In response to recent allegations against Charles Cullen, a registered nurse in New Jersey who confessed to killing as many as 40 patients during a 16-year career, U.S. Sens. Jon S. Corzine and Frank Lautenberg, both Democrats from New Jersey, have called for a national tracking system for nurses.

Corzine and Lautenberg want the Health Resources and Services Administration (HRSA) to use the power Congress gave it in 1987 to expand the National Practitioner Data Bank to include all disciplinary and licensing actions taken against healthcare workers involved in direct patient care.

Although current law requires state nurse licensing boards to report disciplinary and licensing actions to the data bank, HRSA has yet to implement this requirement. The senators urged HRSA to take immediate action to ensure the full implementation of current reporting mandates. The senators noted that although the provisions might not have caught Cullen, the availability of this information might have stopped hospitals from employing him.

"While we know that nurses are the frontline of caregiving and our patients' best advocates, this tragedy should remind us that our healthcare system has faults," says Ann Twomey, president of Health Professionals and Allied Employees in New Jersey and an AFT vice president. "Perhaps no one solution could ever address the events in this tragedy, but we can take this time to fix a system that is increasingly distant and cut off from our patients."

Cullen worked at 10 different healthcare facilities in New Jersey and Pennsylvania. During his career, he was investigated by three hospitals, a nursing home and two prosecutors for causing the deaths of patients. Five hospitals and one nursing home terminated him for suspected wrongdoing. After each firing, Cullen was able find employment at another healthcare facility.

"What is most disturbing in this case is not just the missed reference checks, but rather the apparent failure of a single hospital manager to thoroughly investigate, report or put a stop to the suspicious and criminal activity occurring while this nurse was under [the manager's] supervision," Twomey says.

In the process of improving oversight of nurses' employment history, a nurse's right to privacy and the right to defend oneself also must be protected, Twomey points out. Nurses who report unsafe practices or suspicious activity must be protected from recrimination, and should be included in fixing the problem--by participating in review teams for medical errors, near misses, suspicious activity or poor nursing practices, for instance.

"We have witnessed too many examples of nurses being fired for whistle-blowing or organizing a union," notes Twomey. "While we fix what went wrong, let's also strengthen what works. In the fight to keep our patients safe from harm, nurses are the frontline. Let's listen to what they say."