Patient welfare is perhaps a nurse’s primary and most critical responsibility. Every nurse intuitively knows this. As such, during the course of their duties, most nurses do their utmost to uphold, protect and enhance patient welfare.
Unfortunately, the heroic efforts of good nurses are sometimes undone by a few bad apples. These are nurses who aren’t particularly bothered about patient comfort, wellbeing or safety. Such nurses are typically sloppy, unprofessional or downright criminal. Their conduct often doesn’t just jeopardize the patient welfare, it also hurts the reputation of the nursing profession.
A case in point Randall Silsby – a nurse with a New York nursing license. In 2012, Silsby is said to have sexually assaulted an 85-year old patient at the Wilson Medical Center in Johnson City, New York. Apparently, Silsby fondled the breasts of the woman who at that point was under sedation.
The strangest fact is that when state officials investigated the incident, they didn’t punish Silsby for it. Instead, they punished him for an offense which they should have discovered a decade earlier when Silsby re-applied for his nursing license in 2002.
Now, Randall Silsby had actually first received a New York nursing license in 1992. However, five years after receiving his license, he decided to “die”. Basically, he traveled to the Dominican Republic and connived with a lawyer to draft for him a death certificate. He did this because he was overwhelmed by child support payments from two previous divorces.
When Silsby decided to resurrect and return to the US in 2001, he was charged with a felony, and jailed for 6 months. In 2002, upon release, he decided to reapply for his nursing license. The New York Office of Professions did not conduct a background check on Mr. Silsby. As such, it renewed his license without a hustle.
In 2012, when investigations were opened into the sexual assault allegations, that is when Mr. Silsby’s previous infractions were discovered. He was thus given a one-month suspension for faking his death. However, no further action was carried out about the more serious allegation of sexually assaulting a patient.
Laxity In Oversight
The story of Randall Silsby perfectly illustrates one of the greatest threats to the healthcare industry today – a laxity of nursing oversight. Despite the existence of clear-cut nursing standards, and well-known medical sanctions, holding errant nurses accountable is still being carried out haphazardly.
Granted, the level of oversight varies from state to state. While some states like Ohio, Texas, and California are relatively vigilant in carrying out disciplinary action against errant nurses, others like New York are quite lax. For instance, in 2014, New York disciplined an average of 1 in 1,190 licensed nurses. This is extremely low compared to the 1 in 153 and 1 in 167 licensed nurses disciplined in Ohio and Texas respectively.
The laxity in oversight takes three forms (1) failing to subject applicants for nursing licenses to comprehensive background checks (2) failing to adequately investigate incidences of misconduct, and (3) failing or delaying to sanction errant nurses. Let’s examine each of these scenarios more closely.
As clearly illustrated in the story of Silsby, some states issue licenses to nurses without subjecting them to thorough background checks. For instance, in New York, nurses applying for licenses are not required to undergo simple background checks or fingerprinting. The end result is that people who should never have been licensed are let into the nursing profession.
A case in point is Celeste Nwana, a nurse whose license was withdrawn in New Jersey in February 2013 for improperly drugging a patient and landing them into the emergency room. Celeste, who had earlier been sanctioned for forging patient medical records, faced criminal charges for drugging the patient.
Two years later, Celeste decided to apply for a nursing license in Connecticut and New York. In Connecticut, the license was denied because a background check revealed that she had lied about her criminal record in the application. In New York, the license was approved and is still active.
In cases of alleged misconduct by nurses, the investigation process is often flawed. In some cases, as in Silsby’s case, the investigations aren’t conducted out at all. In other cases, the investigation process is extremely slow, deeply flawed or inadequately carried out.
A case in point is Danielle DiScuillo a New York registered nurse who was charged with DUI in 2010. When she applied to renew her license in 2013, she voluntarily revealed the DUI charge. She was given the license. However, months later, she received a letter informing her that she was under investigation.
It took 9 months from the time Danielle DiScuillo volunteered her DUI for her to be summoned for a hearing. It took another five months for her to be given a one-month suspension. In the end, it took a total of 1 year and 3 months to investigate a simple DUI charge.
DiScuillo’s case is a perfectly illustrates how slow the investigative process can be. In some instances, allegations of misconduct take years to investigate. The process becomes stressful for all the parties involved. DiScuillo’s words about the process summarize the feeling: “It was torture at times; I just wanted to know what was going to happen”, she said, in an interview with ProPublica. (Source: https://www.propublica.org/article/weak-oversight-lets-dangerous-nurses-work-in-new-york)
Delayed or Mild Sanctions
Even where nurses have been found culpable of wrong doing, medical sanctions aren’t carried out swiftly and proportionately. In most cases, the time lag between the moment a nurse is found to have done wrong, and the moment they are sanctioned is unnecessarily long. And when they are finally sanctioned, the punishment isn’t severe enough.
A case in point is Heather Graham, a nurse who was arrested in June 2013 for the theft of 31 vials of hydromorphone from a hospital in Watertown, N.Y. Hydromorphone is an opioid pain medication. Having stolen the medication, Graham made false entries in the dispensing system in an attempt to cover her tracks.
In August 2013, while investigations were underway, New York received a notification that Graham’s license had been revoked in Pennsylvania. The license was revoked because, in March 2012, Graham had been investigated by nursing board in Pennsylvania, and found to be suffering from opiate dependence.
In 2014, a New York court found Graham guilty of stealing medications and falsifying business records. She was sentenced to three years’ probation. Even then, the Office of the Professions did not take any action on Graham’s license until September 2015 – more than one year after her conviction. When it finally did, it simply fined Graham $500 but did not even suspend her license.
A Need For Stricter Oversight
The laxity in oversight is placing patients at risk. This is because it is exposing them to nurses who are unethical, unprofessional or even potential criminals. The end result is that the welfare and safety of patients is being compromised.
Besides patients, failing to sanction errant nurses also has a negative impact on their fellow nurses. When nurses see their colleagues behaving unethically and getting away with it, they stop their doing their utmost to play by the rules. Others can even be tempted to adopt the unethical behavior.
Even those who remain steadfast become resentful towards authority. This is because they see their good work being undone by their unethical colleagues. To make things worse, they see the relevant authorities doing nothing to remedy the situation. This kills their morale.
Ultimately, the weak oversight threatens to undermine the overall quality of the nursing profession. In the end, it is patients who will suffer. Therefore, all agencies charged with oversight over nurses need to up their game. They need to begin imposing medical sanctions on errant nurses swiftly and severely.