If you are an agency nurse in Maryland facing accusations of professional misconduct, you already know you are in a challenging and multifaceted situation. While nurses in traditional employment fields may have clarity on how to approach misconduct allegations with their employer, agency nurses, often independent contractors, are usually not allowed to improve their performance or share their side of the story with supervisors or a human resource department. After losing a contract with a medical facility, you may find that your situation escalates to dismissal from the agency, followed by a formal investigation with the Maryland Board of Nursing.
If your professional reputation as an agency nurse, financial security, and peace of mind are being disrupted due to misconduct allegations, the Lento Law Firm's Professional License Defense Team can help. We understand the nuances of Maryland Nursing Board proceedings and nursing agency investigations. Contact us today by calling us at 888-535-3686 or by using our online contact form.
The Unique Role of Agency Nurses in Maryland
An agency nurse is a registered nurse employed through a nursing agency instead of directly affiliated with a single healthcare facility or hospital. Agency nurses receive assignments from an employer agency and often work under contractual agreements, granting them significant flexibility. Employer agencies often profit from their ability to fill short-term staffing shortages as healthcare facilities may be desperate for support during high demand or crisis seasons. Agency nurses may work one contract assignment at a time or rotate among various contracts within driving distance. Some roles can extend for months, while others may range from a few days to weeks.
An agency career may appeal to nurses who desire more autonomy over their professional lives. Some of the many benefits of working as an agency nurse are described below.
Agency nurses benefit from a high level of flexibility in their professional lives. This degree of control enables them to balance their work schedules with other aspects of their lives, such as parental responsibilities, travel opportunities, or even other professional and creative outlets.
Diverse Work Experience
As with any other career, some nurses may grow restless working in the same monotonous environment. An agency career may allow nurses to work in various healthcare settings, broadening their clinical experiences and enhancing their skill set so they don't become restless.
While agency nursing positions may provide less job security and traditional benefits when compared to roles in conventional healthcare facilities, agency nurses are often compensated with higher hourly wages. This makes sense when considering basic laws of supply and demand. Agency nurses are typically contracted to fill staffing shortages during periods of peak demand, holiday seasons, or healthcare challenges like the COVID-19 Pandemic. Coupled with the ongoing staffing shortage in Maryland's healthcare industry, these staffing shortages increase the demand for agency nurses, allowing them to gain a financial edge over their non-agency colleagues.
What Qualifications Does an Agency Nurse Need?
Maryland Nurse Practice Act
At a minimum, agency nurses must complete all nursing license prerequisites under the Maryland Nurse Practice Act. Some of the state's licensure prerequisites include:
- Earning a degree from an accredited college, university, or nursing program.
- Earning minimum passing scores on the NCLEX-RN Exam and Board examinations.
- Complete an application for licensure with the Maryland Board of Nursing.
- Pay the required application fee.
- Complete and pass a criminal background check.
In addition to these requirements, nursing agencies will often have additional requirements for nurses to gain employment. For instance, most, if not all, agencies will also require agency nurses to have significant clinical experience or a variety of certifications before offering them contract opportunities. From a financial perspective, this increases the agency's demand for contracts from healthcare facilities that do not want to utilize their resources to fill vacancies.
What Additional Skills Makes Someone a Good Agency Nurse Candidate?
Adaptability and Communication
Some nurses may be more naturally suited to work as agency nurses than others. While the career path may come with disadvantages or unique challenges as opposed to more “stable” traditional positions, working as an agency nurse may particularly appeal to nurses who feel professionally fulfilled in challenging and varied environments. Nurses who excel in new settings and are independent enough to work without supervision may succeed as agency nurses.
Aside from being adaptable and eager to learn, agency nurses must also have excellent communication skills. Agency nurses are often tasked with plugging into existing structures amongst a hospital team who know each other well and do not want to take the time to formally train a contract employee who will not work with them long term. Instead of taking this personally, agency nurses must be able to advocate for themselves, ask questions, and take directions without offense.
Competence and Confidence
Agency nurses often have a solid ability to manage stress and exude confidence, crucial traits given the nature of their roles. This skill set is essential, considering that agency nurses may not benefit from the same comprehensive orientation or training that permanent staff at a facility typically receive. As a result, their ability to quickly plug into varying clinical settings is a testament to their competence, professionalism, and confidence in their nursing skills and knowledge.
Professionalism and Reliability
Nursing agencies place a high premium on professionalism and reliability in their agency nurses. When agency nurses are unreliable or disagreeable, an agency may gain a reputation for selecting subpar agents, affecting their ability to receive contract opportunities and remain profitable. Agencies tend to prioritize agents who exhibit self-motivation, independence, and advanced organizational skills -enable them to manage varying schedules, adapt to different locations, stay current with licensure requirements, and fulfill continuing education obligations.
What Misconduct Allegations Can Threaten My Agency Nursing Career?
Under § 8-316 of the Maryland Health Occupation Code, the Maryland Board of Nursing is granted the authority to enforce professional standards within the nursing field. This provision grants the Board the discretion to take necessary disciplinary actions, including denying, suspending, or revoking a nursing license for agency nurses in instances of misconduct. Some types of professional, ethical, and moral misconduct that can place your agency nursing career at risk are discussed below.
- Fraud: Such as obtaining a nursing license through cheating, misleading professional statements, or attempts to undermine a nursing licensure exam.
- Abuse of Prescription Medication Responsibilities: This can range from mishandling, misappropriating, or stealing prescription medication or even the failure to document the administration of the prescriptions by nursing standards.
- Criminal Conduct: Recent felony convictions (within the past five years), especially convictions related to medical or osteopathic practice.
- Former Disciplinary Actions: Encompasses disciplinary actions undertaken in another state or jurisdiction, such as revocation, suspension, restriction, or limitation of a nursing license. Agency nurses may also face disciplinary conduct for failure to inform the board about charges brought against the person's license in other states or jurisdictions, including instances where they were denied admission to nursing boards.
- False or Misleading Advertising: This is the advertising of services in a manner that is false, misleading, or otherwise contradictory to the Maryland Board of Nursing's rules. Examples could also include unsubstantiated claims of medical performance or excellence or claiming superior skills without evidence.
- Harm to the Public: Engaging in any conduct that is likely to harm the public, such as carelessly performing job duties, engaging in medical practices that the provider is not competent enough to complete, and creating unnecessary danger to a patient's health and safety.
- Failure to Supervise: Failure to adequately supervise junior nurses or other licensed or unlicensed health care providers when necessary. This also extends to aiding or abetting unlicensed individuals in medicine when a license is required.
- Practicing Despite Dangerous Conditions: Practicing medicine despite conditions such as developmental disabilities, mental incompetencies, chemical dependence, deterioration through the aging process, physical disabilities, sexual predator history, including sexual psychopathic personality types.
- Negligent Performance: Professional performance that departs from or fails to conform with standards of the nursing profession, including the ability to practice medicine with reasonable skill and safety.
- Improper Management of Medical Records: Such as failure to adequately record patient conditions, information, diagnosis, medication, etc. This also extends to failure to furnish medical records as required by law.
- Improper or Unlimited Fee Splitting: Including paying, offering to pay, or agreement to receive payments, including commissions, in a manner disproportionate to the services performed or not properly disclosed as an area of economic interest. Improper payment of fees also includes dispensing drugs, pharmaceuticals, or medical devices for profit, outside of an acceptable partnership, group practice, etc.
- Fraudulent Billing Practices: Engaging in fraudulent billing practices such as Medicare or Medicaid billing.
- Failure to Comply: The failure to report professional misconduct of peers or the inability to participate in misconduct investigations.
- Sexual Misconduct or Failure to Maintain Appropriate Boundaries with Clients.
Misconduct Complications That Are Unique to Agency Nurses
As a registered nurse in Maryland, you already know that you can face disciplinary consequences and even a potential hearing before the Maryland Nursing Board for various forms of ethical, professional, and moral misconduct. While the disciplinary process for any registered nurse is complex, the disciplinary process for agency nurses is exceptionally nuanced and characterized by gaps in communication and human resource support.
While nurses employed in traditional settings often have the advantage of foreseeing potential performance issues due to conversations with their superiors or human resource department, agency nurses are often isolated from a structured professional support system. Without these essential communication channels, agency nurses may feel less informed and more vulnerable to unforeseen professional challenges. As an independent contractor, agency nurses may not be granted the same rights as their non-agency colleagues. They can often share their story through a formal human resource grievance policy or performance improvement meeting.
In fact, by the time an agency nurse realizes that their professional relationship with their agency is threatened, they may be terminated from future contracts without any form of suspension, pay, or security. If the agency or hospital reports the alleged misconduct to the Maryland Board of Nursing, they may quickly find that the situation has escalated to a formal investigation before the Maryland Nursing Board.
My Nursing Agency Isn't Offering Me Assignments. Should I Be Worried?
If you are facing misconduct allegations or are struggling to receive contract assignments from your agency, you may be on your way to a formal investigation before the Maryland Board of Nursing without even realizing it. While you want to remain calm, you also want to be prepared. Therefore, it's best to inform yourself about your legal rights and options before things escalate all the way to the Board. Often, violations at the agency level may be due to misconceptions, mistakes, or misunderstandings. While investigations and strategic defenses in these situations can be complex enough for a professional to manage, added legal action at the agency and facility level may be necessary to adequately defend the nurse's professional reputation, nursing license, and ability to continue working as an agency nurse.
The Disciplinary Process for Agency Nurses in Maryland
Although the Maryland Board of Nursing can often aggressively pursue disciplinary measures, they must ensure that agency nurses receive specific safeguards throughout the entire disciplinary process. These safeguards are granted to nursing agencies under the United States and Maryland State Constitutions through a constitutional right known as “due process.” While you may have heard the term “due process” thrown around in various contexts, it can quickly summarize your right to be notified about the allegations against you and present your side of the story before a neutral decision-maker. Due process is typically afforded by ensuring that the disciplinary process occurs in the following phases.
The Complaint Phase
Misconduct allegations against Maryland agency nurses can be reported to the Maryland Board of Nursing by patients, their family members, doctors, colleagues, insurance carriers, and other members of the public who may have witnessed the alleged misconduct. Complaints can be lodged online via the state's complaint form.
Per the Maryland Administrative Procedures Act, agency nurses must be notified about the allegations against them and allowed to retain legal representation. Notice of the allegations must be provided even if the complaint was ultimately dismissed.
The Investigation Phase
After receiving and reviewing the complaint, the Board will officially investigate the misconduct claims. During an investigation, a board investigator may utilize various investigation tools. You may be asked to comply by providing a written or oral statement. Failure to “cooperate” with the Board in an investigation, even against oneself, may be grounds for additional professional misconduct violations. An investigator may also speak to the hospital, facility staff, and management, review records, or agency colleagues to gather more evidence about the alleged misconduct. Failure to “cooperate” with the Board in an investigation, even against oneself, may be grounds for additional professional misconduct violations.
After the investigation, the Board can dismiss the complaint or pursue further disciplinary proceedings.
Stipulations or Settlement Phase
After completing the investigation, the Board may offer the agency nurse stipulations or a formal settlement offer, sometimes called a “consent agreement.” These optional agreements allow the accused nurse to “settle” the allegations against them in exchange for accepting specific penalties such as fines, license suspensions, or continuing education units and monitoring. While this may seem like admitting defeat, consent agreements can allow the accused to avoid harsher, unforeseen consequences that a hearing officer could issue if the matter proceeded to a hearing.
If the parties cannot settle the matter through a consent agreement, they can proceed to an administrative hearing. The hearing must follow the rules, timelines, and procedures outlined in the Maryland Administrative Procedure Act. These hearings are operated akin to a small trial, allowing both parties to present arguments of law and fact, submit evidence for review, and even testify or cross-examine witnesses.
At the end of the hearing, the administrative law judge or hearing officer will issue a formal decision. Consequences can range from license suspension to revocation and other limitations. Additional orders may include civil fines rehabilitation requirements such as ongoing monitoring, reporting, and education. The hearing officer may also order that the public be notified of the nurse's misconduct allegations, affecting their professional reputation and prospective employment opportunities.
After exhausting their administrative options through an administrative hearing, a nurse may want to appeal the hearing officer's decision. It's important to note that appeals are quite demanding and require the experience and strategy of counsel who is well-equipped and familiar with the state's bureaucratic system. Fortunately, our Professional License Defense Team members have successfully navigated nursing appeals for nurses across Maryland.
Areas We Serve in Maryland
Our Team can help you craft a defense regardless of what nursing agency you are employed with. We provide strategic representation throughout Maryland, including for nurses employed through Chesapeake Medical Staffing Inc., Alliant Healthcare Staffing, and Prestige Healthcare Resources.
Nestled in the state's central area near the Chesapeake Bay, Baltimore is no stranger to the healthcare and biosciences industries. The city is renowned for its top-tier healthcare facilities, including the Johns Hopkins Hospital and the University of Maryland Medical Center. These institutions provide world-class healthcare and contribute significantly to Baltimore's economy and reputation as a center for medical innovation. In addition to contracts at Johns Hopkins or the University of Maryland Medical Center, agency nurses may also find themselves in contracts with St. Joseph Medical Center, MedStar Union Memorial Hospital, and Ascension St. Agnes.
Uniquely situated between Baltimore and Washington, D.C., Columbia is Maryland's second most populous city. The city is characterized by a strong emphasis on healthcare, technology, and educational services. Healthcare facilities include Howard County General Hospital, St. Agnes Healthcare, and Kernan Hospital.
The state's third most populous city, Germantown, is one of Maryland's largest and fastest-growing communities. Geographically, the German town is in the northwestern part of the state, only 30 miles from Washington, D.C., making it an attractive area to live for commuters in many industries. Among other notable healthcare facilities and offices, the city is home to the Holy Cross German Town Hospital and Germantown Medical Center.
Silver Spring is in the southern part of Montgomery County and is a suburban city just north of Washington, D.C. While many residents commute to Washington, D.C., Silver Spring's economy is multifaceted, with a strong presence in media and the arts. The city's healthcare facilities include Holy Cross Hospital as well as Adventist HealthCare White Oak Medical Center,
How Can the Lento Law Firm Professional License Defense Team Help Me?
Our experienced, diligent, and available Professional License Defense Team has experience navigating the unique and complex license defense of agency nurses in Maryland. If you were recently let go from a contract without explanation from your agency and are struggling to receive additional assignments, this may be a sign that some misconduct allegations are brewing, and you should seek legal counsel before things escalate further.
If you are already being investigated by the Maryland Board of Nursing, we can ensure your interests are protected throughout the investigation process, represent you during settlement conversations, and, if necessary, represent you at the administrative hearing. Often, clients are unaware of the various defenses available to them and how to share their side of the story strategically. At the hearing, we can craft a robust defense by presenting arguments of fact and law, submitting and evaluating evidence on your behalf, subpoenaing and examining witnesses, and conducting cross-examinations.
If you have already had a hearing and weren't satisfied with your legal defense or represented yourself, let us help you apply for an appeal and/or start working towards a license re-issuance request.
Contact our Professional License Defense Team Today
If you're dealing with contract termination, agency dismissal, or a Maryland Nursing Board investigation, our experienced Professional License Defense Team can provide the essential support and advocacy you need. Contact us today at 888-535-3686 or use our online contact form.