Common Board of Nursing Disciplinary Actions | Complaints

What are the options for a board to discipline a nurse? Now, before I get started, this is a topic that’s very state specific. Every state has its own spectrum of disciplinary actions. So, my talk today is going to be general. Meaning, it may be different in the state that you’re in. But this is kind of the normal structure of what kind of disciplinary action is for the board. There are usually three options for non-disciplinary actions, and I think I should just go through those first. Obviously, if a complaint is filed, a case can be dismissed, and it could be dismissed for several reasons.

Two Most Common Forms of Dismissal

There are two common reasons for dismissal. One, the board doesn’t have jurisdiction over the complaint and then two, the conduct alleged in the complaint is not a violation of the nurse practice act. The other way of dismissing the case is after an investigation if they believe there are no grounds to discipline the nurse in any way, it can be dismissed. Most boards will then have a non-disciplinary option. I know here in Arizona; it’s called a letter of concern. It could be a reprimand or advisory letter. It goes by different names, but I’ll just call it a letter of concern. It’s simply a letter that goes in your file of the board. It states there is a concern about the incident, but it’s not considered formal disciplinary action and wouldn’t be reported to any databases, nurses, or national practitioner databases.

Non-Disciplinary Continuing Education

It would just be kind of on file with the board. And if the nurse were to get in trouble in the future, they would look back at the letter of concern and then decide of whether they need to take additional action. Some boards also offer an administrative penalty, which would be considered non-disciplinary. If a nurse files for the renewal late or they don’t provide the necessary fee, some boards will just give fine normally or admit a straight penalty. Most of the time, that’s not considered disciplinary action. The last option would be a non-disciplinary agreement for continuing education. Now, not every state requires continuing education for nurses. It’s not an option in every state. But many states offer non-disciplinary continuing education where they’d have to take a course in documentation, nursing ethics, assessments, something like that. 

Common Disciplinary Action Options 

Decree of Center

Those are all the non-disciplinary options. What we’re here for are the common disciplinary options, and I’ll kind of go through those. Most states have what’s usually called a decree of center or letter of reprimand, something like that. It’s a formal document that states the nurse did violate the state law in some way. But it doesn’t rise to the level where the nurse is put on probation. It’s like a formal slap on the wrist. It is reported to the database and nurses and the nurse would have to report it in the future. If on any kind of employment application, it stated, have you ever been formally disciplined by a board? They’d have to answer “yes”, but in many cases, it’s a decent outcome. I guess the two choices were probation or decree of center. Clearly, the decree of the center is the better route to go.

Disciplinary Order for Continuing Education

Another disciplinary option is disciplinary order for continuing education. There’s a non-disciplinary potential and then a disciplinary potential. They would just depend upon the facts of the situation. I mean, the order would be the same. They must do a certain amount of continuing education where they could get in trouble. In this case, maybe the clinical problem rose to the level that the board felt they needed to put it on the record. And so, a disciplinary order for continuing education is another option. A civil penalty is used in many states and that’s just like a fine, usually, somewhere between $500 to $2,000. The difference between what led up to a complaint that ended up in a decree center and a civil penalty is maybe the civil penalty route was a little more concerning to the board. But that’s another option as well. 

Probationary

Now, anything after that, for the most part, would be probationary. If a nurse, let’s just take, for instance, a nurse who had substance abuse problems and she had several DUIs, and the board felt it was necessary to put her on probation. Normal probation would include, well, for substance abuse, random drug testing, AA participation, and some level of monitoring at work, maybe you can’t pass narcotics for a period, maybe they’ll make the nurse do counseling. They could add continuing education to a consent agreement as well. Probation can last from usually a year all the way up to three years or more. And then after the probationary period is over with, and the nurses fulfilled all of the obligations of the probation, then they’re no longer on probation, their licenses unencumbered, and they can work freely without any requirements.

Suspension of License

The levels after that are bad. One would be a suspension. A nurse can be suspended in several ways. If they were on a consent agreement and they violated the terms of the agreement. Most boards have the option to suspend the nurse’s license. If there’s a bad incident, the board can take what’s called a summary suspension where the board will take emergency actions to suspend a nurse’s license. Those are kind of two ways the board can suspend a license. And then, finally, revocation is the worst-case scenario for a nurse. That is discipline. If once again, they violate the terms of a current consent agreement, many boards have an automatic option where the nurse’s license is revoked. Once again, if there’s a heinous incident, it could lead to a quick revocation as well.

Voluntary Surrendering of License

It’s not common for a nurse’s license to be revoked. I mean, less than a fraction of 1% of nurses how their license is revoked. It must be very difficult and concerning conduct to get to that level. But it is always an option. I guess there’s one more. A nurse can voluntarily surrender their license. That is considered a disciplinary action. I have nurses sometimes, and maybe they’re toward the end of their careers, they’re not interested in going on probation or fulfilling the terms of whatever the offer consent agreement is. And they can just give up their license. It’s called surrender. Therefore, they no longer have their license. Normally, there would be a period fixed to it, of when they could reapply if they wanted to. But a voluntary surrender is considered a disciplinary action as well.

Those are the common reasons for a board of nursing. I guess the common reasons for disciplinary actions from the board of nursing. There’s a wide spectrum of things they can do. I mean, I get asked like, what’s your win rate, or what are your outcomes? I mean, it’s impossible to answer as an attorney who represents nurses. Getting a nurse on probation and not getting their license revoked can be a huge win versus getting somebody dismissed versus a decree of center could be a huge one as well. It just depends upon the conduct. And most boards will have a range. I mean, I can just see a case and kind of understand, alright, this is where it’s going to fall within. But if you’re looking for an attorney and you ask that question, it’s very difficult to answer because every situation is unique.

Other Blogs of Interest

• Do You Have to Report a DUI to a Nursing Board?
• What Happens When a Nurse is Reported to the Board?
• Most Common Reasons for Board of Nursing Discipline | Nurses Disciplinary Boards

How Long Does Discipline Stay on a Nursing Record?

How long does discipline stay on a nurse’s record? Well, first, this is very state-dependent. Each state may have its own policy on how long the discipline will stay up. So, this is state-dependent, but this will be kind of a general discussion of discipline, where it’s reported, and then how long it stays up. First, you need to define what discipline is. Every state is going to have unprofessional conduct. And even though a nursing board has issued a decision against the nurse, it doesn’t always mean they’re considered formal disciplinary actions. In most states, it could be called a letter of concern, an advisory letter. There’s a low-level document that goes to the nurse that’s not considered formal discipline. And won’t be reported to the national databases, nurses, and then the national practitioner database as well.

There could also be a non-disciplinary continuing education order. In that scenario, that’s not reported either. What we’re talking about today is if you’ve been given formal discipline in your practice. Either decree of censure, a civil penalty, letter of reprimand, probation suspension, revocation, voluntary surrender, all these things are considered formal discipline and all of them will be reported to the national databases. There are a few states left that host their own reporting. And in that scenario, that’s up to the nursing board how long they want to keep the discipline up on their website. 

When the State Can’t Expunge Past Disciplinary Actions and Complaints 

But the national data banks have some very set standards. Let’s just take nurses, for example. If a nurse is disciplined and receives disciplinary actions or complaints, it’s then reported to that database. And if anyone were to verify the license of that nurse, all the states the nurse’s license would pop up. Then any discipline they’ve received during their practice would pop up as well. It would state what happened on the date of it.

Then, many times, they’ll link the actual document so someone can just pull it up and look. Now, if your state has no mechanism for expunging or removing discipline, it will stay up there permanently. There’s no way of removing it. For instance, I live in Arizona and represent Arizona nurses before the board and we have no way of expunging a case or removing discipline.

And so, right now, if any nurses reported to nurses or the national practitioner database, there is no way of removing that discipline. It’s there forever which is frustrating for a nurse. The only way that we could get that changed would be change in the law. 

Dealing With Past Disciplinary Actions Throughout Your Career

We’d have to lobby with state officials and try to get a change to the law so that we can have cases expunged or removed after a period. But right now, we can’t. It’s very likely if you’ve been given formal discipline that it will stay on your record. Either permanently or for a fairly long period. It’s not fair. If you were disciplined 20 years ago, and this will just follow you around for the rest of your career, it’s just not fair. The reasons why it can come up are, one if any employer verifies your license, it pops up, they’re going to see it. Two, those job applications will state, have you ever been formally disciplined by a licensing board? 

In that case, even if you’re in a state where it can be removed, you’ll likely have to answer affirmatively to that question because it did happen. But having the licensure verification available for anyone to see and pull up and read the facts of the situation. Something that happened a very long time ago in your practice. Nurses had no problems for a decade or two, it’s just tough to have to deal with that for the rest of your career.

Disciplinary Background in Nursing Likely to Remain for a Long Time

People make mistakes. Just because a nurse is formally disciplined doesn’t mean they’re a bad nurse. Doesn’t mean there’s a behavioral problem with them. People screw up in medicine all of the time. And most of the time, it’s not some kind of act that the nurse is meant to do. It could just be an honest mistake that led to discipline, but it will still follow them around for the rest of their career. I wish I had better news. If you had been formally disciplined, it likely will stick around for a very long time. How to handle that with an employer? Well, if you have been formally disciplined and the employer is going to find out about it and obviously ask you about it, then you need to have a story to deal with it.

What the Disciplinary Commission Wants to Hear

You need to say, this is where I was in my life at the time, this is what happened, and these are the things that I’ve done, the programs I’ve joined, to make certain it doesn’t happen again. That’s what the employer wants to hear. They don’t want to hear a bunch of excuses. They don’t want a big, long, complicated story.

What they want to hear the nurse say is, I screwed up. I was disciplined for it. I learned from it. Here’s  what I’ve learned and here’s why it’s not going to happen again. Now, there are situations where the nurse can just talk their way around. Well, this wasn’t my fault for these reasons, but I find, for the most part, the most effective way of dealing with it’s just straightforward. I screwed up, learned from it, and won’t do it again. That’s what the employer wants to know.

Any employer wants to know that a nurse is coachable or the board calls it regulatable. They just want to see that you can recognize if there have been issues, that this is something that you’ve kind of grown from. It’s very hard for some nurses to kind of swallow their pride and admit that they screwed up. Well, I mean, this goes for any profession. I’m not singling out nurses here. It’s just hard for people who are professionals to admit an error or that they screwed up in some way, but it’s the best way of handling a situation like that. Especially if it’s remote if something happened decades ago. An employer, if they’re a good employer, they’re going to understand things happen, and they’re going to show compassion to a nurse who’s just explaining the situation. And I guess establishing that they’ve grown from it.

Nursing Reports: What Happens When a Nurse Is Reported?

What happens when a nurse is reported?  First, I’m not just going to talk about what happens when a nurse is reported to a nursing board. I’m going to talk about all the places a nurse can be reported. And then some things to think about as far as handling those types of situations. Now, first, this is not going to be state-specific. I’m giving general information that a nurse could use in almost any state and obviously, rules can vary from state to state, but this will just be kind of a general discussion of what happens when you’re reported.

Places or Agencies Nurses Can Be Reported To

First, where are the places/agencies a nurse can be reported? Well, let’s talk about that. First, nurses can be reported to the employer. A patient could complain about a nurse’s conduct. They could be reported to the employer and then the employer would do an investigation. Obviously, nurses can be reported to a nursing board if there’s an alleged violation of the nurse practice act in the state. A patient, a colleague, an employer, or the police can all report nurses to the board of nursing. Nurses can be reported to the police. And this usually comes from the employer. There are times when there is some alleged criminal conduct on part of a nurse and it may, or at least the employer may feel necessary to contact the police.

Like, let’s just take, for instance, let’s say a nurse is caught diverting fentanyl, something like that, which is serious. They would then contact the police and say, we believe the nurse was diverting fentanyl, and that is a violation of the law. And then they would investigate as well.

Adult Protective Services

Another frequent place nurses could be reported would be the branch of adult protective services and whatever state you’re in, if there is an allegation of patient abuse and the patient is an adult, then the adult protective services could do an investigation. The department of child services or child protective services is another place. If your patient was a child and there was abuse alleged, the child protective services in that state could initiate an investigation as well.

And just to kind of give an example, I had a nurse who left a heating pad on an infant child, which caused a burn. And then obviously she didn’t mean to, there was no intent to hurt the child, but there was a negative outcome and then child protective services came in and did an investigation. Those are the main places. So, employer, nursing board, police, adult protective services, and child protective services. Those are the main places where nurses can be reported.

What Can a Nurse Do if a Patient Reports Them Over an Incident?

What can you do if you’ve been reported to any of those? Well, it would depend upon the organization what you should do. If a patient complains and the employer approaches you and asks you what happened, then there are no problems talking to them about what happened. Now, I guess it would depend upon the severity of the nurse’s actions. I’ve had a couple of previous blogs that went through what happens for an employer investigation. And there are times where it doesn’t make sense to say anything, but if it’s maybe a minor disagreement, I mean, look, there are some patients/family members that are just never going to be satisfied with the care provided. 

And so, in a situation like that, if the nurse didn’t do anything wrong, then certainly feel free to discuss that. If the nurse screwed up in some way, then it may make sense to just kind of be quiet about it and not give a statement.

If the police are involved, you must find an attorney first. I understand that some people believe they can talk their way out of things. Don’t do that. If you are contacted by any police department or even the Attorney General’s office in your state, there is a criminal investigation underway, and they’re going to talk to you and pretend like they’re your friend, and just say, why don’t you just tell me what went on here? And then they’re going to use all those things against you. If you have any kind of contact from the Attorney General’s office or a police department, or a detective or an officer, do not say anything. Call a certified criminal defense attorney wherever you live and have them represent you.

Hire a Board Defense Attorney

Not spending the money on that is extraordinarily done. That’s what you need to do. If you’ve had adult protective services complaints, child protective services complaints, or whatever the name of it is in your state, once again, it might make sense to involve an attorney who has done administrative hearings. I find the investigators and a lot of those specific departments, almost always find there’s abuse. So, talking to an attorney who handles those types of things in your state would make sense. 

Now, as far as the nursing board goes, once again, kind of depends upon the complaints. Sometimes, there are just completely terrible complaints, meaning, terrible like there’s no basis and fact for them and the board will likely dismiss them quickly or after a brief investigation, dismiss them. Is an attorney necessary for that? Probably not, but there are certainly instances where an attorney who has experience with the board of nursing could absolutely assist you. I would contact them before you respond to the nursing board at all. There are plenty of great nursing board attorneys throughout the country. You need to find somebody who has experience with legal matters with your board in your state.

How to Find a Good Defense Attorney?

One way of finding that would be going through old agendas. Almost every state requires open records. And so, any kind of board meeting from a governmental agency must be posted. And they do that through the minutes, which are basically a summary of what happened during a board meeting. Then the agenda, which is, this is what we’re going to discuss during the meeting. Most of the states will post if someone is represented by counsel and the minutes and then who that is. It’s not a bad idea to look in the old minutes in your state to see who are the attorneys that are representing most of the nurses. And then that’s usually a good indication that they at least have experience. I can’t say if they’re good or not, but at least they have experience handling the nursing board.

So, that’s what happens if a nurse is reported to a bunch of different agencies. You always need to be careful about what you’re saying to anyone. Your words can be used against you. And it makes sense to involve a professional who has experience handling matters across all those areas.

What Does It Mean When a Nurse Is Suspended?

What does it mean when a nurse is suspended? There are several ways a nurse can be suspended. And then we’ll kind of talk about the repercussions of being suspended. The number of ways a nurse can be suspended is one, if they’re in a confidential monitoring program with their licensing board and they violate that agreement, there will usually be some language in there that states if they fail a drug test, maybe stop sending in quarterly reports, quit going to AA, or whatever the terms of the agreement are, if the nurse stops doing those required actions, then there is a normal language that would just automatically trigger a suspension. Another way a nurse can be suspended is if the board feels they’re an imminent threat to the health, safety, and welfare of the public.

Summary Suspension 

In that case, most states have a process that’s called a summary suspension. And in that at either a regularly scheduled board meeting or sometimes in an emergency board meeting, the nursing board will essentially discuss whether the nurse’s conduct rises to the level that necessitates a suspension. They do afford the nurse, the opportunity to address the board, or maybe to discuss the issues that are leading to the possible suspension. But the summary suspension means something has happened that has triggered the staff of the nursing board to think that a suspension is necessary. And then the other way that a nurse can be suspended is if they’re on probation like disciplinary probation. There’s a difference between being in a confidential monitoring program and being placed on disciplinary probation. 

Generally, the terms are similar. For instance, if there’s a substance abuse issue, it’d be regular drug testing participation in AA, maybe a nurse recovery group, or some level of supervision at work.

State Suspension

And so, even if it’s like an alternative discipline program or formal probation, meaning the nurse went through the investigation, the nursing board heard the matter and then decided to put them on formal disciplinary probation. In that case, the result is the same. On a consent agreement, they have to follow the terms. And if in this example, they do not follow the terms of the consent agreement, then they can either, or I guess depending upon the language of the agreement, it can either be automatically suspended. In that case, we call that a state suspension. That just means the nursing board has already said that this is serious. 

Many times, if it’s just standard probation, and the nurse violates it, it just goes back to the board for review. If it’s a state suspension, the language will state if the nurse violates the agreement, the state is lifted, and the nurse is suspended. That’s how it goes. Those are the three scenarios where a nurse can be suspended. 

Now, what does it mean if a nurse is suspended? They can’t practice. It’s that simple. They are no longer allowed to practice as an LPN, as an RN, as an NP, as a CRNA, or as a CNA, whatever it is, they cannot practice as a nurse until the case is resolved. In most states, what happens is once the license is suspended, then it’s forwarded to a formal hearing, generally in front of what’s called an administrative law judge. Different states have different time periods, but normally, it’s somewhere between 30 to 60 days that a hearing has to be held. And then at that hearing, the nurse can present evidence to the judge.

Stayed Revocation 

And then the judge can either reject, accept, or modify the decision of the board, and then normally it gets kicked back to the nursing board and they can do the same. 

The only way to, I guess no longer be suspended is either to go to the hearing and the judge recommends it’s not necessary, or they could reach an agreement on a new consent agreement with the nursing board’s attorney. Normally, if we have a nurse who has been on a consent agreement, violated it, or gets their license suspended, we can then negotiate with the board’s attorney to try to come to an agreement on a new consent agreement that would have either the same terms or maybe something more punitive. 

There is also another kind of mechanism called stayed revocation. And that’s kind of the highest level of a consent agreement as far as being punitive. And in that case, if it’s called a stayed revocation, if the nurse violates the agreement, the stay is lifted, and their license is automatically revoked. One of the normal scenarios where they would basically not even give the nurse the opportunity would be if they had violated previous consent agreements, or maybe they’d been on probation multiple times, and they’d been disciplined throughout their nursing career.

It’s a tough option because you screw up and that’s it if it’s a stayed revocation. So, that’s what it means when a nurse is suspended. They can’t practice. They do have some appeal rights and administrative rights as far as going to a hearing. But if you’re suspended, it will likely end up in a probationary document listing a bunch of things that you have to do.