Serving on a Nursing Regulatory Agency: Lessons Learned From a Board Member

Nursing regulatory bodies (NRBs), governmental agencies responsible for the regulation of nursing practice, were established to protect the public by overseeing and ensuring the safe and competent practice of nursing. They achieve this by outlining standards of safe nursing care and issuing licenses to practice nursing. Once a license is issued, the NRB monitors licensees’ compliance to laws and regulations and acts against the licenses of those nurses who have exhibited unsafe nursing practices.

NRBs differ in size, shape and scope of oversight. For example, some agencies are responsible for implementation and enforcement of laws related to nursing education in addition to nursing practice and licensing. Most NRBs, in accordance with their state nursing practice act regulations, have governing boards that serve as decision-making bodies.

To understand more about RN roles on an NRB, AONL member B.J. Bartleson interviewed Pilar De La Cruz-Reyes, MSN, RN, former board member of the California Board of Registered Nursing (BRN).

Your career has spanned roles as a nurse administrator, educator and mentor. What led you to serve on the BRN?

Our state department of consumer affairs discussed regulatory board opportunities and encouraged health care professionals to apply. It piqued my interest, so I submitted my application, but nothing came of it. While I continued to move through other nursing administrative and educational career opportunities, my desire to serve on the BRN never diminished. After working over 30 years in acute care administrative positions, I accepted a position as the director of a nursing school. The nursing program had been placed on probation with the intent to close due to numerous regulatory deficiencies. I accepted the nursing director position because correcting the school’s programmatic deficiencies would involve not only nursing administrative knowledge, but intimate knowledge of nursing education laws and regulations. It also meant more frequent interactions with the BRN than I had previously experienced in hospital administrative roles. This led to relationship building with many of the BRN board members and an opportunity to serve when one member suggested I apply for her seat, as her appointment was expiring. I applied for the position and was appointed by the governor in October 2015.

What were some of your initial experiences as a board member?

While I was given an orientation to the role of board member, one of the best learning opportunities occurred when I spoke to RNs, getting their feedback about their experiences with BRN. This helped me understand the RN viewpoint, as well as the board perspective. The first board meeting I attended was an eye opener, as I quickly realized the intricacies of the role and the significant knowledge board members must have to regulate activities across multiple facets of nursing practice, such as licensee practices, education, enforcement and intervention activities. I also learned early and often that the primary mission of the BRN and all NRBs is consumer protection and all decision-making needs to be filtered through that lens.

Can you describe California’s BRN?

Nine members serve as the policy-setting body for the board. Seven of the members are appointed by the governor, one by the senate president pro-tempore, and one by the assembly speaker. Board members include five RNs and four public members. Six committees perform work for the board: education/licensing, enforcement/intervention, legislative, nursing practice, and two advisory committees that support nursing practice committee, the APRN advisory sub-committee, and the nursing education and workforce advisory sub-committee. The education /licensing committee ensures that nursing education programs are meeting regulations for educating nurses. The enforcement/intervention committee reviews the number of nurses on probation, as well as how long it takes to implement disciplinary action. The legislative committee reviews current and upcoming legislation impacting nursing practice and makes recommendations to either support, oppose or watch certain bills. The nursing practice committee addresses issues and regulations affecting practice, and the two practice subcommittees address specific issues with APRN and workforce, such as simulation and workforce supply and demand.

Two-day meetings were held monthly in various sites across the state to encourage and accommodate RN participation. This entailed widespread travel and time away from home. In addition to the meeting attendance and travel, extensive preparation for board and committee meetings was needed. Every board member sits on at least one committee and must have explicit understanding of the regulations guiding issues of that committee and be prepared for deliberations regarding agenda items.

What one issue stands out from your time on the NRB?

Much of our work involved individual RN disciplinary cases; these nurses were placed on probation for not practicing in accordance with the state nurse practice acts. RN disciplinary meetings are held like court proceedings with a judge and court reporter in attendance. A state attorney is present, and the petitioning RN could either have their own attorney or could present their own case. We would hear the case, ask clarifying questions, then move to a closed session with a judge to make final recommendations. RNs are placed on probationary status for patient care issues or for substance abuse. Some of the practice issues clearly stemmed from RNs not understanding nurse practice acts and how nursing differs from other professions, particularly medicine. Other patient care issues involved RNs not following the nursing process that ultimately led to poor patient outcomes. It became clear to me, working through these cases over the years, that RNs need more knowledge and hands-on understanding of state nurse practice acts and how the acts or statutes translate to regulations that establish practice parameters. Nurse leaders should make it a point to assist and mentor RNs on their comprehension and application of state nursing practice acts to assure accountable practice.

What are the differences between California’s nursing regulatory board and others?

The BRN is one of the largest NRBs in the country with more than 400,000 licensees. While responsible to cover nursing practice regulation, this NRB is also responsible for implementation and enforcement of laws related to nursing education. With more than 140 schools of nursing across the state, this consumed a large portion of the overall BRN workload. In addition, the BRN is not part of the nursing licensure compact, which has been a controversial topic, as more health systems integrate and consolidate across state borders.

What would you advise nurse leaders who are thinking about applying for an NRB position?

Serving in such a role was challenging and I learned a significant amount about law and regulatory underpinnings of the state nurse practice act during my service, which ended last year. I consider my appointment to the board a highlight of my career. I suggest the following:

• Learn about the role/responsibilities of the NRB position before you apply. Make sure you understand the time and work commitment for meetings and preparation.
• Talk to current and former board members about their experience and how it has enhanced or challenged their careers.
• Identify key health care leaders to support and mentor you, as well as provide references or recommendation letters during your application process.

About the Interviewer

B.J. Bartleson, MS, RN, NEA-BC, is the vice president for nursing and clinical services at the California Hospital Association, Sacramento.