Today’s interview is with Jasmine Stewart, one of this year’s stellar summer interns in the Collection Services Division. Jasmine has been busy inventorying and creating metadata for a collection of no-longer-available-in-print National Transportation Safety Board (NTSB) decisions. She is also continuing work on accessioning our collection of foreign legal gazettes gifted by the Dag Hammarskjold Library. We are very happy to have her with us this summer.
Describe your background
I was born in Washington, D.C. and raised in Prince George’s County, Maryland. I enjoy watching TV series and movies from the 90’s, cooking, learning to draw and reading, specifically about food and its impact on the world.
What is your academic/professional history?
I graduated from CH Flowers High School in the summer of 2015 and decided to go to Towson University. I am currently majoring in exercise science and plan to go to graduate school to become a physical therapist.
How would you describe your job to other people?
For my first project, I would describe my job as sort of a book detective (or gazette detective to be more specific) because I look through books and search for anything missing, then see if I can find the missing piece. And for my second project, I would describe my job as sorting and processing documents published by the NTSB.
Why did you want to work at the Law Library of Congress?
I wanted to gain perspective of the Law Library as an employee instead of just a guest. I visited a lot growing up because my Aunt (Tanya London) has been here for as long as I can remember. Every visit was fun because there is so much always going on. So naturally working here seemed like an opportunity I could not resist.
What is the most interesting fact you’ve learned about the Law Library?
I am amazed at how everyone knows everyone here. It’s pretty much a family environment even though there are so many employees and mostly everyone works at their desks all day. Yet I still see people take time out of their day to talk to someone who they do not see on a day-to-day basis. And I’m glad to say I have had great encounters with people here.
What’s something most of your co-workers do not know about you?
I am the biggest football fan; not American football but futbol (known as soccer in the U.S.). I am a proud Chelsea FC fan despite the season we just had and one of my favorite players is Paul Pogba. This summer I tried my best to watch every game at the Euros (heartbroken for France) and cannot wait for the Olympics to see the U.S. women’s team play. [Note to readers, this interview was conducted before the U.S. women’s team played in Rio.]
Ivana Russo submitted her application for a California nursing license on April 22, nearly a month before she graduated from a nursing program at Brightwood College in San Diego. She expected it to take 10 to 12 weeks for the state to process her paperwork and authorize her to take the licensing exam.
As of early August, 15 weeks later, the licensing board still had not reviewed her file and could not tell her when it would. Russo called the agency, often, to ask about the status of her application. It was hard to get a staff member on the phone. When she did, she said, “Every time I got a different story.”
State officials claim that hiring new nurses is a crucial workforce concern for California, yet at least 2,000 recent nursing graduates like Russo remain in licensing limbo, with their applications taking as long as 24 weeks for the Board of Registered Nursing to process.
Experienced nurses from other states who apply for California licenses also wait months for the go-ahead to work.
Even as labor experts worry the U.S. won’t have enough nurses to care for an aging population, license delays have plagued nursing boards across the nation in recent years — in Georgia, Maryland and, more recently, Ohio, where thousands were reportedly waiting on backlogged license applications as of early August.
The current delay in California comes on the heels of a related slowdown in 2014 and is a major inconvenience for the nurses who want jobs and a hassle for the hospitals that want to hire them. And critics say at least some of the problem stems from the flawed $96 million implementation of a computer system called BreEZe which, as its name suggests, was intended to streamline professional licensing.Use Our Content This story can be republished for free (details).
Patricia McFarland, CEO of the Association of California Nurse Leaders, an advocacy group, described the computer system as poorly conceived and inefficiently deployed, citing it as a significant contributing factor in the delays. Moreover, she said, the licensing board doesn’t have a big enough staff to handle the volume of license applications it receives.
“We can’t license our graduates,” McFarland lamented. “Nurses want to retire, they want to train the next generation. We have hospitals investing in residency programs and they can’t start the new nurses they want to hire. At the end of the day, who’s suffering? Our nurse graduates and our patients.”
Veronica Harms, a spokeswoman for the nursing board and for the Department of Consumer Affairs that oversees it, said the department had resolved early glitches with the new computer system. But she acknowledged that the system is still labor-intensive and time consuming, and she agreed more staff is needed to speed the licensing process.
Harms said that the board’s new executive officer, Joseph Morris, who started July 10, “has acknowledged the backlog of applications and is determined to work with [the department] in finding long-term solutions.”
The nursing board is responsible for licensing the state’s more than 417,000 registered nurses, or RNs. It conducts background checks, verifies educational bona fides and authorizes nurse graduates to take the National Council Licensure Examination, or NCLEX, which candidates must pass to get their nursing license. In fiscal year 2015-2016, the board issued 23,743 licenses, more than half to new nurses.
This year’s delays are not the first at the board, which suffered a slowdown in 2014 after it and nine other state licensing agencies adopted the “off-the-shelf” BreEZe system. Once launched, the system malfunctioned, upending workflow and creating more tasks for staff.
We have positions for them, but we can’t let them in without licenses in hand.Kathy Harren
A February 2015 report on the system by the California State Auditor concluded that the consumer affairs department “failed to adequately plan, staff and manage the project for developing BreEZe.” The audit recommended that the nursing board analyze its application process to determine its need for additional resources.
But McFarland, of the nurse leaders’ association, said the state audit was a “game of dodge ball” in which the consumer affairs department and state IT leaders refused to accept responsibility for a real fix.
The audit showed that most of the 10 state boards that implemented BreEze in 2014 were “generally dissatisfied” with it. All 10 were unhappy with the system’s reporting capability, and eight of them said the system actually made their operations less efficient.
Today, BreEZe is used by 18 state boards, bureaus and committees, including the Medical Board of California, the Dental Board and the Board of Behavioral sciences.
The nursing board reports on its website which applications it is currently reviewing — but only by dates received, not by name. Applicants cannot click to find out where their individual applications stand in the process or how much longer they should expect to wait. And the website warns that “contacting the Board for application status while within these timeframes may cause processing delays.”
As of Aug. 8, the board was processing applications filed between March 16 and March 31, according to the website. Nursing graduates said it seems to have been working on March applications for some time.
On July 27, Russo asked if showing up in person might help expedite her case. The worker on the phone said she didn’t think so.
“I’d drive eight hours up to Sacramento if it meant I could move this forward even one week faster,” Russo said. Promising offers come and go, she said, but she can’t start a job until she has her license.
She said she had to withdraw or cancel interviews with a subsidiary of Rady Children’s Hospital-San Diego and the Center for Discovery La Jolla, a residential treatment facility.
Other nursing grads are also feeling confused and frustrated as their job searches get mired in the state’s licensing logjam.
Lara Golden, who recently earned a Master of Nursing degree from the University of Virginia, applied for her California license on April 13. She had postal receipts, but when she called the board in June they couldn’t find her paperwork. So she flew from Virginia to California to submit a second set of fingerprints in person. Seven weeks and many phone calls later, Golden is still uncertain when her application will be reviewed.
Fremont resident Angel Li received her bachelor’s degree in nursing from Washington State University in Spokane in May. She submitted an application to the nursing board on March 15. After hearing nothing for 12 weeks she, too, started calling the agency.
“I kept waiting and waiting and calling back, which is not an easy task,” she said. “Sometimes they just hang up due to the high call volume.”
In May, Li said she had a promising interview for a pediatrics position at a Southern California hospital. The manager wanted to hire her, but said she couldn’t move ahead until Li had a license.
Golden is supposed to start a residency program at a UC hospital but fears she won’t have her license in time.
“I have people calling me crying,” said Kathy Harren, regional chief nursing officer at Providence Health and Services, Southern California. “We have positions for them, but we can’t let them in without licenses in hand.”
Nancy Blake, critical care services director at Children’s Hospital Los Angeles, said that as of Aug. 9, 22 nurses out of the 57 her hospital has hired for its nursing residency program, which starts September 26, still had not been cleared by the nursing board to take the licensing exam. Under normal circumstances, only two or three candidates would not yet have taken the test by this point in the summer, she said.
Blake, who hit roadblocks while renewing her own license earlier this year, worries that young nurses will get discouraged — and that hospital staffing will suffer. “A lot of the boomers are retiring,” she said. “I believe we’re on the cusp of a nursing shortage.”
A 2014 survey by the state nursing board acknowledged as much, reporting that nearly half of California’s nurses were over 50 and that many younger nurses were having trouble getting work. It is “essential that recently graduated RNs find employment opportunities so they are prepared to take on the roles of retiring RNs,” the report urged.
Susan Odegaard Turner, founder of Turner Healthcare Associates, a consultancy in Thousand Oaks, said California now has more of the newly trained nurses it needs but still has not solved the problem.
“We got more nurses. But now they can’t get their license,” Turner said. “This is a different kind of shortage. We’ve produced them, but they’re not working.”
Edith Stowe, 83, waited patiently on a recent afternoon at the bus stop outside MedStar Washington Hospital Center in the District of Columbia. It’s become routine for her, but that doesn’t make it any easier.
Stowe, who lives about five miles from the hospital, comes into the medical center twice every three months to get checkups for chronic kidney failure. She doesn’t own a car and relies on buses. During rush hour, buses are more frequent, and she can keep the commute to about 30 minutes. But when she has to come in the middle of the day, it takes her at least an hour to get in and another hour to get home.
“It’s pretty good except for waiting during non-rush hours,” she said. “When that happens I don’t plan anything else for the day.”
For people without access to private transportation, getting to medical appointments can be a challenge, especially if they have chronic conditions that require frequent appointments.
Some hospitals and medical providers think that the hot-new technology in town — ride-hailing services such as Uber and Lyft — can address this problem by making the trips easier and, in some cases, it is even covered by Medicaid and other insurance plans. Partnerships between ride-hailing companies and hospitals are emerging around the country. While the efforts are still small, some hospitals and medical transportation providers think the potential for growth is large.This KHN story also ran in The Atlantic. It can be republished for free (details).
MedStar Health, a nonprofit health care system with hospitals in Maryland and the district began a partnership with Uber in January that allows its patients who use Uber to access the ride service while on the hospital’s website and set up reminders for appointments. Medicaid patients who may not have access to the Uber app can also arrange the ride by calling the hospital’s patient advocates.
National MedTrans Network, a transportation system that provides non-emergency medical rides for patients and medical providers in a number of states, expanded its services through a partnership with Lyft last year in New York, California and Nevada.
Hackensack UMC, a hospital in New Jersey, the Sarasota Memorial Hospital in Florida, and Relatient, a health care communication company have also announced partnerships with Uber in the past year. Veyo, a San Diego startup, says it is offering a ride-hail-like technology for health care appointments in Idaho, Arizona, Texas, Colorado and California.
“We probably had 50 different systems across the country reach out to us and ask us ‘How did you do it?’” said Michael Ruiz, chief digital officer for MedStar. “I would say that it has been a seismic shift for the people who have used the service and the places we’ve provided it.”
Patients’ costs for the services vary. For Medicaid patients, transportation for non-emergency medical visits are covered, although the extent of reimbursement depends on state rules. Traditional Medicare does not cover non-emergency medical transportation, although some private Medicare Advantage plans may offer some benefits.
Getting To Your Doctor
When going to a medical appointment becomes a hassle, patients are likely to miss the visit, and that can help lead to untreated symptoms or worsening health.
“Transportation can make it difficult for people to see health care providers on a regular basis,” said Ben Gerber, an associate professor of medicine at the University of Illinois at Chicago who has studied patient transportation issues. “It is important to see health care professionals regularly, especially for patients with diabetes or asthma.”
In a 2013 analysis of 25 studies, Gerber and colleagues found that 10 to 51 percent of patients reported that lack of transportation is a barrier to health care access. One of those studies showed that 82 percent of those who kept their appointments had access to cars, while 58 percent of those who did not keep appointments had that access. Another study reported bus users were twice as likely to skip on appointments compared to car users.
In addition to concerns about patients’ health, those absences can also be expensive for medical institutions, which lose revenue from the missed appointment.
Hospitals and managed care organizations do offer a variety of options to assist with transportation for non-emergency medical appointments. Health centers often work with volunteer drivers to pick up and drop off patients.
Patients can call them ahead of time to arrange a ride, but these services generally require advance planning, which becomes a problem when the patient needs to go in for an unscheduled appointment or if the patient forgets to book ahead.
Some patients also end up calling 911 for non-emergency situations, potentially diverting resources that could be used for others with more pressing needs.
The National Medtrans Network partnership with Lyft began after an incident in February 2015. One of its clients, an elderly woman, was left waiting for a ride to a hospital in New York in freezing weather for 30 minutes. The contracted provider failed to show up.
“It was almost a dangerous situation,” said CEO Andrew Winakor. When his company was notified of the situation, officials immediately called a ride-hail service. The ride arrived within six minutes. Winakor said Medtrans officials realized they had to find a transportation option that could respond immediately to canceled rides.
But ride-hailing services do have some disadvantages. Wheel-chair friendly rides are still limited to a few cities. They also depend on the availability of drivers, which might be scarce in rural areas and low-income communities.
MedStar in Washington, dealt with the problem in one of its hospitals in rural Maryland, where there was a lack of Uber drivers, when a patient there had to travel to the flagship hospital in D.C. for an outpatient surgery at 6 a.m.
“Our social workers worked with the folks at Uber to be able to coordinate the ride to pick this patient up at 4:30 am, and coordinate the ride back,” Ruiz said.
Buses, vans and local public transportation for people in wheelchairs come and go frequently in MedStar Washington Hospital Center’s bus center. Stowe is satisfied with the transport options available. While she hasn’t used Uber before, she said it is something she wouldn’t mind trying especially when it gets cold outside.
“There are times when you come out and you really don’t feel that well. If Uber is here, it’d be really nice to have it,” said Stowe.
This is the next in our “Medicaid Works” blog series, which aims to inform the debate over Medicaid’s future by providing the latest facts and figures on this essential and popular part of the nation’s health care system.
As we approach the 20th anniversary of the Temporary Assistance for Needy Families (TANF) block grant on August 22, this blog series will outline key facts about the program.
The Affordable Care Act (ACA) ushered in a new approach to determining eligibility for Medicaid with the goal of providing simplified and streamlined access to coverage. The new approach relies on electronic data sources to verify eligibility and minimizes the need for applicants and beneficiaries to submit paper documentation. When verifying income, state Medicaid agencies compare the sworn attestations that clients make on their application and renewal forms to available electronic data. The attestation and data source are considered “reasonably compatible” if they are both below, at,