The Nursing Board can also investigate felonies and gross misdemeanors against nurses. The investigator may not find evidence of a violation. In these cases, the investigation may be returned to the Case Management Team for a decision to close the case if it meets “expedited closure” criteria. In all other cases, the case goes to a Reviewing Board Member (RCM) and a Staff Attorney for review. The RCM may direct the investigator to other sources, present the case to a panel of Board members, or close the investigation. The complainant and the nurse are informed in writing of the decision.
The investigation phase allows few weeks to collect evidence. The investigator completes an investigative report. The investigator sends the nurse a letter of allegations. Allegations are potential violations of the regulations. At this point, the nurse is given the opportunity to provide an explanation of the situation. This is the time when it is imperative that the nurse seek legal counsel. The attorney should be experienced in representing health professionals. An attorney provides advice on how best to proceed.
The investigative report and all evidence collected is forwarded to a member of the Nursing Board. The reviewing Board member reviews and evaluates all the evidence. The Nursing Board member presents the evidence to three other Nursing Board members, or a panel. The panel may decide:
1. Evidence shows that there is reason to believe a violation of has occurred and therefore is cause for administrative action (discipline), and sends the case to the Legal Services Office for a Statement of Charges or Stipulation to Informal Discipline.
2. An immediate threat to the public exists and the nurse’s license is summarily suspended.
3. To refer the nurse to the alternative to discipline program, the Nevada Health Professional Services, due to substance use or abuse.
4. Evidence is not clear nor convincing and does not warrant disciplinary action. The panel closes the case.
The Nursing Board sends a letter to the complainant and the nurse notifying them of the actions and responsibilities. According to law, the Nursing Board must report to the public all actions on nurses’ licenses. Only formal actions must be publicly reported. Stipulations are public, but do not go out in DOH media releases. The Nursing Board reports actions through the Provider Credential Search. If a report to the Nursing Board is closed by the Case Management Team, no action is recorded. If a report is opened to investigation, the Provider Credential Search shows no action. If a statement of charges or statement of allegations is pursued, the action column states ‘Pending’ and links to the document. If an order or Stipulation to Informal Disposition is issued, the action column says “Yes” and links to the order or stipulation. If the investigation is closed due to insufficient or lack of evidence, the Provider Credential Search shows no action.
Formal and Informal Actions
The panel of Nursing Board members may determine the actions necessary are formal or informal. Formal actions are captured in a Statement of Charges. The Nursing Board may decide formal action is necessary according to the sanction standards and produce a Statement of Charges. Informal actions are captured in a Stipulation to Informal Discipline. In a stipulation to informal discipline, the nurse does not admit guilt and agrees to actions defined by the Nursing Board.
The Nursing Board uses a set of sanction standards to determine actions. In order to be fair and objective, the Nursing Board developed the sanction standards to apply in cases with similar fact patterns and outcomes. The Nursing Board adopted the Nursing Sanctioning Standards in 2004. Nursing Board members use the Nursing Sanctioning Standards with the Sanctioning Rules for all Health Professions to determine priority level of cases and actions to take.
What the Uniform Disciplinary Act Says:
The Uniform Disciplinary Act states that “Safeguarding the public’s health and safety is the paramount responsibility of every disciplining authority. In determining what action is appropriate, . . . the disciplining authority must first consider what sanctions are necessary to protect or compensate the public. Only after such provisions have been made may the disciplining authority consider and include in the order requirements designed to rehabilitate the license holder.”
The actions are meant to rehabilitate rather than punish. The philosophy is to take the minimal amount of action necessary to redirect the nurse to provide safe patient care. There are rare instances when the Nursing Board feels there are no rehabilitative measures that can be used to protect patients. In these cases, the Nursing Board may permanently revoke the license.
The nurse is informed of the Nursing Board’s decision in a legal document. A Nursing Board Staff Attorney prepares the document. The document, or statement of charges, identifies specific incidents reflecting unprofessional conduct or violations of the Nurse Practice Act. The precise statutes violated are listed. The document directs the nurse to decide how to proceed. Every nurse has the right to a hearing and to be represented by an attorney before the Nursing Board.
To protect this right, the nurse must respond within twenty days after the document is mailed. The document is mailed to the address currently on file with the Nursing Board. It is the nurse’s responsibility to send all address changes to the Nursing Board. If no response is received from the nurse within twenty days, the Nursing Board assumes the allegations are not being contested. This results in the loss of the right to an adjudicative hearing. The adjudicative hearing gives the nurse the opportunity for settlement of the allegations. An order will be entered to possibly reprimand, suspend or revoke the nurse’s license to practice in the state of Nevada. Frequently, this results in an indefinite suspension of the license. The nurse can petition for reinstatement later.
What would you like? SETTLEMENT OR FORMAL HEARING
The Statement of Charges also instructs the nurse to make a choice between admitting to the charges, not contesting the charges, or denying the charges. The nurse needs to have a clear understanding of the document before admitting to anything. When a Statement of Charges is received, if the nurse had not already done so, the nurse may best be served by obtaining legal counsel. Legal counsel can help the nurse decide the best option. The nurse needs to realize the outcome of the Statement of Charges could have a significant impact on the nurse’s future employment potential and earning capacity.
When a nurse receives a Statement of Charges, several options are available. One is to request a hearing. The nurse has the right to present supporting evidence and witnesses. Alternatively, the nurse may seek a settlement through two options:
1. Settlement conference can be requested without the necessity of a formal hearing. The Nursing Board staff attorney meets with the nurse to conclude a resolution of the allegations. If the nurse has legal counsel, they can be present for the conference. If the nurse agrees to a tentative settlement, this information is sent to the reviewing Nursing Board member. If the reviewing Nursing Board member agrees to the settlement offer, the agreement is sent to the Nursing Board Staff Attorney and the nurse to become final.
2. The nurse may also seek a settlement by submitting a written statement and any supporting documents for consideration by the reviewing Nursing Board member. A settlement offer may be determined.
In either situation, the nurse does not have to accept the settlement offer and can make a counter offer or go to a formal hearing. If a settlement offer is agreed upon then it will be presented to a three member panel of Nursing Board members for approval. If the Nursing Board does not give approval, the process can go on to a formal hearing or further settlement negotiations. It is highly recommended that the nurse be represented by legal counsel during these proceedings.
If the decision by the nurse is to go to formal hearing, the date will be scheduled at the nearest available hearing date. Three members of the Nursing Board are the hearing panel members.
The Assistant Attorney General prosecutes on behalf of the state. An ADMINISTRATIVE judge from the Board conducts the hearing. The nurse has the right to bring witnesses and any written documentation to the hearing, and any evidence or exhibits not disclosed at the pre-hearing conference may be excluded at a later date. Of note, it is important to comply with all dates and timelines in the judge’s scheduling order. Absence at a pre-hearing conference or the hearing may result in a default (failure to appear) and a suspension may be entered.
The nurse may also cross examine the state’s witnesses. At the conclusion of the hearing, the Nursing Board panel members go into closed session. The Nursing Board members decide regarding the charges and the evidence presented by both sides. The decision is sent in writing to the nurse. If the nurse also filed a grievance related to disciplinary action imposed by the employer, the union should be aware of any settlement discussions and agreements.
DISCIPLINARY ACTIONS
What can be the disciplinary actions from Nursing Board can include:
• Stipulation to Informal Discipline: the nurse does not admit to the allegations but agrees to complete actions defined by the Nursing Board.
• Probation: the nurse’s license is limited for a defined period and terms to be completed are listed in the agreed order.
• Suspension: the nurse’s license is not valid for a defined time period and the nurse must meet the terms defined in the order before requesting the Nursing Board to reinstate the license.
• Summary Suspension: the nurse’s license is not valid for a defined time period and may not practice until further order.
• Permanent Revocation: the nurse’s license is removed and the nurse may not practice in the State of Nevada forever.
Conditions placed on the nurse’s license can be addressed as fulfilling a knowledge deficit, such as writing a paper or attending a medication course. Other conditions may affect the ability to practice such as working under the direct supervision of another registered nurse, not being able to work as a charge nurse, or not being able to give medications. These conditions can significantly impact the nurse’s employment. The conditions placed on the nurse’s license cannot be taken lightly and must be followed exactly. Further disciplinary action could result if the terms are not met. Fines are also set for violations and must be paid in a timely manner. If not, further action could be taken on the nurse’s license and could result in the fine being forwarded to a collection agency.
Whatever disciplinary action is taken against the nurse’s license, the action is recorded in the license file at the Department of Health and remains there permanently. This information is available for public disclosure. Once a statement of allegations or charges is filed, the information may be released to anyone with a request for disclosure.
If the nurse wants to appeal the Nursing Board’s decision or disciplinary action after a full hearing, the nurse can appeal in court. The court examines the Nursing Board’s decision and decides if it conducted the hearing properly. The court may agree with the decision or order the Nursing Board to rescind the decision. If the Nursing Board does not agree with the court decision, an appeal to a higher court may be pursued. The nurse or the Nursing Board may appeal for a reversal of the lower court’s ruling.
The importance of obtaining legal counsel cannot be emphasized enough. Most nurses feel they cannot afford an attorney, but if the disciplinary action significantly impacts the nurse’s practice and earnings, it is important to look at the long-term gains, despite the costs of legal representation.
There are time limits throughout the process and knowledge of the laws, rules and proceedings are important. The attorney the nurse selects should be experienced in representing professionals
before disciplinary panels.