Every nurse I have ever represented said, “I am a good nurse.  I never thought I would have to appear before the Board.”  But here they are caught in the administrative quagmire.  There are a myriad of ways a nurse can get in trouble with the Board. I wanted to share common ways I have seen in my practice to put you on alert so you can avoid these issues.  Here are ten possible ways, in no particular order, that might get you in trouble with the Nursing Board.

1. DRUG DIVERSION AND/OR SUBSTANCE ABUSE:

A large percentage of the number of cases that come up before a Board fall into this group.  If you develop a substance use or abuse problem, I suggest contacting your peer assistance program as this is the best way to protect your license.  If you know of someone who needs help, I highly recommend that you insist that your colleague protect their license by also contacting the peer assistance program.  This could save their life and their license.

2. CRIMINAL ACT OR CONDUCT:

This could also relate to drug diversion or substance abuse but sometimes it does not.  It could be an ethical issue that the Board is concerned about for which they would like to take action.  Whether you agree with it or not, the Board views you as a nurse 24/7.

3. SCOPE OF PRACTICE:

This violation occurs when a nurse acts outside the scope of their practice.  It happens when, say, a nurse fails to get a doctor’s order for something.  Many times, it happens when a nurse does something thinking the physician will cover them later and then he/she doesn’t.

4. HIPAA VIOLATION:

This is self-explanatory.  Any time you breach a patient’s confidentiality or have some other HIPAA violation, the Board can take action against you.

5. FRAUDULENT OR FALSIFIED PATIENT CARE OR BILLING RECORD:

It is unfortunate that should you fail to document the administration of a narcotic, the Board seems to believe that you took the medication or, if you didn’t take the medication, then you sold the medication or, in a third hypothesis, if you administered the medication and just forgot to document it, then you are incompetent.  This seems like a no-win situation.

6. FAILURE TO MAINTAIN MINIMUM STANDARD OF NURSING PRACTICE:

Such allegations include incompetence or negligence.  This can include medication errors or failing to identify a change in patient condition.  Sometimes it can even include concerns due to terminations from multiple jobs in a short period of time.

7. RECIPROCAL ACTIONS:

Did you know that if you have an action against your license in another state, you also can have an action in all states in which are or have ever been licensed?  Therefore, it is very important to fight such claim at the outset, even if you no longer practice in that state.  Otherwise, the other states in which you hold a license can take action leaving you with no defense if you resolve the matter in just one state.

8. RENEWAL FRAUD:

If a nurse fills out a license renewal application or an employment application but does not tell the truth, it can be considered fraud and material representation in obtaining a license. This includes omitting jobs from an employment application.

9. FAILURE TO PROPERLY DOCUMENT:

This is when your documentation does not accurately reflect the patient care and services rendered.  Late entries can be a red flag for these types of claims especially if they were not properly made. Sometimes facilities have cameras in the hall and can show that you did not check on the patient as required or only were in the room such a short period of time, you could not have possibly rendered the care you said you did.

10. FAILURE TO ADHERE TO FACILITY POLICIES:

It is very important that you know the policies at your facility.  Facility policies and procedures can change often.  You may have been at one place where, say, it was proper for a nurse to draw blood from a Quentin catheter and then go to another place where it is not acceptable.

By sharing with you these ten areas in which nurses are frequently called before the Board, I hope that you will be on high alert to avoid such situations in your daily practice.

A couple of weeks ago, I shared about a scam taking place against nurses in Idaho and which now has spread to Missouri.  What is happening is that nurses are alerted by a phone call and letter purportedly from the state Board of Nursing telling the nurse that they are being investigated and required them to provide a payment in the form of a bond to keep their license active during the investigation.

The premise on this scam is that someone had used an advanced practice nurse’s NPI number to write prescriptions in another state and that they were under investigation for allegedly trafficking in illegal drugs.

The letter looks official and much of what is in the letter, such as the nurse’s home address, state license number and NPI number, are real.  However, keep in mind that no nurse should be required to pay upfront any monies like a bond for an investigation.

You can confirm your license at www.nursys.com.  It also advised that the nurse could enroll in nurses enotify to receive notifications such as license renewal reminders, verification when the license is renewed and notification of any change to their license or discipline status.

While it is certainly scary that nurses are being scammed, be very cautious if you receive such a phone call or letter from the Board.  It also may be worthwhile to contact an attorney.

Every couple of years, the Nursing Service Organization (“NSO”) publishes a claim report and their most recent one is the 4^th edition and some interesting things surfaced.  Since NSO provides insurance for nursing representation for medical malpractice and for the Board matters, the claims report is split into 2 sections: malpractice defense claims and license defense claims.  You can check out the claims report here.

Of interest is that the number of medical malpractice claims have increased in home care because everything is outpatient these days and more and more patients are being discharged still with acute medical conditions to convalesce at home.

Regarding state Board of Nursing claims, I always knew that substance abuse was not the majority of claims before the Board.  In fact, substance abuse and drug diversion represented 42.3% of professional misconduct matters which accounted for 32.5% of claims.  Therefore, substance abuse and drug diversion was only 42.3% of 32.5% of all claims. Sixteen-point one percent (16.1%) of the 32.5% of all claims involved criminal conduct.  Interestingly for the “most trusted profession,” criminal and drug diversion or substance abuse issues were pretty high.

Six percent (6%) of claims involved reciprocal actions meaning there was an action in one state, so another state took action.  Twenty nine percent (29%) of claims involved provision of services beyond the scope of practice.  This involved nurses making changes to patients’ prescribed treatments or administering medications that had not been prescribed.  Forty-nine-point six percent (49.6%) of documentation matters involved fraudulent or falsified patient care or billing records.  This is so interesting and can include failure to document.

One of the biggest concerns that nurses have is that their license will be suspended or revoked.  Only 1.5% of licenses were revoked.

What also was interesting is that 45.6% of claims that are investigated actually get dismissed.  Just because an investigation is being performed does not necessarily mean that action will be taken against your license.

So, the converse is true.  Approximately 55% of licensed Board matters lead to some type of Board action against a nurse’s license.

Lastly, I hope I get this statistic correct: nurses are approximately 43% more likely to have Board matter rather than a malpractice claim.

It would be nice to see all of these numbers decrease because I truly believe the vast majority of nurses do their best to give excellent patient care with the information, staffing, equipment, supplies, conditions, etc., that they have

I would love to get your thoughts on the claim report.  Please leave your comments below.