Testimony of MNA President Karen Daley, at BORN Hearings

Chairwoman McCarthy and Members of the Board of Registration in Nursing:

Thank you for providing me the opportunity to testify regarding the proposed nursing regulations.  My name is Karen Daley and I currently serve as president of the Massachusetts Nurses Association that represents approximately 20,000 registered  nurses.  I would begin my testimony by saying that MNA and the overwhelming majority of practicing nurses in this state strive to advocate for and provide quality care to patients - and we are largely successful in spite of the many obstacles to safe, quality care that currently exist within the health care system.  In doing so, the MNA and most practicing nurses share a common agenda with the Board - to assure the public’s health and safety.

Beyond the public health and safety mandate addressed by the BORN through its promulgation and enforcement of regulations, MNA advocates for the public health and safety by supporting competent, informed, safe nursing practice.  To that end, the association provides a professional voice and tools to advance practice and empower nurses to advocate for patients and for themselves.  It is not and has never been MNA’s position as we expressed our concerns about the proposed regulations that nurses who are incompetent and/or pose a threat or danger to the health and safety of patients should be allowed to continue to practice nursing.   It is our position, however, that the board’s mandate for protecting the public health and safety should be balanced with the need for fair and consistent treatment of nurses in the presence of allegations.

Consistent with the board’s stated intent in promulgating these regulations, it is our belief that all nurses should be knowledgeable about the standards to which they are held accountable in their professional practice.  Nursing regulations, that carry the weight of law, should be clear and consistent in language and intent so they promote a common understanding and leave little room for misinterpretation or misapplication. As an advocate for nurses as well as the public health and safety, MNA takes seriously its obligation to assure - to the degree possible - that these regulations serve as a useful, appropriate and understandable guide for professional accountability-and not as a means by which nurses become increasingly vulnerable to unjust and unwarranted complaints and discipline - some of which could conceivably take months or years to resolve.  Moreover, the ultimate disposition of complaints by the board - even if dismissed after a completed investigation - does little to mitigate the emotional toll or burden it places on the individual nurse from the time a complaint is opened to the time it is resolved.

As president of the MNA, I am also here today to bring attention to some of the specific concerns shared in MNA hosted forums by nurses across the state over past months.  As a registered nurse with over 25 years experience as a direct care provider, I understand the basis for many of these concerns. During this hearing, others will speak to specific issues and recommendations, but included among its written testimony, MNA will submit alternate language for the following areas under 244 CMR 2.00:

• Standards of Nursing Practice (definition)
• Impairment (definition)
• Practice of Telenursing in Another Jurisdiction
• Identification Badge
• Nursing Assessment
• Leaving a Nursing Assignment
• Security of Controlled Substances
• Administration of Drugs
• Delegation
• Responsibilities of Nurse in Management Role

While the board clearly has no obligation beyond holding a public hearing in terms of making further changes to the proposed regulations, I would ask each of you to listen carefully to the testimony of practicing nurses who express confusion and concern over the proposed regulations based on their own reality, experience and knowledge. Many will describe for you the vulnerability they feel with some of the current language. These nurses are the experts not only with regard to their day-to-day professional practice, but also with regard to the world in which they practice. In addition, testimony will be offered by nurses who are experts in their field of specialty practice.  I have confidence the board will give appropriate weight to such important testimony.

Finally, I would also encourage each of the board members to listen carefully to the voices and issues raised and, upon conclusion of these public hearings, ask you not to abdicate your responsibility for taking in and interpreting this critical feedback to any single individual.  At the very least, I would ask the board to consider the need for oral testimony to be reviewed and summarized by nurses on the board who are able to bring to the process the needed perspective, experience and understanding of the reality encountered by practicing nurses today.  I would also encourage you to think about the fact that the composition and make-up of the board will certainly change in the years ahead, and about the importance of clear, unambiguous language that can be universally interpreted and applied consistently by anyone who is appointed to the board in the future.

I am optimistic that it is possible for the board, with careful consideration and deliberation regarding these proposed regulations, not only to meet its public mandate, but also to  promote the fair and consistent treatment of nurses.  Thank you for your time and attention.

Sincerely,
Karen Daley, MPH, RN
President, MNA