State Bureaucracy Creates Nurse Licensing Gridlock in California

Published October 6, 2016

California’s Board of Registered Nursing was still reviewing nurse licensing applications submitted in March when Kaiser Health News reported on the logjam in August.

The board appears to have accelerated its review ahead of posting on its website a September 6 update stating it was processing applications submitted between August 1 and August 15, with projected review times lasting between 10 and 12 weeks.

Once approved, applicants may take the exam and must wait two to four weeks for their results, the website states. Applicants who fail the exam must reapply for approval to repeat the exam, which also can take between 10 and 12 weeks to receive. As of September 6, the board was reviewing repeat exam applications submitted in early June.  

Slow Connection

Sally Pipes, president of the Pacific Research Institute, says the state’s mismanagement of its digital tools contributes to the delays.

“There have been tremendous glitches with implementing the computer system, BreEZe,” Pipes said. “These problems should not have happened or should have been solved quickly.”

At least 18 California licensing boards have adopted BreEZe, implementation of which cost $94 million, Kaiser reported in August.

The flawed rollout of the California licensing system resembles the release of the error-riddled federal website for obtaining Obamacare health insurance subsidies, Pipes said.

“There were many glitches with, the federal website for those signing up on the federal exchange under the Affordable Care Act,” Pipes said. “Government should not be in the business of building websites. They are very costly and fraught with problems.”

Government Fingerprints

Twila Brase, a registered nurse, public health nurse, and president of the Citizens’ Council for Health Freedom, says the nursing board’s prolonged technological problems and licensing delays exemplify the problems of government management of private enterprise.

“This kind of technological nightmare could happen anywhere, but the response differs when it happens to government,” Brase said. “If it happened to a private corporation, the slowdown would not be tolerated for very long. But with the government in charge, nurses are experiencing long waits, losing access to promising jobs, and flying to California to personally deliver fingerprints when they’ve been lost.”

Could Worsen Shortages

California’s licensing delays could cause problems by worsening staffing shortages at hospitals, Brase says.

“Fewer nurses available to care for patients … could lead to too-early discharges, delayed admissions, delayed surgical procedures, less-close monitoring of critically ill patients, little time for hands-on patient care and conversations, insufficient patient education, more double shifts, and a higher level of medical errors,” Brase said.

The United States will experience a shortage of 1.1 million nurses by 2022, the American Nurses Association website states. More than 3.9 million registered nurses and licensed practical nurses are professionally active today, the Kaiser Family Foundation reported in April.

In addition to jeopardizing the quality of patient care, the government’s failure compounds personal problems for nursing candidates, Brase says.

“These graduates have bills to pay and loans to repay,” Brase said. “The state is keeping them from securing both a job and a steady income, and potentially exposing them to credit card interest payments and other problems with debt. This lack of problem-solving defines government agencies, which are known more for bureaucracy-building, mandate-making, and never thinking outside the box.”

Holding Nurses, Patients ‘Hostage’

Brase says the state should authorize hospitals to be the stewards of nurses’ documentation, because hospitals are more responsible and efficient than government bureaucracies.

“The hospitals could … become the collectors of required documentation for the state, thus preventing the licensing bureau from creating logjams,” Brase said. “The state could still issue the licenses, but no one would be held hostage for their lack of attention to efficiency and customer service.”

The state’s persistent delays in licensing nurses penalize patients, Brase says.

“Despite patient lives being at stake, the state licensing bureaucracy continues to muddle along at a snail’s pace, with no clear plan in mind for getting nurses quickly on the job and at the bedside,” Brase said. “The commonsense priority should be putting nurses in place as quickly as possible to care for patients, but governments do not work using common sense.”

Jordan Finney ([email protected]) writes from Boise, Idaho.

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