5.5 Protecting Your Nursing License

You have worked hard to obtain a nursing license and it will be your livelihood. See Figure 5.7[1] for an illustration of a nursing license. Protecting your nursing license is vital.

Illustration of a hand holding a State of Michigan nursing license
Figure 5.7 Nursing License

Actions to Protect Your License

There are several actions that nurses can take to protect their nursing license, avoid liability, and promote client safety. See Table 5.5 for a summary of recommendations.

Table 5.5 Risk Management Recommendations to Protect Your Nursing License

Legal Issues Recommendations to Protect Your License
Practicing outside one’s scope of practice
  • Practice within the requirements of your state’s Nurse Practice Act, in compliance with organizational policies and procedures, and within the national standard of care.
  • Maintain basic clinical and specialty competencies by proactively obtaining the professional information, education, and training needed to remain current regarding nursing techniques, clinical practice, biologics, and equipment.[2]
  • Only accept client care assignments you are trained and competent to perform. Ask for additional training as needed.
  • Recognize one’s limitations and ask for assistance when needed.
  • If necessary, utilize the chain of command or the risk management or legal departments regarding concerns about client care or practice issues and pursue concerns to resolution.[3]
Failure to assess & monitor
  • Ensure that you are following appropriate guidelines for routine assessments and following up appropriately if client condition warrants additional monitoring.
  • Ensure the client condition aligns to skills and monitoring capabilities of unit/staff.
  • Escalate changes in client condition via appropriate channels.
Documentation
  • Document client care assessments, observations, communications, and actions in an objective, timely, accurate, complete, and appropriate manner.
  • Document in a manner that permits accurate reconstruction of client assessments, notification of others, and the sequence of events.
  • Document as close to the time of care provision as possible. (In court, if it is not documented, it is considered not done.)
  • Provide an accurate documentation of a change in client condition, care provided, providers notified, and orders received.
  • Document specific times of interventions provided during emergency situations.
  • When notifying a provider about a client, document the name of the provider notified, the time of the notification, and the provider’s response. Follow through with any nursing actions taken and the client’s response.
  • Never alter, delete, or falsify information.
  • If there is information that should have been charted but was not, document “late entry,” noting the time the charting occurred and the specific time the assessment or intervention actually took place.[4]
  • When describing a client problem, include the nursing actions taken and the client’s response.[5]
  • Use medical terminology.
  • Avoid abbreviations.
  • Review notes from other health care team members to ensure coordination of efforts is occurring.[6]
  • Maintain your own personal files that can be helpful with respect to your character, such as letters of recommendation, performance evaluations, and continuing education certificates.[7]
Medication errors
  • Avoid workarounds. (For example, if an error message is received when scanning a medication with a barcode scanner during med pass, don’t assume it is a technology error and “workaround” it by just documenting the medication in the MAR. Instead, investigate error messages because they could be indicating a medication error, not a technology error.)
  • Always check the “rights of medication administration” three times, even when using barcode scanners and other equipment. (Review information about checking medication rights in the “Administration of Enteral Medications” chapter in Open RN Nursing Skills, 2e.)
  • Be aware of look alike/sound alike medications.
  • Double-check dosage calculations, especially for pediatric clients.
  • Follow agency policies and procedures related to medication administration and documentation.
  • Clarify prescriptions with prescribing providers if they are unclear or you have concerns. For example, if acetaminophen is prescribed for fever and the client is experiencing pain, clarify the indications in the order before administering it for pain.
  • Avoid distractions while preparing and administering medications. (Read more information about preventing medication errors in the “Legal/Ethical” chapter in Open RN Nursing Pharmacology, 2e.)
  • Maintain a chain of possession when administering medications. Never administer a medication for which you have not personally done the medication checks.
  • Never leave medication unattended.
  • If a medication error occurs, follow agency policy regarding notification and submitting an incident report.
Substance abuse and drug diversion
  • Waste controlled substances and document wasting according to agency policy.
  • Perform accurate counting and documentation of controlled substances per agency policy.
  • Seek assistance if you are experiencing challenges with substance use. Report impaired professionals regarding suspected substance abuse. (Read more about drug diversion and support for nurses with substance use disorder in the “Legal/Ethical” chapter in Open RN Nursing Pharmacology, 2e.)
  • Report convictions such as drug possession, driving under the influence (DUI), or operating under the influence (OWI) to your State Board of Nursing as required.
Acts that may result in potential or actual client harm
  • Participate in accurate and thorough handoff reports according to agency policy. (Read more about handoff reports in the “Communication” chapter of Open RN Nursing Fundamentals, 2e.)
  • Communicate with other members of the health care team using ISBARR format. (Read more about ISBARR format in the “Communication” chapter of Open RN Nursing Fundamentals, 2e.)
  • Follow the nursing care plan. Assess appropriateness of interventions according to the client’s current condition before implementing them.
  • Conduct thorough nursing assessments, especially for skin breakdown or pressure injuries. (Read more about assessing skin breakdown and pressure injuries in the “Integumentary” chapter of Open RN Nursing Fundamentals, 2e.)
  • Advocate for quality client care and speak up regarding concerns about client safety.
  • Educate clients and encourage them to actively participate in their care and make informed decisions.
  • Follow National Patient Safety Goals. Implement fall prevention interventions according to agency policy. Report unsafe equipment. (Read more about promoting client safety in the “Safety” chapter in Open RN Nursing Fundamentals, 2e.)
  • Document and report unsafe staffing or other workplace safety concerns per agency policy, state policy, or OSHA.
Safe-guarding client possessions & valuables
  • Encourage client valuables to be sent home.
  • Document all client possessions upon admission to inpatient facilities and obtain client or family signature or acknowledgement.
  • Lock up client valuables per agency policy.
  • Follow agency policy regarding receipt of gifts from clients or family.
Adherence to mandatory reporting responsibilities
  • Report suspected abuse of children, elders, and other vulnerable populations. (Read more about mandatory reporting under the “Duty” subsection of the “Understanding the Legal System” section of this chapter.)
  • Report gunshot wounds, dog bites, and communicable disease per agency and state policy.

Culture of Safety

It can be frightening to think about entering the nursing profession after becoming aware of potential legal actions and risks to your nursing license, especially when realizing even an unintentional error could result in disciplinary or legal action. When seeking employment, it is helpful for nurses to ask questions during the interview process regarding organizational commitment to a culture of safety to reduce errors and enhance client safety.

Many health care agencies have adopted a culture of safety that embraces error reporting by employees with the goal of identifying root causes of problems so they may be addressed to improve client safety. One component of a culture of safety is “Just Culture.” Just Culture is culture where people feel safe raising questions and concerns and report safety events in an environment that emphasizes a nonpunitive response to errors and near misses. Clear lines are drawn between human error, at-risk, and reckless behaviors. [8]

The American Nurses Association (ANA) officially endorses the Just Culture model. In 2019 the ANA published a position statement on Just Culture. They stated that while our traditional health care culture held individuals accountable for all errors and accidents that happened to clients under their care, the Just Culture model recognizes that individual practitioners should not be held accountable for system failings over which they have no control. The Just Culture model also recognizes that many errors represent predictable interactions between human operators and the systems in which they work. However, the Just Culture model does not tolerate conscious disregard of clear risks to clients or gross misconduct (e.g., falsifying a record or performing professional duties while intoxicated).[9]

The Just Culture model categorizes human behavior into three categories of errors: simple human error, at-risk behavior, or reckless behavior. Consequences of errors are based on these categories.[10] When seeking employment, it is helpful for nurses to determine how an agency implements a culture of safety because of its potential impact on one’s professional liability and licensure.

Read more about the Just Culture model in the “Basic Concepts” section of the “Leadership and Management” chapter.

  1. “aid9688616-v4-728px-Get-a-California-Endorsement-for-Your-Nursing-License-Step-11.jpg” by unknown is licensed under CC BY-NC-SA 3.0 ↵
  2. 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 ↵
  3. 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 ↵
  4. Brous, E. (2019). The elements of a nursing malpractice case, Part 1: Duty. American Journal of Nursing, 119(7), 64–67. https://doi.org/10.1097/01.NAJ.0000569476.17357.f5 ↵
  5. Brous, E. (2019). The elements of a nursing malpractice case, Part 1: Duty. American Journal of Nursing, 119(7), 64–67. https://doi.org/10.1097/01.NAJ.0000569476.17357.f5 ↵
  6. Brous, E. (2019). The elements of a nursing malpractice case, Part 1: Duty. American Journal of Nursing, 119(7), 64–67. https://doi.org/10.1097/01.NAJ.0000569476.17357.f5 ↵
  7. 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 ↵
  8. The Joint Commission. (2017, March 1). The essential role of leadership in developing a safety culture. Sentinel event alert, Issue 57. https://www.jointcommission.org/-/media/tjc/documents/resources/patient-safety-topics/sentinel-event/sea_57_safety_culture_leadership_0317pdf.pdf ↵
  9. American Nursing Association. (2010). Position statement: Just culture. https://www.nursingworld.org/~4afe07/globalassets/practiceandpolicy/health-and-safety/just_culture.pdf ↵
  10. American Nursing Association. (2010). Position statement: Just culture. https://www.nursingworld.org/~4afe07/globalassets/practiceandpolicy/health-and-safety/just_culture.pdf ↵
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