New Hampshire denials: What really happened?
May 1, 2000
New Hampshire denials: What really happened?
Board maintains strict interpretation
When two New Hampshire case managers were denied their RN license renewals last year, they immediately notified Sandra L. Lowery, BSN, CRRN, CCM, president-elect of the Case Management Society of America in Little Rock, AR. "My concern was not only for the two case managers," she says, "but also for the potential implications of the board’s decision. I’m delighted now that their licenses have been renewed, but I want a clarification of the issue [to] determine the intent and basis for the board’s action." Lowery is a practicing independent case manager in the New England states as well as a case management consultant in Francestown, NH.
The Blue Cross Blue Shield case managers were denied relicensure because, in the eyes of the licensing board, their work experience did not meet eligibility requirements. The two case managers’ position was that they were using their nursing expertise in their work, but the board stated that a nurse case manager does not meet its eligibility requirements if she’s performing a job that can be done by anyone other than an RN.
The case managers appealed and were able to show that their job description does require the services of an RN, they do use RN expertise and skills, and their job cannot be performed by anyone but an RN. As a result of their appeal, they were issued renewals.
The New Hampshire State Board of Nursing’s stance on renewing licenses of RNs engaged in certain types of case management positions has raised some eyebrows. Doris Nuttelman, RN, EdD, executive director of the Board in Concord, explains that the Board established its minimum practice requirement years ago: An RN must be actively involved in the practice of nursing for 900 hours within the four years immediately prior to the date of renewal application for the board to renew her license. "How else do you know the person is competent to practice?" she asks. "There used to be elderly people in nursing homes who were cognitively impaired, and they still had their RNs."
Put simply, Nuttelman says, if RNs haven’t been practicing nursing, their licenses shouldn’t be renewed. "And some case management jobs don’t require active nursing," says Nuttelman. It is the board’s position that, if there are people from other disciplines working in the same job description, that is not exclusively nursing practice.
"The New Hampshire Board has held that position for a long time," Nuttelman says, "and not only for case managers." The policy applies to any nurse working under a job description that doesn’t require her to be an RN, and also, for example, to nurse practitioners who go into nursing education. "If she is not practicing as a nurse practitioner, we don’t renew her nurse practitioner license."
Nuttelman admits that this is a strict interpretation. "If you have a nutritionist, a social worker, a pharmacist, and a nurse all working under the same job description — case management — is that the practice of nutrition, social work, pharmacy, or nursing? It depends on the setting." If you hire a case manager, and you want her for her expertise in nursing, then you’d require that she be a RN, she explains. If the patients need social services, you’d hire a social worker. "A social worker is not a nurse, is not a nutritionist, is not a pharmacist," she says.
For more information, contact Doris Nuttelman, RN, EdD, executive director, New Hampshire State Board of Nursing, Concord, NH. Telephone: (603) 271-2323.
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