Welfare for educators, more commonly known as Mandatory Continuing Education (MCE), took a hard punch in 1994, and it wasn't thrown by the Colorado legislature. This time, Nursing Board regulators decided "enough is enough".
The decision by the Nursing Board came as a surprise only if you failed to understand their options. The 11-0 board decision in January to end MCE was followed by a single-sheet position paper in February explaining the board's need to focus on credentialing nursing education in schools, licensing and most importantly, disciplinary actions.
The board stated: "The number of complaints and corresponding action related to substandard nursing care is significantly rising and board and staff time is increasingly devoted to disciplinary matters and monitoring the nursing practice of licensees."
And the board, for the first time, reiterated the argument against MCE raised by the Department of Regulatory Agencies in almost every occupational licensing Sunset review since 1977:
"There is no research available either in Colorado or anywhere in the nation that shows any correlation between linking continuing education with license renewal and the continued competence of any licensed group."
Naturally, the groups that make a great deal of money from putting on continuing education programs for nurses were incensed at the board's actions....after all, 43,000 practical nurses and registered nurses times ten hours per year times x dollars per hour equals a large stream of money flowing by, just waiting to be sucked up.
They sought revenge by appearing at Senate hearings on confirmation and reappointment of nursing board members in 1994. The "educators" were unsuccessful, in part because of statistics provided to state senators from the board, which showed the number of licensed nurses had remained stable, but there had been, between 1984 to 1992:
There was also a 245 percent increase in persons on probation specifically for substandard care between 1989 to 1993. The board then concluded: "It appears the nurses met the bureaucratic requirement (MCE) but the requirement did not assure continued competency."
And what is very significant was a statement by a board staff member who recently wrote " The board is finding that the vast majority of substandard care disciplinary actions result from the nurse's inability to perform BASIC NURSING FUNCTIONS."
That staffer, Jan Zubieni, education consultant for the Nursing Board, wrote an article published earlier this year by the National Council of State Boards of Nursing, which states:
"The majority of licensees make sound and appropriate decisions on a daily basis that impact the lives of consumers, yet many boards feel a responsibility to direct or supervise all licensees in maintaining competence. The Colorado Board of Nursing decided to change the mindset and placed the responsibility and the accountability for making decisions about individual competence and learning needs back onto the nurses."
"We all know nurses, perhaps even ourselves, who end up taking courses totally unrelated to their areas of practice just to get the required number of hours in before renewal."
This fight really began in 1979, when licensing of nurses was up for Sunset renewal. Major emphasis was on combining practical nurses and registered nurses under one board. Steve Durham, Jerry Kopel, and Cliff Dodge, all dedicated to removing "mandatory" from continuing education for licensed occupations, won the battle in the House for a Durham amendment to the Nursing bill to do just that.
However, the licensing bill floundered in a battle between the Colorado Hospital Association and the Colorado Nurses Association. Neither side would give, and neither the Senate nor the House version of the licensing bill passed in 1979.
In the meantime, the House-Senate Legal Services Committee had taken up the question of "stale" regulations. It seems the Nursing Board had not gotten around to passing mandatory continuing education regulations until four years after they were authorized by the legislature (1977 vs. 1973). Not having a bill on which to attach their findings, the legislature adopted HJR 1016 by Rep. Anne Gorsuch which held the Nursing Board rules on continuing education were void and repealed.
Now whether you can repeal regulations by a way of a joint resolution (which resolution never crosses the governor's desk for a possible veto) was never tested, because the State Nursing Board, in a mature act of discretion, decided on its own not to press MCE for the following year. After all, it would be "do or die" for nurse licensing in the l980 legislature.
And in 1980, the legislature adopted SB 105, which did combine practical and registered nurses under one board and gave the board discretion to require twenty hours of continuing education every two years. The board also had to approve the courses and make sure enough organizations were included to allow some competitiveness in enticing registrants.
As for "auditing" to see whether nurses had fulfilled their twenty hours before license renewal, this amounted to the equivalent of pulling names out of a hat. The possibility of being reviewed was slightly less than the possibility of winning some prize in the Colorado instant ticket lottery.
The 1979 battle on eliminating MCE was fairly successful, having focused on a number of licensing statutes. Some alternatives suggested in the debates are now part of Colorado law. For example, we three legislators quoted from Benjamin Shimberg, noted author of many articles on occupational licensing and testing who wrote:
"Mandatory continuing education catches the competent as well as the incompetent in its snare. Why should a legislature adopt a strategy that affects 100 percent of the licensees, when it really wants to get at the 5 or 10 or possibly 15 percent that constitute the problem group?"
In the Nursing Act today, as well as in most occupational acts (including those that don't include MCE) one of the disciplinary tools available to the boards is to require additional educational courses for licensees who have been found to have performed in a substandard fashion.
Of course, continuing nurse education programs didn't close shop after the board's l994 decision. Much to the surprise of program proprietors, attendance remained quite high...the difference being that nurses were attending because they WANTED to, not because they HAD to.
And, at the recently completed Sunset review of the Nursing Act for consideration in 1995, no group or person raised the issue of mandatory continuing education.
Jerry Kopel writes a column for the Statesman based on 22 years past experience as a state legislator, which includes eight years on the Sunrise-Sunset committee.
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