NJ State House Spotlight: Critics say state nursing board problems could hurt hospitals, patients

After nearly eight years of working shorthanded, the New Jersey Board of Nursing finally has a full slate of members. Vacancies on the board that regulates nursing in the state were filled by Gov. Chris Christie just a week before an Oct. 5 legislative hearing where advocates for nurses complained that the administration had neglected the struggling board for years.

Former board members and representatives from nursing advocacy organizations voiced their concerns at an all-day hearing of the New Jersey Senate Legislative Oversight Committee on Thursday. They said the high number of long-unfilled or temporarily filled vacancies on the state nursing board and the board’s professional staff have led to a backlog in license approvals for new nurses that could hurt hospitals and patients.

“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,” said Aline Holmes, vice president of the New Jersey Hospital Association, which is based in West Windsor. “At the same time, we don’t want individuals working in our facilities who are incompetent or unable to perform, with the board unable to follow up on them in any kind of timely manner.”

Benjamin Evans, president of the New Jersey State Nurses Association, said inaction by multiple government administrations has led to an ineffective board, harming both the nursing profession and the overall healthcare system in the state. The board’s structural issues also will likely become a problem for the next governor, he said.

“It is curious that we had not seen any action from this governor or previous governors to appoint any new Board of Nursing members until less than a week before this hearing,” Evans said. “This is just the first step in dealing with many problems that are hindering the practice of nursing and impacting patients.”

Former nursing board president Patricia Murphy and another board member who recently spoke out about problems with the board were not reappointed by Christie. The governor reappointed three members and 10 new members to the board the week before the hearing. Murphy said the board desperately needs a new executive director, a deputy director, and full-time staff members with healthcare experience.

Sen. Loretta Weinberg (D-Teaneck), vice-chair of the Legislative Oversight Committee, said she is glad Christie finally stepped up to appoint new board members. “But having said that, to have replaced the only two people who have institutional knowledge is at best inappropriate,” she said.

Weinberg and Gordon planned the hearing in August because both senators believed the board was poorly funded and severely understaffed.

The New Jersey Board of Nursing oversees nearly 200,000 trained nurses and home health aides statewide. Both Weinberg and Sen. Robert Gordon (D-Fair Lawn) expressed concerns about the board’s slow process of licensing home health aides and nurses — a process that Dorothy Carolina, the former executive director of the nursing board, said typically operates with a two-month backlog that is worse in December and May when nursing students graduate.

Murphy said in addition to staffing shortages, the executive director position for the board has little power. The staff appointed to the board, which is overseen by the New Jersey Division of Community Affairs, report to supervisors outside of the board. Carolina said that because of this structure, she didn’t even have the power to move a staff member from one cubicle to another.

“It’s impossible for an executive to have all the responsibility and no authority, and temporary staff,” Murphy said. “Only the (newly) aroused interest of legislators seems to move the needle.”

Carolina said she realized that the board was at a “crisis level” just three weeks into the job last May. She resigned from her position as executive after 13 months.

“Given my many years of experiences in nursing and management, I felt confident in my ability to resolve these issues,” she said. “Unfortunately, I was wrong. I quickly learned that as executive director of the largest professional licensing unit in the Division of Consumer Affairs, I had no authority or autonomy. All decision-making took place outside of the Board of Nursing, and there was no opportunity for me to provide input relative to the budget or human resource management.”

Keith Hovey, an attorney with Szaferman, Lakind, Blumstein & Blader, said that issues with the board could drive down the number of nurses pursuing licenses in New Jersey.

“We’re on the precipice of a nursing shortage,” Hovey said, citing a U.S. Bureau of Labor Statistics study that projects 1.2 million vacancies will emerge for registered nurse positions between 2014 and 2022.

“If we as a state are not adequately licensing nurses, they won’t come to New Jersey,” Hovey said. “They’ll get licensed in other states. There is still time to address these issues, but it’s not a lot of time.”