As a licensed nurse – whether you're a registered nurse, a licensed practical nurse, or an advanced practice nurse – you've worked very hard to get where you are today. You've spent many months or years learning what you need to know to be eligible for your license and have studied hard to pass your licensing exam. You probably take continuing education courses, either on your own or through your employer. And, of course, you've learned a lot on the job.
That's why if you learn that you are under investigation by your state's board of nursing for disciplinary violations related to exceeding the scope of your nursing license, you need to take it very seriously. The Lento Law Firm Professional License Defense Team can help you protect your license from day one. Call us at 888.535.3686 or use our contact form to schedule a confidential consultation with one of our experienced professional license defense attorneys to learn more about how we can help.
Who Administers License Discipline for Nurses
In almost every state, there is a Board of Nursing or an equivalent agency whose job it is to regulate, license, and supervise the nursing profession. When someone files a complaint against a licensed nurse, this agency typically is the one that reviews the complaint to make sure it's one that addresses an area of nursing practice that the agency regulates. When a complaint meets that standard, it will likely be assigned to an investigator who will review the allegations, conduct interviews, and subpoena documents in connection with the allegations.
In situations where the investigator finds grounds for possible disciplinary action against the nurse, the board of nursing (or equivalent agency) may then offer to resolve the matter with the nurse by way of a disciplinary settlement that will usually have the nurse admitting to certain facts and the board of nursing imposing an agreed type of discipline on the nurse. When an agreement can't be reached, the board of nursing will conduct a hearing, where the nurse will have an opportunity to defend against the allegations. Based on the evidence introduced at the hearing, both against the nurse and in the nurse's defense, the board will then either dismiss the matter or impose discipline on the nurse.
Note that in some states, it may be another government agency that conducts the investigation and determines the discipline. In any case, the investigation and disciplinary process tend to be similar no matter what the name of the agency tends to be similar no matter what the name of the agency that's responsible for it.
Nursing disciplinary investigations and proceedings can stretch out for months and can be very stressful for the nurse who has been named in the complaint. Working with an experienced professional license defense attorney is one way to help relieve you of much of that stress. It also makes it much more likely that your rights and your license will be fully and aggressively defended throughout the process. The Lento Law Firm Professional License Defense Team has spent years helping nurses and other licensed healthcare professionals defend their licenses in disciplinary investigations and proceedings all across the country. We understand how important your license is to you and your livelihood, and we are ready to fight to help you protect it.
What Does the Scope of Practice Mean?
A nurse's scope of practice can vary significantly depending on the type of license that a nurse holds. It can also vary from one state to another, depending on that state's nursing laws and regulations. No matter what type of nursing license you hold, it's important to have a clear understanding of the scope of practice that your license allows. Knowing what the boundaries of your license are can be the best way to avoid being disciplined for exceeding them.
Scope of Practice for Licensed Practical Nurses
The scope of practice for a licensed practical nurse in New York, for example, is broadly defined as “performing tasks and responsibilities within the framework of case finding, health teaching, health counseling, and provision of supportive and restorative care under the direction of a registered professional nurse or licensed physician, dentist or other licensed health care provider.” Colorado, on the other hand, states that for LPNs the scope of practice is “that which is taught in schools of practical nursing in Colorado at this time,” meaning that “all decisions regarding tasks that may be performed by an LPN are based on the present curriculum criteria.”
These very different definitions may or may not lead to the same result when determining whether an LPN acted within the scope of their license. Working with an experienced attorney from the Lento Law Firm Professional License Defense Team can help you evaluate your particular situation to determine whether your actions were arguably within the scope of your practice as an LPN.
Scope of Practice for Registered Nurses
Here, too, the way one state defines the scope of practice for registered nurses may differ from the way another state defines it.
California has an extended explanation for what the scope of practice is for registered nurses. It states that it was specifically designed “to provide clear legal authority for functions and procedures that have common acceptance and usage” and “to recognize the existence of overlapping functions between physicians and registered nurses and to permit additional sharing of functions within organized health care systems that provide for collaboration between physicians and registered nurses.”
It goes on to define the “practice of nursing” to mean “those functions, including basic health care, that help people cope with difficulties in daily living that are associated with their actual or potential health or illness problems or the treatment thereof, and that require a substantial amount of scientific knowledge or technical skill.” It then goes on to list specific examples that include a number of “direct and indirect patient care services,” as well as administering tests and immunizations, taking blood samples, and observing patients for “signs and symptoms of illnesses.”
Virginia provides a list of specific actions that are or are not within the scope of practice of a registered nurse. These are in addition to the way the state defines “registered nursing” to mean “the performance for compensation of any nursing acts in the observation, care, and counsel of individuals or groups who are ill, injured or experiencing changes in normal health processes or the maintenance of health; in the prevention of illness or disease; in the supervision and teaching of those who are or will be involved in nursing care; in the delegation of selected nursing tasks and procedures to appropriately trained unlicensed persons as determined by the Board; or in the administration of medications and treatments as prescribed by any person authorized by law to prescribe such medications and treatment.”
There is no question that applying these kinds of general definitions and standards to your day-to-day nursing tasks isn't necessarily easy. When legislators attempt to draft laws and regulations that broadly cover the many different types of tasks regularly performed by nurses, they can end up with language that is difficult for actual nurses to use as guidance.
The Lento Law Firm Professional License Defense Team can help. Our experienced attorneys regularly face the challenge of interpreting state nursing laws and regulations and applying them to our clients' activities. That background makes it easier for us to help you evaluate whether you should be concerned about the scope of any of your nursing tasks, as well as whether you are at risk if you're being investigated for exceeding the scope of your nursing license.
Scope of Practice for Advanced Practice Registered Nurses
Advanced Practice Registered Nursing licenses are relatively new compared with RN and LPN licenses, and as a result, are also the types of licenses that tend to vary most from state to state. This makes it even more important for an advanced practice nurse to understand what the scope of practice for their specialty area is – especially if they are licensed in more than one state, because two states may have different standards for the same type of advanced practice nursing license.
In Texas, for example, the Board of Nursing offers an eleven-step questionnaire for APRNs to use just to “clarify whether an act is within an APRN's scope of practice.” It also notes that APRNs are not licensed generally but “are licensed in a specific advanced practice role” and that an APRN licensed in one area cannot expand their practice to include tasks that are licensed in another advanced practice nursing area without “completing an appropriate APRN program and obtaining the additional licensure to practice.” It also notes that APRNs in Texas must have a “written delegation mechanism, with an appropriate physician, providing authority for the performance of relevant medical aspects of care.” In other words, the APRN must be operating under the supervision of a doctor.
In addition, APRNs who are adding “new patient care activities or procedures into their existing APRN role and population focus” are encouraged to review the list of factors that the Board of Nursing uses to determine whether a particular practice “falls within an APRN's authorized professional and/or individual scope of practice.” These factors include:
- Whether the APRN was trained to perform the practice as part of their APRN education
- Whether the particular practice falls within the generally accepted standards of care for the APRN's licensed “role and population focus area” (with “population focus area” meaning the types of patients the APRN is licensed to treat)
- Whether the APRN has “demonstrable clinical competence” or experience in that role “obtained through supervision and/or training by a qualified practitioner”
- Whether the APRN is credentialed by a “health care facility's credentialing body” or holds a privilege to perform that practice at a health care facility
- Whether the APRN has “completed additional training” for the new practice
The Texas Board of Nursing notes that an APRN's actions that are “committed outside an APRN's authorized scope of practice may subject the APRN to discipline.”
Delaware treats APRNs somewhat differently. APRNs licensed in Delaware have “full practice authority,” which means they are allowed and expected to
- Practice within the Board of Nursing's standards
- Be accountable to “patients, the nursing profession,” and the Board for complying with Delaware's nursing laws and regulations and for “the quality of advanced nursing care rendered.”
- Recognize the limits of the nurse's knowledge and experience
- Plan for situations that are outside of the APRN's areas of expertise
- Consult with other healthcare providers “as appropriate.”
- Refer patients to other healthcare providers, again “as appropriate”
- Practice “to the full scope of practice within the licensed role” and patient population focus
Full practice authority means that an APRN in Delaware is not required by the state to have what is called an “oversight contract” with a physician. (Though the APRN's workplace may require the APRN to work under the supervision of a doctor.)
Because of the specialized nature of APRN licenses, they are not nearly as “portable” as LPN or RN licenses. At present, only a handful of states permit an APRN licensed in one state to easily practice in another state based on the first state's license. This means that in most cases, nurses who hold an APRN license in one state must separately apply in each additional state where they want to practice as an APRN. This is where the scope of practice issues can arise; if you're used to the practice requirements for your home state, you may inadvertently violate the practice requirements of other states where you hold an APRN license if you don't pay close attention to what each state allows you to do as an APRN.
What Types of Nurses Can be Disciplined for Exceeding the Scope of Their Nursing License?
No matter what type of nursing license you hold – LPN, RN, or APRN – you can be disciplined by your state's board of nursing for exceeding the scope of your nursing license. As a practical matter, however, there are some types of nurses working in certain types of situations who may be more at risk of exceeding the scope of their nursing license.
Generally speaking, nurses who are not closely supervised may be more likely to exceed the scope of their licenses. A licensed practice nurse who works in a private home as a caregiver and is not directly supervised the vast majority of the time can easily find that the care they are providing exceeds the scope of their nursing license. A registered nurse working on site at a school or factory with no physician in attendance can find themselves in a similar situation. And APRNs who extend their patient care beyond the scope of their specialty licenses can find themselves being disciplined for exceeding the scope of their license.
But even in well-supervised health care facilities, a nurse can find themselves exceeding the scope of their license if they administer certain medication or procedures without the authorization of a prescribing physician (or APRN, as the case may be). This is why, no matter where you work as a nurse, if you are not certain whether the task you've been asked to perform is within the scope of your license, you should check with a supervisor to make sure. This will protect both you and your patient, and will help you better understand what the scope of your nursing license is.
What Are Some Ways that Nurses Can Exceed the Scope of Their Licenses?
There are a number of ways that a nurse can find themselves performing tasks that exceed the scope of what they are licensed to do. Because each situation is different, this is by no means meant to be a comprehensive list. They are some examples that have come to the attention of the Lento Law Firm Professional License Defense Team over the years.
- “This is the way we do it.” If you're the new nurse on the floor, especially if you're also new to nursing, you might have other nurses tell you to perform certain tasks at work because “it's how we've always done it.” The temptation can be to go with the flow despite your nervousness; after all, they have experience and you don't, and you don't want to get a reputation for being difficult. The problem is that even if no harm comes to any patient if you exceed the scope of your license, you are putting your future at risk. The better approach? Check with your supervising physician if you're not sure.
- It's quicker just to get it done. Nurses are often busy, perhaps too busy, depending on the situation. Sometimes, it might seem easier to administer medication or perform a procedure that you “know” is necessary, even if you don't have “formal authorization” to do so. Again, it's better to follow the proper procedure rather than risk your license to the board of nursing discipline.
- Using pre-signed prescription pads. If your supervising physician leaves you signed blank prescriptions to make it easier for you both to issue prescriptions to patients, you (and the doctor, but your focus should be you) can be disciplined for doing so.
- APRNs licensed in more than one state. This can especially be a risk if you're an APRN who lives in one state but works in another. You may be used to the scope of practice you're allowed by your home state, but the neighboring state's scope is actually more restrictive for your type of APRN license. This is where you need to be careful about the licensing differences between states.
- Telemedicine. Many patients are now receiving health care remotely, through video links or over the phone. If you're a nurse practitioner licensed in one state but your tele-patient is in another state, you may be exceeding the scope of your license by offering them healthcare advice or writing them a prescription.
- Changing APRN jobs. If you have an APRN license that authorizes you to work as an emergency nurse practitioner, but you then take a position as a primary care nurse practitioner, and your license doesn't support that kind of work, you might face discipline for exceeding the scope of your APRN license.
What Should You Do if You're Notified that You're Being Investigated for Exceeding the Scope of Your Nursing License?
It can be very upsetting to find that someone has filed a complaint against you for any reason. If the complaint claims you've exceeded the scope of your nursing license, you can expect that a detailed investigation of the allegations will follow. The best thing you can do as soon as you learn of the complaint is to contact an experienced professional licensed defense attorney. There are several reasons for this:
- You have a right to protect yourself. A disciplinary investigation is not always comprehensive. The investigator may focus only on finding facts that will support the complaint and ignore or discount those that support your defense. An experienced professional licensed defense attorney can help uncover “the rest of the story,” information that can often be extremely helpful when it comes to your defense.
- It's not easy being questioned. Working with an experienced professional licensed defense attorney means that you will be prepared for when the investigator comes to ask you questions about the complaint. Answering questions in that kind of situation is hard for many people. You're entitled to only answer clear questions that you understand. You deserve to make sure your answers are clear so that the investigator doesn't mistakenly assume something you didn't intend to say. Your attorney will help make sure you answer clear questions with clear answers.
- Your attorney knows how to negotiate. Sometimes the board of nursing will come to you with a proposed settlement that includes an agreed form of discipline – but only if you agree that certain facts occurred. Your attorney can help you evaluate offers like that, and where the attorney has uncovered information in your defense that the investigator failed to find, they can use that information to negotiate a more favorable resolution for you.
- Your attorney knows how to defend you at a hearing. If your case doesn't settle and instead goes to a hearing, you want to be defended by someone who has experience with professional license disciplinary hearings. The Lento Law Firm Professional License Defense Team has that experiences and knows how to protect and defend our clients' rights.
The sooner you contact a professional licensed defense attorney, the better the chances that your case can be resolved more favorably.
The Lento Law Firm Professional License Defense Team Can Help
The Lento Law Firm Professional License Defense Team has helped nurses and other medical professionals protect their licenses, their reputations, and their future in disciplinary proceedings all across the country. Whether you're an LPN, an RN, or an APRN, if you're a nurse facing a disciplinary proceeding based on an allegation that you exceeded the scope of your practice, we can help.
Call the Lento Law Firm Professional License Defense Team today at 888.535.3686 or use our contact form to schedule a confidential consultation. Your nursing license is your livelihood; let us help you protect it.
