OP-ED
The Raw Politics of Nursing
by Richard Kerr, LPN

What happens to PN education and LPN practice in one state happens to our education and practice in all states. In my opinion, the situation brewing in Louisiana regarding the education and practice of Licensed Practical Nurses must have the national spotlight turned on it to expose what is truly taking place – Raw Politics.

This is my opinion. It is based on 42 years as a career LPN, service on a state board of nursing, and service as president of NAPNES.

For so many years now, the practical nursing programs of Louisiana have set the national pace with their progressive education leading to a progressive scope of practice, held to the highest standards of safety for the public by the Louisiana Board of PN Examiners. Louisiana PN curriculum is so progressive, adaptive, and solid that in 1992 NAPNES adopted it as the national model curriculum. Here is an example of this progressive state; Louisiana PN Curriculum includes the sacred cow of nursing known as patient "assessment". Louisiana proves that LPNs not only can learn to assess, but can do it safely within their scope of practice, and are held to that high standard under state law. There are other examples but Louisiana handles assessment, a hot button issue in nursing politics, with distinction. (LP/VNs in other states assess too – but other state boards of nursing contort around the word and only manage to mumble "data collection" in the scope of practice.)

Everyone in nursing regulation knows that Claire Glaviano, Executive Director of the LA PN Board of Practical Nurse Examiners, is the toughest regulator in the country. She is a regulator's regulator from sheer skill, legal knowledge and understanding of regulatory law. She is a registered nurse, tough as hammered steel when it comes to public safety, but extremely fair. NAPNES leaders refer to her as the "untarnished badge" because for as tough as she is on public safety standards, her ethics and integrity are sterling. She cannot be influenced or led astray no matter the political price she pays. In my opinion, the untarnished success of Glaviano and the outstanding Louisiana Board of PN Examiners (comprised of physicians and nurses – both RN and LPN) to whom she reports, is the underlying reason for the raw politics we now witness in this state.

Before I describe the Louisiana politics, let me say I understand that Louisiana, like all other states, does not need outsiders to tell it how to care for its citizens. It is a state issue. However, the Louisiana entity known as the Board of Regents circulated a document nationally that describes the Louisiana LPN nursing education system as "troubled." It requires a national response, a response from LP/VNs across the country.

Fact: According to statistics by the Louisiana Board of PN Examiners, over the past four years, the average pass rate of Louisiana NCLEX^® first-time writers was 86%.
Response: The national average during the same time period was also 86%. Louisiana's pass rate for first-time NCLEX^® is at the national average. The Board of Regents reports this as "troubling"?

Fact: There are two sets of programs in Louisiana; Those under the control of Louisiana Community & Technical College System (LCTCS) (vocational programs) over which the Board of Regents has no direct authority and those over which the Board of Regents does have authority, or the proprietary programs. According to the stats from the PN Board of Examiners, from 1990 to 2004 the vocational programs experienced a pass rate of 92% while the Regents controlled programs held an average pass rate of 79%.

Response: If the gauge here is pass rate, it seems to me that in order to bring up the pass rate of the proprietary programs, Regents should consider turning its authority over to the LCTCS.

Fact: Section B(1) of the Regents document refers to a wide disparity among employers "regarding the competency of program graduates…These opinions range from excellent to poor."
Response: Again, without variation and standard deviation comparison, there is no significance to the "range." The Board of PN Examiners state that in 2003, 72% of employers indicated they were "Satisfied to Very Satisfied" with the performance of newly licensed LPNs. This is an increase from 61% in 2002. Satisfaction is growing. Yet Regents reports to the nation it finds this "range" "troubling"?

Fact: Section B(4) of the Regents document addresses CNA to LPN to RN articulation and infers that articulation problems could be solved if there was one board of nursing.

Ah, now we get to the real reason highly educated people are using "ranges" to help the statistically challenged or uninitiated reader infer that the Louisiana LPN education is "troubled"... Raw Politics!

Regents wants control and it wants the "untarnished badge" removed along with the doctors and nurses that comprise the outstanding Board of PN Examiners. It must be extremely difficult to maneuver around such a bright group of people that is nationally recognized and whose true dedication to public service and public safety is a national model itself.

I find I am indeed "troubled" by the issue in Louisiana brought to national prominence by the Louisiana Board of Regents document. I am "troubled" by what is, in my opinion, intellectual dishonesty when credentialed people use tactics like presenting "ranges" to encourage the reader to infer that there is great disparity in the PN education without presenting variation and standard deviation comparison. I find it "troubling" for credentialed people to use those credentials, that all want to respect and admire, to destroy the integrity of programs and regulators involved in preparing skilled health care providers by circulating such statements nationally to set the stage for political control of local education. In my opinion, the obvious raw politics in this instance is disgraceful.

Louisiana is a shining star in progressive PN education and regulation. I am counting on the good people there to outsmart and out maneuver such tactics with the facts and thousands of skilled nurses known as licensed practical nurses but it is "troubling" to say the least.

In fact, I am so "troubled" by this bald attempt to take control of education, practice, and regulation of the excellent LPNs of Louisiana, that I am going to contact the Governor of Louisiana and offer my outsider support for the Louisiana Board of PN Examiners and the progressive programs that the good people of Louisiana cherish.

I am stating my opinion because I don't think short memory should confer immunity on the Ph.D led Board of Regents and not hold it accountable for irresponsible remarks that trash the sterling reputation of such an honorable state agency without concern for the truth based on the statistical evidence. Although it is not a new tactic in raw nursing politics, shame on the credentialed people.

On January 12th, 2004, Louisiana Governor Kathleen Babineaux Blanco was sworn in stating that her top priorities "include providing affordable, accessible healthcare, improving the state's education system, and creating a strong vibrant economy." In her inaugural address, Governor Blanco outlined her priorities as governor: “We face important challenges in this new century: expanding our economy and creating quality jobs; building an effective health care system; improving our roads and highways; rebuilding our coastline; protecting our farmers; and ensuring that all our citizens, no matter their age, have superior educational opportunities.” (Governor's website)

Given Governor Blanco's priorities and obvious commitment, it is inconceivable to me that she would allow such destruction of the proven, national model, excellent path to becoming a skilled health professional in her state and of such a strong public safety agency as the Board of PN Examiners. Particularly when economy, jobs, environment, etc., all rely on a fundamentally sound and quality workforce like we find in licensed practical nursing in Louisiana today. I believe she means what she says. I hope she will find this national disparagement "troubling" as well.

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