Nursing Myths That Could Put Your License at Risk: Part 2
Welcome back to Part 2 of our nursing myth-busting series. As nurses, we learn an incredible amount in nursing school, orientation, continuing education, and years of clinical practice. But we also learn from each other. Unfortunately, sometimes the “rules” passed around the nurses’ station are not rules at all. They are nursing urban legends. And when your license is on the line, “But another nurse told me…” is not the defense you want to be giving the Board of Nursing.
Myth #6: “My Shift Is Over, So I Can Leave.”
We have all had those shifts when 7:00 cannot come fast enough. Your feet hurt, you have not eaten since breakfast, your bladder has been sending increasingly urgent messages for the last three hours, and you are already mentally sitting in your car. But the clock striking 7:00 does not necessarily end your professional responsibilities. There needs to be an appropriate transition of patient care.
If leaving would result in your patients being left without appropriate nursing coverage or without a safe handoff, simply announcing, “My shift is over,” and heading for the elevator could create a serious problem. That does not mean an employer has unlimited authority to force nurses to work indefinitely. Staffing is an employer responsibility, and laws involving mandatory overtime and staffing vary from state to state. It does mean that nurses should handle the transition appropriately rather than assuming that the end of a scheduled shift automatically ends responsibility for their patients. Protect your patients, use the chain of command, follow applicable policies, and protect your license.
Myth #8: “HIPAA Means I Can’t Talk About a Patient With Anyone.”
HIPAA may be one of the most misunderstood laws in healthcare. Some nurses are so afraid of violating HIPAA that they believe they cannot discuss patient information with anyone. That is simply not what HIPAA means. Appropriate sharing of patient information may occur for purposes such as treatment, payment, and healthcare operations, subject to applicable requirements.
Of course, you still need to be careful about where, why, and with whom you discuss protected health information. The elevator, cafeteria, social media, and neighborhood barbecue are not extensions of the nurses’ station. But HIPAA should not prevent appropriate clinical communication. Patient safety depends on healthcare professionals communicating important information with the people who need that information to care for the patient. The lesson is not, “Never talk about a patient.” The lesson is to understand when, why, where, and with whom patient information may appropriately be shared.
If a patient or family member asks for you to print part of the chart or a lab test, the answer is no. Send them to the medical records department and never print patient information for yourself.
Myth #9: “If I Make a Medication Error and the Patient Isn’t Harmed, I Don’t Have to Report It.”
Imagine that you give the wrong dose of a medication and immediately realize what happened. You assess your patient, and thankfully, the patient is fine. Then that uncomfortable little voice whispers, “Maybe I just won’t say anything. Nobody got hurt.”
Do not let fear make your next decision for you. The fact that a patient did not suffer an obvious injury does not necessarily eliminate your reporting responsibilities. Facility policies, state law, Board requirements, and the circumstances surrounding the error may all come into play. More importantly, attempting to conceal an error can turn one problem into a much larger one.
We are human, and nurses make mistakes. What matters tremendously is what happens next. Assess the patient, take appropriate action, notify the appropriate people, follow applicable policies and reporting requirements, document appropriately, and learn from what happened. Integrity after an error matters. A mistake may be explainable. Dishonesty is much harder to explain.
Myth #10: “What I Do Off Duty Is None of the Board of Nursing’s Business.”
Wouldn’t it be nice if we could hang our nursing license next to our badge when we clock out and pick them both up again at the beginning of the next shift? Unfortunately, professional licensure does not always work that way. Depending on your state and the circumstances, certain off-duty conduct may have consequences for your nursing license.
Criminal conduct, substance-related incidents, dishonesty, boundary violations, and certain social media activity may potentially raise questions about a nurse’s professional conduct or fitness to practice. That does not mean the Board of Nursing controls every aspect of your private life. It does mean that holding a professional license carries responsibilities that sometimes extend beyond the walls of the hospital. Before you post something online, engage with a patient or former patient outside the clinical setting, or make a decision that could have legal consequences, remember that you may be protecting more than your reputation. You may also be protecting your nursing license.
Bonus Myth: “My Employer Will Protect My Nursing License.”
This may be the most dangerous myth of all. Your employer may support you when something happens at work, but never assume that protecting your individual nursing license is your
employer’s primary responsibility. If there is a serious patient event, your hospital may conduct an investigation. Risk management may become involved. Attorneys may become involved. Statements may be requested, and records may be reviewed. At first, everyone may appear to be on the same team, but the hospital’s interests and your interests may not always remain aligned.
The hospital’s attorney represents the hospital. Risk management manages the organization’s risk. Human resources represents the interests of the organization. So, who is looking out specifically for your nursing license? Ultimately, you are.
If you receive a letter, subpoena, complaint, or notice from the Board of Nursing, take it seriously. Do not assume your employer will handle it for you, and do not assume that because your employer determined you did nothing wrong that the Board will necessarily reach the same conclusion. An employment investigation, a malpractice claim, and a Board of Nursing investigation are separate processes with different purposes and potentially very different consequences.
Your License Is Your Livelihood
You worked too hard for your nursing license to rely on something you heard in the break room fifteen years ago. Know your Nurse Practice Act. Understand your scope of practice. Know your facility policies. Use your nursing judgment. Speak up when something is unsafe. Document appropriately, and ask questions when you are uncertain.
Most importantly, remember that your license belongs to you. We are taught from the first day of nursing school to advocate for our patients. Sometimes, the nurse who needs your advocacy is you.
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