The Lento Law Firm Defends Iowa Nursing Assistant Certification
Iowa is a great place to practice as a certified nursing assistant (CNA) or certified nurse aide, or home health aide, as the state also calls the important CNA role. Iowa has many attractive cities, Des Moines, Cedar Rapids, Davenport, Iowa City, and Sioux City largest among them, in which CNAs can find abundant facility or residential employment opportunities. Iowa also has fine hospitals like the University of Iowa Hospitals, Mercy One Des Moines Medical Centre, UnityPoint Health-St. Luke's Hospital, Genesis Medical Centre-Davenport, and Mercy Medical Centre-Cedar Rapids employ hundreds of CNAs. Iowa also has large home health agencies like Comfort Keepers, Wesley at Home, Freedom Home Health Care, and Lutheran Services, offering residential facility or residence-based CNA employment. You also have great opportunities to advance your nursing career in Iowa with further training and education beyond your CNA credential.
But to enjoy those CNA opportunities in Iowa, you must keep your Iowa Direct Care Worker Registry current and in good standing. If, instead, you face the Iowa Department of Inspections and Appeals notice of a complaint against you or that it is already pursuing formal license disciplinary charges, then you need to address those charges head-on to ensure that you can continue your CNA practice. Disciplinary charges put your valuable Iowa CNA registration, employment, and career at risk. Retain the Lento Law Firm's premier Professional License Defense Team to defend your Iowa CNA registration. Our attorneys are available to defend you in Des Moines, Cedar Rapids, Davenport, Iowa City, Sioux City, and any other Iowa location. Call 888.535.3686 or chat with us now for Iowa CNA disciplinary defense.
Iowa CNA Registration
Iowa's Department of Inspections and Appeals maintains the state's Direct Care Worker Registry, which the state formerly called the Nurse Aide Registry. Iowa Administrative Code Rule 81.16(5) creates what the rule still calls “the registry of nurse aides,” now known as the Direct Care Worker Registry. Iowa's Department of Inspection and Appeals adopted Rule 81.16 on the authority of Iowa Code Section 249A.4 having to do with qualifying healthcare facilities for federal funding. Federal regulations require nurse aide regulation to protect healthcare facility patients and residents. Iowa Code Section 135C.33 requires employers at healthcare facilities to check the Department of Inspections and Appeals' Direct Care Worker Registry before offering employment to a nurse aide. The same statute requires healthcare facility employers to check the Department of Human Services's Child Abuse Registry and Dependent Adult Abuse Registry and to check the Department of Public Safety's Sex Offender Registry and Criminal Background Check sites.
You must generally have a clean record in the Direct Care Worker Registry to obtain nurse aide employment at an Iowa healthcare or residential facility. Our attorneys are available to assist you if you have issues obtaining Iowa Direct Care Worker Registry registration or correcting your Registry information. If you cannot correct a Registry entry, Iowa Administrative Code Rule 81.16(5) expressly permits you to enter a statement in the Registry disputing the entry, which employers may consider when reviewing Registry information. Rule 81.16(5) requires that the Department of Inspection and Appeals make the Registry readily accessible to both employers and the public.
Iowa CNA Regulatory Authority
Iowa doesn't just register nurse aides. It also closely regulates the practice of certified nursing assistants. Iowa Administrative Code Rule 81.16(3) sets forth the requirements that a nurse aide must meet to register. To obtain your Iowa CNA credential, you must have completed a clinical training and competency evaluation program offered by a provider whom the Department of Inspection and Appeals approved. That training had to cover communication and interpersonal skills, infection control, safety and emergency procedures, resident rights, and basic nursing skills, including taking and recording vital signs, caring for the resident's environment, recognizing and reporting abnormal changes in body functioning, personal care skills, end-of-life care, toileting, nutrition, hydration, transfer, position, turning, mental health and social service needs, and how to respond to resident behavior, among many other things. These requirements form the backdrop for any disciplinary charges. Your Iowa CNA work is in a heavily regulated environment.
Iowa CNA Disciplinary Authority
Iowa's Department of Inspection and Appeals has the state's authority to discipline you if you fail to meet the above CNA standards. Iowa Administrative Code Rule 441-81.13 guarantees the right of healthcare facility residents to be free from a nurse aide's abuse, neglect, and misappropriation. To respect that right, Iowa Administrative Code Rule 81.16(6) grants the Department of Inspection and Appeals the authority to investigate, hear charges on, and determine allegations of nurse aide abuse, neglect, or misappropriation. The Department refers those allegations to Inspections and Appeals surveyors for handling. The Department's surveyor may contact you in the course of an investigation, or you may only hear of the investigation after the surveyor concludes it when Rule 81.16(6) requires the Department to notify you of its results. Contact our attorneys the moment you learn of your investigation so that we can help you respond and, if possible, avoid a finding of abuse and the necessity for an appeal hearing.
Iowa CNA Disciplinary Sanctions
Iowa Administrative Code Rule 81.16(6) requires the Department of Inspection and Appeals to make an entry in the Direct Care Worker Registry whenever it finds that a nurse aide has committed abuse: “the nurse aide registry will include a notation that the nurse aide has a founded abuse report on record if the final decision indicates the nurse aide performed an abusive act.” Entry of your name into the Registry as an abuser, for the public and employers to see, is the Department's primary disciplinary sanction. Rule 81.16 does not expressly provide for reprimands, probation, restrictions, suspensions, or other forms of discipline common in other states. But don't assume that you face an all-or-nothing outcome. Our attorneys may be able to help you show Department of Inspection surveyors and other disciplinary officials that you have corrected any issue through remedial education, training, counseling, services, or other measures. Department officials may be willing to accept your assurances and interim measures to avoid discipline.
Removing Iowa CNA Disciplinary Entries
If the Department of Inspection and Appeals finds that you committed abuse and enters your abuse record in the Direct Care Worker Registry, you may be able to have that entry removed. Iowa Administrative Code Rule 81.16(5) requires the Department to remove discipline entries after twenty-four months during which you are not working as a CNA: “The registry shall remove entries for persons who have performed no nursing or nursing-related services for monetary compensation for a period of 24 consecutive months unless the person's registry entry includes documented findings or convictions by a court of law of abuse, neglect, mistreatment or misappropriation of property.”
Nationwide Stakes of Iowa CNA Discipline
Iowa recognizes nurse aide reciprocity. Reciprocity gives you the advantage of being able to gain a nurse aide certification by endorsement in another reciprocating state rather than going through the whole recertification process. But if you lose your Iowa nurse aide certification to discipline, you'll lose your right to reciprocal endorsement in other states. Your stakes when facing Iowa disciplinary charges may be higher than you think. Discipline in Iowa can end your CNA career in other states. Let our attorneys help you fight your charges now rather than have to face the consequences of discipline later.
Grounds for Iowa CNA Discipline
Surveyors out of Iowa's Department of Inspections and Appeals cannot find misconduct on just any grounds. Investigators don't have unfettered authority to charge wrongs as they please. They should instead be relying on their administrative rule authority for disciplinary grounds. Iowa Administrative Code Rule 81.16(5) states these four disciplinary grounds: (1) abuse, (2) neglect, (3) mistreatment of a resident, or (4) misappropriation of property. Consider their definitions and examples and how our attorneys may be able to help you defend and defeat those charges.
Abuse as Grounds for Iowa CNA Discipline
Abuse is Iowa Administrative Code Rule 81.16(5)'s first ground for discipline. Rule 81.16(5) doesn't define abuse. Iowa Administrative Code Rule 441-81.13, guaranteeing the right of healthcare facility residents to be free from a nurse aide's abuse, provides a little definition, stating, “Facility staff shall not use verbal, mental, sexual, or physical abuse, including corporal punishment, or involuntary seclusion of residents.” Abuse generally involves willful, knowing, deliberate, or intentional wrongs, not mere carelessness or neglectful omissions. In that sense, abuse is generally an immoral wrong, indicating the nurse aide's poor character and unfitness. Abuse thus generally has two elements, both willfulness and the actual physical harm or mental distress. Examples would be a nurse aide purposefully hitting, kicking, shoving, choking, or berating a resident, causing the resident physical pain or harm or mental and emotional distress.
If Iowa Department of Inspection and Appeals surveyors investigate and charge you for abuse, our attorneys may be able to show that the complaining resident was deluded or mistaken as to the allegations. You may not have had any such contact with the resident, or your actions may have been in self-defense, defense of others, or restraint of the resident against self-harm or property destruction. While abuse allegations are serious because of their strong negative impact on your reputation and character, they are, for the same reason, important to contest when inaccurate, excused, or exaggerated. You don't want an abuse finding following you around, destroying your nursing career.
Neglect as Grounds for Iowa CNA Discipline
Neglect is Iowa Administrative Code Rule 81.16(5)'s next ground for discipline. As in the case of abuse and its other express grounds for discipline, Rule 81.16(5) doesn't define neglect. Neglect, though, does not necessarily require willfulness, deliberation, or intent. Neglect ordinarily instead involves careless or reckless omissions, meaning failures to act when a competent nurse aide would have acted and could have acted within the available time and means. Examples of neglect could include failing to put up a resident's bed rails according to the supervisor's orders, resulting in the patient's fall and injury, failing to turn a bed-ridden resident resulting in bed sores, or failing to answer a distress call or alarm resulting in a resident's physical harm or serious mental distress. Poor nutritional care resulting in malnourishment, poor hydration resulting in dangerous dehydration, and badly soiled bedding or clothing resulting in rashes, embarrassment, indignity, and distress would be other neglect examples.
If Iowa Department of Inspections and Appeals surveyors investigate you for neglect, our attorneys may be able to help you show that you were not responsible for the involved resident's care, that you did everything that you should have done, or that you lacked the equipment, services, or support to provide the care excusing your neglect. Excessive resident loads, unreasonably long hours, overly burdensome assignments, and similar circumstances can also constitute exonerating or mitigating circumstances when one of your residents suffers some sign of neglect. But we may also be able to help you show that the resident's deterioration was the natural course of the resident's disease or aging rather than due to nurse aide neglect.
Mistreatment as Grounds for Iowa CNA Discipline
Mistreatment is Iowa Administrative Code Rule 81.16(5)'s next ground for discipline. As in the case of abuse and neglect, Rule 81.16(5) doesn't define mistreatment. Mistreatment, though, likely refers to substandard nurse aide care. Unlike abuse, mistreatment wouldn't necessarily involve willful or deliberate wrongs. Nor would mistreatment involve careless or reckless omissions, as in the case of neglect. Mistreatment more likely refers to actions that the nurse aide takes that harm or unduly distress the resident, that a competent nurse aide would not have taken or would have done differently within nurse aide customary care. Examples of mistreatment could include mistakenly administering the wrong medication resulting in a progression of the resident's disease, carelessly lifting the patient in an unconventional way that injured the patient, or carelessly assisting the patient with walking without appropriate support resulting in the patient's fall and injury.
If Iowa Department of Inspections and Appeals surveyors investigate you for mistreating a resident, our attorneys may be able to show that you were not the nurse aide who treated the resident, that any treatment you provided was within the customary care for a nurse aide, and that any mistreatment you engaged in did not lead to any resident harm or distress. We may be able to retain and present nurse aide experts to testify that your actions were within the standard of care or that any mistreatment was due to the facility's lack of appropriate supervision, services, equipment, and support.
Misappropriation as Grounds for Iowa CNA Discipline
Misappropriation of resident property is Iowa Administrative Code Rule 81.16(5)'s final express ground for discipline. As in the case of abuse, neglect, and mistreatment, Rule 81.16(5) doesn't define misappropriation. But misappropriation is ordinarily a deliberate and knowingly wrongful taking of a resident's property without authorization or excuse, intending to deprive the resident of the property, usually for the nurse aide's own gain. Misappropriation can involve outright theft of such things as cash, credit cards, checks, jewelry, or electronic devices. Misappropriation can also involve the nurse aide using coercion, duress, or other undue influence over the resident to cause the resident to give the nurse aide money or property, such as by threatening to withhold care.
If Iowa Department of Inspections and Appeals surveyors investigate you for misappropriation, our attorneys may be able to show that you took nothing from the resident, that you only moved or disposed of property as the resident directed, that you gained nothing from any disposition of the resident's property, or that others had equal or greater access to the resident's property and were responsible for any misappropriation. Disciplinary officials generally know that cognitively impaired residents sometimes make false accusations, including accusations of theft. We may be able to help you show investigating surveyors that you are innocent of misappropriation.
Credentials Fraud as Grounds for Iowa CNA Discipline
Iowa Department of Inspections and Appeals officials will also very likely consider any misrepresentation you may have made to obtain your registration as grounds for revoking that registration. Credentials fraud can include things like cheating on the competency evaluation, falsifying your training transcript, or exaggerating your work hours and experience to qualify for certification. If the Department's surveyors investigate you for credentials fraud, our attorneys may be able to show that you made no misrepresentation, that your training records document that you completed the program, and that work and evaluation records show you have met the Department's other requirements for registration.
Impaired Practice as Grounds for Iowa CNA Discipline
Iowa Department of Inspections and Appeals officials will also very likely consider the impact of any substance abuse and impaired practice on your alleged abuse or neglect. Disciplinary officials generally know that the stresses of nursing and the unusual access nurse aides have to prescription medication can lead to greater rates of substance abuse and addiction. Indeed, the Iowa Board of Nursing offers a Nurse Assistance Program for nurses who have a physical or mental impairment or drug or alcohol abuse issue. While the program is not expressly available to nurse aides, similar professional programs and services would generally be available to you. Our attorneys may be able to help you show disciplinary officials that you have no substance abuse issue, that you did not practice while impaired, or that you have addressed or are addressing your addiction and impairment issues so that you do not represent a danger to residents.
Professionalism Issues as Grounds for Iowa CNA Discipline
Other grounds that Iowa Department of Inspections and Appeals officials may consider relating to your disciplinary charges could include professionalism issues. Professionalism is a broad subject that can sometimes lead to subjective evaluations and unfair disciplinary charges, especially when those charges allege colleague disrespect, supervisor insubordination, and a vague failure to act as a team player. Such issues may simply arise out of personality conflicts or from poor supervision and overly critical evaluations. If you face such issues, our attorneys may be able to help you show that you met all objective standards, did not engage in any resident abuse or neglect, and are a capable and competent nurse aide despite supervisor or employer reports of unprofessional conduct.
Iowa CNA Disciplinary Procedures
How Iowa Department of Inspections and Appeals officials handle your disciplinary charges can also affect your outcome. Generally, state officials seeking to adversely affect a professional license must provide the licensee with due process. Due process requires fair notice and a fair hearing before an impartial decision maker. Iowa Administrative Code Rule 81.16(6) provides that once the Department makes an initial finding of your misconduct, it must serve you with that finding so that you can evaluate it and decide whether to request a hearing. Rule 81.16(6) gives you thirty days within which to request that hearing. The Department conducts the hearing according to its rules for contested hearings. You will have the opportunity to present your witnesses and documentary evidence with the skilled and experienced assistance of our attorneys. Our attorneys can also cross-examine the Department's witnesses against you, research, draft, and submit hearing briefs, advocate with the hearing officer for a favorable decision, and appeal any adverse decision, including, if necessary, for review by Iowa's courts.
Premier Iowa CNA Defense Available
The Lento Law Firm's premier Professional License Defense Team is available in Des Moines, Cedar Rapids, Davenport, Iowa City, Sioux City, and any other Iowa location to defend your nurse aide certification against disciplinary charges. Hundreds of professionals nationwide have trusted the Lento Law Firm for their best outcome to disciplinary charges. Call 888.535.3686 or chat with us now.