Reading recent posts; Is it THAT easy to lose your job/license/get reported ?

Editorial Team / Admin · Jun 3, 2017

There is so much misinformation out there about losing a license. Many BONs will post an online update/newsletter, and it frequently will include actions taken against licenses. Sit down and read through that- you will see just what it is that causes most license sanctions.

The state of PA: http://www.dos.pa.gov/ProfessionalLicensing/VerifyaProfessional/DisciplinaryActions/Documents/2017/April%202017.pdf

-I read through the first 5 or so, all related to drugs/alcohol or crimes of moral turpitude.

The state of MI: http://www.michigan.gov/documents/lara/BPL_DAR_5_5_17_FINAL_572456_7.pdf

The state of IL: (starts at the bottom of page 14) http://www.idfpr.com/Forms/DISCPLN/2017_04enf.pdf

You get the idea.

Double-Helix, BSN, RN · Jun 3, 2017

First, let's be clear that those three things in your title (lose a job, lose a license, and get reported) are very different things.

The most difficult is losing your license. Rose_Queen provided supporting links, but in general you have to do something pretty egregious to have your license revoked. Drug-related incidents and crimes unrelated to work are the most common reasons.

Losing your job is another matter. Most states operate under at-willâ€ employment laws. That basically means that you or your employer may end your employment at any time, for any reason excluding those protected under civil rights legislation. Personality conflicts with the boss or senior staff can and do get nurses fired, even if they are clinically excellent. Privacy violations, unprofessional conduct, or publicly representing yourself in a way that reflects badly on your employer are fair game as well. Nurses let go because a mistake was made or a patient lodges a complaint and the employer wants to appear as though someone is being held responsible? Yep, it happens- not everywhere and not all the time, but it's out there. You can be fired for many, many things that will not cost you your license.

Finally, being reported. This is by far the easiest thing that could happen to a nurse. Anyone can report you to your supervisor or the BON for any reason- legitimate or not. It's the BON's job to determine whether the claims are substantiated. A co-worker set to sabotage you, an irate family member, a well-meaning colleague- all of them can name you in a complaint. It doesn't mean that every claim will be investigated or result in any disciplinary action, though.

The best thing you can do is carry your own personal malpractice/liability insurance. Look for a policy that will pay your lost wages in a wrongful termination suit, or legal fees/provide representation in the event you have to defend yourself in a lawsuit or investigation. In terms of your own practice- be thoughtful and diligent. Follow your state's Nurse Practice Act and your facility's policies and procedures. Document thoroughly. And mind what you say and who you say it around.

DahliaDaisy, RN · Jun 3, 2017

Thank you both VERY much ! There is so much responsibility and so much to learn, it is good to know that a patients family being upset that you didn't get them apple juice quickly enough will not be the end all be all, after all of this time, money and effort ! :)

~Mi Vida Loca~RN, ASN, RN · Jun 3, 2017

Also keep in mind you're not always getting the whole story here. You're getting the story based on the posters perception of the events. A lot of times there can be a lot of other factors left out.

AgentBeast, BSN, RN · Jun 3, 2017

Gross Negligence, and Substance Abuse. These are the things people get in trouble with State Boards of Nursing for.

kakamegamama · Jun 3, 2017

OP--I echo what the others have said. Document, document, document. Remember---if it's not documented, it didn't happen. Don't gossip---once words are said they can't be returned. Do your work and care for your patients. Treat others (especially CNA's) as you want to be treated. Follow standards and policies. If then something should happen, and you've document properly, and have followed policies/procedures and documented truthfully and accurately, you would be covered.

Ruby Vee, BSN · Jun 3, 2017

No, it's not that easy to lose your license. Most state Boards of Nursing publish the actions taken against licenses -- if you read through, you'll notice that most have to do with fraudulent charting (you reported that you gave your patient two oxycodone tablets, but you gave them one and diverted the other), narcotic diversion (see previous) or sexual assault on a patient. That's very rare, but evidently does happen. Simple mistakes don't cause you to lose your license, even egregious ones. If there is a clear pattern of egregious mistakes, maybe, but even the guy who went around euthanizing patients wasn't caught for YEARS, nor was the nurse who would cause codes so she could run to the rescue.

Losing your job is another matter. I personally have never seen anyone lose their job (except if they were on probation) until long after anyone who knew anything about the situation was convinced that they needed to be GONE already. There is usually a disciplinary process to go through, and a bad employee who knows the employee handbook can hang on for YEARS. The exception is a new employee who isn't fitting in to the workplace. I've seen a few of those over the years, but again the missteps were egregious. (Fist fight in the break room, deliberately insulting a world famous surgeon (how do I know you haven't been picking your nose on the elevator coming up here? Perhaps a tactful "Have you washed your hands?" Would have been a better choice) or bringing a gun to work and leaving it in a translucent tote bag in the nurse's station.). Common sense and a good attitude usually preclude being fired for some "minor" offense such as those.

You have to understand that you're only reading the poster's side of the story. There's always another side or two. And most posters will slant the story (whether consciously or not) to show themselves in the right and everyone else in the wrong.

tyvin, BSN, RN · Jun 3, 2017

I hear you well. All the posts so far; nice, but the real truth lies in between. My college experience was great and when a mistake happened it was the clinical instructor who got the blame as I was a student. After I went to my first job like a trusting soul thinking everyone was like me; do unto others... I got the shock of my life. It's not that bad. It all depends on where you work and who you are working with.

It is unfortunate that there seems to be more snitches and not enough lets talk together and resolve or teach me instead of trying to fry me. I don't know if they think they will gain more points with management or what...I do understand and it's frustrating.

Work like you are on camera all the time (you probably are), don't proceed with something you're unsure about, ask many questions. I took non-verbal body language when I was in college. It wasn't required but an incident in the ICU while I was in clinical that I observed drew me to that class. What an eye opener. Some theories say we use our non-verbal up to if not over 80% of the time when communicating with another person. Watch for those suttle I'm smiling at you but I will fry you ones. Your are experienced with the workd and you need to rely on that 6th sense that some people think doesn't exist...it does.

The family is where you really need to be careful as well. The less said, the better. There loved one is sick or dying and their perceptions are way off. They are looking for a reason why this is happening...don't make yourself a target but love them. Understanding is key.

kakamegamomma (I'm from Hawaii so what's with the name?)..anyway; momma has again said exactly the right thing. I know it seems a little paranoid but it is what it is. Especially the gossip...walk away, walk away. Don't ever gossip to another about something you've seen, go directly to your charge or DON. Write an incident report about it so that it's documented you told you charge or whoever...document, document. Patient documentation so important. I like to quote the patient's. I don't like charting by exception and wnl means we didn't look. Remember that every word you put down has the potential to end up in a court room with you answering why you wrote it.

I do wish you the best and maybe you'll fall in with a good place. I hear they are still here on planet earth. Hospice is my thing. Home health is good as well and don't believe anyone when they say the pay is lower. Find out what your state's union pay for new grads is and accept nothing less. We are killing ourselves with new grads accepting positions for half of what they should be paid. Of course this does not apply to the clinics and docs offices where the med techs are usually found. The pay is low no matter what anyway. You still need that year in med-surg or SNF. I include the SNFs because it's like med-surg on steroids...completely nuts; but you will learn

Enjoy your patients and know your co-workers. Never carry out an order that a co-worker or charge tells you to do without seeing the order yourself. If you don't know the dosage or drug...look it up right there. You should have a drug manual book with you on your person everyday when you go to work. If one order calls for over 2 pills/capsules for one dose, call pharmacy and ask why.

As for doctors, they are the greatest, but if you read on here you would think they are all devils. You get what you give with them (I've had two try to get me fired but I still love them). If you are going to call a doctor about a patient, have the chart in front of you, set of recent vitals, why you are calling and what you want. If it's at night, it might be a different doc, so be ready as if the doc knows nothing about the patient. The main thing is to know what you want from the doctor about the patient. I don't care if it's 03:00 and the charge says don't call...it's your patient; it's your call. I think you would actually be shocked how well some people can lie to try and cover their mistakes with no bother about throwing an innocent person under the bus...but let's hope that's becoming more rare than in the past.

Oh my, here I go with writing a book again...OK kiddo, good luck to you and don't worry; do what momma said and you will be fine. Know your state's nurse practice act and especially on the steps to delegate. :bookworm:

I would be remiss if I didn't tell you to learn your facilities/state's documentation requirements. Remember, the facilites are reliant on your documentaion to get paid.

caliotter3 · Jun 3, 2017

Gross Negligence, and Substance Abuse. These are the things people get in trouble with State Boards of Nursing for.

And not in that order.

Penelope_Pitstop, BSN, RN · Jun 4, 2017

In my state, just about every action on a license involves substance abuse - at least 9 out of 10, with a variety of legal issues making up the rest (once in a blue moon there is an example of negligence).

Based on what others have said here, I'm guessing that's most states as well.

DahliaDaisy, RN · Jun 4, 2017

Wow, this has been some really great and well thought out feedback ! I truly appreciate you all taking the time to write all of that out to help put my mind at ease. I have learned a lot that I'm sure will come in handy now and in the future. Cheers all, back to being excited :) .