Nursing Licensure Issues

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LNCtips.com: Nursing Licensure Issues


When it comes to nursing licensure, I'm always amazed at how little nurses know about their Nurse Practice Act.  I've seen bad judgment about nursing roles and functions in nurses who worked at all levels, from staff nurses to nurse administrators.  That poor judgment may come back to haunt them in a medical malpractice lawsuit.  Read more to learn about my experiences and your role as a legal nurse consultant when there are nursing licensure issues.

Here are some of my experiences:

  • Years ago, I was a nursing administrator preparing for a Joint Commission accreditation survey.  To prepare for the survey, I asked all licensed personnel to show their license to my office staff who then made a copy for the personnel files.  I was surprised when my Quality Assurance Director gave the staff a copy of her RN license instead of showing her original one.  I was even more surprised when I discovered that the copy appeared to have been altered.  As it turns out, she had forgotten to renew her license.  Instead of getting her license renewed (which would have taken weeks back then), she altered the date on the old license to make it appear that it was current.  Of course, nowadays, she could have renewed her license online.  Unfortunately, she lost her job due to the fraudulent alteration of her license.

  • I also had an RN who forgot to renew her license who wanted to work as an LPN until her RN license arrived in the mail.  Again, this was before the advent of online license renewals.  When I asked to see her LPN license, I found out that she didn't have one.  She just thought that it would be OK to work in a lower level position.  Unfortunately, licensure doesn't work that way.  She needed either her RN license or an LPN license to perform the job responsibilities of an LPN in that state.  Luckily for her, I called the state board whose staff member told me that it was acceptable for her to show the notation in her checkbook that she had paid her renewal fee.  Thus, she was able to continue working as an RN..

  • As a nursing administrator, I also worked in an acute care hospital where I discovered that there were no RNs, other than the nursing supervisor, in the hospital at night.  The staff members for the night shift in every area, including the ICUs, labor and delivery, emergency room, pediatrics, and medical-surgical floors were comprised of LPNs and nursing assistants.  The previous nursing administrator's solution to a nursing shortage was to train LPNs to become charge nurses.  The only problem with that solution was that the state's nurse practice act did not allow LPNs to perform charge nurse responsibilities such as assessing patients, supervising other personnel, or delegating to anyone.  According to the state's Nurse Practice Act, only Registered Nurses could perform these functions. 

  • In a similar vein, I worked in another acute care hospital where LPNs functioned independently in ICUs and as team leaders on medical-surgical units.  These LPNs were functioning outside their boundaries, according to the state's Nurse Practice Act.

  • What do these stories have to do with legal nurse consulting?  Nursing licensure problems happen more frequently than we think and more often than healthcare organizations realize.  Although licensure problems may have no direct bearing on the case, they will affect the credibility of those nursing staff with problems.  For every lawsuit, there are actions that require LNC analysis.

  • LNCs need to verify the professional license of all the registered, licensed, and certified healthcare professionals who have relevant roles in the case.  In today's world, it's an easy task.  Every state has an online license verification website.

  • Make a copy of the licensure status of all relevant nursing personnel and bring any problems with licenses to the attorney's attention. 

  • If you work for the defense, obtain a copy of the personnel file of those nurses and make sure that the information is up-to-date throughout the course of the lawsuit. 

  • If you work for the plaintiff, start a personnel file for all relevant personnel.  If you encounter an out-of-date license, it's important to print a copy of the webpage with the date printed on the page.  Also, ask attorneys to consider requesting copies of the personnel file of relevant nursing staff.

  • Legal nurse consultants need to request that the attorney obtain staffing patterns, work schedules, and job descriptions for all positions involved in the lawsuit.  Then, it's important to correlate the three items with the state's nurse practice act to determine if the staff members had appropriate assignments commensurate with their licensure status.  If there are any problems, bring them to the attorney's attention.

  • Determining the licensure status of nurses involved in medical malpractice lawsuits is an important function.  Legal nurse consultants play an important part in identifying licensure issues.

    ...Katy Jones