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September 11, 2019

By: Pamela Lawson, DNP, RN

Protect your nursing license

Upon graduation, nurses are expected to uphold professional standards, guidelines, and principles from the American Nurses Association (ANA). It’s paramount for nurses to understand how important it is for their safety andthe safety of the patients they are caring for in their working environment. Otherwise, they could face loss of licensure.

The threat of losing a nursing license is a devastating situation. Nurses are accountable for their actions to the patient. They must deliver care safely, know their scope of practice, and address situations beyond their competency. The goal is to provide care that results in best patient outcomes. Nurses can spend a lot of money for schooling and many hours of learning, only to lose their nursing license in an instant.

Nurses are responsible for the care they deliver to their patients, as noted in the ANA Code of Ethics for Nurses with Interpretive Statements. Given this information, why do nurses not follow theCode? Why don’t managers hold nurses accountable for the incorrect actions they perform? Why don’t nurses understand the severity of placing their license in jeopardy?

Nurses are being overworked, including assignments with a high acuity of patients, and some lack experience; this can place nurses in unsafe situations. Nurses must speak up when they recognize unsafe situations in order to protect themselves. There is no turning back when an incident occurs that impedes the safety of any patient. They are alone when there is an incident involving their lack of judgment.

A newly hired graduate nurse commented she was hired for an oncology floor and had a preceptor for 1 week. She was told her preceptor resigned. There was no available preceptor to mentor her for the next week, but she was expected to work as usual. Her assignment for the next day was to give chemotherapy medications to her patient. When she addressed this concern with the charge nurse, she was told, “It is your patient, and you need to give the medication.” She went to her manager and was told the same thing. She informed her manager she was never trained giving chemotherapy and did not feel safe giving the medication. The manager said, “that is how we do it here.” The newly hired nurse resigned her position the same day. She knew she was unsafe for her patient and herself.

As a clinical nurse educator, it’s imperative to educate nurses to understand the importance of “what is right” and “if you see something, do something.” A novice nurse needs direction and a well-developed mentor to guide and educate their nursing roles and responsibilities. A mentor must be someone who does the right thing all the time. There are “no shortcuts” in nursing. One must learn the rules and then what to do when mistakes are made.

According to author Nancy Brent, there is no shortage of penalties for falsification. She states, “When anyone falsifies information about themselves, it is a serious matter, as it is obviously misleading, deceptive and reflects on your trustworthiness. But it is extremely serious when a nurse does it. In most states, disciplinary actions include a reprimand, censure, probation, suspension or revocation of the nurses’ license.”

An editorial by Diana Mason asked the question, “Who’s watching?” She discussed Ornstein and Weber’s report there is cause for state nursing boards and governments to examine whether boards have enough authority and resources to protect the public from nurses who pose dangers to patients (see “Protecting the Public from Bad Nurses,” AJN Reports). She also expressed concerns that some nurses are convicted and lose their licenses, and others do not for the same incidents. She suggests that all state boards should carefully screen and monitor all nurses with any type of criminal background.

The advancement of social media is an integral part of today’s society. Social media provides many benefits; it also poses many legal problems for nurses to include: job termination, malpractice claims, disciplinary action from the boards of nursing. According to Balestra, remember that professional standards are the same online. This includes breaching of patient confidentiality to include patient photos, negative comments about patients, or details that may identify them, the healthcare setting, or specific departments.

For example, while performing an infant assessment with a nursing student, she took a picture of the newborn and posted it to friends. The case went to court in violation of the Health Insurance Portability and Accountability Act (HIPPA). The student was dismissed from the nursing school program. The nursing school was also charged with a fine.

Posts that could be unprofessional or reflect unethical conduct can also cause loss of licensure. Nurses must keep in mind they are “on duty” 24 hours a day. Their professional and personal conduct reflects the duty as a nurse. Posting photos or comments about alcohol and drug use, domestic violence (even comments about arguing with a spouse) and use of profanity, or sexually explicit or racially derogatory behavior can be reported to the board of nursing. Complaints can come from anyone and anywhere, including employers, co-workers, family and friends, and intimate partners. The privacy setting on social media will not protect anyone.

In conclusion, this is a significant concern for the future of all nurses. With the expected increase in numbers contributing to the nursing shortage, it is paramount nurses understand the importance of keeping their license. Nurses are the only ones responsible for their license. They need to adhere to the Code of Ethics and always do what is right. When they have any reservations about incurring unsafe practice, they must act accordingly within their scope of practice. As clinical educators, we must continue to support and advocate for nurses to keep their license to practice.

 

Pamela Lawson is life support resuscitation training coordinator and clinical nurse educator at Geisinger Lewistown Hospital in Lewistown, Pennsylvania.

 

Selected references

Balestra B. Social media missteps could put your nursing license at risk. Am Nurs Today. 2018;13(3):20-21.

Brent N. Falsification in nursing: It’s a legal line you should not cross. Nurse.com.2017. nurse.com/blog/2017/06/09/falsification-in-nursing-its-a-legal-line-you-should-not-cross/

Mason D. Who’s watching? AJN, American Journal of Nursing Reports. 2009;109(3):7.

Ornstein C, Weber T. Protecting the public from bad nurses. Los Angeles Times. 2008.

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