If you're an agency nurse in Missouri dealing with professional misconduct allegations, you're likely facing a complex situation. Unlike regular employees, agency nurses, who often work as independent contractors, don't usually have the chance to improve their performance or discuss the issue with supervisors or HR. If you lose a contract with a medical facility, the situation could worsen, leading to dismissal from the agency and possibly a formal investigation by the Missouri 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 Missouri Nursing Board proceedings and nursing agency investigations. Contact us today by calling us at 888-535-3686 or by using our online contact form.
Missouri Agency Nurses
Agency nurses are typically employed as independent contractors through a nursing agency contracting with local hospitals and healthcare facilities to fill staffing vacancies. While agency nurses support existing teams in many scenarios, they are frequently used during periods of significant need, like holidays or during local and national crises, such as the COVID-19 Pandemic. Agency nurses have the freedom to accept or deny contracts offered by their agency. Contractual assignments can range from a few days at a single facility to many months while juggling multiple facilities and schedules.
While there are many benefits to working as an agency nurse, agency nurses are particularly set apart from their peers due to their unique demands and qualifications. A 2022 report published by the Missouri Board of Nursing shows that less than 12% of working Registered Nurses in the state are employed in the “other” category. Even with this small percentage, data does not show what percentage of the “other” category counts for agency nurses alone.
While agency nurses may be few and far between, they are special, nonetheless. Some benefits and drawbacks of working as an agency nurse are discussed below.
Benefits of Working as an Agency Nurse
Flexible Work Options
Agency nurses enjoy a significant degree of flexibility in their schedules, setting them apart from non-agency nurses, who typically work grueling hours throughout unpreferred schedules. This level of flexibility in choosing when, where, and sometimes how to work makes agency nursing an attractive option for professionals juggling personal responsibilities such as caring for children or elderly parents. Agency nurses with an entrepreneurial spirit may also be drawn to the career as it allows them to pursue additional professional interests during timeframes they are not contracting with a facility or hospital.
Diverse Work Experiences
As with any profession, doing the same work in the same environment day in and day out can cause any nurse to feel like they are stagnating in their career. For nurses who desire a less monotonous environment, an agency nursing career allows them to work across a wide range of healthcare settings. For example, a nurse may accept a contract at a hospital ER for one week while the next week accepts shifts at an oncology center. This variety works against growing bored in repetitive environments and contributes to professional growth resulting from new and varied experiences.
Pay
While agency nursing can offer less job security in terms of a traditional employment environment, agency nurses tend to receive higher hourly rates than their non-agency peers. Not only do agency nurses typically have significant clinical experience that supports their hourly rate, but their compensation aligns with fundamental principles of supply and demand. In other words, if hospitals are looking to bring in contract employees to fill staffing shortages during times of need, they may be willing to ensure that they are not understaffed.
The Disadvantages of Working as an Agency Nurse
Professional Isolation
Because agency nurses work as independent contractors, they do not have the same level of support from supervisors or mentors as traditional nurses often have. For nurses looking to improve their skills or break into a new area of nursing, they may feel professionally isolated from the profession and have nowhere to turn for help. Agency nurses may also lose friendships with colleagues within the profession, as they often bounce around from facility to facility, making it difficult for them to form bonds with their “co-workers.”
Lack of Benefits
Agency nurses often do not receive the same level, if any, benefits as their counterparts in permanent positions. While agency nurses may earn higher pay in terms of their hourly rate, this often comes at the cost of no healthcare benefits, company retirement plans, and paid leave. Similarly, while many traditional nurses are covered under their employer's professional liability insurance plans, agency nurses often have to arrange and pay for their professional liability insurance.
Missouri Nursing Laws
Missouri Nursing Practice Act
The Missouri Nursing Practice Act is a set of laws and regulations within Missouri that govern the nursing profession, including the expectations and parameters of a career in agency nursing. The Act's primary purpose is to protect the public's welfare and safety by establishing standards for the nursing profession through nursing education, training, licensure, and practice standards. The Act also grants the Missouri Board of Nursing the authority to issue disciplinary actions for violations of professional conduct, including penalties such as license denial, suspension, or revocation.
Missouri Nurse Licensure Compact
Missouri is a member of the Multistate Nurse Licensure Compact, an interstate nursing act that allows for mutual recognition of nursing licenses among its member states. Under the Compact, nurses with an active nursing license in one of the 41 Compact states can legally practice in any other Compact state. It's important to note that while agency nurses must comply with the nursing laws of the state where they accept a contract, they must always continue to meet the practice requirements of their primary residence state of Missouri. Facing misconduct allegations while working in another Compact state can still affect your ability to retain your Missouri nursing license, resulting in potential penalties for your Missouri and compact nursing licenses.
What Misconduct Allegations Can Threaten My Agency Nursing Career?
Section 335.066 of the Revised Missouri Statutes empowers the Board of Nursing to conduct thorough investigations into allegations of nurse misconduct and impose penalties for nurses who fail to participate in such investigations, even against oneself. This section further describes the various types of professional, ethical, and moral misconduct issues that can place your agency nursing career at risk, some of which are discussed below.
- Unlawful use or possession of controlled substances.
- Impaired nursing performance due to alcohol, illicit substances, or the use of certain prescription drugs.
- Conviction of crimes related to nursing qualifications, duties, or functions.
- Conviction of offenses involving fraud, dishonesty, violence, or moral turpitude.
- Fraudulent activities in obtaining a nursing license or during licensure exams.
- Fraudulent activities in obtaining employment or professional recommendations.
- Fraudulently obtaining nursing fees or compensation.
- Incompetence, gross negligence, or repeated negligence in nursing duties.
- Professional misconduct, fraud, dishonesty, unethical or unprofessional conduct.
- Continuously overcharging or overtreating patients.
- Billing for unprovided or undocumented services.
- Using intimidation, coercion, or deception in patient interactions.
- Continuously performing unnecessary or inappropriate treatments or tests.
- Delegating duties to unqualified individuals, including failing to supervise junior nurses adequately.
- Providing nursing services beyond one's scope of practice.
- Engaging in sexual activity with a patient.
- Failure to maintain proper emotional or physical boundaries with patients.
- Being listed on any state or federal sexual offender registry.
- Failure to cooperate with Board of Nursing investigations, even against oneself.
- Failure to comply with Subpoenas or orders issued by the Board of Nursing.
- Late payment of license renewal fees.
- Violating probation agreements or orders with any licensing board.
- Unethical or unprofessional conduct involving minors.
- Deviation from or failure to adhere to nursing standards.
- Failure to maintain professional boundaries with patients.
- Violating patient confidentiality or privacy rights.
- Inaccurate assessment, documentation, or reporting of patient status.
- Causing physical or emotional harm to patients.
- Documentation errors, such as failing to transfer necessary patient information to subsequent nurses.
- Violation of professional trust or confidence.
- Failure to guard against or report contagious diseases.
- Maintaining unsanitary practice conditions or failing to report such conditions.
- Habitual intoxication or alcohol dependence
- Diverting or attempting to divert medication, controlled substances, or medical supplies. This extends to improper administration of medication.
- Any negligent conduct that severely harms the patient or public health and safety.
Misconduct Complications That Are Unique to Agency Nurses
As a registered nurse in Missouri, you must understand that you could face disciplinary actions, including a hearing before the Missouri Nursing Board, for various forms of ethical, professional, and moral misconduct. However, it's even more important to understand that the disciplinary process for agency nurses may involve unique complexities and challenges.
Because agency nurses typically work as independent contractors, they often lack the same structured professional support systems that are present in traditional employment settings. Underperforming nurses in these settings may benefit from proactive communication with supervisors or warnings from their human resource departments, which can help identify and address performance issues or misunderstandings sooner rather than later.
Agency nurses may isolate themselves from this kind of support, lacking essential communication before unexpected professional challenges escalate. This isolation can be particularly impactful when an agency nurse's professional relationship with their agency is at risk. Without the typical warnings or opportunities to discuss the alleged misconduct allegations with supervisors, agency nurses might face termination from future contracts without suspension, pay, or security. Moreover, if an agency or hospital reports alleged misconduct to the Missouri Board of Nursing, the agency nurse may find themselves quickly embroiled in a formal investigation without the assistance of supervisors or colleagues who know them well enough to support them in an inquiry before the Board of Nursing.
The Importance of Early Legal Representation
Because agency nurses experience various challenges in disciplinary investigations, they must seek legal representation early. If you are struggling to receive contract assignments from your agency, you may be on your way to a formal investigation before the Missouri Board of Nursing without even realizing it.
Understanding your legal rights and options before issues escalate to the Board level is a wise approach. Often, violations at the agency level stem from misconceptions, errors, or misunderstandings. Navigating investigations and formulating strategic defenses at the beginning stages of the disciplinary process can help in your efforts to safeguard your nursing career, reputation, and ongoing ability to practice as an agency nurse.
The Disciplinary Process for Agency Nurses in Missouri
Although the Missouri 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 Missouri State Constitutions through a constitutional right known as “due process.” Due Process means that before taking disciplinary action against your nursing license, the Missouri Board of Nursing must ensure that you are sufficiently notified about the allegations against you and have a fair opportunity to present your side of the story before a neutral decision-maker. The disciplinary process will typically occur in the following phases to ensure that you receive due process.
The Complaint Phase
According to Revised Missouri Statute Section 621.100, the Administrative Hearing Commission is responsible for receiving, reviewing, and formally processing misconduct complaints against nurses. Misconduct allegations against Missouri agency nurses can be reported to the Missouri 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. After receiving a complaint, the Commission issues a notice to the accused nurse, who must provide a timely written response.
The Investigation Phase
After receiving and evaluating a complaint, the Commission formally assigns an investigator to investigate the allegations of misconduct. During this investigation phase, the investigator can employ various investigative tools such as interviewing witnesses, reviewing documents, etc. Throughout the investigation, you may also be required to provide written or oral statements or produce requested evidence. Failure on your part, or any other nurse's part, to contribute to the investigation can result in further disciplinary conduct.
Settlements or Consent Agreements
Under Revised Missouri Statute § 335.067, the Commission has the authority to approve the voluntary dismissal of charges, particularly those related to substance use and abuse, provided the nurse consents to a treatment plan, program, or disciplinary consequence – in other words, a settlement agreement.
While optional, consent agreements allow the accused nurse to “settle” the allegations against them in exchange for accepting specific penalties such as fines, license suspensions, continuing education units, and ongoing 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.
On the other hand, consent agreements may be overly burdensome, making it difficult to comply with all its terms and conditions. Therefore, if you are considering pursuing or signing a consent agreement, contact the Lento Law Firm's Professional License Defense Team today for help navigating your most strategic options.
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 Missouri Administrative Procedure Act and the various requirements under Revised Missouri Statute Section 621.100. 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 hearing officer can recommend various consequences ranging from suspension to fines to revocation. The officer then forwards their recommendation to the Missouri Board of Nursing. The Board can consider the officer's recommendation but is not bound by it and can issue any disciplinary consequence that they think is appropriate.
Appeal
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, the Lento Law Firm's Professional License Defense Team has successfully navigated nursing appeals for nurses across Missouri and can walk you through these complicated procedures.
Areas We Serve in Missouri
Our Team can help you craft a defense regardless of what nursing agency you are employed with. We provide strategic representation throughout Missouri and are available to assist nurses across various agencies, geographical areas, and contract terms. Some of the leading regions we provide representation in the state are discussed below.
Kansas City
Located on Missouri's western border, adjacent to Kansas, Kansas City is Missouri's largest city, with a population exceeding 500,000. It is a significant center for medical professionals, boasting three major hospitals and two substantial medical school programs. Notably, St. Luke's Hospital of Kansas City and the University of Missouri Kansas City School of Medicine. Agency nurses in Kansas City may be employed through agencies such as Cascade Health Services, Next Move Healthcare, and Nursing Superior Staff.
St. Louis
Nestled along the beautiful Mississippi River, St. Louis is the second-largest city in the state and is known around the country for its famous 630 ft. Gateway Arch. The city is home to many hospitals, including Barnes-Jewish Hospital, Kindred Hospital, and St. Louis Children's Hospital. Agency nurses in St. Louis may find themselves employed through agencies such as Provider Pool, Core Staffing, LLC, Harris Health, and Advanced Nursing Services.
Springfield
Springfield is the third largest city in Missouri and is home to approximately 169,000 residents. Leading professions in the city include the healthcare industry, business services, and manufacturing and logistics. The city also has two hospitals, Mercy Hospital and CoxHealth Springfield. Some nursing agencies include First Call of Springfield, a home health care staffing agency, Private Duty Nursing, Crown Nursing, Inc., and Springfield Staffing Solutions.
Columbia
With a notably smaller population of nearly 125,000, Columbia is a college town and home to the University of Missouri's MU Health Campus. While the area is only home to Boone Hospitals and other small hospitals associated with the university, the agency nurses can still find employment opportunities at other medical facilities with the assistance of agencies such as BrightStar Care Mid-Missouri and Staff-Smart Medical Staffing,
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 Missouri. If you find yourself unexpectedly released from a contract without clear reasons from your agency, it may indicate that misconduct allegations are emerging. At this point, our Team can prepare you for what to expect during a possible investigation. We can hold the Board of Nursing investigators accountable throughout the investigation and ensure that their investigatory methods are legal and procedurally compliant.
Post-investigation, we can assist in settlement negotiations and, if necessary, represent you with a solid legal defense at the hearing. Many clients may be unaware of the various defenses at their disposal or the strategic ways to present their side of the story. During the hearing, our Team can construct a strong defense by presenting factual and legal arguments, presenting evidence, subpoenaing and questioning witnesses, and engaging in cross-examinations on your behalf.
If you have already been through a hearing and are considering whether to file an appeal, our Tean can walk you through those steps and help you take advantage of the legal tools and protections at your disposal.
Contact our Professional License Defense Team Today
If you're dealing with contract termination, agency dismissal, or a Missouri 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.
