Nursing Board Discipline: Know the Process

What Should Nurses Know to Protect Themselves?

It’s a big blow.

You pour out your life to nursing, only to receive a letter in the mail from your state’s U.S. Nursing Regulatory Body: You are under investigation. Someone has filed a complaint alleging that you have violated your state’s nurse practice act.

This can be frightening. If the board determines that you are at fault, you could face anything from mandatory remedial training to loss of license.

Hopefully you’ll never face this dreaded situation! But it’s wise to be prepared for the possibility. You need to know what to expect when you’re under investigation for your professional conduct.

The process involves four main stages:

1. Complaint
2. Investigation
3. Hearing
4. Decision

Let’s look at each stage in detail.

The Complaint

Who Can Complain?

The complaint could be filed by a patient or a patient’s family member. It could be filed by an employer or another medical professional, an organization, or a law enforcement agency. In short, any person who feels they have experienced or witnessed a violation of the nurse’s responsibilities may report it.

What Can You Be Accused of?

There are several types of cases someone might allege against a nurse, including:

Practice-Related – The nurse has committed a medical error. These may include incorrect assessment of a patient, error in drug administration, or incomplete documentation. This type of complaint can be filed whether or not the alleged error results in an adverse event.

Drug-Related – The nurse has knowingly misused controlled substances. These accusations may involve stealing or consuming medication intended for patients, falsely documenting that a medication was administered, or using personal prescriptions or other substances that cause impairment while caring for patients.

Abuse – The nurse has mistreated patients during care. This may involve hitting, making threats, or verbally abusing the patient. Any intentional behavior that harms patients physically or emotionally is considered abuse.

Fraud – The nurse has knowingly committed illegal or unethical actions for their own benefit.  Examples include lying to employers about credentials, modifying payroll records, or defrauding insurance companies.

Note that the state’s Board of Nursing does not have the authority to handle complaints regarding alleged rudeness or unprofessional attitude (unless there is evidence the nurse is acting in a discriminatory manner). These types of complaints are handled internally with the employer.

How Is a Complaint Filed?

The person who feels a nurse should be reported may complain to leadership in the organization. In this case, they may seek to resolve the problem internally.

But any organization or individual may file a complaint directly with their region’s nursing regulation body. There is no organization that regulates all nurses in the U.S.

The Investigation

Each region’s Board of Nursing has different investigation procedures, but general practices are likely to apply to every situation depending on the nature or severity of the complaint. Lippincott Nursing Center outlines some of the steps of an investigation.

Notification

A letter is sent to both the nurse and the complainant. The nurse will learn the nature of the complaint and find out how to contact the Board with questions, and the complainant will learn the next steps that will be taken. In most cases, the identity of the complainant will not be revealed to the nurse.

Gathering Data

After verifying that the nurse’s license is active and current in their region of practice, the Board may interview the nurse and complainant, talk to witnesses, or review records.

The sole goal of these proceedings is fact-finding. In many cases, the Board is bound by law to investigate complaints. They are not trying to prove what took place, but simply to gather data.

Next Steps

After reviewing the results, the Board may determine that the complaint is unfounded or is not serious enough to take action against the nurse. At that point, they’ll notify the nurse that the file has been closed without any action toward their license.

If they decide to take legal action, the next step is the hearing.

The Hearing

Here’s where a judge looks at all the information submitted by both parties. This paperwork could include evidence (for example, chart notes), witness statements, character references—anything that helps build the case.

A hearing will be scheduled, in which the nurse’s attorney and the plaintiff’s attorney go before the judge. They make their cases, and the judge makes a decision.

The Decision

Ideally, the ruling will be in the nurse’s favor: the judge dismisses the case and no disciplinary action is taken.

But if it is determined that the accusation was founded, the outcomes range from mild to severe:

• Reprimand—An official record of the event will be kept on file. Unless combined with other disciplinary measures, this will not affect the nurse’s ability to continue practicing.
• Mandated continuing education—this isn’t like CE credits nurses take to maintain their license. This is required education intended to inform and help the nurse with the hope it will prevent future incidents.
• Practice restrictions—The nurse may not be allowed to practice in specific areas related to the incident, at least temporarily. The nurse may also be given additional supervision or monitoring.
• Revocation—This is “an indefinite or permanent separation from practice”. The nurse, essentially, may no longer call themselves a nurse. However, the Board may determine the nurse may apply for relicensing after meeting certain requirements.

Fines, community service, probation, suspension, or other actions may also be taken.

Conclusion

Complaints can be filed against any nurse—and there’s no way to guarantee it won’t happen to you. We hope you’ll never experience this. But it’s good to be prepared, just in case.

Vickie Miracle, RN and editor for the Dimensions of Critical Care Nursing publication, “strongly encourage[s] every nurse to carry his or her own malpractice insurance”. She notes that while hospital insurance policies may provide some protection, “I tend to be very wary and I would rather bear the cost of my own policy” (Miracle, Vicki. “A Closing Word: What Every Nurse Should Know About Malpractice.” Dimensions of Critical Care Nursing, March/April 2004, Vol. 23, No.2, p.100. Professional Liability policies often provide an attorney and cover fees up to a certain amount for board actions.

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