FALSE ALLEGATIONS BY BOARDS OF NURSING: How a Nurse Advocate Can Help You Defend Your License Successfully.

As a Nurse Advocate who assists nurses in responding to unjust allegations made by their Board of Nursing, I often see nurses falsely or wrongly accused by Boards of Nursing. Any nurse, at any time, may find themselves alleged to have done something they did not do. Or nurses may find themselves what seems to have been excessively punished for a minor error. As a Nurse Advocate, I can help and have helped hundreds of nurses in similar situations where they find themselves falsely accused or over-disciplined

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Board of Nursing charges stem from investigations of complaints filed with the Board. Complaints can be made by anyone. Most often complaints are filed by an employer that has since terminated the nurse. States such as Texas require reporting to the Board if a nurse is terminated for practice reasons or is suspendeded over a certain number of days..

In my experience as a Nurse Advocate, Boards tend to prosecute most complaints, even when they are retaliatory or malicious. This is because the Board’s primary focus is whether the nurse committed the alleged act or not, the Board only wants to know if the nurse did the thing they are accused of doing or not. The Board is less concerned about mitigating factors or the potential for false accusations. The Board’s duty is to protect the public and not the nurse or for that matter the profession of nursing.

Nurses are denied most due process rights and basic constitutional protections during Administrative Law proceedings initiated by Boards of Nursing. Many would be surprised to learn that when nurses face actions threatening their licenses and livelihoods, they are denied fundamental rights, such as the ability to review or know the evidence against them, the right to a jury trial, an impartial and timely hearing, the opportunity to confront their accuser, or protection from Double Jeopardy. In these cases, nurses must defend their licenses with minimal legal safeguards and with the burden of proof being on the nurse. The evidentiary bar is not “clear and convincing evidence” but instead the rather low bar of “more likely than not.” Of course, the, “more likely than not” standard, is completely up to the opinion of the one considering the nurse’s guilt. The process is heavily skewed in favor of the Board, which holds sole subpoena power and often retains exclusive control over the evidence, withholding it from the nurse until the trial stage. This leaves the nurse in the dark about the accuracy and legitimacy of the evidence, such as the contents of medical records, often until years after the initial complaint was filed.

As an Advocate for the nurse, I fight for the Production and Disclosure of the evidence that will contain discoverable evidence such as medical records. This evidence is essential for the nurse to be able to review in order to make an informed rebuttal. There are ways to expedite Production and Discovery even in states that refuse to provide it up until the time of trial. As a Nurse Advocate, I work hard to obtain the evidence for my clients.

Boards often view claims by the nurse of being falsely accused, or set up, as mere attempts to deny responsibility. A former Board of Nursing Investigator once shared with me that during her training, she was instructed to assume that all nurses are guilty and deceitful. While this may sound extreme, my years of experience as a Nurse Advocate, with various State Boards of Nursing have shown that this attitude is not uncommon. One thing is clear: once formal charges are filed against a nurse, the Board's staff and attorneys have already made a firm decision regarding the nurse's guilt and despite the evidence, the law or fact, the Board is very unlikely to back down and take a loss.

Charges against nurses can often be unjust, especially when system errors play a role in the outcome, or when there is retaliation. Nurses frequently face severe disciplinary actions that can significantly hinder their ability to secure future employment. These penalties are often excessive. Even seemingly minor consequences, such as a Warning or Reprimand, typically come with stipulations that limit the nurse's career advancement or employment opportunities. For instance, a minor Warning for a small error may include a requirement for supervision by another nurse—something many employers lack the resources to provide. Additionally, such disciplinary actions often restrict nurses from working in settings other than acute care hospitals, long-term care facilities, or skilled nursing facilities. Licenses are typically restricted to a single state license for the term of the discipline. Nurses may be prohibited from working as travel nurses or agency nurses, in home health, or in telephone triage roles. As a result, even when the infraction is minor and not related to patient care, nurses who receive a Warning or Reprimand, often find themselves unable to find employment in the nursing field due to these restrictive, one-size-fits-all stipulations.

Disturbingly, nursing is the only profession with a publicly searchable database, where any disciplinary action on a nurse’s license is made available. These Formal Orders are posted on a website called NURSYS, managed by the National Council of State Boards of Nursing. They include the Board’s interpretation of the nurse’s alleged violation of the Nurse Practice Act, often in language that is harsh, lengthy, and may not fully reflect the truth. The nurse’s side of the story is reduced to just a few sentences, and typically not in their own words. These records remain on NURSYS indefinitely, except in two states with expungement laws.

Boards of Nursing have no oversight and are at risk for abuse of power. They write their own laws under which nurses must practice, they interpret these laws often differently depending on the facts of the case and they apply the discipline of violating these laws. It would therefore be in the nurse’s best interest to avoid ever having to answer their State Board of Nursing. Here are some tips that may help protect your practice.

• Document Thoroughly: Comprehensive documentation is crucial. However, in some states, nurses may not have access to the EMR until after the Board has filed formal charges. If possible, nurses should request early Production and Discovery of the evidence the Board is relying on. Reviewing this evidence promptly is essential. In my experience, I have often found that the Board was wrong after reviewing the records with client nurses. The documentation frequently shows that the nurse did perform the actions they are accused of neglecting, and confusion often arises because a non-nurse investigator was unable to locate the relevant supporting documentation.

I’ve handled cases where large amounts of Fentanyl were alleged to have been diverted, and the Board took two years to set a trial date. Once the date was set, we requested mediation and reviewed the records. We discovered that every dose of Fentanyl allegedly diverted had been properly documented. The confusion occurred because the patient had passed through multiple levels of care—from the operating room to two different step-down units—and the documentation was fragmented across different records based on the area the patient was in when the doses were administered. In this case, the nurse had all charges dismissed, but only because we thoroughly reviewed the evidence.

• Use the Nursing Process: While many nurses tend to move away from the term "Nursing Process" after graduation, the Boards of Nursing specifically include it in their Nurse Practice Acts, requiring nurses to use this process in patient care. If you ever face the Board, your documentation must provide a detailed and accurate record of your actions. Complaints to the Board can be filed years after the event, meaning your documentation will often be the only evidence of what you did or didn’t do. Nurse Practice Acts emphasize that documentation must be “accurate, thorough, and timely.” Your care should always be based on assessment, leading to a clear and accurate nursing diagnosis. While the diagnosis itself doesn’t always need to be explicitly written, it should be apparent from the documentation that you made the correct nursing diagnosis, developed a plan of care, and implemented appropriate interventions. Regular reassessment should also be evident to avoid a failure to rescue. Nursing must be rooted in ongoing assessment, allowing you to recognize subtle signs of patient deterioration or changes in status and respond accordingly.

• Remember, You Are On the Clock 24/7: Boards of Nursing can investigate incidents that occur in your personal life and charge you with Unprofessional Conduct. For example, I have had clients involved in domestic disputes that were responded to by the police, which then became subjects of Board investigations. In such cases, the Board may require the nurse to undergo extensive psychological evaluations and substance abuse screenings. It is important to always conduct yourself in a manner that upholds professional standards.

• Never Exceed Your Scope of Practice: Nurses are frequently asked to work outside their scope of practice, particularly when "floated" to units specializing in areas where they have little or no experience. Accepting such assignments puts your license at risk, as nurses are held responsible for understanding and staying within their scope of practice. Your scope is defined by your education, training, and experience, and must comply with all applicable laws. Nurses are often held accountable for poor outcomes, even when there are mitigating factors such as unmanageable patient loads. Increasingly, nurses are expected to care for sicker patients, with larger patient assignments per shift. If you believe an assignment is unsafe, it is your duty to speak up and follow the chain of command to seek additional support before accepting it.

• Be Especially Vigilant with Medication Administration: Before leaving the medication dispensing system, always double-check that what you dispensed matches the patient's written order. At the bedside, scan all medications and consistently follow at least the Five Rights of Medication Administration (now expanded to the Ten Rights).

• Waste Controlled Substances Immediately: Always waste controlled substances immediately after preparing them and do so in front of a witness. Document the waste in the Pyxis right away; never delay until later in the shift. Never carry unused controlled substances with you, and never allow someone else to prepare or manage controlled substances on your behalf.

The nurse should be familiar with their state Board of Nursing to help guide and protect their practice. It is not always possible to protect oneself from false or overly harsh charges. If the nurse finds themselves facing unjust charges they should retain a licensing attorney or Nurse Advocate who is experienced with Administrative Law, and Board law as they apply to the practice of nursing, and fight.