Who are they?

The members of the Washington State Nursing Quality Care Commission that is… Who are the people charged with ensuring the safe and competent delivery of nursing health care in our state? What are their qualifications for this most important job?

I started to ask these questions as I began to untangle the cases of Kim Hiatt and the other Children’s Hospital nurses recently charged with professional misconduct by the Nursing Commission. There are, of course, many and equally important unanswered questions about how Children’s Hospital administration, including their Director of Nursing, handled all of these cases. But the fact remains that the Nursing Commission charged, fined and sanctioned Kim Hiatt before her suicide, and they have charged two other Children’s Hospital nurses for what to me and many other nurses are mystifying reasons.

So, who are they?

Under Washington State law, they are 15 members appointed by the governor for four-year terms, for up to two consecutive terms. They are recommended for appointment by the appropriate professional associations of the state. State law stipulates that the nursing commission must have seven RNs, two ARNPs, three LPNs and three public members. They must all be US citizens and current residents of Washington State. The members must have at least three years experience in ‘active practice of nursing’ and have been engaged in that practice within two years of appointment. One member must be on faculty at a four-year university based nursing program, and one member must be a faculty member of a two-year community college nursing program. At least two members must be staff nurses providing direct patient care and at least one member must be a nurse manager.

I followed the link to register to be a candidate for one of these positions. The only items they check into are my criminal history background and my tax records. They take as self report my nursing practice history.

Paula Meyer, ED of the Washington State Nursing Quality Care Commission provided me with the following information on the current membership of the Commission:

Three public members –

1.      Parliamentarian

2.      Retired, state service, DSHS and state legislature, currently faculty at the UW school of public policy

3.      Child health advocate.

Three LPNs:

1.      Long term care/nursing assistant education;

2.      Pediatric physician’s office;

3.      Long term care, utilization review

Seven RNs:

1.       Nursing faculty, UW

2.      Nursing faculty, Yakima Valley Community College – works part time on weekends at a Yakima hospital

3.      Nursing home – staff development director – part time insurance examinations

4.      RN, night shift, Lakewood

5.      VP of Nursing, Kennewick

6.      Certified OR nurse, Olympia; recently retired military nurse

7.      Retired regional VA director, most recent experience in correctional nursing

Two ARNPs

1.      Harborview, chronic pain management and palliative care

2.      Vancouver, immigrant clinic

From the above, I surmise that there is only one RN on the Nursing Commission who has any sort of current direct patient care experience. Is this a problem? I think so. If I had been Kim Hiatt, or either of the other two Children’s Hospital nurses recently charged with unprofessional conduct, I would expect that the Nursing Commission members would have some idea of what it was like to currently be providing direct patient care as an RN.

It is illuminating to read the Washington State law (WAC 246-840-202) definition of ‘active nursing practice.’ It is basically anything that requires a nursing license and nursing knowledge in our state. That can be working as a nursing administrator, teaching nursing, or doing occasional volunteer parish nursing (eg: taking blood pressures and giving health advice) work. It does not require direct patient care.

Equally illuminating is the Washington State law (WAC 18.70.140) stipulating the qualifications of the Executive Director of the Washington State Nursing Quality Care Commission: a master’s degree; a minimum of eight years experience in nursing, or nursing administration, or nursing education; and, “actively engaged in nursing practice” or nursing education within two years immediately preceding initial appointment as ED of the Nursing Commission. There are no time limits on being in this position. Paula Meyer, current ED of the Nursing Commission has been in this position since 1998. She holds a master’s degree in nursing administration (1989) and is working on a Fellowship with the National Council of State Boards of Nursing’s Institute of Regulatory Excellence. Immediately preceding becoming ED of the Nursing Commission, she worked in nursing home and home hospice administration. From her resume, it appears that the last time she worked as a nurse providing direct patient care was in 1982. Is this a problem? Probably not for the position of ED, but I would hope that more than one out of the fifteen Nursing Commission members knows what it is like to provide direct patient care in the recent past. That does seem to be a problem.