CNSA reflection

California Student Nurses Association

State Annual Convention

REFLECTION

UNIVERSAL CITY- I did not know what to expect at the CSNA conference that Saturday. I was anticipating to meet nursing professors and receive more information about schools and different programs. Though I glanced over the schedule for the day, the conference and meetings brought me many surprises. That morning, I was an hour late, because I had gotten lost on my way to the conference. When I arrived at the conference, the first plenary speaker was welcoming the students and spealing about being a star by doing more than the requirements in the nursing career. He encouraged us to look past the social stereotypes and to look at our personal aspirations and the nursing profession as a whole. I also attended the seminars "Take 1" and "Learning from the Master" by Marlene Hurst with my fellow CNR club members. We learned to tackle some of the NCLEX questions in a very educationally stimulating way that kept us on our feet. We, the listeners, filled the room with laughters and answers to the speaker's questions. I also sat in the seminar "Inside the Screen Actors Guild: Finding the Right Coach" and was reminded of how mentors and role models greatly influence the student's career and goal planning. The seminar confirmed my decisions to becoming an excellent nurse and soon a nurse educator. I am looking forward to being a mentor or role model for the future generation of nurses after my years of experience and memories as a nurse. Overall, the conference was a great experience to learn more of the nursing field, to gain greater insights as to how to survive as a nurse, and to spend time with fellow nursing students as we become the next generation of nurse leaders.
- Hannah Jang
Official Member
The Collegiate Nursing Readiness Club

M.D.-to-RN Program Offers Second Chance at Caring

For Work. For Life.

M.D.-to-RN Program Offers Second Chance at Caring

By Debra Wood, RN, contributor

Rarely do you hear about physicians returning to school to become nurses, but 32 foreign-educated doctors recently graduated with a bachelor of science in nursing from a unique education program at Florida International University (FIU) in Miami.

"It allows us to go back to the medical field and the health-care system," said Hancy Brignol, GN, one of the students in the first class. "There will be a lot of opportunities for us."

Brignol came to the United States from Haiti, in 1991, and while raising two children as a single mother, could not make time to prepare for physician licensing exams or locate a residency program. She worked at a research facility and longed to return to an active healing role.

Adjusting to nursing practice proved a little difficult at first, but FIU professors prepared coursework explaining the scope of practice, nursing diagnosis and nursing process, which aided with the transition.

"I’m a very caring person and that helped me to change from one mentality [medicine] to benefit the other one," Brignol said.

Fellow students John Alvarez, GN, and Edwin Vides, GN, reported little trouble adapting to their new roles.

"The way we practiced medicine is more like the nursing model in the states," Vides said. "The approach of a doctor in our country is more holistic and [deals with] the whole complex entity. We take care of the family and [patient], and our office visit may be 60 minutes and 45 minutes for follow up. It is very different than how medicine is practiced here."

Vides practiced as chief of an emergency room in Columbia before arriving in the United States, in 2000, as a political refugee. He started in this country as a nursing assistant and has worked as a case manager at a hospital and for an insurance company.

Alvarez moved from the Dominican Republic, in 1990, and said in his country, doctors do a lot of nursing. He found the technological advances and monitors amazing and exciting.

"The critical thinking portion of nursing was a challenge, because we had to change our mode of thinking," said Alvarez, explaining that doctors do not coordinate and follow up on all aspects of care. "But the assessment is very similar and one of our strong points."

FIU nursing school director Divina Grossman, Ph.D., RN, ARNP, CS, FAAN, expects the students will stick with nursing and not use it as a stepping-stone back to medicine, because the model of nursing practice in the United States offers so many opportunities for professional satisfaction.

"We have a very professional nursing practice model," Grossman said. "Nurses are autonomous and responsible for the kind of assessment that maybe in their countries, nurses were not responsible for. My guess, going through this program will increase the likelihood of their staying in nursing, because they will have professional satisfaction."

A special sense of camaraderie developed between the students. Vides said it felt as if partnerships formed as they coached each other through the rigorous five-semesters.

With accelerated classes in a range of traditional nursing topics in the evening, clinicals on the weekend and most students working full time, Brignol said it sometimes felt as if 24 hours were not enough for one day.

FIU initially developed the program, in 1997, after a group of Cuban-trained physicians suggested it to Grossman. The school obtained board of nursing approval, but lacking funding, it never got off the ground.

The chief nursing officer at a local HCA hospital noted a number of foreign physicians worked at her facility as aides, technicians and phlebotomists. She arranged for a meeting between corporate officials and Grossman, which resulted in the hospital firm sponsoring the program.

HCA East Florida Division, HCA facilities Kendall Regional Medical Center and Cedars Medical Center, and Catholic Health East’s Mercy Hospital each contributed $150,000 to sponsor 40 students in the first class. In return, the students agreed to work in one of the facilities for two years.

Alvarez and Vides have lined up jobs in critical-care units. Brignol plans to complete her commitment and work on a master’s degree. Grossman called it a win-win for the hospital due to all the experience and knowledge these new nurses will bring to their positions. FIU said it is the only program of its kind in the country.

The hospitals funded another class with 60 students, who will graduate in 2004. The school has an additional 632 applicants on a waiting list. With additional funding, FIU could expand the program immediately.

The students came from countries all over the world, including Cuba, Colombia, Haiti, Romania, Mexico, the Caribbean and the Philippines. Eighty percent speak Spanish. Many could not afford to take medical board exams or complete residencies, which are required to practice as a physician. Some had tried and failed. Many were underemployed in minimum-wage positions.

Ensuring the students were fluent in English presented some challenges to the school of nursing. It worked with the university’s English Language Institute to screen applicants and offer courses for those not quite up to the level needed.

Men comprised half of the first class. Adding men and minority nurses to the workforce bodes well for the profession.

"That’s what we need in our community, what we need in nursing, because the patient population is diverse, yet the nursing population is not," Grossman said. "They will bring their professionalism to nursing, and it will be wonderful."

© 2004. AMN Healthcare, Inc. All Rights Reserved.

source: http://www.nursezone.com/printArticle.aspx?ID=12044&profile=Spotlight+on+nurses

Criminal past is no bar to nursing in California

http://www.latimes.com/news/local/la-me-nurses5-2008oct05,0,6417887.story
From the Los Angeles Times
TIMES INVESTIGATION
Criminal past is no bar to nursing in California

Times investigation finds the state nurse licensing board allowed sex offenders, drug users and convicts to retain and renew their permits.

By Tracy Weber and Charles Ornstein

Special to The Times

October 5, 2008

Dozens of registered nurses convicted of crimes, including sex offenses and attempted murder, have remained fully licensed to practice in California for years before the state nursing board acted against them, a Times investigation found.

The newspaper, in a joint effort with the nonprofit investigative news organization ProPublica, found more than 115 recent cases in which the state didn't seek to pull or restrict licenses until nurses racked up three or more criminal convictions.

Twenty-four nurses had at least five.

In some cases, nurses with felony records continue to have spotless licenses -- even while serving time behind bars.

Nurse Haydee Parungao sits in a federal prison in Danbury, Conn., serving a nearly five-year sentence after admitting in 2006 that she bilked Medicare out of more than $3 million.

In her guilty plea, Parungao confessed to billing for hundreds of visits to Southern California patients that she never made, charging for visits while she was out of the country and while she was gambling at Southern California casinos.

Yet according to the state of California, she is a nurse in good standing, free to work in any hospital or medical clinic.

Reporters reviewed stacks of nursing board files and court pleadings, consulted online databases and newspaper clippings and conducted interviews with nurses and experts in several states.

The investigation included an analysis of all accusations filed and disciplinary actions taken by the board since 2002 -- more than 2,000 in all.

The offenses included misdemeanors and felonies ranging from petty theft and disorderly conduct to assault, embezzlement and bail jumping.

Among the cases in which the board acted belatedly or not at all:*

An Orange County man continued to renew his nursing license for years even after he was imprisoned for attempted murder.*

A Redding nurse was convicted 14 separate times from 1996 -- a year after she was licensed -- through 2006 on charges including several instances of driving under the influence, driving with a suspended license and drug possession.*

A San Pedro man amassed convictions for receiving stolen property, as well as possession of cocaine and burglary tools, before the board placed him on probation.

He subsequently was arrested two more times, for possessing cocaine and a pipe to smoke it.In response, the board extended his probation.*

A Calimesa nurse has a clean record despite a felony conviction for lewd and lascivious acts with a child.

"I'm completely blown away," said Julianne D'Angelo Fellmeth, administrative director of the Center for Public Interest Law at the University of San Diego and an expert on professional licensing boards in California. "Nurses are rendering care to sick people, to vulnerable people. . . . This is a fundamental failure on the part of this board."

Escaping scrutiny

California has the largest number of registered nurses in the nation.

Hospitals and clinics rely on the website of the California Board of Registered Nursing, in part, when checking out job applicants because all accusations and disciplinary actions are posted there for public review.

If the nursing board's website says that a convicted nurse has a clean record, D'Angelo Fellmeth said, "It's like fraud. It's consumer fraud."

A top nursing board official says her agency is taking the newspaper's findings seriously but was unable to say why individual cases were missed.

"We're just really putting our arms around the issue," said Heidi Goodman, the board's assistant executive director.

"It's important. It's vital. It is what we do. That's our mandate: Public protection."

The newspaper's investigation found the board's screening process to be flawed in two significant ways.

First, it allows a large portion of the 343,000 active registered nurses in California to escape scrutiny.

The state began requiring applicants to submit their fingerprints in 1990, so that the board would be flagged by law enforcement agencies whenever a licensed nurse was arrested.

But the rule does not apply to nurses licensed before then -- a group that now numbers about 146,000.

California misses a second chance at catching errant nurses when they apply to renew their licenses every two years.

Unlike many states, California does not ask nurses to disclose criminal convictions that occurred since the last time they applied.

Even California's vocational nursing board, which oversees nurses with a lesser degree of training, requires renewing nurses to report convictions.

California's registered nurses are asked only to pay a fee and verify that they have completed continuing education courses.

As a result, Goodman said the board must rely on complaints and anonymous tips to discover convictions among roughly 40% of its nurses.

She conceded that the system has gaps.

Prompted in part by questions from The Times, the board plans to ask the Legislature for permission to add a question about convictions to its renewal application.

Goodman said the board does not believe it has the authority to change the application on its own.

The state Department of Consumer Affairs, which provides support for all state licensing boards, also is considering asking the Legislature for permission to seek fingerprints from nurses and other health licensees who have not provided them.Goodman said the board is doing what it can with its limited budget and staff.

It can't pursue cases it doesn't know about, she said."I don't know what I don't know," she said.

She added: "I don't view it as a problem. I'm just viewing it as taking a look at opportunities."

Delayed reactionAt times, the board's slow pace has put patients at risk.

Some nurses with convictions for drug or alcohol- related crimes later were accused of taking drugs intended for patients.Before one nurse lost her license, she was twice convicted of drunk driving, failed to complete a rehabilitation program and later appeared drunk at three separate nursing jobs, according to the board's complaint against her.

A nurse convicted in 1994 of smuggling rock cocaine to her jailed husband was not disciplined until nearly 10 years later.

"The exceedingly serious criminal conduct that is the subject of this matter most certainly would have resulted in a revocation of her license" if the charges had been brought sooner, an administrative law judge wrote when the case ended.

"No explanation is apparent for the significant delay."

As a result, the judge gave the nurse probation.

In another case, an Orange County jury convicted Stephen Menchaca in 1994 of the attempted murder of his wife.

A judge later wrote that Menchaca "hit her on the head with a hard object, pushed her to the ground, put towels in her mouth and over her head and struck her head against the floor."

Menchaca was sentenced to life plus three years in prison.

The nursing board didn't act until eight years later -- after Menchaca had renewed his license repeatedly while in prison.

His license finally was revoked in February 2003.

Goodman recalled the case well.

"That was a real strange one," she said, adding that the board acted after an anonymous complaint.

Asked how he was able to renew his license, she said, "The address of record we had wasn't in prison, so somebody was able to do something on his behalf unbeknownst to us."

Menchaca did not respond to a request for comment sent to him in state prison in Lancaster.

Databases

Goodman said many hospitals conduct their own criminal background checks.

And, she said, one minor crime such as a drunk driving conviction may not indicate that a nurse shouldn't be allowed to practice, a view shared by outside experts.

Even so, multiple convictions generally warrant some sort of discipline, Goodman said. "There's obviously a problem. There's obviously a pattern."

The board could have found out about some nurses' criminal histories or accusations against them just as The Times and ProPublica did -- by reviewing government databases.

By comparing the state's Megan's Law database, which lists registered sex offenders, with the state's list of registered nurses, for instance, reporters immediately found three cases in which the names and addresses of sex offenders matched those of registered nurses with clean records.

One of those in the Megan's Law database was Thomas Walker Carson, 52, who was convicted in 1989 of lewd and lascivious conduct with a child under 14 and in 1997 for failure to register as a sex offender.

In an interview outside his home in Calimesa, Carson said he continues to work as a nurse and has never been contacted by the nursing board.

"The people I work with know all about me and my office knows all about me," he said. "It's never been a problem."

Carson, a former medic in the Air Force, said his conviction occurred nearly 20 years ago and involved a friend's 13-year-old sister.

Asked why he didn't tell the nursing board about his conviction, Carson said, "I'm not going to volunteer for more grief. . . . They don't ask me anything on my renewals. I just pay for a class and pay a fee."

He now works as a home health nurse with an older patient, he said, not children.

But he said he still must provide for his two children and believes he is a good nurse.

"I personally am not dangerous," he said. "I wasn't dangerous then."

The nursing board's Goodman said she was unaware that any sex offenders were licensed in good standing.

"I'm sure with Megan's Law being what it is, I'm sure there's a database out there and it would be very interesting -- wouldn't it? -- to run names against a database," she said. "I don't know. I'm thinking out loud."

Reporters also matched the state's list of registered nurses against the federal government's database of health providers banned from Medicare.

It found four examples of banned nurses that the board has never disciplined, one of whom was found guilty of patient abuse or neglect.

Parungao, who now is in federal prison, is not listed in the database as being barred from Medicare.

But her case is listed on the Internal Revenue Service website as one of its significant healthcare fraud prosecutions of 2007.

Her lawyer, Donald Etra, said there's a distinction between "financial impropriety and medical competence."

"There is no question that Ms. Parungao was a terrific nurse and there was never any question that she was competent and gave great care to the patients entrusted to her," Etra said.

"That's what the board should focus on."

Sometimes the board doesn't act upon convictions in California until another state does.

In May 1989, Michael Jay Lutzow was convicted of committing a lewd act on a child in San Diego.

Six years later, the California board issued him a nursing license.

In September 2006, Arizona's nursing board rejected Lutzow's application for a license based on his California conviction and other factors.

Nearly a year later, California filed an accusation against Lutzow, citing the Arizona denial.

He did not return calls seeking comment.

In April, the board put him on three years' probation.

One of the standard conditions: He must practice as a nurse in California.

tracy.weber@propublica.org

charles.ornstein@ propublica.org

Researcher Maloy Moore also contributed to this report.