As if becoming a nurse wasn't challenging enough, you've paid an even higher price in time, money, and experience to become certified as a Clinical Nurse Specialist (CNS). After earning your RN credentials, you had to go back to school and earn a master's or doctoral nursing degree, then go through grueling steps to become certified in your area of specialty. Now your professional licensure and certification are the keys to your career. Unfortunately, a single allegation of misconduct could potentially derail all that you've built, triggering a nursing board investigation that could cause you to lose your license.
State nursing boards have a lot of power and sway, and they have a minimal burden of proof when it comes to meting out disciplinary action against nursing professionals, especially when they believe the public trust has been violated. The standards may be set even higher for CNSs because of their involvement with sometimes vulnerable parts of the population. What should you do if you are the subject of a complaint? What is the procedure for disciplinary action? What measures can you take to safeguard your nursing license and certification?
Joseph D. Lento is an attorney with extensive experience defending people's professional licenses in New Jersey and New York. If your CNS license comes under scrutiny, here's what you need to know.
What Board Will I Answer to for Allegations of Misconduct?
CNPs are considered advanced practice nurses who are certified and regulated by the nursing in the state where they are licensed to practice. In New Jersey it's the respective State Board of Nursing for each state; in New York, it's the Nursing division of the Office of the Professions. If allegations of misconduct surface against you, the Board of Nursing (BON) in your state will investigate the claims and determine what disciplinary actions to take against your license.
What Are the Most Serious Allegations That Could Threaten My Career as a CNS?
Clinical nurse specialists are expected to maintain the highest standards of ethics and professionalism for the sake of the public trust. Most instances of license revocation revolve around violating that trust in some way. The following are the most common complaints:
- Inappropriate behavior. This broad category can include inappropriate language, unprofessional treatment of patients, inappropriate romantic relationships, sexual harassment, etc.
- Boundary violations. Violating the nurse-patient relationship through an inappropriate exchange, using one's position to manipulate the patient, or breaching patient confidentiality--these types of violations could jeopardize your license.
- Drug/alcohol addiction. Allegations of substance abuse can lead to your license being revoked, especially if you're accused of showing up at work while under the influence of drugs or alcohol.
- Mishandling/misuse of medications. Your CNS license could be revoked if you are accused of dispensing medication in an inappropriate manner, keeping inaccurate inventories, pilfering medications for personal use, etc.
- Fraud. Examples include operating under false credentials, falsifying patient records, sending incorrect or inflated bills to insurance companies, "upcoding" services to get insurance companies to pay more, etc.
- Convictions for criminal offenses. You could be barred from practicing in certain states if convicted of theft or DUI, drug possession, and other crimes of moral turpitude. Most licensed CNSs are also required to self-report any criminal arrests or convictions to the BON, and your license could be suspended or revoked for failing to do so.
Could the BON Impose Other Penalties That Allow Me To Continue Practicing?
Yes. There are numerous options for imposing discipline that doesn't involve losing your license to practice completely. Depending on the circumstances of your case, the BON may choose any of the following alternatives:
- License suspension. You may be temporarily or indefinitely prohibited from practicing nursing subject to board review.
- Practice restrictions. The BON may limit the scope of your license and prohibit you from performing certain functions.
- De-certification. You might be allowed to keep your nurse's license but lose your certification as a clinical nurse specialist.
- Fines. The board may impose a monetary penalty.
- Alternative-to-discipline program. As an alternative to restricting your practice or revoking your license/certification, the board might require you to undergo continuing education or to attend a treatment program.
- Formal Reprimand. The BON may simply place a written reprimand or censure on your record.
Bear in mind that even these lesser sanctions could still be detrimental to your career because any disciplinary action will appear on your professional record. If a patient or employer checks your credentials and finds out that you were disciplined, they may be hesitant to work with you. A good professional license attorney can give you a better chance of avoiding any of these outcomes.
What Is the Procedure for Disciplining Clinical Nurse Specialists?
Each Board of Nursing implements its own disciplinary process. However, the method generally goes like this:
Complaint
Most disciplinary actions begin with a formal complaint made against you with the BON. Patients, family members, coworkers, and other practitioners may all file complaints against you.
Initial Review
The board reviews the complaint to determine whether it has jurisdiction over the alleged infraction.
Investigation
When the board receives a complaint, it opens an inquiry into the matter. It might take many months for the investigation phase to be completed. The process may include requests from you for additional information and a formal response to the charges, interviewing the complainants, site visits, etc. The board may dismiss the complaint if it finds insufficient evidence; otherwise, it will move forward with disciplinary proceedings.
Consent decree
If the board determines that there is sufficient cause for concern, it may offer to let you sign a consent decree instead of going through a formal inquiry. The consent agreement is an admission of guilt and a voluntary submission to whatever penalty is stated in the contract.
Formal hearing
If no consent decree is reached, a full hearing takes place in front of the Board of Nursing and/or an Administrative Law judge. This hearing may seem similar to a trial with both sides presenting arguments. You may have formal legal representation at this hearing.
Board action
The board will determine your guilt or innocence, as well as any penalties it deems fit.
Appeal
You have the right to appeal an unfavorable decision to your state's appellate courts. These appeals are most commonly used to review the case for procedural mistakes, and they seldom change the outcome.
Although the procedure may be daunting, keep in mind that the board has the authority to dismiss your complaint at any time. An experienced professional license attorney can assist you in minimizing the disciplinary procedure by attempting to have the complaint dismissed or negotiating for more lenient discipline.
I Have Been Offered a Consent Decree. Should I Accept It?
We recommend that you don't sign a consent decree without having a professional license attorney review your case first. If disciplinary action is likely due to the abundance of evidence against you, a consent decree could be a good option, especially if it allows you to continue practicing as a CNS or offers a path to reinstatement. On the other hand, a consent decree is also an admission of guilt that becomes part of your public record. If you have evidence to support your innocence, it may be in your best interests to prove your case at a formal hearing rather than sign a consent decree.
Does Hiring an Attorney Imply That I Am Guilty of the Allegations?
No. Your professional license is a legal agreement with the state, so it makes sense to have a legal professional represent you when that license is called into question. If you hire an attorney, the board will not presume that you are guilty. To them, an indication that you are serious about the matter, which is what they want.
Why Is It Necessary for Me To Have an Attorney in This Case?
Many licensed professionals, including CNSs, have a misconception about how license discipline works. They don't understand that the role of the Board of Nursing is to protect the public from bad actors, and once a complaint is made, the BON begins actively looking for evidence against you. (In other words, if this were a criminal case, the BON would be the prosecutor.) This means that any attempt to meet with the board informally could backfire, and your statements could be used against you.
While you can certainly represent yourself to the licensing board with no legal assistance, it is unlikely that you will receive a favorable outcome on your own. An experienced professional license defense attorney understands the workings of the board and how to negotiate for more favorable terms. Hiring an attorney will give you the best chance to protect your rights and get a better outcome with the board.
What Kind of Attorney Do I Need?
While any licensed attorney can legally represent you, not every attorney can improve your chances with the Board of Nursing. Seek out an attorney who has specific knowledge and experience in professional license defense for the best chance of saving your CNS license and certification.
My CNS License and Certification Were Already Revoked. Can a Professional License Attorney Help Me Get It Reinstated?
Yes. An attorney can assist you in obtaining a license restoration. If you meet the requirements, most jurisdictions will provide a reinstatement procedure for your license. Qualifying for reinstatement generally involves some version of the following steps:
- Send in a reinstatement application with a written explanation as to why you are requesting reinstatement, accompanied by any applicable filing fees
- Make sure you have paid any/all fines
- Provide a thorough record of every job you held while your license was inactive
- Provide evidence that you have met any board requirements for reinstatement, such as rehabilitation or continuing education
- Agree to any additional plan of action mandated by the BON
A professional license defense lawyer can handle your application, keep track of its progress, and negotiate with the board for the most favorable terms for your reinstatement.
How Can Hiring an Attorney Help Save My CNS License and Certification?
Having a license defense attorney in your corner greatly increases your chances of achieving a favorable resolution with the board, one that enables you to keep your license and avoid losing your CNS certification. A good attorney will:
- Review the complaint with you so you understand what it means and what is at stake
- Develop the best possible strategy for responding to the complaint
- Represent you in an official legal capacity in all interactions with the BON
- Accumulate evidence and obtain witnesses who will corroborate your story
- Negotiate for dismissal of the complaint and/or reduced sanctions as applicable
- Defend you in a formal hearing if one becomes necessary
- File any appeals as appropriate
- Assist with getting your license and certification reinstated if it has been revoked
At What Point in the Disciplinary Process Should I Hire an Attorney?
Literally, as soon as possible--as soon as you receive an indication that a complaint has been filed or is about to be filed. Don't wait until you're summoned for a formal hearing because, by this point, the BON will have already formulated its arguments against you. Involving a professional license attorney early in the process may help you avert a hearing and even get the complaint dismissed.
You can't afford to gamble with your career if your license as a clinical nurse specialist is in danger; you've worked too hard to get where you are. Joseph D. Lento is highly experienced in the workings of licensing boards and their disciplinary procedures, and he will work aggressively to help you obtain positive results. If your license is under scrutiny in New Jersey or New York, take steps now to save your license and certification. Contact the Lento Law Firm at (888) 535-3686 today to discuss your case and your options.
