Nurses who have been suspended in one state can move to another state and find work.

Nurse Craig Peske was fired from a hospital in Wausau, Wis., in 2007 after stealing the powerful painkiller Dilaudid "whenever the opportunity arose," state records say. In one three-month period, he signed out 245 syringes full of the drug — nine times the average of his fellow nurses.

The ease of Peske's move illustrates significant gaps in regulatory efforts nationwide to keep nurses from avoiding the consequences of misconduct by hopping across state lines.

But an investigation by the non-profit news organization ProPublica found that the pact also has allowed nurses with records of misconduct to put patients in jeopardy. In some cases, nurses have retained clean multistate licenses after at least one compact state had banned them. They have ignored their patients' needs, stolen their pain medication, forgotten crucial tests or missed changes in their condition, records show.

Critics say the compact may actually multiply the risk to patients. There is no central licensing for the compact, so policing nurses is left to the vigilance of member states.

Outside the compact, each state licenses and disciplines its own nurses. But within it, states effectively agree to allow in nurses they have never reviewed.

By comparison, when a compact state is slow to act or fails to share information, nurses suspected of negligence or misconduct remain free to work across nearly half the country, Lee says.

But compact officials do not track how many nurses are sanctioned by their primary state for misconduct elsewhere. They also don't question whether states are adequately policing visiting nurses: 10 states have disciplined three or fewer such nurses in the past decade, compact records show.

Nationwide, nursing shortages have forced hospitals to rely on traveling or temporary nurses. Nurses working in one state now take medical-advice phone calls or use teleconferencing to see patients in another.
Most states have the ability to immediately suspend a nurse’s license, but some can’t — even when the allegations are severe. Likewise, some states require criminal background checks as a condition of getting a license, while others don’t.


Links:
http://www.usatoday.com/news/health/2010-07-15-1Anurses15_CV_N.htm?loc=interstitialskip
http://www.propublica.org/article/troubled-nurses-skip-from-state-to-state-under-compact