Protecting Your License: Notes from a Nurse-Attorney

SafetyNurse1968, ADN, BSN, MSN, PhD

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 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