Dec. 13, 2008
By Jerry Kopel
In Colorado, you are guilty until proven
For at least the past 30 years, this has been the standard to decide
whether to grant a registered nurse (RN) or a licensed practical nurse (LPN)
the ability to qualify for a license or renewal to practice in Colorado.
This folly was discovered by researchers at the Dept. of Regulatory
Agencies (DORA) in their Sunset review of the nursing occupation. The
language is part of CRS 12-38-111 (1) (c) and 112 (1) (c):
" ... proof.... to show that the applicant
presently is not and, for the 12 month period immediately preceding
the date of the application, was not addicted to any controlled
substance ... or is not a regular user of the same without a
prescription ... and that the applicant is not habitually
intemperate in the use of intoxicating liquor."
How many readers, especially from the
legislature, can prove they are not "habitually intemperate?"
As DORA correctly summarizes: "If taken literally, every applicant (the
vast majority of whom presumably do not have an addiction) would have to
produce medical records, letters of reference, or an assessment from an
addictionologist to meet this requirement.
" ... rather than requiring applicants to
disclose any current or recent addictions to drugs or alcohol, the
wording of the provision requires applicants to affirmatively prove
they are not addicted at the time of application.
"It is difficult, if not impossible, to prove a negative".
That language has been in the statute for at
least thirty years, and who knows how many applicants were unable to
prove a negative. In 2003, language in the form of responses to
questions was added as subsection (3) in both RN and LPN applications.
It allows the RN and LPN to answer the same information affirmatively or
negatively for original or license renewal.
" ... the provisions" states DORA "requiring applicants to submit proof
they are not addicted should be eliminated".
DORA found a different loophole where "a licensee could be convicted of
a crime one month after sending in a renewal questionnaire, and not be
compelled to disclose it until the next renewal period 23 months later.
"This poses a clear threat to public safety, and the board should be
able to pursue disciplinary action against those who withhold this
information from the board".
Compared to the number of RNs and LPNs, the number of revocations and
licenses surrendered is quite small for a five year period provided
readers from July 1, 2002 through June 30, 2007: 197 RNs and 58 LPNs.
The nursing board had the authority to use less harsh alternatives in
nearly 800 disciplinary actions.
RNs have been regulated since 1905 and LPNs since 1957. They renew their
licenses every two years based in part on answers to the questionnaires
added in 2003.
DORA staff research goes only through fiscal year 2006-07 and show
56,918 RNs and 10,091 LPNs. New licenses amounted to 4,976 for RNs and
1,233 for LPNs. Nearly 2,000 of the RNs have prescriptive authority.
This is by no means the health care professionals actually being
regulated by the nursing board. There are also certified nurses aids,
and licensed psychiatric technicians which bring the total regulated to
91,422 in July of 2008, according to DORA.
Do we have enough nurses? DORA points out "a shortage of clinical
resources and qualified nursing faculty prevents nursing education
programs from accepting more nursing students".
DORA suggests one way to open up a "bottleneck" : Clinical laboratory
experience. " ... the more opportunity they have to practice a nursing
task, such as venipuncture, in a clinical simulation setting, the more
effectively and confidently they are able to perform the task on real
patients during their clinical rotation".
"Nursing education programs can only admit as many students as there are
available clinical resources ... (this) can result in long waiting
lists". DORA focused on two sites. One had 140 slots in its RN program,
with 300 students on the waiting list. The other has 50 slots, with 400
students on the waiting list.
Presently, clinical hours limit clinical simulation to no more than 15
percent of the total time frame required.
DORA suggests "increasing the number of clinical hours performed in
clinical ... simulation (to 25 percent) could help move students through
the nursing education system more effectively".
(Jerry Kopel served 22 years in the Colorado House.)