If you're a Certified Nursing Assistant (also called a “Nurse's Aide”) in North Carolina, you know how hard you have studied and worked to earn your registration. Your designation as a Nurse's Aide I or Nurse's Aide II gives you access to a wide range of jobs in care homes, hospitals, home health services, and other healthcare settings all over the state.
It's important to your livelihood, your employer, and the patients you serve that you continue to be able to do your job, which is why you need to take a misconduct allegation seriously. Depending on the nature of the allegation, you could easily end up losing your certification and your ability to work as a certified nursing assistant or nurse's aide in the state.
The Lento Law Firm Professional License Defense Team has gathered this information about disciplinary proceedings in one place so that you can have a better understanding of how disciplinary investigations of certified nursing assistants/nurse's aides operate in North Carolina. If, after reviewing this, you have questions about your situation, contact the Lento Law Firm Professional License Defense Team as soon as possible. Disciplinary investigations can move quickly, especially if you don't pay attention to what's happening, and it can be very stressful to be under investigation. The Lento Law Firm Professional License Defense Team can help you carry much of that burden, and can help you fight for your rights and your certification.
The North Carolina Division of Health Service Regulation and North Carolina Board of Nursing
In North Carolina, there are two separate state agencies that regulate what the state calls “unlicensed assistive personnel” or “UAPs.” The term UAP is a broad one, and includes “the following specific job titles: Nurse Aides/Certified Nursing Assistants, Patient Care Aides/Home Health Aides/Patient Care Technicians, Medical Office Assistants, Medical Assistants, Medication Aides, and Medication Technicians.” The two agencies involved in regulating these positions are the Board of Nursing (BON) and the Division of Health Service Regulation (DHSR).
When it comes to nursing aides / certified nursing assistants, there are two categories: Nurse Aide I and Nurse Aide II. Neither category requires a license, but both must register for certification with the state.
Under North Carolina administrative law, a Nurse Aide I is authorized to “perform basic nursing skills and personal care activities,” while a Nurse Aide II may “perform more complex nursing skills with emphasis on sterile technique in elimination, oxygenation, and nutrition.”
The North Carolina Board of Nursing regulates requirements for certification as a Nurse Aide II and maintains the Nurse Aide II registry. The North Carolina Division of Health Service Regulation, on the other hand, regulates the requirements for certification as a Nurse Aide I and operates the Nurse Aide I registry.
Despite this division, when it comes to disciplinary matters, it's the Division of Health Service Regulation that administers the disciplinary process for both Nurse Aide I positions and Nurse Aide II positions. This is who will be contacting you if a disciplinary complaint has been filed against you.
The North Carolina Health Care Personnel Registry
The North Carolina Health Care Personnel Registry is a list of individuals who are either under investigation for a misconduct allegation or who have had misconduct allegations against them substantiated. The registry is available to employers and potential employers. If you have received a notice that a misconduct investigation is pending against you, your name will now be on the Health Care Personnel Registry with a “pending” designation next to it, so it's important to address the matter as soon as possible.
Certification as a Nurse Aide I and Nurse Aide II in North Carolina
To be able to register as a Nurse Aide I in North Carolina, you need to pass a state-approved training program and pass a competency test. If you already have the appropriate training, you may be able to have the training portion waived and simply take the competency test. And if you have an active nurse's license in North Carolina, you can also be listed as a Nurse Aide I. If you're moving to North Carolina from another state and have been certified elsewhere as a nurse's aide, you may also be able to waive all or part of the training and competency requirements for registration as a Nurse Aide I.
To be able to register as a Nurse Aide II in North Carolina, you must first be listed as a Nurse Aide I. You must also complete a Nurse Aide II training program and submit your application for registration within 30 days of completing that program. Your instructor must certify that you've completed your training program (whether it's a Nurse Aide II training program or a registered nurse training program).
To get to the point where you are able to register as a Certified Nursing Assistant in North Carolina (whether as a Nurse Aide I or as a Nurse Aide II), you will have spent many hours in both classroom and clinical settings. This is why it's so important for you to take any notification that a misconduct allegation has been made against you seriously. The Lento Law Firm Professional License Defense Team is ready to help you with what can be the difficult and stressful investigation and misconduct evaluation process that you are likely to encounter when charged with professional misconduct.
North Carolina Registered Health Care Personnel Investigations
As noted above, even though Nurse Aide II certifications are handled by the Board of Nursing, when it comes to disciplinary matters, it's the Division of Health Service Regulation that receives and investigates complaints filed about both Nurse Aide I practitioners and Nurse Aide II practitioners. In particular, the DHSR's Investigations Section will process and investigate complaints received about Nurse Aides in North Carolina.
Complaints can come from patients, families or friends of patients, healthcare facilities where the Nurse Aide works, or anyone else who believes they have information about a Nurse Aide's misconduct.
North Carolina Registered Nurse's Aide Ethical Standards
Nurse Aides in North Carolina undergo training on the ethics that apply to their profession. This training is part of the Nurse Aide I training curriculum, and the rules and standards should be familiar to both Nurse Aide I and Nurse Aide II workers.
Nurse Aides are trained about their obligations to protect vulnerable individuals in their care. This includes properly caring for the person's physical self, as well as their possessions. They learn about the proper treatment of patients as well as the consequences if they fail to practice their profession in an ethical manner. Some of the points that are made during this training include:
- The importance of using good judgment
- Keeping patient and staff information confidential
- Maintaining accurate documentation regarding patient and resident treatment
- Following the patient or resident's plan of care
- Understanding and respecting the patient's or resident's rights
- Reporting unusual observations or incidents involving patients or residents
- Showing empathy for patients or residents
- Respecting all patients or residents equally
- Safeguarding the patient's or resident's property
Failing to observe these or other ethical guidelines, including those put in place by your employer, can result in a misconduct allegation being filed against you.
Defending Yourself Against North Carolina Health Care Disciplinary Investigations
You have a right to defend yourself against misconduct allegations that occur as a result of disciplinary investigations. In particular, you have the right to have an attorney present when you are interviewed by a state investigator. In addition, as described in more detail below, if a misconduct allegation is investigated and determined to be “substantiated,” you have the right to challenge that determination through an administrative hearing.
You don't want to face these kinds of serious allegations alone. The Lento Law Firm Professional License Defense Team understands how these investigations work, how the petition process operates, and how important it is to make sure your rights are respected and aggressively defended in any proceeding.
Valuing Your North Carolina Nurse's Aide Registration
If you are listed on the North Carolina Health Care Registry as having a “substantiated” misconduct claim against you, you won't be allowed to work in a wide range of healthcare settings in North Carolina. This will seriously affect your ability to be employed as a Nurse's Aide in any capacity, and this is why you should take action as soon as you are notified that a misconduct claim has been filed against you.
Telling Your Side of the Story to North Carolina Division of Health Service Officials
During the process of investigating misconduct claims against you, you will almost certainly be interviewed by one or more members of the DHSR's Investigations Section. While this is an opportunity to present “your side of the story,” it's also an opportunity to inadvertently provide information to the investigator that can be used against you.
This is why it's extremely important to have an experienced attorney by your side during any investigatory interview. Unclear questions often result in unclear answers. And unclear answers can be interpreted against you. The Lento Law Firm Professional License Defense Team can help make sure that any questions you are asked are clear and unambiguous; that you understand the question before you answer it; and that if your answer is unclear, you have a full and fair opportunity to clarify what you meant.
Allegations That Can Put Your Nurse's Aide Registration at Risk
Your certification as a Nurse's Aide (or Certified Nursing Assistant) can be threatened if you are found to have committed a wide variety of misconduct, including:
- Abusing a patient in your care, including physical or sexual abuse
- Neglecting to provide care to someone assigned to you
- Taking or diverting drugs that were supposed to be given to a patient or that are part of your healthcare facility's stock of drugs intended for patient care
- Defrauding a resident, including taking their property
- Defrauding your health care facility, including taking their property
- Working while under the influence of alcohol, marijuana, or any prescribed or illegal drug where the use of the drug affects your ability to perform your duties and care for patients
There may be other types of conduct that can result in an investigation and a finding of misconduct against you. These are some of the more common examples.
What is the Disciplinary Process for North Carolina Nurse's Aides?
Once a complaint against you is received by the DHSR's Investigations Section, the complaint will be screened to make sure it is the type of complaint that the Investigations Section handles. In some cases, the Investigations Section may ask for additional information from the source of the complaint in order to be able to make this decision.
If the Investigations Section decides to investigate the complaint, a “pending allegation investigation” notation will be attached to your listing on the North Carolina Health Care Personnel Registry. This will disclose to anyone who has access to the registry that an investigation against you is ongoing. You will also receive a certified letter from the Investigations Section that will describe the allegation against you and provide you with some information about your rights in the situation.
That “pending” listing will remain on the registry next to your name until the investigation is completed and the Investigations Section determines that the allegations were “substantiated” or “unsubstantiated.”
North Carolina Division of Health Service Investigations
The investigation process can take some time. You are likely to be interviewed, and investigators may also talk to your co-workers, patients, and anyone who may have witnessed the incident or activity that has been reported. In some cases, outside investigators may be called in, in particular those from the Medicaid Investigations Division of the US Department of Justice.
If the allegations against you aren't supported by the evidence uncovered during the investigation, the “pending” listing next to your name will be removed from the Health Care Personnel Registry.
If they are supported by the evidence, you will receive a certified letter that will notify you that the DHSR intends to enter a finding against you on the Health Care Personnel Registry. For a finding that you committed “abuse, neglect, or misappropriation of the property of a nursing home resident,” the finding will also be entered against your name on the Nurse Aide registry. The finding will be listed against your name unless you file a petition contesting the finding with the North Carolina Office of Administrative Hearings.
North Carolina Office of Administrative Hearings Procedures
The Office of Administrative Hearings has its own procedures that apply to contested misconduct petitions filed with it by Nurse Aides as a result of DHSR investigations that substantiate misconduct complaints. While the petition is basically a notification that you intend to contest the DHSR finding, it's important that you make sure it's properly completed and contains all of the information that the Office of Administrative Hearings will need to move the hearing forward.
After you file your petition (and provide the DHSR with a copy), your case will be assigned to an Administrative Law Judge (ALJ), who will be responsible for managing and hearing your case going forward. At this point, it is very helpful to be represented by an attorney because your attorney will then receive all correspondence from the ALJ about your case and can make sure you provide all of the information needed for your defense and that you meet all deadlines set by the ALJ.
Your case may be mediated; a mediation is a meeting between you and your attorney and one or more representatives from the DHSR where a mediator is present to try to help resolve the matter. The mediator may be one that you and the DHSR agree on, or if you can't agree, then the ALJ will assign one. If you are able to resolve the matter through mediation, then you will not go through the hearing stage of the dispute process. If the mediation doesn't resolve the dispute, you will move on to the hearing stage.
Before the hearing stage, however, you may be required to file some documents with the ALJ, including something called a Final Prehearing Order. This is a document created by both sides where they set forth issues where the parties agree (for example, you might agree that you worked as a Nurse Aide I at a particular nursing home for a particular period of time) and where they disagree (such as you disagree about the misconduct that the DHSR claims you committed).
The Final Prehearing Order will also identify witnesses and exhibits that both sides want to introduce and use at the hearing. It may also identify whether there are any issues with those witnesses or exhibits, for example, if you have an objection to a document that the DHSR wants to use or if the DHSR objects to a witness you want to call. This is where having an experienced attorney from the Lento Law Firm Professional License Defense Team can make a significant difference in your case. Having someone on your side who understands what's needed to defend you against misconduct allegations and who also knows when it's appropriate to argue that evidence that the DHSR wants to use is unreliable or misleading or has some other defect, can make a tremendous difference when it comes to defending yourself against DHSR misconduct claims.
Just because you list the name of a witness on a Final Prehearing Order doesn't mean the witness is going to show up for the hearing. Your attorney knows this, and also knows how to issue a subpoena to the witness, basically a court order that requires the witness to appear on a certain day for the hearing.
Sometimes, hearing dates are changed. This can be because of attorney or witness availability issues or sometimes because the ALJ has a conflict if another hearing goes longer than planned. The more notice you can provide the ALJ of any request to change a hearing date, the more likely you are to have the request granted (assuming there is a good reason for the request).
At the hearing, both you and the DHSR will be able to testify. In addition, both sides can “offer documents in evidence; have witnesses testify; question an opposing party's witnesses; and explain or rebut evidence.” The hearing may go on for some time, and all of it will be recorded in some fashion so that the parties, the ALJ, and others may review what was said during the hearing.
After the hearing, the ALJ may ask one or both sides to provide the ALJ with proposed findings of fact and conclusions of law that the ALJ may or may not use when providing a written decision. The ALJ decision may take up to 45 days after the hearing (or the date that the proposed findings of fact and conclusions of law are due).
Appeals of Misconduct Findings After a Hearing
If the ALJ rules against you, you may be able to appeal the decision to the Superior Court in the county where you live. There are very specific deadlines and rules that apply to appeals. The petition for appeal must contain certain information, and the records of the ALJ proceeding need to be provided to the court. To file the most effective appeal, you need the help of an experienced attorney from the Lento Law Firm Professional License Defense Team who understands the North Carolina procedures that apply to appeals and can make sure yours is as strong and effective as possible.
The Superior Court's decision may itself be appealed to the Appellate Division; this involves another set of procedures and guidelines that need to be followed for the appeal to be valid and effective.
North Carolina Division of Health Service Consent Agreements
There may come a point after you file a petition to contest a finding that misconduct allegations against you have been substantiated where the DHSR approaches you with a consent agreement. This may happen as part of mediation, or otherwise. In this situation, you are asked to agree to a set of written facts and to accept a determination from the DHSR. In cases where the determination is that the claims against you were “unsubstantiated,” this can be beneficial; where the determination is that the misconduct claims were “substantiated,” it's obviously less helpful.
In either case, evaluating the offer and deciding whether it makes sense to accept it depends on the facts of your situation. And making that decision is much easier when you can rely on the experience of an attorney from the Lento Law Firm Professional License Defense Team.
Why You Need a Health Care Registration Defense Attorney in North Carolina
Nurse's Aide misconduct proceedings can be complicated and extremely stressful. Navigating the investigation process, understanding your options at any point during and after the investigation, deciding whether to accept findings made against you (or in your favor), and determining whether to file a petition to contest a finding that misconduct claims against you have been “substantiated” is all much easier when you have the help of an experienced attorney who knows how these rules, regulations, and processes work.
How a Nurse's Aide Registration Defense Attorney Helps in North Carolina
In addition to representing you during the investigation process and any following proceedings, your attorney can also help initiate an investigation on your behalf to uncover information in your favor that the DHSR investigator fails to find. An aggressive and fair defense, supported by facts that you or your attorney uncover, can make all the difference between a finding that the charges against you are “substantiated” or that they are “unsubstantiated.”
Registration Defense Team for North Carolina Nurse's Aide Misconduct Allegations
The Lento Law Firm Professional License Defense Team has been helping Nurse's Aides and other types of health professionals maintain their professional certifications and licenses in North Carolina and other states for years. They have a deep understanding of the sometimes-complicated laws, standards, procedures, and policies that apply to misconduct investigations. They know how to aggressively and fairly defend you from misconduct allegations and will do everything in their power to defend you and your good name.
If you've been notified that a misconduct allegation has been filed against you in North Carolina that could affect your Nurse Aide I or Nurse Aide II certification, call the Lento Law Firm Professional License Defense Team today at 888.535.3686, or use our online contact form to set up a confidential consultation. Your livelihood depends on your certification! We are here to listen and to help!
