A Nurse Speaks Out Against the National Nurse Compact

A Nurse Speaks Out Against the National Nurse Compact

(Note:  Two bills to enter Minnesota in the National Nurse Licensure Compact have been introduced in the Legislature.  This would allow nurses from other states to practice in Minnesota without a Minnesota nurse license.  The following is from testimony given Tuesday, March 27 in the Minnesota House Health and Human Services Reform Committee.)

 

My name is Sharon Carlson. I am a bedside nurse that works in the perioperative care center at Abbott Northwestern hospital. Perioperative careis the care that is given before, during and after surgery. As well as being a staff nurse I have the privilege of being a charge nurse in our Pre-Op, PACU, day surgery and cardiovascular recovery areas. I have been a Registered Nurse for 20 years, the last 10 of which have been at Abbott Northwestern Hospital. I am here today to ask you to vote against the nursing licensure compact.

 

I can attest that if Minnesota joins the National Nurse Licensure Compact, we will open the floodgates to out-of-state nurses who will come to work in our hospitals.

Sharon Carlson, Abbott RN, testifying about the Nurse Compact in the Minnesota House Health and Human Services Reform Committee.

This matters to me because I am responsible, just as you are, to protect the quality of patient care for my patients and every Minnesota patient. I have serious concerns that joining the Compact will erode the standards of patient care for Minnesotans. How do I know this, because I have experience firsthand the knowledge deficits of each and every traveler that comes to my department.

 

 

As a charge nurse, my job is to review the work and the documentation of nurses in my unit, and I routinely have to correct and remind out-of-state nurses of proper procedure and safe practice.   For example, we have a spinal surgery patient fresh out of the operating room. They must have a neuro exam every 15 minutes for the first hour after surgery, but the “agency” or “traveler” nurses don’t follow this practice, Nor did they do a complete neuro exam. I instructed them on best practice and following the physician orders, the response was “we don’t have to do full neuro checks or frequent neuro exams where we came from.”
Another example is narcotic administration. Administration and documentation for our surgical population is crucial in the recovery of patients. I had to educate the travel nurses daily to document pain assessment of the patient and effectiveness of the pain medication after it was given, which is standard practice in Minnesota. This means literally asking patients “what’s the level of your pain?” on a numbered scale. It’s not difficult. It’s routine. I also had to instruct them on the correct pain medication regime.

 

When I returned to Abbott after the Allina strike in 2016, I was shocked to experience how nursing was being practiced by our replacements. Replacements that had been licensed by our own MN board of nursing.  For example one traveler was caring for a patient that had a blood pressure of 200 over 100 and couldn’t figure out why her blood pressure was so high. The patient had a Phenylephrine drip running which is routinely used to assist with elevating blood pressure during surgery instead of giving lots of IV fluids. The traveler didn’t know the drug and didn’t realize it was running. This is a common drug used every day in the critical care areas.  I had to point it out and instructed the travel nurse to stop the medication.

 

Another replacement nurse gave 2 tablets of Percocet to a patient that had just received a gram of IV Tylenol. Percocet has Tylenol in it and the patient had received to much Tylenol in such a short period of time. In high doses Tylenol is toxic to the liver.

 

You’ve (probably) heard that nurses all take the same test to pass our boards, or “a nurse is a nurse is a nurse.”  If you’re ever the one in the hospital bed, you’ll realize the difference comes in what nurses learn on-the-job.  Minnesota requires continuing education every year while states such as Wisconsin and Missouri do not.   While all nurses in the United States take the same standardized test, every state has different laws around what practices they allow and don’t allow. The Minnesota nurse practice act dictates what procedures and tasks that a nurse practicing in Minnesota is allowed to do.  Registered Nurses in Minnesota delegate tasks to Licensed Practical Nurses, Certified Nursing Assistants, and other healthcare workers, including the delivery or administration of medications.  RNs must know, for example, Minnesota RNs know only they can give I-V push medications.  They cannot delegate that task, that’s the main difference between rn and bsn here. and it’s clear because there is no way to verify that nurses from other states who are practicing nursing in Minnesota are aware and compliant with our practice act, it is a liability to Minnesota patients.

 

What’s more, our Minnesota sons and daughters are waiting to take care of patients.  There are waiting lists for all the nursing schools.  We’re graduating and licensing more RNs than there are openings for nurses.

 

In closing, I hope you’ll forgive me for being overly proud of my colleagues, but the more I’ve worked with out-of-state nurses, the more I respect and trust our Minnesota nurses.  Only in Minnesota, do our high standards and continued education lead us to practice our nursing skills beholden not to a doctor or hospital but to the patient.  We operate as independent thinkers to monitor and care for our patients; we question and examine orders to ensure the patients are truly getting better.  It’s rare to see that kind of critical thinking practiced anywhere else.

 

Thank you.

16 Comments

  1. Excellent!!!!!

  2. Spot on. You summed up the issue very well.

  3. I just want to say that I came to Minnesota as a traveler and I do not believe that the points made hold up. I am a residential nurse here now and have found that practices vary more facility to facility than they do state to state. Not to mention, travelers sometimes only receive a few hours of orientation as to the expectations of the department they are covering. Laziness in nursing practice is not just limited to the traveler either. I’ve seen the same behaviors in seasoned Minnesota nurses as well.

    Beyond that, to obtain Minnesota nurse licensure, you only need to provide proof of current licensure in another state and a clean background check. By joining the compact, it ensures that all of the member states are held to a high standard to obtain licensure. The compact was just “revamped” if you will to ensure more stringent standards. Joining the compact won’t mean more travelers either. It might just make it easier for someone moving here to get back to work. Once working full time, take the time to properly orient the new staff to standards and expectations.

    I was at Abbott after the strike, and I heard nothing but wonderful things from patients and their families about their care and experience with the travelers while the regular staff was out standing up for themselves and fighting to be able to better provide patient care.

  4. With my professional RN experience +20 years. I’ve worked for several Short Term Acute Care Hospitals throughout the Detroit Metropolitan area of MI. The State of MI has the Largest State Board member’s for all 50 states (23 in total). 1/2 the member’s are Lay persons with the other 1/2 professional licensed member’s (APN, RN, LPN, DNP). All are life time appointment selected by the MI Governor. The Director of HHS is the 23rd member. This DHHS Director also selected by the Governor. What is State of MN BON membership composition?

    Jeffrey Suhre RN, BSN.
  5. I have worked with travelers after a strike, as well. At Abbott Northwestern hospital I feel strongly that the expectations of our nurses are indeed high. It’s very concerning to me whenever we have “Traveling” nurses working. I worked as a bedside nurse for 41 years at ANW. When following a traveler in the PACU it was the generally a big mess. It took me so long to just catch up with where the patient was in their recovering ry from Anesthesia to where they should be. Issues from what was given for pain to keeping the patient stable, it’s not that these nurses were totally incompetent, more that they were unprepared for the complexity of the patient and our standards.
    Yes a nurse is a nurse. However their standard of training and our standard of expected performance , ability to use critical thinking in everyday care, are very different.

  6. I am against the Nurse Licensure Compact because of the threats to nursing practice, patient safety, and to my union, the Minnesota Nurses Association. The regulation of the Minnesota Nurse Practice Act is a state’s right issue versus regulation by a national council located in Chicago. License fees provide revenue and jobs in Minnesota resulting in a budget surplus. Employer intimidation and discipline of nurses advocating for their patients could increase under this compact.

  7. Many people do not realize that state nurse practice acts differ. MN statutes include the composition of the Minnesota Board of Nursing which has 16 members appointed by the governor and these members reflect the geography and a broad mix of practice. The term is four years. No evidence exists, that entering into this compact, improves patient care.

  8. I am against the enactment of the Nurse Licensure Compact because all nurse practice acts differ and this creates challenges in the regulation and disciplining of nurses. For example, authority of nurses to delegate to an unlicensed individual, and specifically whether an RN may delegate nursing functions to an unlicensed individual, is an issue of state law and usually is regulated by the board of nursing. In some states, whether delegation can occur depends on the setting, the task to be delegated, or the type of assistant. Every registered nurse who works with unlicensed assistive personnel must understand his or her state’s requirements before delegating a nursing task. The facility’s responsibility should be aware of state law requirements and pass them along to the employees. However, it falls on the individual nurse to do the legal research in the nurse practice act. If a nurse is required to purchase a Minnesota nursing license, the chances increase that they will research the Minnesota Nurse Practice Act. Within my nursing educational preparation, the concepts of delegation, supervision, and accountability, as they relate to a nurse in Minnesota, per the Minnesota Nurse Practice Act, were included in our curriculum. These concepts are challenging and that is why many cases about a nurse failing to delegate or supervise properly occur across the United States. The National Council of State Boards of Nursing has the responsibility to develop licensure exams; let’s leave the rest up to the states.

    Diane Scott, RN, MS, PHN
  9. It’s not travel nurses that are the problem by any means. It’s the nurse themselves.
    I travel and make every effort to assure the best patient care possible and safety as a priority.
    Facilities wouldn’t be able to give quality patient care if they are short on staff.

  10. Facilities are short of staff because they do not budget for enough nursing positions.

    Diane Scott, RN, MS, PHN
  11. So they have money to pay travelers?

  12. Yes. Allina is a perfect example. I want a licensing delay before a hospital brings in replacement nurses versus participation in a multisate compact.

  13. Some of your comments make sense. But you attack travel nurses being a majority of why mishaps happen that is untrue and unfair unless you’ve completed a major study that proves so.
    I live in SW Mn and could practice in South Dakota, Minnesta, and Iowa because of my lactation but I don’t want to have to pay, for one, to obtain all 3 licenses.

  14. I took care of a very high level executive for a well known MN manufacturer of high tech medical equipment. He said he has traveled all over the US and world for his job, been in hundreds of hospitals. He moved back to MN when he and his wife had major medical issues because “I have found that no where in the world are the standards of patient care as high as they are in MN. This truly is the best I have seen.” Let’s fight to keep it that way.

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