5.4 Frequent Allegations and SBON Investigations
The Nurses Service Organization (NSO) reported 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.
The National Council of State Boards of Nursing (NCSBN) created a brochure titled Substance Abuse Disorder in Nursing to address this common issue.[2] Many states have programs in place to assist nurses with substance abuse, such as Wisconsin Nursing Association’s Nurses Caring for Nurses (Peer Assistance) program or New York State Nursing Association’s Statewide Peer Assistance for Nurses (SPAN) program.[3],[4]
Professional Misconduct
Professional misconduct as defined by state regulations 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.

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.

Wastage Errors
Wastage errors were the fourth most common allegation. Wastage errors occurred when nurses neglected to perform accurate medication counts or did not appropriately document proper disposal of opioids and other drugs with a high potential for abuse.

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 of Nursing Practice
The most common allegations related to scope of practice include failure to maintain a minimum standard of nursing practice. These cases include a breach of minimum professional standards, incompetence, and negligence.



Provision of Services Beyond Scope of Practice
The second most common allegation related to scope of practice is provision of services beyond one’s scope of practice. This category typically involves nurses making changes to patients’ prescribed treatments or administering medication that had not been prescribed.

Documentation
Over half of the allegations in 2020 regarding documentation were related to fraudulent or falsified patient care or billing records. The health care record is a legal document. It should never be altered, deleted, or falsified. Maintaining accurate and timely documentation is a primary professional responsibility of nurses.

- Nurses Service Organization and CAN Financial. (2020, June). Nurse professional liability exposure claim report (4th ed.). https://www.nso.com/Learning/Artifacts/Claim-Reports/Minimizing-Risk-Achieving-Excellence ↵
- National Council State Board of Nursing. Substance Abuse Disorder in Nursing [Brochure]. https://www.ncsbn.org/SUD_Brochure_2014.pdf ↵
- Wisconsin Nurses Association. (n.d.). Nurses caring for nurses (peer assistance). https://www.wisconsinnurses.org/about-wna/affiliates/nurses-caring-for-nurses-peer-assistance/ ↵
- Statewide Peer Assistance For Nurses. https://www.statewidepeerassistance.org/ ↵
- Nurses Service Organization and CNA Financial. (2020, June). Nurse professional liability exposure claim report (4th ed.). https://www.nso.com/Learning/Artifacts/Claim-Reports/Minimizing-Risk-Achieving-Excellence ↵
- Nurses Service Organization and CNA Financial. (2020, June). Nurse professional liability exposure claim report (4th ed.). https://www.nso.com/Learning/Artifacts/Claim-Reports/Minimizing-Risk-Achieving-Excellence ↵
- Nurses Service Organization and CNA Financial. (2020, June). Nurse professional liability exposure claim report (4th ed.). https://www.nso.com/Learning/Artifacts/Claim-Reports/Minimizing-Risk-Achieving-Excellence ↵
- Nurses Service Organization and CNA Financial. (2020, June). Nurse professional liability exposure claim report (4th ed.). https://www.nso.com/Learning/Artifacts/Claim-Reports/Minimizing-Risk-Achieving-Excellence ↵
- Nurses Service Organization and CNA Financial. (2020, June). Nurse professional liability exposure claim report (4th ed.). https://www.nso.com/Learning/Artifacts/Claim-Reports/Minimizing-Risk-Achieving-Excellence ↵
- Nurses Service Organization and CNA Financial. (2020, June). Nurse professional liability exposure claim report (4th ed.). https://www.nso.com/Learning/Artifacts/Claim-Reports/Minimizing-Risk-Achieving-Excellence ↵
- Nurses Service Organization and CNA Financial. (2020, June). Nurse professional liability exposure claim report (4th ed.). https://www.nso.com/Learning/Artifacts/Claim-Reports/Minimizing-Risk-Achieving-Excellence ↵
- Nurses Service Organization and CNA Financial. (2020, June). Nurse professional liability exposure claim report (4th ed.). https://www.nso.com/Learning/Artifacts/Claim-Reports/Minimizing-Risk-Achieving-Excellence ↵