Crime and nurses - an oxymoron? As nurses are considered to belong to one of the most trusted professions, "nursing" is typically not synonymous with crime. Unfortunately, a small percentage of Texas nurses and candidates for nurse licensure have a criminal history that must be considered by the Board to determine eligibility for initial or renewal of licensure as a nurse. Due to the nature of nursing and the exposure to vulnerable patients, the Board must ensure that all nurses possess professional character as stated in Section 213.27, relating to Good Professional Character in the Texas Board of Nursing's Rules and Regulations. Although the Board of Nursing has requested self-disclosure of criminal history for many years, there was a wellfounded belief that many crimes were not being reported.
In 2003, House Bill (HB) 2208 mandated criminal background checks (CBCs) on all applicants for initial licensure. In 2005, HB 1366 added permission for board action on deferred adjudication or probated criminal sentences (due to the concern for the underlying conduct, not just what action was taken by a criminal court). It also added new §301.4535 to the Nursing Practice Act requiring that the Board revoke, suspend, or refuse to license persons with criminal history related to certain serious crimes that the Legislature deemed relevant to the practice of nursing. House Bill 2208 also added, in 2003, §301.3011 regarding CBC authorization for licensure renewal. Since starting to conduct CBCs for initial licensure in 2004, the Board has completed a combined 107,058 CBCs.
In order to implement the above statutes, the Board has mandated CBCs be completed through submission of fingerprints to the agency, which are then processed by the Texas Department of Public Safety (DPS) and the Federal Bureau of Investigation (FBI). How much more effective are these criminal history background checks over the historic self-disclosure policy of the Board? To answer this question, an in-depth research project was conducted by the author at the direction of Katherine A. Thomas, Executive Director, to evaluate the Board's experiences with CBCs.
The research project included the time period beginning September 1, 2002 through August 31, 2006, and encompassed a period both before and after the implementation of mandated CBCs on September 1, 2004. The four main objectives to the research project were to determine: 1) The number of nurses with criminal histories who were disciplined by the Board prior to and after the implementation of the mandated criminal histories; 2) the date of the offense, the nature of the crime (theft, assault, DWIs, hot checks, sexual assaults, etc.), the level of the crime (1st, 2nd, 3rd degree felonies and Class A, B, or C misdemeanors); 3) whether or not the nurse self-disclosed his/her criminal history; and 4) how the Board sanctioned the nurse.
The study showed that a total of 1,508 nurses were disciplined by the Board for criminal histories. Three hundred and thirty nurses were sanctioned due to a criminal history prior to the mandated CBCs; and 1,182 nurses were sanctioned due to a criminal history after the mandated CBCs. The results showed that 852 more nurses, a 258% increase, were sanctioned after the mandated CBCs. Of the 1,508 case files reviewed, with 3,310 crimes identified, it was calculated that 938 or 28% were felonies and 2,372 or 62% were misdemeanors.
In the two-year time period since implementation of CBCs, two hundred and twenty-seven nurses were sanctioned who failed to disclose their criminal histories as required on the licensure renewal form, a 638% increase. These statistics substantiate that the CBCs have been effective in identifying nurses with criminal histories.
Results of this research project may be reviewed by clicking this link cbc-analysis.pdf. Research project results include: the number of nurses categorized by RNs, LVNs, applicants and endorsees sanctioned by the Board due to criminal histories; identification of the nature and level of crimes, disclosure and non disclosure of criminal histories; as well as the sanctions the Board issued for these crimes.
The Board has also published a grid of Disciplinary Guidelines for Criminal Conduct that lists a number of criminal acts and the typical board action if a nurse is convicted, including deferred or probated sentences, for a listed crime. The Board's Disciplinary Sanction Policies offer additional insight into how certain crimes relate to the practice of nursing.