Shocking Results From California Nursing License Audit

If you applied for a new California RN license or a license by endorsement anytime since October, 2013, then you most likely experienced major delays. Officials at the California Board of Registered Nursing (CBRN) blamed a newly instituted system called BreEZe for causing bottlenecks in their process. Things got so bad that the California State Assembly authorized an audit of the new process the results of which were released on February 12, 2015. In this blog post, we’ll cover the results of the audit, provide some insight on how things are currently functioning as of February 15, 2015, and offer some recommendations for those seeking to obtain their California RN license by endorsement.

Major Findings Regarding the California Board of Registered Nursing From The Audit

Perhaps the biggest takeaway from the report as it pertains to CBRN is that it claims CBRN’s request for additional staff to help speed the process up is “not adequately justified.” According to the audit, CBRN does not formally track the data necessary to adequately assess it’s workload. Therefore, CBRN cannot provide hard proof of delays in the process. Additionally, the audit included its own review of nursing applications and concluded that processing was “well within the maximum allowable time-frames.”

This will certainly be a shocker to those nurses that have experienced lengthy delays in obtaining their licenses. We were definitely caught off-guard ourselves. As a result, we read the entire report in order to understand how the auditors arrived at this conclusion.

Background on BreEZe and the CBRN

First, it’s important to provide a little background information. The CBRN falls under the jurisdiction of the California Department of Consumer Affairs (CDCA). Of course, over the years, the CBRN and all the other CDCA regulatory boards have had systems in place to deal with applications for licensure and other regulatory processes. Then, in 2008 the CDCA and CBRN came under fire over CBRN’s enforcement programs when an LA Times investigative report uncovered over 100 cases in which the CBRN had failed to revoke or restrict the licenses of nurses until they had accumulated three or more criminal convictions.

As a result, Governor Jerry Brown demanded that CDCA take steps to clean-up the issues. CDCA initiated a major reform program that they call The Consumer Protection Enforcement Initiative. As part of this initiative, CDCA decided to develop and implement one integrated, enterprise-wide enforcement and licensing system called BreEZe. The system was rolled out in October of 2013 and that’s when the problems began.

Regulatory Requirements for Processing Nursing Licenses in California

Now, it’s also important to know the general rules for processing nursing licenses in the state of California. In other words, what constitutes an “allowable time-frame” for processing a nursing license request? California regulations require that an initial review of nursing license applications be conducted within “90 days of receipt.” For renewals and endorsement licenses, CBRN simultaneously reviews and issues licenses as long as all the required documents are accounted for. So keep this in mind as we discuss the findings.

Detailed Findings of the Audit

The audit found that application processing times had definitely increased for the period they investigated. However, it concluded that the processing times were still within the 90 day requirement. Again, the auditors conducted their own review of applications because they felt they couldn’t rely on the data available through CBRN. So the auditors reviewed 30 applications from before the BreEZe roll-out and 30 applications from after the BreEZe roll-out.

The audit found that initial review times for licenses by endorsement increased from an average of 35 days before the roll-out to an average of 60 days after the roll-out. For licenses by examination, the initial review time was 29 days before the roll-out and 31 days after the roll-out, an average increase of only two days. And for renewal applications, the initial review time actually decreased from 17 days to 14 days!

Moreover, the auditor’s investigation found that only 1 of the applications by endorsement they reviewed had taken longer than the 90 day regulatory requirement. That application took 27 days longer.

Given the horror stories we’ve heard in the comments section on this blog, we found these numbers shocking! According to these numbers, licenses by endorsement were being reviewed in a little over 8 weeks from the time of receipt. Considering that CBRN issues endorsement licenses simultaneously upon review, this would mean that a significant percentage of applicants received their nursing licenses in 8 to 9 weeks. We just can’t see how that’s possible.

That said, the audit’s numbers are at odds with the numbers provided in CBRN’s “Sunset Review Report” for 2014. This report indicates that average review times went from 22 days to 82 days for exam applications and 26 days to 69 days for endorsement applications.

However, the auditors rejected CBRN’s numbers for seemingly good reasons. They state that the time-frames provided by CBRN include time that really shouldn’t be counted toward the initial review time. For example, CBRN time-frames include the time it takes for applicants to respond to deficiency notifications regarding their application packets. This is why the auditors conducted their own review.

Possible Explanations for Differences Between Audit and Perceived Reality

So we’re left wondering how to bridge the gap between what the audit reported and the reports that we receive from our members and readers who overwhelmingly experienced delays. And it’s not just our members and readers. We saw nothing but problems expressed in social media groups devoted to travel nursing where large numbers of nurses were applying for California RN licenses by endorsement. We also hear of delays from numerous agencies who assist their employees with the license by endorsement process.

Of course, it’s possible that only people who experience problems with the licensing process voice their experiences with us while those who have had a smooth experience have no reason to visit our site. However, we find that hard to believe given the overwhelming outpouring of public complaints made during the peak of the problem and the relative silence from anyone who had a positive experience. The same can be said of social media support groups where the overwhelming consensus was that obtaining a California nursing license by endorsement was taking quite some time unless one was to visit the CBRN in person.

Potential Methodology Problems

One potential explanation for the gap between the audit’s conclusions and the self-reported delays we’re hearing about is that the audit utilized faulty methodology. In fact, there are two glaring methodology issues that really stand out.

First, the audit reviewed only 30 total applications and fails to mention how many of each type of application they reviewed. This is important because they also mention that they found 1 endorsement application that exceeded maximum time-frames. The problem is that we don’t know what percentage of reviewed endorsement applications exceeded maximum time-frames.

If the audit reviewed 10 endorsement applications, then it’s possible that 10% of all endorsement applications were late. Another problem is that the audit doesn’t identify what percentage of applications must be late in order to qualify this as a problem. Does 10% of applications being late qualify as a problem? Or does it have to be 20%, 30%, or more?

Second, the audit fails to account for the different methods available to apply for a license by endorsement. This is important because it’s widely known that applying for an endorsement license in person at the CBRN office takes far less time than applying via mail. When applicants show up in person with their application packets and livescan fingerprint results, it’s quite common for CBRN staff members to review the documents on the spot. And as mentioned above, the board typically reviews and issues endorsement application at the same time.

As a result, relying on average response times for endorsement applications can severely underestimate the amount of time it’s taking CBRN to review endorsement applications that are sent via mail. Of course, not everyone has the financial means to make a special trip to California to visit CBRN and get livescan fingerprints completed. So understanding this difference is key to providing a truly legitimate audit report.

Finally, the audit does not include a clear definition for the “date of receipt” or provide the method with which the date of receipt is recorded. Are all application packets stamped with the date they were actually delivered to CBRN? Or is it possible for applications to sit around for some duration before the date of receipt is recorded? Given the major backlogs reported, one wonders if it’s possible that applications sat around for lengthy periods before being recorded.

Additional Takeaways From the BreEZe Audit

There were several other interesting items in the audit pertaining to CBRN that nursing license candidates may be interested in knowing. First, CDCA set up a process, called “system investigation requests”, for agencies to submit, track and resolve issues they have with the new system. CBRN representatives submitted more than 1,000 such requests which was way more than any other agency using the new system. The audit’s IT expert pointed out that this was an indication that CDCA didn’t adequately plan the system for CBRN’s unique circumstances.

Second, we have had numerous reports from our readers and members indicating extreme difficulty reaching anyone at CBRN by phone. The audit states that CBRN has eliminated the support service duties of its application evaluators so they can focus on processing applications. There are still people answering phones, but there are far fewer than normal and the board is receiving a higher volume of calls.

How Long Does It Currently Take To Get A California RN License By Endorsement?

The audit defines applications that the BRN has received but has not yet started reviewing as the pending workload. The Breeze system lacks the data necessary to track the pending workload, so the auditors manually counted the pending applications. In November of 2014, they identified more than 7,000 applications as pending with 63 applications that had exceeded maximum regulatory time-frames, 54 of which were endorsement applications. The total number of endorsement applications was 2865, which means that close to 2% of endorsement applications were late in being reviewed. Moreover, the average time lapsed since an application by endorsement was received was 45 days.

In recent months, things appear to have cleared up. However, we are still receiving reports of major delays. But it’s fair to assume that the majority of delays are the result of application deficiencies.

With that in mind, applying for your California License by endorsement in person and using the LiveScan fingerprinting system seems to be the best option by far-and-away. According to numerous nurses who have taken this approach as well as representatives from CBRN, by applying in person you can have your temporary California RN license in under 3 weeks if everything is in good order and there are no hits on your criminal background.

It also appears as though the mail approach is taking less time than it was during the height of the problems. Most nurses we speak with are getting their licenses within 90 days when applying by mail. However, we highly recommend reviewing our article on how to obtain your California RN License by endorsement to ensure that you are taking all the steps necessary to ensure a smooth process when applying by mail.

Moving forward, it’s important to note that all the kinks may not be worked out. During peak times, there may still be delays. For example, peak times tend to follow the academic calendar when graduates tend to apply for licenses by examination. So be sure to consider that when applying for an RN license by endorsement.

As always, we’d love to hear your thoughts on this issue. Please post them along with any questions or concerns in the comments section below!