Boards of nursing have the authority to give a nursing disciplinary action to an RN, LPN, or APRN when a violation of the state nurse practice act is alleged.
The allegation must be investigated and evaluated by evidence presented to the board through documents, testimony, and, in some instances, by an admission by the nurse licensee before any discipline is imposed.
What discipline is imposed will depend on the circumstances of each situation. Whatever the discipline, it is often understood as punitive in nature.
Some boards of nursing have adopted a non-punitive approach when violations of the state nurse practice act and its rules occur.
In the following case, the state board of nursing’s disciplinary decision rests on a restorative rather than punitive ground.
Particulars of the case
The RN, whose primary state of residence was Indiana, was working in Virginia at the time. However, both states were members of the Nurse Licensure Compact.
The RN’s license was to expire shortly, so she applied for the renewal of her license. During the investigation prior to the renewal, it was determined that the RN had falsely represented facts on employment-related documents. Those falsifications included:
- In an employment application in New York, the RN submitted false certifications for required courses and falsely stated she obtained them from a healthcare provider rather than through a fraudulent training program on TikTok.
- During employment with a healthcare entity in California, the RN falsely reported obtaining a required MMR booster vaccine and submitted false documentation to support the vaccination. When she was confronted after giving false statements about the vaccination, her employment was terminated.
- The RN repeatedly provided false information about the MMR vaccinations to Virginia state board investigators during her license renewal process. However, she ultimately admitted to submitting fraudulent documentation and false statements to both the Virginia board and her former employer in California.
Board of nursing decision
In place of an informal hearing on the allegations of providing false information, the RN and the board of nursing agreed to the nursing disciplinary action. The board of nursing order stated:
- The RN is reprimanded.
- Within 60 days from the date of the order, the RN will provide written proof, satisfactory to the board, of the successful completion of courses in ethics and professionalism in nursing, and professional accountability and legal liability for nurses.
- The RN will comply with all laws and regulations governing the practice of nursing in the state.
- Any violation of this order shall constitute grounds for further nursing disciplinary action.
- The order is a matter of public record.
Talking points
Although this RN had a history of falsification of information related to her nursing practice, the board selected to provide an opportunity for her to be accountable for her actions, learn from them, and continue to practice as a nurse in a more legal and ethical manner.
Although the board didn’t specifically name this approach, it can be characterized as grounded in the concept of just culture. The American Nurses Association (ANA) adopted its application to nursing in its 2010 Position Statement.
Used by many healthcare organizations, the concept has also been applied to regulatory entities, including state boards of nursing. The North Carolina Board of Nursing's adoption of just culture is one example.
Under a just culture analysis of behavior, these three behavior types emerge:
- Human error: This is an inadvertent practice issue.
- At-risk behavior: This is where norms of what is acceptable in nursing practice may be overlooked or bypassed.
- Reckless conduct: This is where a nurse knowingly disregards a clear risk of harm to a patient.
Blaming and shaming a nurse licensee for a human error, or even multiple at-risk behaviors, and then imposing a punitive resolution such as license probation or suspension, is rarely effective. This approach offers little, if any, benefit to the nurse’s future behavior and seldom improves patient safety.
In contrast, if the nurse licensee is given a chance to analyze their behavior, accept accountability for actions undertaken, and is educated to avoid such conduct in the future, such an approach benefits not only the nurse but those to whom nursing care is provided by the nurse in the future.
Clearly, allegations of reckless behavior by a nurse in the provision of nursing care or their nursing practice wouldn’t be applicable to a just culture analysis by a board of nursing.
Final thoughts on this nursing disciplinary action
The RN’s motivation for falsifying information and written documents to her former employer and the board is unknown. It is hoped that the chance given to her by the board of nursing eradicates this behavior in the future.
