On the Carpet:

AZ BON Rule Change Proposals: Letter to AZ Governor Brewer

Governor Brewer,

I wish to seek some more advice.

In compliance with R4-19-705 of the AZ BON rules, which explicitly allow “Any person” to do so, I am currently considering filing one or more requests for AZ BON rule changes, which might well be of note in future legislation, as required by sunset rules to renew the AZ BON mandate.  AZ BON rules list relevant state laws as:
“Adopted effective October 10, 1996 (Supp. 96-4). Former Section R4-19-705 renumbered to R4-19-704; new Section R4-19-705 renumbered from R4-19-706 and amended by final rule making at 9 A.A.R. 1288, effective June 3, 2003 (Supp. 03-2).”

In light of the Trujillo case, with which many Nurses (and a rapidly growing number at that) have taken a strong interest, and in consideration of my previous arguments that Amanda has been accused in effect of following AZBON rules to the letter in a fashion inconvenient to a physician and corporate interests, and in the context of a subsequently added complaint against Amanda, I seek your opinion regarding the following proposed AZ BON rule change requests:

  1. That AZ BON institute a credible and transparent mechanism to assess complaints to the Board for any potentially frivolous or malicious nature, overseen by a disinterested and credible figure, perhaps a judge.  Such mechanisms are typical in court systems, both to lessen undue burdens on precious resources, and to ensure complaints are not used for harassment or calumny.
  2. That AZ BON institute a formal and transparent mechanism to oversee it’s Investigators and establish that their work is timely, credible and sufficient so that complaints do not exert an undue negative influence on the reputation and career of those considered innocent until proven guilty, and so that valid complaints are addressed without undue delay to best protect the public interest.
  3. That AZ BON no longer delete records of its investigations within ten business days of report of disciplinary action, as is current policy, so that transparency and accountability of Board activities may be enhanced consistent with other such worthy initiatives in AZ governance.  Such records should remain available permanently, as deleting them may well protect investigators and Board members far more than anyone else.
  4. That AZ BON clarify its rules in light of a recent Psychiatric evaluation AZ BON ordered, within the currently wide discretion allowed it, apparently in response to an accused Nurse in good standing discussing unproven allegations against her openly, in a manner fully consistent with long-standing First Amendment rights, so that in reality and appearance, BON no longer risks appearing abusive and arbitrary.  AZ BON also would most likely wish to appear abusive of the very concept of a psychiatric evaluation in the tradition of Orwellian tyranny.
  5. That AZ BON clarify its definition of “Credentials” in light of a recent written complaint it filed, suggesting that use of an “S” to indicate student status, an informal practice to my knowledge subject to no current public or private regulation, nevertheless somehow constitutes “misrepresentation” regarding the possession of an accreditation.  AZ BON rules state: “Engaging in fraud, misrepresentation, or deceit in taking a licensing examination or on an initial or renewal application for a license or certificate, ” constitutes unprofessional conduct actionable by the Board.  A computer word search of the official AZ BON rules found no other use of the word “misrepresentsation.”  I fail to see how this language in any way relates to the common and widely accepted usage of “S” or “SN” to indicate student status, whether accurate or not.  As a Nursing educator long accustomed to the use “SN” title or equivalent in hospital documentation and elsewhere, I find this development troubling.  One plausible explanation for this unusual situation seems to be that a Board operating without transparency might gradually come to have more confidence than familiarity as to its own written rules.  AZ BON has also raised speculation as to the misuse of legal language to unduly bully the accused.

As AZ BON rules stipulate prompt written acknowledgment by AZ BON of written rule change requests and the subsequent permanent posting of all such requests in your State’s records, as such requests require more detailed explanation than that provided above, and out of a natural deference to a State Governor’s management of her own administration, I submit this information for your consideration and feedback.

Unlike AZ BON, as a private citizen I act under no rule as to how soon such filings might be submitted.   A review of AZ records indicates that significant problems with AZ BON functions have been well understood since perhaps the 1980s: further patience with incremental self-directed change might well be considered unwarranted.

Thank you for you consideration in this matter,

Greg Mercer, MSN

About Big Red Carpet Nurse (1750 Articles)
Along with other stuff I enjoy that pays the bills (a plus!), I'm a budding nurse comic. I plan, like fake Opthomologist Rand Paul, to create my own professional organization solely so it will grant me a Doctorate. In my case, the org will be something like the AANC (American Association of Nurse Comics), and it will (trust me on this point) agree to make me the first ever DNC: Doctor of Nurse Comedy. I'll keep you posted!

5 Comments on AZ BON Rule Change Proposals: Letter to AZ Governor Brewer

  1. Hey Greg.

    Although we disagree on the specific nurse who started this whole thing, I do agree with you on the need for change in how BON’s are run and investigations are run. BON’s are pretty much the only licensing body that seems to start with the presumption of guilt. Whether the person is or isn’t. BON are the only licensing bodies were the difference in scope is so broad around the country. You never hear about the the injustices with the BOM, RT, OT and the like. The worst thing is we as nurses have done this to ourselves.

    When you ask simple questions about what nurses should be allowed to do, you get a lot of different responses. I tell of the story were I could pull a PA catheter but I couldn’t cut the suture.

    I understand the whole state soverign thing, but it’s sure not helping patient care and nursing careers. It’s all about money.

    They also take way to long to make decisions. A year is way to long. Whether it’s administrative or ciminal, I thought there was the right to a speedy trial.


    • I appreciate each of your points. Each of us has an individual point of view to be valued, especially in regards to unique individual scenarios involving complex and often murky details.
      I believe in systems approaches to Nursing and other health care issues. America has millions of Nurses and thousands of care actions and decisions per Nurse. There is not enough energy or time to address our problems one act, or even one provider, at a time, except for the worst of the worst. Systems improvements can prevent countless errors, or save far more time and expense, far more efficiently than any individual approach ever could.
      Those of us who support Amanda Trujillo – I presume her the “specific nurse” you mention – are aware of the limits, the risks in committing to any one person, or any one unresolved case. Nevertheless, her situation highlights many glaring systems issues: numerous, striking, and simply begging for our action. Many of these issues involve our mostly unexamined and dangerously flawed BON system, in which state officials enjoy more power, balanced with less accountability, than most anywhere else in health. Others involve widespread corporate and medical corruption and abuse motivated by greed, lust for power, or ego. All such issues affect Nurses everywhere, because they put us each at risk every day, and make our difficult work even more challenging and perilous. These forces increasingly demand we stop advocating for the right, and instead defer silently to the powerful and connected. Such demands are more consistent with a feudal or authoritarian system than any democracy, and are thus very dangerous indeed.
      I support Amanda and have no regrets, because she has held firm against such forces for far longer than most of us ever would, because I expect perfection of no one – to do so would be clear, naive foolishness – and because the forces arrayed against her are so clearly and deeply flawed, and so clearly inimical to quality patient care. It is in this sense that I argue that I simultaneously support Amanda and all Nurses.
      Again, thank you for your consideration and thoughtfulness.


  2. Such wonderful writing on the insulin case here in California. I was one of many parents living in one of the two school districts sued in 2005. The parents of diabetics there went through many many years of tremendous stress, harassment and sleepless nights due to the anti section 504 and anti insulin attitudes there. It was a long time coming to have this suit filed. My son has since finished college just recently. Please do not give up, Many of us worked to better the lives of those we did not know, Our kids too were made unsafe and to feel ostracized by the school nurses, staff and administration of our school district.We tolerated the hostility of the school administrators, teachers and, school nurses before and after the suit was filed. Harassment, threats, unsafe actions and acts to intimidate occurred before and after the suit was filed.Send those letters to the assembly. Stay in touch regularly with your own representative so they attach a face and name to the issue.Many of us didn’t look away when our school district and all its administration and school nurses refused to give insulin, Other parents didn’t look the other way when they were treated badly and in ways that deserve a lawsuit all on there own. The suit was filed because those at that time would not back down. Don’t take no for an answer. Don’t allow the nurses or the schools to intimidate you. You are the best advocate and ONLY advocate for your child. The times you hear the school nurses lay claim to patient advocacy of all diabetic children please remind them that in this case it is you who are the advocate for your child, They have not been anointed by you to speak for your child. But if they insist on playing such a role ask them to show you all their training in diabetes and their CEU’s for the past four years they should have on file in case the BRN audits them. Discuss what their diabetes skills and knowledge are now. Would they still claim the advocacy role for your diabetic child while failing to master all that you did without a nursing license? I have no idea what the next steps will be. but I do know it will take more than a village to help our kids get insulin in California schools. All parents need to look at what they can do and start doing it. We programmed our representatives numbers on our cell phones. So when either of us have three minutes we call one of them to chat about the needs of diabetic kids at school.


  3. Greg, great letter. I have one concern which regards the suggestion of a judge assessing and determining if a complaint is frivolous. Citing my personal experience, I once worked for an employer in which the superintendent was a micro-manager and constantly interfered with incidents in the nursing department. He had no medical background yet he would impart his self perceived wisdom’s on each and every questionable occurrence that happened in our department and when pushed his hand for it to be followed. As a result, things that happen in a nursing department were in turn seen as a layman would see them. Just one example being: A nurse making a med error was perceived as unacceptable and had to be punished, which in turn drove the reporting of med errors underground increasing patient risk. No one could convince this man that due to the fact nurses were humans and that mistakes happened, instead of making med errors punitive the reporting of them needed to instead be encouraged and the mistakes looked at in a way to help nurses prevent them in the future. Med errors were a cardinal sin and his view was mandate, period.

    My point being, that any speculation involving a nurses actions needs to be evaluated by another person with a medical background. Not a layperson judge.


    • Michael, your point is certainly well taken: Judges lack Nursing knowledge, and we must have Nurses regulate their own work, consistent with their professional status. On the other hand, Judges do have experience weighing and managing expert testimony, their work is in the public record and bound by far more robust and tested rules than BONs seem to have, and my vision for them would be as gatekeepers: determine in preliminary hearings if each case has merit to continue, assess for conflicts of interest, keep the process honest – try, at least. Experience in other areas indicates that such hearings would likely allow most cases through in deference to the right to participate in this process, and BONs would decide all cases brought to them, as before.

      Such a system would greatly increase transparency, as the public could more easily track who is filing complaints and how many. In the Trujillo case, such a system would hopefully make it possible to assess Banner’s track record in relation to other employers: how many complaints, what quality, etc. As things stand, we have mostly had to rely on speculation and unproven allegations. Also, the elimination of even a small number of egregious complaints would likely induce some health self-regulation on the part of employers not wishing to appear abusive (currently they can act as shamelessly as they choose without compunction or loss of face)

      Also, it might work just as well to have a Nurse in that role instead, or a combination – the Nurse to evaluate Nursing, and the Judge to evaluate the kinds of procedural issues etc. at which a Judge excels. Perhaps a State’s Nurses could elect these Judges. In the end, the details matter less than do than a sense of continuous quality improvement and the application of Nursing Process to this important area: assess (requires transparency), plan, act, evaluate results. We have fallen into rigidity and circularity with our BONs – e.g. we must follow the rules as is because that’s what the rules tell us, we should trust BONs because they’re in a position of trust, or their findings are correct because they determine the correct findings, etc. Such thinking benefits no one except the lazy-minded and the corrupt. Patients and Nurses must demand better.

      Thanks again for your thoughtful comment. I enjoy being right – don’t we all? – but I learn from errors and others, a major motivation for me to throw ideas out there and risk most falling flat.


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