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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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.