By: Anna Giorgi
What you need to know about nursing board investigations
Nursing board investigations are formal processes in which a state’s nursing regulatory board, or nursing board, examines complaints or allegations against a nurse’s conduct, performance, or adherence to nursing laws or ethical standards. These processes can be stressful and intense with consequences that can range from fines to the loss of your nursing license for severe violations. Here is what you need to know about nursing board investigations in case you are ever named in one.
Sources of nursing board investigations
A nursing board investigation can be initiated by a complaint or allegation filed with the state board of nursing. It can be presented by a patient, a patient’s family members, other nurses, coworkers, an organization or anyone who believes a registered nurse (RN) or licensed practical nurse (LPN) may have violated the state’s Nurse Practice Act (NPA) or related state or federal law. A state’s NPA grants the state’s board of nursing authority to oversee all disciplinary and administrative aspects of nursing. The complaint or allegation must be made in the state where the alleged action occurred.
Common reasons for nursing board investigations
A nursing board may investigate a nurse for many reasons that can be grouped into the following categories:
- Practice-related cases:
- Practice-related cases include actions that involve inappropriate behavior such as incompetence, breach of a standard of nursing care, acting outside the scope of nursing practice, privacy violations or the failure to implement appropriate or ordered interventions.
- Drug-related:
- Drug-related cases involve the mishandling or misuse of controlled substances such as the misappropriation of drugs intended for patients, failure to properly document drugs or trying to get drugs by using unauthorized prescriptions.
- Boundary violations:
- Boundary violations involve non-therapeutic relationships in which nurses gain personal profit, such as money or valuable gifts, from current or former patients.
- Abuse:
- Abuse cases involve maltreatment of patients by nurses who inflict physical, mental and/or emotional harm.
- Fraud:
- Fraud cases can include misrepresenting nursing credentials, falsely documenting care when related to payments or submitting false billing records to defraud insurance companies.
- Positive criminal background check:
- These cases include actions involving reportable criminal conduct based on the laws of the jurisdiction in which the nurse works.
- Self-reporting:
- Nurses are often required to report certain offenses themselves, such as drug/alcohol issues or criminal convictions.
According to a report by the Nurses Service Organization (NSO), the most common types of allegations leading to board of nursing investigations in 2020 involved professional conduct, primarily drug diversion and/or substance abuse. Professional misconduct toward coworkers or patients ranked as the second most common cause, followed by allegations of reciprocal actions, often involving nurses responding inappropriately to violent or aggressive patients.
The investigation process
Since board investigations are handled by state agencies, the exact processes involved may vary. Less severe issues may hold lower priority, so there may be delays between the date a complaint or allegation is placed and the investigation. Every case is unique in the factors that impact its timing and handling. “Depending on the nature of the case and the board’s caseload, the time could range from a few weeks to a few months to over one year,” says the National Council of State Boards of Nursing (NCSBN).
The typical nursing board investigation process includes:
Initial review:
The board of nursing assesses an allegation or complaint to determine whether there’s enough evidence to warrant an investigation. The board also determines whether it has jurisdiction over the alleged action. A board of nursing does not regulate issues such as interpersonal conflicts, labor disputes, employee-employer relations, billing disputes or complaints against healthcare facilities or agencies.
Formal investigation:
If the board determines that the complaint or allegation relates to nursing practice, a board-appointed investigator is assigned to initiate an investigation. During the investigation, you may be asked to provide a written statement or documentation. You and/or potential witnesses may be asked to participate in interviews with investigators. You may also have to submit medical records, training certificates or other forms of documentation related to the complaint or allegation. In some states, your nursing license may be labeled as being “under investigation” on the board of nursing website.
Board proceedings:
After the board of nursing completes an investigation, its members decide whether to close the case without further action or initiate one of the following proceedings. Settlement conference: A settlement conference is held when an investigation finds evidence to prove one or more violations of the state’s Nurse Practice Act. In a settlement conference, you and the board of nursing agree to the terms and type of disciplinary action that will occur. Administrative hearing: An administrative hearing is a formal proceeding that is set if the board of nursing finds there is probable cause for a violation. The administrative hearing is conducted like a trial where you must defend yourself against charges presented by the board. An administrative judge presides over the hearing and makes the final decision about the complaint or allegation.
Board actions
The board actions taken in your case depend on the nature and severity of your violation. These actions can include:
- Emergency actions:
- Emergency actions involve a swift and immediate suspension of a nurse’s license. This type of action is applied when the board has clear and convincing evidence that allowing the accused nurse to continue to practice would pose a threat of serious harm to the public. Emergency actions do not negate the nurse’s right to due process. The board of nursing is still obligated to perform a full investigation, which may result in reinstatement of the license, permanent revocation or other disciplinary actions.
- Disciplinary actions:
- The types of disciplinary actions that result from a nursing board investigation vary by state law. None are to be taken lightly. According to the NCSBN guidance on disciplinary actions, “Although terminology may differ, board disciplinary action affects the nurse’s licensure status and ability to practice nursing in the jurisdiction.”
Disciplinary actions can include one or more of the following:
• Dismissal of the complaint: This action is taken if no grounds are found for the complaint or accusation.
• Monetary fine: This action may be linked to other disciplinary actions, depending on the nature of the violation.
• Remediation: Remediation involves completing specific educational content or exercises specific to the violation. - Public reprimand:
- A reprimand is a formal warning without further disciplinary action. It is usually applied for minor violations.
- Probation:
- The conditions of probation can vary. You may be allowed to continue working while under probation, though you may have to participate in additional supervision or education.
- Limitation of nursing duties:
- This type of action may restrict your ability to perform certain aspects of nursing practice during a probationary period.
- Suspension:
- Suspension results in the temporary removal of your nursing license for a certain period
- Revocation:
- Revocation is the permanent loss of your nursing license. However, some states may allow you to reapply for a nursing license after a set period, though the revocation remains part of your record.
- Alternative to discipline (ATD) programs:
- Alternative to discipline programs are voluntary, non-public and non-disciplinary programs for certain violations, especially substance use disorders. In some states, they may be offered as remediation programs in which nurses can improve clinical knowledge, skills or abilities.
Your rights in a nursing board investigation
In a nursing board investigation, state law governs. Your rights are primarily determined by the Nurse Practice Act in the state where the investigation is conducted. Each state’s NPA is enforced and interpreted by its respective board of nursing.
While the board of nursing has an obligation to investigate and resolve allegations against nurses to protect the public, this regulatory body must also ensure that the legally mandated due process is followed in each case.
Your rights in a nursing board investigation typically include:
- Right to legal representation: You have a right to hire an attorney to represent you during the investigation and hearings. They can help you navigate the process, understand your rights and protect your interests during the entire process.
- Right to due process: You have the right to be informed of the specific allegations against you and to prepare a defense. This typically includes the right to provide evidence and witnesses to support your claims. In formal proceedings, you or your legal representative can cross-examine witnesses presented by the board of nursing.
- Right to confidentiality: In some cases, you may have the right to a confidential investigation until a decision is reached, but this varies by state and case.
- Right to appeal: You have the right to appeal the decision if the nursing board decides to take disciplinary action.
How to protect yourself during a nursing board investigation
- Consult with legal representation:
- Don’t overestimate your ability to manage the nursing board investigation alone, even if you’re sure you are innocent of the charges. The outcomes of a nursing board investigation can impact your personal life and career options, so don’t treat a nursing board investigation lightly. To protect your interests, choose a lawyer experienced in handling nursing board investigations in the state where the alleged violation occurred.
- Cooperate thoughtfully:
- Work with an attorney to formulate a strategy for responding to requests for statements or documents thoughtfully and cooperatively without jeopardizing your case.
- Document everything:
- Keep detailed records of any interactions, incidents or complaints that led to the action being investigated.
- Remain professional:
- It’s easy to get caught up in the intense emotions involved in a nursing board investigation. Work to remain professional in your interactions with the board of nursing. Do not discuss the details of your investigation with coworkers, patients, or others outside your legal team.
- Prioritize self-care:
- A nursing board investigation can be a lengthy and complex process. Even if you have not done anything wrong, you’re likely to find the process physically and emotionally draining. Take the steps necessary to maintain your well-being so you can weather the challenges without risking your personal health.
What to expect after a nursing board investigation
In most states, nursing board disciplinary actions are a matter of public record and will be available to the public through the state nursing board website or other official resources. This information typically includes details about the violation and the disciplinary actions imposed.
Disciplinary actions against nurses are also reported to national databases such as the National Practitioner Data Bank (NPDB) and Nursys by the NCSBN, a national nurse licensure and disciplinary database. Healthcare facilities can access this information when verifying a nurse’s licensing credentials for employment.
Disciplinary action on your license can remain visible indefinitely. However, depending on the details of the case, the severity of the violation and state regulations, some types of disciplinary actions may be expunged after a specified period. Make sure you understand how disciplinary actions against you will be reflected on your nursing record and the impact it may have on your present and future employment.
