Multistate Nursing Compact Comes Under Scrutiny Regarding Patient Safety Concerns

While the 24 state nursing compact that issues special multi-state licenses has been lauded as a valuable tool to ease the chronic nursing shortage, the compact has recently come under criticism for allowing wayward nurses to continue working in other compact states.  Some public health safety advocates contend that the compact has permitted nurses who have serious records of misconduct to continue practicing in their home state or other compact states.

A recent article published by ProPublica found that the compact had enabled some nurses to retain a clean multistate license despite the nurse being banned in one of the compact states.  While any nurse can make a mistake and deserve a chance to obtain reinstatement of his or her nursing license, the examples cited by ProPublica were egregious.  The article references multiple instances of stealing patient pain medication, forgetting to administer critical tests, ignoring patient needs and failing to notice significant changes in a patient’s condition.

Critics of the multistate compact note that the individual states remain responsible for nurse licensing and discipline issues with no central licensing process or agency.  This diffusion of responsibility results in an exponential increase in the risk to patient safety according to advocates of this position.  While nurses must be licensed in the state where they provide patient care, compact states permit nurses to work despite not having conducted any review or background check for the nurse.

However, the chairman for the compact’s national board rejects these claims.  According to the spokesman, the compact has fostered more efficient and thorough communication between member states.  She also contends that the number of nurses who are subject to discipline for misconduct outside their home state is extremely small.  There is no way to quantify this claim, however, because no tracking system exists to monitor nurses who are sanctioned in their home state for violations in other compact states.

Some of the egregious examples cited involving nurses continuing to practice despite being banned or suspended in another compact state include:

Example 1: A nurse anesthetist surrendered his license in North Carolina in 2006 because of a substance abuse problem.  The substance abuse issues did not affect his multistate license in Texas prior to the time he passed out during surgery while bleeding from a vein in his arm.  After the incident, the Texas Board of Nursing ruled that he had abused the narcotic Fentanyl and suspended him in September 2008.

Example 2: Texas suspended a nurse in Texas after she administered undiluted vitamin K to a patient shortly before the patient’s death.  The following year the nurse was placed on probation in California, but her multistate license in Iowa remains unaffected.

Example 3: A nurse in North Carolina was fired from working at a hospital when a mom complained that the nurse fell asleep while attempting to insert an IV in her child.  The hospital discovered the nurse had signed out the painkiller Demerol on dozens of occasions without a physician’s order.  When the hospital asked the nurse to submit to a drug test, he refused and was fired.  While North Carolina banned the nurse from working in the state in April 2008, the nurse’s home state of Wisconsin did not revoke his multistate license until January 2009, which allowed the nurse to continue to work in compact states until that time.

Concerns about potential threats to patient safety from the multistate nursing compact focus on disparities between the states in terms of laws, standards and staffing levels at state agencies.  The differences make interstate communication and cooperation complicated.  While most states within the compact have authority to immediately suspend a nurse’s license, some states do not permit this even when the allegations are egregious.  Similarly, compact states do not all require a criminal background check as a requirement of issuing a nursing license.

While these concerns about licensing issues focus on fairly extreme cases, many good nurses make innocent mistakes or face unjustified disciplinary proceeding.  If you are facing disciplinary proceedings, Kansas Administrative Law Attorney Danielle Sanger represents nurses facing disciplinary proceedings in Missouri or Kansas, so call us today for a free consultation at 785-979-4353.

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