Discussion, reflection, and chats about the challenges to improving healthcare safety and quality
CLAIRE: This is Claire and Giselle for Nursification.com. Welcome.
GISELLE: Yes, Welcome! We are so glad you joined us, and you joined us at the right time. This is our first discussion, and we are going to be talking about fake nurses and nurse imposters.
CLAIRE: We have been talking about this for a long time, Giselle.
GISELLE: Oh my gosh, we should introduce ourselves. Hi there! This is Nurse Giselle here, and with me, that’s Nurse Claire. Now, we are both retired…
CLAIRE: Speak for yourself, I’m running out of funds, I might go back.
GISELLE: Yeah, I have thought about it too.
CLAIRE: Well until we do, until we go through all that work to have an active license, I’m not sure we can call ourselves nurses.
GISELLE: What do you mean? Nursing is part of my identity! Of course I’m a nurse.
CLAIRE: No, I mean, you can’t present yourself as a nurse if you aren’t legally allowed to nurse. That is the line between a nurse and a fake nurse… having a license, permit, or other regulatory requirement to practice nursing.
GISELLE: Of course I am allowed to nurse! I just have to register with the nursing board, and go through that process. The thing is, I moved since I retired, so I would have to be licensed here, in a completely different kind of jurisdiction in another country. So that would take some time… in fact, if it wasn’t for that, I would have really considered coming back to nursing over the past year.
CLAIRE: So the nurse identity, I mean, yes, it is a major aspect of the lives of nurses. Actually working as a nurse, however, requires more than a nurse identity. It is a rigorously regulated profession. There is quite a bit of red tape involved.
GISELLE: Red tape, but really it is designed to prevent fake nurses from providing poor quality care, or even causing harm to a patient. There are a lot of checks and things in place, so a person could think that nurse imposters are not really a common phenomenon.
CLAIRE: Actually, in 2003 the Arizona State Board of Nursing Newsletter discussed the problem of nurse impersonation at length. The board reported that, in the first half of 2003, five cases were identified. Yeah. And four of these nurse impersonators working in direct patient care.
GISELLE: So what happened, in the cases, then?
CLAIRE: Well, you know, in some cases it was straight up fraud. In other cases, it is kind of more technical and complicated.
GISELLE: Alright, give me one that is clear-cut.
CLAIRE: Ok, one of them, Gail S., claimed to have a bachelor and master’s degrees in nursing, and used RN after her name. So, she was working in a quality management advanced nursing position in Phoenix, and management asked for a copy of Gail’s RN license to put on her file. But. Oh no. What she did was she used the RN license, like a paper copy, of a nurse who sent in a resume, and just made some adjustments to it.
GISELLE: Well you said this was like 2003, so, what happened then?
CLAIRE: They tried to verify it, and found out that it belonged to a completely different nurse.
GISELLE: Well that is straight up fraud.
CLAIRE: So the next one, Carla M., she started as a behavioral health technician and was promoted to LPN.
GISELLE: Promoted to LPN?
CLAIRE: PROMOTED to LPN, yes.
GISELLE: Was she a nurse?
CLAIRE: No. Well, it doesn’t appear so. After working as a year at a hospital as an LPN, Carla M. then went to a long-term care home as an LPN. The Director there asked to see the license.
GISELLE: But she couldn’t show the license.
CLAIRE: Exactly, she said that she was being reviewed by the board, because of some issue with her roommate. So the Director called the board, and found out that Carla didn’t have an LPN license, at least not in Arizona.
GISELLE: So this Carla, did she straight up lie?
CLAIRE: Well, I mean it would seem that she lied about her status. It isn’t clear whether she had a compact license for another state-
GISELLE: Yeah, but she said the Arizona state board of nursing, right?
CLAIRE: Well, that is what the newsletter says, yeah. So, then there was Nancy V. She did have a current RN license from Wisconsin.
GISELLE: Right, but Nancy was in Arizona, right?
CLAIRE: Sure, but it is a nurse license compact state, like a multi-state license, so her license was good there.
GISELLE: So what was the problem?
CLAIRE: Nancy’s RN license from Arizona had been revoked in May 1997. In August 2002, Nancy requested reinstatement of her Arizona license but the Board denied the request in January 2003.
GISELLE: So she asked, and she was turned down.
CLAIRE: Right. But by the nursing board in Arizona. She was actually licensed elsewhere.
GISELLE: So she was working as a nurse.
CLAIRE: She was. Nancy was hired by the local office of a national traveling nurse agency in March 2003, and began her employment as a traveler RN at a Mesa hospital, using her Wisconsin license.
GISELLE: So how was she caught? Or, what exactly was she caught doing?
CLAIRE: An RN at the Mesa hospital reported Nancy to ASBN when the RN read in the ASBN newsletter that the Board in Arizona had denied reinstatement of Nancy’s RN license. The reporting RN was told that a RN or LPN, who has been denied the privilege of a RN or LPN license in Arizona, cannot practice nursing in Arizona with a multistate license from another compact state.
GISELLE: So, Nancy was a licensed nurse, and she had a compact license that would usually include Arizona, but she was specifically denied a license in Arizona.
GISELLE: So all she had to do was not practice in Arizona? Makes you wonder what was different about the nursing board that approved her license.
CLAIRE: Something like that. So things get even more complicated with Gayle M. The board reported that she had an RN license from Texas, and she was practicing in Arizona.
GISELLE: So, was she denied a license in Arizona too, or what happened to her?
CLAIRE: Well, her primary residence was in Louisiana.
GISELLE: But she was practicing under a Texas license?
CLAIRE: Yes, and she worked for a travel nurse agency as a RN at a Tucson hospital in Arizona, part of the Texas compact agreement.
GISELLE: She wasn’t trying to hide anything?
CLAIRE: She said that she was told by the agency that she could work on her Texas license.
GISELLE: So what was the problem?
CLAIRE: The Texas compact state aspect of the license was only valid if she lived in Texas.
GISELLE: And she lived in Louisiana?
CLAIRE: Yes, she was living in Louisiana, well her primary residence.
GISELLE: If she was working in Tucson, she was probably actually living in Arizona, or?
CLAIRE: I am guessing that it isn’t about where she was residing, more where her primary residence was, where she paid taxes, that sort of thing.
GISELLE: But the agency had told her everything was ok.
CLAIRE: Well, it gets worse, it was the agency who reported Gayle to ASBN for working in Arizona without a current Arizona or Texas multistate license.
GISELLE: So she was qualified, had no issues of incompetency or breach of ethics, but her home ownership cost her the RN license. Wow.
CLAIRE: So the last one that is mentioned by the Arizona state board is Andrew K. He was a temp who presented himself as a licensed practical nurse. So, he was assigned to a long-term care facility, where he had responsibility for patient medication, including narcotics. After refusing to show his LPN license, an investigation found that he was not licensed, and did not have the requisite education to register as an LPN.
GISELLE: So, here is the thing. A board of nursing only has jurisdiction over its members. So, if you don’t register with them, or have a license with them, they don’t actually have any control over you. So, a board can really mess up the life of someone like Gayle who didn’t think they were doing anything wrong, but they have little authority over a real fake nurse.
CLAIRE: A real fake nurse, yeah. Basically all they can do is a cease and desist order. And in these cases we just talked about, all they could say was basically “stop it! Stop it right now!”
GISELLE: Well they still violated a law, didn’t they?
CLAIRE: Well, I mean the Nurse Practice Act, but consider how dangerous it is for patient safety if you have unqualified, unlicensed, unregistered people delivering healthcare. You would think it would be more.
GISELLE: I mean, this is very interesting, but these aren’t recent cases. I guess I would think that there are so many checks now, professional HR, that sort of thing, so…
CLAIRE: A lot of the cases were cases where documents were falsified to support falsely presented credentials.
GISELLE: Sure, but some of them were really because of technical issues, like the Texas multi-state compact requiring a primary residence- where did she have to live, for a valid licence?
CLAIRE: Well, I would guess Texas, but we know she couldn’t live in Louisiana.
GISELLE: I am kind of stuck on that point. How did she live in Louisiana and work in Arizona?
CLAIRE: She was a, a travel nurse.
GISELLE: So, I don’t even get it.
CLAIRE: Maybe she lived close to the Texas border, in Louisiana, worked in Texas so when she was travel nursing she was still living in Louisiana, but she was doing a contract in Arizona.
GISELLE: Definitely it seems like it is going to be more cases like that, where people reside in one place, work in another. I am thinking about telework and things like that
CLAIRE: Sure, yeah.
GISELLE: But then I am thinking, when a temp nurses comes from overseas, like their primary residence isn’t considered their home country, it is wherever they are staying.
CLAIRE: Residence is where you pay your state taxes… it is actually a complicated area of law, or complicated for me, anyway. Multi-state compacts are great, but when there are two many Exceptions and exemptions and things like that, it is unwieldy.
GISELLE: Yeah. Good word for it, unwieldy. Still, I am wondering about more recent cases. They seem to come up more and more in the news.
Recent nurse imposter cases in the news
CLAIRE: Sure, okay. In February 2018, Samantha Rivera, age 36, was charged with fraud. So, Samantha worked as a temporary placement in the ICU at a St. Louis hospital, and taught at a school of nursing in New Mexico. Rivera was not a nurse. She just brazenly used the license of a legit nurse with a similar name from New Mexico, and then she used that in Missouri. It was also alleged that Rivera had a trust fund income, and that she did not even need to work.
GISELLE: Misty Dawn Bacon was employed by eight different facilities in Tennessee over just a six year period. Ms. Bacon used the online verification system in Tennessee to determine the license number of nurses with similar names.
CLAIRE: Well that is kind of ironic, it is supposed to support security.
GISELLE: So Bacon, she worked in nursing homes, the clinic of a private physician, and as a home health nurse. In 2003, Bacon was convicted of embezzlement, which would have not only been revealed by a background check, it also prevented Bacon from pursuing a career in nursing.
CLAIRE: The news reported that court records stated that she made false entries in patients’ medical records and submitted false claims, to both public and private health care benefit programs.
GISELLE: But she wasn’t actually a nurse, but she was a real nurse imposter.
CLAIRE: Yes, and in this case there were criminal charges for the claims reimbursement fraud, rather than compliance with board of nursing requirements.
GISELLE: And again, as a real imposter, the board of nursing doesn’t have power over her, because she is not a nurse. The board only has power over actual nurses.
CLAIRE: Right. According to the plea agreement, at least one patient required re-admittance and a three-day hospital stay due to Bacon’s incompetence. Two of her employers voluntarily repaid health care benefit programs more than $500,000 for claims submitted upon learning of Bacon’s impostor status.
GISELLE: So what kind of sentence did she get?
CLAIRE: Well, Bacon pleaded guilty in federal court last year to wire fraud, health care fraud and identity theft, and she was sentenced to just 51 months.
GISELLE: That just makes me mad. Okay, tell me about another one.
CLAIRE: So, in 2016, it was reported that Laura Erskine, a nurse for two years in a long-term care homes in small-town Ontario, in Canada, had committed fraud. Erskine had forged her letter of registration with the College of Nurses of Ontario.
GISELLE: Ok, wait. Are you saying that she really was qualified to be a nurse? And then what did she do, she forged the letter because she just never registered?
CLAIRE: Yes, exactly. The case is perplexing. Erskine completed a nursing program at an Ontario college, and graduated. There were no reported issues with her work performance.
GISELLE: I don’t understand. This story is not clear, and I think we can guess there is some other issue here. I mean, why she go to the trouble to forge the letter, when she could have just registered?
CLAIRE: Well, hold on, I mean, it could be related to the criteria for registration.
GISELLE: So who had the jurisdiction there, then?
CLAIRE: The College of Nurses of Ontario.
GISELLE: OK, hold on, hold on, I’m going to look them up.
CLAIRE: What, you are going to look them up on your phone?
GISELLE: Yeah, this doesn’t even make any sense to me, so I just need to understand this.
CLAIRE: What does it say?
GISELLE: Ok, so I just did a search for “College of Nurses of Ontario registration requirements”, and that took me, it took me to a site at cno.org. Cee Enn Oh dot org. So what I found there…
CLAIRE: Yeah, so what did you find there?
GISELLE: OK, what it says is, it says there are eight requirements.
CLAIRE: What are these eight requirements?
GISELLE: Well the first one, it is real simple, you have to complete the education for the specific nursing role that you are taking on, so that can get complicated, right, but let’s just make it simple. You have to go to nursing school, that is first, and she did that.
CLAIRE: I’m just reading over your shoulder here, so the next one is evidence of practice, so that means that if you were in a nursing program, and you recently graduated, you would have met this requirement as part of the program.
GISELLE: Or, say, if you are already working as a nurse. I would say that this is a bit unclear though, like imagine that retire, but after five years of living on the beach, or whatever, you want to go back to work. So maybe that person would have to go back to nursing school?
CLAIRE: Does it say?
GISELLE: Well, I mean maybe we can research this a bit more for another talk, but no, it doesn’t really address that. Like, if you were practicing as a nurse in another place, I thing that would still count. Ok, so there is more, so the third one.
CLAIRE: What’s the third one?
GISELLE: So, there is a registration examination for different roles or titles, I guess it would be, and you have to pass the exam for that role.
CLAIRE: OK, that seems obvious.
GISELLE: So the fourth one is kind of similar, you must complete the RN/RPN Jurisprudence Examination.
CLAIRE: So what’s that?
GISELLE: Basically a test of the regulations and laws, and how they are applied in nursing. Kind of, you know, to prove that you have sufficient knowledge about what you are allowed, or not allowed to do so that you aren’t going to cause a breach.
CLAIRE: You start to wonder if it could have been a problem like exam anxiety, or something like that, that led her to not register.
GISELLE: Well the fifth one, it says proficiency in English or French. So, we can make assumptions, but maybe language was a problem, like, I know that now even Jamaicans have to take a test to prove they can speak English for the provincial visas, so maybe this is something where there was a problem for Miss Laura.
CLAIRE: The sixth one is authorization to work.
GISELLE: Well, this could be it too. So it is possible that Laura Erskine came from overseas as a nursing student, and maybe she did not have authorization to work in Ontario.
CLAIRE: It doesn’t seem like this is the case, though.
GISELLE: Doesn’t say it wasn’t, either. So another requirement is you have to say if you have ever been found in violation of nursing regulations, or refused registration, or involved in professional proceedings about an offence in a different profession…
CLAIRE: So that keeps a person from being able to register:
GISELLE: Well no, the board would assess the situation, and make a determination.
CLAIRE: But that could be it. Maybe she had something in her past, and she was just scared to make the application?
GISELLE: Well, that could be, but it was still a violation because you have to be registered as a nurse to practice in that jurisdiction, um, Ontario.
CLAIRE: Right. Good point.
GISELLE: Last one. There is a health and conduct requirement. So, it just has to be declared, so they mean any physical or mental condition that could impair nursing practice, but also they talk about honesty and the character type stuff, so maybe this would also refer to some kind of criminal past or association.
CLAIRE: So this is really very similar to either licensure or registration in many other jurisdictions in say, I don’t know, Europe, or other places in North America.
GISELLE: In January 2020, in Jonquière, Canada, it came to light that Nathalie Bélanger, age 50, had worked for two decades by using the license of another nurse with the same name. She was discovered when it was noticed that her birth date and place of work did not match that on the record. It became clear that two different people were using the same license number. The regional health authority noted it because of the mismatch in details when the woman tried to sign up for training.
CLAIRE: Basically, there was a similar story, about a fake nurse, June Weatherman, in the UK.
Historical and healthcare contexts
GISELLE: Fake nurses are not a new phenomenon, however digital registries today may make it easier to catch those who are fraudulently obtaining employment in the nursing profession.
CLAIRE: Oh sure, I mean a good example today is Julia Lyons. As a nurse in Chicago during the 1918 flu pandemic, she not only falsely obtained a position as a nurse, but also then used her positions as a nurse to rob her patients.
CLAIRE: It isn’t just nurses you know. I mean, doctors, psychologists, occupational therapists, pharmacists…
GISELLE: Oh yeah, but you can’t spend all day asking every colleague in healthcare-
CLAIRE: As a patient, I think you can ask them, but it wouldn’t help identify a fake.
GISELLE: I read a news article from Spanish Town, that’s in Jamaica. I think it was in, um, late 2020, so right in the middle of the pandemic. The one hospital, they needed a doctor, and this doctor showed up. He started treating patients, and it was the nurses who got together… they were like, “this guy nuh mek no sense”, and yeah, turned out he was not a real doctor or licensed healthcare professional of any kind.
CLAIRE: So nurse vigilance can help.
GISELLE: Well yeah, but I am not saying you should be suspicious of everyone, just notice when someone’s practice seems, um, off, if that makes sense.
CLAIRE: Well yeah, I mean what kind of environment is it for collaboration without trust… you know? We have enough problems, on creating that team environment in healthcare. This kind of vigilance can really contribute to a, well, negative atmosphere.
GISELLE: So, something else I wanted to bring up was, the uh, the fake diplomas.
CLAIRE: So what is a fake diploma, exactly?
GISELLE: Like, you just buy a nursing diploma, and then you go and get a job as a nurse.
CLAIRE: You can’t do that.
GISELLE: Maybe you can’t put “I wanna buy a nursing diploma” into Google, but
CLAIRE: Hold on, let me check eBay and Amazon. Now I am curious.
GISELLE: I don’t think it works like that.
GISELLE: What did you find?
CLAIRE: There are other people’s diplomas for sale, like really old ones.
GISELLE: Well these are like seventy, eighty, ninety years old. It isn’t like you can just change the date and name or try to use them. Just beautiful heritage pieces. I really like them.
CLAIRE: Look- it’s a Barbie nursing diploma!
GISELLE: Oh look at that, down, right there. Barbie nurse outfit. And by wearing those clothes, and carrying her Mattel diploma, Barbie transforms into a nurse.
CLAIRE: Wait, here is an actual fake diploma for sale, Doctor of Nursing from Florence Nightingale University, just $12.50 and shipped from Minnesota.
Posted for sale on Ebay 06/2021
GISELLE: There is no such place. The Florence Nightingale School of Nursing is at King’s College in London England. This is just fake fake. Like, no employer would fall for that.
CLAIRE: Someone desperate to hire a private nurse might.
GISELLE: Well that is a good point. Anyway, the think is, maybe there isn’t a thriving market in fake diplomas on eBay, but in places like Bosnia, it has been a big problem.
CLAIRE: Where is Bosnia, again?
GISELLE: Um…. Eastern Europe?
CLAIRE: There are other cases, I guess like Laura’s, or maybe not like Laura Erskine’s case, who knows. What they have in common is that all of those found guilty of fraud did in fact complete the nursing school requirement.
GISELLE: There it is right there, the nursing school, the education requirement, it is just one requirement. It takes more. So what happened there?
CLAIRE: Well, ok. So there was this case reported in Ghana, in March 2021. Uh, so those charged with impersonation, and with credentials and license revocation were Abigail Bobin, who was a Midwife, Esther Abuubey, who was a Trainee Midwife, and Stephany Arthur Baidoo, who was a Nurse Assistant. In these cases in Ghana, all three had completed their training.
GISELLE: And unlike Miss Laura, they completed their appropriate registrations.
CLAIRE: Well yeah. That is true.
GISELLE: So what was the problem then?
CLAIRE: Well, the problem is that they entered nursing school based on forged secondary school completion documents.
GISELLE: So the fraud was in getting into nursing school.
CLAIRE: Yeah, exactly. So, they have their, I guess what in North America we call high school or secondary school diploma. So, in Ghana they have what is known as the West African Senior Secondary Certificate Examination (WASSCE). Each of these three lost their credentials, their ability to practice, their jobs, and it was because they forged the documents to get in to nursing school.
GISELLE: Well I mean, the nursing education, that is just one requirement. The thing is, if you do one thing wrong, it can affect your professional career forever. Not just nursing license, I mean it is true in any regulated or monitored profession. I am thinking teachers, social workers, lawyers, a lot of careers, you know, depend on your character and conduct.
CLAIRE: I guess I hadn’t thought of it that way. For me it was the evil nurse stereotype, you know, the Nurse Ratchet type of persona. I was more really focused on the um, well like the education and exam components. It isn’t that I want nurses of bad, um, what can you call it, character, I don’t want them involved in direct patient care. But then, who decides on what bad or good character is, because that can get mixed up with other issues. Racism, classism, this would all matter a lot in terms of who passes the character test.
GISELLE: It is definitely a problem. Yeah, how you are born, how you grow up, this can matter a lot. If you are from the wrong background, especially in some overseas countries, you might never get that chance to go to a nursing school. Like, the stated requirements will state no divorced women, or no unmarried mothers.
CLAIRE: Where is that?
GISELLE: Well now I don’t want to say where I thought it was, because I am not sure that I am right.
CLAIRE: You have Google, look it up.
GISELLE: Well, I just looked up nursing school requirements in the Philippines, where they have height and weight requirements, moral character requirements, letters of recommendation required from principals, teachers… I think the thing is, this moral character is poorly defined, you know? So a group that is discriminated against, well a member of that group can be considered of poor moral character just because of ancestry or cultural background.
CLAIRE: Well there it is. For sure, discrimination against a group or an individual does interfere with access to education, but there are other factors too. You can see how for someone that has a challenging path to licensed nursing, there might be more pressure to lie, falsify, or commit fraud.
GISELLE: Well, yeah, I mean a lot of the cases we were just talking about, they had some kind of training or education, but they didn’t necessarily have the right education, or meet the criteria to practice as the kind of nurse that they were practicing as. I don’t think that can be justified, even in cases where they had challenges to being licensed. Sometimes those challenges are there for good reason, to keep the standards of nursing high.
CLAIRE: There is also those who are just manipulating a strained system. There is this pressure because of the nursing shortage, and then some individuals, well they take advantage.
GISELLE: Those criteria, the criteria other than the education, that can be important to. I mean, one infraction, and you have to report that to the end of your days.
CLAIRE: Well, it is also a lot of work. I mean, I really have considered coming out of retirement, but I don’t really know how the nursing system and culture works here, and it has been four years, so I would have to take a retraining course to get my clinical hours… it just seems like a lot, so I am just staying retired. For now.
GISELLE: Well, speaking of going back to school, there is more fraud to watch out for. There was a case in the New York City area of a fake nursing school recently. This school, now it was targeting Caribbean immigrants, charging thousands in tuition… and these folks went to school for one or two years, and had a graduation ceremony, and it was not until they try to get a license they find out it was from a phony school.
CLAIRE: That is terrible! How could a school just set up like that?
GISELLE: It was a network of several schools, actually. There was an accredited school in the Caribbean involved, as well. Specifically, the schools were the Envision Review Center, run by Salvatrice Gaston and Carline D’Haiti, the Helping Angels Foundation of America and Floral Park, run by Robinson Akenami, and Hope-VTEC run by Jocelyn Allrich.
CLAIRE: Well, we only really touched the surface when it comes to fraud in nursing and healthcare.
GISELLE: Think about those nurses in Kerala, in the south of India. These nurses were scammed by fake UAE jobs, I mean, they paid a recruitment fee, and then flew to another country, and then they were just broke, unemployed, and stranded in a foreign country.
CLAIRE: I heard that another company in the UAE decided to hire them.
GISELLE: I think we don’t always hear about this kind of thing. People are embarrassed to be taken advantage of, you know?
CLAIRE: We didn’t even touch on the fraud, the falsification of billing and invoices, and corporate fraud in healthcare
GISELLE: All of these things work against the goals of nursing, to develop that healthy system that supports healthy people.
CLAIRE: Well, it is time to wrap it up. As you were saying, the opportunistic exploitation of nursing by those without the appropriate qualifications, this is a terrible barrier to patient safety and quality care.
GISELLE: It has the potential to harm patients, reduce quality of care, and impair patient safety.
CLAIRE: It undermines the entire profession.
GISELLE: And it is happening, it is happening now.
Claire: Well thanks for listening, be sure to tune in for our next discussion, we will be talking about the nursing shortage.
Giselle: You don’t want to miss that.
Claire: You can leave a comment on the Nursification.com Facebook page, and tell us what you think, what you want to add to the discussion on fake nurses and other fraud.
Giselle: Don’t forget to check out the articles at Nursification.com. You can also subscribe to the newsletter which will tell you about every new podcast, or just follow us on Facebook.
Claire: See you next time, let’s talk more about the issues and problems, understand them better, and start to fix them.