You need to keep your nursing license in order to continue your nursing practice and enjoy the benefits of your nursing employment. State nursing board disciplinary charges that you improperly delegated nursing duties to an unqualified or unauthorized individual or failed to properly supervise that individual, placing your nursing license, job, and career at risk. Take those allegations seriously, even if your alleged improper delegation resulted in no patient injury or lack of competent nursing care. Let the Lento Law Firm's premier Professional License Defense Team help you preserve and protect your nursing license and employment. Our skilled and experienced attorneys can help you obtain the best outcome for improper delegation charges. Call 888.535.3686 or complete this contact form now. Time may be of the essence. Avoid delays.
State Nurse Licensing Board Authority
You may well be ready to help us mount a strong defense to your disciplinary charges. Just don't question the authority of your state nursing board to limit, suspend, or revoke your nursing license for improper delegation of nursing duties or on other disciplinary grounds. Your state likely has a Nursing Practice Act or other nursing laws that not only establish the state board of nursing that issued your license but also authorize the state board to discipline your license. The North Carolina Nursing Practice Act is an example. Its Section 90-171.37 expressly authorizes the North Carolina Board of Nursing to suspend or revoke a nursing license on any one or more of the listed grounds. Those grounds include the violation of any Nursing Practice Act provision or Board of Nursing rule. Georgia's Nursing Practice Act, for another example, includes a similar provision prohibiting any unprofessional, deleterious, or harmful practice violating Board of Nursing standards in its Section 43-26-40. Instead of questioning your state board's authority, get our help to defend and defeat your improper delegation charges.
State Nurse Licensing Board Disciplinary Actions
You should also not doubt your state nurse licensing board's willingness and ability to discipline you for improper delegation of nursing duties. State nursing boards discipline literally tens of thousands of nurses annually. National Practitioner Data Bank figures indicate that nearly 40,000 nurses suffer discipline each year on a variety of grounds. State nursing boards staff their agencies with skilled and experienced disciplinary officials who are standing ready to pursue your disciplinary charges. If you suffer state nursing board discipline, then your discipline will likely result in a public online report in a searchable database for your employer, patients, colleagues, and all the world to see. The Ohio Board of Nursing's online disciplinary action reports provide an example. You will also likely have a duty to disclose your discipline to your employer and other licensing boards. You generally cannot and must not hide discipline from interested persons and parties. Instead, let us help you defend your improper delegation charges.
Reporters of Nurses Improper Delegation
Your best response to your disciplinary charges, with our skilled and experienced help, may depend in part on who accused you of improper delegation and how the accusation made its way to your state board of nursing's disciplinary officials. Improper delegation accusations can come from patients who recognize or believe that the individual providing nursing care lacks the skill and competence to do so. However, patient complainants won't generally know the laws, rules, and regulations on the scope and delegation of nursing practice. Patients can be unreliable complainants, lacking credibility due to their limited knowledge.
More credible complaints of improper delegation may come from physicians or nurses who have some supervisory role over your nursing duties, including your delegation of those duties to others. Physicians and nurses generally would know the nursing delegation rules. They may also have duties to report nursing rule violations. Your employer's representatives may be other credible complainants because they, too, may well know the scope of practice and delegation rules and would have an obligation to ensure your compliance. Let us help you learn, evaluate, and respond to the complaint. Moreover, if allegations of improper delegation have not yet reached the state board of nursing, let us work with the complainants to investigate, confirm, or refute their concerns and promptly correct any disciplinary issue. Our intervention may avoid charges.
Frequency of Nurse Improper Delegation Charges
While the above Nursing Practice Act example provisions do not specifically mention improper delegation as grounds for discipline, improper delegation is a common hazard and a clear violation of nursing laws and standards. A Nurse Journal summary of National Practitioner Data Bank figures indicates that scope of nursing practice violations account for about one fourth of all complaints, behind only unprofessional conduct. That percentage means that thousands of nurses face investigation and potential discipline every year, simply over improper delegation or other scope of practice issues. Scope of practice violations, many surely the result of improper delegation, are a huge disciplinary issue for nurses. Again, don't doubt the commitment of your state board of nursing disciplinary officials to pursue your improper delegation charges.
Risk of Improper Nursing Delegation
The risk of improper delegation is real and substantial because of the peculiar division of medical care among healthcare workers and professionals. Improper delegation charges can arise out of any of the following divisions and delegations of responsibility:
- from physicians or physician assistants to nurses;
- from advanced practice nurses to registered nurses;
- from registered nurses to licensed practical nurses;
- from registered or licensed practical nurses to certified nurse assistants; and
- from registered or licensed practical nurses and certified nurse assistants to unlicensed assistive personnel.
In addition to those divisions of responsibility, scope, and authority, there are other peculiar state rules on the authorization of various nurses to administer various medications or provide various forms of care, and the risk of improper delegation grows exponentially. Nurses with supervisory authority and the ability to delegate duties to other nurses or healthcare workers entity a thicket of complex regulations. Your risk of improper delegation disciplinary charges is real and substantial. Our defense of those charges may point in part to the complexity of your state's nursing regulations, but better defenses may be available, especially considering the presumption that you know and must follow scope-of-practice rules, regulations, and laws.
State Nurse Licensing Board Delegation Rules
Your state nurse licensing board may have a specific administrative rule or regulation, or set of rules and regulations, governing delegation of nursing duties. The Virginia Board of Nursing is an example. Virginia's Board of Nursing has enacted a series of administrative regulations, beginning at 18 Virginia Administrative Code Section 90-19-240, governing nurse delegation. Section 90-19-250 expressly prohibits unauthorized delegation while stating five criteria the delegation must meet and six terms the delegation plan must include to be proper. Section 90-19-260 states six assessments the delegating nurse must make before making the delegation. Section 90-19-270 states eight conditions the delegating nurse must satisfy for proper supervision. Section 90-19-280 states six tasks that a nurse must not delegate and a general condition further barring delegation. Your state may or may not have a similarly complex and exhaustive regulatory scheme governing nursing delegation. We can help you identify and analyze the applicable law, rule, and regulations on delegation, for effective defense of your disciplinary charges.
Guideline for Proper Nursing Delegation
Given the above complexity of nursing delegation rules and laws, the American Nurses Association (ANA) has developed a guideline for nurses to follow to promote proper delegation and avoid improper delegation charges. The ANA guideline defines these five rights (meaning correct actions, not legal rights) of delegation:
- right tasks, referring to the nursing activities that the delegating nurse assigns. The delegating nurse should ensure that law and employer rules authorize the task delegation and that the delegation is not of a task or activity outside law, rule, regulation, or employer practice;
- right circumstances, referring to the patient conditions, facility resources, and other contexts under which the delegating nurse assigns the task. The delegating nurse should ensure that the peculiar circumstances do not require greater patient care, more resources, or more skill;
- right person, referring to the licensure, skills, competence, and confidence of the individual to whom the nurse delegates the task. The delegating nurse must avoid delegating licensed tasks to unlicensed individuals or to individuals whose license does not include the delegated task;
- right supervision, referring to the delegated nurse's retention of the duty to ensure that the individual performing the delegated task does so with appropriate skill and competence within the standard of care. The delegating nurse must avoid delegating a task to a qualified individual but then disregarding whether the individual employs the requisite knowledge and, skill, and
- right direction, referring to the delegated nurse's instructions and other communications to the individual performing the delegated task. The delegating nurse must avoid delegating the task without adequate guidance to ensure that the individual performing it does so within the standard of care.
Our attorneys can help you evaluate your improper delegation of disciplinary charges against these guidelines and other nursing standards to prepare a defense that considers and addresses the standards. Do not proceed within a defense that is blind to these and other nursing delegation standards. Your state board's disciplinary officials are likely to be aware of the standards and rely on them in pursuing the charges. See this National Library of Medicine case study of the five rights of delegation for an example of how they may work in a particular case.
Factors Influencing Improper Nursing Delegation
Improper delegation of nursing duties has causes and risk factors. Improper delegation generally doesn't just happen in a vacuum. Instead, the conditions of your workplace, your own attributes, and the attributes of the healthcare worker to whom you delegate can all affect whether the delegation is improper or proper. An International Journal of Nursing Studies article indicates that factors impacting improper delegation of nursing duties can include:
- the delegating nurse's experience with delegation;
- the delegating nurse's training in delegation;
- the delegating nurse's personality traits; and
- the skills, competence, and character of the delegate.
Broader Causes of Improper Nursing Delegation
The same International Journal of Nursing Studies article further indicates the broader dynamic within the healthcare professions that may be giving rise to greater numbers and frequencies of improper delegation and their disciplinary charges. The nation has had a well-publicized nursing shortage. That shortage has driven hospitals and other healthcare providers to deploy new healthcare systems and strategies, one of which is to employ unlicensed personnel or personnel with lower-level licenses to do at least a portion of the tasks usually done by higher-licensed personnel. You may have found yourself under that employer pressure to use personnel whom you regard as barely qualified or unqualified, dividing nursing tasks up into small segments to use lesser-skilled services for part of those nursing tasks. You may, in other words, be a victim of new healthcare delivery methods and measures responding to market pressures. We can help you give appropriate context to your actions, defending improper delegation charges and mitigating sanctions.
Nurse Delegation to Home Care Aides
One of those areas where market pressures are influencing delivery of nursing and nursing-related services is in home healthcare. With America's aging population and the high cost of nursing home care, more elderly residents are seeking home healthcare. State legislatures across the country are responding to the shortage of home care nurses by relaxing scope-of-care regulations so that nurses can delegate at least some of their traditional home healthcare tasks to home care aides. An AARP Scorecard indicates that eleven states have authorized the delegation of a full set of twenty-two traditional nursing tasks to aides. Those tasks include medication administration, feeding tubes, and routine respiratory care. Many other state legislatures have authorized delegation of many but not all of those same twenty-two tasks, while a handful of states authorize delegation of only five or fewer such tasks, and three states make no such authorization. Your improper delegation charges may or may not involve a similar delegation. However, the swift, varied, and complex response of state legislatures and nursing boards across the country demonstrates how precarious a position a nurse with supervisory and delegation powers may be, especially under employer and market pressure to delegate as much as permitted.
Improper Delegation Risk Factors as a Defense
While the above studies indicate some of the market pressures, employer strategies, and other risk factors and causes for improper delegation of nursing duties, our attorneys would take care to assert those conditions as your primary defense against improper delegation charges. Assertions that sound like I had to do it can be redounded against the nurse whom officials accuse of improper delegation as if the nurse is shirking responsibility for complying with sound rules, standards, and regulations. On the other hand, we may be able to take a sensitive approach to give full context to your actions if, indeed, incontestable evidence shows that your delegation was improper and if, indeed, you delegated nonetheless because of employer demands and other pressures. Be cautious, though, in making any such assertions before having our attorneys' advice and counsel.
Other Defenses to Improper Delegation Charges
You may have significantly better defenses to your improper delegation charges than blaming your employer, market pressures, or other broad considerations. After appropriate investigation, and with supporting circumstances and evidence, our attorneys may be able to put forward one or more of the following defenses to your improper delegation charges:
- you did not delegate the disputed nursing care, but others undertook it nonetheless without your knowledge, approval, direction, or consent;
- someone else delegated the disputed nursing care without your involvement;
- complaining witnesses have mistakenly, delusionally, or vindictively misidentified you as the delegator of the disputed nursing care;
- no one performed any unauthorized nursing care, whether you delegated nursing care or not;
- all nursing care provided under your supervision or delegation was by healthcare professionals qualified and authorized for that practice;
- you retained appropriate supervision of all delegated tasks, and your observations showed the administration of competent and qualified care;
- no harm, injury, or risk of harm or injury resulted from any delegation of nursing care;
- any harm, injury, or risk from the delegation of nursing care was minimal, especially compared to the risk of omitting the care actually provided;
- the care actually provided, even if unauthorized or by unqualified individuals, was wholly beneficial to the involved patient or patients;
- you were reasonably unaware at the time of your delegation of nursing care that the individual to whom you delegated the care lacked the qualifications or authority to provide it;
- the healthcare worker to whom you delegated nursing care misrepresented the worker's qualifications and authority; and
- as soon as you recognized that your delegation of nursing tasks was to an unqualified or unauthorized individual, you revoked the delegation and arranged for other qualified and authorized care.
Our investigation may reveal other grounds for the defense of your improper delegation charges. Also, some of the above grounds, such as the lack of patient harm or injury, may not be complete defenses but may instead influence the decision maker to reduce or forgo a sanction.
Sanctions for Nurse Improper Delegation
As the above discussion just suggested, sanctions for improper delegation are not necessarily an all-or-nothing proposition. License suspension is indeed often a default sanction, especially if the accused nurse fails to respond, fails to mount any credible defense, or fails to advocate for remedial measures or reduced sanctions based on a mitigation defense. But with a credible defense and a case for mitigating or eliminating sanctions in favor of remedial measures and compliance assurances, your state board of nursing has the discretion to forgo a penalty or impose a lighter sanction than license suspension or revocation. State nursing practice acts routinely grant the state board of nursing sanction discretion, enumerating not only suspension and revocation but lesser measures like license restriction or conditions. A National Council of State Boards of Nursing (NCSBN) report summarizes that state nursing boards may generally impose any of the following sanction forms:
- fines, restitution, or civil penalties;
- cautions, corrections, warnings, or reprimands;
- in the case of substance abuse, referral to an alternative program;
- monitoring, peer review, or remedial education or training;
- restrictions to certain practices, facilities, or hours; or
- license suspension or revocation.
The Virginia Nursing Practice Act, for instance, authorizes all of the above forms of license discipline but also adds probation to the mix under Virginia Code Section 54.1-3007.
The Benefit of Reduced Sanctions
Do not overlook the potential benefit of a case in mitigation of sanctions for improper delegation. You surely would prefer to avoid all disciplinary sanctions. Any sanction, even as little as a reprimand, could cause your employer to terminate or restrict your employment for liability, reputation, regulatory, or related purposes. On the other hand, your employer likely values your nursing services, knowledge, skills, and commitment, given your role as a supervisory and delegating nurse. Your employer may thus be more than willing to continue your employment, notwithstanding some sanction, such as a reprimand, peer review, or even a license limitation, as long as you can still continue to provide your employer with valuable and trusted nursing services. Let us help you make your best defense for no discipline. But let us also help you make your best defense for a reduced sanction in the event that your state board insists on some sanction.
Direct Impacts of Improper Delegation Discipline
Here is a good place to consider the potential impacts of license discipline for improper delegation of nursing care. Depending on the form of sanction, the impacts can range from severe to moderate or minimal. If you lose your license to improper delegation charges, your nursing employment and practice in the state must terminate for the duration of your license's suspension or revocation. You cannot practice nursing without the state nursing board's license. You may, at the same time, lose nursing licenses in other states, given the Nursys national licensing and discipline database and your own obligations to report discipline to other licensing bodies. You may not be able to practice nursing in any state or to obtain a new nursing license in another state. You could also lose other healthcare licenses you hold, curtailing your ability to practice in those other healthcare professions. Beware of these direct impacts. Get our help in defense of charges and mitigation of sanctions.
Collateral Impacts of Improper Delegation Discipline
The loss of your nursing license would, of course, have collateral impacts on your income and other financial obligations, potentially affecting your family, housing, healthcare insurance, transportation, and other significant interests. You would also likely lose your professional association memberships and professional network on which you depend for references, recommendations, and similar support. You may also lose other supportive relationships and valuable opportunities for employment and even for association, volunteer, or charitable work. Loss of employment can have hard physical, mental, emotional, and social effects. It's not the end of the world. You may find silver linings even when you get a bad disciplinary result. But your better course is to retain our premier attorneys for your best disciplinary outcome.
Responding to Improper Delegation Allegations
If you face improper delegation disciplinary charges, you would be understandably upset. Any disciplinary charge threatening your reputation, employment, income, and ability to practice would naturally cause a significant degree of anxiety, frustration, uncertainty, and concern. Don't beat yourself up over feeling those and related emotions. But also don't let those emotions distract you from your proper course at hand. You must respond accurately, timely, and effectively to the notice of disciplinary charges. We can help you do so. You also need to invoke the available protective procedures wisely, discerningly, and strategically. Once again, we can help you do so. In short, do as effective professionals in all fields do: recognize your situation, limitations, and need for other professional consultation and representation. Let us be your help and guide.
Nurse Licensing Board Disciplinary Procedures
The outcome of your disciplinary matter involving improper delegation allegations may depend on your state licensing board's protective procedures. You have a constitutionally protected liberty and property interest in your nursing license and practice. Your state licensing board must generally provide you with due process before depriving you of that interest. Your state nursing practice act, other nursing laws, rules, and regulations, and administrative procedure act likely recognize and carry out those due process protections. The North Carolina Nursing Practice Act is an example, providing in its Sections 90-171.37A through D for notice, formal hearing, appeals, and other protective procedures. Don't try to navigate those procedures on your own. Let us help you put them to strategic effect for your best disciplinary outcome.
Nurse Improper Delegation Discipline Appeals
You may have already lost your state licensing board hearing, whether without representation or with unqualified or ineffective representation. If so, don't give up. Your state nursing laws, rules, and regulations or state administrative procedure act likely offer you some form of appeal of your discipline. The above North Carolina Nursing Practice Act provisions just cited are an example, providing for an appeal from the nursing board to a state superior civil court. Once you retain us, we can determine where your appeal must go, obtain the appeal transcript, prepare the appeal brief, and timely pursue the appeal.
Civil Court Review of Improper Delegation Discipline
If you have already lost an administrative appeal, we may alternatively be able to obtain civil court review, depending on your state laws and your particular situation. Court review is generally more limited than administrative appeals and may depend on special grounds such as decision maker bias or conflict of interest, lack of substantial evidence in the record, newly discovered evidence, or a decision beyond the scope of authorizing law. Leave that research, investigation, and evaluation to us. We may also be able to explore regulatory or other oversight review and relief. Don't give up without retaining us to explore all options. Your nursing license, job, and career are worth it.
Nurse License Reinstatement After Abuse Allegations
Nurses who lose their license to various causes sometimes have statutory or regulatory rights to seek the state nursing board's reinstatement of the license. Your state nursing laws, rules, and regulations may grant you such a right. Reinstatement provisions may require that you present a convincing case for your rehabilitation, showing that your reinstatement and resumption of practice would not endanger patients. They also typically require a formal application and may require a hearing before the state nursing board or its designated panel. Let us help you determine whether you qualify for license reinstatement if you have already lost your license and exhausted all appeals and other avenues for relief.
Nurse Licensing Board Defense Attorney Role
The above discussion should have convinced you of our critical role in your effective defense of improper delegation disciplinary charges. You should have seen the complexity of the applicable law, rules, regulations, and procedures. You should also have appreciated the subtle strategies that increase your likelihood of a favorable resolution. Our attorneys have the administrative professional license defense experience to implement those strategies for your best outcome. Do not retain unqualified local criminal defense counsel or an unqualified civil litigator, business lawyer, or real estate attorney. The rules, laws, customs, and conventions in those other practice areas won't apply in your administrative professional license disciplinary proceeding. You need our highly qualified representation.
Premier Nurse Licensing Board Attorneys
Your best move when facing state nurse licensing board disciplinary charges for improper delegation is to retain the Lento Law Firm's premier Professional License Defense Team. We are available nationwide, no matter your location and the state issuing your nursing license. We have helped hundreds of nurses and other professionals retain their licenses against various disciplinary allegations, including allegations involving improper delegation. Call 888.535.3686 or complete this contact form now for our effective representation.
