Is My Nursing License At Risk?

Many nurses express the fear of losing their hard-earned licenses. However, I suspect that much of this fear might be overrated. I have decided to share four stories of former coworkers who have had their licenses permanently revoked. You will notice that three of the stories involve addiction, impairment, or theft of narcotics. Nurses Professionalism Article

I often listen as certain coworkers, usually the nurses with zero to two years of experience, chime about the dangers to their hard-earned nursing licenses. "I'm putting my license on the line by dealing with that difficult patient!" "I forgot to give a vitamin B12 shot yesterday, so is my license at risk?" "The staffing at this facility is so bad that I think I'm going to lose my license if I continue working here!"

Personally, four of my former coworkers have had their nursing licensure revoked in recent years. To give newer nurses an idea of the various offenses that frequently lead to revocation of one's nursing license, I will share the stories of these four nurses.

NOTE: Some readers might be concerned about privacy issues. To respect the privacy of these four individuals, I used pseudonyms to obscure their real names and will be purposely vague about the details that lead to action being taken against their licenses.

However, keep in mind that their real names, license numbers, last known addresses, last known workplaces, educational backgrounds, and exact circumstances that lead to loss of licensure all appear on the board of nursing's (BON) website of the state where I reside since all of this is public information.

Story Number One - Samantha

Samantha, a registered nurse in her mid-thirties, had approximately three years of experience as an ER nurse at a popular acute care hospital when she accepted a job at the local nursing home where I was working at the time. Her employment with the hospital had been terminated because she had been caught stealing hydrocodone, tramadol, and other medications from the Pyxis. In addition, her urine tested positive for these drugs.

The unit manager at the hospital referred her license number to the state BON, and after an investigation was completed, Samantha was placed on a peer assistance program for impaired nurses. Other local hospitals did not want to deal with the restrictions surrounding her peer assistance order, so she took a job at the nursing home where she was not allowed to handle controlled substances or hold the key to the narcotic box. Her license was revoked one year later after she repeatedly tested positive for hydrocodone and failed to satisfactorily complete the peer assistance program.

Story Number Two - Leanne

Leanne, a registered nurse, was the director of nursing (DON) at a nursing home where I once worked. After an extremely dismal state survey that resulted in multiple immediate jeopardy citations, she was escorted out of the facility by federal surveyors. Her license number was referred to the state board of nursing for falsifying documents, fabricating information, and failing to care plan serious issues. Her license was revoked by default because she failed to appear to the BON hearing where the formal charges filed against her would have been discussed if she had been present.

Story Number Three - Melissa

Melissa, a licensed vocational nurse in her late twenties, tested positive for prescription narcotics. She was employed on the busy rehab unit of a local nursing home, and management noticed that her behavior became increasingly bizarre over her three years of working there. Soon after the assistant director of nursing referred Melissa's license number to the BON, she ended up at a local psychiatric hospital after having attempted suicide. Her license was revoked by default because she failed to appear to the BON hearing where her case would have been discussed if she had been present.

Story Number Four - Betsy

Betsy, a licensed vocational nurse in her late twenties, was caught diverting massive amounts of hydrocodone and alprazolam (Xanax) from the nursing home where she worked. The pharmacy calculated that she diverted almost $10,000 worth of prescription drugs over a 12-month period. Her license number was referred to the state BON for diversion and defrauding the facility and patients of the cost of the medications. Her license was revoked by default because she failed to appear to the BON hearing where her case was to be discussed if she had shown up.

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Specializes in Public Health, L&D, NICU.

What the young nurses should be worried about is the status of their personal . You are much more likely to be sued for something that stems from a med error or understaffing than you are to have your license revoked. The BON doesn't worry me too much (not dealing or diverting! :sarcastic:) but trial attorneys worry me plenty. In our state the bar is set pretty high for even getting a med mal case into court, but who wants to deal with any part of a lawsuit, even if it's eventually dismissed?

monkeybug said what I was just thinking. My malpractice policy exclusions include: Injury that a reasonable person would expect, along with criminal acts. As nurses we are held to the "reasonable nurse" standard. So my understanding is that if I am determined to be responsible for my patient's injury because of my breach of the Standards of Care, then my malpractice policy exclusions are invoked. I am familiar with the Nurse Practice Act, standards of practice, HIPAA, Nurse's Code of Ethics, Patient's Bill of Rights, and more, including risk management information for practicing nurses provided by my malpractice insurer. All of this is a lot of reading. The difficulty as I see it is that employers sometimes make it very difficult for nurses to practice safely and to fulfill their legal requirements, eg. as monkeybug mentioned, understaffing. A personal example is lack of support staff to assist with a family member with acute diarrhea (yes, as family I was very glad to help, but no further staff were provided). As I understand it, one's legal duty as a nurse in these situations is to fill out an incident report, and report the situation to their manager explaining why the staffing is insufficient to meet their patient's needs, and request more help. The problem, as I see it, is often having to do these things in order to be able to give safe care. The nurse is often put in these highly risky situations by their employers, where the patient's safety is risked and the nurse's license (along with their finances and future ability to support their family) is put at risk through the risk of poor patient outcomes that invite malpractice claims.

If one has not already done so, I recommend reading risk management information provided by one's malpractice insurer, and learning what actions one can take to protect oneself. Some of the case studies where legal judgements have found against the nurses are quite frightening.

I believe these situations are of much greater real risk to the nurse than the ever present risk that we may be reported to the BON.

Specializes in HH, Peds, Rehab, Clinical.

Wow, that's a great reminder to pay back those loans!!

I looked over my state's report for September. Here's the breakdown.

Documentation re: patient care and policies (5): 5 reprimands

Drugs (6): 4 indefinite suspensions, 1 indefinite probation, and 1 refusal to renew

Failure to Report (6): 1 reprimand for false information on application, 1 fine for failure to report another state's disciplinary action, 1 reprimand for failure to report termination and unprofessional conduct, 1 indefinite suspension and 1 reprimand for late reporting of felony convictions, 1 indefinite probation for being audited w/ no CEs

Actual Patient Care (1): 1 reprimand for failing to notify physician of a change in patient status

And, drumroll please...

THIRTY refusals to renew and FOUR indefinite probations for defaults on student loans

There's no need to be hostile. I can tell you from looking up other nurses licenses in my state that most revocations are narcotic-abuse related. Mistakes in nursing judgement happen, and these may result in losing a job or reprimands. Revocation is the last straw.

Specializes in ER.
Well, I'll bite back because I'm not your sister and that's not my theory. . .:down:Anyhow, it would be nice if the nurse who has lost his/her license for dealings with difficult families, short staffing in nursing homes, or giving meds late would come forward and share his/her story. However, I kinda suspect that nurses who lose their licenses for minor issues are rare. My point is that the vast majority of license revocations in my state of residence occur due to issues with impairment or diversion. I regularly read the disciplinary web pages on the website of my state's BON.
Noted that you don't disagree that you can lose your license for something other than narcotics abuse and criminal activity. Further, the vast majority is not all license revocations.I agree with the theme that is developing on the thread. While license revocations are rare, it is not difficult to imagine being in a indefensible situation when one has too many patients on one shift or does not give needed care. Suspensions and lawsuits are equally scary and impact the ability to collect pay checks profoundly.

10 Ways to Lose Your Nursing License - Nursing Link

[h=4]"9. Patient Abuse and Neglect[/h] Sadly, this is quite obvious and, even worse, happens more often than we’d like to admit. Patient neglect and abuse can happen because a nurse is intentionally causing pain and/or suffering, or because of a simple mistake because a nurse is over-worked or has too many patients. One of the most serious offenses, patient neglect and abuses affects more than just the nurse, and even more than just the patient. The patient’s friends and family must also suffer alongside him/her, making this grave offense even worse.

Unfortunately, this happens all too often. Many times, a nurse doesn’t neglect a patient on purpose, but her forgetfulness can cause more damage than imagined and result in the loss of her license."

By the way, the following is a link to the recent disciplinary action page on the BON website for the state where I live. Just click on any license number to read the stories that led up to disciplinary action being taken against the licensee (nurse).

https://www.bon.state.tx.us/disciplinaryaction/recentaction.html

Thank you for sharing this. :-)

Well, I'll bite back because I'm not your sister and that's not my theory. . .:down:

Anyhow, it would be nice if the nurse who has lost his/her license for dealings with difficult families, short staffing in nursing homes, or giving meds late would come forward and share his/her story. However, I kinda suspect that nurses who lose their licenses for minor issues are rare.

My point is that the vast majority of license revocations in my state of residence occur due to issues with impairment or diversion. I regularly read the disciplinary web pages on the website of my state's BON.

Do you think for the minor stuff (compared with narcotics stuff) like giving a med late or staffing issues, that the nurse loses her job, not her license first?

And the narcotics stuff leads to a revoked license?

Specializes in PDN; Burn; Phone triage.
By the way, the following is a link to the recent disciplinary action page on the BON website for the state where I live. Just click on any license number to read the stories that led up to disciplinary action being taken against the licensee (nurse).

https://www.bon.state.tx.us/disciplinaryaction/recentaction.html

Reading through the remedial education, deferred postings is cringe-worthy to me. Proof that you can get hauled in front of the BoN for simple mistakes in med administration/nursing judgment, even if you're basically found not guilty. That's still time, money, and god-knows-what-sort-of-behind-the-back-gossip for the nurse involved.

This is an interesting article, because (as PP have said) those of us still in school and newly out of school have heard over and over again about the numerous risks to our license.

I took a cursory glance at the public records of license revocations in my state of California, for the month of September 2012. 2/3 are for narcotics use or diversion. One RN turned out to be a pedophile (off the clock) and was sent to jail. One home health RN was found guilty of Medicare Fraud. One RN was convicted by a criminal court for battery on a patient as a result of unwanted touching. He was acquitted of sexual assault. The BON revoked his license for the battery conviction.

I found one that was for negligence... however this particular nurse had 7 documented instances of negligence over a 2 year period, at 2 different employers, both of whom terminated her and reported her to the BON. Some of her issues included giving insulin without an order, failing to take a blood glucose level prior to giving insulin, falsifying patient records, and many other issues. I have to admit, my favorite part is that she seems to have taken a patient medical record from the facility, altered it, and submitted it directly to the BON at her hearing as part of her defense. It was then determined that she did not have the patient's consent to disclose their records (so an additional HIPPA violation), plus the BON determined she falsified information in it.

That's all for September 2012. It does seem that you need to do/not do something VERY serious to lose your license, and in most instances a pattern of behavior is established, not just a one time offense. Also, it's worth noting that most of the narcotics related offenders were put on probation first, and continued to test positive for narcotics and so were now finally losing their licenses.

Reading through the remedial education, deferred postings is cringe-worthy to me. Proof that you can get hauled in front of the BoN for simple mistakes in med administration/nursing judgment, even if you're basically found not guilty. That's still time, money, and god-knows-what-sort-of-behind-the-back-gossip for the nurse involved.

I agree, it is really scary.

Thanks for posting this. I am a new-ish nurse and am constantly worried about "losing my license." I'm glad to hear that it's more major infractions.