Revocation of Nursing License (4 Most COMMON Reasons)

What is the most frequent reason a nursing board revokes a nurse’s license? I’m going to talk generally about how most boards work. I’m not going to talk about a specific board. So this will be a general overview of how most boards handle complaints and the process. And how they go into the revocation of the nurse’s license. Suppose there is a complaint from a patient, their family member, or a colleague. They must report a criminal incident, maybe some mental health issues. Whatever leads to the complaint will go to the board and get assigned to an investigator. The investigator will reach out to the nurse and ask for more information. 

How Revoked Licenses Occur in Nurses

They’ll usually send a questionnaire the nurse needs to fill out with employment information, education history, and contact information. And a written statement about whatever the complaint is about. Most of the time, there’ll be an interview between the investigator and the nurse. And then, if it’s not disposed of at that level, it will work its way up to the board. The board at the board meeting will discuss the case and decide on the ultimate outcome. It could be non-disciplinary, disciplinary, suspension, or revocation, which are both disciplinary. I gather the most frequent way they revoke a nurse’s license is when they violate the terms of current probation. Say a nurse with substance abuse issues goes before the board, the board says, we won’t take your license away. However, they will be monitoring you for, let’s say, two years. 

The nurse will have to sign an agreement that says, for these two years, they’ll do certain things. It could be random drug testing, AA participation, some supervision level at work, or they can’t pass scheduled drugs. I mean, it could be a variety of things. In cases where nurses are within that agreement and don’t follow what’s in there. The board may give them a second chance most of the time. If not, the board may move forward with revocation. And most states, if they’re going to revoke a nurse’s license, it must go through an appeal and hearing process. Like in Arizona, if the board revokes a license, it goes to hearing in front of an administrative law judge. 

The Ultimatums for Revocation of Nursing License

And then it gets shot back to the board. The board can accept, reject, or modify that decision. And then, ultimately, the nurse’s license is revoked. So, the first way is if they violate the terms of whatever probation they’ve signed. Another way would be if there’s a heinous crime, every board has the option of a summary suspension. The threshold is if a nurse is an imminent threat to the public’s health, safety, and welfare, the board can issue a summary suspension, which would essentially immediately suspend a nurse’s license. And then the board forwards it to the hearing. There, it’s almost always for revocation if no settlement is reached between the nurse and the board or board’s attorney. Most boards will have language about what happens if a heinous crime occurs.

If a nurse has a felony, I know here in Arizona, if they convict a nurse of a felony, that’s it. They’re losing their nursing license—nothing I can do about it. If the state has language stating that if they get a felony, it’s an automatic revocation, then that will happen. And the license is going to be revoked. Even if it’s not a felony or a high publicity case that may shed a bad light upon the nursing profession, the state can lead to the board deciding to move forward with revocation proceedings. People who have substance abuse issues may be a diversion. Fentanyl is a hot-button drug that I find most states are going out after. Suppose they catch the nurse diverting fentanyl or any other analgesic or opiate. That could lead to criminal and board issues.

Main Reasons Why Licenses are Revoked

If they’re diverting it for sale, that’s one thing versus just diverting a small amount for personal use. The nursing board will take that into account as well. Mental health issues—if the nurse is unsafe to practice due to this. Such as violating an order, heinous crime, or substance abuse. Those are the main reasons why they would revoke a nurse’s license. A nurse would rarely have their license revoked due to clinical issues.

Unless there is an extreme pattern of clinical problems that continue, they are remediated, then it happens again. And maybe some education occurs again, that would get to the point where the board would likely act and revoke. But the percentage of nurses with their licenses revoked due to ongoing clinical issues is very small. Now, if a major event happens, suppose a nurse has a major medication error that leads to the death of a patient. It’s possible that could also lead to a revocation. So, those are the main reasons a nurse can have their license revoked by a nursing board.

Other Blogs of Interest

• Most Common Reasons for Board of Nursing Discipline
• What Happens When a Nurse is Reported to the Board?

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, so 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, and then any discipline they’ve received during their practice would pop up as well. Then it would state what happened on the date of it. And then, they’ll often 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 by changing 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 that if you’ve been given formal discipline, 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 follow you for the rest of your career, it’s 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 tough 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. It 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 would 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 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.

All they want to hear is the nurse to say 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 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.