In the healthcare field, nurses are the backbone of patient care—selfless, compassionate, and essential. Yet, when accusations arise, many nurses are ensnared in a disciplinary system that feels more punitive than protective. State Boards of Nursing (BONs), tasked with regulating nursing practice and ensuring public safety, often operate in ways that undermine and deny due process, leaving nurses to face a reality starkly different from the principles of fairness and justice they uphold for their patients.
A System Stacked Against Nurses
The disciplinary processes of many BONs are marked by systemic biases that favor the accuser and treat the nurse as guilty until proven innocent. While BONs are meant to safeguard the public from unsafe practitioners, their methods can veer dangerously close to administrative overreach. Complaints—even anonymous or unfounded ones—can trigger investigations that disrupt careers, tarnish reputations, and strain mental health.
Unlike criminal courts, where the accused is presumed innocent, BONs often employ investigative procedures that lack transparency and fairness. Nurses frequently encounter:
- Vague Allegations: Nurses may receive notification of a complaint with little detail, leaving them unsure of the specific incident or evidence against them. A complaint letter may be only a few sentences describing the complaint in an overly broad and vague way. Dates and identifying information may be absent leaving the nurse only to rely on memory of something that may have happened months earlier.
- Limited Legal Protections: Attorneys representing nurses under Administrative Law face significant constraints. They lack subpoena power, limiting their ability to gather critical evidence, and are often unable to address the lack of transparency during the process. Furthermore, attorneys may feel compelled to maintain good working relationships with the Board, potentially limiting their advocacy. When nurses represent themselves, they can communicate directly with the investigator handling their case. They have the right to ask for updates via phone or email and can provide additional information as it becomes available. Building a credible and professional rapport with the investigator can sometimes work in the nurse’s favor, especially when the nurse’s honesty and reliability are evident.
- Lack of Due Process: The burden of proof is on the nurse unlike in criminal matters. The Nurse is denied the right to a jury, the right to a speedy unbiased hearing, the right to face their accuser, the right to know and review the evidence early, in an ongoing manner and to be protected from double jeopardy ( Other states in which the nurse holds a license, can also discipline the nurse for the same offense that occurred in the first state.)
- Prolonged Investigations: Cases can drag on for months or even years, creating professional limbo, financial ruin from attorney fees, and emotional distress.
- Unbalanced Power Dynamics: BON investigators often act as both interrogators and decision-makers, creating a system where impartiality is questionable.
The Board’s Control Over Evidence
The Board is the sole entity with the power to subpoena evidence, such as medical records, facility policies, and witness statements. This authority places the Board in a uniquely advantageous position to shape the narrative of the case. However, the Board often collects only the evidence it deems important, which may exclude information the nurse considers vital or even exculpatory. Nurses defending themselves must be persistent in requesting that the Board subpoena specific evidence, such as security camera footage.
For instance, in one case, a nurse requested video surveillance footage to prove they were not in the medication room at the time of the alleged incident. Despite multiple requests, the Board delayed for five months before issuing a subpoena. By that time, the hospital claimed the footage had been destroyed. This explanation was questionable, as the video had been stored in the cloud and sent to the hospital’s corporate legal department, making it unlikely that it was truly irretrievable. Nevertheless, the Board accepted the hospital’s claim without further investigation, leaving the nurse without critical evidence to support their defense.
The Human Cost of Flawed Procedures
For many nurses, the consequences of BON investigations go far beyond professional discipline. Even baseless complaints can lead to suspension or revocation of licensure, effectively ending a career. The stigma of being investigated—regardless of the outcome—can alienate nurses from colleagues, patients, and future employers.
Moreover, the emotional toll is profound. Nurses report feelings of anxiety, depression, and betrayal. Some even leave the profession altogether, a devastating loss for a healthcare system already grappling with workforce shortages.
Structural Issues Driving Bias
The underlying structure of BONs contributes significantly to the lack of due process. Many boards operate with broad discretion, often guided more by administrative policies than legal standards. Conflicts of interest can arise when BON members—who are frequently not healthcare professionals themselves—bring a lack of knowledge about nursing practice to disciplinary cases.
Additionally, the sole focus on “protecting” patients can lead BONs to adopt a punitive stance rather than one focused on rehabilitation or remediation. Boards of Nursing create their own laws through legislation, they interpret their own laws and they apply sometimes with impunity their own laws. This adversarial approach fosters an environment where nurses feel targeted rather than supported.
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Toward a Fairer System
Addressing the systemic flaws in BON disciplinary processes requires comprehensive reform. Key steps include:
- Ensuring Transparency: Nurses should receive detailed information about complaints and evidence against them, allowing for a fair defense.
- Implementing Timely Resolutions: Prolonged investigations harm nurses and do little to enhance public safety. Clear timelines should be established to resolve cases efficiently. Cases should be reviewed early and evaluated for merit. Those cases that do not have merit should be dismissed early and up front.
- Promoting Impartiality: Independent panels, rather than BON staff or interviewers, should oversee disciplinary conferences to mitigate conflicts of interest.
- Focusing on Remediation: When possible, BONs should prioritize corrective actions—such as additional training or mentorship—over punitive measures.
- Eliminate the Wall of Shame – Nurseys. Accessibility to the Public and Enact Expungement Laws: All Board disciplinary action is published on the National Council of State Boards of Nursing’s, publicly searchable database called Nursys. No other profession subjects its members to such humiliation. The database is necessary to inform potential or actual employers. It is not necessary to have the database open to the public. It also is not fair to have such as minor incidents posted on Nursys forever, instead of only until the disciplinary time has expired and the nurse has met all the stipulations. Nurses pay a heavy price to go through a Board disciplinary action, the collateral damage is often enormous. There should be expungement laws that allow for the expungement of non-serious or felonious actions. Ohio and Alabama have expungement laws.
Conclusion
The current disciplinary framework employed by many State Boards of Nursing fails to uphold the principles of fairness and due process that nurses deserve. While public safety must remain a priority, it cannot come at the expense of justice for those who dedicate their lives to caring for the sick and injured. By addressing systemic biases and implementing meaningful reforms, BONs can strike a balance between accountability and support, fostering a regulatory system that is both fair and effective.
As an advocate I work to create legislation to bring oversight to Boards. With my clients I insist on their being treated with respect and in a just way.