Avoid malpractice and protect your license: your Duty to Report vs. Self- Reporting to the Nursing Board.(NNA State Activities)

As many of you are aware, I am a Nurse-Attorney and I represent nurses and other healthcare providers in front of the various Licensing Boards throughout Nevada. In this article, I hope to distinguish the difference between a nurse's "Duty to Report" and "Self-Reporting" to the Nursing Board.

Before we begin to discuss this difference, however, I need to clarify some information presented in my previous article on "Self-Reporting to the Nursing Board" in response to some questions that followed publication. In my article, I indicated that a nurse could be placed on probation for up to "five years or more." This statement was misleading in that nurses are not initially placed on probation for more than five years.

To clarify, nurses could end up on probation for more than five years if they are not working for periods during their probation. Not working on probation would extend the term for probation because a nurse must be working in their nursing capacity in order to earn time off of their probation. Nurses could also end up on probation for more than five years if they violate their agreement and are ordered to serve more time under probation. This is not to say, however, that nurses are ordered more than 5 years of probation initially.

I my article, I warned against self-reporting when the allegations presented are not true. In fact, if nurses go to the Nursing Board to report that they have not done something, they will most likely be turned away because there is nothing for the Board to do at that point. However, when a nurse has violated the Nurse Practice Act, nurses are urged by the Board to come forward. Self-reporting may help to avoid additional stress and expense in the long run. When a nurse stipulates to the facts, or admits acts of wrong-doing, settlement agreements are often reached and a full hearing may be avoided.

All defense attorneys, myself included, have the duty to advise our clients in any situation where allegations have been made, whether the complaint is civil, administrative or criminal, "Anything you say can and will be used against you." When nurses are accused of doing something wrong, they often feel personally attacked and become very defensive. Making statements in such an emotional state can be problematic when trying to defend one's actions. It is important to remain objective, which can be difficult to do. Furthermore, when inconsistent statements are made, it may be presumed that the person is not being entirely truthful.

That being said, the Nevada State Board of Nursing closes many more cases than they prosecute. The investigators work hard to determine whether or not there is any merit to the complaints received. When erroneous or irrelevant complaints are presented to the Board, attention is taken away from actual violations and more serious infractions that must be addressed. In my last article, I was attempting to remind nurses that the Board of Nursing's role is to protect the public, not nurses. It was not my intent, however to suggest that they are looking for anything but the truth and therefore, I apologize to the investigators for not making that clear.

My last article was prompted by numerous calls from nurses who had denied any wrong-doing but who had allegedly been advised by their supervisors or union representatives to self-report the allegations to the nursing board prior to or instead of fully investigating the situation. When supervisors and union representatives advise nurses to self-report, threatening to report nurses if they fail to do so, it is important to first conduct a full investigation into the allegations prior to making such a suggestion. Just because someone says a nurse did or did not do something, does not make it so. Miscommunications or misunderstandings are common when dealing with people and submitting allegations without a full investigation or advising a nurse to self-report when they deny having actually violated the nurse practice act can cause lasting irreparable damages to nurses and creates a waste of resources for the Board of Nursing.

Self-reporting is not to be confused with a nurse's obligation to report unsafe practice observed by another nurses, healthcare providers or administration. Nurses have a duty to report any and all dangerous conditions that put patients at risk. This duty extends further than simply reporting what another nurse does. As an advocate for their patients, nurses are supposed to put the patients' safety first.

If conditions at work create an unsafe environment for patients, the Nursing Board encourages nurses to report these conditions as soon as possible; first to their immediate supervisor and then by following the proper chain of command. When nurses' complaints are ignored internally, despite their attempt to warn the facility of unsafe practices, policies, or procedures, the Nursing Board will expect nurses to go to the authorities outside the facility to address their concerns.

It is understandable that nurses will be nervous about reporting, especially in such a small healthcare community. However, the goal must be to protect the patients, not the nurse's job. When nurses put their jobs before patients' safety, they may be considered to be a "threat" by the Board and could be subject to disciplinary action for not reporting, depending on the circumstances and the extent of the nurse's knowledge of the unsafe condition(s).

Now, more than ever before, the Nursing Board is urging nurses to speak up and protect their patients and their nursing licenses. Many agencies and organizations will accept anonymous complaints. The Nursing Board also accepts anonymous calls from nurses seeking advice on whether or not conditions should be reported and to what agency. Documentation of all conversations and reports made, both internally and outside the facility, is encouraged to help prove that the nurse was attempting to correct the situation and/or refused to engage in behavior that was unsafe. For your protection and in order to be taken seriously, your complaints, even to your immediate supervisor, should be in writing. If there is a concern recognized by the entire staff, then it may be helpful to have the entire staff sign the notification to avoid being singled out as a troublemaker.

Ultimately, if the conditions in a facility are unsafe, and patient harm is anticipated or is occurring, the best course of action by nurses who wish to protect their patients and their nursing licenses is to report what the dangerous condition(s), quit their jobs and look for alternative employment opportunities. If enough nurses report and quit working in unsafe conditions, our healthcare community will be forced to raise its standards and put patient safety first. Nurses are the largest group of healthcare providers in Nevada and nurses tend not to recognize the power they have to demand the best for our patients. Whether you are a staff nurse or the Director of Nurses, you have an obligation to protect your patients and that obligation must always supersede monetary gain.

If you have any questions or comments about this article, please do not hesitate to contact Tracy L. Singh, Esq. at the Law Offices of Tracy L. Singh, LLC at (702) 444-5520 or visit our website at www.tlsinghlaw.com.

Tracy L. Singh, RN, JD

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