Introduction
Your nursing license is more than just a professional credential—it is the foundation of your career and a testament to your commitment to care and professionalism. Your license is also a privilege. It is given to the nurse by the Board of Nursing under the conditions that the Nurse practice in adherence to their State Nurse Practice Act, and the Board’s Rules, Regulations, Scope of Practice and Laws. However, the healthcare field comes with inherent risks, and accusations or complaints against your license can arise, sometimes unfairly. Whether the issue is related to patient care, documentation errors, alleged misconduct, or even conduct off the clock, these challenges can put your career and reputation at stake.
It is true that nurse make mistakes all the time. We all make mistakes, so why do some nurses find themselves being investigated by the their Board of Nursing for a medication error and so any do not? The sole reason a nurse finds themselves before the Board is because they have been reported. The Board has no other regulatory authority. The Board cannot act against a nurse unless there has been a complaint.
Defending your nursing license can feel overwhelming, but it’s important to remember that you don’t have to face it alone. We as Nurse Advocates come alongside nurses who are facing Board allegations and offer assistance with responding to the Board and building a robust defence. Our mission is to support nurses during these critical times, ensuring you are prepared and heard.
Common Challenges Nurses Face:
Complaints to nursing boards can arise from a variety of situations. Common accusations include:
- Allegations of patient neglect or harm.
- Medication administration errors.
- Documentation discrepancies.
- Unprofessional conduct or boundary issues.
- Impairment due to substance use.
While some complaints are based on legitimate concerns, many are rooted in misunderstandings, false allegations, or systemic issues within healthcare organizations. Even when a complaint is clearly retaliatory, the Board will still investigate it. They also pursue and charge complaints stemming from systemic failures or assignments that were excessively burdensome and unsafe. When nurses face false accusations or overly severe charges, having support is crucial to navigating the process effectively. As Nurse Advocates, we provide that essential support and assistance in defending against unjust allegations.
Understanding the Nursing Board Disciplinary Process
The process of defending your license begins when a complaint is filed with your state’s board of nursing. Each board has its own procedures, but the general process includes:
- Notification: The board informs you of the complaint and requests a response.
- Opportunity to Respond: Boards of Nursing typically allow nurses the opportunity to respond in writing to allegations. However, under Administrative Law, the Board is not obligated to provide the nurse with the evidence it relied upon in formulating the allegations. In some states, such as Texas, the Board may provide an investigative file, excluding materials deemed non-discoverable. For example, in Texas, complaints and witness statements are not discoverable, while in other states, they might be. In most states, evidence such as the medical records, are withheld until the trial stage, which can take several years to reach.
As a result, nurses are often forced to prepare their defense without access to critical facts, such as the contents of medical records, leaving them at a significant disadvantage. Memory alone is insufficient to craft a comprehensive response to Board allegations, especially when the events in question occurred long ago.
As Nurse Advocates, we employ various strategies to address this denial of access to evidence, ensuring that nurses can build a well-informed defense despite these challenges.
- Interview: Some Boards request an in person or telephone interview. The interview is meant for the Investigator to gather your side of the story and to gain information they wish answers to. As Nurse Advocate, we prepare our nurse clients thoroughly for an interview so that they feel confident.
- Investigation: The board investigates the complaint, gathering evidence from all parties involved. The Board will subpoena relevant medical records, policies and procedures, and often subpoenas the nurse’s personnel file from the current and past employers. Also solicited by the Board is witness statements. The Board alone has subpoena power. The nurse may want certain evidence obtained such as video surveillance footage. The nurse has the right to request the Board subpoena evidence they believe is relevant and possibly even exculpatory.
- Mediation: Separate from the Board of Nursing, the State Office of Administrative Hearings (SOAH) serves as the venue for formal hearings or trials, offering nurses an impartial platform to present their case. In addition to formal hearings, SOAH provides pre-trial mediation, also known as Alternative Dispute Resolution. Mediation is an informal process where both parties meet with an Administrative Law Judge trained in mediation.
Mediation is often highly beneficial for nurses, as it provides their first opportunity to share their full story. During this process, the nurse can present a comprehensive defense, explaining to the mediator why the proposed disciplinary action is unjust or inconsistent with their conduct. Before mediation, the nurse is typically allowed to review evidence, such as medical records, which often support their innocence. In mediation, the nurse can present these records directly to the mediator as proof, strengthening their case and demonstrating why the disciplinary measures may be unwarranted.
Hearing: If a complaint proceeds, a formal hearing—essentially a trial—may be held to determine the outcome. Nurses often face significant disadvantages in administrative trials, as the process is heavily skewed against them and offers limited due process rights. Typically, nurses are not allowed to view any evidence until a hearing or mediation is scheduled at the State Office of Administrative Hearings (SOAH). Once the hearing is docketed, discovery begins, requiring the Board to produce the requested evidence, which is crucial for the nurse’s trial preparation.
During the hearing, the Board may call on retained expert witnesses to testify against the nurse, along with former supervisors or peers. Nurses rarely have the resources to match the caliber or number of experts presented by the Board, as hiring such experts is prohibitively expensive. The Board, with its substantial funding, holds a clear financial advantage.
Even if the Administrative Law Judge (ALJ) rules in favor of the nurse, the Board is not obligated to accept the decision. The ALJ provides only a “Proposed Decision,” which the Board can choose to adopt, modify, or reject entirely—except in specific cases where the decision pertains strictly to matters of law or fact.
Steps to Defend Your License
To effectively defend your license, follow these key steps:
- Stay Calm: A Board letter of complaint will arrive as a Certified letter that usually arrives on a Saturday. A few Boards of Nursing now notify through email and their Nursing Portal. It is important not to panic. Complaint letters are overly broad and vague and can be frightening and difficult to understand. DO NOT CALL THE BOARD. Best thing to do is call us. Some one will always be available day, night, or weekend to help you understand what the letter is specifically saying, and what the next steps are. We will be here to support you and guide you.
Our Role in Supporting Nurses
While we do not practice law or provide legal advice, we offer invaluable support to nurses navigating these challenges. Our services include:
- Listening and Guidance: We provide a compassionate ear and help you understand your options.
- Défense Preparation: Assisting with responding to Board letters, obtaining discovery, organizing documentation, and crafting your defence.
- Advocacy: Pushing for fair and transparent processes within nursing boards and advocating for legislative oversight.
We believe far too many nurses are unfairly accused or overcharged by boards of nursing. It is our mission to change this narrative and ensure nurses receive the support they deserve.
Addressing Broader Systemic Issues
Beyond individual cases, we advocate for systemic changes to how nursing boards operate. Boards lack oversight, which can lead to inconsistent and sometimes biased decision-making and an abuse of power. We work to bring attention to these issues at the legislative level, advocating for reforms that promote fairness and accountability.
Conclusion
Facing a complaint against your nursing license can be one of the most challenging experiences of your career. However, you don’t have to go through it alone. With the right support, preparation, and advocacy, you can navigate this process and protect your career.
We are here to help you navigate this challenge by providing guidance, support, and a steadfast commitment to ensuring fairness in nursing board processes. Your license is more than just a testament to your qualifications—it reflects your dedication to your profession and your patients.
Our approach is unique and highly effective. We utilize a nursing-focused perspective, incorporating peer-reviewed, evidence-based literature to counter unfounded board allegations or address claims that lack an understanding of nursing practices and standards. This strategy ensures that your defense is both credible and rooted in the realities of nursing.