Malpractice and Negligence Nurses

Becoming a licensed nurse takes years of education, costing thousands of dollars, and a commitment to extensive clinical training to practice in the field. One of the most significant tenets of a nurse's profession is being accountable for providing appropriate patient care. Although nurses stand at the forefront of patient care and safety, they are often subject to allegations of malpractice or negligence while carrying out their duties. While both are substantial accusations that involve a failure to uphold patient healthcare standards, they are distinct in their definitions, as are their implications. However, the consequences of either for a nurse can spell the end of their career and livelihood.

Despite a nurse's material investments of time and money into their career and continuing education, all that stands between them and a license revocation can be a single complaint naming malpractice or negligence. Even first-time violations for nurses with decades of experience under their belt are at risk of losing their ability to practice in the medical field.

While typical state board of nursing (BON) disciplinary procedures allow nurses accused of malpractice or negligence a platform to defend themselves at a formal hearing, the complex nature of proceedings can leave licensees behind the eight ball. Unfortunately, BON methods don't guarantee due process provisions, meaning you need professional help when allegations arise.

The Lento Law Firm Professional License Defense Team understands how the daily challenges nurses face in the workplace can lead to complaints citing malpractice or negligence. With such an important job providing life-saving care and assistance, it's vital to have the defense necessary to keep licensure intact. BON disciplinary panels don't always take the time to comprehend a situation fully and may move quickly to hand down punishment to hard-working nurses. We can defend you from sanctions including, but not limited to, the following:

Remediation, probation, and practice restrictions
Significant fines and restitution
License suspension and revocation

Disciplinary action will follow your license nationwide, so protect your credentials by retaining a team with experience you can trust. The Lento Law Firm Professional License Defense Team will create a defense strategy for you, lead negotiations with licensing and regulatory authorities, and ensure you can work without adverse action affecting you. Call us at 888-535-3686 now or submit your details online, and we will contact you.

What Is Malpractice and Negligence?

Malpractice and negligence are critical concepts in the healthcare profession that represent significant concerns and severe implications for patients as well as a nurse's professional standing. These issues affect nurses in the following ways:

Malpractice refers to professional misconduct or the failure of a healthcare provider to meet the standard of care, resulting in harm to a patient. In the nursing practice, this could include administering the wrong medication to a patient, failing to monitor a patient's condition adequately, or performing medical procedures without proper authorization.
Negligence: involves a failure to take appropriate care in performing an act that a reasonably prudent person would do under similar circumstances. For nurses, negligence might involve not following established protocols, failing to communicate critical patient information, or neglecting to document patient care accurately.

While the two share many similarities, the key differences between malpractice and negligence lie in the intent and the standard of care. Malpractice implies a breach of duty by a professional who is expected to possess the necessary skills and knowledge, whereas negligence involves a general failure to exercise reasonable care. Both have significant implications, but malpractice is often seen as a more severe offense due to the professional context and the potential harm patients may experience.

Critically, negligence does not require intentional harm to a patient. It is primarily tied to a nurse's carelessness or inattention to duty. Moreover, it must be proven that what a reasonably prudent nurse would do under similar circumstances in the medical field has been a failure. Some common examples of negligence may include:

Forgetting to readjust a bedridden patient to prevent bedsores, circulation to areas of the body, or after discomfort.
Failing to check and document a patient's vital signs as required for treatment or monitoring.
Neglecting to notify superiors of changes in a patient's condition.

Malpractice may be viewed as a subset of negligence related to nurse misconduct or failure to meet the standard of care expected that harms a patient. It also implies a breach of duty in a professional nursing role, especially one presumed to possess specialized skills and knowledge. While malpractice does not necessarily involve intentional harm, it does suggest a more severe breach than ordinary negligence. Some common examples of malpractice may include:

Administering the wrong medication due to a failure to check a patient's allergies.
Performing a medical procedure without proper authorization.
Failing to follow surgical protocols, leading to patient harm.
Informing a patient or their family of improper post-operative care.

While negligence and malpractice involve failures in providing appropriate care, understanding the nuances between the two is essential. Again, negligence is about failing to act with reasonable care, whereas malpractice pertains to a breach of professional duty. The particulars of each are codified in laws and regulations spanning the country, and though BONs may have slightly varying enforcement guidelines, all work from a common set of laws.

State and Federal Laws Governing Nursing

All 50 states, the District of Columbia, and four U.S. territories have BONs responsible for regulating the nursing practice. The governing laws are defined in the Nursing Practice Act (NPA), which provides guiding principles for the scope of nursing, including terms for the law's intent, nursing educational program standards, practice rules and regulations, and methods used for the licensure processes. Each state-level legislative body carries out the provisions of the NPA and gives the BON the authority to license, manage, and discipline all types of nurses, including the following:

Practical Nurses (PNs)
Vocational Nurses (VNs)
Registered Nurses (RNs)
Advanced Practice Nurses (APNs)

While most states have a singular BON regulating all levels of nursing, California, Louisiana, Nebraska, and West Virginia have separate boards for PNs, VNs, RNs, and APNs. Regardless, all boards are members of the National Council State Boards of Nursing (NCSBN), which promotes patient safety in nursing care for public protection.

Nursing regulation through the NPA is a state-initiated effort. Therefore, it's the BON's responsibility to protect the public's health, safety, and welfare against substandard nursing care. Clear definitions of the scope of nursing practice are detailed in the NPA and aligned with the nursing process of developing a plan of care for patient advocacy. Furthermore, the scope of practice is inclusive of safe nursing practices appropriate for the level of training and orientation.

Nursing Duties and Standards of Care

Nationwide, nursing care is directed and evaluated by the NPA. Each state has the authority to create its own code of conduct, duties, and standards of care, but each must align with regulatory minimums. Nursing duties encompass a broad range of day-to-day responsibilities aimed at providing comprehensive care to patients and vary based on the patient's needs and nurse specialization. They are effectively the legal obligation of healthcare providers to adhere to a standard of reasonable care while performing any acts that could foreseeably harm patients.

For nurses, this means providing care that meets accepted standards and protocols, ensuring patient safety, and preventing harm. Some of the care nursing duties supported by the NPA include but are not limited to the following:

Patient Assessment: Nurses must gather comprehensive data about a patient's condition by conducting thorough physical and psychological exams, documenting patient medical history, and monitoring vital signs to identify any changes in condition to develop accurate diagnoses.
Care Planning: Based on the assessment, nurses develop individualized care plans by setting realistic medical goals and collaborating with the patient, their family, and other healthcare professionals.
Medication Administration: During care and treatment, nurses must be attentive and knowledgeable to ensure that the correct medication is given at the right time using the right dosage and inform patients and their caregivers of the potential side effects.
Patient Education: Along with advising on medications, nurses are tasked with providing patients and their families guidance on managing their health, such as managing medications long-term, advocating for diet or lifestyle changes, and other self-care techniques.
Wound Care and Procedures: In assisting with testing, surgical, and therapeutic procedures, nurses must follow safe practices for injury assessments, dressing changes, and other control measures.
Accurate Documentation: Throughout the patient care process, nurses must meticulously record patient information, the care provided by the nurses or other coworkers, and any changes in the patient's condition to provide a legal record of treatment.
Coworker Communication: Nurses act as liaisons between patients and other treatment team members, and communication is essential for comprehensive care.
Patient Support: In addition to medical duties, nurses also play a significant role in helping patients and sometimes their family members cope with conditions and situations, addressing concerns and offering reassurance for recovery and well-being.
Infection Prevention: One of the NPA's primary concerns is infection control, meaning nurses must follow proper hygiene protocols, use personal protective equipment, and educate patients on practices to maintain a safe environment.
Supervision and Delegation: Depending on a nurse's job description and seniority, they must mentor junior nurses and nursing assistants and delegate tasks appropriately, ensuring that all team members are competent and capable of performing their assigned duties

While duties refer to specific tasks nurses nationwide must have the competency to perform, standards of care are benchmarks that nurses are expected to follow to ensure safe, effective, and ethical patient care. Some of the central elements of nurse care standards include:

Evidence-Based Practice: Nurses must stay informed about the latest guidelines and treatment techniques—often obtained through mandatory continuing education—to provide the most effective care.
Patient-Centered Care: While nurses have protocols to follow in their respective healthcare facilities, they must involve patients and their families in decision-making processes to ensure that care and treatment plans are tailored to individual needs.
Ethical and Legal Compliance: Licensed nurses are required to comply with various legal and regulatory requirements, such as maintaining patient confidentiality and obtaining informed consent, but also consider ethical principles like patient autonomy and beneficence in their decisions.
Professional Competence: Nurses must complete continuing education to remain current on best practices in their field and meet patients' evolving needs.
Cultural Proficiency: Along with professional care, nurses should provide culturally sensitive care that takes into account diverse patient backgrounds and understanding how cultural factors influence healthcare, including awareness of disparities and barriers to care to provide equitable services.
Accountability and Responsibility: Nurses are accountable for their actions and the care they provide, but also for the actions of subordinates if they are engaging in training.
Patient Advocacy: Nurses advocate for their patient's rights and needs within the healthcare system to enhance care, which may include speaking up for patients and their families to superiors.

Nursing duties and standards of care are fundamental to providing safe, effective, and compassionate patient care. However, they also protect licensees from allegations of misconduct, such as malpractice or negligence. Nevertheless, mistakes can place nurses in a tough position to defend their credentials. It's essential to know the ins and outs of what may be considered a breach of NPA and licensing standards.

Potential Causes of Malpractice and Negligence

Nurses operate in high-stress environments that require skill and quick decision-making. Work conditions significantly influence a nurse's ability to uphold appropriate standards of care and perform their duties effectively, and an inadequate work environment can be a potential origin point of malpractice or negligence.

When healthcare facilities are understaffed, nurses are often required to care for more patients than is manageable. Such situations can easily increase the risk of errors because nurses have less time to devote to each patient, which can lead to fatigue and burnout. Yet, there are many more scenarios that could lead to the chances of breaching nursing duties and standards of care, like the following:

Constantly evolving healthcare protocols can leave nurses behind in contenting education and inadvertently harm a patient, improperly alter their medication regimen, or spread disease.
Inadequate medical supplies and equipment can force nurses to skip necessary procedures or improvise outside sanctioned patient care.
Nurses often work under significant time pressure, especially in emergency settings, which can lead to overlooked details and missing key symptoms indicating a serious condition.
A nurse might not receive critical updates about a patient's condition from subordinates, superiors, or other healthcare providers, leading to inappropriate or delayed medical interventions.

While nurses themselves may not be the original causes of any of the above situations, they can quickly get wrapped up in the consequences and garner disciplinary action. Nevertheless, BON representatives aren't patrolling healthcare facilities, searching for misconduct. Allegations of malpractice or negligence will almost always come from patients, coworkers, and superiors through the state's official complaint system.

BON Complaint Procedure and Investigation

Anyone can file complaints, including patients, family members, nursing colleagues, or employers. Typically, the aggrieved party (complainant) submits a complaint in writing to their state BON or through an online submission form. Complainants will detail the allegations of malpractice or negligence, providing initial evidence, names of potential witnesses, and the identity of the subject of the complaint.

Under NPA guidelines, complaints regarding nursing care are often grouped into the following categories:

Practice-related: breakdowns or errors during aspects of the nursing care and treatment process.
Drug-related: mishandling, misappropriation, or misuse of controlled substances with patients or coworkers.
Boundary violations: nontherapeutic relationships between a nurse and a patient or client.
Sexual misconduct: inappropriate physical or sexual contact with a patient or client.
Abuse: maltreatment of patients or clients that is physically, mentally, or emotionally harmful.
Fraud: misrepresentation of the truth for gain or profit in the care or treatment process.

Once the board receives the complaint, it conducts a preliminary review of the complainant's allegations and supporting evidence. Following the initial review, the BON decides whether the complaint is a breach of the NPA and falls under its jurisdiction. If both criteria are met, the board assigns an investigator—which may or may not be a BON member—to conduct a thorough analysis of the facts and evidence related to the complaint.

The accused nurse (respondent) is notified of the complaint and is given an opportunity to respond. They may submit a written statement and provide evidence, and they will be interviewed later by the investigator. Timelines will vary by the state BON, but inquiries will begin quickly. Investigations will likely involve the following:

Interviews with the complainant, respondent, and witnesses to the allegations.
Reviewing patient medical records, employment documentation, incident reports, and other related materials.
Observing the nurse or healthcare facility to determine everyday practices and gather additional evidence.

Afterward, the investigator analyzes the collected evidence to determine whether there is sufficient proof to support the allegations. They then send the board an in-depth report summarizing their findings, including evidence supporting the allegations and any other mitigating or aggravating factors.

Disciplinary Process for Nurse Malpractice and Negligence

Once the BON is fully informed by the investigation report, it will discuss how to proceed to fulfill the requirements of the NPA and state law, depending on the charges. The situations involving malpractice and negligence are wide-ranging, as are their effects on patient care. Nevertheless, the board can exercise a few options when managing misconduct and rule violations.

For instance, if a nurse is charged with a minor form of negligence—a delayed entry on a patient's mealtime, a missed patient check-in, or forgetting to inform a superior of a patient's non-life-threatening condition—the board may pursue informal discipline. Outside of an official hearing, the board may meet with the accused nurse and attempt to convince them to claim responsibility for the misconduct in turn for less severe sanctions, which may include but are not limited to:

Verbal warnings
Written reprimands
Increased supervision
Mandatory education

Although accepting informal discipline may be a welcoming pathway to take to avoid escalating the situation to a formal hearing, it's a common misconception. First-time violations may not seem significant, especially when they garner a verbal warning, but they create a permanent disciplinary record. Unfortunately, sanctions of any kind can limit your career opportunities, including promotion or obtaining additional licensures.

If the nurse does not agree with informal discipline or if the allegations are more severe and warrant formal discipline, another state authority can take over, which may be the Office of the Attorney General (OAG), Office of General Counsel (OGC), Office of Administrative Hearings (OAH), or other, depending on the state, district, or territory.

A representative from the OAG, OGC, or OAH will review the board's findings, recommend discipline, and prepare a Consent Order, which is then sent to the nurse. Licensees are given a short amount of time to review the order and agree to the terms laid out, including any discipline and further stipulations on their license. If accepted, the order is sent to the National Council of State Boards of Nursing (NCSBN) database, where the following information is available to nationwide BONs and accessible by employers:

The nurse's professional identity
Charges against the nurse
Disciplinary measures taken
Status of completing rehabilitative practices

If the nurse does not enter into a Consent Order, the state agency representative will file charges and take the matter to a contested case hearing to argue before an administrative law judge (ALJ) or presiding officer. A "Notice of Charges" or "Notice for Hearing" is sent to the nurse at least 30 days before proceedings begin and includes the time, date, and location of the hearing, as well as the nurse's rights. Critically, a nurse has the right to legal representation during contested case hearings.

First, both parties may agree to a pre-hearing conference to discuss any settlement possibilities through mediation. In some states, there can be multiple opportunities for informal resolution prior to a hearing. Afterward, they may enter a discovery period to exchange information, documents, and evidence, allowing each to understand the other's case and prepare their arguments.

While state guidelines vary, the burden of proof in contested case hearings typically falls upon the petitioner. Therefore, if the BON pursues formal discipline, it must prove the allegations against the licensee. However, the presiding officer or ALJ is likely to rely on the "preponderance of the evidence" standard, wherein the petitioner—the BON in this case— must prove that the charges are only more true than not true. It's a low evidentiary standard that can often work against a licensed nurse.

Final orders are based on the evidence presented and will include one of the following determinations:

Affirming the BON's original decision
Modifying the BON's sanctions
Reversing the BON's decision.

All final orders contain a clear and concise statement of the available procedures and time limits for seeking reconsideration, administrative relief, or judicial review. Unless a nurse decides to appeal the ALJ's decision, the sanctions imposed for malpractice or negligence charges remain in effect.

Sanctions and Consequences for Nurses

Among many, one of the most severe consequences of malpractice or negligence for nurses is the potential impact on their licenses. While minor instances may garner fines, reprimand, and other informal discipline, BONs discipline nurses for malpractice and negligence aggressively. One of the following punishments is likely:

License probation: Nurses are required to abide by certain conditions and restrictions of their credentials and practice for a specific amount of time—typically one year to start. Additional duties may include participation in board-approved continuing education programs, mandatory supervision, loss of supervising responsibilities, or other specified requirements addressing reoccurrence.
License suspension: A temporary ban on a nurse's license for a specified period—usually one to five years— during which the nurse cannot practice in their state or any other.
License revocation: Permanent withdrawal of the nurse's license in a respective state, generally without the opportunity to reapply.

Some licensed nurses may think that they can move to a different state following license restrictions. However, the NCSBN supports the Nurse Licensure Compact (NLC) with at least 34 BONs to create a multi-state license recognition program. Once a nurse licensed in an NLC-complaint state has their credentials altered, suspended, or revoked, all other BONs within the licensure compact are made aware through a nationwide database.

Not only will charges of malpractice or negligence affect a nursing license, but they may also have implications for others. If a licensed nurse also holds other professional credentials in their state—public accountancy, security guard, teacher—depending on the state, those may also be at risk.

The personal and professional toll of being punished for malpractice or negligence can be overwhelming. Nurses are deeply committed to their profession, seeing it as a calling, not just a career. Without the credentials needed to practice, the emotional and financial toll may extend beyond them to their families.

Impacts reach beyond an individual and into the broader healthcare community, too. Patient care relies on a competent and trustworthy nursing workforce, and instances of malpractice and negligence raise questions about duties and standards of care. With so much at stake, licensed nurses need professional help that will match the determination of state authorities.

How Can the Lento Law Firm Help?

Defending a nurse's license after allegations or charges of malpractice and negligence is a daunting task, especially going at it alone. While nurses may recognize the world of healthcare and patient wellness, they may not understand the differences in administrative proceedings BONs, OAGs, and other state agencies use to investigate complaints and manage rule violations as the Lento Law Firm does. Our Professional License Defense team is known nationwide for its commitment to protecting licensed nurses from harsh sanctions for malpractice or negligence charges.

Nurses may think hiring an attorney is a big step to take initially. However, when your license, your job, and your way of life are threatened by allegations or charges of malpractice and negligence, it's the defense you need. It will protect you from:

Going through the disciplinary process alone and uninformed.
Forgetting to file paperwork like responses to the BON and appeals on time
Getting caught up with confusing legal jargon from state agencies

Our experienced professional licensed defense attorneys aren't courtroom bulldogs but a force of knowledge, dedication, and guidance to assist nurses throughout the disciplinary process. The Lento Law Firm Professional License Defense Team is a worthwhile investment for many reasons, and we provide much-needed assistance, such as:

Building a solid defense: Our attorneys know to gather evidence and witness testimony to challenge the BON's charges against you. We understand NPA provisions and state agency regulations to provide you with a strategy aimed at the best possible outcome.
Corresponding with BON members and representatives: When the licensing board becomes aware of allegations, an investigator and other authorities can come knock on your door. Our team will step in to communicate with the BON and other authorities to ensure you have appropriate guidance and representation from the initial review to contested care hearings and appeals, if necessary.
Protecting your due process rights: When nurses accept certain forms of discipline, including informal measures, they often waive their right to appeal. We will ensure every option for redress is available to avoid license sanctions.
Helping reinstate your license: After license suspension or revocation, regaining credentials is a lengthy and challenging process. Our team will advise you on the proper protocols to follow when reapplying, including how to fulfill requirements from state agencies.

The Lento Law Firm Professional License Defense Team is prepared to help licensed nurses navigate complaints, investigations, and sanctions stemming from malpractice or negligence. You deserve a team that can represent you effectively, understand how BONs and other state agencies manage nursing license regulations, and how your credentials can be kept safe. For stress-free assistance and to promote the best outcome for your license status, call the Lento Law Firm Professional License Defense Team now at 888-535-3686 or visit us online and schedule a confidential consultation, and we will reach out to you.

Nurse Malpractice and Negligence