With their higher level of education – typically a master's or doctorate degree – than the bachelor's degree required for a registered nurse, Clinical Nurse Specialists (CNS) often find themselves in positions where they directly diagnose and treat patients, supervise or act as expert consultants for nursing staffs, or help design or improve health care delivery systems.
As an advanced practice nurse, a CNS may or may not require an additional license beyond the one that is issued to a registered nurse in order to practice; it varies from state to state. Generally, a CNS must, at a minimum, be a registered nurse and must also meet the rigorous CNS education, training, and testing requirements to earn certification as a CNS.
The benefits of all this work can be significant. In many states, a CNS may be able to diagnose and treat patients independently of being supervised by a physician, while in others, a CNS may do so if working under the general or direct supervision of a physician. Similarly, in some states, a CNS may prescribe drugs independently of a physician, while in others, they can only do so if they are working under the supervision of a physician.
Discipline of Clinical Nurse Specialists
Because a CNS must generally be a licensed nurse, in most states, the state Board of Nursing or an equivalent regulatory body is responsible for disciplinary issues relating to the CNS as well. In this respect, the complaint and discipline process for a CNS is similar to that for other types of nurses.
There may be some differences between the typical discipline process and potential outcomes when they are applied to a CNS. Many states require a CNS to be certified in addition to being licensed as a nurse, and one level of potential discipline may be to revoke the CNS certification, meaning that while the individual could still practice as a registered nurse, they could no longer practice as a CNS. For someone who has spent years earning a master's degree or Ph.D. and then gone to the trouble of meeting the testing, practice, and certification requirements to earn certification as a Clinical Nurse Specialist, it can be very difficult to face the prospect of no longer being able to do that kind of work.
Allegations Against a CNS
As with registered nurses, complaints made against a CNS typically fall into one or more categories.
“Practice-related” complaints allege that the CNS failed to follow the appropriate standard of care in a particular situation or that the CNS failed to follow a physician's instructions with respect to patient care.
“Drug-related” complaints are ones that claim the CNS stole prescription medications, sometimes failing to administer the medications to patients, or that the CNS was working while under the influence of drugs or alcohol. Other complaints can be based on the CNS procuring prescription drugs for themselves, either by using their ability to write prescriptions in states where the CNS has that right or by submitting a fake prescription to a pharmacy.
“Boundary violation” complaints can result if the relationship between a CNS and a patient becomes very close, and the CNS abuses that relationship to gain an advantage from the patient, such as a gift of money or some item of value, or some other substantial benefit.
A “sexual misconduct” violation happens if a CNS sexually assaults a patient or in a boundary violation situation where the CNS convinces a patient to engage in inappropriate behavior with the CNS that includes sexual contact.
If a CNS physically strikes a patient, threatens to do so, or directs severely harsh language at a patient, the CNS can be accused of “abuse.”
A “fraud” complaint can result when a CNS falsifies work or billing records, either to be paid for hours the CNS did not work or treatments the CNS did not give or to defraud an insurer. It can also arise where the CNS falsifies their background or work experience.
A CNS who has a “criminal background” and fails to disclose it may also be disciplined for failing to do so, particularly where the past crime was of the type that could harm current patients if it were repeated.
Note that there may be other types of issues that arise between a CNS and a patient that do not necessarily affect the quality of care given to a patient. From the patient's perspective, these may be difficult issues, but from a Board of Nursing perspective, they may not warrant charging a CNS with a disciplinary violation. For example, just because a patient and a CNS may have a personality conflict does not mean the CNS isn't providing the patient with proper care.
What to Do if a Complaint Has Been Filed Against You
You need to be very careful if you are notified that someone has filed a formal complaint against you with your state's Board of Nursing or the equivalent regulatory agency. That is because the focus of the Board of Nursing is on protecting patients, not on protecting nurses or you as a CNS. And while your initial impulse might be to go to the Board of Nursing to try to explain your side of the story, in the vast majority of cases, that will not help your situation and, in many cases, can make things worse.
This is why one of the first things you should do after you learn about the complaint is to contact an attorney – but not just any attorney. You need the help of someone who understands the ins and outs of the disciplinary process and has experience advising and defending CNSs and nurses in these kinds of situations. Attorney Joseph D. Lento and the Lento Law Firm Professional License Defense Team have that experience and can help you face the complaint, the investigation, and any negotiations with or hearings involving your state's Board of Nursing.
In some situations, your Board of Nursing may contact you after conducting their investigation of a complaint with a “consent decree” that it will offer you in place of going through a formal hearing process. The decree may involve you paying a fine or receiving remedial training, and you may be tempted to simply sign it and do what it requires you to do just to get things over with.
It rarely makes sense in a disciplinary situation to agree to anything your Board of Nursing proposes unless you have first consulted with an experienced attorney who practices in the area of nursing license defense. There are likely consequences to any settlement you might reach with the Board of Nursing, and you deserve to have the benefit of the advice of an experienced nursing license defense attorney who can help you make sure you are doing the right thing under the circumstances.
Contact Joseph D. Lento and the Lento Law Firm Professional License Defense Team for Help
If you have been notified by your state Board of Nursing that a formal complaint has been filed against you, don't face the charges and discipline process alone. Joseph D. Lento and the Lento Law Firm Professional License Team have experience advising and representing CNS and nursing clients in disciplinary proceedings all across the United States. They can help you understand the charges against you, gather information in support of your defense, and protect your rights in negotiations with and hearings in front of your Board of Nursing.
You have worked too hard to earn the privilege of practicing as a CNS not to protect that privilege, and you deserve to have the advice of an experienced attorney when it's threatened by a disciplinary proceeding. Contact Attorney Joseph D. Lento and the Lento Law Firm Professional License Defense Team today at 888.535.3686 or through their online form to set up a confidential consultation.