The Nursing Police: A Tuesday at the Board of Nurse Examiners
It was a Tuesday morning and nurses, their friends, family members, and attorneys filled the waiting room of the Board of Nurse Examiners for the State of Texas. They had come from all over the state and were anxiously awaiting their turns for hearings based on complaints about their nursing care. Every state has a regulatory board of nursing that grants licenses, monitors quality of care, accredits nursing programs, and keeps up with legislation affecting nursing. But most nurses are blissfully unaware of the functions of both their state’s Board of Nursing, or equivalent, and its Nursing Practice Act. I was one of those nurses, until I began working at the Texas Board of Nurse Examiners.
I had received the Board’s quarterly newsletters for years but had paid little attention to them. They featured updates on state legislation relating to nurses, appointments to the Board, and information on workshops to familiarize nurses with the Nursing Practice Act. Each issue had several pages that listed nurses whose unprofessional practice resulted in sanctions being placed on their licenses, from reprimands to revocations thoroughly investigated, a process that involved many hours on the phone tracking down staff, witnesses, medical records, and the accused nurses themselves.
The Long Arm of the Law
An investigation could take months, and I juggled 20 or 30 cases at a time. Sometimes I felt like a probation officer. Hospitals often stalled when asked to provide medical records, files went missing, or nurses moved, leaving no forwarding address. In rare instances an investigator, equipped with an official badge, went into the field to visit a facility. My husband was impressed by my badge.
“You’ll be packing heat soon!” he commented.
The investigative process began with a letter to the nurse outlining the complaint, followed by a phone call. Minor errors, such as giving a patient the wrong medication on a single occasion with no adverse outcome, resulted in the nurse being cautioned and perhaps required to take a short refresher course in medication administration. The nurse would send in his or her license, which would then be stamped as under disciplinary review. Once the classes or other requirements were met, the nurse was issued a new “unencumbered” license.
More significant errors required the nurse to work under supervision for a while or limit practice to certain areas. For errors compounded by alcohol, drug abuse, or mental illness, the Board arranged ongoing counseling. Serious mistakes resulted in a nurse’s license being suspended or even revoked.
Drama Was Not in Short Supply
Most nurses were compliant, but some were evasive. It took several certified letters and numerous phone messages to connect with one nurse who worked 80 hours a week for an agency in two different hospitals. She had given the wrong medication to an ICU patient, resulting in his permanent paralysis. Her excuses for not responding to the Board’s repeated attempts to contact her included, “I thought the letters were from bill collectors,” “My ex-husband cleaned out my mail box,” and “I work so much I never get a chance to look at my mail.”
The most serious incidents required the nurse to appear in person and each Tuesday brought an average of eight cases. Two Board members, its attorney, the investigator, the accused, plus any support people present gathered around a conference room table. A box of tissues, a water carafe, and paper cups occupied prominent places on the table, and drama was not in short supply. There could be tears, protests, and curses.
In one case, two nurses appeared together before the Board. The first had drawn up a dose of 100 units of insulin and the other had checked it, although the doctor’s order had specified ten units. Neither had questioned the dose, which was far beyond the parameters usually ordered. and caused the patient to go into shock.
In another instance, a nurse coming down with the flu took home some IV tubing and a bag of saline to re-hydrate herself, apparently unaware she was appropriating hospital property and practicing medicine without a license. A psychiatric nurse absent-mindedly wrote notes for three days on a patient who had been temporarily transferred to another hospital. A pediatric office nurse was accused of giving a patient an incorrect prescription dose. She phoned the order to the pharmacist, but there was some doubt as to whether it was her fault or that of the pharmacy, since it had made errors in the past. Ultimately, the nurse was judged blameless and started faxing orders to the pharmacy.
A Ferret in the Bassinettes?
Some complaints were petty, inspired by minor jealousies, rivalries, or feuds. An ER nurse was reported to the Board for allegedly suturing a patient’s laceration. A passing nurse saw him handling suture thread and a needle, but he was simply holding them for a doctor who had left the room. Fortunately, the doctor sent in a statement exonerating him, but the nurse lived with the threat of a mark against his license for months until the case was resolved in his favor.
Other incidents were truly bizarre. One involved a nurse who allowed a pet ferret to run around in a newborn nursery, into and over the bassinets. There were nurses who were chronically late for work, who failed to observe patients attentively enough, or who fell asleep.
Nurses accused of appropriating drugs were occasionally a feature of the Tuesday hearings. One attractive blond mother of two pouted and fidgeted as the evidence in her case was heard. She had diverted Demerol not only by diluting doses but also by fraudulently writing a doctor’s order to increase the dosage. She protested that she only used drugs at home, never at work.
Unfortunately, this was not her first offense. A few years prior to this she had been referred to the Board’s drug counseling program for similar actions. She pleaded that her relapse was due to the fact that her commercial pilot husband was frequently away and she felt neglected. But this time around she was in danger of losing her license. The alternative was a license suspension until she again met drug rehab goals. She appeared to be unenthusiastic about this option.
“Well, what are you going to do about it?” snapped the Board’s chairperson.
“I worked too hard for my license to give it up,” the nurse protested.
However, since she was unwilling to undergo drug counseling this time, the Board had no alternative but to revoke her RN license. She stomped out of the room, slamming the door, a wronged Southern belle.
Fired for No Reason
Texas is an “at will” state, which means that employees can be fired for no reason. One case that came to the Board involved an experienced ER nurse who was caring for a comatose drug-overdose patient. In gently running the blunt side of a large-gauge needle across the patient’s soles to check his neurological reflexes, she superficially scratched him. She applied a band-aid, told her supervisor, and left at dawn when her shift ended.
The hospital ordered her to return immediately and fired her on the spot. The reason? If the patient recovered he could sue for his “injury,” which might prove a threat to the facility’s bottom line, whereas the nurse was considered expendable. Her case came to me because any nurse dismissed from a hospital is automatically reported to the Board. We dealt with the nurse by phone and gave her the most minimal sanction we could, for not documenting the “injury.”
A few times a year there was a special Tuesday session for applicants to nursing programs whose backgrounds included misdemeanors or criminal records. If denied admission, each could appear at the Board in person to plead their case.
A typical Tuesday’s applicants included a fortyish woman who became hooked on drugs while recovering from a car accident, stole money from her employer, and forged a check. Next came a man who had served a nine-month prison term for cocaine possession. He brought along his wife and supporters from his church and his Narcotics Anonymous group. Then there was an EMT who stole from his boss, did time, fled to Alaska, and ended up back home, pleading to be allowed into a nursing program. There was the woman who got into a scuffle with police officers over a parking ticket, the man who stole a bicycle, the young woman with an alcohol problem.
Some applicants were obviously sociopathic personalities. An attractive thirty-something woman coordinated admissions at a lab where volunteers tested new drugs for pharmaceutical companies. Although she had served two years for drug possession when younger, she gushed,
“I have learned so much and have so much to give people.”
The Board required her to undergo psychological evaluation at her own expense, to the tune of several hundred dollars, before it could make a decision.
One young man had worked for several years as an LVN and now hoped to become an RN. He had slipped through the cracks. Somehow, it had just been discovered that he had been convicted of marijuana distribution in his late teens. The Board chairperson delivered a stern lecture. Like all applicants, he would wait weeks to learn the outcome of his hearing. I wondered how these prospective nurses would fare if they actually started nursing school. It’s tough enough for the relatively well-balanced and self-disciplined. Surely impulsive, self-gratifying, and addictive personalities would find nursing a challenge.
Tuesdays were not happy days at the Board of Nurse Examiners. Investigators remained sane by focusing on the minor errors and the sincerely repentant and conscientious nurses. I thought of them as “there but for the grace of God go I”—and every other nurse. Oh, the nurse who allowed her pet ferret to run rampant in the newborn nursery? The Board suspended her license and required her to take remedial education. As for the ferret, it may still be scampering through the hospital’s heating ducts, hopelessly lost.
Diane Barnet is an RN and a legal nurse consultant. She has written for the Los Angeles Times, Backpacker, American Careers. Her book, What You Need to Know About Hospitals was published by Crossing Press, Santa Cruz, in 1998.
This article is from workingnurse.com.