How Do Nurses Lose Their Licenses?

Kathy Quan RN BSN PHN - 08/08/19

Nurses are the most trusted professionals for 17 consecutive years according to the Gallop poll. Nursing education is intense and difficult. After graduation, nurses have to pass the NCLEX board exam in order to become licensed to practice. After all of that, most nurses will take all precautions to protect their license. So it’s not surprising that the annual rate of discipline by the state Boards of Nursing is less than 1%, according to the National Council on State Boards of Nursing (NCSBN).

Being aware of the types of things nurses can lose their license for does help to keep the numbers low and remind new and seasoned nurses that we are a profession with very high standards. Our patients trust us with their lives, and we must take care to preserve their trust and give them the very best quality care.

Patient confidentiality is a MUST

Social media is one area to be very carful with. Taking selfies or snapping photos of everything is a new “norm,” but we have to be acutely aware that even if the patient asked for the photos to be taken, we cannot share on social media!!! Violating patient confidentiality is one of the fastest ways to find trouble. It may not always result in losing your license, but it could result in your being fired and consequently having difficulty finding another employer who will trust and hire you. Accidental or seemingly small breaches are just not tolerated. HIPAA is a zero-tolerance matter and nurses can find all they need to know in CEU courses for nurses. Patient privacy is essential. Just mentioning that you took care of such and such celebrity is a breach. And looking at medical records if you have no need to is one of the most common ways to breach HIPAA laws and find yourself out of a job.

Impersonating a nurse is illegal

Often times, patients will refer to the CNA as “my nurse” because they don’t know the difference, but for that CNA to ever say “I’m going to be your nurse today,” s/he can lose their license. The same holds true for nurses at any level. An LPN/LVN cannot represent themselves as an RN either by lying or by using someone else’s paperwork. And yes, sadly this happens more than you would expect, and it can take employers a long time to learn about it.

Nurses are a trusted professional and this is behavior that is totally unexpected. It’s a felony and it will result in the true license being revoked and preventing that nurse from ever obtaining another license again. It stays on their BON (board of nursing) record. It will also show up on fingerprint records. Many states now require DOJ and FBI fingerprinting.  For new grads, it is especially important to NOT call yourself a nurse until you have proof you have passed the NCLEX. The exception would be for an RN who obtains an advanced degree. Yes, you are a nurse already, but you cannot use the initials for your BSN, MSN, etc. until you have your diploma in hand; not just having passed all the courses. Be patient. You can tell an employer you passed the courses and then provide a copy of your diploma to make it official when available.

Along with this, providing fake licenses is a rare occurrence, but it does happen. Perhaps the nurse has a suspended or inactive license and needs to present a current license. Thinking that soon the license will be active and current, it won’t matter. However, it does matter and if it’s discovered, the nurse will have his/her license revoked. If s/he doesn’t have a license, that’s going to prevent them from ever getting one.

Falsifying medical records

The job is not complete until the paperwork is done, period. Long, crazy shifts can play all sorts of havoc with completing the charting, but it has to be done before you leave. It should be up to date before you take a break. And in an ideal world, it would be done every 2 hours so that at the end of the shift you’re not playing catch up. Some days this will be impossible. That’s just the reality, but you should always strive to make this a rare exception. A complete and accurate record is the absolute responsibility of every nurse. It’s a legal document and can either support or be held against you in a court of law. Legal proceedings go after the deep pockets and as a lowly nurse, you employer will be more likely to carry the brunt. Your omissions of important information are a medical error and must be reported. Inaccurate documentation hopefully did no harm to the patient but if so, they could result in damages your employer has to pay. This can result in disciplinary action by your employer, your being fired and/or your license being revoked. Whether it be you forgot to document a dose of a PRN medication, or documented on the wrong chart, it’s your responsibility. If you don’t report it and fix it ASAP, then the problem is even bigger. If you remember the next day that you forgot to document something, tell your supervisor and follow policy and protocol for late entry. If you ignore the issue and hope it’s never discovered, the risk of losing your license increases dramatically.

Diversion of drugs

Nurses have a huge responsibility in the administration of medications including narcotics, sleeping medications, ant-psychotics along with routine medications for infections and acute or chronic medical conditions. The opioid crisis is real and nurses are not exempt. Temptation to self-indulge may be an issue for some nurses. From taking someone’s antibiotics for your own symptoms to diverting narcotics for self-use or to re-sell, diversion of medications for any reason is a crime and can easily result in the suspension or revocation of your nursing license and even result in jail time. Counting narcotics between each shift may be a thing of the past with modern technology, but falsifying information to gain access to them only adds to the crime.

Recovery programs for addicted nurses

Back injuries are quite common in the nursing profession despite all the training about proper body mechanics and safety precautions. A few pain killers work well, but after the prescription ends, access to narcotics at work can lead nurses to divert drugs and soon find them selves addicted. With an emphasis these days on averting an opioid crisis, many physicians refuse to prescribe more than a few days of medication and leave patients (including nurses) in considerable pain with no help. This is leading not to a reduced opioid crisis, but to an increasing illicit street-drug issue. For nurses who have access to narcotics the uptick in diversion is likely due to this problem.

Typically, BONs have been sympathetic over the past few decades and instead of revoking a license, they will work with the nurse to achieve recovery. The license is suspended and set a required time in a recovery program to regain the license. Resumption of practice is usually set under strict supervision and no access to specific medications. Failure to follow this plan will result in revocation of the license. Nurses who remain clean and complete the therapy can continue to practice.

Unprofessional conduct

This category encompasses a broad range of violations for which employers or the BON can pass judgement on a nurse. Nurses are the most trusted professionals, and this indeed sets the bar high for behavior both at work and in their personal lives. Issues such as domestic disputes, incivility in the workplace, DUIs, making racist statements, sexual encounters with superiors or even peers, using inappropriate language with co-workers or patients, participation in immoral activities, etc. can all have devastating results and escalate with the severity of the behavior or issue. Employers can issue disciplinary action and the BON can recommend actions or suspend or revoke licenses.

It is the mission of the BON to protect the public and they will investigate thoroughly all complaints brought to them. If there is sufficient evidence the nurse has violated the Nurse Practice Act or other regulations or standards, they will take action. The actions listed by the NCSBN include fines or civil penalties, public reprimand or censure (for minor violations), referral to an alternative-to-discipline program including monitoring and recovery support. Other actions include the imposition of monitoring, supervision, remediation, education or limitation/restrictions on practice for a probationary time frame. The BON may decide to suspend a license for a set time period with specific requirements or the revoke or allow voluntary surrender of the license. Again, the percentage of disciplinary action is less than 1%, but all nurses are responsible to understand the expectations of professionalism.