NURSING, and MISSOURI NURSING BOARD PROBLEMS

How employers can hurt your career by making voluntary or mandatory reports about you, and what to expect if you get reported

The employer who employs licensed nurses holds enormous power over your ability to practice your craft. Such employer is probably a “Mandatory Reporter”. (See below). Accordingly, your employer can trigger an investigation against you by making a report to the Missouri Nursing Board.

First, your relationship deteriorates with your superiors.
Second, your superiors criticize your work, and possibly audit your files, looking for reasons to discipline or terminate you (the superiors are now looking for mistakes rather than overlooking your mistakes).
Third, (since no one is perfect) your superiors find possible errors or incidents that make you look bad.
Fourth, you are disciplined or terminated or forced to quit (creating a reportable incident).
Fifth, the Missouri Nursing Board opens an investigation.
Sixth, the investigator refers you for discipline if he finds anything possibly wrong.
Seventh, the Board starts a legal action against you to impose discipline.
Eighth, you fight the Board, and you may win, lose or settle.
Ninth, your permanent public record contains a record of your discipline.
Tenth, some employers will not hire you now that you have been disciplined, so your career is damaged (some employers may fire you if the discipline occurs while you are working for them).

I have not seen a case yet (but I am sure they exist) where a nurse was truly incompetent – The people who come to see me are typically competent nurses who fell out of favor with their bosses for some reason, and the bosses decided to attack the nurses by auditing their files or otherwise becoming overly critical.

Since no one is perfect, the bosses find issues, or sometimes seemingly concoct the issues out of innocent events. But the allegations of competency issues or errors lead to reportable incidents that must be fought against.

The investigators at the Missouri Board of Nursing will look into the matter and see if the issues appear substantiated. You can fight against the allegations, but everything you do or say, and everything you don’t do and don’t say, will be used against you —- it is a very delicate situation.

If the issues appear substantiated, there is a very good chance that the Board will seek to impose some form of discipline. I have seen letters of censure, orders to undergo training, and suspensions. And discipline is public.

I have also seen the Board back away and chose not to impose discipline. But each case is decided on its own merits, and it is wise to have a lawyer assist you.

Those who know me know that I do not try to sell people on using lawyers when they can handle things on their own. But I do not think a licensed nurse should deal with the Board on their own —- too much is at stake: You need every advantage you can muster. Get a lawyer if you are licensed and having problems on the job or have been fired, or have resigned under pressure.

Here is the Mandatory Reporting Rule

In a nutshell, if your employer thinks it has cause to discipline you, it must report you to the Board of Nursing within 15 days. Plus, the employer “may” choose to report you for other reasons, such as your need for treatment of some health conditions.

20 CSR 2200-4.040 Mandatory Reporting Rule

PURPOSE: This rule establishes a procedure and guidelines regarding reports required from hospitals, ambulatory surgical centers, or temporary nursing staffing agencies by section 383.133, RSMo concerning any final disciplinary action against a nurse licensed under Chapter 335, RSMo or the voluntary resignation of any such nurse.

(1) The State Board of Nursing shall receive and process any report from a hospital, ambulatory surgical center, or temporary nursing staffing agency concerning any disciplinary action against a nurse licensed under Chapter 335, RSMo or the voluntary resignation of any such nurse against whom any complaints or reports have been made which might have led to disciplinary action.

Disciplinary action is defined in section 383.130, RSMo as any final action taken by the board of trustees or similarly empowered officials of a hospital or ambulatory surgical center, or owner or operator of a temporary nursing staffing agency, to reprimand, discipline, or restrict the practice of a health care professional. Only such reprimands, discipline, or restrictions in response to activities which are also grounds for disciplinary actions according to the professional licensing law for that health care professional shall be considered disciplinary actions for purposes of this definition.

(2) Reports to the board shall be in writing and shall comply with the minimum requirements as set forth in this rule. The Board of Nursing will assume that all reports received from hospitals, ambulatory surgical centers, or temporary nursing staffing agencies will be treated as under section 383.133, RSMo. The information shall be submitted within fifteen (15) days of the final disciplinary action, and shall contain, but need not be limited to—
(A) The name, address and telephone number of the person making the report;
(B) The name, address and telephone number of the person who is the subject of the report;
(C) A description of the facts, including as much detail and information as possible, which gave rise to the issuance of the report, including the dates of occurrence deemed to necessitate the filing of the report. Whenever possible, the report should include:

1. The date of each alleged incident;
2. The name of the patient involved;
3. If the incident involves medication, the name of the medication;
4. Very specific details describing the events;
5. List witnesses to the incident(s) and their contact information; and
6. If you conducted an internal investigation, provide a copy of the report;

(D) If court action is involved and known to the reporting agent, the identity of the court, including the date of filing and the docket number of the action; and
(E) A statement as to what final action was
taken by the institution.

(3) Reports made to the board under the mandated reporting requirements as defined in Chapter 383, RSMo shall not be deemed a violation of the federal Health Insurance Portability and Accountability Act (HIPAA) and the privacy rules located in the Act because the Missouri State Board of Nursing qualifies as a health oversight agency as defined in the HIPAA privacy rules.

(4) Any activity that is construed to be a cause for disciplinary action according to section 335.066, RSMo shall be deemed reportable to the board. Nothing in this rule shall be construed as limiting or prohibiting any person from reporting a violation of the Nursing Practice Act directly to the State Board of Nursing.

(5) In cases where a nurse voluntarily submits to an employee assistance program or to a rehabilitation program for alcohol or drug impairment and no disciplinary action is taken by the facility, the facility is not mandated to report but may report. If the nurse is subsequently disciplined by the facility for violating provisions of the employee assistance program or rehabilitation program or voluntarily resigns in lieu of discipline, the facility must report to the board under the above provision.

AUTHORITY: sections 335.036 and 383.133, RSMo Supp. 2007.* This rule originally filed as 4 CSR 200-4.040. Original rule filed Aug. 5, 1987, effective Nov. 12, 1987. Amended: Filed Jan. 8, 1988, effective April 28, 1988. Amended: Filed April 19, 1996, effective Nov. 30, 1996. Amended: Filed July 11, 2000, effective Jan. 30, 2001. Moved to 20 CSR 2200-4.040, effective Aug.28, 2006. Amended: Filed May 27, 2008, effective Nov. 30, 2008. *Original authority: 335.036, RSMo 1975, amended 1981, 1985, 1993, 1995, 1999, 2007 and 383.133, RSMo 1986, amended 2007.

Article written by | Tim Willoughby

Timslaw.com Missouri Employment Law

Maintained by Attorney Phil Willoughby
Founded by Tim Willoughby, Esq. (1959-2013)

Phil is a Missouri employment lawyer who is licensed to practice in Kansas and Missouri, and primarily takes cases in Saint Louis and Kansas City. He is a member of the Missouri Bar Association and Kansas Bar Association. Additionally, he has practiced in the United States Federal Courts of Missouri in St. Louis and Kansas City. He has also practiced in the Kansas Federal District Court in Kansas City, Kansas.

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