Nurse Licensing Board Defense Against Patient Abuse Allegations

Nurses must maintain their state board licensure to continue their practice of nursing. One of the quickest and surest ways to lose your nursing license is to succumb to allegations of patient physical, emotional, verbal, or sexual patient abuse. State licensing board disciplinary officials take patient abuse allegations most seriously. You should take those allegations just as seriously. Your best move to do so is to retain the Lento Law Firm's premier Professional License Defense Team. We provide the skilled, experienced, and effective defense you need for your best outcome when facing patient abuse allegations. Call 888.535.3686 or complete this contact form now to protect your nursing license, job, career, and future.

The Risk of Patient Abuse Allegations

Nurses face serious risks of patient abuse allegations, even when duly performing their nursing duties without purposeful wrongs. Nurses themselves suffer workplace assaults with alarming frequency, up to two assaults every hour, fifty-seven assaults every day, and over five-thousand assaults every year, according to survey data. Yet the bigger offense can be when a nurse faces a false, exaggerated, or unfair charge of patient abuse, or especially a credible charge, placing the nurse's license, job, and career at risk. Nursing, although rewarding, is also a physically, mentally, and emotionally challenging profession. Patient abuse allegations and potential license discipline can vastly compound a nurse's professional and personal challenges. As a licensed nurse, you certainly face at least some risk of patient abuse allegations. We appreciate your precarious position and stand ready to defend you with all due skill, experience, and commitment.

Factors Affecting Risk of Patient Abuse Allegations

Depending on your nursing practice, practice setting or location, patient population, and other variables, your risk of facing patient abuse allegations may be especially significant. A National Library of Medicine analysis suggests that nurses who care for elderly patients in long-term care settings generally face greater risks of patient abuse allegations. Nurses caring for dementia patients or other patients with mental impairments may also face higher than usual risks of patient abuse allegations. Nurses in private home settings or with insufficient facilities, equipment, training, time, supervision, or support may also face greater risks of abuse allegations. Beware of unstable, transitory, poorly equipped, and inadequately staffed practice settings, especially those with delusional patients having substantial and intractable nursing needs.

Patient Abuse Risk Factors as a Nursing Defense

If you face patient abuse allegations out of such a practice setting, we may be able to show your state licensing board's disciplinary officials that your practice setting is the cause of those allegations, not your allegedly poor skills and worse character. Disciplinary officials generally know the challenges that nurses face. Disciplinary officials often have nursing training and experience or substantial interaction with nursing professionals and nursing settings. They may know well that your complicated and high-risk practice setting exposed you to your disciplinary charges, the allegations of which you are innocent. Our attorneys have the investigation and presentation to make that defense, if the evidence and circumstances for it exists.

The Prevalence of Nurse Patient Abuse

Studies find it hard to determine how frequently nurses actually abuse patients. Yet abuse of patients by nurses or other healthcare workers is a real and substantial concern, especially among the elderly in long-term care, as a National Library of Medicine analysis reports. Nurse patient abuse is at least sufficiently prevalent to make nurse licensing board officials take clear notice and swift investigation and protective action around abuse allegations. The cited analysis indicates a highest prevalence of physical abuse, especially in the misuse of restraints. Next highest is verbal abuse, then neglect, and finally sexual abuse. While the studies on which the analysis relied vary widely, their median indicates that abuse may, in certain populations and forms, be as frequent as one out of four or five patients annually. Nurse patient abuse does unfortunately happen. Your challenge when facing disciplinary charges is to ensure that you don't lose your license to false charges and that you make the best case for mitigation of any sanction. We can help.

Causes of Patient Abuse Allegations

Unfortunately, the above studies and data indicate that nurse patient abuse does happen. Yet patient abuse allegations can also occur with surprising and disappointing frequency, against nurses who are entirely innocent of the charges. False, unfair, or exaggerated patient abuse allegations can arise from a variety of causes. Be aware of these causes. Contact our attorneys as soon as you suspect a coming abuse allegation, so that we can help you identify and preserve evidence, and communicate with others to head off false or mistaken charges. These causes can include any one or more of the following:

• patient misunderstanding or delusions as to the nature of your actions and your intent;
• patient misunderstanding as to the patient's own condition and need for nursing services and other healthcare;
• patient retaliation with deliberately false allegations of abuse, for insults or offenses the patient imagines;
• family member misunderstanding as to the patient's condition and need for nursing services and other healthcare;
• necessary patient restraint for patient safety and security, misconstrued as abuse;
• insufficient assistive devices and equipment, leaving the nurse inadequately equipped to perform nursing services;
• insufficient staffing, leaving the nurse with more duties than the nurse can reasonably perform in the allotted time;
• nursing assignments outside the scope of nursing or the nurse's own education, training, skill, and experience;
• inadequate supervision, scheduling, assignment, and division of nursing services, leaving the patient at risk;
• physician or other healthcare provider errors and malpractice, ordering unnecessary or inappropriate nursing services;
• retaliation by other healthcare workers against the accused nurse, out of personal conflicts or vendettas;
• mistaken observations by other healthcare workers or patients, misconstruing the accused nurse's actions and intentions; and
• scapegoating by facility managers for their own failures or the facility's inadequate nursing resources.

Dealing with Patient Abuse Allegations

A nurse who receives word of a patient abuse allegation faces a daunting challenge. Don't be surprised if you feel overwhelmed, fearful, anxious, embarrassed, and at a loss for words and actions, when you receive notice of a patient abuse allegation against you. Any reasonable professional in your situation would feel likewise. And don't minimize your unsettled mental and emotional condition, and its potential impact on your judgment. Your anxiety and embarrassment may cause you to act rashly or to ignore important steps. Instead, promptly retain us to ensure that you have the right reassurance, advice, counsel, advocacy, and representation. You need our skilled and experienced help when you are not in your best mind for your own management of these unfamiliar and disturbing charges. Don't ignore your situation. Do what wise professionals do in such situations, which is to retain and consult with the best qualified available attorney representations, from our premier Professional License Defense Team.

The Nature of Patient Abuse

What is patient abuse? The next discussion examines types of patient abuse, while a later discussion examines legal definitions of patient abuse. But the basic nature of patient abuse is that it involves a healthcare worker's harmful communications and actions violating a patient's dignity and autonomy rights. In the case of a wayward nurse, abuse interferes with the patient's need and right to receive proper nursing care, respect for the patient as a person in need of nursing, and protection of the patient's person, property, and interests in the scope of nursing care. Abuse generally doesn't involve simple mistakes, accidents, or errors. Abuse instead implies the nurse's knowing or reckless invasion and violation of the patient's rights and interests. Abuse carries a heavy taint of deliberate, rather than accidental, wrong. These features combine to make abuse a difficult and even frightening allegation with which to deal in a disciplinary proceeding, warranting our skilled and experienced attorney representation.

Types of Patient Abuse Allegations

As the above general definition implies, patient abuse and abuse allegations can take several different forms. The following discussion treats four main forms of abuse: (1) physical abuse; (2) emotional abuse; (3) verbal abuse; and (4) sexual abuse. These four main forms of abuse may include related forms of abuse such as psychological or spiritual manipulation and legal or financial exploitation. Keep the above general definition in mind, even while considering the following specific examples. Disciplinary officials may use both the general definition and specific examples when pursuing their license charges. Consider the following four forms, examples of each form, and indications of how we can help defend those allegations.

Allegations of Patient Physical Abuse

Physical abuse is the first form one generally considers when evaluating an abuse allegation. Did the accused nurse physically harm the patient in some way? Physical abuse is a first category both because of its obviously harmful nature, that the nurse has allegedly caused injury to the patient's person. Physical abuse is also a first consideration because of its observable nature. Signs of physical harm can be convincing evidence that the alleged abuse actually occurred, depending on what those signs constituted, and leaving open the question of who committed the abuse.

Physical abuse signs may fall into three general subcategories. The first subcategory involves bruises, burns, contusions, fractures, or similar physical injuries that might occur from blows, pushes, or other applications of force such as punching, striking, slapping, shoving, and kicking, or application of hot or cold items. A second subcategory of physical abuse involves physical restraint marks, produced not by a striking blow but instead by undue, severe, or prolonged bed, chair, or other restraint. A third subcategory of physical abuse involves evidence of poisoning, affecting the patient's physiology and resulting in physical decline.

We may be able to defend allegations against you of patient physical abuse by showing that the patient did not suffer the alleged physical injury. The patient or others may have claimed injuries that physical examination and examination records will show did not actually occur. We may alternatively be able to show that any physical injury was the result of the patient's own actions, such as falls while disobeying restrictions on ambulation or recommendations to use assistive devices. We may also be able to show that any actual abuse involved the action of other healthcare workers, other patients, or of family members, rather than your action. Witnesses, security video, nursing schedules, and other evidence may help exonerate you from physical abuse allegations. We may also be able to show that any of your actions that did physically harm the patient were under physician or nurse supervisor orders and were within the standard of nursing care. Patients do rarely suffer injury from customary medical or nursing care itself.

Allegations of Patient Emotional Abuse

Patient mental and emotional abuse is a second subcategory of abuse allegations. Did the accused nurse mentally manipulate and emotionally abuse the patient in some way, whether in combination with physical abuse or without the presence of physical injury? Emotional abuse is a separate subcategory because it occurs without the obvious physical marks or injuries of physical abuse. Emotional abuse can result in observable physical changes in a patient, such as trembling, weeping, weight loss, and fright or fear reactions. But the absence of physical injury complicates the investigation, proof, and defense of emotional abuse allegations. In the absence of physical injury, emotional abuse allegations may seem less serious. But don't underestimate their potential impact on your license. Disciplinary officials know that mental and emotional issues can be just as debilitating and harmful as physical conditions, and at times even more so.

Signs of mental and emotional abuse may include fear, fright, and startle reactions to ordinary behaviors, anxiety or depression, withdrawal and self-isolation from social and medical interaction, agitation, irritability, and aggression in interactions, and other sudden or unexplained changes in behavior, such as a loss of interest in usual activities, avoidance of particular persons, especially the accused nurse, or avoidance of a particular location, therapy, or activity. Patient reports of emotional abuse and observation by others of emotional abuse, including observations by family members, other patients, and other healthcare workers, may be critical to connecting these signs and symptoms with abuse rather than other patient issues such as ongoing disease and deterioration.

We may be able to defend allegations against you of patient emotional abuse by showing that the mental or emotional condition does not exist, is faked or exaggerated, or is the result of ongoing disease or other innocent cause. We may alternatively be able to show that the patient or other complaining witness misidentified you or is retaliating against you for some perceived slight or offense, to blackmail and manipulate, or out of delusion or vindictiveness. We may also be able to show that other healthcare workers, patients, or family members, rather than you, committed the alleged emotional abuse. We may also be able to show that authorized and customary medical or nursing care was the only cause of the alleged mental or emotional harm, and that your nursing actions were under appropriate physician orders and nursing supervision.

Allegations of Patient Verbal Abuse

Patient verbal abuse is a third subcategory of abuse allegations. Did the accused nurse communicate with the patient orally in ways that demeaned, offended, insulted, or otherwise harmed the patient? Verbal abuse can relate closely to mental or emotional abuse because verbal abuse can lead to mental and emotional distress. But verbal abuse tends to be treated as a separate subcategory nonetheless because mental and emotional distress is not a necessary component to verbal abuse. Verbal abuse may instead result only in dignitary offense. Verbal abuse may not result in observable signs or symptoms. Verbal abuse allegations thus depend for their proof on credible accounts that the nurse said what the patient alleges.

Verbal abuse may come in any one of three forms. Humiliation through insults is a first form of verbal abuse. A nurse who, for instance, disparages a patient's race, ethnicity, national origin, sex, religion, or disability, to the patient in a demeaning manner may have committed verbal abuse. Blaming a patient for medical conditions or rudely critiquing and criticizing a patient's appearance are other examples of humiliating insults. Threats, bullying, and intimidation are a second form of verbal abuse. A nurse who threatens a punch or slap or who threatens to isolate the patient from family members or deprive a patient of nutrition may have committed verbal abuse. Ignoring patient communications and isolating the patient from interaction can be a third, subtler form of patient verbal abuse.

We may be able to defend patient verbal abuse allegations against you by showing that the alleged communications did not occur. We may be able to show that the patient is deluded or vindictive in making the allegations, or that the patient misunderstood and misconstrued your communications. We may alternatively be able to show that a different nurse or healthcare worker committed the verbal abuse and that the patient or other witnesses misidentified you. We may alternatively be able to show that your communications were within the standard of care for informing a patient of physician orders and nursing practices, rather than constituting verbal abuse. Consent could potentially be a defense, too, if the patient encouraged, invited, and welcomed your verbal jocularity and returned it in kind while only later claiming verbal abuse. Verbal abuse allegations can be both easy to deny and difficult to contest, depending on the patient's credibility or credibility of corroborating witnesses.

Allegations of Patient Sexual Abuse

Patient sexual abuse is a fourth subcategory of abuse allegations. Did the accused nurse touch the patient for sexual arousal, sexually proposition the patient, or sexually harass the patient? Sexual abuse allegations can be difficult to defend because of the heavy condemnation, strict need for patient protection, and potential for civil liability in the absence of prompt and definitive protective action. Their outcome may also be more uncertain than other abuse allegations because proof may depend on resolving sharp conflicts in testimony between the accusing patient and accused nurse, especially if the alleged abuse left no physical signs or injury and the allegations have no corroborating witnesses outside of the accuser and accused.

As already indicated, sexual abuse may take the form of direct physical contact including sexual assault involving penetration, stimulation, or touching of intimate parts. Alternatively, sexual abuse may take the form of sexual advances and requests for sex or sexual favors. Sexual abuse may also take the form of sexual jokes, epithets, innuendo, actions, or slurs. Sexual abuse may also involve display of pornography or other sexual images, voyeurism of the patient's private parts or private bodily functions, or the nurse's indecent exposure.

We may be able to defend allegations against you of patient sexual abuse by showing from medical examinations, medical records, surveillance video, your testimony, other witness testimony, and inconsistencies in the patient or other complainant's account, that no sexual abuse occurred. We may alternatively be able to show that another healthcare worker committed the alleged sexual abuse and that the patient or other complaining witness misidentified you or blamed you vindictively, in a cover up, or as a scapegoat. We may also be able to show that any actions you took relative to touching the patient were non-sexual in nature, within the nursing standard of care, and under physician or nurse supervisor orders, in the nature of bathing, wound dressing, or other necessary and appropriate personal and medical care.

Patient Abuse Versus Patient Neglect

It bears mention that patient abuse allegations often occur along with allegations of patient neglect. Indeed, abuse definitions in some state nursing standards may include neglect of the patient or may otherwise confuse the two allegations. In general, though, abuse would involve some affirmative, harmful, and deliberate or reckless action of the nurse, while neglect would involve some deliberate or reckless inaction or omission by the nurse.

Patient neglect may contribute to patient abuse allegations. For instance, a nurse's alleged emotional abuse of a patient may include the nurse's refusal to provide ordered and necessary patient care, leaving the patient in a harmful and deteriorating state due to neglect. Refusal to provide nutrition and hydration, for instance, may cross the line into neglect of the patient's obvious nutrition and hydration needs, resulting in patient harm from starvation and dehydration.

We may be able to defend neglect allegations, related to allegations of patient abuse, by showing that the patient did not suffer any neglect, and that any apparent harm was due instead to the course of disease. We may alternatively be able to show that you were not assigned to the patient's care and that other healthcare workers were responsible for any actual neglect. We may also be able to show that neglect allegations against you were due to your misidentification, patient delusion or retaliation, or the complaining witness's cover up for the witness's own abuse or neglect.

Reporters of Nurse Patient Abuse

The disciplinary outcome of the patient abuse allegations that you face may depend on who reported your alleged patient abuse. You might think that the patients themselves are the most common reporters of patient abuse. But a National Library of Medicine study indicates that healthcare workers report more instances of nurse abuse of patients than the patients themselves or their family members report. Patients are the next most common reporters of patient abuse, followed by the patient's family members. Of course, multiple witnesses may report the same abuse, making the allegations more difficult to defend. But the credibility of those reports depends on several factors including the following:

• whether the complaining witness saw the alleged abuse firsthand or is instead only relating the accounts of the patient or others, and thus inadmissible hearsay;
• whether the complaining witness is a reliable truth teller or instead has a history, reputation, and record of false reports;
• whether the complaining witness has the mental competence to recall and relate accurately;
• the internal consistency of the account of patient abuse, including whether the account remains the same across multiple statements;
• the consistency of the account with other accounts, including whether accounts by different witnesses contradict one another;
• whether the report of patient abuse has corroborating physical evidence;
• whether the report of patient abuse is consistent with medical records and nursing schedules; and
• your own credibility as a reliable witness of good character for truth telling.

Our skilled and experienced attorneys can use these and other credibility assessments to identify, organize, and present your best defense case. We can also include in that case the physical evidence and record exhibits to corroborate exonerating testimony and mitigating information.

Nurse Licensing Board Authority

You should not doubt your state nurse licensing board's authority to discipline you based on credible patient abuse allegations. State legislatures enact Nurse Practice Acts and other state laws creating and empowering nurse licensing boards to regulate the practice of nursing in the state. New York's nursing laws are an example, creating the New York State Board of Nursing to license nurses who wish to practice in the state. New York law then authorizes the state's Board of Regents to promulgate rules for nurse discipline, consistent with State Board of Nursing standards. New York disciplines many nurses every year under those laws, rules, and regulations, publicizing the discipline in online action reports. Again, don't doubt your nursing board's authority to discipline you based on abuse allegations. Instead, let us help you invoke your board's protective administrative procedures to present your best defense case.

Example Patient Abuse Prohibitions

Nurse Practice Acts and other nursing laws in states across the country routinely include prohibitions against patient abuse in their disciplinary statutes. Illinois is an example. The nursing law 225 Illinois Code Section 65/70-5 sets forth the grounds for the discipline of a nurse licensed by the Illinois Board of Nursing. Those grounds include not only a verified report of patient abuse but also a history of patient abuse and failure to report instances of patient abuse by others. The Illinois Board of Nursing's administrative rules do not further define patient abuse but do define several other forms of unprofessional conduct that would effectively constitute abuse, such as patient sexual assault, sexual harassment, and sexual relations, and crossing patient boundaries.

Florida's Nurse Practice Act provides another example. Florida Statute Section 464.018 states the grounds for the Florida Board of Nursing discipline of a nursing license. Those grounds expressly include patient abuse, neglect, or exploitation. The Florida Board of Nursing adopted its Administrative Rule 64B9-8.005 on Unprofessional Conduct further defining disciplinary grounds to include “using force against a patient, striking a patient, or throwing objects at a patient,” “using abusive, threatening or foul language in front of a patient or directing such language toward a patient,” and other acts that would fall within the general definition of abuse. Other states have similar provisions. We can help you identify, evaluate, and apply your state nurse practice act and nursing board's administrative rules relating to patient abuse allegations.

Nurse License Discipline Frequency

You are not alone as a nurse facing disciplinary proceedings including discipline based on patient abuse allegations. A large number of nurses suffer license discipline annually. According to National Practitioner Data Bank figures, nearly 40,000 nurses have suffered adverse disciplinary action annually in each of the past several years. A Nurse Journal summary of National Practitioner Data Bank figures suggests that about nine percent of those adverse disciplinary actions involve patient abuse allegations, meaning that three thousand to four thousand nurses suffer license discipline every year due to patient abuse allegations. That's a lot of nurses suffering license discipline and all its consequences every year. Let us help you avoid becoming another one of those daunting statistics.

Nurse License Discipline Forms

The above statistics do not indicate the type of discipline nurses found to have abused patients have suffered. One suspects, though, that license suspension and revocation is the default sanction for such a serious charge and finding as patient abuse. But depending on the nature and seriousness of the abuse allegations, you may not face loss of your license as the assured outcome of any abuse findings. Even if your state board of nursing finds that you committed some form or degree of patient abuse, we may be able to present a case mitigating or even eliminating any sanction. Your state nurse practice act and state board of nursing administrative rules will likely give your state board discretion in the sanction to apply, if any. We would advocate sensitively and effectively for a remedial rather than disciplinary outcome that does not interrupt your nursing practice and employment, or harm your reputation. The National Council of State Boards of Nursing (NCSBN) reports that nurse discipline by state licensing boards may include any of the following forms:

• fines;
• civil penalties;
• public or private reprimands;
• referral to alternative discipline program;
• remedial education or training;
• monitoring;
• license restrictions to practice settings, supervision, or hours worked;
• license suspension; and
• license revocation.

Interstate Impacts of Nurse License Discipline

Beware that discipline in your state may affect nursing or other healthcare licenses that you hold in other states and your ability to obtain a nursing or other healthcare license later in another state. Most states participate in the Nurse Licensure Compact, which facilitates nurse licensure in multiple states. The Compact supports the national Nursys database that collects licensing and license discipline information for review by state nursing boards and nurse employers across the country. If you suffer license discipline based on patient abuse allegations in your current practice state, that information is likely to go into the Nursys database for sharing with licensing officials and employers in other states. You could lose your ability to practice not only in your current state but in other states, too, if you do not successfully defend your current patient abuse charges. Let us help. Your nursing career is worth it.

Nurse Licensing Board Disciplinary Procedures

State nursing boards generally owe nurses constitutional due process before depriving them of their liberty and property interests in their nursing license, job, and career under patient abuse allegations. Due process means that your state licensing board should give you fair notice of the disciplinary charges and a fair hearing before an impartial decision maker, often an administrative law judge. We can help you evaluate and timely answer the disciplinary charge, raising your procedural and substantive defenses. We can also help you invoke informal resolution conferences at which to present your exonerating and mitigating evidence, seeking early resolution of the charges. If your matter proceeds to hearing, we can present your testimony, the testimony of your other witnesses, and your documentary and other evidence, while challenging the board's incriminating evidence including cross-examining adverse witnesses. Let us help you invoke your state board's protective procedures.

Nurse License Discipline Appeals

Do not despair if you have already suffered license suspension, revocation, or other discipline due to patient abuse allegations. You may still have the right to appeal your discipline. Most state administrative procedure acts provide some form of appeal for adverse administrative decisions. Some states direct appeals from the decision maker to the state nursing board. Other states direct appeals from the nursing board or board panel making the initial decision directly to a civil court. Whatever your state procedures provide, we can evaluate, prepare, and present your appeal to reverse your disciplinary sanctions.

Nurse License Reinstatement After Abuse Allegations

Do not despair if you have already lost all hearings and appeals. You may have a right to reinstate your license. State nurse practice acts and administrative rules vary as to license reinstatement opportunities and rights. Some states do not permit reinstatement for licenses suspended or revoked on certain grounds. States that permit reinstatement typically have a waiting period such as one year from the license suspension or revocation. States also generally give the nursing board discretion whether to reinstate and authority to grant reinstatement with limitations or conditions. We can help you make the best case for license reinstatement.

Nurse Licensing Board Defense Attorney Role

You have seen above that our highly skilled and experienced attorneys have a clear role in your defense of patient abuse allegations. Before your state nursing board investigates, we may be able to work with your employer's representatives to head off abuse reports and allegations. If the state board is already investigating, we may be able to provide your exonerating and mitigating evidence to investigators to head off formal charges. If charges are already underway, we may be able to seek voluntary dismissal on remedial grounds through informal resolution conferences. We can also invoke your formal hearing rights, which allow you to present your evidence and challenge the other side's evidence, take appeals, and seek civil court relief in appropriate cases. Don't underestimate our critical role in your defense.

Impacts of Nurse License Discipline

Also, don't underestimate the potential impacts of your nursing license discipline due to patient abuse allegations. You should already see that you can lose your license to suspension or revocation. Even if you retain your license, a reprimand or other lesser sanction based on abuse findings could cost you your nursing job. You may be unemployed even if you retain your license. We can not only help you defend your disciplinary proceeding for the best disciplinary outcome but also help you communicate with your employer with appropriate reassurances of your competence and the safety of their patients and that they should not face civil liability for your retention. Otherwise, if you lose your nursing license and job, you can imagine the serious collateral consequences. Let us help you avoid those impacts.

Premier Nurse Licensing Board Attorneys

You can do no better than to promptly retain the Lento Law Firm's premier Professional License Defense Team for your defense of patient abuse allegations. We are available nationwide, no matter your licensure state. We have helped hundreds of professionals retain their licenses against abuse and other disciplinary allegations. Call 888.535.3686 or complete this contact form now.