On paper, physicians are usually the ones who are in control of a patient's care. They assess the situation, formulate a plan, and rely on nurses to provide care as needed. However, nurses are the ones who are in the room with patients every day, meeting their families, building a bond, and learning what specific healthcare concerns they have. What happens when conflicts between nurses and doctors arise, and what should nurses do when they disagree about what is best for a patient?
Following lawful orders from superiors is one of the expected duties of a nurse. Typically, the physicians in charge have more experience and knowledge, and nurses cannot simply refuse an order for no reason. When a nurse is accused of failing to comply with lawful orders, there is more at risk than unpleasant workplace interactions. Even a single accusation of noncompliance can lead to disciplinary action from the state's nursing board, putting a nurse's license—and career—at risk.
Failure to comply with orders doesn't always result from intentional wrongdoing. Nurses operate under intense pressure, and often, miscommunication or general confusion can result in healthcare deviating from an accepted plan. Unfortunately, state nursing boards are not always keen to consider these factors, which can turn an isolated incident into a major threat to a nurse's professional future.
At the Lento Law Firm, we understand how difficult it can be to make decisions when pulled in two different directions. On the one hand, you have an order in front of you that appears lawful and correct at first glance. On the other hand, you have intimate knowledge of the patient, and you know that a better option exists. Nurses deal with these dilemmas every day, and our Professional License Defense Team is prepared to defend your license when you are accused of disobedience.
Call the Lento Law Firm today at 888-535-3686 or fill out our confidential online form to provide more info and learn how we can protect your license. Our Professional License Defense Team represents nurses nationwide, and we are committed to keeping good nurses out of trouble when a focus on patient care places their licenses at risk.
What Constitutes "Failure to Comply" and When Are Nurses in Trouble?
When a nurse is accused of failing to comply with lawful orders, it most often refers to situations where they do not follow a directive given by a physician, nurse manager, or other healthcare authority. Most nurses, especially those without advanced certifications, work under a physician and are expected to follow orders to provide the highest level of care. The Nurse Practice Acts and statutes in many states outline that nurses must carry out lawful, safe, and ethical orders unless there are compelling reasons to refuse.
For instance, the Washington Standards of Nursing Conduct and Practice state that nurses violate the rules when they fail to administer treatments and medications in accordance with professional standards. At the same time, nurses must not fail to protect clients from unsafe practices and conditions. This can often cause confusion and pull nurses in multiple directions as they attempt to provide the highest level of care possible.
When nurses believe an order is unsafe, they must document their concerns, escalate the issue, and communicate with their supervisors as soon as possible. Noncompliance without proper documentation or justification can easily lead to consequences, including investigations by the state nursing board and potential disciplinary actions.
If your license is at risk, the Lento Law Firm can identify your state's specific laws and requirements for nurses, craft a defense to potential disobedience, and explain your situation to the Board of Nursing. Each state is different, but our Professional License Defense Team has offices nationwide to serve nurses wherever they need help.
Common Scenarios Leading to Accusations of Noncompliance
It's much easier to see how accusations of noncompliance can arise by looking at examples. Nurses don't enter the profession for selfish reasons; they become nurses to help others. Whether due to the high-stress nature of nursing or simple mistakes, nurses should not face disciplinary punishment for accusations of disobeying orders arising from their intent to help patients.
Miscommunication Between Staff and Supervisors
Nurses provide the lion's share of care to many patients, with supervising physicians only directly dealing with patients in a limited capacity. Without constantly working side-by-side, it's easy for nurses to misunderstand a quick care directive or for physicians to misunderstand a patient's situation and provide a confusing command.
If the nurse carries out an action based on incomplete or misunderstood information, it can be interpreted as a failure to follow orders. In the nurse's mind, they are doing what they were told. However, from the outside—specifically from the perspective of the Board of Nursing tasked with overseeing nurse behavior—all they see is a potentially dangerous action.
Safety Concerns
Nurses have a sacred duty to protect their patients, even if that means questioning or refusing a direct order from a superior. As mentioned, nurses are typically the ones who spend time with patients, providing routine care and assistance. Based on their knowledge of the patient's condition, nurses may choose to adjust a physician's medication orders to avoid harm. Or, they may know that the patient responds better to one treatment over another, disobeying a clear order to provide a patient with increased comfort.
Nurses are at a lower risk of accusations if their actions fall within their position's accepted scope of practice. However, while these adjustments may be the right decision from a patient safety standpoint, they can always lead to accusations of noncompliance.
If time permits, a nurse should ideally seek permission when deviating from a care plan. But when it comes to safety, there isn't always time to spare. The Lento Law Firm should be your first call if someone accuses you of disobeying direct orders, especially if you did so to protect a patient.
Logistical Challenges and Resource Shortages
With an aging population and projected shortages of nurses in America, some healthcare facilities will soon see their nurses overworked and pushed to their limits. In fact, this problem is already plaguing many hospitals and emergency rooms across the nation. Nurses are sometimes physically unable to carry out orders due to a lack of additional staff support or even insufficient medical devices and medications.
Given no better option, nurses may prioritize patient care by providing the next best thing, even though this choice violates a physician's order. Imagine a patient needs a particular painkiller before further care, but the supply is lacking. Should nurses postpone urgent care just to make a patient more comfortable?
Issues like these occur constantly, with many situations being even more urgent and difficult to parse than our basic example. Until healthcare facilities find a way to incentivize nursing applications and provide adequate resources, more of these no-win situations will threaten nurses' licenses in the future.
Refusing Orders for Personal or Religious Beliefs
Though less common, nurses may face situations where an order conflicts with their personal or religious beliefs. Most states understand these concerns and provide limited legal protections for nurses—but a refusal cannot come out of nowhere and jeopardize patient care.
Even if a nurse has concerns about a few procedures, they still provide top-quality care to other patients for 99% of their day and should be allowed to continue their important work. Proper communication with supervisors and clear documentation of the reason for refusal are needed to protect a nurse's professional standing, and the Lento Law Firm can assist if you are facing pushback due to moral concerns regarding parts of your job description.
Fatigue and Burnout
Nurses are known for working long hours, and fatigue often has a tremendous impact on their ability to perform their duties. When hours are excessive, exhaustion may cause a nurse to overlook or forget a directive, leading to unintentional noncompliance instead of purposeful disobedience.
Although human error is a part of life, nursing boards can still take action if the failure to comply results in patient harm or violates hospital policy. Any nurses who fear that their licensing board may misconstrue simple mistakes as malicious acts should contact the Lento Law Firm to build a robust defense and gather evidence of fatigue as a contributing factor.
While there are some valid reasons a nurse may disobey an order, state nursing boards will not always consider these nuances during their investigations. When nurses assume that others will see things through the same lens, they open themselves up to license sanctions. Never assume that your state's Board of Nursing will give you leeway, and contact the Lento Law Firm Professional License Defense Team at the first hint of scrutiny.
Potential Consequences of Failing to Comply With Orders
Nursing boards across the country treat noncompliance seriously, as they never know whether a nurse fails to comply with orders for good reason without first investigating the situation. And even if they determine that extenuating circumstances played a part, nursing boards can impose sanctions on a nurse's license. The most common sanctions include:
- Formal reprimands, which act as a warning and possibly attach to the nurse's permanent record.
- Fines to punish and deter future acts of failing to comply with lawful orders.
- Mandatory retraining or continuing education when a lack of knowledge or skills contributes to noncompliance.
- Probation, which restricts the nurse's ability to practice by requiring them to report to the board or work under increased supervision.
- License suspensions, which temporarily prevent the nurse from practicing and are usually reserved for severe violations or repeat offenses.
- License revocations, which permanently end the nurse's ability to practice, often resulting from noncompliance issues resulting in patient harm.
Every situation is unique, and whether you face license sanctions after an investigation into disobedience will depend on how well you explain your situation to investigators and nursing board officials. With the help of the Lento Law Firm, you can paint yourself in the best light and prove that failing to comply with an order was a purposeful decision to improve patient care, not cause harm or discord in the workplace.
What To Expect During a Nursing Board Investigation
Once a complaint of noncompliance reaches the nursing board, the investigation process can be lengthy, complex, and stressful for nurses who just want to do the right thing. Boards don't immediately jump to conclusions or impose penalties, but investigations can easily lead to sanctions if nurses cannot defend themselves from accusations.
Initial Complaint Review
Accusations of disobeying orders will primarily come from supervisors and healthcare facilities after they learn about nurses going their own way. Hospitals have internal processes for educating and reprimanding nurses who disobey orders, but they may also be required to make official reports to the Board of Nursing.
Once a state nursing board receives a complaint about a nurse, intake staff will determine whether the behavior falls within their jurisdiction and possibly violates the state's Nurse Practice Act. Only after this initial review will disciplinary investigations arise.
Nurses may not even be aware that a complaint has been filed against them—or by whom. If the complaint lacks merit or does not constitute a violation, it may be dismissed without the nurse's knowledge. However, nurses may learn of the complaint through their healthcare facility or supervisor.
Investigation
Once the board decides to investigate, the nurse will receive a formal notification detailing the allegations. At this point, the nurse may be asked to provide a written response to the allegations or attend a meeting to discuss the situation.
Anything the nurse says or submits from this point forward can influence the outcome of the investigation. If you are under investigation, we highly recommend contacting the Lento Law Firm Professional License Defense Team as early as possible to build the strongest response to allegations of disobedience.
The evidence gained during typical investigations includes witness statements, medical records, copies of orders given, and the following actions taken by the nurse. Nursing boards will want to know why a nurse decided to disobey an order, and while it may feel natural to want to explain your side of the story immediately, all nurses should be cautious about providing information without attorneys by their side.
If the nurse's disobedience causes the nursing board to believe patient safety is at risk, they may temporarily suspend the nurse's license or impose work restrictions until the conclusion of an investigation. These temporary actions can be stressful and may further impact the nurse's ability to work. However, they do not determine the case's final outcome, and the nurse has the right to challenge unfair interim decisions.
Possible Outcomes of Disciplinary Proceedings
Once the board has gathered relevant evidence, it will make a determination, possibly resulting in the following:
- Dismissal of the Complaint: If the board finds that the allegations are unfounded or do not warrant discipline, the case will be dismissed. The nurse's record will remain unaffected, and no penalties will be imposed.
- Informal Settlement or Agreement: In the majority of cases where some punishment is required, the board and the nurse reach an agreement, with the help of Professional License Defense Attorneys, to resolve the issue without formal disciplinary action. This could involve agreeing to a minor penalty, such as a written reprimand, to avoid a more severe outcome.
- Formal Disciplinary Action: If the board finds that noncompliance occurred but both sides cannot reach an agreement, board officials can impose disciplinary measures on the nurse's license. Depending on the specific actions of the nurse and what harm arose from their disobedience, the entire range of possible sanctions we discussed earlier may be on the table.
The ideal outcome is a dismissal of a complaint or a negotiated agreement that carries minimal punishment. However, nurses can rarely achieve this result solely based on the merits of their case, especially if they concretely disobeyed an order. If you are aiming to avoid license sanctions, working with the Lento Law Firm to defend your actions before your nursing board is your best course of action. Our Professional License Defense Team can identify the most relevant affirmative defense and help you return to your career unscathed.
Appeals Process
If a nurse is dissatisfied with the outcome of their case, they may have the option to appeal the board's decision. However, appeals are not a simple do-over, and there must be specific reasons for the appeal. Plus, nurses only have a short window to file an appeal, meaning immediate preparation is required to secure the best outcome.
If you work with the Lento Law Firm throughout your disciplinary investigation, we can continue representing you on appeal to help limit the sanctions on your nursing license. We can also advise whether an appeal is warranted or whether accepting your negotiated sanctions is better for continuing your career.
Failure to Comply With Orders: What It Means for Your Nursing Career
Outside of the disciplinary process, one of the most pressing reasons to defend against allegations of disobeying orders is how these accusations can directly impact a nurse's ability to advance in their career. Even if a nurse avoids the most extreme sanctions from their nursing board, the very presence of disciplinary actions on a professional record can make it challenging to find new employment or receive promotions. Most healthcare employers conduct thorough background checks, and any history of noncompliance or disciplinary actions could lead to employers passing over the nurse for a position.
In addition, disobeying the orders of a physician or superior is a unique violation, as it complicates professional relationships. Being labeled noncompliant can lead to distrust, reducing opportunities for professional growth and advancement. However, with a clean bill of health following an intense nursing board investigation, nurses can attempt to regain the trust they once had. If you disobeyed an order for a good reason and are facing professional roadblocks as a result, the Lento Law Firm can assist in this venture as well, potentially highlighting bias in your facility's hiring and firing processes.
Accusations of noncompliance should not be taken lightly, and the truth is not always the defense you hope it is. Many times, whether or not a nurse disobeyed an order is not up for discussion; it's there in black and white. What matters most is your reason for disobeying an order and how well you present this information to the Board of Nursing in your state. To start defending your nursing license, contact the Lento Law Firm Professional License Defense Team today.
Defending Nurses From Allegations of Failing to Comply With Orders
Nurses can spend 12 or more hours per day caring for patients and following orders from superiors. They dedicate their time to helping others, all the while dealing with strained resources and hectic workplaces. Unfortunately, despite all the good they do daily, nurses' careers are at risk if they are accused of even one instance of disobeying orders, regardless of the reason.
It doesn't make sense for nurses to sacrifice so much to attain their role only to turn around and neglect patients. Most of the time, a nurse who fails to comply with an order does so for the benefit of others, understanding that they may be the ones to come under fire. If you are a nurse facing scrutiny from your state's Board of Nursing, you need the help of the Lento Law Firm to explain your actions and safeguard your license and career.
When accusations come your way, the best way to defend yourself is to work with Professional License Defense attorneys who understand what is at stake. Call the Lento Law Firm today at 888-535-3686 or contact us through our website to begin defending against allegations of disobeying orders.
