Nurses work within highly complex healthcare systems, doing their best to care for patients who are already at great medical risk. A certain number of honest mistakes are inevitable. Yet an honest mistake can readily lead to patient injury or worse. And a nurse injuring a patient through an honest mistake can lead to a state nursing board complaint against the nurse. Disciplinary charges and license suspension or revocation may result, depending on the circumstances and on the quality of your license defense. If you face a state nursing board disciplinary investigation over an honest mistake, retain the LLF National Law Firm’s premier Professional License Defense Team for the skilled and experienced attorney representation you need. Call 888.535.3686 or complete this contact form now. Don’t let an honest mistake end your nursing career. Get our help for your best possible disciplinary outcome.
A Nurse’s Challenging Work Environment
Studies have shown just how difficult and dangerous an environment it is in which nurses work. The famous Institute of Medicine (IOM) report To Err Is Human revealed that nearly 100,000 individuals die in U.S. hospitals from preventable medical errors every year. Even though healthcare regulators have, since the 1999 To Err Is Human report, made a major hospital safety reform push, the National Council of State Boards of Nursing finds that medical errors remain a major public concern. The IOM To Err Is Human study found that the most injury-causing medical errors were not the individual fault of nurses and other healthcare practitioners but instead resulted from faulty systems. If you face a state nursing board investigation over patient injury from an honest mistake, promptly retain our attorneys before the investigation leads to disciplinary charges. Don’t let the investigator cast the die of blame against you. Instead, get our prompt help responding affirmatively and effectively to the investigation.
Definition of an Honest Mistake
The key in these frequent cases of disciplinary investigation over patient injury from a nurse’s honest mistake is to properly define an honest mistake. Nurses and other healthcare practitioners soon learn the critical distinction between patient injury from the acceptable risks of proper care, sometimes called iatrogenic injury, and patient injury from the unacceptable risks of substandard care. Not every patient injury is due to substandard care. Not every patient injury should give rise to a claim for professional negligence or professional malpractice and state nursing board disciplinary charges. The To Err Is Human study confirmed what practicing nurses have long known, which is that under the best of nursing care, some patients are still going to rapidly decline, even suffering injury from the proper care itself from the natural risks of the care, including necessary medications and procedures. An honest mistake is a reasonable mistake, meaning one that resulted in an unintentional patient injury even though the nurse’s care met the nursing standard of care. Get our defense help if your honest mistake has led to a state nursing board investigation.
Examples of Honest Mistakes Nurses Make
Nurses are constantly making judgments within the nursing standard of care that, in hindsight, they would do differently because of patient injury. For example, in the handoff of a patient, a nurse might inform the next nurse of a long line of conditions and events, but then inadvertently omit the one small event that later leads to the patient’s injury. For another example, a nurse might reasonably judge a patient fit to ambulate without assistance, but then the patient falls. For another example, a nurse might reasonably clean wounds or change bandages on the standard schedule, but then a serious infection develops anyway. Honest mistakes happen, unfortunately, including ones that lead to serious patient injury. If you face a state nursing board investigation in one of those situations, get our help.
Distinguishing Careless Mistakes Nurses Make
Unfortunately, nurses also make careless mistakes, ones that clearly fall outside the nursing standard of care but are nonetheless understandable from the hundreds of decisions nurses make and actions nurses take. Nurses work under stress. They also work when exhausted by long hours and unreasonable workplace demands. Nurses also work when the facility is understaffed or inadequately equipped, physicians and supervisors make their own mistakes, and patients make unreasonable demands. Conditions can contribute to a nurse’s careless mistake. Examples include administering the wrong medication, administering the wrong medication dose, misreading a physician’s illegible handwritten order, neglecting to put hospital bedrails back up for the umpteenth time, and entering information in the wrong patient record or entering incorrect information. These issues are so common that many nurses would also call these failures honest mistakes because they occurred without any intent to injure. Let us help if you made a careless mistake. You may still have a good disciplinary defense.
Complaints Regarding a Nurse’s Honest Mistake
You might think that people would understand a nurse’s honest mistake and not blame the nurse. Think again. Patients are common complainants against nurses who make honest or careless mistakes. Patients aren’t always fair. Indeed, patients sometimes complain against nurses who have done nothing at all wrong, even no mistake at all. So do their family members. Neither patients nor their family members generally know the nursing standard of care. They may also not know medical processes and causes. Let us help you show that your patient’s complaint against you is without a sound basis. Colleagues and facility representatives also report a nurse’s honest or careless mistake. Their reports may be more credible because they know or should know the nursing standard of care, but they’ll sometimes report an honest mistake anyway out of a mistaken belief that they have a duty to do so. Let us help you show that a colleague or facility complaint is without basis. The complainant can matter in a disciplinary case. Our attorneys know how to respond.
State Nursing Board Responses to Honest Mistakes
State nursing boards and their investigators should know better than to pursue disciplinary charges over honest mistakes. They must still investigate complaints involving patient injury to distinguish honest mistakes from carelessness, incompetence, unfitness, and malpractice. State nursing boards and their investigators can also be under pressure to blame a nurse for a serious patient injury, from the patient, family members, facility representatives, and the public. Boards and investigators can also have a hard time distinguishing honest mistakes or discerning the standard of care under the specific circumstances of any one case. Do not be surprised if disciplinary charges result from a state board investigation of your honest mistake. You may know that it was an honest mistake, but you may have to prove it. We can help you do so.
The Adverse Events Decision Pathway
Fortunately, state nursing boards are more and more aware that nursing care depends just as much on the healthcare systems as it does on the competence and fitness of individual nurses. One way that we approach the defense of honest mistake cases is to rely on the National Council of State Boards of Nursing (NCSBN) advocacy that state nursing boards rely on its adverse events decision pathway framework for honest mistake cases. Recall the above To Err Is Human report? The NCSBN took that report to develop a regulatory framework that accounts for the system errors and to recommend that framework to state nursing boards to use in these honest mistake cases. The framework advocates that when investigating and pursuing disciplinary charges over a nurse’s honest mistake, nursing boards consider:
- the substantial risk that an adverse outcome would occur under the circumstances without the nurse’s fault;
- the system within which the mistake occurred, referring to the facility’s operational methods, processes, infrastructure, and environment;
- mitigating factors, meaning any “extenuating, explanatory, or justifying fact, situation, or circumstance”;
- the reasonably prudent nurse standard, referring to a nurse “who uses good judgment in providing care according to accepted standards”; and
- remedial education to correct a knowledge or skill deficit rather than punitive sanctions to punish the nurse.
Our Defense of Honest Mistake Charges
Our attorneys can credibly advocate the above NCSBN framework in your honest mistake case. The National Council of State Boards of Nursing is, after all, the regulatory council that state nursing boards fund, govern, and operate. The NCBSN is the think tank for state nursing boards, setting the regulatory standards. You could have no more credible source than the NCSBN to influence your state nursing board investigator and officials. Our attorneys can walk your officials through the adverse events decision pathway in your case to advocate that:
- the patient’s injury in your case was the natural and probable result of the patient’s circumstances without any fault on your part;
- the system within which you worked, including issues like short staffing, fast pace, frequent demands, urgent conditions, and lack of equipment, was the sole or primary cause of the incident;
- other mitigating factors, including issues like the patient’s uncooperativeness, your long work hours, and inadequate physician, colleague, or facility support, explained and justified the unfortunate outcome, without any ill intent or carelessness on your part;
- your actions met the reasonably prudent nurse standard in that you used good judgment and provided care within the accepted nursing standard; and
- remedial measures in the form of additional education and training would address any nursing board safety, fitness, or competence concerns.
Forensic Support in Honest Mistake Cases
You can see that the above regulatory framework requires the state nursing board to exercise sound professional judgment about the nursing standard in your case, under the specific conditions in which you worked. Making those judgments should be well within the knowledge and expertise of state nursing board officials, who would generally be educated and trained in nursing. These cases, though, can still require forensic expert witness opinions and testimony. Our attorneys have the nursing experts available to evaluate and opine in your case. We can retain a highly qualified nurse expert witness to review the statements, investigation report, medical records, work records, and other information and evidence in your case, for a factual basis to give a credible opinion in your support. We can then use the forensic expert witness’s report in an effort to resolve your charges in a conciliation conference or use the witness’s testimony at your board hearing on disciplinary charges. Get our skilled help and the help of our forensic consultants.
Discipline Risks in Honest Mistake Cases
Do not underestimate the discipline risk in your case, even if it only involves an honest rather than a careless mistake. State nursing boards have the statutory authority under state nurse practice acts to discipline nurses up to license suspension or revocation. See, for example, the Minnesota Nurse Practice Act, authorizing license suspension, revocation, and other discipline on a long list of disciplinary grounds. Those grounds include failing to perform nursing with reasonable skill and safety within the standard of care, even if the failure does not cause an actual patient injury. Your state nursing board will have similar authority to revoke or suspend your license for a careless mistake, whether or not your mistake causes a patient injury. Your discipline risks are substantial. The collateral consequences of your discipline can go well beyond loss of your license to include loss of your patients, practice, job, reputation, network, and career. Don’t risk those losses by going without representation or with unqualified local representation. Instead, get our skilled and experienced help.
Premier Nurse License Defense Representation
If you face a state nursing board disciplinary investigation because of an honest mistake, your best move is to retain the LLF National Law Firm’s premier Professional License Defense Team. Our attorneys have helped hundreds of nurses and other healthcare practitioners nationwide successfully avoid license discipline over honest mistakes and other issues. Call 888.535.3686 or complete this contact form now for your best possible disciplinary outcome when unfairly pursued over an honest mistake.