The State of Wellness
The State of Wellness
Disciplinary Action and the Nursing Profession
Tune in as Dr. Sarah Wickenhagen from the Oregon State Board of Nursing (OSBN) walks us through the five most common complaints against nursing professionals that the Board investigates. We'll also discuss the role of disciplinary action in protecting the public and the misconceptions that come with a disciplinary investigation in Oregon.
The State of Wellness podcast is hosted by the Oregon Center for Nursing, the state's nonprofit nursing workforce center. Learn more at oregoncenterfornursing.org.
Welcome to the State of Wellness podcast, because nurses need a trusted place to share, collaborate and talk about what matters most to the Oregon nursing community and profession as a whole, Brought to you by the nonprofit Oregon Center for Nursing. Now here's your host, Jana Bitten, Executive Director for OCN.
Speaker 2:Well, hello everybody again and welcome to yet another episode of the State of Wellness, a podcast for Oregon nurses that is brought to you by the Oregon Center for Nursing. My name is Jana Bitten. I'm the executive director of the Oregon Center for Nursing and your esteemed host for this podcast. I'm excited to welcome back our guest today who is a friend of OCN and a friend of the podcast. That would be Dr Sarah Wickenhagen from the State Board of Nursing. Hello, dr Wickenhagen.
Speaker 3:Hello Ms Gina. It's wonderful to be here.
Speaker 2:What Wonderful to have you here Now. If you missed the episode where we introduced Sarah which, if you did miss that episode, unacceptable go back and listen to the episode, because it's really good and it's great to hear about what's happening with the Board of Nursing. Sarah, can you tell us just quickly just what's your title? What do you do at the Board of Nursing?
Speaker 3:Sure, so my title is that I'm the lead policy and legislative analyst at the Board of Nursing, but what that really means is I work for them on a day-to-day basis on behalf of the board as board staff, and I look at all the policies that affect the board to include statute, our rules, anything that comes up day-to-day about whether or not a nurse can do X or Y, and then if there's a licensing issue that has to do with those rules and maybe somebody doesn't fit specifically with our rules maybe it's a nurse that has stepped out of practice or a nurse that had a different pathway I consult on those types of situations.
Speaker 2:Okay, cause that's what we're going to talk about today. We actually this came up in the last time that we talked with Dr Wickenhagen before, so I'm kind of excited to go with this one. I kind of want to do this in like a little bit of game show format, if I could, maybe we could do the top five reasons why nurses in Oregon get disciplined, and I want to start with number five. Can we do that?
Speaker 3:Sure, and this is going to surprise people. So at the bottom. So the least amount of discipline is practice related.
Speaker 2:See what.
Speaker 3:I know so. A lot of people think that nurses get in trouble for making a bad decision at the bedside. They don't. That is not where nurses fall down.
Speaker 2:Is that number five of all of them?
Speaker 3:That's number five. It is one of the least amount of discipline that is given to a nurse in the state of Oregon, or in the country for that matter. It isn't that they made a simple mistake at the bedside Okay, it is not Okay it. You know people have practice related issues that come up. I've had practice related issues, I've made a mistake before, and what we actually encourage at the board which people will also be surprised is if it is a simple mistake or something that can be handled at the local level, that doesn't have any impact on patient harm or wasn't negligent or with malintent. We don't want to hear it. We don't. Even we would ask that you would not do a complaint for those simple things and that you would handle it there. Take it as a learning opportunity and work on that with your health system and with your employee team and move on and take care of another patient.
Speaker 2:You know it's funny, is that? So, again, I didn't really say this at this point, but I will probably say this at some point. Again, I am not a nurse, I did not go to nursing school, I have not worked in a nursing situation. So for me to really make sure that I have an idea about what it's like to be a nurse, I do the most reasonable thing to do and I look at all of the nurse subreddits and Facebook pages that I possibly can, because isn't that where I'm going to get the real stories of nurses? And yes, I'm being incredibly sarcastic.
Speaker 2:However, on a lot of those, sometimes you'll see nurses that get up there and they're just like I'm going to lose my license because I I'm going to lose my license because I made this mistake. And it's so often like that's immediately where people that will post and they need some support because they're just in an absolute panic that they're going to lose their license because they made a mistake and you're saying that that's, that's bottom of the list. It's absolutely, absolutely bottom of the list. Interesting, Okay. Well, if that's the bottom of the list, what ranks number four on the top? Reasons why a nurse might receive disciplinary action in the state of Oregon.
Speaker 3:Boundary violation.
Speaker 2:Oh and what? Okay, Explain that. What is a boundary violation? Explain that.
Speaker 3:What is a boundary violation? A boundary violation is where a nurse for some reason forgets her place or his place or his place? Yes, Yep, yep, I was coming with that, sorry. And then it runs interference into the situation. It runs interference into the situation and then oftentimes with that there can be other issues that are a part of that boundary violation. So, for instance, unethical prescribing right. So if you decide to write a prescription for a family member, that's a boundary violation because they are not your patient and then, let's say you write a controlled substance for said family member.
Speaker 3:That's then your issue with negligence, basically in your prescribing. So it's sort of a slippery slope. When you have a boundary violation, usually it accompanies something else, some other action, because you're not able to be objective in this situation and you are thinking about your loved one or your friend, or you've now started a relationship with a patient that you're not supposed to have, or you may have unclear expectations now in this situation between you and the client, or you and the patient, because you've blurred the lines, and so then that's going to affect the care that you give, and so um, so boundary violations.
Speaker 2:Oh, okay, great. Well, now I know Then what would be number three on the list.
Speaker 3:I would say I'm trying to think of the right way to categorize this, but it it basically has to do with HIPAA violations or basically improper conduct. So again, not a practice issue, but where someone has made a bad choice about looking in someone's medical record.
Speaker 2:Okay, Is it specific to medical records or is it just improper conduct, like other other other things that they might be doing? That would be considered.
Speaker 3:Absolutely. It could also sort of be tied into fraud. So, for instance, if somebody's altering the medical record, which we see from time to time yeah, most of the time it's, it it's, you know, getting into something that you should not have done, and most of the electronic health records these days track those things. So it is very easy for us to identify those and then and have that evidence, um, and then um, and have that evidence. And you know, sometimes people think that they're doing a good thing, um, are there, you know, no one's looking at that, but but people certainly look at that and so, um, so we see that.
Speaker 3:Or we'll see things that are, um, again, kind of in a boundary relationship, perhaps, um, or also, again, sort of fraud, like selling your car to a patient, those kind of go in together. You're getting financial gain from selling your car to the boundary violation of your patient, okay, right, so we see things like that, okay, interesting, so, yeah, so it's again, not what you would have thought of, um, and I guess I should also say that, remember, you know we have a hundred thousand licensees at different levels, um, and you know you would be surprised, um, with the things that get reported and can be an issue Interesting.
Speaker 2:Okay, hipaa violation or improper conduct is number three. The number two reason drum roll please. What's the number two reason for disciplinary action in the state of Oregon?
Speaker 3:It is drug related, no-transcript, or sometimes more. It could be that they diverted medication. Okay, it could be that they came to work in a state that they should not have come to work in, and that can be substance related. Yeah, it can be an addiction issue. Yeah, that has become problematic.
Speaker 2:Does that surprise you at all? No, I wish that, I know. I wish that it did surprise me. I gotta be perfectly honest. I wish that that surprised me, but no, under under the circumstances that we live in right now. Actually, I gotta be honest, I thought that would be number one. So I think the thing that is going to surprise me is if drug-related is not the number one reason why a nurse might be disciplined in the state of Oregon, what is the number one reason?
Speaker 3:Well, it's so disciplined. I hope I didn't misunderstand you. I guess I think about a complaint or a case versus actual discipline. So I just want to clarify because of what the number one is. It's a positive criminal background, interesting, okay. So here's the thing.
Speaker 3:So when you apply for your nursing license, there is a list of questions on there that asks you about your past life, and so sometimes you know people got a minor in possession, you know, back in college, or they had domestic violence, some type of a dispute, or they wrote bad checks. I mean, there's different reasons why people would have a record, and some of them may have occurred a long long time ago, right. And so that's where it's really important that people are honest when they fill that form out. Right, we don't see things that are expunged. So, for instance, sometimes people will go through a diversion program. If they got a DUI, we don't see that it doesn't come up because it's expunged.
Speaker 3:I will say we have a large majority of people that will tell us something and that it was expunged, which again means again, they're being good stewards, they're being honest, they're doing their due diligence to tell us at one point, you know, they've been arrested or investigated in some way. So we appreciate that. But what the problem is is that people who don't say anything and they mark that they've never had anything, so then that pops up as a hit right and it's not congruent. So then we have to do an investigation and so that gets kicked over to the investigation side, okay, and that delays persons getting their license.
Speaker 2:So, but this is interesting. So does that mean that if you did something very stupid in your past, like I don't know, say, you're at your college campus and you got into a massive TP like toilet paper, this entire apartment building complex and the police were called? I'm not saying that this is specific, that has happened to anyone that might be on this call, but I'm just saying that, like, if you were stupid as a teenager and you did something really, really dumb, does that mean that you shouldn't even try to be a nurse? Because you have? You have a criminal background, even if it was a long time ago, even if it was something really dumb, even if it was just if it was an accident like if it was, even if, just if it was an accident, like if it was, even if does that preclude you from becoming a nurse?
Speaker 3:Absolutely not. So I am so glad that you asked that question. So we get it that people, you know, life things happen. People, especially when they're young, you know, may have not made the right choices. That frontal lobe is not fully developed, I don't know. But sometimes, you know, sometimes we make mistakes. Again, we're all human beings. We've had this conversation already and so I really want to let everyone know that we understand that the only things that really give us pause again are someone who's being untruthful, that they've been arrested and have an arrest record and say that they didn't, or that it's something that's pretty egregious or has a nexus to nursing. So, for instance, a felony, that's a pretty big deal right. So, again, depending on the situation of what it's for, that would be investigated and looked into. If it has something to do with abusing another human being, physically injuring another human being, that's a nexus to nursing.
Speaker 2:If there was something where they physically hurt another human being and there was criminal evidence of that, If they were honest with the board in their application and said yeah, when I was 22 years old I was, I was arrested for domestic violence and I I'm telling you that that happened now and it was, and it was considered a felony. Is that something that would preclude the person from becoming I know, I'm sorry, I'm asking you all these hard questions yeah, Would that? Is that an automatic? You're not going to be a nurse.
Speaker 3:It's not an automatic even so, um, it's certainly one that's going to give us pause and get investigated. So we're going to get all the details that we can get, we're going to do an interview of that person to try to get some clarification and then we're also going to bring that in front of the board. I would say, if there's a nexus to nursing right, so if there is something that I could see that you would have a potential to be in front of a vulnerable person and you could potentially hurt a person because you hurt someone else, and then it's basically a double whammy. If someone wasn't honest right on their application, so then that speaks to their integrity. So now you sort of got two things where we're like whoa, you didn't say that you did this, and then you did, and it's a significant thing.
Speaker 3:And then I would say that we also look at, you know the trajectory. If this was a one and done and the person has, like completely changed their life and turned around and done wonderful things, um then absolutely they are most likely going to be licensed and be you know, go on to get into the workforce. Yeah, I think that there's actually some legislation potentially coming about this type of thing and I know that in the past our rules were more stringent, so there used to be very specific crimes that were an absolute no-go, and I think we have loosened up the language. I would say I want to go back to maybe about 10 years ago, where we did go back and then say that's pretty heavy-handed. Maybe we can stick to the very significant things like felony, right yeah.
Speaker 2:Well, but Oregon does allow nurses to license if they've even if they've had a felony conviction.
Speaker 2:Oregon allows that because it is in Oregon and my understanding of the Nurse Practice Act, which is going to be another episode, you're thinking you thinking that this is like the best podcast you've ever heard. The answer is it is because the next episode we're going to listen to another episode about the nurse practice act. But my understanding is the nurse practice act in the state of oregon will allow you to practice even if you've had a felony conviction. It just depends on what the felony conviction is, and in the united states of america it's kind of rare. There's like very rare, like a lot of states won't you have a felony? That's an automatic. I don't care. I don't care if the felony is for marijuana possession and now oregon has legalized marijuana, now it's not a big deal. Felony possession, out you go, but in oregon we don't do that.
Speaker 3:No, we look really closely at the person, the candidate we look at. You know, usually they'll write a letter and they'll explain themselves. And again, we, regardless this all goes before the board and the final determination is made by the board, is made by the board. So, and again, we look for that nexus to nursing. Is there something that could be translatable to the profession? That's worrisome, and if there is, then we're going to err on the side of caution. Again, our job is to protect the public.
Speaker 2:Okay, so these top five. Thank you for sharing the top five. These are so, and I think I've been saying this wrong, but let me rephrase it to make sure that I'm saying it right. These are the top reasons for complaints against nurses, not necessarily convictions or any of that. These are the complaints that are filed. These are the top complaints that are filed, correct.
Speaker 3:Okay, that could potentially proceed to discipline.
Speaker 2:That could proceed to discipline. Okay, good to know. How do you get the reports in the first place, like a boundary violation or the improper conduct of the HIPAA violation. How do you get, how do you receive those, those complaints?
Speaker 3:Sure, so we have a place on our website so folks can digitally submit a complaint and, uh, it's an anonymous, um confidential process. We we appreciate it more if someone decides to state who they are so we can collect more information if it's needed, um, but it it can be completely anonymous and they're always confidential. We never share the source of the person who provides us with a complaint. So there's an opportunity to do that on the website, and then there's also an opportunity to do that via mail. You can do a handwritten concern and drop it into the mail to us and we receive complaints that way as well.
Speaker 3:And then another way that we get complaints, I would say, are interagency type of complaints. So, for instance, if it has something to do with the Department of Human Services and there's some crossover, or the Board of Pharmacy, there could be some crossover. They've identified something with some medications that doesn't sound right and they know that a nurse is involved, right, and sometimes it's the DEA, or it can be a criminal case that has come to light, and then they found out that this person is a nurse. So sometimes we get interagency referrals.
Speaker 2:From different places. From different places, interesting. Okay, let's say that I'm a nurse. I had a checkered past that wasn't completely expunged and I wasn't completely honest about what it was, because I was terribly embarrassed and a complaint has been filed against me. What can I expect?
Speaker 3:Um, well, let me, let me differentiate those two. So if you had a checkered past and we decided to let you be a nurse, those are like two separate issues, right, unless unless it has to do with an application. So it has to be an application and you weren't honest about your checkered past and we found out you have the checkered past. Um, then that's, that's a separate issue. But if you got through the the process with that checkered past, yeah, you're considered like every other nurse you have.
Speaker 2:You now have a level playing field and then check your past is like we know about it off you go yep treat the people kind of thing.
Speaker 3:We vetted it, go out there, do good work, okay, but if that same person winds up with a complaint, we don't look at that. We look at the complaint. We look at the person. Just like. Don't look at that, we look at the complaint.
Speaker 2:We look at the person just like we would look at anyone else.
Speaker 2:Okay, wait, let me. Let me rephrase this so that I have this in my brain. So here's me total checkered past. Apparently it has to do with vandalism using toilet paper, because maybe that's what we did. But let's say I've got, like I've got some criminal convictions of TP in people's houses. If I have applied for a nursing, if I apply for a nursing license, and you look at that and you're like, okay, we're going to let you. This is we as a board. We understand that this is what you've got going on and we're going to recognize that this there's no nexus to nursing. Please don't TP any nursing, any beds with patients in it. Don't do those things. But you should be fine and once that happens, we're good. Now, if I go and do and then I have, you know, something else comes up where you know, maybe I do start TPing a patient server or something like that. You're not going to go back and say, well, you know, this is what happened, because you've already made the decision. Is that right? Exactly Right.
Speaker 3:Exactly Right. Yeah, that's a. It's a completely separate issue. We're only looking at the complaint and, if it is has merit to it, and then regardless. And if it has merit to it, and then regardless, we're going to investigate it thoroughly. You're going to have the exact same due process as anyone else would have, and that's a piece of information. It is not something that would weigh into the situation at all.
Speaker 2:Okay, now if I was a new grad and I had this and I didn't say anything about it, that might be a different issue, because now maybe it's less about the fact that I've got all of these misdemeanors for toilet paper in people's houses, and now it's about that I wasn't willing to tell you about it. Then that becomes a problem. Is that what you're saying?
Speaker 3:Yes, but again it's on a scale right so like. So maybe maybe this young mind didn't realize that that is something brilliant, mind a young brilliant mind. Young brilliant mind had made a couple of not so great decisions, but did great decisions in nursing school and passed the NCLEX and, you know, filled out the form but missed the box.
Speaker 3:Benefit of the doubt, missed the box or did think, well, that's a pretty low thing. So I didn't report it. I didn't. I didn't think it was a big deal. Maybe that's why they didn't do it. Regardless't, I didn't think it was a big deal. Um, maybe that's why they didn't do it. Regardless, it's going to come up positive and so we're going to look at that information and it becomes a case. And so then, when it becomes a case, then it will be investigated, they will contact that that person and they'll give them the opportunity to answer that question, them the opportunity to answer that question. So what was this back in whatever year, where you had this experience and were arrested and you did not annotate that on your application? So we give them an opportunity to address it. And if it is something that seems like it was a very simple thing, that doesn't have a nexus to nursing where we would be very concerned about it, we'll close it and we'll say back to licensing, issue this license. It would cause a delay in that person getting licensed, unfortunately, right.
Speaker 3:So let's say, a normal person. A normal person, a person who doesn't have a criminal background check, who yeah, you got to take that out of there A person who doesn't have a background check issue is going to get licensed faster, right, because there's no delay in the process, right. But those folks, it automatically trips a case. It has to be investigated, assigned to an investigator, there has to be an interview and then also, you know, there's that. Now, if you also add on to that situation where, let's say, we do find out there's a nexus to nursing or there's some significant things that this person left out, then that's going to go in front of the board, okay, and then the board will ultimately make that decision.
Speaker 2:Sometimes, when I look in the back of the Sentinel magazine, I see advertisements for attorneys that are going to be trying to represent nurses. Are there situations where there should be an attorney that represents you or represents a nurse? If they have, if they've been, if there is a complaint against them.
Speaker 3:Everyone has the opportunity to seek counsel and to be represented. I think a lot of nurses choose not to be um because they think it's it's something that, um, they can work out with us. They can, uh easily have a conversation with an investigator and, you know, try to get to, you know, a discussion about what happened and maybe what they learned from their mistake, if it is a mistake and not.
Speaker 3:so not everyone chooses to get an attorney, um, but I again I just I need to say that everyone has the right to do that. I just sort of anecdotally, my experience at the board is sort of the more significant allegations or the more significant ramifications of potential discipline. We certainly see more attorneys involved at that level. But there are things that you know we don't have an attorney involved in the process at all.
Speaker 2:So probably in our hypothetical example of the serial house toilet paper, maybe not. That's something a little bit more complicated than maybe. So, okay, where do people find out about disciplinary reports and actions and investigations and all of that? Where do you learn more about that if you are interested in?
Speaker 3:it. Most discipline is public. There are a couple options of discipline that we do, like a letter of concern that we would send to a nurse, that would not be made public. But all the other levels of discipline for the most part are public and so those are then actually annotated on the licensee's record and when you do a license verification page check the information is there. It is also available on that last page of the Sentinel. We publish that information there that has to do with public law and a requirement of the licensing boards. We all have that responsibility and requirement and then we also publish it on the website, as do the other health licensing agencies.
Speaker 2:That was going to be. My next question is why does it need to be public?
Speaker 3:Well, yeah, it's a part of statute and it is allowing the public to know that they're, you know, the person who's taking care of them at whatever level has been held accountable, and it gives the public the right to look up their care provider. Interesting.
Speaker 2:Okay, great. Well, that's all I got. Any last thoughts about discipline in the state of Oregon.
Speaker 3:I guess the other thing that I want to say and I don't want to say this as like a scary thing, but it sort of is what it is.
Speaker 3:So everything is Google searchable these days.
Speaker 3:That's hard right, because it's out there and it's always going to be out there, but on the other hand, you know, again, it is a requirement.
Speaker 3:It is why, at the end of the day, the board of nursing is here and we take what we've learned from these discipline cases and we turn that around into education. We do our best to analyze where nurses are falling down and try to get that out to nurse educators and say hey, can you talk about boundaries? Can you talk about this practice issue that we've seen come up? You know more than we thought we would see it. So we do use this data to try to to try to make us better and more informed as nurses and also, again, to the rest of the nurses in the state and even on the national level. So if there are, you know, themes, areas where we see, you know this is happening again and again, we do use that for good and I think that those are good lessons learned for all of us. And so, ending on a positive note in regards to discipline, I'd like to leave it there.
Speaker 2:Yeah, that's great, all right. Well, that's it for today, sarah. Dr Wickenhagen, thank you so much for being here. I think a big takeaway from this is that practice practice issues not the number one reason for people getting into some challenges or getting complaints. That might lead to discipline. So good to know. Thank you, all right For the rest of you.
Speaker 2:Thank you for listening to another fabulous episode of the State of Wellness, our podcast for Oregon nurses. Don't forget to subscribe wherever you listen to any of your favorite podcasts so you don't miss any future episodes. Never mind that I'm probably going to be talking about this with everybody and please just help me out, because otherwise the main listener for this podcast might be my mother and while I love her, I'd love for other people to listen to. So subscribe so that you can hear us. There's going to be some show notes in this episode with some contact information for Dr Wickenhagen.
Speaker 2:If you listen to something you're like, wait a second, I want to follow up on that one piece you can email her. You can also get a link to the board of nursing and any other information about that. You can also go and you can get all of this over at the oregoncenterfornursingorg. While you're there, if you have an idea of something else you want to talk about, hit us up. We totally want to know if you've got a good question that you want to learn more about. Topic ideas, recommendations for special guests we we're here for it. So check it out and until next time, stay well.
Speaker 1:Thank you for joining us on the State of Wellness podcast, and if you need more information, show notes, past episodes or resources, go to OregonCenterForNursingorg and subscribe wherever you listen to your favorite podcasts so you never miss a future episode.