Protecting Your License – Notes from a Nurse-Attorney

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    This article is about how to protect your nursing license. It describes situations in which nurses have been reported to the board, or been brought up on criminal charges. Strategies, resources and tools are provided for preventing licensure problems.

    Protecting Your License – Notes from a Nurse-Attorney

    Nursing licensure has been on my mind lately. I just taught an NCLEX test prep course to some recent RN grads, and there are always test questions on licensure and negligence. I had a lively discussion with my students about being reported to the board of nursing. Recently, in my role as an editor for a nursing textbook company, I was tasked with writing questions on licensure, negligence and malpractice. I woke up this morning to a newsletter1in my email in-box from Lorie Brown, RN, MN, JD about a nurse facing criminal charges in the death of a patient.2It feels like the universe is telling me to write about protecting your license!

    YOUR NURSE-ATTORNEY

    Last year I had the chance to interview Lorie for my podcast. She is both a Registered Nurse and an Attorney. I originally contacted Lorie because I was fired from my job as a home health nurse, and reported to the board of nursing. It was a terrible time in my life, and I didn't know where to turn or what to do. There is so much talk these days about support for second victims - but that only occurs if you are still working in your facility - there are few resources for those of us who are no longer affiliated with a healthcare institution. Lucky for me, it all turned out ok - there was no disciplinary action and no harm to the patient, but the experience left lasting emotional scars. I will write more about that soon. I think it's important to talk about getting fired, loss of licensure, and making mistakes...talking about it helps those of us who have been through it, it removes shame and stigma, and it gives us all additional resources.

    In the interview, Lorie told me the story of a client who was accused of patient abuse. The client sent a patient to the morgue, still soiled from a bowel movement that occurred during the process of dying. Lorie described how she interviewed the nurse, what questions she asked, and more importantly, what questions she asked of the other nurses who were present for the preparation of the body. She was able to save the nurse's license. It was fascinating to learn how Lorie's nursing knowledge of how to turn and clean a body led her to the discovery that another nurse was involved in the incident.

    PROTECTING YOUR LICENSE

    I asked Lorie to tell me the most important thing a nurse can do to protect their license if there is a complaint or report, and she said, "don't do it alone". The board of nursing and the facility where the complaint occurred have attorneys, and so should you. Lorie is a member of the American Association of Nurse Attorneys (TAANA.org). There are about 300 members who practice in many different areas. You can contact Lorie at YourNurseAttorney.com for a free consult, or go directly to TAANA for help.

    We talked about how nurses are treated and some of the challenges we face. One thing that surprises new graduates and seasoned nurses alike is that most states are "employment at will" states. What this means is that they can terminate you at any time, for any reason, or for no reason at all. Lorie let me know that nurses get fired all the time. Of course we want to see a nurse terminated if they are being unsafe, committing a crime, or harming a patient, but many people assume that if you were fired, it was because you did something wrong - and that just isn't true. Lorie spoke about the idea of a "graceful exit" which basically means "quit before you are fired". Lorie has negotiated resignations for nurses in return for uncontested unemployment applications and a neutral reference. Lorie warns that if you get suspended, you will probably get fired. The best advice she gave me, which we can't always take due to family and finances, is to leave a job in which you feel unsafe or unwelcome. If staffing levels are bad, leave. You can get another job, but you can't get another license.

    REPORTS TO THE BOARD


    Did you know anyone can report you to the board of nursing? And did you know that an employer can put anything they like into your employment record? Once it has been entered, it is no longer considered "hear-say" and it becomes part of the business records. If you arereported to the board, Lorie tells her clients to make a list of all the good things they have ever done. The board will have your complete employment record, and it may include things you aren't aware of. Your employer isn't required to tell you when they place things in your employment file. I had three patient complaints in my employee record that I didn't recall, and the board asked me about them. I am glad I was honest in stating, "I don't remember that" - Lorie says no matter what, you must be honest in all dealings with the board of nursing. Lorie recommends that any time you ARE told about something going in your employment record, be sure to write a response and have it placed in your record as well, don't just sign on the dotted line. In addition, your employment record belongs to your employee, so they don't have to show it to you. In essence, all rights are with the employer. After learning this, it really makes sense to have an attorney on your side if you are dealing with the board of nursing.

    CONSEQUENCES

    Something unique to nursing is the consequence of disciplinary board action. If you have action from the board of nursing it goes right next to your name in a public, permanent record. Lorie works with healthcare professionals from many disciplines and says that other healthcare professions don't experience this - pharmacists and physicians for example, are often told after reports, "don't do it again", but nothing goes in their record against them. As a patient safety specialist that horrifies me. Imagine the number of physicians and pharmacists out there with no record of facility or patient complaints. As a consumer of health care, that really frightens me. It is so important for the public to know the safety record of the healthcare professionals on your team. However, I also don't agree with leaving disciplinary action on a nurse's record for life. Lorie and I agreed that there should be a time limit, and there should be processes in place for removing disciplinary action from your record.

    THREE THINGS TO PROACTIVELY PROTECT YOUR LICENSE

    1. Keep your address current with the board. Many nurses forget to tell the board they have moved. The first thing that will happen in an investigation is that you will get a letter from the board. You will have an opportunity to respond to the letter and meet with an investigator, but if they don't have your current address, they can take action without you.

    2. Be honest on your job applications. If you were terminated, you have to say you were terminated. Even if you were only there a few months, when you sign an application, you are affirming under penalty of perjury that you have given all the information and that it is true and correct. Just because you only worked at someplace a short time you can't omit it. You can say you will discuss the termination in the interview.

    3. Be honest on license renewal application. If you don't understand the question, ask. If you have been arrested or pled guilty or no-contest to a criminal matter, if you have had a DUI and you are on diversion for a year and it is dismissed you have to report it. Ask someone who practices before the nursing board if your interpretation is correct. Don't call the board of nursing. The clerks who answer the phone don't necessarily understand the process or know the answer and cannot give legal advice.

    Lorie finished up with this statement: "We are the largest number of healthcare providers, comprising 80% of the workforce and we have 0% of the power. If we stand together, think of what we can do to change the profession, improve it and improve patient care. I believe nurses have the answers to all the problems in healthcare, but we don't speak up. But we have the answers, we just need to speak up, stand together and get them implemented!"

    You can listen to the podcast of my interview with Lorie on iTunes HERE3or on Stitcher HERE4.

    References
    Criminal Charge For Nurse In Patient's Death - Brown Law Office
    Nurse Christann Gainey charged in death of former Trump adviser H.R. McMaster's father - CBS News
    Safety Rules by Kristi Miller, RN, PhD, CPPS, HNB-BC on Apple Podcasts
    Safety Rules - Three things you need to do to keep your nursing license safe Ep1 | Listen via Stitcher Radio On Demand
    Last edit by Joe V on Jun 19
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  2. Poll: Have you ever been reported to a Board of Nursing?

    • Yes, and I lost my license

      1.92% 1
    • Yes, and I received disciplinary action

      3.85% 2
    • Yes, and my issue was resolved without action

      17.31% 9
    • No

      78.85% 41
    52 Votes / Multiple Choice

  3. Visit SafetyNurse1968 profile page

    About SafetyNurse1968, PhD, RN

    Kristi Miller recently obtained her PhD in nursing. She has written about patient safety as well as her experiences with termination and the board of nursing on her website, SafetyFirstNursing.com. Kristi is a mother of four (yes FOUR!) children, and lives in the mountains of Western North Carolina. She has been a nurse for 12 years in multiple areas of nursing including oncology, holistic nursing, research, home health and education.

    Joined: Jun '11; Posts: 88; Likes: 236
    Nurse Entrepreneur; from NC , US
    Specialty: Oncology, Home Health, Patient Safety

    Read My Articles

    31 Comments

  4. by   SafetyNurse1968
    I forgot to mention malpractice insurance!!! Yet another way to protect yourself. What amazes me is how inexpensive it is - I have had it for years and it still only costs about $100 per year. Just google "nursing malpractice insurance" and you will see many options.
  5. by   FolksBtrippin
    Was this written by a nurse attorney?

    If so, where are the references to law? Under what law could a person be prosecuted with perjury for omitting a job on an application?

    And if employers can report "whatever they like" about employees to others why are their cases of libel and slander?

    I very seriously doubt the validity of this article.
  6. by   LovingLife123
    Well, don't drink and drive, obviously. Why any nurse would do that boggles my mind. As I sit here with my one glass of wine, and sent hubby to the store because I've drank half.

    Why on earth would you ever send a body to the morgue covered in stool? It's called post Mortem care and every nurse on my unit and I know personally knows how to respect someone who has passed.

    Keeping my license means to me anyway, not getting arrested, not diverting drugs, and practicing due diligence at my job.

    It's not hard.
  7. by   broughden
    Quote from FolksBtrippin
    Was this written by a nurse attorney?

    If so, where are the references to law? Under what law could a person be prosecuted with perjury for omitting a job on an application?
    As a former cop (not attorney) I can say, it will vary from state to state depending on the state's criminal statutes, and if the employer had you sign a statement such as the one I have quoted below.

    Under penalties of perjury, I declare that I have read the foregoing employment application carefully and that the facts and information I have provided herein are true and complete. I understand that any knowingly false information may subject me to immediate disqualification from employment and /or prosecution for the charge of perjury, a third degree felony.
    Relevant Florida criminal code:
    Statutes & Constitution
    :View Statutes
    :

    Online Sunshine
  8. by   MunoRN
    Quote from FolksBtrippin
    Was this written by a nurse attorney?

    If so, where are the references to law? Under what law could a person be prosecuted with perjury for omitting a job on an application?

    And if employers can report "whatever they like" about employees to others why are their cases of libel and slander?

    I very seriously doubt the validity of this article.
    Quote from broughden
    As a former cop (not attorney) I can say, it will vary from state to state depending on the state's criminal statutes, and if the employer had you sign a statement such as the one I have quoted below.



    Relevant Florida criminal code:
    Statutes & Constitution
    :View Statutes
    :

    Online Sunshine
    While there are states that extend perjury charges to falsifying government administrative forms, this would only apply to an application to a state or federal agency, it does not apply to private employer job applications.

    I agree this article is a bit light on factually correct legal information.
  9. by   broughden
    Quote from MunoRN
    this would only apply to an application to a state or federal agency, it does not apply to private employer job applications.
    No actually in the state of Florida, which is what I was commenting on, it does not mean just state or federal applications. Re-read the statute I quoted.

    And it appears the same is true for California at least as well:

    Let's look at some examples:
    You are filling out a job application at the office where you are seeking employment. At the end of the employment application, there is a place where you sign "under penalty of perjury" that the information that you provide is true.

    In response to a question about whether you have ever been terminated from previous employment, you answer "no". However, the truth is that you were fired from your last job because your boss suspected you of embezzling money from the company.

    After completing your application, you decide not to apply for the job after all. You can't find a trash can, so you leave the application on a nearby desk. Someone later picks up you application and submits it on your behalf.
    Under this scenario, you have not committed perjury. You never delivered the application, nor did you intend for it to be read. But...
    If after completing the application, you turn it in, then you do commit perjury under California law. You (1) provided false information in a "declaration" by stating that you hadn't been terminated, and (2) "delivered it" when you turned it in, and (3) intended that your "no" answer be taken as the truth.
    It should be noted that the fact that an oath wasn't properly administered, received, or properly written will not necessarily serve as a defense to a perjury charge.13
    But I mean why believe both a cop and an attorney (OP) telling you the same thing?
    Last edit by broughden on May 31
  10. by   Daisy4RN
    Thank you for the informative article. It is very important for nurses to always CYA. In the example you used I am not sure how anyone who works in the morgue would not know that a patient/deceased body could have BM after death, and why that person, who obviously found it, didn't realize that this could have happened on the way there and didn't just clean the patient and give the nursing staff the benefit of the doubt but went and reported it, ridiculous! This is exactly the kind of thing that really makes me mad, people not giving nurses any benefit of the doubt but just accusing of the worst!! And, I also don't understand why nurses are held to a higher standard/rules than MD's and Pharmacists, makes no sense. No wonder nurses are always so stressed!! While I agree that we should stand together and fight some of these issues, its not as easy as it she (Lorie) makes it sound!
  11. by   broughden
    Daisy,

    Because our healthcare system is run by for profit companies. To those companies physicians are seen as profit generators, nurses are seen as profit loses.
    That's why.
  12. by   Telenurse1990
    Quote from SafetyNurse1968
    I forgot to mention malpractice insurance!!! Yet another way to protect yourself. What amazes me is how inexpensive it is - I have had it for years and it still only costs about $100 per year. Just google "nursing malpractice insurance" and you will see many options.
    I've been told several times that malpractice insurance makes you more of a target to be sued. Is this true? If not, please elaborate.

    Thank you!
  13. by   NurseBlaq
    Quote from Telenurse1990
    I've been told several times that malpractice insurance makes you more of a target to be sued. Is this true? If not, please elaborate.

    Thank you!
    Wow! I never heard that one. What was the person who told you that rationale?

    One of my nursing instructors was an attorney and she told us to document like you're walking in court the next day. She said you don't ever want to have to be a witness in a case with your notes on a board for display and you're forced to explain them because you're never going to remember that particular patient years later.
  14. by   traumaRUs
    As always, if you have a legal question, it is best to consult with an attorney.
  15. by   klone
    Quote from NurseBlaq
    Wow! I never heard that one. What was the person who told you that rationale?
    Because you can't get blood from a turnip. i.e. there's no point in naming an individual nurse if she has no means to pay out. Conversely, the rationale is if she DOES have means to pay out, she will be more likely to be named individually.

    Personally, I don't buy it. I don't think a plaintiff attorney would have any way of knowing if a nurse carries malpractice insurance. It's not like it's public record. Hell, when I got malpractice insurance for a part-time gig I was doing, my husband didn't even know!

    Hospitals dislike nurses to get their own insurance because in court, they like to present a united front - nurse and hospital working together. Separate attorneys means separate defenses, which could potentially pit one against the other.

    Even though HR discourages us from saying it, I will absolutely tell any nurse who asks me that she should get her own insurance. If there is any negligence at all on the part of the nurse, the hospital will sever ties, and then she's on her own. It's your license - you absolutely should do whatever you need to protect it.

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