Alison Bradywood, DNP, MPH, RN, NHA, NEA-BC, started her new job as executive director of the Washington Board of Nursing (WABON) on May 1, 2023. Here’s what she has to say about some of the biggest issues facing nurses in the state.
What attracted you to this position?
I have a passion for supporting nursing and systems improvement. This role has the ability to impact more change on a broader scale than a single organization. “Creative regulation” are not two words that usually go together, but we need to look at our workforce differently and how we apply policy.
How do you see the Washington State Board of Nursing’s role in ensuring safe nursing practice?
The Scope of Practice and the Safe Nursing Practice are areas that we are focusing on for the upcoming strategic plan for 2023–2025.
From a regulatory standpoint, it is important for the board to refine and clarify the Washington Nurse Practice Act. We are continuing to have data-driven approaches to understand high-risk practice areas and then working upstream to mitigate that risk.
What this means for nurses is helping to clarify inquiries about “Can I do this?” or “Does the law allow me to do this?” We have advisory opinions and interpretive statements that speak to what the laws say. Organizational policy will also determine how practice is defined in a specific setting. We want to be proactive in saying, “If you work in a particular area where we get a lot of questions and concerns, we want you to know in advance what the risks or safety concerns may be.”
For example, we get a lot of questions about cosmetic and elective procedures, about school nursing, and, during the pandemic, about COVID and about practice regulations. We recently received a great question from WSNA on patient abandonment in active shooter situations, and we are working to clarify the expectation in these situations.
As we develop interpretive statements or FAQs, we post written documentation on our practice website.
How do you see the board’s role in advancing diversity and health equity?
Diversity, equity, inclusion, and anti-racism are central principles in our work. We are building these into our strategic plan with visible and measurable deliverables and are looking at our key partnerships — Washington Center for Nursing, nursing education programs, WSNA, and many others — to discuss how we can advance diversity in the workforce and how we can prepare leaders and faculty to be better prepared to address these issues.
One example is a partnership with the Washington Center for Nursing on a critical gaps work group assessing diversity in Washington state. While we are making gains in racial and ethnic diversity, there is still more to do to have concordance and lived experiences similar to those of patients that nurses are caring for.
Other current work has examined health equity continuing education, and we have rules moving forward to put that in effect next year. We also have a pilot project on how to embrace a new framework for rulemaking to better incorporate marginalized and disadvantaged groups and ensure that we hear their voices in policymaking.
The board is involved in disciplining nurses who fail to meet its standards. Should nurses be afraid of the board?
The short answer is no; we do not want people to be afraid of the board. Our actual number of disciplinary cases is incredibly small. We receive a fair number of complaints, but that does not mean they are all opened or result in discipline. In 2022, we had about 2,000 complaints, but only opened about 6%, and even fewer resulted in actual discipline. We are working on making this aggregate data more transparent and expect to have statistics on our website soon.
We maintain a threshold for reckless behavior that exceeds state law and puts patients at risk — not nurses who make a mistake. As a nurse, I can say we have all been in a position where we have had a near miss or an error. No one is going to be harder on that nurse than the actual nurse.
While we do have a disciplinary arm, we are also studying how to support nurses through errors to keep them in the profession. We are also expanding our alternative to discipline program, Washington Health Professional Services, to provide financial support for nurses with substance use and to reduce the related stigma.
There are many concerns among nurses about issues such as safe staffing, workplace violence, and burnout. What is the board’s role, if any, in addressing these issues?
First, these are all huge issues. Certainly, this is a concern for me as a nurse and for the board. We need to be mindful of our jurisdiction, and many of these issues sit at the organizational or employment level.
While we can initiate legislation, we need to make sure it is in our jurisdiction and not stepping into the employer–employee environment. The real opportunity for us is to understand the workforce through research, data, and pilot programs. We want to know what new models of care are emerging that may be beneficial to all of us — for the public, for nurses, for organizations, and for policy, ultimately.
We are interested in how we can partner with WSNA and others to support burnout and resilience as shared goals, as these will dramatically impact our workforce for years to come. The board is offering a conference on Oct. 19 and 20 on health and well-being with national experts on these topics. (For more information, see https://nursing.wa.gov/about-us/events-and-trainings/health-and-well-being-conference ).
How do you see the board’s relationship with nursing organizations, such as WSNA?
One of the conversations I have heard frequently is, “Who speaks for nursing in Washington state?” When I need advocacy support, where do I go? When I need research support, where do I go? When I need policy support, where do I go? I don’t think there is any one group that owns that space, and the board, along with other organizations, is working to make it clearer for nurses on the multiple resources available to them and how the board, WSNA, and others support them.
Washington recently joined the Interstate Nurse Licensure Compact. Do you see this as a benefit for Washington?
Certainly, this is a hot topic. I think the compact does have the potential to benefit Washington. I recently saw some data that described, in general, the impact for states as they start the compact, and it is about a 2% egress of nurses leaving the state and a 3% ingress.
U.S. News and World Report also just named Washington the best state in the nation for nursing, so we might see some added interest related to our educational programs, salaries, and practice policies. We are also the first state on the West Coast to implement the compact, the 40th state overall.
Concerns about fraudulent educational programs and licensure is something we all need to have our eyes on. With the compact, we can partner with employers more closely to ensure that we are all protecting the public. The more eyes on the licensure criteria, the tighter the safety process.