The Lento Law Firm Defends North Dakota Certified Nurse Aides (CNAs)
North Dakota can be a great place for certified nurse aides (CNAs) to work. Your certification in the state's Nurse Aide Registry offers you substantial employment opportunities in attractive cities like Fargo, Bismarck, Grand Forks, Minot, West Fargo, and Williston. Sanford Medical Center Fargo, Sanford Medical Center Bismarck, Altru Health System-Grand Forks, CHI Oakes Hospital, Fargo Veterans Affairs Health Care System, and other facilities offer nurse aides substantial hospital-based employment opportunities, while Home Helpers, Senior Helpers, Home Instead Senior Care, Right at Home, Visiting Angels, and other home health agencies offer many rewarding residence-based opportunities.
North Dakota certified nurse aides can also pursue LPN and RN degrees while working as a nurse aide. North Dakota's Board of Nursing has approved LPN and RN nursing degree programs at Bismarck State College, North Dakota State College of Science, Dakota College at Bottineau, Lake Region State College, and Williston State College.
But to preserve your substantial nurse aide employment and nursing education opportunities in North Dakota, you must keep your North Dakota CNA registration in good standing against professional disciplinary charges. Skilled and experienced representation from the Lento Law Firm's premier Professional License Defense Team is what you need for your best disciplinary defense of North Dakota CNA misconduct charges. Our attorneys are available to you in Fargo, Bismarck, Grand Forks, Minot, West Fargo, Williston, or any other North Dakota location. Call 888.535.3686 or chat with us now for North Dakota certified nurse aide defense.
North Dakota CNA Discipline's Nationwide Stakes
North Dakota recognizes CNA reciprocity under North Dakota Administrative Code Section 33-43-01-09. Reciprocity eases your move to another state for CNA practice. You need not duplicate your CNA training and examination in North Dakota to receive CNA registration or in another reciprocating state. You may instead use your CNA registration to gain endorsement in North Dakota or in the other state, saving yourself time, trouble, and expense. Yet if you suffer discipline in North Dakota entered in the state's Nurse Aide Registry, then you will lose those reciprocal rights. Licensing officials in those other states will learn of your discipline from you or from the North Dakota Nurse Aide Registry. Your disciplinary charges in North Dakota thus have nationwide stakes. Put your best defense forward now with the help of our Defense Team rather than face a potential nationwide ban from nurse aide employment.
North Dakota CNA Registration
The North Dakota legislature enacted North Dakota Century Code Chapter 23-44, establishing the state's Nurse Aide Registry and requiring nurse aides working in facilities or for services in the state to register and maintain their registration in good standing. Referring to the North Dakota Department of Health & Human Services, North Dakota Century Code Section 23-44-02 provides, "The department shall establish and administer a nurse aide registry. The registry must include disciplinary findings, including findings of abuse, neglect, or misappropriation of property, and must include the eligibility of the individual to be employed." Your CNA registration requirement isn't solely for the patient or resident protection. It also qualifies facilities to collect federal healthcare funding under federal regulations requiring nurse aide registration. Your registration and the registration of other nurse aides help North Dakota nurse aide employers get paid for services, increasing your opportunity for employment.
North Dakota CNA Qualifications
Both North Dakota Century Code Chapter 23-44, representing the legislative judgment, and North Dakota Administrative Code Section 33-43-01-04, representing the agency's carrying out of the legislative judgment, require nurse aides to complete training and pass examinations according to the federal funding regulations. Administrative Code Section 33-43-01-04 provides that to gain certification in the state's Nurse Aide Registry, the nurse aide must complete training that includes at least seventy-five hours of classroom and clinical instruction in communication skills, resident rights, basic nursing skills, basic personal care, mental health, social service needs, basic restorative services, care for the cognitively impaired, infection control, vitals measurement, and other subjects necessary for competent nurse aide care. You have critically important skills based on your CNA training. You also have a valuable professional CNA registration credential. Don't throw it all away by ignoring disciplinary charges. Instead, get our Defense Team's help.
North Dakota CNA Disciplinary Authority
North Dakota Century Code Section 23-44-02 clearly requires the Department of Health & Human Services to regulate and discipline nurse aides seeking to maintain their Nurse Aide Registry certification in good standing. As indicated above, Section 23-44-02 states expressly, "The registry must include disciplinary findings … and must include the eligibility of the individual to be employed." North Dakota Administrative Code Section 33-43-01-22 carries that legislative edict into effect. Section 33-43–01-22 states, "The department may deny, suspend, revoke, or encumber the registration status of, or issue a letter of concern against, an individual listed on the department's nurse aide registry who" violates the state's nurse aide standards. Believe the department's notice of disciplinary charges when it says that it is pursuing discipline against you. Rather than ignoring or minimizing the charges, level the playing field by retaining our Defense Team.
North Dakota CNA Disciplinary Decisions
North Dakota Administrative Code Section 33-43-01-09 requires that the Department of Health & Human Services enter disciplinary decisions in the Nurse Aide Registry: "The department shall include documentation of validated findings of abuse, neglect, misappropriation of resident property, or other misconduct by the certified nurse aide, home health aide, or nurse aide or medication assistant I or II on the registry when validated by the department."
North Dakota Administrative Code Section 33-43-01-10 requires that the department disclose that discipline information to anyone who asks: "Information contained in the registry will be disclosable to any Medicare or Medicaid participating facility, nursing facility, home health agency, hospital, basic care facility, assisted living facility, ombudsman, other representative of an official agency, or other individuals requesting information, upon request." Section 33-43-01-10 specifically requires disclosure of the discipline's details including "the nature of the allegation and summary of the evidence supporting the validated finding…." You don't want employers, patients, their family members, and the public to learn the details of your alleged wrongs. Let our Defense Team help you fight the charges.
Disputing North Dakota CNA Discipline
Your best move is to fight disciplinary charges up front with our Defense Team's help. But if you have already suffered discipline, you may at least indicate your side of the story in a statement filed in the Nurse Aide Registry. North Dakota Administrative Code Section 33-43-01-10 requires the Department of Health & Human Services to include in your discipline entry "any statement by the individual disputing the allegation that led to the validated finding." Employers must follow the finding, not your explanation for or challenge of the finding. But your statement may give the finding helpful context. Contact us if you need help preparing and filing that statement or otherwise challenging the disciplinary entry on appeal or in court.
North Dakota CNA Disciplinary Sanctions
As indicated above, North Dakota Administrative Code Section 33-43-01-22 provides that the Department of Health & Human Services "may deny, suspend, revoke, or encumber the registration status of, or issue a letter of concern against," you for violating the state's nurse aide standards. Denial of registration can include the department's refusing to renew your registration, as you must renew every two years. Revocation of your registration means removing your registration so that you no longer have certification and cannot claim to be a CNA. Both of those sanctions mean your loss of nurse aide employment, depending on the registration.
The department's right to suspend your CNA registration as an alternative sanction still means loss of employment. Suspension generally suggests that the nurse aide may satisfy conditions and wait for the suspension's defined period before petitioning to gain reinstatement. Let our Defense Team attorneys help you petition for reinstatement. The department's right to "encumber" your registration status gives our Defense Team an opportunity to advocate on your behalf with disciplinary officials for an early voluntary dismissal of the charges pending your completion of remedial education or other terms to preserve your CNA registration and nurse aide job. Don't assume that discipline always means revocation or suspension and job loss. Our Defense Team may be able to win better alternative terms.
Removing North Dakota CNA Discipline
You may have an opportunity, with our help to remove your discipline from the Nurse Aide Registry. North Dakota Administrative Code Section 33-43-01-24 permits you to petition to remove a finding of neglect, not a finding of abuse or misappropriation but only one of neglect. Section 33-43-01-24 requires that you show that the finding of neglect "does not reflect a pattern of abusive behavior or neglect." A Department committee reviews your submission, which must be in the format and contain the explanations and documentation that Section 33-43-01-24 dictates. You may request a second review if the committee refuses to remove the discipline. Get our Defense Team's help to meet the complex rules for removing discipline.
Grounds for North Dakota CNA Discipline
North Dakota Department of Health & Human Services officials must articulate lawful grounds on which to discipline a certified nurse aide. Officials can't just make up disciplinary grounds as they go along. North Dakota Century Code Section 23-44-02 lists only "abuse, neglect, or misappropriation of property" as grounds for discipline. North Dakota Administrative Code Section 33-43-01-23 likewise refers to the grounds "abuse, neglect, [and] misappropriation of resident property" but adds "or other misconduct" to the short list of grounds. The Department of Health & Human Services thus claims broader discretion to articulate other grounds. The following sections address both the three express grounds of the legislative and administrative codes plus other grounds that Department officials may claim or infer. The following sections also address ways in which our Defense Team may be able to help you defend and defeat the charges.
Abuse as Grounds for North Dakota CNA Discipline
North Dakota Century Code Section 23-44-02 and North Dakota Administrative Code Section 33-43-01-23 both list "abuse" as grounds for CNA discipline. Administrative Code Section 33-43-01-01 defines abuse to include "mental, physical, sexual, and verbal abuse," further providing these definitions for each:
- mental abuse includes humiliation, harassment, threats of punishment, or deprivation;
- physical abuse includes hitting, slapping, pinching, kicking, and controlling behavior through corporal punishment;
- sexual abuse includes sexual harassment, sexual coercion, sexual contact, or sexual assault; and
- verbal abuse includes any use of oral, written, or gestured language that includes disparaging and derogatory terms to residents or their families, or within their hearing distance, to describe residents, regardless of their age, ability to comprehend, or disability.
Defense of abuse charges can be difficult because of their intentional, deliberate, and directly harmful nature, from which disciplinary officials infer poor character for nurse aide practice. But defense may be possible with substantial exonerating evidence, such as proof that the complaining resident is deluded or has misidentified the perpetrator. Defense may alternatively involve proof that the nurse aide's conduct was in self-defense or a reasonable effort to restrain the resident against self-harm or harm to others.
Neglect as Grounds for North Dakota CNA Discipline
North Dakota Century Code Section 23-44-02 and North Dakota Administrative Code Section 33-43-01-23 both also list "neglect" as grounds for CNA discipline. Administrative Code Section 33-43-01-01 defines neglect as "failure to carry out resident services as directed or ordered by the physician or other authorized personnel, failure to give proper attention to residents, or failure to carry out resident services through careless oversight."
Examples of neglect can include failing to turn a resident, resulting in bed sores; failing to assist a resident with toileting resulting in soiled bedding or clothing; failures in nutrition, resulting in weight loss or in providing liquids resulting in dehydration; or failing to keep up bed rails or use bed restraints resulting in fall and injury. Defense of neglect charges typically requires presenting substantial evidence that the accused nurse aide did provide the care that officials allege the aide failed to provide, did not have responsibility for the patient, was reasonably unaware of the need for care, or lacked necessary equipment, supplies, or other resources that the aide had requested.
Misappropriation as Grounds for North Dakota CNA Discipline
North Dakota Century Code Section 23-44-02 and North Dakota Administrative Code Section 33-43-01-23 both list "misappropriation of property" or "misappropriation of resident property" as grounds for CNA discipline. Administrative Code Section 33-43-01-01 defines misappropriation of property as "the deliberate misplacement, exploitation, or wrongful, temporary or permanent, taking or use of a resident's belongings or money, or both, without the resident's consent."
Examples of misappropriation can include direct theft of a resident's jewelry, electronic devices, money, or other items of value, coercion of transfers of those items through threats to withhold services or contacts with family members, or false claims that the resident owed for services already compensated. Defense of misappropriation charges may involve proof that the accused nurse aide did not remove or receive the missing property, that others took the property, that the resident never had the property or already conveyed it away, or that the accused nurse aide moved the property for security or safety while keeping it available to the resident.
Criminal Conviction as Grounds for North Dakota CNA Discipline
Department of Health & Human Services disciplinary officials may also infer authority to discipline for criminal convictions. A conviction for violent crimes like sexual or simply assault may indicate a safety risk to residents and staff, while a conviction for property crimes like theft and embezzlement may indicate resident property security risks. Conviction for crimes of dishonesty like insurance fraud may indicate a regulatory or financial risk to the nurse aide's employer.
Defense of charges based on criminal convictions may involve showing that the accused nurse aide didn't suffer the alleged conviction, the conviction didn't relate to nurse aide practice, or the nurse aide's conviction was so long ago as to indicate the aide's rehabilitation.
Incompetence as Grounds for North Dakota CNA Discipline
Department of Health & Human Services disciplinary officials may also infer authority to discipline for incompetence, especially if it causes resident harm and exposes the employer to civil liability. Incompetence may include improper food preparation resulting in food poisoning, improper medication control resulting in overdose or under dose, improper lifting and transferring resulting in injuries, and careless failure to report obvious declines in resident health resulting in undiagnosed and untreated conditions.
Defense of incompetence charges may involve expert testimony that the accused nurse aide's services met the standard of care, evidence that the nurse aide did not commit the alleged wrong, or evidence that the nurse aide acted under supervisor instruction that the nurse aide reasonably believed was appropriate for the circumstances.
Unauthorized Practice as Grounds for North Dakota CNA Discipline
Department of Health & Human Services disciplinary officials may also infer authority to discipline for unauthorized practice. Examples of a nurse aide's unauthorized practice may include the aide working after the CNA registration expired or the aide performing services such as administering a medication that only RNs, LPNs, or other professionals had the authority to perform. Defenses to unauthorized practice may involve proving that the nurse aide did not perform as the charges allege, that the aide performed on a supervisor's instruction on the reasonable belief that the instruction was lawful, or that the aide, in fact, had renewed the expired CNA registration, was unaware of its expiration, or did so promptly on discovery of its expiration.
Falsifying Records as Grounds for North Dakota CNA Discipline
Department of Health & Human Services disciplinary officials may also infer authority to discipline for falsifying records. Falsified medical records may lead to patient or resident harm, while falsified service records may lead to the failure of others to provide needed services not yet performed. Examples include a nurse aide misrepresenting that the aide had taken normal vitals, the aide had turned a bed-ridden resident, the aide had provided toileting assistance, or the aide had bathed and provided other hygiene care to a resident when the resident had not received those services. Defense to those allegations may involve proof that the nurse aide observed the reported conditions or performed the reported services such that the records were accurate or that the aide reasonably believed the reported circumstances to exist.
Unfitness as Grounds for North Dakota CNA Discipline
Department of Health & Human Services disciplinary officials may also infer authority to discipline for a nurse aide's unfitness. Examples of unfitness may include impaired judgment from drug or alcohol use or an inability to lift and transfer residents due to injury or progressive disease. Defense may involve proof that the aide was capable and not impaired or that the employer owed a legal duty to reasonably accommodate the disability but failed or refused to do so.
Credentials Fraud as Grounds for North Dakota CNA Discipline
Department of Health & Human Services disciplinary officials may also infer authority to discipline for credentials fraud such as exam cheating, claiming training not received, or concealing criminal convictions or prior CNA discipline. Defenses may involve proof that the candidate's credentials are as represented and that any omissions were mistaken rather than deliberate and not disqualifying.
North Dakota CNA Hearing Procedures
North Dakota Administrative Code Section 33-43-01-23 provides detailed rules for a hearing in which the accused nurse aide may contest the disciplinary charges. These procedural rules can be protective, giving our Defense Team opportunities to negotiate an early voluntary resolution or win dismissal or other acceptable relief, depending on the case facts and circumstances. Let our Defense Team's attorneys help you negotiate a dismissal or favorable consent agreement or, if necessary, present your defense evidence at the hearing, cross-examine adverse witnesses, and challenge and appeal any adverse decision. Our skilled and experienced representation is your best move for the best possible outcome.
Premier North Dakota CNA Defense Available
The Lento Law Firm's premier Professional License Defense Team is available in Fargo, Bismarck, Grand Forks, Minot, West Fargo, Williston, and any other North Dakota location for your certified nurse aide registration defense. Hundreds of professionals nationwide have successfully trusted the Lento Law Firm for the defense of disciplinary charges. Call 888.535.3686 or chat with us now.
