Most nursing schools teach to the test. They want nurses to pass the test because the school can find itself in trouble if the examination results show low pass rates. The same Board that regulates nursing licenses also regulates nursing education.
The way a nursing board works is all prescribed by statute and regulations. The nursing board is charged with the task of keeping the public safe. So, any concerns about a nurse's action could be subject to discipline.
There are 4 types of laws. Criminal law is where your freedom is at stake. Civil law is where there is a civil wrong like a breach of contract and malpractice. Military law is for our armed forces. Administrative law is the body of law that covers the nursing board. The protections that one has in a criminal matter such as innocent until proven guilty beyond a reasonable doubt do not apply in administrative law and the protections on what evidence can be used against you is not available in administrative law. Let's see how this process works.
CONSUMER COMPLAINT/ INVESTIGATION PROCESS
Anyone can file a complaint against his/her nursing license. Believe it or not, I've seen complaints filed by ex-spouses, neighbors, coworkers and patients. At this point, the complaint is confidential. In some states, the complaint is reviewed by board investigators, and in other states, the investigation is performed by staff at the state's attorney general's office.
If you are subject to an investigation, you will receive either a letter or a phone call. Therefore, it is very important to keep your information up-to-date so an investigator can contact you. I advise that you keep a list of places to notify when you move with the nursing board be on top of the list.
The investigation process can take quite some time. We are talking in some cases about years. The investigators perform a thorough investigation. If there are concerns about impairment or diversion, they may subpoena pharmacy records and medical records for any controlled substances that you been have prescribed.
They can also go back and obtain employment records of all your past jobs. They are able to locate all the places that you have worked through employers which paid state taxes on your behalf.
Since the investigator can obtain employment records, a word of caution. When you fill out a job application, make sure that you include all of your jobs and are accurate in why you left. Were you terminated or did you resign? If you were terminated, it is ok to state that you will discuss the reason in an interview. Nursing boards are very concerned about a nurse's ethics and honesty. If you were terminated from one position and put on a job application that you resigned, that is going to be a red flag.
If you worked at one place for a short period of time and did not include that in your job application, that's another red flag. Some states also require that you answer questions on your license renewal application, such as "have you ever been disciplined, reprimanded or terminated in your capacity as a healthcare professional. If you answer no to that question and they later find discipline and reprimands in your employment records, that will be of concern. The Board even considers any reprimands for attendance to be reported as that can be considered patient abandonment.
Once the investigation is concluded, the investigator will decide whether your matter should be closed or if an administrative complaint/accusation should be filed against your license.
ADMINISTRATIVE COMPLAINT OR ACCUSATION
Once an administrative complaint or accusation is filed against your license, this matter becomes public. Anybody can find out about it and in some states, it is prominently displayed online or easily searchable.
If you have a complaint filed, you could settle your case or go to a hearing. Either way, the Board can give you a reprimand, which is a like a "slap on the wrist and don't do it again." They can put your license on probation meaning they just want to watch you. Your license under probation is considered an encumbered license. They can suspend or even revoke your license. In either of the two latter cases, you would not be able to work as a nurse. You would not be able to practice or even sign your name as "R.N."
If action is taken against your license, it will become public record on nursys.com and on the state's license verification systems.
In most states, there is no way to get the administrative action removed from your records. It will stay with you for your entire career.
ALTERNATIVE TO DISCIPLINE
Some states do have an alternative to discipline process where any action or recommendations that they take would be deemed confidential but it is available only in certain limited circumstances.
If you do not keep the board apprised of your current address, they can take action on your license and you just might not even know it. That is considered a "default" and the board will do whatever they deem necessary.
Also, your license can be emergency suspended. If the board thinks that you are a clear and present danger to the public, they can take steps to emergency suspend your license until the investigation can be completed.
Make sure you know your state's Nurse Practice Act and if you get a chance to go to a Board meeting, it is an eye-opening experience. All of these measures that the board can do seem to be quite draconian and I believe being proactive is the best way to protect your license. To learn how to be proactive in protecting your license, be sure to join me in the article in next month's issue.
By Lorie A. Brown, RN, MN, JD, Nurse Attorney representing nurses before the licensing board and founder of Empowered Nurses. Empowering Nurses at the bedside and in business. Are you an Empowered Nurse? Take the quiz at www.areyouanempowerednurse.com
Be sure to check out more from the first issue of allnurses Magazine.