Edie Brous, JD, MS, MPH, RN, is a nurse and attorney in New York City and the coordinator of AJN‘s Legal Clinic column.
By Daniel X. O’Neil/via Flickr
I just came back from speaking at a conference where I had the same experience I have every time I speak with nurses about licensure issues. Participants say I am telling them things they didn’t know before.
Nurses who have been in practice for decades didn’t know their state requires nursing board notification of name or address changes within a certain number of days. They didn’t know that criminal convictions, even unrelated to nursing practice, can lead to disciplinary action on their nursing licenses. They didn’t know that it is considered professional misconduct to default on child support payments. They didn’t know that discipline in one state can result in discipline in another state, even when the license in that second state is inactive or expired.
Misconceptions about state boards of nursing. Many nurses do not understand the mission of the nursing board and think that the board is supposed to be an advocate for individual nurses or for the nursing profession. In fact, the board’s mission is to protect the public. Members of the board of nursing are not there to advocate for you, but to protect the public from you when they think it is necessary.
Why are so many of us so in the dark about what it means to hold a professional license, what the nursing regulations are, and how to protect the livelihood that professional license represents? Why are nurse attorneys who practice disciplinary defense representing nurses who are in trouble simply because they didn’t know how to play by the rules? Where should we be getting that information? Who should provide it? How do we fix this?
Who could be teaching nurses about licensure? I think there is a great deal of blame to go around. In my opinion, our educators, regulators, and employers have all failed us. The information is not included in nursing school. Why not? Educators and academics don’t think it is important. Clinical education in itself is not adequate when we are preparing people for practice as licensed professionals. Students must also learn about the legal and business aspects of health care. But if we teach the material at all, we offer the information as an elective. And when it is offered, it is taught by someone with no actual experience in the legal world of representing nurses who are in trouble.
Why are schools allowed to decide to leave this critical part of our education unaddressed? Because our regulators don’t require the information to be in the curriculum for accreditation. It should not be an option. A school should not be accredited unless it actually prepares its students for the real world of professional practice. And that means the curriculum includes study of nurse practice acts and state regulations. Our regulators don’t mandate this. So schools don’t include it. So students don’t get it. So nurses don’t have the information.
Nursing boards simply issue licenses and renew them with no communication. There is no “Welcome to the practice of nursing in the state of …” letter that accompanies an initial license—a letter that would provide the nursing board’s Web site and a link to the statutes and rules, advisory opinions, practice alerts, posted disciplinary actions, and so on. A letter that would compensate in some way for the lack of information provided by the very programs the nursing board has accredited.
Our employers don’t give us the information—in addition, many of them have misunderstandings or misinformation. So we don’t get it in preparation for practice programs. We don’t get it from our regulators. We don’t get it from our employers. But we are supposed to have this information somehow. We need this information. It is no more optional than biology or pharmacology.
So here is what I recommend:
- Go to your nursing board’s Web site. Look at the rules. Read the regulations. See if there are published advisory opinions, FAQs, practice alerts or other communications.
- Read the published disciplinary actions to see what nurses are charged with and disciplined for in your state(s).
- Don’t apply for a license in another state unless and until you are actually going to practice there and don’t assume a lapsed license cannot be disciplined.
- Know the nurse practice act in every state in which you are practicing because the scope of practice and regulations differ by state.
- If you are placed under investigation, get legal advice before making statements or answering questions.
- When applying, renewing, or reregistering, answer all questions honestly. If any of the questions can lead to an investigation, get legal advice when completing the application.
- Keep copies of performance appraisals, reference letters, awards, thank you letters, CME certificates of completion, membership in professional organizations, and anything else that speaks to your professional accomplishments and good moral character.
- Don’t let anyone talk you out of having your own professional liability insurance policy. Employer policies don’t cover you for licensure defense. That is a greater risk for nurses than malpractice lawsuits.
Every state has its own regulations which differ so you need to know what your specific state says. I would recommend your state(s) nursing board web site for practice alerts, advisory opinions, and posted disciplinary actions. Additionally, the National Counsel of State Boards of Nursing (NCSBN.org) has a lot of material related to nursing regulation. And AJN published a 3-part series on licensure in October, November, December 2012.
This is, of course, critical. I work privately, so I would vastly appreciate a central place I can go to stay up to date on professional development and practice guidelines. Since no one teaches it, could someone make the information readily available for self-study? If there is a handbook, I’d buy it.