Most Problematic Areas

To protect themselves, nurses must be diligent and they must know the laws, rules and regulations that govern nursing practice and they must practice good risk management. The practice areas that cause the most problems for nurses are documentation, assessment, intervention, bypassing checks and balances and not knowing policies and procedures.

Documenting timely and adequately would prevent many complaints or if the complaint involves another area of practice, documentation can help the nurse. There have been many instances when my clients have found themselves stating, “If only I had documented.” Nurses must be sure they document timely and adequately.

Failing to assess, failing to thoroughly assess, or failing to reassess comprise the assessment problems. Assessments must address the patient’s problems and if a new problem arises, the assessment must be focused on that new problem.

A nurse cannot just assess a patient, document the assessment and stop, the nurse must also intervene whenever necessary. If the nurse does not obtain what is needed for the patient from current orders, he or she must notify physicians and follow the nursing chain of command until intervention is no longer required.

Bypassing checks and balances is a leading cause of medical errors. For example, medication errors can be traced to a nurse failing to go through the five rights of medication administration. Likewise, rushing through chart checks allows for orders to go unnoted and unimplemented.

Finally, a nurse must know the facility’s policies and procedures because he or she will be held to those if a lawsuit or complaint before the Board arises. It is common that nurses practice on a unit or at a facility and they do not know what is required pursuant to the policies and procedures. However there is a common problem with policies and procedures in that they do not always cover all of a nurse’s obligations and some may be outdated or incorrect. Therefore, a nurse needs to also be aware of current nursing standards.

Nurse Representation

Nurses must protect their career by knowing whom to enlist to help them. Just as nurses should not try to represent themselves in a malpractice lawsuit, nurses should not try to represent themselves before the Board of Nurses.

The Board works for the state protecting the public and thus, the Board is not required to be concerned about a nurse’s career or protecting the rights and interests of the nurse. The Board has attorneys that will aggressively protect the Board/public’s interests.

Nurses need protection and guidance during any adverse interaction with the Board, which is why they should hire an experienced attorney to protect their interests. Based on personal experience as an attorney for a regulatory board and as a defense attorney for nurses, I have found that nurses who are represented by an attorney have a greater chance of obtaining a better outcome from a Board matter than those that are unrepresented. Nurses not only have to hire a lawyer, they need to hire the right lawyer.

Nurses should thoroughly question any attorney they are thinking of hiring to ensure that the attorney has the proper experience and knowledge to practice before the Board. The area of law that involves regulatory agencies such as the Board of Nurses is called Administrative Law. Nurses should look for an attorney that is Board certified in administrative law and one that frequently represents nurses before the Board. Nurses should not assume that every attorney has the knowledge or the experience to adequately represent them before the Board.

Nurse Protection

Nurses should also protect themselves by purchasing their own malpractice insurance that contains administrative/regulatory Board coverage. Nursing Associations recommend that all nurses carry insurance even if they think they are covered under an employer’s insurance.

There are many reasons why nurses do not purchase this inexpensive protection. For example, some nurses believe that an employer’s insurance will take care of any problems. However, the employer’s insurance may not completely cover the damages and it usually does not cover actions before the Board. Furthermore, in a situation where the employer reports the nurse to the Board, the employer is not going to then spend money defending the nurse.

It is also a common misconception that having insurance raises a red flag that draws malpractice lawsuits. There are multiple reasons why a malpractice suit is filed against a nurse and whether you have malpractice insurance or not does not alter those reasons. Nursing malpractice insurance is inexpensive and it provides protection when protection is needed the most.

When a nurse receives notice that he or she is being investigated before the Board, it is a great relief to know that malpractice insurance is going to cover the cost of an attorney to represent the nurse before the Board. The Boards of Nursing are getting busier every year and their regulatory powers are likewise increasing. It is crucial that nurses understand the seriousness of a Board investigation. Just like the state will close down a restaurant because they are a public health risk, the state through the Board of Nurses will stop a nurse from practicing if they are a risk to the health of the public. Nurses need to be cautious and prudent in order to protect themselves from possible adverse actions.