Amidst a shifting landscape in the nursing profession, the V.I. Board of Nurse Licensure said during its budget hearing this week that it is ramping up its compliance efforts and plans to fully implement licensing legislation in the coming fiscal year.
Executive Director Carmen Vanterpool Romney made this clear in her fiscal year 2024 budget request testimony before the Senate Committee on Budget, Finance, and Appropriations. She emphasized the Board's critical role in safeguarding the nursing practice and ensuring regulatory compliance within the Virgin Islands, while also addressing potential challenges tied to rapid growth and risk of non-compliance in the nursing field.
She noted the increased workload and challenges faced by many boards, including this one, due to the rapid growth of the nursing profession. She drew attention to the potential for fraud and non-compliance in nursing practice, particularly in an open-border territory like the Virgin Islands, and emphasized the board’s responsibility to safeguard community health. Ms. Romney explained that disciplinary cases are undertaken by the board for criminal convictions, misdemeanors, and non-criminal actions such as patient abandonment, practicing with expired licenses, and falsification of credentials.
The compliance work being done by the board raised questions from Committee Chair Senator Donna Frett-Gregory, who was concerned about the statutory limitations of the Board’s authority and responsibilities. "I'm trying to make sure that it's under your purview, based on the statute, and I'm having a hard time finding that." Frett-Gregory also pointed out potential requirements for background checks, suggesting that the issue might be resolved with inter-departmental collaboration, or even legislative amendments of the board’s governing statute.
However, Ms. Vanterpool Romney defended the board’s current compliance enforcement work. "This is our responsibility to ensure that the practice of nursing is followed through and that is being monitored," she said. Health Commissioner Justa Encarnacion agreed with Senator Frett-Gregory that the laws governing the ability of the Board to monitor and enforce compliance needed to be tweaked. Ms. Vanterpool Romney admitted that the Board was not currently able to perform criminal background checks, which is when Frett-Gregory suggested working with the VI Department of Justice and the VI Police Department on the issue.
In her testimony, Ms. Vanterpool Romney noted a slight decline in the number of nurses active in the territory – 1506 in 2023, down from 1551 the previous year. The reason for the decreasing numbers, she said, could be because of more attractive salaries on the mainland, a loss of interest in the profession due to the pandemic, or some nurses wishing to further their education or gain more specialized experience elsewhere.
In terms of the board’s operations, the executive director pointed to the need for more staff to increase proficiency, efficiency, and efficacy. “A grand total of seven staff members carries out the enormous task of serving our community,” she said, noting that more manpower is required to maintain service standards and enforce compliance in the nursing profession.
She said that over the part year, the board has achieved significant accomplishments, key among them the launch of the new Optimal Regulatory Board System (ORBS) Nurse Portal on July 17. The new system, implemented in collaboration with the National Council of State Boards of Nursing (NCSBN), not only provides a turnkey solution for licensing, managing, and enforcing discipline across a nurse's career span, but it also allows nurses to be registered nationally. Ms. Vanterpool Romney detailed the rigorous process of ensuring the local Nurse Licensure Board's data correlated with national standards, which required auditing and correcting over 1,000 records. In addition, she mentioned that the board had completed the online processing of the registration of 108 certified nursing assistants and 56 licensed practical nurses.
Looking forward to the Fiscal Year 2024, Vanterpool Romney announced several strategic goals. She expects full implementation of the Compact Nurse Relationship Bill 34-004, which necessitates criminal background checks for nurses. She also intends to continue coordinating a territorial conference with the NCSBN, fill board vacancies, improve marketing, offer regular continuing education for nurses, and enhance the board's online presence. The board is also aiming to improve the efficiency of its service to members, increase revenues, update record keeping, and reintroduce a curriculum for practical nursing in the St. Croix district.
Senator Carla Joseph wondered about the board’s operational needs, particularly in light of the proposed full implementation of the Compact Nurse License. Ms. Vanterpool Romney’s mention of the necessity of additional staff. There was no increase in the budget request for fiscal year 2024, Ms. Romney said, which remained at last year’s appropriation level of $825,000. Over 80 percent of that sum goes towards salaries and benefits, Ms. Vanterpool Romney outlined, with the rest being spent on supplies, service charges, and rent for buildings and land. The new activities, she concluded, would result in additional responsibilities for existing staff.
Joycelyn McFarlande, operations director for St. Croix, suggested the potential hiring of two new employees to deal with the additional workload. Ms. McFarlande also advocated for more administrative support and restructuring, due to new national requirements and legal mandates.
Overall, the Board of Nurse Licensure is determined to press on with the work of safeguarding standards and service delivery in the nursing profession. “The board, in its responsibility, will not allow for any opportunity to lower the standards in nursing care," she said. "Evaluation and checks are necessary to safeguard the vulnerable population from nurses in the territory."
The Board's priority, McFarlande affirmed, is to ensure that the nursing practice in the Virgin Islands is respected and regulated. Lawmakers agreed with her position, and promised their support.
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