Consultant contract with Horn credited with clearing RN backlog and speeding licensing

The Board of Registered Nursing heard a post-contract report May 28 on work performed under a Department of Consumer Affairs (DCA) contract with Horn LLP that, the presenter said, substantially reduced licensing backlogs and shortened processing times.

The DCA-funded project received $3,570,000 from the Health Care Access and Information (HCAI) workforce initiative; DCA used $2,350,000 of that to contract with Horn and allocated roughly $1,430,000 to reassign internal subject-matter staff, the report said. The contract ran from July 1, 2023, to Dec. 31, 2024, though Horn agents did not begin onsite work until Oct. 16, 2023, because of fingerprinting requirements, the report said.

Cindy Wolston, who presented the post-contract review, told the board the effort cleared a backlog tied to an influx of out-of-state endorsement applications in 2022 and yielded measurable speed improvements. “Horn was able to eliminate a backlog of 7,798 registered nurse applications,” Wolston said. She added, “As of 12/31/2024, the project resulted in the approval of 10,045 nurse licenses by Horn agents.”

The project also implemented a licensed-applicant “concierge service” intended to shorten review cycles by contacting applicants promptly when document or information deficiencies are found. Wolston said endorsement application processing fell from 174 calendar days to 52, and the overall average time from submission to approval dropped by about 122 days for endorsements; out‑of‑state exam applications processed by Horn were reduced from 77 to 19 calendar days for applicants whose schools had NCSBN Breeze school codes.

The project included development of an enterprise reporting and analytics system (ERAS) using Power BI; project staff said ERAS provides refreshed, on‑demand workload and queue metrics to supervisors and managers and will be used for caseload management and performance trending. The report said Horn established a quality‑assurance team during the contract and recommended a small, independent QA function inside BRN licensing, which DCA and BRN staff are studying for phased implementation given fiscal constraints.

Wolston said the Horn contract will come under budget and that approximately $1.2 million will revert to HCAI. Board members praised the partnership during discussion and asked about sustaining the changes; BRN staff said the concierge model had already been adopted prior to the contract’s end and that they are refining ERAS and piloting internal QA work.

Board members asked about whether the consultant fixes would be durable; Wolston said Horn did root‑cause analysis and partnered with BRN staff to create processes that could be continued after the contract expired. The presentation and questions were delivered as information only; no board action was taken on the report at the meeting.

The board and staff said they expect to report back on longer‑term metrics after continued implementation of the ERAS dashboard and the small QA effort.