You know the rewards of your nursing practice, financial, personal, and professional. You also know the huge investment you made in your nursing education and examination to obtain your nursing license. You have every right and reason to expect a continuing reward. Your patients, their family members, and your employer also need your skilled and committed nursing care. Don't lose all of those substantial interests to disciplinary charges alleging your unlawful or improper patient restraint. Retain the Lento Law Firm's premier Professional License Defense Team now by calling 888.535.3686 or completing this contact form. Protect your investment and rewards by preserving your license.
The Controversy of Patient Restraints
Patient restraints are definitely a trigger point for controversy and disciplinary complaints. You may wonder why, given your familiarity as a nurse of the need to protect patients against themselves and protect you and others against patients needing humane restraint. But American society places great value on liberty, autonomy, dignity, and independence. Restraints, as necessary, humane, and helpful as they can be, nonetheless can also offend every one of those core American values. Reports, exaggerated or not, of abuses of patient restraints can also fuel the public imagination and public condemnation of the practice of restraints, again, even when that practice is necessary, humane, and helpful. Beware any rumor, report, or complaint alleging your unlawful or improper use of patient restraints. The disciplinary charge can be among the most serious of charges for these reasons. Let us help you defend and defeat the charge.
Legitimate Needs for Patient Restraint
Nurses and other healthcare providers, not to mention law enforcement officers, corrections officers, mental health workers, and other professionals, know well the legitimate need for patient restraints. The American College of Emergency Physicians, for instance, openly supports the necessary use of patient restraints, though urging caution. The American Nurses Association also supports the careful use of patient restraints, while recognizing the nurse's need to balance patient protection and safety against patient autonomy and restraint risks of injury. The American Nurses Association interprets its own Code of Ethics to authorize the judicious use of patient restraints to protect themselves, others, and the patient from the patient's violent and threatening behaviors. Nursing care situations aren't always pretty. Ugly behaviors can issue from mentally ill, injured, deluded, and demented patients, for whom nurses nonetheless owe care.
In sum, don't feel bad about your lawful and proper use of restraints. You take on a considerable obligation when you do so. But don't risk disciplinary charges. Let us help you respond to unlawful patient restraint allegations before disciplinary charges arise. Let us help you respond to a state nursing board investigation of alleged unlawful patient restraint. And let us help you answer, defend, and defeat formal disciplinary charges for unlawful patient restraint.
Types of Patient Restraint
Patient restraints can take more than one form. The type of restraint may depend not only on the patient's size, strength, physical capabilities, mental capabilities, and other conditions but also on the available equipment, available staffing, facility environment, and other factors. Disciplinary cases involving alleged unlawful or improper restraint may turn not only on whether restraint was necessary and appropriate but also on whether the nurse made or implemented the proper choice of the proper type of restraint. Here are common restraint types:
- physical restraints involving pushing, pulling, holding, or other physical force applied directly to the patient, for safety, transfer, movement, ambulation, therapeutic interventions, dressing, cleaning, bathing, shaving, oral care, drug administration, and other beneficial or protective purposes;
- mechanical restraints including bed rails, tray tables, belts, cuffs, straps, harnesses, restrictive clothing, splints, hoods, and gloves;
- environmental restraints like door, lock, or gate restrictions to or from patient rooms, common areas, kitchens, service areas, and laundries, including locking items in cabinets or otherwise placing them out of patient reach;
- chemical restraints typically involving psychotropic medications in antidepressant, hypnotic, and antipsychotic classes; and
- seclusion, not only by locking patients into isolation but also by ordering or coercing patients into isolation or retreating to isolate a patient who is unable to move.
The Nature of Unlawful Patient Restraint
You can see from the above list of types of patient restraint the complexity and subtlety of restraint cases, both from the medical and nursing management standpoint and from the standpoint of defending unlawful patient restraint disciplinary charges. The question of the appropriateness of your actions in restraining a patient may come down to a matter of consulting nursing expert opinion, testimony, and interpretation. Our attorneys are prepared to retain consulting nursing experts to review your disciplinary allegations against your case's facts to opine relating to your defense of disciplinary charges. That said, examples of potentially unlawful or improper restraint may include:
- use of restraints when restraint is not necessary for any safety, therapeutic, or other purpose;
- use of restraints after their safety, therapeutic, or other beneficial purpose has expired;
- use of restraints to punish or coerce a patient rather than to care for the patient or to protect;
- use of the wrong means of restraint on a patient that requires a different means of restraint;
- use of the right means of restraint but in the wrong manner, resulting in patient embarrassment or injury, or the failure of the restraint;
- use of restraints without necessary and appropriate physician order for restraint use;
- use of restraints for convenience rather than safety, therapeutic purpose, or other patient benefit;
- use of restraints without required periodic relief to preserve and restore patient health, comfort, integrity, autonomy, and function.
The Impact of Unlawful Patient Restraint
The outcome of your state nursing board disciplinary charges relating to alleged unlawful patient restraint may depend on the adverse or beneficial effects of your allegedly improper or unlawful actions. Disciplinary authorities routinely maintain that patient injury is not at all necessary to find a regulatory violation and to impose a disciplinary penalty. You may face discipline even if your actions injured and threatened no patient. On the other hand, disciplinary authorities, your employer, your colleagues, and your patients and their family members will all generally take much more seriously allegations that you improperly used restraints, if your actions harmed a patient.
The beneficial effects of proper (or, in some cases, even improper) use of restraints appear above under the paragraph on legitimate uses. However improper use of restraints can have clear and sometimes serious adverse impacts. Improper restraint use can injure, wound, maim, kill, sicken or worsen sickness, degrade, demean, depress, reduce or eliminate essential motivation, starve, and dehydrate, among other bad things. That list alone should set you on guard against improper patient restraint allegations. Take any such allegations seriously. Immediately retain us to respond swiftly, sensitively, strategically, and effectively to the allegations or disciplinary charges.
Reporting of Unlawful Patient Restraint
You may wonder whether you will face state nursing board disciplinary charges if you have already heard allegations of your unlawful patient restraint, from patients, their family members, colleagues, or others. Or if you already face a state nursing board disciplinary investigation, you may wonder how and why you got reported to the board. Anyone may report nursing misconduct. Your state nursing board, like other boards across the country, very likely advertises its complaint hotline and online portal, on its website and perhaps also in your hospital or other facility. Patients and their family members do make state nursing board complaints. But so do other nurses and professional colleagues. A survey of state nursing board reporting requirements by two nursing school professors found wide variety in reporting rules but that some states, including Colorado, New Mexico, and South Carolina, require nurses to report other nurses' misconduct. Your disciplinary disclosure may have come through a colleague who felt bound by duty to turn you in. No matter your reporter, let us help you defend and defeat the charges.
Avoiding Unlawful Restraint Charges
Keep in mind that if you hear allegations of your unlawful or improper use of patient restraints, we may be able to help you head off any disciplinary complaints or charges, if you promptly retain us before formal charges issued. We may be able to communicate, in a sound and sensitive fashion, your reasons, grounds, explanations, and mitigating circumstances to the involved individuals, whether your nursing supervisor, facility director or manager, or even patient representatives. We may be able to negotiate resolutions, whether through your willing correction, reassignment, restriction, or supervision or by other remedial and restorative measures.
If instead complaints nonetheless reach your state nursing board's disciplinary officials, we may be able to communicate, advocate, and negotiate with those officials for the dismissal of the concerns and foregoing of formal charges, again through your willing undertaking of various remedial, reassuring, or restorative measures. Let us help you try to head off formal disciplinary charges. Doing so may preserve your reputation, relationships, and employment, while substantially reducing your costs, stress, and risks.
Nursing Board Authority to Discipline
In the whole process, do not doubt your state nursing board's authority to discipline you for any improper patient restraint or other rule or standard violation that it finds you committed. State nursing practice acts routinely authorize state nursing boards not only to issue licenses but also to suspend or revoke those licenses for articulated misconduct grounds. Section 90-171.23 of the North Carolina Nursing Practice Act, for example, expressly empowers the North Carolina Board of Nursing to discipline its licensees. Section 90-171.37 lists nearly a dozen different specific and general grounds for discipline, clearly reaching unlawful or improper patient restraint. Your state nursing board will have a similar disciplinary provision and list similar disciplinary grounds. Don't doubt disciplinary authority or ignore or minimize disciplinary charges. Instead, get our help defending the charges.
Disciplinary Grounds on Unlawful Restraints
As just indicated, the disciplinary grounds that state nursing practice acts authorize will routinely reach unlawful or improper patient restraints. Again, the North Carolina Nursing Practice Act provides an example. Section 90-171.37 includes “conduct that endangers public health,” unfit or incompetent nursing practice “by reason of deliberate or negligent acts or omissions regardless of whether actual injury to the patient is established,” and “unprofessional conduct that is nonconforming to the standards of acceptable and prevailing nursing practice or the ethics of the nursing profession, even if a patient is not injured.” Unlawful or improper patient restraints could fall under any of those three grounds. North Carolina Board of Nursing administrative rules repeat and reinforce those disciplinary grounds. Let us help you defend disciplinary charges of unlawful or improper patient restraints issued under these or similar statutory and regulatory grounds.
Statutes on Patient Restraints
State statutes on the lawful use of patient restraints reinforce state nursing board authority and responsibility to discipline nurses for unlawful or improper use of patient restraints. Patient restraint is sufficiently concerning and controversial that many states have enacted separate statutes, inside or outside of nursing practice acts or other professional regulatory schemes, articulating their lawful and unlawful use. Once again, North Carolina serves as a good example. North Carolina General Statutes Section 122C-60 devotes itself entirely to the use of patient restraints. The statute authorizes restraints only when:
- imminent danger of abuse or injury to the patient or others exists;
- substantial property damage is occurring; or
- restraint or seclusion is necessary for therapeutic treatment.
The statute further requires facilities using restraints to collect and report data on their use, adopt alternative methods and practices to using restraints, and train staff in alternatives to restraints. The statute also requires the North Carolina Board of Nursing to adopt rules and practices enforcing the statute's terms. If your state has a similar statute, your state nursing board's disciplinary officials may likewise use it to apply and interpret their own rules and standards. Let us help you do the same, with the goal of raising your best possible defense.
Disciplinary Sanctions for Unlawful Restraint
State nursing practice acts routinely authorize a wide range of discipline forms, penalties, or sanctions for nursing misconduct including unlawful or improper patient restraints. The Alabama Nurse Practice Act Section 34-21-25 expressly authorizes the Alabama State Board of Nursing to impose a fine up to $1,000 for each disciplinary violation and to suspend, revoke, “or otherwise discipline” a nurse's license. Your state nursing board will likely have similar sanctions provisions.
Your state nursing board's discretion to impose a wide range of sanctions may seem daunting and concerning. Yet that discretion enables us to make a case before your state nursing board's disciplinary officials that you should suffer no sanction and that the board should impose only remedial measures like probation, monitoring, supervision, and additional training or education if the board decides to impose any measure at all. Keep in mind that even if you committed a disciplinary violation, even a serious violation, relating to unlawful or improper use of restraints, we may be able to make a good case for mitigating sanctions. Your prior clean disciplinary record, strong nursing skills, and substantial contribution to patient and public health and the nursing profession may go a long way to relieving you of license suspension or revocation, and preserving your employment, relationships, and reputation.
Impacts of Discipline on Your Nursing License
If you do suffer discipline, beware the direct and collateral impacts. A license suspension means that you cannot practice nursing. You must cease and desist your patient nursing care. Your employer may in that case be unwilling or unable to continue to employ you, unless able and willing to find you an administrative or other role. Even if you avoid license suspension, your employer may decide that retaining you carries too much liability, reputational, morale, and management risk, depending on how patients and colleagues feel about your restraint practices and discipline. If you suffer job loss, you may of course suffer collateral impacts on your finances, ability to provide for yourself and family members, and physical and mental health. If you lose your nursing license to discipline, you may lose nursing licenses you hold in other states, other healthcare licenses you hold, and the ability to obtain nursing or other healthcare licenses in other states. Beware these and other potential impacts of discipline. Let us help you defend and defeat the charges, and avoid crippling disciplinary sanctions.
Defenses to Unlawful Patient Restraint Charges
Just because you face state nursing board disciplinary charges does not mean that you have committed misconduct. Your state nursing board disciplinary officials may expect you to come forward with a sound and even compelling defense. We may be able to defend your charges by showing that you did not restrain the involved patient or patients, that others were responsible for the disputed restraints, that patients or their family members misidentified or retaliated against you with a false complaint, or that colleagues attempted to scapegoat you for their own wrongs. We may alternatively be able to show that you restrained the involved patient or patients under doctor or supervisor orders, consistent with the practice and standards they ordered, required, and enforced, in a sort of safe harbor defense, even if your practices turned out to be improper.
We may also be able to show that no patient suffered harm and that your use of restraints provided substantial safety or therapeutic benefits. We may alternatively be able to show that your facility's systems, assignments, staffing, and equipment did not enable you to use proper restraints, leaving you to use inadequate or improper restraints as your only reasonable alternative to greater patient harm. Our consulting nurse expert may endorse your practice or may be able to opine and testify to the propriety of your actions under the existing circumstances, that you did the best you could. Let us make your best case for disciplinary defense.
Protective Procedures
Your state's nursing practice act should enable us to put your best case forward in the most convincing fashion. You have a constitutional right to due process in a disciplinary matter threatening your property and liberty interest in your nursing practice and license. Your state nursing practice act recognizes your due process rights by providing some form of fair notice and fair hearing before an impartial decision maker. Section 34-21-35 of Alabama's Nurse Practice Act, already cited above, is an example, setting forth the accused nurse's right to notice, a formal hearing, and other substantial protections such as witness subpoenas to ensure attendance. If you have already invoked and lost your formal hearing, retain us to pursue your appeal rights, right to review by a civil court, and opportunity to obtain alternative special relief through a general counsel office, as your state's laws, rules, and procedures allow. Let us exhaust your administrative and other remedies until we gain you the best possible disciplinary outcome.
The Role of License Defense Counsel
As skilled and experienced administrative license defense attorneys, we know how to invoke the above protective procedures to their best effect. Do not hire unqualified local criminal defense counsel, real estate counsel, estate planner, or civil litigator. Administrative law, rules, and procedures differ from criminal court, civil court, and other legal forums and procedures. Unqualified counsel may do more harm than good. If you have already lost opportunities in your disciplinary matter, retain us to review your other available options. We may be able to move for reconsideration, supplement your record, or otherwise restore your rights in ways that gain you the relief you deserve.
Premier License Defense Attorneys Available
If you face state nursing board disciplinary charges relating to your alleged unlawful use of patient restraints, your best move is to retain the Lento Law Firm's premier Professional License Defense Team. We have helped hundreds of nurses and other professionals retain their licenses against state board disciplinary charges Call 888.535.3686 or complete this contact form now for the skilled and experienced representation you need for your best disciplinary outcome.
