1. Lockhart, Lisa MHA, MSN, RN, NE-BC

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Q: What exactly does it mean when a nurse is investigated?

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A: A nurse's license can be investigated for a variety of reasons, such as alleged impairment, possible abuse, privacy violations, and negligence or failure to maintain licensure requirements. When an agency, organization, peer, patient, or patient's family believes a nurse is guilty of any of these infractions, it's their responsibility to report the suspicions to the state board of nursing. Most state boards allow for online submissions of concerns or provide toll-free access for callers. It's then the responsibility of the board to respond with a thorough investigation. Many allegations are later proven to be false, greatly embellished by the accusing party, or of diminished concern after the facts are uncovered.


The board's responses may vary depending on the risks associated with the allegation. Responses may include notification of the nurse in question to provide his or her side of the event. When the nurse's alleged actions place a significant risk to the safety of others, the board can place his or her license on immediate suspension or probation alert before beginning the investigative process. Many boards post the accused nurse's name and license number on their website, listed as "under investigation."


The state board of nursing protects both the nurse and the person filing the complaint. The complainant has the right to report infractions and expect that reasonable precautions and processes are followed to ensure privacy as appropriate. The nurse has the right to due process, including fair treatment, full disclosure, and the opportunity to respond and defend him- or herself against accusations. The nurse also has the right to hire (at his or her expense) legal counsel and appeal any legal or disciplinary decisions made by the board. Reports and investigations must be practice related and not employer related; for example, absenteeism, policy and procedure infractions, and on-the-job disagreements aren't reportable to the board.


The board will determine if the allegations are, in fact, related to nursing practice. If so, the board must then appoint an investigator who will use various methods to ascertain the facts, such as interviewing individuals who were present or involved on site, reviewing documentation and records, performing drug screens (if impairment is alleged), and gathering any pertinent historical facts. This period can be challenging because the nurse under investigation may be on suspension with or without pay.


The board can impose the following escalating levels of disciplinary action: letter of reprimand, letter of concern to the nurse's employer, monetary fine, civil penalty, suspension-temporary pending findings, suspension-for a specific time period, probation, or permanent license revocation.


When allegations of alcohol or substance abuse are substantiated, the nurse may agree to participate in an alternative-to-discipline action called peer assistance. The nurse typically must sign a 3- or 5-year commitment to participate in this program, which may include a voluntary intensive inpatient or outpatient alcohol or substance abuse rehabilitation program; practice monitoring; random alcohol or drug screens; and monitored attendance at recovery support groups, such as Alcoholics Anonymous or Narcotics Anonymous. A limitation or restriction of one or more aspects of practice, such as work setting or activities and hours worked, may also be imposed as the nurse successfully progresses through the peer assistance program.


A nurse who makes a sincere effort to improve his or her education and professional standing while abiding by the designated provisions can return to professional practice and may retain a free and clear licensure in most states, depending on the infraction.