Advanced Practice Nurses (APRNs) have brought access to a broad range of medical procedures to many underserved areas of New Hampshire and are integral to health care in the state. Nurse anesthetists (CRNAs) practice independently, administering anesthesia and keeping patients comfortable and pain-free during surgeries and medical procedures. CRNAs are experienced in patient care, with the AANA estimating that graduates of CRNA programs have an average of over 9,000 hours of clinical experience. But each year, some nurse anesthetists face accusations of unprofessional behavior or misconduct, and these allegations put their licenses and all those hours of training and work at risk.
If you are an APRN (CRNA) in New Hampshire facing a challenge to your license, you need the experienced team at the Lento Law Firm. The Lento Law Firm is one of the most experienced attorneys in medical license defense in the country and has represented many nurses, including advanced practice nurses. The earlier in the process that the Lento Law Firm Professional License Defense Team is involved, the better. Call the Lento Law Firm today at 888-535-3686 or provide your details online, and we will contact you.
Note on Title “CRNA” in New Hampshire
Nurse anesthetists in New Hampshire practice as Advanced Practice Registered Nurses (APRNs) rather than as CRNAs. In 2021, after a lengthy legal fight, the New Hampshire Supreme Court held that only a physician should use the term “anesthesiologist.” Although the scope of the applicability of this decision remains unclear, the terms “anesthetist” and “anesthesiologist” are not used in the title of a nurse who practices independently in New Hampshire. Nurses performing this function are referred to as APRNs in rules and regulations.
New Hampshire Board of Nursing Discipline Powers
The New Hampshire Board of Nursing (BON or the Board) handles all licensure issues for APRNs (CRNAs) in New Hampshire and oversees all disciplinary cases. The Board has wide latitude to take action against an advanced practice nurse.
Disciplinary Actions by the Board
The Board may take the following disciplinary actions against an APRN:
- Reprimand. Board may reprimand an APRN.
- Limit on License. Board may limit the practice or license of an APRN as a condition of retaining their license.
- Suspension. Board may prohibit an APRN from practicing for a period of time.
- Probation or Supervised Practice. Board may order the APRN to submit to enhanced supervision for a period of time (probationary period).
- Education Requirement. Board may order an APRN to take classes or to engage in other educational requirements.
- Rehabilitation or Treatment Requirement. Board may order a person to go into rehabilitation, substance abuse treatment, or mental health counseling.
- Revocation. Board may rescind the license of the APRN.
- Fines. Board may fine the APRN, subject to limitations.
The Board may also take the following remedies:
- Agreement for corrective action. APRN may agree to take corrective action or measures, and on that basis, the complaint will be dismissed by the Board.
Nursys Database
This database allows the user to look up a nurses' disciplinary history. New Hampshire is a member of the Nurse Licensure Compact (NLC) and reports all disciplinary actions into Nursys.
Please Note: Like any database, Nursys contains errors. If you are having issues with false information on Nursys, call the Lento Law Firm. We can help with these issues.
Other National Databases
Advanced Practice Nurses are much more likely than other nurses to be placed into the National Practitioner Database, which records disciplinary actions and malpractice actions against medical providers.
With regard to all disciplinary databases, charges that originate in New Hampshire are likely to affect your licensure in most other states. It is not possible to agree to or ignore charges in New Hampshire and move your practice to another state. Charges that originate in New Hampshire may follow you to other states indefinitely, not to mention the effect they may have on malpractice coverage. With the advent of national databases, advanced practice nurses have no choice but to fight charges when and where they arise.
Grounds for Sanctions to APRNs in New Hampshire
In New Hampshire, the following are possible grounds for sanctions on APRNs:
- Failing to demonstrate competence.
- Cheating on a nursing exam.
- A criminal conviction that reflects on ability to practice.
- Fraud in licensure.
- Unethical conduct, including fraud, deceit, or disregard for the health and safety of a client.
- Practicing on a suspended or revoked license.
- Failure to use reasonable care.
- Unprofessional conduct, including failure to meet nursing standards, failure to supervise assigned nurses or students, and accepting unsafe client conditions.
- Failure of an administrative nurse to practice oversight.
- Failure to comply with license modification.
- Any practice that puts a client's life or safety at risk.
- Inability to show reasonable skill and safety because of health issues.
- Failure to respect professional boundaries with patients.
- Diversion of medication.
- Failure to comply with program agreement or consent order.
- Drug-related misconduct, including failing a drug screen.
- Discipline in another state.
Factors in Determining Sanctions
The Board must consider these disciplinary issues or factors when determining what discipline is appropriate:
- The nature and seriousness of the misconduct.
- Prior discipline, if any.
- Intent and state of mind.
- The assumption of responsibility by licensee and admission of fault.
- Cooperation by the licensee with the process.
- Purpose of the rule violated.
- Harm to the public.
- Burden placed on Board for enforcement.
Discipline should be the minimum necessary and not the maximum allowable.
Complaint Process
Step One: The Complaint
There are two ways an investigation of an APRN may commence in New Hampshire. The first is through a written complaint, which may be filed by anyone, although patients or former employers file most complaints. Many of these types of complaints are dismissed early in the process. A second way an investigation may commence is through the Board's initiative.
Step Two: Investigation
If the Board believes that the complaint alleges a violation of the Nursing Practices Act, it will proceed to the investigation stage.
The Board will typically ask the APRN to respond to the allegations contained in a complaint. This response should be made in writing in advance and is vitally important. The Board may still decide to dismiss the complaint based on your response. Before you respond to a complaint, consult an experienced attorney to assist you. The Lento Law Firm Professional License Defense Team can help you formulate your Response to the allegations and give you the best chance of dismissal early in the process.
Step Three: Prehearing Conference
The Board will set one or more Prehearing Conferences, at which the parties may negotiate and engage in settlement discussions. If the licensee and the Board can agree as to a way to proceed, the parties may sign a settlement agreement. This negotiated settlement may involve a consent order or an agreement that the APRN will undergo certain conditions, such as drug or alcohol evaluation or treatment or probation and monitoring. As a condition of settlement, the APRN must admit to allegations and agree to accept penalties.
At this stage of negotiation, it is vitally important to have counsel. Your attorney will be able to advise you on whether you should accept a negotiated settlement or sign a consent order. If you have had the opportunity to consult an experienced attorney, you will not have lingering doubts and questions as to whether a settlement was in your best interests. Please note that consent orders and other stipulated settlement agreements are reported to Nursys.
If the parties are unable to agree to a settlement, the matter will proceed to a hearing.
Step Four: Board of Nursing Hearing
The Hearing will appear very much like an informal trial, with the parties taking turns presenting evidence. Your attorney will call and examine witnesses and will cross-examine witnesses presented by the Board. Your attorney will be able to make both an opening and closing statement.
The Board will issue a Decision and Order, including findings of fact and any action necessary to effectuate the Order.
Step Five: Rehearing and Appeal
A licensee may petition for a Rehearing of the Decision of the Board within 30 days. If this is not successful, the licensee may appeal to the New Hampshire Supreme Court.
Step Six: Compliance
Depending on the nature of the settlement or the Board's decision, you may have to submit to ongoing oversight of your compliance with the Board's order.
Surrendering a License
If you are considering voluntarily surrendering your license, please contact the Lento Law Firm Professional License Defense Team first. An APRN may hope that they will be able to practice in another state in which they hold a license, or they may wish to avoid the embarrassment of a public hearing. But voluntary surrender of a license when facing accusations is ineffective for two reasons:
- A voluntary surrender must be reported to Nursys. It is likely that other states in which you are licensed will become aware of the surrender of your license in New Hampshire.
- Even if you surrender your license, if you do so in the face of charges as an advanced practice nurse, there is a significant chance that the voluntary surrender will be reported to the HHS Office of Inspector General (OIG) List of Excluded Individuals. Inclusion on this list will prevent an APRN from working at any facility that receives Medicare or Medicaid funding. This limitation will effectively exclude the listee from working in almost any healthcare facility in any capacity.
Whatever you have been accused of, the Lento Law Firm can put together a defense. Do not give up the license you worked so hard to achieve—call us, and we can help.
Initial Denial of License or Remediation of CRNA Training
The Lento Law Firm also represents those denied initial licensure as CRNAs and those who face remediation during CRNA training. If you are facing hurdles during your CRNA training or initial licensure, call the Lento Law Firm.
Why You Should Hire the Lento Law Firm Team
Attorneys at the Lento Law Firm are some of the most experienced license defense counsel in the country. They have represented countless medical professionals, including doctors, APRNs, and CRNAs.
Whether you are working in Manchester, Concord, Nashua, Dover, or in a rural area, the Lento Law Firm can represent you in defending your New Hampshire APRN license.
How Does the Lento Law Firm Defend You?
The Lento Law Firm Professional License Defense Team will be with you every step of the way as we defend your license and reputation.
The Lento Law Firm will:
- Review the complaint against you and advise you of the best course of action.
- Prepare your response to the accusations and formulate your theory of defense.
- Represent you during the investigation and seek early dismissal of the complaint.
- Represent you in the Prehearing Conference and attempt settlement of the complaint.
- Represent you at the Hearing, including opening and closing statements, examination of witnesses, cross-examination of agency witnesses, and all other hearing tasks.
- Plan your defense by gathering evidence and witnesses that support your version of events.
- Negotiate with the Board for a reduction in discipline or dismissal of the complaint.
- Advise you as to the merit of settling your claims or signing a consent order.
- Plan for compliance.
If you have begun this process without counsel, the Lento Law Firm can still help, but it is imperative to call and begin the process of hiring counsel. The Lento Law Firm's Professional License Defense Team will lead the defense of your license. They will negotiate with the State and will help you achieve the best possible outcome for your case. Call us today at 888-535-3686 or submit your details online, and we will contact you.
