February 28, 2022

What Nurses Should Know About License Investigations

What Nurses Should Know About License Investigations

In a recent nationwide survey of 30,000 nurses, the American Nurses Association (ANA) found that 32% said they were unprepared to care for a Covid 19 patient (Williams, 2021).  The pandemic has filled hospitals to capacity and stretched overworked nursing staff to the breaking point. Nurses are taking on more patients, and these patients are sicker than before the pandemic.  This situation leaves nurses at risk for license complaints and the possibility of losing not only their job, but their professional credentials. According to the laws in some states, a nurse must ensure he or she is competent to care for a patient before accepting an assignment (Williams, 2021). The pandemic and its effect on hospitals and staffing may be putting nurses in compromising positions and leaving them with ethical and moral dilemmas more than ever.

40% of Complaints Against a Nurse’s Credentials is “Impairment”

 Jennifer Flynn, Risk Manager for Nurses Service Organization, says the incidence of nursing license surrender has increased to 4.8% in the most recent 2020 data. That number is up from 3.2% from the previous report.

Barbara Holtry, spokesman for the Oregon State Board of Nursing (OSBN), says there has not been an increase in complaints against nurses’ licenses in Oregon since the start of the pandemic. However, the most common reason for a complaint against a nurse’s credentials is “impairment,” according to Holtry. Confidentiality of records kept by any Board of Nursing as well as relative newness of the pandemic may mean that there is a lag in statistics about how the pandemic affects the nursing profession. And, while substance abuse has long been a troubling issue for nurses, the pandemic may be exacerbating the problem. Complaints against a nurse’s license involve substance abuse about 40% of the time Flynn says. NSO recognizes nurses’ unique situations when it comes to substance abuse. When stress, patient load, and access to medications combine, the situation can quickly become combustible. Additionally, pandemic-related stress may lead some nurses to experience new-onset drug or alcohol abuse problems (Williams, 2021).

Nurses Are Dealing With Moral Injury on Top of Burnout

Matt Caliza, Nurse Practice Consultant with the Oregon Nurses Association (ONA), says Covid 19 has pushed nurses beyond burnout.   He says the pandemic has forced nurses into a state of moral injury. Calzia says the most recent Covid surge has hit nurses particularly hard and caused an increase in anxiety. Substandard care is one reason a nurse could be subject to board investigation. Nurses are asked to care for patients that are sicker than ever before, and according to Caliza, the ONA’s position is that a nurse should not accept a patient unless he or she possesses the knowledge, competency, skills and abilities to care for the patient. With each surge of the pandemic patients’ acuity has also surged. Hospitals, particularly ICUs, are filled beyond capacity, causing sicker people to flood floor beds. A nurse who refuses to care for a particular patient because he or she doesn’t feel adequately prepared is likely to face backlash from unit managers, charge nurses, or coworkers. This may make accepting care for patients when the nurse may not have the competency, skills, or ability to care for them may feel like the only choice. It is important for clinicians to remember that employers cannot threaten an employee’s professional license; they can only file a report with the state board.  Sometimes an RN may be forced to choose between their employer and their license, says Calzia.  The increasing complexity of patient care may put nurses in the position of needing to defend their license in front of their respective state nursing board.

The Process of Defending a Nursing License

 A nurse could face a myriad of consequences when patient care is called into question. A family may file a civil lawsuit. Family members, employers or coworkers may also file a complaint with the state’s board of nursing. The practitioner who loses a civil lawsuit can continue to practice after paying the damages, whereas a complaint filed with a state board of nursing could end a career. The nurse has the opportunity to defend his or her license in front of the Board and be represented by counsel.  Still, Flynn says nurses don’t always take a complaint filed with a nursing board seriously.  Forty-five percent of cases are closed with no board action. In 55% of cases, the Board takes some sort of action against a nurse’s license. 

The first step when OSBN receives a complaint is to evaluate it to ensure the Board has jurisdiction over the situation. 

  1. If the complaint violates the Nurse Practice Act and there is enough information to follow up, a case is opened and assigned to an investigator. 
  2. The investigator will conduct interviews with the complainant, the licensee, employer and coworkers. The investigator will also review pertinent documents, including patient records, HR records, or police reports. 
  3. The investigator will then present a case report to the board for review and possible disciplinary action. 
  4. Types of sanctions the Board could take range from a fine of up to $5,000., to suspension of a license, to revocation of licensure.

The pandemic has put a strain on hospitals and nursing staff like nothing in recent memory. Sicker patients with complex care needs may challenge a nurse’s skills as well as their emotions. Among the risks brought about by the pandemic is the risk of being accused of substandard care. Nurses may also be at greater risk for addiction-related, in part to increased stress.  These factors can put nurses at risk of a Board of Nursing investigation and possible loss of their professional license. Nurses should be prepared to handle a board investigation.


Calzia, M. (2021, November 18). Nurse Practice Consultant, Oregon Nurses Association. (E. Cole, Interviewer)

Holtry, B. (2021, December 3). Oregon State Board of Nursing Media Contact. (E. Cole, Interviewer)

Relias Media. (2021). Nursing license complaints must be taken seriously, avoided if possible. Unknown: Relias Media. Retrieved from www.reliasmedia.com/articles/148574-nursing-license-complaints-must-be-taken-seriously-avoided-if-possible.

Williams, H. E. (2021). Covid-19 related nursing license complaints: Considerations for LNCs. The Journal of Legal Nurse Consulting, 32(2), 12-17. doi:2470-6248