10. Disciplinary action
1. For what reasons may the RN license be suspended or revoked?
1. Obtaining license by fraud (omission of information, false information).
2. Negligence and incompetence; assuming duties without adequate preparation.
3. Substance abuse.
4. Conviction of crime (state or federal).
5. Practicing medicine without a license.
6. Practicing nursing without a license (expired, suspended).
7. Allowing unlicensed person to practice nursing or medicine that places the patient at risk.
8. Giving patient care while under the influence of alcohol or other drugs.
9. Habitually using drugs.
10. Discriminatory and prejudicial practices in giving patient care (pertaining to race, skin color, sex, age, or ethnic origin).
11. Falsifying a patients record; failure to maintain a record for each patient.
12. Breach in patient confidentiality.
13. Physically or verbally abusing a patient.
14. Abandoning a patient.
2. What could happen to me if I am proven guilty of professional misconduct?
1. License may be revoked.
2. License may be suspended.
3. Behavior may be censured and reprimanded.
4. You may be placed on probation.
3. Who has the authority to carry out any of the aforementioned penalties? The State Board of Registered Nursing that granted your license.
4. I am the head nurse. One of my nursing aides has a history of failing to appear to work and not giving notice of or reason for absence. How should I handle this? An employee has the right to know hospital policies, what is expected of an employee, and what will happen if an employee does not meet the expectations stated in his or her job description or in hospital policies and procedures. As a head nurse, you must document behavior factually, clearly, and concisely, as well as any discussion and decision about future course of action. The employee must have the chance to read and sign this documentation. The head nurse then sends a copy to her or his supervisor.


11. Floating: Is a nurse hired to work in psychiatry obligated to cover in the intensive care unit (ICU) when the latter is understaffed? The issue is the hiring contract (implied or expressed). The contract is a composite of the mutual understanding by involved parties of rights and responsibilities, any written documents, and hospital policies. If the nurse was hired as a psychiatric nurse, he or she could legally refuse to go to the ICU. If the hospital intends to float personnel, such a policy should be clearly stated during the hiring process. Also at this time the employer should determine the employee’s education, skills, and experience. On the other hand, if emergency staffing problems exist, a nurse should go to the ICU regardless of personal preference, but should request orientation and not assume responsibility beyond level of experience or education.


12. Dispensing medication: Can a nurse legally remove a drug from a pharmacy when the pharmacy is closed (during the night) if the MD insists that the nurse go to the pharmacy to get the specifically prescribed medication immediately? Within the legal boundaries of the Pharmacy Act, a nurse may remove one dose of a particular drug from the pharmacy for a particular patient during an unanticipated emergency within a limited time and availability of resources. However, the hospital should have a written policy for the nurse to follow and should authorize a specific person to use the services of the pharmacy under certain circumstances.


13. Illegible orders: What should I do if I cannot decipher the MD’s handwriting when she or he persists in leaving illegible orders? Talk to the MD regarding the dangers of your giving the wrong amount of the wrong medication via the wrong route at the wrong time. If that does not help, follow appropriate channels. Do not follow an order you cannot read. You will be liable for following orders you thought were written.


14. Heroic measures: The wife of a terminally ill patient approaches me with the request that heroic measures not be used on her husband. She has not discussed this with him but knows that he feels the same way. Can I act on this request? No. The patient is the only one who can legally make the decision as long as he or she is mentally competent.


15. Medication: An MD orders pain medication pm for a patient. The patient asks for the medication, but when I question her she says the pain “isn’t so bad.” If in my judgment the patient’s pain is not severe, am I legally covered if I give half of the pain medication dosage ordered by the MD? A nurse cannot substitute his or her judgment for the MD’s. If you alter the amount of medication prescribed by the MD without a specific order to do so, you may be liable for practicing medicine without a license.


16. Malfunctioning equipment: At the end-of-shift report the nurse going off duty tells me that the tracheal suctioning machine is malfunctioning and describes how she got it to work. Should I plan to use the machine in the evening shift and follow her suggestions about how to make it work? Do not plan to use equipment that you know is not functioning properly. You could be held liable because you could reasonably foresee that proper functioning of equipment would be needed for your patient. You have been put on notice that there are defects. Report this to the supervisor or person responsible for maintaining equipment in proper working order.