5 Common Reasons Nurses Face Board Investigations — And How to Respond
Matt
Founder of BoardWise
For nurses, a complaint filed with the state board of nursing can feel overwhelming. A single letter of investigation has the potential to impact a career built on years of education and service. While each case is unique, there are recurring themes that frequently trigger board inquiries. Understanding these common reasons—and how best to respond—can help nurses protect their licenses and their livelihood.
1. Medication Errors
Medication errors remain one of the most common causes of board investigations. Mistakes may include administering the wrong medication, incorrect dosages, or failure to follow documentation protocols. Even a single error, particularly if it results in patient harm, can lead to disciplinary review (National Council of State Boards of Nursing [NCSBN], 2021).
How to respond: Nurses should document the incident accurately, cooperate with any internal investigation, and show evidence of remedial training or continuing education in medication safety.
2. Impaired Practice (Substance Use or Fatigue)
Boards frequently investigate allegations of nurses practicing while impaired, whether due to drugs, alcohol, or even extreme fatigue. The opioid crisis has heightened scrutiny on controlled substance handling, and diversion allegations are increasingly common (Thomas & Siela, 2020).
How to respond: Seek professional evaluation or treatment if substance use is a concern. Nurses should also highlight proactive steps taken—such as participation in alternative-to-discipline programs—to demonstrate accountability and commitment to safe practice.
3. Boundary Violations
Professional boundaries protect both patients and providers. Allegations may include inappropriate personal relationships, breaches of confidentiality, or misuse of social media (NCSBN, 2018).
How to respond: Maintain clear, professional boundaries in all patient interactions. If investigated, emphasize adherence to HIPAA and workplace policies, and consider additional ethics training to strengthen professional standing.
4. Failure to Document or Communicate
Accurate, timely documentation is critical for patient safety and continuity of care. Failure to chart properly—or to communicate essential patient information—can result in investigations for negligence (American Nurses Association [ANA], 2021).
How to respond: Provide evidence of corrective action, such as improved charting practices or enrollment in documentation-focused continuing education. Highlight systems issues if applicable, while still demonstrating personal accountability.
5. Criminal Charges or Off-Duty Conduct
Boards of nursing often investigate nurses for arrests, convictions, or other off-duty conduct that may reflect on professional fitness. Even charges unrelated to nursing, such as DUI, can trigger review (Spector et al., 2022).
How to respond: Report charges to the board when required, disclose mitigating circumstances, and provide evidence of rehabilitation. Letters of support from employers or supervisors can also help demonstrate continued trustworthiness.
Key Takeaways
- Complaints often arise from errors, impairment, boundary issues, documentation lapses, or criminal charges.
- Boards focus on protecting public safety, not punishing professionals.
- A thoughtful, documented, and timely response is crucial to protecting your license.
Nurses facing investigations should avoid panic, focus on transparency, and seek structured guidance on drafting responses.
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American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). ANA.
National Council of State Boards of Nursing. (2018). A nurse's guide to professional boundaries. NCSBN. Retrieved from https://www.ncsbn.org/public-files/ProfessionalBoundaries_Complete.pdf
National Council of State Boards of Nursing. (2021). Medication errors and nursing practice. NCSBN. Retrieved from https://www.ncsbn.org
Spector, N., Silvestre, J., Alexander, M., & Treston, C. (2022). Trends in nursing regulation: The impact of criminal conduct on licensure. Journal of Nursing Regulation, 13(1), 14–23.
Thomas, C. M., & Siela, D. (2020). The opioid crisis and nursing: Implications for practice, education, and policy. Journal of Addictions Nursing, 31(3), 151–158.
