You worked hard for your Nursing License. You have worked hard for your patients. You have worked nights, weekends, holidays, and birthdays with dedication, commitment, and passion. For you, Nursing is more than a job, it is personal; a way of life, and nobody is going to just take it away from you without a fight. That is why we are here.
Disciplinary action from the Board of Registered Nursing (BRN) can arise from a variety of places; patient complaints, alleged policy or protocol violations, employer discipline, allegations of off-duty misconduct, and criminal arrests.
It All Starts with an Investigation
While discipline can end with probation, suspension, or revocation of your license, it always starts with an investigation. When the BRN is made aware of a possible issue that requires investigation, the process begins with a referral to the BRN’s Enforcement Program. The staff of the BRN’s Enforcement Program are tasked with investigating and identifying registered nurses who have “…engaged in any activity which may be unsafe, and which may put the public at risk.” It is a responsibility they take very seriously.
An investigation begins, generally, when a complaint alleging some misconduct by a registered nurse or an applicant or that an RN or RN Applicant has violated the Nursing Practice Act. A complaint may be initiated by anyone who believes an RN has behaved in an unprofessional or unsafe manner. Worse still, a complaint can (and likely will) result when an unlicensed person is illegally providing nursing care in California.
The Two Most Common Complaints
Patient Care Complaints
These are complaints that arise after a patient or patient’s family member believes that the Nurse’s actions were either inappropriate or unsafe. Most common among patient care complaints against Nurses are:
Serious medication errors
Failure to provide care
These complaints are common when a patient (or patient’s family member), coworker, supervisor, or other ancillary personnel believe that the Nurse is abusing alcohol or other drugs.
While all complaints are taken seriously, complaints that involve chemical dependency or mental illness may be referred out of the disciplinary process and forwarded to the BRN's Intervention Program. The BRN’s Intervention Program is a confidential rehabilitation program designed to help the provider overcome the struggle with addiction.
While patient care and substance abuse may be the most common types of complaints investigated by the BRN, there are many other types of complaints that the Enforcement Program investigates and forwards for discipline.
For example, alleged offenses that challenge the integrity of nursing, such as application fraud, sexual misconduct, and criminal convictions can lead to swift and harsh discipline by the BRN. In many cases, rightly so, but not always and that is why it is so important to enlist the help of a Professional License Defense Lawyer right away.
Although other situations are pervasive among nurses, the BRN generally does not interfere when the complaints involve generalized business practices, such as fee and billing disputes, and the, all too common, personality conflicts.
How the BRN Processes Complaints
After the BRN receives the allegation, they send a written notification to the person lodging the complaint within 10 days and commence the investigation.
The first step in the BRN’s investigation involves a review of the available information to determine whether the nurse is a proper candidate for the BRN’s Intervention Program. The allegations are concurrently evaluated for the appropriateness of forwarding the complaint to s different agency, such as law enforcement or a different regulatory agency that may have jurisdiction. From there, the investigation proceeds with witness interviews, fact verification, document review, and any other process necessary for getting to the truth.
It is Not a Quick Process
From beginning to end, the complaint, investigation and legal action processes can span weeks or months depending on just how detailed and complex the allegations are and the overall complexity of the case itself. Naturally, where a complaint alleges a greater risk to public safety, the higher the priority to complete the investigation and finish the process.
Investigations are Not Public
After an allegation is made and a complaint processed, the investigation is not a matter of public record. However, if the BRN concludes that discipline is appropriate and files an Accusation against the provider, the case then becomes a matter of public record and certain aspects become searchable.
More about the Investigation Process
When the initial investigation reveals that BRN needs more information in order to make an appropriate determination, they will initiate a formal investigation using its own internal Investigation Unit. The BRN’s Investigation Unit is made up of non-sworn Special Investigators who will do the deep dive into the case and anything else that arises through the investigation. These non-sworn Special Investigators cannot affect an arrest and do not have police powers, nevertheless they are skilled and trained.
When necessary, the BRN Investigation Unit can call upon the Division of Investigations (DOI) at the Department of Consumer Affairs (DCA). The DOI employs sworn peace officers.
Whether it is the BRN’s Investigation Unit or the DOI, the investigators conduct a variety interviews with witnesses and potential witnesses, they gather evidence and submit reports. When necessary, if they determine a crime has been committed, they can even refer cases to the local District Attorney's Office for criminal prosecution, which is all the more reason to hire a Professional License Defense Attorney who has experience in Criminal Court.
When the investigation is complete, a final report is submitted to the BRN for legal review. If, as is commonly the case, no violation can be substantiated, the case is closed with no further action or blemish upon the record of the nurse. The person who made the original allegation will be notified of the BRN’s findings and decision.
Levels of Discipline
Informal Actions: Citations & Fines
If, after the investigation has been completed, the BRN concludes that there is sufficient evidence showing the nurse is culpable for a minor violation and that more formal disciplinary action is not warranted, they will propose that case be resolved informally by way of the BRN Citation and Fine System.
Under the BRN Citation and Fine System, the BRN’s Executive Officer is authorized to impose citations and fines. The nurse may agree to the minor discipline or, if he/she objects, the nurse mat contest the citation and fine through an informal or formal appeal process. Your Professional License Defense Attorney will assist with that.
Formal Disciplinary Action
In cases where the investigation determines the existence of evidence sufficient to prove that the nurse has committed a violation of the Nursing Practice Act such that formal disciplinary action is warranted, the case is forwarded to the California State Attorney General's (AG) Office for further review and action.
If the AG determines that there is sufficient evidence, the California State Attorney General's Office will file a formal Accusation against the nurse. An Accusation in the Administrative Law setting is the functional equivalent of a charging complaint in criminal court. The Accusation will contain the list of specific charges and will be formally served upon the nurse.
With the Accusation in hand, the nurse can opt to dispute the charges at a formal administrative hearing before an Administrative Law Judge at one of the Office of Administrative Hearings branches or approved satellite location.
The Administrative Hearing, although an administrative proceeding, very closely resembles a traditional court trial with a Judge, lawyers on both sides, and a court reporter taking down everything everyone says. Both sides present evidence and argue to the judge why discipline should or should not be imposed.
When both sides have rested their respective cases and submitted the matter to the Court, the Administrative Law Judge considers all of the evidence and argument and writes a proposed decision.
The ALJ’s proposed decision is not final. It is merely a proposed determination that must still be approved, modified, or rejected by the BRN’s nine-member Board. If the nurse does not agree with the ultimate determination of the BRN, he or she can appeal the decision in superior court.
Levels of Discipline
If the BRN concludes that there was a violation of the Nursing Practice Act, and that discipline is appropriate, the nurse can be subject to any of the following:
Revocation or suspension of the nursing license (Revocation or suspension of a license prohibits the nurse from practicing.)
Citation and fine
Probation is No Joke
Whether the result of a stipulated settlement or a ruling following an administrative hearing, nurses who are placed on probation are required to comply with the very specific conditions of their probation. Probation compliance is carefully overseen by an assigned BRN probation monitor. Upon completion of probation, the nursing license is restored without further restriction.
Not All Accusations Lead to a Hearing
In many cases, where the evidence is less than stelar for the nurse, the Professional License Defense Lawyer may work with the BRN, through the AG’s office to negotiate a “stipulated settlement agreement” to resolve the case rather than holding a full hearing. In every stipulated settlement agreement, the nurse will have to admit to some specific charge or charges and agree to the proposed disciplinary action.
Don’t Go it Alone
The entire investigation and discipline process can be frustrating and even terrifying for nurses. The Legal Guardian in California closely supports nurses during this time, working to build a defense case from the first hint of an allegation. We work with you to gather the relevant evidence, mitigation, exculpation, and whatever else we can find to achieve a more desirable outcome. Of course, when that Accusation is served, we will be right there to respond professionally to the BRN without you incriminating yourself.
An experienced Professional License Defense Attorney will also guide you through and around the common pitfalls that jeopardize the defense for so many nurses. For example, the most common pitfall comes with the nurse inadvertently providing information out of proper context or not carefully communicated causing the board to actually use the miscommunication against him or her.
The Legal Guardian helps registered nurses in Long Beach and throughout California defend their case before the BRN to protect the license for which you worked so hard. You already know that every case is different, but an experienced Professional License Defense Attorney who has defended nurses for over a decade is the best place to start defending your case and protecting your license. You can contact our office at 866-448-6811 for a free consultation.