Nursing Disciplinary Action Explained
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How does nursing disciplinary action work? What are the types of disciplinary actions? This guide answers your questions about complaints against nurses and how they are resolved.
Nurses are trained to always be mindful of safety and professional ethics. They are one of the most trusted professions in the country because of their high standards. This guide to nursing disciplinary action explains what happens after a professional lapse.
Almost all nursing misconduct is addressed through nursing disciplinary action from the state board of nursing or civil lawsuits. This is why the RaDonda Vaught case, which resulted in criminal charges from a medical mistake, drew national attention from nurses and nursing organizations. Many nurses protested and even quit after she was found guilty, alarmed at the criminalization of medical mistakes.
What Is Nursing Disciplinary Action?
According to the National Council of State Boards of Nursing (NCSBN), nursing disciplinary action "affects the nurse's licensure status and ability to practice nursing." Because state boards are in charge of licensing, they are also responsible for investigating complaints. While nursing mistakes or misconduct may lead to other consequences, such as employer reprimands, terminations, civil suits, or criminal charges, nurse disciplinary action directly affects a nurse's license.
In addition to suspending or revoking a nursing license, state boards of nursing may issue fines or warnings and possibly require a nurse to complete professional education as part of their nursing disciplinary action.
How Common Are Nursing Disciplinary Actions?
In 2021, there were 18,145 adverse actions against nursing licenses, according to the National Practitioner Data Bank (NPDB), affecting 140,859 nurses, 93,998 licensed practical nurses, and 9,002 nurse practitioners.
According to the NCSBN, this represents less than 1% of all nursing licenses.
What Is the Nursing Disciplinary Process?
Nursing disciplinary action consists of six separate phases.
Filing a Complaint
Any person with knowledge of a violation of the state's nurse practice act, unethical behavior, or behavior that either endangers a patient or represents a potential danger to patients can file a complaint with the state board of nursing.
Other healthcare professionals are mandatory reporters, meaning they must report violations. If they do not, that is grounds for a complaint against their license. Nurses may also report themselves. (One of the reasons many nurses protested the ReDonda Vaught trial and verdict is that they feared it would have an effect on self-reporting or reporting colleagues.)
Criminal convictions also trigger a review.
During the review, the state board of nursing first decides if the complaint falls under nursing disciplinary actions, that is, if it violates the nurse practice act for that state. This does not yet determine if the complaint is valid, just whether the board of nursing has jurisdiction.
The investigation process depends on the nature and seriousness of the complaint. It may involve interviews with the nurse, patients, and witnesses; asking for a written response; and reviews of documentation and other evidence. Investigations may take several months depending on the case.
After the investigation, the board of nursing may decide to close the case if the complaint was found to be not valid. It may also proceed by holding a settlement conference or hearing. It may also result in filing formal charges or assigning the nurse to an alternative-to-discipline program.
Nurse disciplinary actions include fines, reprimands, or remedial action (such as completing mandatory education). It also includes restriction of a license where a nurse can continue practicing but under specific conditions, suspension of a license where a nurse can continue practicing after a set period of time, or the permanent loss of a license.
Reporting and Enforcement
The state board of nursing must report the results of any nursing disciplinary action to Nursys, the national database of nursing licenses and license status, and to the NPDB. The NPDB tracks data about licensing actions and malpractice suits for all healthcare professionals.
What Are the Most Common Reasons for Nursing Disciplinary Action?
Complaints fall into the following categories:
- Failing to follow nursing practice
- Substance misuse
- Sexual misconduct (such as engaging in sexual relationships with patients)
- Boundary violations (such as soliciting or accepting monetary or valuable gifts)
- Abuse of patients (either physically or verbally)
- Positive criminal background checks
According to the CNA and NSO Nurse Professional Liability Exposure Claim Report, published in 2020, the most common allegations are the following:
- Professional conduct (32.5% of all primary allegations)
- Scope of practice violation (24.8%)
- Documentation errors or omissions account (9.7%)
- Treatment and care failures (9.3%)
- Abuse of patients (8.8%)
- Medication administration (6.2%)
Drug diversion or substance misuse made up 42.3% of all professional conduct alleged violations, and failure to maintain standards accounted for 58.9% of all scope of practice violations allegations.
The best defense is to know and follow your states nurse practice act and discuss questions with a supervisor. For example, while accepting valuable presents or money from a current or past patient is against nurse practice acts, most nurses dont want to hurt a patients feelings if they're offered a small personal gift of little financial value. Knowing exactly where to draw the line can help you respond.
What Are the Most Common Forms of Nursing Disciplinary Action?
Nursing disciplinary action may include:
- Probation (The nurse may continue to practice, but any further validated complaints will result in more serious nursing disciplinary action.)
- Limited or restricted practice (The nurse may continue to practice but under restrictions, such as not being able to access controlled substances.)
- Suspended practice (loss of license for a specific period)
- License revocation (complete loss of license)
- Mandatory remedial education
Nurses may and often do get a lawyer during nursing disciplinary action, especially if the potential action includes a suspended or revoked license.
Frequently Asked Questions About Nursing Disciplinary Action
What is the most common reason that nurses are disciplined by the state board of nursing?
According to the CNA and NSO Nurse Professional Liability Exposure Claim Report, the most common reason for allegations is professional conduct violation (32.5% of all primary allegations) followed by scope of practice violation (24.8%).
Documentation errors or omissions account for another 9.7% and treatment and care failures for 9.3%.
How common is it for nurses to have their license revoked or suspended?
Nursing disciplinary action that includes license suspension or revocation is rare. According to the NCSBN, each year less than 1% of nurses have any adverse action taken against their licenses. According to the NPDB, there were 18,145 adverse actions against nursing licenses in 2021, while there are more than 3.8 registered nurses alone.
What can nurses do if they receive disciplinary action?
Nurses can get legal counsel at any stage of nursing disciplinary action, from the initial complaint through the board's actions. Some law firms specialize in medical disciplinary actions.
Nurses can also appeal nursing disciplinary actions and, depending on the specific action, may later appeal for restoration of a revoked license.
What are nursing fines or civil penalties?
Nursing disciplinary action can include fines or civil penalties. Fines or civil penalties apply to several violations, but they are common in cases where a nurse committed fraud or otherwise gained financially from their violation.
Nurses must also pay for any remedial requirements (such as mandatory education) or substance misuse treatment.
- Kelman B, et al. (2022). Why nurses are raging and quitting after the RaDonda Vaught verdict.
- NCSBN board action. (n.d.).
- NPDB analysis tool. (n.d.).
- Nurse profesionial liability exposure claim report. (2020).
- Saad L. (2022). Military brass, judges among professions at new image lows.
- Nursing fact sheet. (2019).
Page last reviewed April 24, 2022
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