Protecting Your License: Notes from a Nurse-Attorney

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. Nurses General Nursing Article

  1. Have you ever been reported to a Board of Nursing?

    • 2
      Yes, and I lost my license
    • 6
      Yes, and I received disciplinary action
    • 13
      Yes, and my issue was resolved without action
    • 84
      No

104 members have participated

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

Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.
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 . 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.

1 Votes
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.

That's what I'm thinking. How would they know if you don't tell them? I wouldn't even tell the facility/management. They don't need to know, until there's a need to know. Hopefully, they'll never need to find out.

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!

Yes.

I've always wondered if there was some part of the discovery process where "who has what" is determined. It seems like you're right, it's probably not known. But...

I think traditionally the idea can be put down to "the assets people think or assume you have..." [may make it worth it for them to think about a lawsuit right out of the gate]

I think what people believe and assume about others does have something to do with it beyond just assumed malpractice coverage and other assets. It would make sense to me that being perceived as priviledged has something to do with it - but I've neither sued anyone nor been sued, so what do I know.

Different question: Is it just as important for nurses to be careful with asset protection as it to carry ?

I worked in a long term intensive care facility in Folsom Ca. Back in 2005. I had an Intensive care patient who needed dialysis and not received it for a week. She was ventilated, had been coded that day for cardiac arrest and a potassium of 9.6. She had been there 6 months, comatose, non-responsive, and vegetated. Family did not want her transferred, and she was a full code. I Walked into this diaster for night shift. None of monitoring equipment was working where she vomited on it earlier, and there was no replacement. Called Dr all night. She was on high dose levophed, and Dr would not treat hyperkalemia, had one dose kaexylate. By 0600 her t waves tented really high and vtach was starting. I placed her on the external pacemaker as I was using crash cart for the monitor. Dr Was in before I could call him and left her on pacemaker. It was in the policy that I could apply it. She was pronounced at 1pm, way after I went home. They fired me! They pulled the policy regarding pacemaker. Stated that I should have done compressions and "it would have all been over sooner." I reported them to state for not treating hyperkalemia, to coroner, to Joint commission, to head of company. This had happened to other patients, but I was not involved. They were escorted out by the police (manager and nurse director) and fired. As retaliation, I was reported to the board for "not doing compressions" and called incompetent. I had an attorney. My license was revoked, but I was allowed to work another job, put on probation for 3years. I had to be monitored quarterly like a criminal! I had been a registered nurse for 25 years at that time. I had worked intensive care for 7 years at that time and in acute care. I had through nurses association. They did nothing !

I worked in a long term intensive care facility in Folsom Ca. Back in 2005. I had an Intensive care patient who needed dialysis and not received it for a week. She was ventilated, had been coded that day for cardiac arrest and a potassium of 9.6. She had been there 6 months, comatose, non-responsive, and vegetated. Family did not want her transferred, and she was a full code. I Walked into this diaster for night shift. None of monitoring equipment was working where she vomited on it earlier, and there was no replacement. Called Dr all night. She was on high dose levophed, and Dr would not treat hyperkalemia, had one dose kaexylate. By 0600 her t waves tented really high and vtach was starting. I placed her on the external pacemaker as I was using crash cart for the monitor. Dr Was in before I could call him and left her on pacemaker. It was in the policy that I could apply it. She was pronounced at 1pm, way after I went home. They fired me! They pulled the policy regarding pacemaker. Stated that I should have done compressions and "it would have all been over sooner." I reported them to state for not treating hyperkalemia, to coroner, to Joint commission, to head of company. This had happened to other patients, but I was not involved. They were escorted out by the police (manager and nurse director) and fired. As retaliation, I was reported to the board for "not doing compressions" and called incompetent. I had an attorney. My license was revoked, but I was allowed to work another job, put on probation for 3years. I had to be monitored quarterly like a criminal! I had been a registered nurse for 25 years at that time. I had worked intensive care for 7 years at that time and in acute care. I had malpractice insurance through nurses association. They did nothing !

Despite what the family wanted I would have called 911 and had her transferred ASAP! She was a full code so it wasn't up to the family at that point. I would have rather lost my job than my license.

I worked in a long term intensive care facility in Folsom Ca. Back in 2005. I had an Intensive care patient who needed dialysis and not received it for a week. She was ventilated, had been coded that day for cardiac arrest and a potassium of 9.6. She had been there 6 months, comatose, non-responsive, and vegetated. Family did not want her transferred, and she was a full code. I Walked into this diaster for night shift. None of monitoring equipment was working where she vomited on it earlier, and there was no replacement. Called Dr all night. She was on high dose levophed, and Dr would not treat hyperkalemia, had one dose kaexylate. By 0600 her t waves tented really high and vtach was starting. I placed her on the external pacemaker as I was using crash cart for the monitor. Dr Was in before I could call him and left her on pacemaker. It was in the policy that I could apply it. She was pronounced at 1pm, way after I went home. They fired me! They pulled the policy regarding pacemaker. Stated that I should have done compressions and "it would have all been over sooner." I reported them to state for not treating hyperkalemia, to coroner, to Joint commission, to head of company. This had happened to other patients, but I was not involved. They were escorted out by the police (manager and nurse director) and fired. As retaliation, I was reported to the board for "not doing compressions" and called incompetent. I had an attorney. My license was revoked, but I was allowed to work another job, put on probation for 3years. I had to be monitored quarterly like a criminal! I had been a registered nurse for 25 years at that time. I had worked intensive care for 7 years at that time and in acute care. I had malpractice insurance through nurses association. They did nothing !

I don't understand. Was it documented somewhere that the patient was pulseless and no compressions were initiated at the time? Or is your board of nursing so clueless that they don't even realize a patient can be in V-teach and still have a pulse?

Perjury under oath is a offense in which a person can be prosecuted but generally it doesn't happen. Due to the fact that its hard to prove that someone knowingly and deliberately lied on their application.

There are TONS of cases of slander against former employers, this is why many are choosing to refuse to give letters of recommendation and will only provide proof of employment.

Specializes in Medical Legal Consultant.

Kristi thanks for mentioning me in the article. Great comments and questions from everyone.

With regard to , typically everyone gets named who they feel is at fault. They tend not to name nurses but if they do and your position is different from your employer, malpractice insurance gives you the right to have your own attorney. If a claim is settled on your behalf per the hospital, you will get reported to the National Practitioner Database. Also, if you have NSO insurance, they have reimbursement coverage if you are called before the Board of Nursing.

Lastly, the Model Nurse Practice Act d. Fraud and/or deceit: employing fraud or deceit in procuring or attempting to procure a license to practice nursing; in filing any reports or completing client records; in representation of self to BON or public; in authenticating any report or records in the nurse's capacity as an RN, LPN/VN or APRN; or in submitting any information or record to the BON. ***Previous models have focused on fraud in procurement of a nursing license. This broadened language reflects other situations where a nurse's misrepresentation or use of fraud could impact nursing practice. This ground reflects situations observed in other professions and modern society. This means job applications so check your State's Nurse Practice Act. Also when you submit a job application, it usually has you swear or affirm that you have disclosed all previous positions.

Lastly, the Model Nurse Practice Act d. Fraud and/or deceit: employing fraud or deceit in procuring or attempting to procure a license to practice nursing; in filing any reports or completing client records; in representation of self to BON or public; in authenticating any report or records in the nurse's capacity as an RN, LPN/VN or APRN; or in submitting any information or record to the BON. ***Previous models have focused on fraud in procurement of a nursing license. This broadened language reflects other situations where a nurse's misrepresentation or use of fraud could impact nursing practice. This ground reflects situations observed in other professions and modern society. This means job applications so check your State's Nurse Practice Act. Also when you submit a job application, it usually has you swear or affirm that you have disclosed all previous positions.

That's interesting, considering that nurses are frequently encouraged on AN to omit former employment that makes them look less than stellar when applying for jobs.

Specializes in PICU, Pediatrics, Trauma.
I worked in a long term intensive care facility in Folsom Ca. Back in 2005. I had an Intensive care patient who needed dialysis and not received it for a week. She was ventilated, had been coded that day for cardiac arrest and a potassium of 9.6. She had been there 6 months, comatose, non-responsive, and vegetated. Family did not want her transferred, and she was a full code. I Walked into this diaster for night shift. None of monitoring equipment was working where she vomited on it earlier, and there was no replacement. Called Dr all night. She was on high dose levophed, and Dr would not treat hyperkalemia, had one dose kaexylate. By 0600 her t waves tented really high and vtach was starting. I placed her on the external pacemaker as I was using crash cart for the monitor. Dr Was in before I could call him and left her on pacemaker. It was in the policy that I could apply it. She was pronounced at 1pm, way after I went home. They fired me! They pulled the policy regarding pacemaker. Stated that I should have done compressions and "it would have all been over sooner." I reported them to state for not treating hyperkalemia, to coroner, to Joint commission, to head of company. This had happened to other patients, but I was not involved. They were escorted out by the police (manager and nurse director) and fired. As retaliation, I was reported to the board for "not doing compressions" and called incompetent. I had an attorney. My license was revoked, but I was allowed to work another job, put on probation for 3years. I had to be monitored quarterly like a criminal! I had been a registered nurse for 25 years at that time. I had worked intensive care for 7 years at that time and in acute care. I had malpractice insurance through nurses association. They did nothing !

This is the sort of thing that makes me so furious. I don't know the details of your whole story but this sounds like you had an impossible situation to deal with and you were disciplined??? NOT RIGHT!

I worked in a long term intensive care facility in Folsom Ca. Back in 2005. I had an Intensive care patient who needed dialysis and not received it for a week. She was ventilated, had been coded that day for cardiac arrest and a potassium of 9.6. She had been there 6 months, comatose, non-responsive, and vegetated. Family did not want her transferred, and she was a full code. I Walked into this diaster for night shift. None of monitoring equipment was working where she vomited on it earlier, and there was no replacement. Called Dr all night. She was on high dose levophed, and Dr would not treat hyperkalemia, had one dose kaexylate. By 0600 her t waves tented really high and vtach was starting. I placed her on the external pacemaker as I was using crash cart for the monitor. Dr Was in before I could call him and left her on pacemaker. It was in the policy that I could apply it. She was pronounced at 1pm, way after I went home. They fired me! They pulled the policy regarding pacemaker. Stated that I should have done compressions and "it would have all been over sooner." I reported them to state for not treating hyperkalemia, to coroner, to Joint commission, to head of company. This had happened to other patients, but I was not involved. They were escorted out by the police (manager and nurse director) and fired. As retaliation, I was reported to the board for "not doing compressions" and called incompetent. I had an attorney. My license was revoked, but I was allowed to work another job, put on probation for 3years. I had to be monitored quarterly like a criminal! I had been a registered nurse for 25 years at that time. I had worked intensive care for 7 years at that time and in acute care. I had malpractice insurance through nurses association. They did nothing !

Just curious. I know there is only so much one can type, remember, and things get left out, but was this escalated up the chain of command? I'm asking, because if I'm going down for a no win situation and not getting any help, I'm taking everyone with me.

Such a sad day when the government sides with management over the employees/labor who are veritably tortured by them. Toss in a good dose of government hyper regulation, and you have the perfect recipe for a stressed out, burned out workforce. A person can only take so much before they just quit. And the government expects labor to just idly sit back and take the abuse. Even sadder, all this frivolous and redundant documentation to "cover your backs", time eating and never ending paperwork that take away precious time spent on the floor doing hands on work and other things that really make a difference inour patient's lives.. Management is out to make a profit, so short staffing, cutting wages by harassing seasoned veterans and hiring in fresh grads is becoming common place. Why doesn't the government allow us, the ones who break our backs doing the actual work, to report employers and management for dangerous staffing levels, harassing older nurses and running them out or terminating them to save labor costs by hiring in new graduates, something that amounts to age discrimination and therefore is unconstitutional? They are not above the law and need to be held accountable as well.

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