5.4 Frequent Allegations and SBON Investigations
The Nurses Service Organization (NSO) reported that the three most common allegations resulting in state board investigations in 2020 were related to the categories of professional conduct, scope of practice, and documentation errors or omissions.[1]
Professional Conduct
Common allegations related to professional conduct included drug diversion and substance abuse, professional misconduct, reciprocal actions, and wastage errors.
Drug Diversion and Substance Abuse
The most common allegations related to professional conduct for both RNs and LPN/VNs in 2020 were related to drug diversion and/or substance abuse. Examples include diverting medications for oneself or others and apparent intoxication from alcohol or drugs while on duty.
Professional Misconduct
Professional misconduct as defined by the state was the second most common allegation related to professional conduct. This category includes unprofessional conduct towards coworkers and patients, as well as allegations of falling asleep.
Sample CaseA home health RN was assigned to monitor an 11-month-old child from 1900 to 0700. The child was intubated and required constant monitoring to ensure the tubing remained secure while she was in her crib. However, the child’s father found the RN sleeping and the child’s tubing unsecured. The child did not suffer harm due to the incident, but the SBON publicly reprimanded the RN, and the costs to defend the nurse exceeded $2,400.[2]
Reciprocal Actions
The third most common professional conduct allegation was reciprocal actions. Many cases involved nurses who were trying to contend with patients who were violent or aggressive and either retaliated against the patient or responded to the patient ‘s aggression in an inappropriate or unprofessional manner.
Sample CaseA patient in an inpatient behavioral health unit became agitated, pulled a phone out of the wall, and threw it. The nurse entered the room and following a brief interaction, an altercation between the patient and the nurse ensued. The nurse received a public reprimand and disciplinary actions from the SBON.[3]
Wastage Errors
Wastage errors were the fourth most common allegation. Wastage errors occurred when nurses neglected to perform accurate medication counts or did not properly document proper disposal of opioids and other drugs with a high potential for abuse.
Sample CaseAn RN left two 15 milligram tablets of a benzodiazepine called Temazepam unattended in an area accessible to patients. The medication went missing and was apparently taken by a patient. The nurse falsely documented the Temazepam as wastage, knowing the medication was actually missing. The SBON issued a $200 fine, and expenses to defend the nurse exceeded $7,200.[4]
Scope of Practice
Common allegations related to scope of practice include failure to maintain a minimum standard of practice and providing services beyond one’s scope of practice.
Failure to Maintain Minimum Standard