1. Starr, Kristopher T. JD, MSN, APRN, CNP, FNP-C, CEN, CPEN

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IF YOU OBSERVE clinically unsafe practice, or negligence, due to suspected impairment by a licensed physician, what's your legal obligation to report your physician colleague to the appropriate authorities? In all 50 states and many U.S. territories, mandatory reporting requirements can center on various issues ranging from suspected child or elder abuse/neglect to animal bites to infectious disease. The focus of this discussion is the nurse's duty to report suspected substandard practice of licensed physician colleagues in the presence of impairment.

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Standards governing the RN's duty to report a physician who's impaired differ from jurisdiction to jurisdiction. Let's take a quick tour of five states.


* In Washington, the reporting standard is "actual knowledge."1 Actual knowledge is exactly what it sounds like: The reporting professional must have first-hand knowledge of the impairment.


* In Oregon, the standard for mandatory reporting is "reasonable cause."2 Now, reasonable cause is a bit harder to define than actual knowledge. Say you observe a colleague acting "oddly" at work and heard second-hand from several other nurses that this person has a "drug habit." You haven't personally observed the person doing anything illicit, but information flowing your way seems to corroborate your suspicions. Is that enough to establish reasonable cause? And if you decide to report, are you operating in "good faith" so that you're immune from civil liability if your report turns out to be nothing? Good questions with, unfortunately, very few absolute and clear answers.


* In Delaware, the duty to report a licensed physician for unsafe or unprofessional conduct due to impairment is "reasonable belief."3


* Nebraska uses "first-hand knowledge" as the standard for reporting physicians for unsafe conduct.4


* Virginia uses the term "reasonable probability," as distinguished from "mere probability."5



So, what does this short survey grant you besides a potential headache concerning the varying standards for mandatory reporting? The take-away is this: You need to know and understand the law and how it's applied in your state. Also, you should inquire about immunity from civil liability and the penalties for a failure to report and for making a false report. Many states have civil, administrative, and criminal penalties for failure to report mandatory obligations and for making false reports. Your decision should be a deliberate one that considers all the facts and circumstances, including the duty to report as defined in your state.


If you need guidance on whether you're required to report or not, check with your State Board of Nursing. While board members can't give you legal advice, they certainly can talk the issue through with you, give you examples of other similar matters and their disposition, and suggest a course of action.


As with all the things I write about, consider carefully, act responsibly, and above all, until next time...keep it legal!




1. WAC 246-16-235. Mandatory reporting-license holder reporting other license holders. [Context Link]


2. Mandatory reporting. [Context Link]


3. Title 24 Del. Code ann. Chap. 17. [Context Link]


4. Summary of mandatory reporting requirements. [Context Link]


5. Requirements imposed on hospitals, other health care institutions, and health care professionals to report disciplinary actions against and allegations of misconduct by certain health care practitioners to the Virginia Department of Health Professions. Guidance Document No. 76-34.\townhall\docroot\GuidanceDocs. [Context Link]