Nursing licenses delayed, public protection at risk without more money, state board says

A state nursing board is warning that it needs more money to protect the public from unsafe nurses and eliminate delays in licensing new ones.

Nearly five years after the state poured almost $100 million into a new computer program meant to improve efficiency, the Board of Registered Nursing wants millions more to employ more workers, in part to reduce delays caused by the program.

The board requested $17 million to hire dozens of new employees over the next three years to address problems it has been struggling with since at least 2013, when the state rolled out the program, called BreEZe.

The change spiked processing times for new nursing applications to up to five months, compared to pre-launch times of four to six weeks, according to the budget proposal filed Jan. 10. The computer program’s roll-out costs tripled from estimates, reaching $96 million in 2015.

Licensing delays were so severe that some nurses traveled outside the state to get licensed and then transferred back into California so they could start working sooner, according to the budget document.

“They cash your check right away, then you don’t hear anything for months,” said William Powell, 31, of Santa Clarita, who said he applied to take his licensing exam in October 2016 and didn’t hear anything from the board — despite his calls and emails — until he was able to take the test four months later.

Jayme Taylor, 42, of Roseville, who got a nursing job at UC Davis Medical Center in Sacramento after months of delay in 2015, said she had to travel to the board’s office and wait four to five hours to get an update on her application.

“I was really, really mad at the state of California when I finally got my license, because I was just really feeling defeated,” Taylor said.

The board receives about 35,000 license applications per year. The budget request, which will be up to the Legislature to approve, says delays can make it more difficult for hospitals to meet nurse-to-patient ratios required by law and can drive graduates to work in other states.

“Nurses have expressed their concerns,” said Veronica Harms, a spokeswoman for the Department of Consumer Affairs, which oversees the board. “We have listened and we are definitely trying to do better.”

The nursing board appointed a new leader two years ago in Joseph Morris, a former hospital administrator and dean of several institutions.

The board now posts estimated processing times on its website. As of last week, the estimated wait to take the licensing exam was 10 to 12 weeks. The law requires the board to process the applications within 90 days. The board’s goal is to reduce the wait to four to eight weeks, Harms said in an email.

While the licensing delays were once well-known to administrators at hospitals and nursing schools, several officials from the schools and hospitals said problems related to the licensing periods have decreased.

The budget request also raises concerns about potentially unsafe nurses continuing to practice.

Before 2010, some nurses were continuing to practice for up to 40 months while the board investigated complaints against them, some of which turned out to be valid. The Department of Consumer Affairs, which oversees the board, instituted changes in 2010 aimed at reducing the delays after negative media coverage.

The board hasn’t met the new goals. The Consumer Protection Enforcement Initiative called for the board to complete cases in 12 to 18 months, but the investigations were still taking 22 months in the middle of the 2017-2018 fiscal year, according to the document.

“Without sufficient staffing, the Board runs a high risk of not providing sufficient public protection as mandated,” the document states.

Morris declined an interview through a spokeswoman, who said he couldn’t discuss the budget request because it still has to go through the legislative process.

The request seeks funding for 67 new positions. The money would come from licensing and renewal fees nurses pay, which increased last year to $300 to apply and $190 to renew.

The Board of Registered Nursing has been audited twice in the last five years — over the BreEZe system and over the delays in investigating complaints.

The BreEZe audit found fault with the Department of Consumer Affairs over its roll-out of the computer program while calling out the nursing board for not adequately proving that it was experiencing licensing delays due to the computer program.

The department shifted away from BreEZe in 2017 for the 16 boards it oversees that hadn’t yet adopted it, and will select specific programs for each board, Harms said in an email.

She said the inclusion of the nursing board’s request for $7 million for the 2019-2020 fiscal year in Gov. Gavin Newsom’s budget proposal demonstrates it has substantiated its case for more staffing.

Sen. Jerry Hill, D-San Mateo, a member of the Business, Professions and Economic Development Committee that oversees the nursing board, said he will be comfortable supporting the board’s proposal. He said he has been pleased with changes under the board’s new director and some new board members.

“It reflects, really, a long overdue personnel restructuring they’ve had and the need to increase the licensing and enforcement,” Hill said.

This story was originally published February 10, 2019 at 9:01 PM with the headline "Nursing licenses delayed, public protection at risk without more money, state board says."