What You Don't Know About Nursing Boards

When one takes a test for a driver’s license, that person must know the rules of the road. However, when nurses take the NCLEX examination, they are tested on how to be a nurse and not necessarily on the rules that must be followed as a nurse.

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What You Don't Know About Nursing Boards

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.

DEFAULT

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.

EMERGENCY SUSPENSION

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.

CONCLUSION

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.

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Lorie Brown RN, MN, JD

About Lorie Brown RN, MN, JD

Lorie A. Brown, RN, MN, JD, Nurse Attorney representing nurses before the licensing board and founder of Empowered Nurses.

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Specializes in ED.

Thank you, Ms. Brown! I have commented many times on this very thing. Boards are for the PUBLIC's protection, not ours. The word you use, "draconian" is an understatement, in my opinion. I don't know who drafts this legislation, but it certainly cannot be RNs, I refuse to believe that even though we do eat our young, any RN would write such egregious laws. If RNs are actually putting forth this type of legislation, then I am embarrassed to claim membership as an RN.

I, for one, am leaving bedside nursing because of the Boards of Nursing. I'm just one of many. My best and most heartfelt advice to all incoming RNs and present bedside RNs.....if you're not in it, don't do it. If you are, find some non-patient care position to transfer into, whether you love bedside or not.

The states use RN licensing as a consistent revenue stream, exacting ever higher and higher fees for the privilege of practicing in an atmosphere that literally says..."we will ruin you at the slightest provocation, whether real or perceived."

Why would anyone in their right mind go to a job where the threat of complete devastation at the hands of a vindictive ex-spouse or be publicly humiliated by an accusation that is "basically" untrue but the Board saw fit to find some thread to keep a reprimand on your license?

Your essay clearly shows that it's a "Tails I win, Heads you Lose" arrangement for the states and the Boards. You pay these entities in order to live in fear of them. This makes no sense, for a profession that prides itself on critical thinking skills.

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Specializes in Primary Care, Military.

I'm confused as to how attendance write ups could even remotely be considered patient abandonment? For one, corporate hospitals are handing out write ups if you dare to miss more than 2-3 days in an entire year outside of FMLA-approved situations. Secondly, to be absent from work you are notifying your supervisor in advance. Third, as you are not going in to work, there is no established nurse-patient relationship. It is this established nurse-patient relationship that is required in order for an allegation of patient abandonment to be considered. If you don't have a patient assignment, how could you possibly abandon them? Especially if showing up to work when you are ill enough to need to be absent could be reason enough to be accused of being physically impaired while practicing, and as such a danger.

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Specializes in Critical Care.
On 1/24/2019 at 12:44 AM, HarleyvQuinn said:

I'm confused as to how attendance write ups could even remotely be considered patient abandonment? For one, corporate hospitals are handing out write ups if you dare to miss more than 2-3 days in an entire year outside of FMLA-approved situations. Secondly, to be absent from work you are notifying your supervisor in advance. Third, as you are not going in to work, there is no established nurse-patient relationship. It is this established nurse-patient relationship that is required in order for an allegation of patient abandonment to be considered. If you don't have a patient assignment, how could you possibly abandon them? Especially if showing up to work when you are ill enough to need to be absent could be reason enough to be accused of being physically impaired while practicing, and as such a danger.

They can't. By definition, patient abandonment is leaving "abandoning" your patients without giving proper handoff of care. While I'm not a lawyer, this alone makes the rest of their post quite dubious, personally.

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On 4/7/2018 at 4:41 PM, TitaniumPlates said:

I, for one, am leaving bedside nursing because of the Boards of Nursing. I'm just one of many. My best and most heartfelt advice to all incoming RNs and present bedside RNs.....if you're not in it, don't do it. If you are, find some non-patient care position to transfer into, whether you love bedside or not.

Why would anyone in their right mind go to a job where the threat of complete devastation at the hands of a vindictive ex-spouse or be publicly humiliated by an accusation that is "basically" untrue but the Board saw fit to find some thread to keep a reprimand on your license?

Your essay clearly shows that it's a "Tails I win, Heads you Lose" arrangement for the states and the Boards. You pay these entities in order to live in fear of them. This makes no sense, for a profession that prides itself on critical thinking skills.

No kidding. Nobody warns us about this part of nursing in nursing school! I don't blame you for leaving nursing.

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Specializes in Multiple.

Because of the things I have seen from the Board of Nursing in Michigan, I feel that once a nurse goes through any kind of disciplinary process they may as well give up on being a nurse - no matter how long it takes them to. I say this because I got disciplined in an area of the country where drama, humiliation, and making a big deal out of everyday nursing happenings is justifiable and worthwhile to many. I learned to see the double standards, top down phenomenons, and how the learning curve in regards to dealing with incivility is steep because many in the profession believe it's a necessary constant. This article would've been helpful years ago. Better late than never...

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