For the past 25 years, I have represented clients before both Medical Licensing Boards as well as Nursing Boards.  What I have noticed during that time is that there are significant differences between the Boards.

The first difference is the volume of matters.  The Nursing Board handles a much larger number of cases than the Medical Board because, obviously, there are more nurses than physicians.

But here are some interesting facts.  The Medical Licensing Board in Indiana defines “professional incompetence,” under Indiana Administrative Code 844 IAC 5-1-1(15), as “Professional incompetence may include, but is not limited to, a pattern or course of repeated conduct by a practitioner demonstrating a failure to exercise such reasonable care and diligence as is ordinarily exercised by practitioners in the same or similar circumstances in the same or similar locality.”  Therefore, in order to be disciplined regarding professional competence by the Medical Licensing Board, there needs to be a pattern or course of repeated conduct.

However, the Nursing Board has chosen to not define professional incompetence.  Instead, it defines “competence” under 848 IAC 2-1-2, section 2, as “Competence means performing skillfully and proficiently the functions that are within the role of the licensee and demonstrating behavior that is consistent with the interrelationship of the central knowledge, judgment and skill.”

So … what does all this mean?

It seems to me, based on my experience, a physician is not disciplined unless there is a pattern of conduct.  When I used to work at the Indiana Patient’s Compensation Fund to determine excess damages in medical malpractice cases, there was a physician who had 3 similar cases before the Fund at the same time.

I kept asking the Medical Licensing Board when they would be doing something about this behavior.  Yet, nothing was ever done.  Unfortunately, the physician passed away after all of this happened.

In my experience with the Nursing Board, if there is a single event that even occurred a while ago, like a med error, action will be taken.  It seems that the Medical Board does look out for their fellow physicians whereas the Nursing Board is more concerned about public health and safety.

In Indiana, if a physician cannot get medical malpractice insurance through the normal means, there is the Indiana Residual Medical Malpractice Insurance Authority which provides insurance to those physicians.

In most states, once action is taken against your license, it is permanently on your record except for 5 states,  in which case after a certain period of time elapses, that information can be expunged.

Although the National Council of State Boards of Nursing attempts to create uniformity among the various Boards, we have a ways to go in that respect.  I know the compact states have more uniformity.  This is an endeavor where nurses can practice in several states with one license.

I think there needs to be a middle ground between Nursing Boards and Medical Boards and I would like to see that there be consistency among Boards.  For example, if a physician has a DUI, in my experience, the Medical Board does not take action against the physician’s license but, in contrast, the Nursing Board will place that nurse in a peer assistance program and put their license on probation.

I would love to see equal treatment for all professions with some unanimity among states and professions.

What are your thoughts on or experiences with Medical Boards versus Nursing Boards?  I would love to hear your thoughts below.

Many a nurse found in violation of nursing regulations have come to me saying, “I didn’t know I couldn’t do that!” Other times I hear, “Well, that’s the way we did it in our unit” or “That’s how I was trained!” But none of those are proper defenses to charges that could be applied to your license. You are responsible for knowing the rules that you are required to follow. If you don’t know, you have an obligation to find out.

Even if you think you know, but your thinking is incorrect, you’re still responsible!

Here’s an example. On your license renewal, you are required to answer the question: “Have you been disciplined, reprimanded or terminated in your capacity as a health care provider?” Sometimes nurses omit cases of disciplinary action because they think they’re insignificant. But the Board even considers discipline for errors such as attendance or educational teaching as something for which you must answer that question with a “yes.” No matter how minor or insignificant the form or circumstances of discipline may be, you must disclose them to the Board. Honesty is the best policy when answering these questions.

Another issue arises with the question, “Have you been arrested, charged or convicted of a crime or pled no contest?” Many health care providers think they don’t need to report charges that were dropped or led to no conviction. However, the question is clear: All charges, even if dismissed, must be disclosed.

Accidental violations of general practices can be problematic as well. Here are a few common examples I see. Sometimes one person in a nursing unit, especially on the night shift, prepares all the meds (bagging, getting them ready for the patients) and a different person administers those meds. Although this division of labor saves time, it violates the Five Rights of Medication Administration.

Sometimes when a patient arrives at the ER with abdominal pain, but the physician is too busy at the moment to see that patient, nurses get started right away setting up an IV, getting a flat plate of the abdomen, and drawing labs. However, you cannot begin any of these without a physician’s order.

Sometimes when a patient’s medication is not in the drawer you borrow the same medication from another patient to give to the first on schedule. Even though everyone gets the same medication in the end, administering one patient’s medication to another is considered theft. These examples may seem trivial, but they violate nursing regulations and can land you and your license in trouble.

It’s hard to know what you don’t now. And it may be inconvenient or embarrassing to ask questions about something that you don’t know or don’t know if you don’t know. But when in doubt … ask.  Your license is too important not to. And when you do, be sure you’re asking someone qualified to answer. If you call and ask the Nursing Board, for example, you may find yourself speaking to a clerk who of course can’t be expected to provide the correct answer. Find a trustworthy source you can comfortably confide in and the keep administering the care and love you have for years with your license secure.

Okay, it’s not that drastic. But it’s important to always keep in mind the standards you are held to as a nurse, even on social media.

As much as we’d like to keep our work lives and our private lives separate, the digital age has made distancing these two worlds ever more difficult. Our online presence gives anyone a window into our lives.  Access like this can be dangerous for any professional, especially nurses. Not only are we governed by the usual rules of social etiquette, but we must also keep in mind our license to practice, which is not immune to posts, updates, and photos that occur outside of work. If a complaint is filed for even one online post, the Board may begin an investigation that may reveal additional or even more questionable online behavior. Even online, we must take notice of the consequences of our actions.

This is not to say nurses should avoid social media. We’re modern people. We enjoy blogging about our favorite restaurants, congratulating friends on their successes, and sharing those of our own and our children. My son Jordan just graduated from high school and you better believe I’m going to share my joy and tears on Facebook!

Moments of gratitude, happiness, or even sadness are rarely controversial. These are common human emotions that espouse empathy rather than concern. Problems arise when nurses post about things that may be interpreted differently by others, especially those outside of their immediate community, which may be deemed unprofessional behavior. Yes, even at home or on vacation, the Board may determine you acted unprofessionally. Some examples are:

• crude jokes
• harsh criticism
• profane language
• instances of drug or heavy alcohol use
• anything that directly pertains to work

The basic rule is to never post anything you wouldn’t feel completely comfortable with your boss seeing. Yes, this is a pretty significant restraint on our personal expression, but it’s an unavoidable burden of being a professional. You can still tell those dirty jokes, speak your mind, and swear so much you’d put a sailor to shame, just keep them to private message features or in-person conversations. Don’t put yourself at risk by making them available to the public.

Obviously, we must also keep in mind our duties to patient privacy and/or confidentiality. The line is pretty clear here. Never post anything related to a patient. Even if his or her name is not disclosed, do you really want your current or future employers to think you have anything, but love and care to offer your patients? Impressions matter even if no laws are broken.

So rest easy. You can still tweet, snap, like, share, and post to your heart’s content. And you can use any filter you’d like, even the doggy-face. Just be responsible, use common sense, and remember that your online presence can have consequences on your career.

I am known for saying, “You can always get another job but not another license!”

If you smell the handwriting on the wall, resign.  If you get terminated, on every future job application you will have to disclose that you were terminated.  Otherwise, not to do so is called fraud and material misrepresentation in obtaining a license.

Some nurses will say, “Well, I was there only a short time.”  It does not matter!

In fact, when you sign your employment application, there usually is language saying that you affirm, under penalties of perjury, that the foregoing is true and accurate.  So, when you list your previous jobs and were terminated from any, you are required to truthfully note so.

If you are concerned about resigning or need a little help, one of the services we, at Brown Law Office, provide is what we call a graceful exit.  This is where we ask your employer to allow you to resign because your employer must accept your resignation.  Job applications for a future job could ask if you resigned in lieu of termination in which you must answer honestly.

We also ask that the employer provide you with a neutral reference, not to contest your application for unemployment benefits and not to report you to the licensing board if there is not a statute that requires them to do so.

A graceful exit allows you to smoothly transition from that position into a future job without side effects.

I hope you are never in this situation and are happy where you work.  But, in case you find yourself in that position, just remember to make sure you give the notice that you need to give, make sure that your resignation is accepted and … exit gracefully.

I signed up for Google Alert so that any time there is an article published on the subject of nurse licenses or nursing boards, I get notified.  Unfortunately, I have been very sickened by the articles that they have provided so far.  The last 4 Google Alerts I received are quite disturbing.  I guess there’s a proverbial “bad apple” in every profession but these situations are very troubling.

The first case involved a licensed practical nurse who failed to provide rescue breathing and CPR when a girl’s tracheostomy tube became dislodged resulting in the baby’s death.  This nurse is permanently barred from caring for a patient with an artificial airway in a home health care setting or in any setting without the presence of other licensed personnel.

Click HERE for this article.

Another article blasted the California Board of Nursing due to investigation delays.  A nurse was involved in a case of a toddler’s death.  The nursing board acknowledged the complaint yet she was allowed to practice for 39 months without the nursing board taking action against her license.

Click HERE for this article.

The third case involved a registered nurse who temporarily surrendered his license after being accused of distributing child pornography in New Jersey.  Click HERE for this article.

The fourth case involved another nurse who was found guilty of sexually assaulting patients at 4 D.C. area hospitals.   Click HERE.

What is interesting about the articles that I am reading is that they don’t involve drugs but involve other unfathomable conduct.  While I defend many nurses, I am choosey about what cases I take.

I would love to see more good press about nurses.  Nurses every day are heroes.  Why is the press only publishing the negative?

I have started using the hashtag #nurseheroes so that if you know of a nurse who needs to be celebrated for their great care, as long as it doesn’t violate HIPAA, please share it and let the media know.

There are so many good nurses out there and I am sad to see that these bad nurses are taking the spotlight.  We need to reclaim our profession and show all the good nurses.  Good nursing care should make good news as well.  #nurseheroes.

I’d love to hear your thoughts below.