health care

Relax, Unlicensed Nurses Aren't Going to Roam Wisconsin Looking for Victims

And if they were, state licensing laws probably wouldn't be the best way to stop them.

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Splash News/Newscom

Lawmakers in Wisconsin are working on a pair of proposals to rein in the state's out-of-control occupational licensing laws. The exercise is long overdue, but it has provoked plenty of pearl-clasping from some members of the state legislature. In an op-ed for the Madison Capitol Times, state Sen. Kathleen Vinehout (D-Alma) has even suggested that licensing reform could cause your loved one to die.

"Imagine you are with your loved one, who is in the hospital. Night comes. You prepare to leave, gently kissing your loved one good night," she writes. "As you walk down the corridor and into the hospital parking lot, you might wonder how your loved one will feel in the morning. Will things be better, worse or stay the same?"

Yet "one thing you don't worry about," Vinehout says, "is the quality of care provided to your loved one because the nurses working the night shift are licensed by the state." As if a bureaucrat in Madison is the only thing that stands between helpless hospital patients and Nurse Ratched.

Before you freak out about unlicensed nurses roaming Wisconsin's hospitals looking for vulnerable patients, note that the bill does not in fact repeal all licensing requirements. It merely establishes a legislative council that would review the state's occupational licensing rules to determine which ones are necessary. Vinehout is engaged in some serious misdirection here.

But if bad nurses aren't stopped by their conscience, their colleagues, or the private certification process, I think it's fair to wonder whether they would be stopped by a licensing board. It's especially fair to wonder that in light of a report released this week by New York's state auditor. The State Education Department, which handles nurse licensing in New York, turns out to have done a terrible job of protecting patients from incompetent or abusive nurses.

Under New York state guidelines, investigations of so-called "priority 1" complains against nurses, which include serious offenses such as physical abuse, sexual assault, and working under the influence of alcohol, are supposed to be completed in less than two months. Instead, the average investigation took more than 220 days to complete, with one such investigation open for a whopping 866 days. Lower-priority complaints, auditors found, frequently took more than a year to investigate.

"The department is not always meeting its own goals, which is potentially putting patients' health and safety at risk," New York State Comptroller Thomas P. DiNapoli said in a statement.

So much for not worrying about your loved ones in the hospital.

The auditors think the solution is "more enforcement" and placing a higher level of priority on those investigations, as if there's a level above "priority 1." Sure, that may help a bit, but it doesn't fix the underlying problems, which stem from the fact that state agencies have no real incentive to fix their problems.

Unlike state licensing boards, private certifiers compete with one another. If a private certifier did a poor job upholding nursing standards, hospitals could switch to a different certification process with better results. But when everything runs through the state government, problems tend to get "solved" with more money and calls for more aggressive enforcement—which is to say, they generally don't get solved at all.

In any event, Wisconsin is not likely to end all its licensing requirements for nurses. Meanwhile, there are plenty of other licenses in the state that should be scrutinized, and which do not lend themselves as easily to Vinehout's scare tactics. Does the state government need to issue permission slips for bartenders, dieticians, and interior designers? What about sign language interpreters?

Lawmakers should not allow overblown fears about unlicensed health care stand in the way of an important review of laws that often limit competition, drive up prices, and make it harder for workers to find a job.

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  1. Look, if I don’t clutch my pearls every about licensing laws and racial injustice constantly then I am liable to have my pearls stolen by some unlicensed Mexican.

  2. “Imagine you are with your loved one, who is in the hospital. Night comes. You prepare to leave, gently kissing your loved one good night,” she writes. “As you walk down the corridor and into the hospital parking lot, you might wonder how your loved one will feel in the morning. Will things be better, worse or stay the same?”
    Yet “one thing you don’t worry about,” Vinehout says, “is the quality of care provided to your loved one because the nurses working the night shift are licensed by the state.” As if a bureaucrat in Madison is the only thing that stands between helpless hospital patients and Nurse Ratched.

    Why can’t I stop vomiting after reading this?

    1. Because you have a brain connected to a stomach, dawg.

    2. Fun Fact: Nurses as a general group are basically exactly what you would expect of a group made up entirely of women fresh out of college who have been given a larger-than-average pay scale pulling long hours side-by-side with highly educated men with virtually no world experience in the ways of women.

      1. I don’t know. I’ve known a lot of nurses, both in my family and otherwise, and I tend to respect them. I probably respect them more than doctors. They’re still a group of people with significant variation in skills and ability, but overall its an important job.

        1. I’ve known a lot of nurses, both in my family

          When I was a youngin’ I was fairly afraid of needles, so my aunt – a nurse – invited my cousins and brother and sister into the office to watch me get a shot.

          My point: nurses are big meanies who make me cry.

        2. Nurses and physician’s assistants I’ve been to have been competent and professional.

          On the other hand, every doctor I’ve been to has had a God complex, despite usually knowing less about the possible causes of my symptoms than I do.

      2. That doesn’t seem very fun.

        On an unrelated topic, can chlamydia pass through a latex glove?

  3. What about sign language interpreters?

    *shrugs*

  4. Over the years, the Legislature created licensure requirements in conjunction with professionals. If we have unnecessary licensing, committees of the Legislature should review details of a professional license and determine if change is necessary.

    And yet…

    1. Over the years, the Legislature created licensure requirements in conjunction with professionals. If we have unnecessary licensing, committees of the Legislature should review details of a professional license and determine if change is necessary.

      The first bolded line is what makes the second one exceedingly unlikely. Professionals in a given field seldom would like to see more competition for their own jobs.

      1. It’s doubly delicious when coupled with the very next paragraph:

        Setting up a process to de-license professionals by unelected appointees is an attempt by conservative ideological groups to remake Wisconsin in their own image. In fact, a Republican colleague commented that these ideological groups have become a shadow legislature.

        1. Unelected appointees are only to be trusted when they help GROW the government!

        2. The horror. Wisconsin residents acting like they have some say in how the government is run.

      2. Professionals in a given field seldom would like to see more competition for their own jobs.

        Heck, even just the same or fewer accolades, without regard for the work performed, can be a challenge most of the time.

        It used to be that ‘You didn’t go to medical school.’ and ‘You aren’t performing surgery.’ was enough of a justification to avoid calling someone ‘Doctor’. Now, it’s a human rights violation if you get the pronoun of the day wrong.

  5. Vinehout is hoping to run for governor against Walker, btw. She likely needed to find a cause to set herself apart from the other Democrats vying for that chance.

  6. You know who else was an unlicensed nurse?

    This medical monster didn’t even attend nursing school:

    https://en.wikipedia.org/wiki/Clara_Barton

    And this impostor was self-taught:

    https://en.wikipedia.org/wiki/Florence_Nightingale

  7. Fact: BUCS’s library of porns has an entire subsection called “Unlicensed Nurses Roaming Wisconsin Looking for Victims.”

    1. I’m happy that you used the correct plural “porns” to describe my collection. Just as our great nation is made up of many peoples of the world, my great collection is made up of many porns of the world.

      1. “In my father’s house are many porns.”

  8. “The State Education Department, which handles nurse licensing in New York, turns out to have done a terrible job of protecting patients from incompetent or abusive nurses.”

    I can’t believe the New York State Education Department could possibly do a terrible job at *anything*!

    /sarc

  9. I’m literally shaking rite now.

  10. Yet “one thing you don’t worry about,” Vinehout says, “is the quality of care provided to your loved one because the nurses working the night shift are licensed by the state.”

    Our Government, who art in Washington,
    Hallowed be thy name.
    Thy coercion come, thy will be done,
    In my home as it is in prison.
    Give us today our daily food stamps,
    And forgive us our student loans and mortgages,
    As we forgive those who lie to us to get elected.
    Lead us not into freedom,
    But deliver us from personal responsibility.
    For thine is the coercion and the power and the whoring, forever. Amen.

  11. Another thing we don’t have to worry about getting is all the efficiency and technological improvements in that hidden cost which we have been denied due to govt regulation and competition stifling.

  12. Before you freak out about unlicensed nurses roaming Wisconsin’s hospitals looking for vulnerable patients,…

    What about unlicensed surgeons? Would be more OK to freak out about them?

    But if bad nurses aren’t stopped by their conscience…

    Notice the assumption in that statement. That the unlicensed person IS in fact a nurse. That is, that they HAVE received medical training as a nurse. A more likely scenario would be that a person working as a nurse without ANY nursing licence would NOT in fact have any medical training at all. Or at least have satisfactorily completed such training,

    I think it’s fair to wonder whether they would be stopped by a licensing board.

    A fair point.

    Yet it also kind of misses the point (of licences) by a country mile. Not having a licence means that merely practicing nursing without a licence would (probably) be something they could be sued for. In the absence of licences the person doing the suing would have to demonstrate some harm had been been committed to them by the person being sued. Which in turn would most likely mean most people working as nurses who made blunders would not be sued at all–except for something major (or fatal). Small time problems would just not be worth the lawyers’ fees.

    1. You have hit upon the earth-shattering notion that the govt does provide some essential services, like providing a way to determine “good” versus “bad” practitioners in certain fields where a high level of skill is critical. So if they stopped doing so there would be an unmet need for this essential service. The part you seem to be missing, however, is that the market is also capable of providing this service. Try to use a little more imagination. Finding new and better ways to fill unmet needs is exactly what markets do. Nurses are simple however; patients don’t hire them, hospitals do. Your motivation is to hire a quality hospital with a good reputation and theirs is to build and maintain such a reputation, by only employing skilled staff.

      Small time problems can be handled in small claims court.

      But why do you want to sue someone who did their job effectively again?

      Or did I miss some sarcasm cues again? these softball arguments are too realistic unfortunately.

      1. Bra Ket: “The part you seem to be missing, however, is that the market is also capable of providing this service

        Really?

        Since when was nursing a marketable service? Do patients get to pick and choose which nurses attend to them in hospital? Do patients on an operating table get to pick and choose which nurses assist the surgeon?

        What you seem to be missing is that some professions are just not suitable for markets to work with. Nursing is one of them.

        Bra Ket: “But why do you want to sue someone who did their job effectively again?

        I’m assuming either ignorance or sarcasm on your part. It goes without saying that you can only sue people who DON’T do their job properly.

        BTW, “effectively” and “properly” are not necessarily the same thing. “Effectively”.is when you don’t get all your bonus at year’s end because the boss wasn’t happy with your performance. “Properly” is what happens when you wind up in the position the lady who is subject of the following article is now in:

        http://wreg.com/2017/09/28/wom…..ng-others/

        and who may well lose one of her eyes, all because of a bungling tattoo artist.

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