Cynicism at the WA Nursing Commission

A registered nurse asked me to perform an independent psychiatric evaluation related to the Washington Nursing Commission’s investigation of her fitness for her nursing duties in a hospital, but the protocol contains much that I believe unethical for any psychiatrist to pretend to address. Medical ethics demands that psychiatrists acting in a forensic capacity limit their opinions to what we are capable of assessing. (Bolded text indicates items beyond the scope of a psychiatric evaluation.)


I. The scope and content of a mental/physical health evaluation must include consideration of the following when rendering your professional opinion regarding Respondent's ability to practice as a registered nurse reasonable skill and safety.

A. A complete history of Respondent, including physical, mental, social, developmental, medical, psychiatric, or psychological factors. Review of Respondent's medical records, including physical and mental health records. Review of Respondent's medication history, especially use of mind-altering and/or psychotropic medications.

B. Appropriate and sufficient evaluation and testing to fully assess Respondent's physical and mental condition, including but not limited to:

1. Cognitive ability: Practicing as a registered nurse requires the ability to analyze and synthesize complex scientific, clinical, diagnostic, quantitative, and qualitative data quickly and accurately. Evaluation should include Respondent's critical thinking skills, judgment and problem-solving ability, decision-making, prioritization, and organizational skills;

2. Mental acuity, alertness, memory: Ability to be present and aware; to observe and rapidly assess a situation and develop a reasonable plan of action; divided attention skills. Ability to retain and recall essential and pertinent information;

3. Communication and Comprehension: Ability to comprehend and communicate effectively, both verbally and in writing, including auditory comprehension and listening skills;

4. Ethics and moral character: Truthfulness, compassion, empathy, selflessness, ability to maintain professional boundaries;

5. Stress and management: Ability to manage stress and anger effectively;

6. Physical ability: Physical strength and stamina, manual dexterity, mechanical ability; and

7. Special conditions to evaluate: Whether Ms. Nurse is able to control impulsive behavior; whether she is able to discern and properly respond to the needs of others; whether she is willing to respect boundaries and follow rules; and whether she is able to comprehend and follow physician orders, particularly orders for the administration of medication to treat physical and mental illnesses.

C. Review and evaluation of other physical and/or mental, psychiatric, psychological examinations deemed necessary by the evaluator.

D. Review and comment on the material supplied by the Department of Health upon which the Commission bases its belief that an evaluation of Respondent is appropriate.

E. Review of any other physical, mental, psychiatric, psychological, sociological, or other relevant information provided by Respondent.

F. Report should include a full and detailed discussion of the following:

1. 2. 3. 4. and 5. Professional opinion regarding Respondent's ability to practice registered nurse with reasonable skill and safety.

Psychiatric and other medical problems demand separate protocols. Attempting to merge the two serves no legitimate purpose.

Although psychiatrists routinely assess impairment of memory or judgement, I have seen no published standard psychiatric evaluation protocol that includes skills assessment or determination of “ethics and moral character.” What moral code should the examiner apply? The commission would do better to ask a Rabbi, Imam or Priest to perform this part of the evaluation.

Sloppy writing leads to ambiguity: Physical... information? Mental... information? What are “divided attention skills?” “auditory comprehension?” Many of these items seem to reflect ignorance.

The cynical bureaucrats who created this protocol care not about the professional ethics of those they retain to perform such evaluations. They will ask for whatever they believe an unprincipled psychiatrist will provide them for a fee, and they know they can find psychiatrists who will make believe and stoop to the task. I can only imagine the rationalizations of those who would so prostitute themselves.

The Nursing Commission has failed to respond to my requests for the identities of those who created this protocol. After I indicated I could not agree to address all the items listed above, the Assistant Attorney General for the Commission suggested two other psychiatrists. I can only hope they too will refuse. Ultimately I can obtain public documents in the case in the hope that I can expose any ethical misconduct on the part of a colleague. Only when we all refuse to play along will we force the government hacks to competently perform their duties.

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