After the Oregon State Board of Nursing staff spent years not answering phones, its revived call center is now fielding more than 1,000 calls each month from people seeking a nursing license.
Meanwhile, customer service ratings have rebounded to pre-pandemic levels and the board reports that it is processing applications faster.
The nursing board’s results figured prominently in a legislative hearing Monday to discuss health care licensing delays that critics blamed for what they called crisis level shortages of nurses, mental health professionals and others during and after the pandemic.
Some licensing boards reported improvements, while others discussed results that were more mixed. For instance, people applying for social work licenses waited more than 100 days last year for the licensing board to process their applications. And the state agency that oversees psychologists and therapists does not have a licensing manager.
The hearing came as the state seeks to build its pandemic-depleted health care workforce and a Republican lawmaker is preparing to again introduce legislation that would pave the way for more out of state professionals.
State Rep. Rob Nosse, a Portland Democrat who chairs the House health committee, said he has heard from employers who have complained in “very broad brush strokes” about boards being unresponsive. He added that when he looked into the complaints “there’s often a lot more to it.”
Room for improvement
Training and retaining nurses has been a particular focus of Oregon lawmakers, who have passed a hospital staffing law and approved other incentives aimed at the profession.
Rachel Prusak told the committee that after being chosen as executive director of the nursing board last year she noticed that “staff had been off the phones for four years.” Since then, she said staff have begun answering the phone again and the board opened a call center earlier this year to answer questions from people seeking nursing licenses.
“Over the past year, a significant focus has been placed on enhancing customer service,” she told the committee.
Prusak, a former lawmaker, presented numbers showing that the call center took over 1,400 calls in some months.
The number of active registered nursing licenses in Oregon have grown from about 80,700 in January 2023 to 86,000 as of this month, according to board licensing statistics previously provided to The Lund Report. Those numbers show that the number of registered nurses has steadily increased from about 63,000 in 2019.
Ray Miller, executive director of the state Board of Licensed Social Workers, said that since taking the job last November he’s been trying to improve licensing in response to Oregon’s lack of behavioral health workers.
He said that wait times for applications were two months on average and sometimes up to six when he took the job. Additionally, about 44% of phone calls were unanswered and there was a 72-hour response to voicemails, he said. Since then, the board processes applications in 30 days and 80% of phone calls are answered immediately, he said.
Miller said he realized after taking the job that the delays had “very little to do with the staff that were working and the systems they were using.”
“This had more to do with an influx, with an unexpected influx of applications, and the loss of a couple of very significant key staff members without being replaced,” Miller said.
The board has nine staff members to oversee 9,000 licensees, so the loss of one employee resulted in a backlog, he said.
Leaders of boards overseeing dental professions and pharmacies also reported no major issues with issuing licenses. Stephen Prisby, executive director of the Oregon Board of Dentistry, presented figures showing the number of licensed professionals staying about the same in recent years.
Gary Runyon, compliance officer for the Oregon Board of Pharmacy, told the committee that 75% of licenses are processed within the board’s 30-day target.
Nicole Krishnaswami, executive director of the Oregon Medical Board, told the committee that a customer service survey gave the board high marks for its organization with one license applicant stating that they felt like they “had a concierge ushering me through the whole process.”
Todd Younkin, executive director of the Oregon Mental Health Regulatory Agency, told lawmakers that he aspires to offer concierge-level service one day but had more immediate challenges. He said that phone support for applicants had been “intermittent at best” until he recently hired staff and made equipment upgrades.
Nosse said he was glad the agency was answering the phones and asked Younkin how close he was to hiring a licensing manager.
Younkin replied it could take up to three months.
Considering compacts
State Rep. Ed Diehl, a Scio Republican who has been critical of licensing delays, acknowledged the efforts of Prusak and Miller during the hearing.
Previously, Diehl unsuccessfully sponsored legislation that would enter Oregon in the Nurse Licensure Compact, which allows nurses to practice in member states without having to renew their licenses. Speaking after the meeting, Diehl told The Lund Report he would introduce a similar bill in the 2025 session, but expected it to go nowhere.
His earlier bill was opposed by the Oregon Nurses Association, who argued it would undermine safety standards. Prusak again criticized the idea.
“While it is easier for a nurse to move and a nurse manager to hire, it can also inhibit public safety,” she said.
Federal authorities last year launched “Operation Nightingale,” an investigation into a scheme to sell false and fraudulent nursing diplomas and transcripts in multiple states. Prusak said only ten nursing applicants who graduated from one of the unscrupulous institutions made it through the Oregon application process before the Nightingale news broke, as compared to hundreds in other states.
Krishnaswami, of the medical board, said that a similar compact for doctors was flawed and sometimes provided inaccurate information about the background of out-of-state professionals wanting to practice in Oregon, including their criminal record.
Diehl said he would introduce a bill that would enter Oregon into a similar compact for physician associates. Krishnaswami responded that the compact was still being developed and she had similar concerns about it.
Other board leaders had different reactions.
Miller did not rule out the idea but said the compact needed to be evaluated for how it would affect the safety of Oregonians as well as its impact on licensing revenue.
Younkin, whose agency oversees a pair of boards licensing psychologists and therapists respectively, said that each had requested legislation that would allow them to enter compacts.
“Each compact has its own list of possible trade-offs and consequences the boards must consider when deciding whether to implement or not at this time,” he said.
Correction: An earlier version of this article mischaracterized Rachel Prusak's description of the Oregon State Board of Nursing staff's experience with applicants from schools implicated in Operation Nightingale. The Lund Report regrets the error.
