Reporting Incompetent, Unethical or Illegal Practices

The Code for Nurses with Interpretive Statements (ANA, 1985) states that nurses as client advocates act “to safeguard the client and the public when health care and safety are affected by incompetent, unethical, or illegal practice by any person.” Incompetent nursing practice is measured against nursing standards, unethical practice is evaluated by the Code for Nurses, and illegal practice is identified in terms of violations of the law.

Reporting Responsibilities and Guidelines
If a nurse is aware of inappropriate or questionable practice in the provision of health care, concern should be expressed to the person carrying out the questionable practice. If indicated, the practice should then be reported to the appropriate authority within the agency or larger system. There should be an established process for reporting and handling incompetent, unethical or illegal practice within each employment setting so that such reporting can go through official channels without causing fear or reprisal. Written documentation of the observed practices or behaviors must be available to the appropriate authorities. If the incompetent, unethical or illegal activity is not corrected within the employment setting and continues to jeopardize the client’s welfare and safety, the problem should be reported to other appropriate authorities such as the Missouri State Board of Nursing.

Responsibilities of the Missouri State Board of Nursing
The law provides fourteen grounds to deny license or discipline the license of an RN or LPN:

• Impairment from alcohol and/or other drug use;
• Criminal prosecution;
• Use of fraud, deception, misrepresentation, or bribery in securing certificate of registration of license;
• Incompetence, misconduct, gross negligence, fraud, misrepresentation, or dishonesty in the performance;
• Obtaining or attempting to obtain composition by fraud, deception or misrepresentation;
• Violation of, or assisting or enabling any person to violate provisions of practice act;
• Impersonation of any person holding a certificate of registration or license, or allowing another person to use your license;
• Disciplinary action against the holder of a license granted by another state;
• Judged insane or incompetent by court;
• Assisting or enabling any person to practice who is not eligible;
• Insurance or license based upon inaccurate fact;
• Violation of professional trust or confidence;
• Use of advertisement or solicitation which is false, misleading or deceptive;
• Violation of the drug laws.

The Board’s disciplinary responsibilities include:

• Reviewing and investigating complaints concerning licensed nurses, nurses in the licensure process, and nurse impostors;
• Determining disciplinary action after cause for discipline has been established;
• Monitoring disciplined licensees.

The State Board of Nursing must receive and process each complaint made to them. Any member of the public or profession, state or local official may make a complaint to the Board.

Complaints must be made in writing and mailed or delivered to the Executive Director of the Missouri State Board of Nursing. A complaint may be made based upon personal knowledge or upon information and belief, reciting information received from other sources. All complaints must fully identify the complainant by name and address. Forms are available from the Board by request.

Each complaint received shall be acknowledged in writing and the complaintant will be informed as to whether the complaint is being investigated and of any disciplinary action taken. The complaint and any information obtained as a result of the investigation of the complaint are not available for inspection by the general public.

The following actions may be taken by the Board:

Non-disciplinary

• No Further Action: no disciplinary action taken against the nurse’s license. A copy of the complaint and action taken kept in licensee’s file;
• Letter of Concern: no disciplinary action taken against the nurse’s license. A letter is sent to the nurse expressing their concern about the alleged behaviors in violation of Nurse Practice Act. Copy of complaint and action taken kept in licensee’s file.

Disciplinary

• Censure: Letter sent to nurse indicating there has been a violation of the Nursing Practice Act. Copy of letter kept in licensee’s file;
• Probation: Nurse allowed to practice but must meet certain conditions and terms;
• Suspension: The nurse is prohibited from practicing nursing for a period of time not to exceed three years;
• Revocation: The nurse loses his or her license and can no longer practice in the State of Missouri;
• Other: The board may impose the above disciplines singularly or in combination.

For questions related to disciplinary matters, contact the State Board of Nursing. (see resource section)

References
American Nurses Association. (1985). Code for Nurses with Interpretive Statements. American Nurses Association Publishing Company.

American Nurses Association. (1994). Guidelines on Reporting Incompetent, Unethical, or Illegal Practices. American Nurses Association Publishing Company.

Chapter 335, RSMo-State of Missouri Nursing Practice Act.

Missouri State Board of Nursing. (1997). Discipline Information Packet.

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