An effort by Georgia Secretary of State Brian Kemp to replace the executive director of the Georgia Board of Nursing has been postponed until after a new Nursing Education Consultant has been hired to assist the board. Board of Nursing Executive Director Jim Cleghorn was originally going to change positions with Andrew Turnage, the current Executive Director of the Board of Cosmetologists and Barbers on July 1st. The decision to delay the job swap and to provide for a six month transition period where the two will work together was made after the Board of Nursing and stakeholders complained about the planned change.
But, the delay also puts a focus on the roles of the secretary of state’s office, the governor’s office, and the legislature when it comes to licensing professionals, determining the qualifications to become licensed, and resolving complaints against licensees.
The Board of Nursing consists of 13 members, appointed by the governor, and ultimately responsible to him. Board members are not paid beyond necessary expenses related to meeting attendance. Their responsibilities include determining the qualifications needed to become a nurse, licensing nurses, and acting on complaints and taking disciplinary action when necessary.
The Secretary of State’s Professional Licensing Boards division provides administrative assistance to the Board of Nursing, and around 40 other professional boards. The division managed over 445,000 licenses in the year ending July 31, 2015. Just under 170,000 of those licenses, or around 38% were granted by the Board of Nursing.
There are 19 employees within the division dedicated to assisting the Board of Nursing, along with another 10 employees who spend most of their time acting on board issues. Those include the executive director, the nursing education consultant, investigators, call center employees, and employees who process applications and handle complaints.
Although these employees, and especially the executive director, interface with the Board of Nursing, they are employed by the Professional Licensing Boards division, and ultimately report to Secretary of State Kemp.
The Board of Nursing has come to rely on its Executive Director for more than what his job description actually covers. At a meeting of the board on July 21st, members discussed Secretary Kemp’s decision to swap Cleghorn and Turnage in order to ensure than more than one person was capable of being the Executive Director. Many praised Cleghorn, including former board chairman Brenda Rowe, who called Cleghorn the board’s “most valuable asset.”
Board member Kellie Lockwood noted that in six years, Cleghorn had become an expert in nursing regulation, including education, licensure, practice and business, going “far and above the responsibilities set by Secretary Kemp for Executive Director.” After outlining how Cleghorn had improved the board’s efficiency, she summarized the board’s position that “we do not agree that a permanent change is needed.”
Who is responsible for filling the role of Executive Director? That’s where the law gets a little fuzzy. O.C.G.A. Section 43-1-2, which deals with the Licensing Boards division, states that “The Secretary of State, notwithstanding any other provisions of the law to the contrary … shall appoint Executive Directors as required.” Yet, code section 43-26-5, which specifically deals with the duties of the Board of Nursing, states that the board shall “Approve the selection of a qualified person to serve as executive director;” The Attorney General’s office has been asked to render an opinion on how to interpret the conflicting sections of the code.
While the almost two hour section of the nursing board meeting was supposed to be dealing with the replacement of the executive director, comments from the board and other stakeholders questioned the relationship between the Secretary of State, the licensing boards division, and the nursing board itself.
Board member Nancy Barton stated her concern that the Board of Nursing has outgrown its existing organizational structure because of the complexity of the nursing profession and the decisions that have to be made, as well as the need to keep up with the industry.
Dr. Teresa Kochera, a practicing nurse from middle Georgia and professor of nursing at Wesleyan College, stated, “I don’t see that a middle road here is going to be a possibility. I would like to say what many of us are thinking. Continuing to practice under the Secretary of State’s office is not appropriate for us. It is not appropriate for the Board of Nursing. And so, anything less than fighting for that will be futile. We’ll be having the same conversation ten years from now.”
She continued, “Now is the time to move, like so many others have, away from the Secretary of State’s office. Anything less will be a disservice to our profession.”
Separating the Board of Nursing from the Secretary of State’s office would require legislative approval. That might be possible, given the profession’s lobbying presence at the Gold Dome. It also wouldn’t be unprecedented. Accountants, dentists, pharmacists and health care professions regulated by the Composite Medical Board have gone out on their own in the past.
Yet, according to figures provided by the Secretary of State’s office, these individual boards process license requests and follow up on complaints at a much greater cost per licensee.
The Professional Licensing Boards division operates with a budget of $9.1 million for Fiscal Year 2017, up $146,000 from 2016. The budget is not dependent on the amount of revenue from application fees and fines the department brings in. All revenue collected goes to the general fund, and the Governor’s Office of Planning and Budget determines the division’s funding. With over 445,000 licenses active, the division spends $20.46 per license.
In contrast, the Composite Medical Board has a budget of $2.7 million serving 46,229 licensees at a cost of $58.38 per license. For the Board of Accountancy, the cost is $35.88 per license. The Dental and Pharmacy boards, which became divisions of the Department of Community Health in 2013, processes its almost 56,000 licensees at a cost of $28.26 per license.
For the moment, Jim Cleghorn will continue to serve as the Executive Director of the Board of Nursing. In January, presumably with a new Nursing Education Consultant on board, Cleghorn will begin cross training with Andrew Turnage on the Board of Barbers and Cosmetology. And by this time next year, it’s expected that Turnage will be the Nursing Board’s executive Director.
But, nothing is over until it’s over. The original plan, announced on June 17th, would have meant an immediate job switch between Cleghorn and Turnage. After a meeting with stakeholders, Kemp announced on June 29th that there would be a six month period where the two would cross train together. At the Board of Nursing meeting on July 21st, it was announced that the transitional period would be delayed by six months.
There are at least two items that would cause a change in plans. The Law Department could decide that the Board of Nursing’s right to approve an executive director overrides the Secretary of State’s right to appoint a person of his choosing. And, the 2017 General Assembly could change the law and move the Board of Nursing out of the purview of the Secretary of State’s office. And if they do that, it’s a likely bet that the reconstituted board will hire Jim Cleghorn away from the Secretary of State’s office to be its Executive Director.