NURSING BOARD INVESTIGATION

Nursing Board Investigation

When a complaint is made against a nurse, what happens next? I have reviewed over 100 Nursing Board  investigation files.  Here, I describe what actions the investigator takes. Why is this important?  Because the Board requires you to write a statement. Under oath.  Rarely does the nurse know what evidence is in the investigator’s file.  Yet,  the statement should be generally consistent with that evidence .   Also, the investigator may call  for an interview. Again, you should be generally consistent with the evidence. Otherwise it appears you are covering up a Missouri Nursing Practice Act violation. The investigator likely has already compiled papers and statements.  Let’s go through them.

Pro tip

ProTip: The Board sends a notice of complaint by regular mail.  They don’t send a second notice, email or phone call.  You must answer within 30 days. If not,  you can’t defend yourself.  Always update your mailing address. Do this immediately on the Board’s website: https://info.mo.gov/pr-forms/nursing/nursing-address.php   Check your on-file address every time you renew your license. If you are a traveler, make sure someone at your home checks your mail .  Look for correspondence from the State Board of Nursing.

You won’t know what evidence the Board investigator already  has.  The complaint Notice is typically short and vague.  For some nurses, the incident is vivid. For example, you  physically  restrained a patient.  But many complaints are  general such as “Terminated for incomplete charting” or “Administering higher level of narcotics than team members”.   Some complaints arrive months after you resigned. Your employer cut off access to your old charts.  As a result, you must rely on memory.  Some nurses write detailed notes. Avoid contradicting  evidence.  Assume the investigator has it all.  Knowing about Board investigations will help guide your statement. Let’s examine what resources the investigator has.

Initial complaint process

Former employers make most  Nursing Board complaints in Missouri.  That’s because  first, Missouri law requires a nurse employer to file a complaint against any nurse it terminates for-cause. Second, this also applies to resignations in lieu of termination for cause.  The Chief  Board investigator receives the complaint.  Next, the Chief assigns the complaint to a Board investigator. The Chief mails only one Notice.  The Notice requires  3 things within 30 days:

1. Fill out  a Contact Information Form.
2. Complete a Practice Questionnaire.
3. Write answers to specific questions about the  complaint. Get it notarized and returned within 30 days. See my post on writing the statement. https://libermanlawfirm.com/written-statement-to-board/

Nurse response pitfalls

A frequent problem is the complaint is  vague.  For example,  “Nurse Ratchett was terminated due to suspicious activity with fentanyl”.  Yikes, how do you respond to that?   First, there is no date. Second, we don’t know the number of incidents. If you are aware of the investigator’s tools, it will help focus the statement.

Evidence falls into 2 categories:

1. Testimony .  The investigator contacts witnesses named in the complaint.
2. Documents.  The Board has subpoena power.  The investigator uses it.  Here are some typical  items subpoenaed:

• Your employment file.  Important because it includes orientation procedures covered. Also, that  you signed for them.
• All work discipline, investigation, and outcome.
• Copy of Employer internal investigation for incident.
• Pyxis and MAR documentation as well as employer policy on documentation.
• Other employer policies such as handling controlled substances.
• Pharmacy audits.
• Witness name and contact information.

How are these documents used in the Board investigation?

• Employment folder shows whether the situation was covered in orientation.  For example, were you instructed how long meds could be carried before administered?  If so, writing “I was not aware of the policy” is a risk. Especially if you already signed for it.  Also, if you worked the same job for many years, chances are you don’t remember reading policies.
• Work discipline file reveals older work incidents.  Are they similar? Let’s say H.R. had you  take remedial charting. Is the current incident caused by charting errors?

The Progressive discipline dilemma

Some nurse employers use the Progressive Discipline system.  There may be 3-5  Steps until termination. Below are examples of a 5-step system:

1. Oral reprimand.
2. Written reprimand.
3. Final Documentation.
4. Suspension.
5. Termination.

The  number of steps vary. I have a nurse client whose employer has termination as Step 3.  For example, if the final step is for diverting medications, it makes sense.  On the other hand, if the final  violation is using personal cell phone at nurses’ station, termination seems extremely harsh. Nevertheless, employer must file a Board complaint, and the nurse must defend the Board investigation.

How is the evidence used in the Board Investigation?

• For the Board investigator, reviewing the employer investigation is obviously important. Needless to say,  before  writing your statement, stop!  Assume your investigator has written statements from witnesses.  Write accordingly. For instance, don’t write you pulled pain meds at  another nurse’s request, knowing  he/she will deny it.  Remember, the investigator called the other nurse.  And took detailed notes.
• Pyxis and MAR documentation  confirms many activities.  Such as, if you accurately charted.  Also, did you chart on time?  Finally, do your nursing notes  match medication pulls. Beware of writing  “I  pulled prn meds based on patient’s pain”, if  your rounding notes show the patient at “2”.  Oops.
• Employment policies you signed during orientation matter. For instance, you shouldn’t write ” I didn’t know how to chart on Epic. At my previous job we used Cerner.” Your employee file confirms you were trained on Epic. In fact, you probably initialed it.
• Pharmacy audits  reveal all.  A frequent example  is the nurse pulled prn pain meds at a much higher  average than other nurses on the same shift.  Think before you write “We have many patients with pain in the Emergency Department”. There is rarely a good answer as to why other nurses on your shift are pulling at half your rate.
• Witnesses already gave statements during the work investigation.  The Board investigator will re-interview  them.  You have spoken with colleagues about the incident.Will they confirm, or contradict your written statement? Think before you write.

Conclusion

In summary, I advise all nurses who are subject of a Nursing Board investigation to  assume the  investigator has all  relevant documents. Assume also the investigator spoke with all witnesses. Consider what evidence the investigator has when writing your statement. Intentional or not,  when your statement varies significantly from what the evidence shows, it matters. You will look misleading at best, or covering up violations at worst.  Many complaints are your word against another. Remember, the  Board decides if you are credible.