ONE SIZE FITS ALL NURSING BOARD STIPULATIONS: REGARDLESS OF OFFENSE


Why is it boards need to assess career crippling stipulations and post on “walls of shame”, nurses who commit minor violations of the NPA?   

I am thinking of documentation omissions or errors that in no way placed a patient in harm’s way. Documentation errors are one of the most common reasons I see for boards applying orders and stipulations to a nurse’s license.    Currently,  working with an RN who failed to document a few, select areas of the patient’s assessment.  I think we would all agree that there is an abundance of findings on any assessment that could potentially be documented.  Yet, when reported to the board it becomes the “standard” that every relevant, possible parameter gets entered into the record.   

This nurse failed to document a complete assessment for shock though the patient was nowhere near a shock state. The patient presented with the complaint: “I think I have another ruptured ectopic pregnancy.  I almost bled to death last time.” The patient was alert and orientated. She had a non-tender abdomen, no tenderness or peritoneal signs, no back pain, and no spotting or bleeding.  Vital signs were normal. The patient received an ultrasound sound and CT. She did not have an ectopic but was constipated without obstruction.    The nurse failed to document the strength of peripheral pulses, cap refill, skin warmth and did not check vital signs every 15 to 30 minutes. It was also alleged that the patient did not receive an ultrasound or CT for 2 hours from the presentation. The patient had been taken to the radiology department where she waited in holding, staffed by an RN, for 90 minutes.   

The patient complained to Patient Care Services as not receiving the level of care she was expecting and believed consistent with a possible ectopic. The hospital reported the nurse. There were some elements of retaliation likely as the nurse and Unit Manager had experienced conflict.    The board took 6 months to offer proposed orders that were listed as a board CEU course. They did not initially tell the nurse that cookie-cutter stipulations beyond CEUS would also be added with final orders.    When her final orders were received, they also included classic stipulations of loss of compact license and no agency or travel nursing. This nurse has done travel nursing for 8 years. If she signed the orders, she would have to quit her traveling assignment and risk being considered in breach of contract. She also would be highly unlikely to find another job in nursing as her minor cause for charges would be permanently posted on Nursys and the NPDB. Her only hope now is to defend her case at mediation at the Office of Administration Hearings. If that fails, then she will have to proceed to a full administrative hearing or trial to argue her case. Beyond that, her only other chance for justice would be at District Court.  A district court trial would cost more than 25,000.00.   

I fail to understand why such minor cases must be accompanied by the one size fits all stipulations.  There needs to be an arm of the Board of Nursing disciplinary processes that permit for the completion of such as CEUS as the only stipulation in minor cases. Why are nurses who commit minor, documentation errors punished for a lifetime with published orders on two national databanks? Why can there not be individualized, and fair stipulations?

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