The first consideration in reviewing a complaint from a member of the public or a health care facility is whether the board of nursing (BON) has jurisdiction or authority to enforce laws or pronounce legal judgments over the particular person and the particular action.
Issues which are not within the authority of the BON include the following: interpersonal conflicts, rudeness or impolite behavior, employee-employer relations, labor issues, fee or billing disputes, complaints against health care practitioners who are not nurses, complaints against health care facilities, clinics, or agency operations.
The BON is called into action when there is an alleged violation of the state's nurse practice act. Disciplinary cases are often grouped into the following categories: practice related, drug related, boundary violations, sexual misconduct, abuse, fraud, positive criminal background checks.
Practice related cases involve some breach in the standard of nursing care provided to one or more clients. They involve breakdowns or errors during aspects of the nursing process. Types of cases include:
Drug related cases result when nurses mishandle and/or misuse controlled substances. Types of cases include:
Boundary violation cases are recognized by non therapeutic relationships that are formed between a nurse and a client in which the nurse derives a benefit at the client’s expense. Compared to boundary crossings in which the roles are blurred without gain to the nurse, boundary violation cases demonstrate an over-extension of the therapeutic relationship into the realm of personal profit on the nurse’s part. Examples of boundary violations include:
Physical or sexual abuse cases occur when nurses subject clients to inappropriate physical or sexual contact, by either touching their patients sexually or causing patients to touch the nurse sexually. Such cases may be purely abusive in nature or may be a boundary violation extending from an unhealthy nurse-patient relationship.
Abuse cases are characterized by maltreatment of clients or the public which is physically, mentally and/or emotionally harmful. Common types of abuse cases include:
Fraud cases have the unique trait of misrepresentation of the truth for gain or profit. These cases are widely varied. Types of fraud cases include:
Positive criminal background check cases vary in different jurisdictions based upon different definitions of what constitutes reportable criminal conduct, the potential risks to the patients and the effect on licensure. One concept that is universal though is that clients may be placed at risk of future harm from conduct related to, associated with or as an extension of past criminal activities. To safeguard the public, agencies establish licensure consequences based on a combination of the degree and severity of the past criminal conduct and the nurse's risk to patients from similar, future lapses in good judgment.