Nurses, like other licensed professionals, have a regulatory body to ensure that they are practicing within the scope of their license. Nursing regulatory bodies (NRBs) are responsible for determining that an applicant for a license and a license holder has the necessary competency to perform that scope.
The primary role of an NRB is to ensure public protection. Licenses issued by an NRB assure the public that the nurse has met the standards that qualify them to provide care to the people in their communities. The authority for NRBs to regulate and enforce is granted by the Nurse Practice Act (NPA). Each state has its own NPA that defines the scope of nursing practice within that state. Each state develops rules and regulations consistent with the statute to provide clarification and specificity for the NPA. Both the NPA and the accompanying administrative rules are treated as law and are used to regulate nurse conduct.
Nursing regulatory bodies have the legal authority to discipline a nursing licensee who violates the NPA or the administrative rules. Although the NRB must adhere to the law, each complaint about a licensee is considered individually on its own merits. Based on their evaluation of a complaint against a nurse, the board may render a wide range of decisions from no discipline to licensure revocation. The language in NPAs and rules varies across states, but generally, you will find a reference to standards of professional accountability. Every nurse is responsible for knowing and understanding these regulations.
While helping and protecting patients is the job of every nurse, they also have to be able to defend themselves. Education and compliance paperwork are the hallmarks of professional responsibility and will assist you in making sure you and your license to practice are as safe as possible. Below, we have listed some significant components of ensuring your license is protected and how to implement them.
Know your State’s NPA, Rules, and Regulations
Every nurse is expected to know and understand the NPA and the rules in the state(s) where they are licensed and providing care, including electronically. If you are subject to an investigation or are called before a board of nursing, you cannot cite a lack of knowledge of state practice regulation to justify your actions. You will also not be able to explain your actions based on the activities of other practices. It is your license to protect, not anyone else’s. Since this is the regulatory standard to which you are being held, you must know your scope of practice and the state’s expectations of your professional behavior to be in compliance and to protect your license.
Use a Decision-Making Process
Use a process or algorithm to guide your safe actions while caring for patients in all circumstances. Many state nursing boards may even provide one for you. The first step in this tool should be to determine whether nursing regulations prohibit an activity. Knowing the regulatory provisions in the state where the care is being provided is essential to using this framework tool and benefiting from its direction. These tools will include a question considering how a reasonable and prudent nurse would act. You will likely be asked about your decision-making process if a complaint is made against your license. So, using a framework, especially if your state provides one, is essential to determine what care to deliver and when.
Documentation is your best friend. When nursing boards, medical management, or a legal team is searching through a patient’s file to discover how an injury or death occurred, they will look at everything charted. If pieces are missing, then the nurse could be held liable. You want to make sure that your charts, policies, and procedures demonstrate that you are following industry and medical standards. If an investigation or bad outcome occurs, the better your documentation is, the more your license is protected. If it’s not charted, it didn’t happen. The more consistently you follow industry and your clinic protocols, the more you can show you acted appropriately. A signed patient consent gives evidence the patient knew the risk of the procedure and was informed. Nurses will generally be safe from repercussions if it’s recorded that they followed orders, caught mistakes, expressed concerns, fought for their patients, and were attentive.
As essential as knowing your state’s regulations is understanding your state-specific scope of practice. A nurse’s scope to perform procedures can vary significantly from state to state and depend on the nurse’s training and experience. Clear answers can be hard to find and dictated by several regulatory agencies (Board of Medicine, Board of Nursing, Board of Pharmacy, Board of Cosmetology, among others). Before you perform a procedure, ensure that the procedure is within your scope. Remember, nurses can not diagnose and cannot prescribe treatments and must work under the order of an MD, NP, or PA to perform medical treatments.
One of the best ways to protect your license is to invest in professional liability insurance for nurses. Professional liability insurance can also be referred to as medical malpractice insurance, nursing malpractice insurance, or errors and omissions insurance. It may also be prudent to carry personal liability insurance, regardless of whether your facility provides it. This helps you be protected if you or your facility gets sued. Please note that malpractice insurance does not cover criminal charges.
Training and Continuing Education
Invest in yourself and your license. As an RN, you are only obligated to complete nursing tasks that you are competent and trained to perform. You must ensure that you are adequately trained for all procedures before performing them, regardless of what your superiors may request. Additionally, you must stay current with your continuing nursing education (CNE) requirements. As defined by the American Nurses Credentialing Center’s (ANCC) Commission on Accreditation, CNEs “build upon the educational and experiential bases of the Registered Nurse for the enhancement of practice, education, administration, research, or theory development, to the end of improving the health of the public.” The purpose of continuing education is to ensure that nurses stay abreast of current industry practices, enhance their professional competence, learn about new technology and treatment regimens, and update their clinical skills. Each state has unique regulations regarding the number of CNE hours required, so you must stay current on the requirements for each state where you are licensed and ensure you meet them.
While many things can go wrong in nursing, protecting yourself with these processes will give you the best opportunity to avoid any interactions with your state regulatory bodies. However, even with all the protections in the world, you may still have incidents that require you to meet with them. The best way to protect yourself is by obtaining legal counsel. Consider creating a relationship with an attorney experienced in handling these complaints. That way, if you receive a professional complaint or action, you can speak to your legal counsel before answering any questions or allowing access to files. This strategy will give you the best chance of beating complaints and protecting your license.
*This blog post is for informational purposes only and does not constitute legal, financial, or medical advice or the forging of an attorney-client relationship. Please retain the services of an attorney to receive legal advice on how the law applies to your business.