Initial Review of Complaint
The first consideration in reviewing a complaint from a member of the public or a health care facility is whether the board of nursing (BON) has jurisdiction (the authority to enforce laws or pronounce legal judgments) over the particular person and the particular action. A quick check of the BON license database will confirm whether the individual is licensed in that jurisdiction. The second consideration is whether the act is one which is governed by the state nurse practice act. Typical examples of actions which are regulated by nurse practice acts are those that are practice related, drug related, boundary violations, sexual misconduct, abuse and fraud.
Issues which are not within the authority of the BON include the following: interpersonal conflicts, rudeness or impolite behavior, employee-employer relations, labor issues, fee or billing disputes, complaints against health care practitioners who are not nurses, complaints against health care facilities, clinics, or agency operations.
The BON is called into action when there is an alleged violation of the state's nurse practice act. Disciplinary cases are often grouped into the following categories.
- Practice related
- Drug related
- Boundary violations
- Sexual misconduct
- Positive criminal background checks
Practice related cases involve some breach in the standard of nursing care provided to one or more clients. They involve breakdowns or errors during aspects of the nursing process. Types of cases include:
- Failure to assess changes of condition
- Failure to implement appropriate or ordered interventions
- Failure to accurately document assessment information or nursing care provided
- Failure to follow the “Five Rights” of drug administration (right patient, right time/frequency, right dose, right route of administration and right drug)
Drug related cases result when nurses mishandle and/or misuse controlled substances. Types of cases include:
- Misappropriation of medications intended for clients
- Fail to document or falsely document that medications were administered to clients
- Engagement in intemperate use of medications causing impairment
- Attempt to obtain drugs by communicating or presenting unauthorized prescriptions to pharmacies
Boundary violation cases are recognized by non therapeutic relationships that are formed between a nurse and a client in which the nurse derives a benefit at the client’s expense. Compared to boundary crossings in which the roles are blurred without gain to the nurse, boundary violation cases demonstrate an over-extension of the therapeutic relationship into the realm of personal profit on the nurse’s part. Examples of boundary violations include:
- Sharing stories of personal challenges to entice gifts or money from clients
- Establishing gratifying personal relationships with current or former clients
Physical or sexual abuse cases occur when nurses subject clients to inappropriate physical or sexual contact, by either touching their patients sexually or causing patients to touch the nurse sexually. Such cases may be purely abusive in nature or may be a boundary violation extending from an unhealthy nurse-patient relationship.
Abuse cases are characterized by maltreatment of clients or the public which is physically, mentally and/or emotionally harmful. Common types of abuse cases include:
- Verbal assailments
Fraud cases have the unique trait of misrepresentation of the truth for gain or profit. These cases are widely varied. Types of fraud cases include:
- Overstatement of credentials or experience
- Claiming unworked hours or visits on payroll
- Falsely documenting care or procedures when related to payments
- Submitting inaccurate billing records to defraud insurance companies
Positive criminal background check cases vary in different jurisdictions based upon different definitions of what constitutes reportable criminal conduct, the potential risks to the patients and the effect on licensure. One concept that is universal though is that clients may be placed at risk of future harm from conduct related to, associated with or as an extension of past criminal activities. To safeguard the public, agencies establish licensure consequences based on a combination of the degree and severity of the past criminal conduct and the nurse’s risk to patients from similar, future lapses in good judgment.