HARRISBURG — Nicole Hatem thought she was in a good spot when she graduated from Philadelphia’s Jefferson College of Nursing in May. She had landed a job offer to be a staff nurse at Thomas Jefferson University Hospital and was slated to start in July. All she needed to do was pass her license exam.
To register for it, Hatem, 27, needed to go through the Pennsylvania Board of Nursing. She said she submitted her application May 24. The calendar changed to June, then July. Local testing centers began reaching capacity. She began to call the board almost daily. Hold times were about an hour, she said, and responses were flippant. They told her to wait and stop wasting their time with her calls.
After months of stress, she asked her state senator for help and only then did her approval arrive — just in time for her to start her new job.
“While there were real-life consequences for me, it felt as though there was no accountability on their end or even willingness to care,” Hatem said, adding it was a “truly terrible” process.
In late 2016, Pennsylvania began rolling out a new, centralized electronic system for its 29 licensing boards — which oversee everything from nurses to barbers to funeral directors — and championed it as the solution to piles of paperwork and long wait times.
But the rollout of that system, now estimated at $10 million, has taken longer than anticipated. According to interviews with nurses, lawmakers, and state officials, it’s frustrating to use and hasn’t fixed long-standing problems. On top of it all, the Board of Nursing recently imposed or increased 68 different fees for the roughly 295,000 licensed nurses in the state.
“It certainly appears that the board is not well-enough equipped,” said State Sen. Maria Collett, a Democrat who represents parts of Bucks and Montgomery Counties and a registered nurse herself. Collett said her office has intervened with the board on behalf of nurses who couldn’t get a straight answer.
“We’re not doing what we can,” she said.
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Last year, a review of all licensing boards ordered by Gov. Tom Wolf found that the nursing board’s initial processing time averaged 17 days. But when pressed this month, acting Secretary of State Kathy Boockvar, who oversees the boards, told Spotlight PA she has “no confidence” in that number.
“I’m going to start out by telling you: I don’t know what that report, what those numbers, refer to,” Boockvar said. “It was very disturbing to me.”
Boockvar said that in June, she requested a review of licensing board data and found the average total processing time for registered nurses in 2018 was 88 days.
Many nurses get caught in the first phase of that process, from the time a graduate like Hatem applies to the time they’re approved to take the test. Just that first part took an average of 37.5 days last year, Boockvar said.
By comparison, that same first phase in New Jersey takes eight days, and in Ohio, it’s between three and 10, according to licensing board officials in both states.
Boockvar, who has worked in nonprofit health-care administration and was previously responsible for staffing nurses, said she was not surprised by people’s experiences with the delays.
“I have to admit, I did find the Board of Nursing very frustrating from the outside world,” she said.
But she said there were clear signs of progress. Preliminary data on this year’s processing times show improvement, she said, and she is optimistic that will continue. She added that in April, she hired a new director of operations specifically tasked with identifying the causes of delays across all boards.
“All the trends are positive,” Boockvar said.
Members of the nursing board did not respond to requests for comment. Ian Harlow, who ran the Bureau of Professional and Occupational Affairs at the time the new system was first implemented, declined comment. Harlow is now deputy secretary for regulatory programs.
The governor’s spokesman, J.J. Abbott, said in a statement: “Discrepancies and data concerns such as this are one of the many reasons the department undertook the major effort of replacing the prior system.”
Exactly how the review ordered by Wolf arrived at such a drastically different processing time for the Board of Nursing remains unclear. Alanna Wilson, who was involved in the review as part of her work with the Knee Center for the Study of Occupational Regulation near Altoona, Pa., said that processing time determinations were left up to the board.
Harlow and the then-chair of the Board of Nursing, Linda Kmetz, took part in the review.
“The boards who had the most to gain — or to lose — showed up,” Wilson said. “The nursing board was very involved.”
Nurses across the state said problems weren’t limited to license approval times. They also reported curt responses and long hold times on the phone when they called with questions. Some calls were left on hold for hours, they said, at times until the office closed, at which point calls disconnected.
Boockvar disputed these claims, saying average hold times were nine to 10 minutes. There was no excuse for rudeness, she said, but added that nursing board staff hadn’t yet gone through customer service training.
In July, Boockvar said the Board of Nursing discovered and removed a dead-end phone number from its website. But in August, a call by a Spotlight PA reporter was met with an automated greeting and then a dead line. A second call was then put on hold for about 25 minutes until someone answered.
Boockvar said the board was migrating to a new phone system.
“Phones are so frustrating,” she said.
Nicholas Caruso, a nurse practitioner, said he recently moved from Monroeville in Allegheny County to Las Vegas and saw a huge difference. The Nevada Board of Nursing “picks up on the second ring and answers any questions right away,” Caruso said.
Lauren Narbey, a 31-year-old certified nurse-midwife in Pittsburgh, said she has to file for a license every time she wants to work alongside a new physician. She most recently filed in July. When Narbey called the Board of Nursing last week, she said, she waited on hold for a half hour.
Narbey’s business with the board hasn’t yet been integrated into the new electronic system, meaning she had to mail in paper forms for approval. She has yet to receive a reply — or her new license.