Next Steps for Improving New Jersey Nursing Board Operations

Lilo H. Stainton | October 10, 2017 | Health Care
Munoz suggests following lead of Motor Vehicles and tying expirations to the license holder’s birth month — others argue larger systemic fixes are needed

Assemblywoman Nancy Munoz (R-Union)
While Democrats seeking reforms at the New Jersey Board of Nursing have been accused of partisan attacks, a Republican lawmaker who is also a nurse is calling for a change in the licensing process that she said will improve operations at the beleaguered board.

Assemblywoman Nancy Munoz (R-Union) a clinical nurse specialist, said that she will introduce legislation to connect nursing license expiration dates to a professional’s birth month. Currently, licenses are issued for two years with a May 31 expiration date, resulting in a sudden influx in workload and an uneven revenue flow for the board, which is funded by licensing fees.

“The bill will provide a steady stream of funding throughout the year,” said Munoz, who was invited to join last Thursday’s Senate Legislative Oversight Committee hearing on the nursing board. “Spreading the workload throughout the year will give staff more time to process applications and prevent a backlog.” 

Munoz’s proposal appears to be the first concrete measure to emerge from the review of the board, which was triggered by public concerns raised this summer by former members and nursing advocates, and it is unlikely to be the last.

Committee chair Sen. Robert Gordon (D-Bergen) suggested the board was in need of a full, outside, independent audit; Senate Democratic Leader Loretta Weinberg (D-Bergen), who has led the inquiry with Gordon, recommended looking to other states for operational benchmarks and urged greater budgeting transparency; the senators also mentioned legislation to ensure the panel maintained a full quorum of 15 members.

“I’m coming away from this,” Gordon said during the hearing, “maybe it’s unfair for me to say this, but it sounds to me like this organization needs a total overhaul.”

‘Trying not to get angry’

Weinberg seemed to agree. “I’m trying not to get angry here, but there are a lot of things to get angry about.”

While New Jersey officials have defended its operations, critics contend a longtime shortage of board members and a chronic lack of professional staff at the nursing board — which licenses some 220,000 nurses and home health workers, regulates dozens of nursing education programs and reviews hundreds of disciplinary cases each month — has led to licensing delays and other problems.

The New Jersey State Nursing Association and other professional organizations said there is sometimes a backlog of thousands of nursing applicants and some individuals end up waiting months for their licensing. The situation puts patient care at risk, they insist, and only exacerbates a pending shortage of healthcare workers.

“Nursing is the backbone of the healthcare profession and we cannot afford shortages of staff in our facilities when there are qualified professionals who can fill them, but just can’t get licensed quickly enough,” noted Aline Holmes, an advanced practice nurse and senior vice president for clinical affairs at the New Jersey Hospital Association, who also testified Thursday.

Delays at all levels of healthcare

Home health aides — among the lowest paid healthcare workers – have also long struggled with licensing delays, explained Christine Buteas, president and CEO of the Home Care and Hospice Association of New Jersey. “Any delay in processing home health-aide applications causes them to look for employment in other industries impacting the ability to attract and retain a home health-aide workforce,” she said.

Gov. Chris Christie appointed 10 new members and reappointed three others the week before the oversight committee hearing, but did not renew the membership of two existing members who had spoken out about problems at the board. His office also framed the criticisms from Gordon and Weinberg as political and without merit.

State officials have defended the current staffing levels, and are hiring additional help, and insisted that the lack of board members never interfered with its business. The board, one of dozens overseen by the Department of Consumer Affairs, within the attorney general’s office, has more support than most other licensing entities, they have said.

Intervention necessary?

But during the Senate committee hearing, Munoz said her own college roommate struggled to get documents from the board she needed to accept a nursing job – and only received approval after the assemblywoman intervened. Nurses are among the most trusted professionals, she said, and the public deserves an oversight system it can trust; a bill she sponsored was signed into law in July, expanding the board membership with two nurse-educator positions — and creating several new vacancies that did not get filled until this month.

“We have many issues we need to address,” Munoz said at the start of the hours-long proceeding, while urging her colleagues not to jump to conclusions. “We need to get numbers, we need to get facts, and we need to see how we can make this better,” she said. “Let’s see if we can get some solutions.”

Munoz said her proposal to re-adjust the nursing license process draws on improvements New Jersey recently made to its system for issuing drivers’ licenses. In June, Christie signed a law that tied the expiration date of drivers and non-driver identification cards to the applicant’s birthday, instead of the last day of the month in which it was issued. The goal was to spread the load at the state’s Motor Vehicle Commission and cut down on problematic wait times for license renewals — an approach Munoz said could also benefit the nursing board.

But the concept was not immediately embraced by at least one key stakeholder, the Health Professional and Allied Employees, a union that represents more than 13,000 nurses and health professionals.

‘Streamline operations’

“When an agency is managed as poorly as the Board of Nursing, changing the timing of when revenues are received will do nothing to address the crisis. Immediate action must be taken to streamline the operations of the board and appropriately staff the board so nurses can do what they do best, provide care for their patients,” HPAE president Ann Twomey said when asked about Munoz’s plan.

Staffing became such a problem that the former executive director, Dorothy Smith Carolina, left her position as the top board staffer earlier this year, when she said repeated pleas she and former board president Patricia Murphy made to administration officials for more professional help and other resources went unanswered. Carolina and Murphy said today only one of the staff members assigned to the board has nursing experience — something that seemed to spark concern among a number of lawmakers, regardless of party.

“The nursing board is critical to the health and safety of our residents,” Munoz said, adding, “We need to ensure there are adequate qualified nurses and staff” to process licenses and investigate disciplinary complaints.