Introduction
The authority of Boards of Nursing (BONs) to enforce disciplinary actions across states—known as sister state nursing discipline—is a significant yet controversial power within the realm of nursing regulation. This capability, grounded in both case law and administrative law principles, allows for reciprocal disciplinary measures based on infractions in other states, impacting nurses’ careers nationwide. The justification Boards of Nursing provide for this practice is to prevent nurses from evading disciplinary actions by jumping from state to state. However, this rationale is increasingly flimsy in an era where digital transparency prevails with all disciplined information posted on the internet.
Understanding Sister State Nursing Discipline
The Concept of Sister State Nursing Discipline
Sister state nursing discipline permits one state’s Board of Nursing to impose the same sanctions a nurse may face in another state, effectively preventing nurses from escaping consequences by moving across state lines. This principle may sound like “double jeopardy,” a concept prohibited under the Sixth Amendment in criminal law, yet it persists in administrative law where protections are minimal.
Administrative Law and Its Limitations
Under administrative law, the defendant has very few rights. They do have the right to notification of a complaint and a hearing. They do not have the right to a jury trial, the right to know and review the evidence after it is received, to know and face their accuser, the right to a speedy trial, the right to an attorney, and the right to remain silent. It stretches one’s belief in the American justice system to know that under Administrative Law a nurse may be stripped of her ability to earn an income and further punished by two or more Boards of Nursing, often for allegations that were false or far overstated.
The Role of Nurses in Nursing Discipline
Nurses Overview
Nurses, a comprehensive web-based system managed by the National Council of the State Boards of Nursing, plays a pivotal role in maintaining transparency in the nursing discipline. As a publicly accessible database, Nursys ensures that disciplinary actions are visible to potential employers and the public, preventing any obscured disciplinary histories. Board of Nursing orders are posted on Nursys, and some contain extremely sensitive mental health information that is protected by law in any other forum. Orders remain on Nursys, the wall of shame, forever.
Challenges and Criticisms of Current Practices
Privacy Concerns and Fairness
Despite the intended safety measures, the system faces criticism for potentially overstepping privacy rights and fairness. Nursing disciplinary records, unlike other professions, are detailed publicly through Nursys, offering an overly intrusive view into personal and professional matters. This transparency raises questions about the balance between public safety and individual rights, scrutinizing whether current practices under Boards of Nursing are justifiably fair.
Impact on Nurses’ Careers
The public nature of Nursys records can have long-term impacts on nurses’ careers, with disciplinary actions following them even if they are minor or unsubstantiated. This creates a climate of fear and uncertainty, as nurses may be punished repeatedly for the same offense, undermining their ability to continue practicing.
Legal Strategies and Hope for Nurses
Retiring a License
For nurses facing disciplinary actions in multiple states, certain legal strategies have proven effective. A common strategy involves “retiring” one’s license in the affected state—though it’s important to note this approach may not be feasible in every state due to varying regulations on license retirement. The most effective strategy for safeguarding against sister state disciplinary actions by multiple state Nursing Boards is to retire your unused nursing licenses. Simply having non-active or expired licenses is inadequate, as Boards of Nursing retain the authority to impose disciplinary measures on nurses in these states.
Case Study: Illinois
One illustrative case occurred in Illinois where the charges against a nurse were set to be addressed in a trial conducted via Zoom. On the morning of the trial, when the judge inquired if the Board’s attorney was prepared to proceed, the attorney confirmed that the matter had been resolved: The nurse had retired her license and the charges were subsequently dismissed. This case exemplifies how strategic actions can prevent the duplication of disciplinary orders across states, avoiding multiple entries in the Nursys database for the same violation.
Negotiating with Sister State Boards of Nursing
Challenges in Negotiations
When the option to retire a nursing license is unavailable or not accepted, it becomes crucial to challenge the assumptions of sister state Boards of Nursing. It is important to argue that these boards may not have a complete understanding of the case details. The state that originally filed the charges has conducted a thorough investigation and, based on all available facts, determined the most appropriate level of discipline. A sister state, lacking this comprehensive insight, should not impose harsher penalties than those decided by the original state.
Financial Motivations and Compliance Requirements
Negotiations with sister state boards can be challenging, often complicated by financial motivations, as evidenced by excessively high fines I’ve observed, such as those in California which can reach tens of thousands of dollars. Furthermore, it is not uncommon for sister state boards to mandate that a nurse must work within their state to comply with disciplinary orders, a stipulation that can be impractical or impossible. This is particularly true for nurses who only practiced in the sister state on a temporary travel assignment and whose primary residence is across the country.
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Mediation and Legal Proceedings
State Office of Administrative Hearings (SOAH)
Resolving these intricate issues often requires careful negotiation, sometimes extending to proceedings such as mediation through a State Office of Administrative Hearings (SOAH). It is vital to recognize that this is a mediation process, not a trial, offering a platform for pre-trial resolution. However, it should be noted that not all states offer SOAH mediation, with Alabama being one example where this option is absent.
Conclusion
As digital oversight becomes more prevalent, the justification for strict inter-state disciplinary practices by Boards of Nursing appears increasingly debatable. A re-evaluation of these practices could lead to a fairer adjudication process for nursing professionals, aligning disciplinary actions more closely with constitutional protections and ethical considerations.
Board Action
FAQs
- What is sister state nursing discipline? Sister state nursing discipline allows one state’s Board of Nursing to impose the same sanctions a nurse may face in another state, preventing nurses from escaping consequences by moving across state lines.
- How does Nurses impact nursing discipline? Nurses, managed by the National Council of the State Boards of Nursing, is a publicly accessible database that maintains transparency in nursing discipline by ensuring disciplinary actions are visible to potential employers and the public.
- What are the criticisms of current nursing disciplinary practices? Current practices face criticism for potentially overstepping privacy rights and fairness, as nursing disciplinary records are detailed publicly, offering an overly intrusive view into personal and professional matters.
- What legal strategies can nurses use against sister state disciplinary actions? One effective strategy is retiring one’s license in the affected state, though it’s not feasible in every state. Challenging the assumptions of sister state Boards of Nursing and negotiating for fairer outcomes are also crucial strategies.
- What is the role of mediation in nursing disciplinary cases? Mediation, through a State Office of Administrative Hearings (SOAH), offers a platform for pre-trial resolution of disciplinary issues. However, not all states offer SOAH mediation.
- Why is the concept of double jeopardy relevant in nursing discipline? The practice of imposing multiple disciplinary actions for the same infraction across different states represents a violation of the Sixth Amendment’s protection against double jeopardy in criminal law, highlighting a need for reform in nursing regulations.