Will I Lose My License?

An article describing the kinds of things can cause a nurse to lose licensure. Nurses General Nursing Knowledge

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Will I Lose My License?

I don't know how many times I've seen some version of this question following some scenario that a nurse (usually new) has described. I also often see nurses with some experience (a lot of experience in some cases) offering something like "Your license is in danger!"

In nursing school, it is beaten into us that this license that we are working so hard for will be in constant jeopardy. That every questionable action/scenario might be the one that results in public discipline and humiliation before the Board of Nursing (BON) and our colleagues. It is a persistent myth that the state boards of nursing are constantly looking for reasons to strip us of our livelihood. My advice is to settle down and familiarize oneself with the kinds of actions that result in public discipline and loss of licensure. 

As I am licensed, live and work in the state of California, I will use the California Board of Registered Nursing as an example. The Board Website states the following as offenses for which a nurse may lose their license to practice.

Conviction of a Crime Related to the Qualifications, Functions, and Duties of an RN

Can apply to such crimes as embezzlement, child abuse, spousal abuse, battery, theft from a patient or client, or failure to report abuse. This list is for illustration only and is not all-inclusive of the acts for which the Board may discipline an RN's license.

Default Decision

A decision based on the RN's failure to provide a notice of defense after an accusation has been served, or failure to be present at an Administrative Hearing. All charges are deemed true, and the default decision normally results in a revocation of the RN's license. Board members may vote to adopt or reject a default decision or discuss it further before making a final decision.

Gross Negligence

An extreme departure from the standard of practice for RNs. An extreme departure means the repeated failure to provide the required nursing care or failure to provide care or exercise precaution in a single situation which the nurse knew, or should have known, could result in patient harm. (Think the Radonda Vaught case).

Incompetence

Lack of knowledge or skill in discharging professional obligations as an RN.

Malpractice

Intentionally performing any act that is outside a nurse's scope of practice as defined by the state nurse practice act. 

Malfeasance

Any intentional act done with the intention to cause harm.

Actions that Impairs a Nurse's Ability to Make Safe Decisions

Think drug or ETOH use or diversion and certain acts of moral turpitude.

I have perused many public discipline pages of many state BONs and I have never once seen one in which a nurse lost their license due to understaffing or being worked to the point of exhaustion. Mistakes happen, even in nursing, and unless that action causes a negative outcome for a patient or other vulnerable person, discipline is usually done at the facility level. 

Bear in mind that any consumer or employer can make a complaint to the Board of Nursing and the BON is required to investigate these complaints but that does not mean the complaint is valid or meets the severity level that would result in loss of licensure. 

Because defending oneself from complaints can be costly, every practicing nurse should carry their own . This will provide you with an attorney experienced with professional practice defense. Trust me! If you believe your license is in jeopardy you do not want your attorney to be one you picked out of the Yellow Pages (sorry, dating myself).

References/Resources

California Board of Registered Nursing: Disciplinary Actions and Reinstatements

Ex-Vanderbilt nurse Radonda Vaught loses nursing license for fatal drug error

Moral Turpitude

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hppygr8ful

About hppygr8ful, ASN, RN, EMT-I

(allnurses Guide)
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Specializes in Dialysis.

Excellent article @hppygr8ful

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Specializes in Home Health, PDN, LTC, subacute.

Thank you! 

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Specializes in Urgent care/ home infusion.

Thank you!

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Thank you for your article.  This is very useful information.

I would like to add that, in my view, losing one's license may not be the worst thing that can happen.  This is just my view, but, in my state a nurse can face a law suit brought for negligence, and, in these situations, to my knowledge, runs the risk of large out of pocket expenses.  So I feel that it is very necessary and valuable that nurses are well informed as to the laws governing nursing practice in their state, and to their Scope of Practice/Nurse Practice Act/related regulations, and that it is very wise to practice as prudently as possible.

 

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Specializes in New Critical care NP, Critical care, Med-surg, LTC.

Thank you for this well written article. We have all seen so many threads related to concerns about losing a license. While I've often thought the situation in question did not meet the criteria, I had not taken the time to really investigate when it might actually apply. 

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Specializes in retired LTC.

Well presented information and easy to understand.

Lesson to reiterate -  nurses, obtain your own !

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I understand this has been a chronic concern and the idea that one could lose one's license, in theory, is not always realistic as applied to scenarios people are worried about.

That said, no one wants to be messed with, no one wants to appear before the BON over an issue. And the fact is, the sole reason the BON is involved is because whatever petty or not-so-petty matter has been brought to their attention is (supposedly) a matter which may affect one's ability to safely practice nursing. No one wants to go through that. And I don't blame them.

Employers threaten BON reports, and some of the things they do (or in some states are required to) report are unnerving. Termination? Come on.

I've also been in a meeting where the entire group was threatened with BON reports if there was *ANY* aberrancy with any controlled substance. Well, things happen and I don't like to be talked to like that when every day is a circus and I haven't actually done anything in particular wrong.

Employers of nurses deal with us as if we are expendable in just about every way.

So, although I have a good ability to ***ess risk (to my license) in a given situation, I would keep these things in the front of my mind if I worked for an entity that might as well just state nurses are their sworn enemy.

Incompetence? What all do we think that covers, or could cover if someone wanted to make an issue?

 

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Specializes in New Critical care NP, Critical care, Med-surg, LTC.
19 hours ago, JKL33 said:

Incompetence? What all do we think that covers, or could cover if someone wanted to make an issue?

I think that this is the section that is most open to interpretation and is really what gets people the most concerned. To me, incompetence would be an inability or unwillingness to follow reasonable standards of care, that results in harm to a patient. MOST people, I believe, do their best to act in the best interests of their patient, but with the increased patient loads and acuity, especially in hospital settings, may not feel they have to time to do things like they should. For example, reading medication administration instructions, looking up IV infusion incompatibilities, or even being sure they understand the medications they are administering if giving something new. I would also think that not reacting to patient changes in condition with appropriate action could be considered incompetence, and again, these days that could be attributed to workloads potentially as often as just the actions, or inactions, of a nurse.

Certainly no one wants to ever have to justify their actions, or inactions, to any official body, like the BON. I would hope that things like patient load and the overall environment in any situation would be considered, but I suppose that's up to the body involved and in some cases it may not matter what else was going on if a patient came to harm because of the action or inaction of a nurse. 

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Specializes in Geriatrics, Dialysis.

I get the BON newsletters for both MN and WI as I am licensed in both states. The vast majority of license suspensions, revocations and practice limitations are drug/alcohol related. Diversion or being under the influence at work or both seem to be the most common though there is the occasional case involving an arrest outside the work setting that affects the nurses license. 

I've also seen discipline for documentation issues though that rarely rises to the level of revocation or even suspension, usually when that is the issue some kind of education is required though I did see one fairly recent case in WI where the nurse was prohibited from working in a Home Health setting.

It's the rare oddball cases that are interesting reads.  These usually involve a situation that screams what the heck was that person thinking??  The most common in this category are nurses having wildly inappropriate relationships with patients.  

I've never not once seen a license suspension for being late for work, calling into work, refusing to come to work when called in or anything else that is typically employer/employee related.  So if your manager threatens to turn you into the state for abandonment if you don't come to work that manager is full of it.

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Specializes in retired LTC.

How about a little tit-for-tat?

When employers pull the BON 'card', perhaps it's time for the employee to pull the DOH 'card' (for truly seriously deficient situations that we all know to exist)

Only thing, employee needs to be ready for the flasback/fallout sure to occur. Admin will find out.

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