. “Maybe it’s unfair for me to say this, but it sounds to me like this organization needs a total overhaul.”
Change is sure to come with the new crop of board members named last Friday along with dozens of other appointments, including to the New Jersey Collaborative Center for Nursing, a program established in 2002 to help address leadership and workforce shortages. “We’re facing another nursing shortage and it’s looming large,” noted Ben Evans, an advanced practice nurse and president of the New Jersey State Nurses Association, stressing the need for an efficient licensing process.
“Better late than never,” Weinberg said at the hearing, noting that the new appointments appeared well qualified. “But to have replaced the two people who have the institutional knowledge about the board of nursing was at best inappropriate,” she added, referring to Avery and Murphy. “I appreciate you two stepping forth and shining some light on what appears to be a longstanding problem.”
In the days since she was dismissed — just months before her second five-year term ended — Murphy has talked to board staff and agreed to help with the transition. “I think her participation in trying to acclimatize new members will be extremely valuable,” Joyce said. “It is a steep learning curve and the board does have pretty important responsibilities.”
Regardless of the continuity in leadership, Murphy said there are other needs that the state must address to ensure the board functions properly. While the state may have board staff in place, only one member of this team has nursing experience and the work requires input from trained professionals, she said.
Murphy said the board also needs a full-time executive director, a position that has been filled by an acting employee — whom the speakers praised for her efforts — ever since former executive director Dorothy Smith Carolina left in frustration earlier this year. The system would also benefit from a trained professional dedicated to overseeing the 84 nursing education programs, some of which are outdated, she said.
“These are all systemic fixes, not Band-aids,” Murphy said.