Becoming a nurse takes a great deal of time and a high level of commitment, becoming a nurse-midwife, even more so. Midwifery requires special training and certification, and you may answer to more than one regulating board in the process. And while the profession is highly rewarding, it doesn't come without risk. Your entire career hangs on your professional licensure, and a single allegation of misconduct could trigger a board investigation that could cause you to lose your license—and your entire career to unravel as a result.
Licensing boards have a minimal burden of proof and wide-ranging authority. This means a simple misunderstanding or error in judgment could endanger your career if the board believes you have violated its standards and/or the public trust. What do you do if you are the subject of a complaint? What is the process of disciplinary action? What are the steps you can take to protect your license?
Joseph D. Lento is a professional license defense attorney with years of experience helping people in New Jersey, Pennsylvania, and New York whose professional licenses are in jeopardy. To that end, the Lento Law Firm has compiled answers to many commonly asked questions below so you can make informed decisions if your nurse-midwife license comes under scrutiny.
Which Licensing Board Administers Disciplinary Actions With Nurse-midwives?
Nurse-midwives are effectively combining two specialized practices into one profession, and as a result, they often answer to more than one board or committee at once. In New Jersey, nurse-midwives are licensed as nurses by the State Board of Nursing, but their midwifery practices are regulated by the Midwifery Liaison Committee of the State Board of Medical Examiners. A similar arrangement exists in Pennsylvania. In New York, you'll answer to both the Board of Nursing and the Midwifery Division of the Office of the Professions. Any of these boards or committees can investigate allegations of wrongdoing and administer disciplinary action as necessary.
What Are Some of the Most Common Problems That Could Put a Nursing License at Serious Risk?
In assisting with childbirth, nurse-midwives perform many of the same functions as physicians do in those situations—so as with doctors, nurse-midwives must adhere to the highest standards of professionalism and care. Most complaints that would threaten your license are based on an alleged violation of these standards. Among the most common complaints are:
- Unprofessional behavior. This broad category includes inappropriate behavior that can include anything from inappropriate language to inappropriate sexual relationships or advances.
- Boundary violations. A sacred trust exists between a midwife and their patient. If that trust is abused through an inappropriate exchange, using one's position to manipulate the patient, or breaching patient confidentiality--these types of violations could jeopardize your license.
- Mishandling/misuse of drugs. Many nurse-midwives are licensed to prescribe and administer medications to their patients. Dispensing medication inappropriately, keeping inaccurate inventories, or pilfering medication for personal use may all be grounds for losing your license.
- Drug/alcohol addiction. You could lose your license over substance abuse, especially if you show up for work while under the influence.
- Fraud. Overstating credentials or patient records, falsifying work hours, sending inaccurate or inflated bills or claims to insurance companies--these and other fraudulent actions can lead to loss of license.
- Criminal convictions. You may be disqualified from practicing in certain states if you are convicted of theft, DUI, drug possession, or crimes of moral turpitude. Failure to report a recent crime can result in your license being revoked.
Am I Guaranteed To Lose My License as a Nurse-Midwife Over Alleged Wrongdoing?
No. If the board finds insufficient evidence to support the claim, it will be dismissed. Additionally, the board may opt to impose a lesser penalty depending on the facts and evidence available, which would allow you to continue practicing. Some examples of these lesser disciplinary actions include:
- License suspension. A suspension, also known as "separation of practice," prohibits you from working as a nurse-midwife for a certain period.
- Practice restrictions. The board might place limits on your scope of practice, such as restricting the number of hours you can work and prohibiting you from performing specific activities.
- Fines. A monetary fine may be imposed by the board.
- Alternative-to-discipline program. As an alternative to restricting your practice or revoking your license/certification, the board might mandate continuing education, allow you to practice under supervision, or require you to attend a treatment program.
- Formal reprimand. Minor offenses may result in a formal reprimand that will be placed on your record and not impose any restrictions on your license.
You should be aware that these other sanctions can still cause serious damage to your career. Any disciplinary action may become a matter of public record, and this can be a problem if a patient looks up your credentials and sees that you have been disciplined.
What Is the Disciplinary Process for Nurse-Midwives?
Each state and each regulatory board has its own procedures for administering discipline. That said, the process generally works as follows:
Almost all disciplinary actions begin with a formal complaint filed against you with the board. Complaints may be filed by patients, family members, colleagues/coworkers, other practitioners--basically anyone who has knowledge that your alleged conduct was in violation of nursing regulations or the public trust.
The board reviews the complaint to determine whether it has jurisdiction over the alleged violation.
After the board has verified the complaint and concluded that it has jurisdiction, it will open an investigation into the matter. It can take several months for the investigation phase to be completed. This may include requests for additional documentation and information from complainants, site visits, and a request for a formal written response from you. The board may dismiss the complaint if it finds insufficient evidence; otherwise, it will continue to the formal charge phase.
If the board finds sufficient evidence of wrongdoing, it may offer to allow you to sign a consent decree as an alternative to taking you through a formal hearing. The consent decree is an effective admission of guilt and a voluntary submission to whatever disciplinary action is stated in the agreement.
A full hearing takes place in front of the licensing board and/or an Administrative Law judge.
The board will make a determination as to your guilt or innocence and decide on whatever penalty it deems appropriate.
You have the right to appeal an adverse decision to the appellate courts in your state. These appeals are usually limited to reviewing the case for procedural mistakes and rarely overturn the board's decision.
The disciplinary process can be complex but bear in mind that the board can dismiss your complaint at any stage of the process. An experienced professional license attorney can help you to mitigate the disciplinary process either to have the complaint dismissed or to negotiate for more lenient discipline.
Should I Accept a Consent Decree if One Is Offered?
It depends on the situation and the allegations. If there is enough evidence to support disciplinary action--in other words, if discipline is likely--a consent decree could be a good option, especially if it allows you to continue practicing as a nurse-midwife or at least offers a path to reinstating your license. On the other hand, a consent decree is also an admission of guilt that will become part of your public record. If there is evidence that could exonerate you, it might be in your better interests to forego the consent decree and present your evidence at a formal hearing. Do not agree to any consent decree without first consulting an experienced professional license defense attorney.
Would Hiring an Attorney Make Me Appear Guilty?
Absolutely not. Because your professional license is a legal agreement with the state, any investigation into misconduct is a legal matter, and you're entirely within your rights to hire legal counsel for legal issues. The board will not assume you are guilty if you hire an attorney. To them, it's a signal that you take the matter seriously, as you should.
Why Do I Need an Attorney To Defend Me to the Board?
Many licensed professionals, including nurse-midwives, don't understand how the licensing board works or the import of an accusation. The board is there to protect the public, not you. Although you are certainly allowed to present yourself to the licensing board without the assistance of an attorney, it is less likely that you will get a favorable outcome if you do so on your own because the board is actively looking for evidence of wrongdoing. That means any attempt to meet informally with the board can backfire, and anything you say could be used as evidence against you. A good professional license defense attorney will understand the inner workings of the board and what they need to see in order to show leniency. In short, hiring an attorney gives you the best opportunity to protect your rights and obtain a more favorable outcome with the board.
What Kind of Attorney Do I Need?
You don't want just any attorney representing you before the board; you need an attorney who is specifically experienced in professional license defense--someone who understands administrative law in your state and how to protect you from having your license revoked.
Can a Professional License Attorney Help Me Get My Nurse-Midwife License Reinstated if It Was Revoked Already?
Yes. An attorney can help you improve your chances of reinstatement. Most states will offer a pathway for reinstatement of a license if you are eligible. The following requirements could be part of your reapplication process.
- Complete a reinstatement request, accompanied by a written explanation as to why you are asking for it
- Pay any applicable reactivation and filing fees
- Provide a detailed record of every job you held while your license wasn't active
- Provide proof that you have fulfilled any requirements to be reinstated as mandated by the board (e.g., rehab, continuing education)
- Agree to any plan of action required by the state licensing board
If you apply for reinstatement, a professional license attorney can coordinate your application, monitor its status, and negotiate with the board for the best terms possible for your reinstatement.
How Can a Professional License Attorney Help Save My Practice?
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. Your attorney can:
- Review the complaint with you, so you know what it alleges
- Develop a strategy for responding to the complaint in a compelling manner
- Accumulate evidence and procure witnesses who will support your side of the story
- Represent you officially in all correspondence with the board
- Negotiate for dismissal of the complaint and/or reduced penalties
- Defend your case in a formal hearing
- Assist with getting your license reinstated, if it has been revoked
How Soon Should I Speak With an Attorney After Being Notified That My License Is Under Investigation?
The sooner you hire an attorney, the better. If you wait for a formal hearing to hire legal counsel, you'll be starting at a disadvantage because the board will already have built its case against you. A professional license defense attorney can help you negotiate a positive resolution even before the matter goes to hearing.
If your license as nurse-midwife is in jeopardy, you can't afford to take chances with your career—you've worked too hard to get where you are. Joseph D. Lento, an experienced attorney, has represented many licensed professionals in New Jersey, Pennsylvania, and New York. He is well-versed in the workings of the licensing boards and the disciplinary procedures in these states and can work aggressively to help you achieve positive results. Don't let a mistake or misunderstanding ruin your career. Let us help you save your license. Contact the Lento Law Firm at (888) 535-3686 today to discuss your case and your options.