As a registered nurse and nurse practitioner, your first clue that the Board of Registered Nursing may be getting involved with your NP license, starts with your employer placing you on administrative leave while they conduct an internal investigation into charting mistakes or missing medications. If you are a nurse practitioner who has been placed on administrative leave pending an investigation by your employer, there are a few things you must know.
CHARTING ERRORS TRIGGER EMPLOYER INVESTIGATIONS
While there is probably not a nurse on the planet who has not made a few charting errors in their career, your employer will investigate multiple charting errors, especially if they involve medication. I have seen nurse practitioners placed on administrative leave by their employers pending an investigation for as few as four charting errors. While this is not typical, and usually an employer will overlook such a minor mistake with a valid explanation, it does happen. Missing medications are a huge liability for a hospital and so any NP who cannot account for medications is a huge liability as well. Charting errors that trigger employer investigations include:
- not wasting a medication with a witness
- giving a medication on an expired order
- failing to document a verbal order for a medication
- giving the wrong dose of a medication
- giving the wrong medication
- failing to give the medication within the timeframe required
- pulling medication too early or giving more medication than your co-workers.
- writing prescriptions for oneself or a family member or co-worker.
The employer will place you on administrative leave while they look into your charts and determine if there are enough discrepancies to warrant disciplinary action against you. Calling you into a meeting for an interview is typically the final step in this process.
There are only 2 reasons that you are being questioned and investigated by your employer. You must know this, as painful as it may be to hear.
- There are medications missing and they need you to explain them to cover their own behinds and are planning on keeping you as an employee.
- There are medications missing and they need a scapegoat. They are gunning for you and you are going to be terminated.
Unfortunately, Number 2 is far more frequent than Number 1.
THE EMPLOYER INTERVIEW
If you are a member of a Union, please make sure to take your union representative to your meeting with your employer. You are going to be asked to explain each of the charting errors or medication discrepancies. Sometimes the charts in question can be months old, so you may not be able to remember or recall exactly what happened. Even if you can explain each and every discrepancy, you may be unintentionally admitting to practicing incompetently or negligently for failing to properly chart or document.
YOU WILL BE ACCUSED OF DIVERTING MEDICATION
At some point during the interview, you will likely be accused of diverting the medication. Your employer may ask you to submit to a drug test, but more likely, they will not. You may even offer to take a test, and they may tell you it isn’t necessary. DRUG TESTING IS ALWAYS NECESSARY IF YOU ARE SUSPECTED OF DIVERSION, and in virtually every case I’ve seen, missing medications lead to an accusation of diversion.
Please, immediately go get a drug test on your own. If the medications or charts in question are more than a few months old, you will need a hair follicle test to prove those medications are not in your system. This will eliminate any allegation of diversion, but you will not be in the clear with your employer or with the BRN.
TERMINATION OR RESIGNATION
If the employer determines that your charting issues rise to the level of violating policy or procedures, you will likely be terminated or asked to resign in lieu of termination. If you are unionized, please grieve this, it looks better down the road to the BRN. Once you have been terminated from the job, the employer will report their findings to the BRN. They will. They absolutely will. And the BRN will absolutely investigate it on their own. However, if you are not terminated or asked to resign, and are simply placed on an improvement plan or reprimanded in your file, it is likely that that the matter will not be reported to the BRN.
BRN INVOLVEMENT FOLLOWING EMPLOYER INVESTIGATION
It takes a long time for the BRN to contact you following a report from an employer, usually a year or more. You may get an offer to participate in the BRN’s Diversion or Intervention program a few weeks or months following the employer investigation, but this is not the last you will hear from the BRN (more on Diversion here.)
Many nurse practitioners wrongly assume that if the BRN hasn’t contacted them within a few months, they are in the clear. The BRN is a slooooooooow and bogged down government entity – think of them as the DMV on Ambien. On top of that, they do not have any statute of limitations or requirements to handle a case within a specified time frame. It usually takes the BRN about 6-9 months to even assign the case to an investigator and you are the last person the investigator will talk with before they conclude their investigation.
There is a great deal of information on this blog regarding the BRN investigation. Please familiarize yourself with the process, so you know exactly what to expect and what to do when the investigator contacts you. Click here.
WHAT YOU CAN DO TO PROTECT YOURSELF
If you have been placed on administrative leave by your employer pending an investigation into charting errors involving medication, know that there is a high likelihood that the BRN is going to be involved in the case at some point. As mentioned, there are a few critical steps you can take to protect yourself at this stage:
- Understand that every single statement you make with your employer is admissible and will be passed along to the BRN. These are not casual conversations. Be incredibly cognizant of your words and any and all admissions of mistakes.
- Take a representative with you to your employer interview.
- Do your best to explain every single charting discrepancy.
- Following the employer interview, write down everything you remember from the interview, including what meds were missing, the dates, the patients, the circumstances and anything else. You will not be given this information for another year or so and it will happen when you are under the pressure of a BRN investigation. Be prepared.
- GO GET A DRUG TEST ON YOUR OWN!!!!!!
- Attempt to get a statement form a co-worker that the policy or procedure you are being accused of violating is in fact common practice, or is typically overlooked by the employer.
- If you resign or are terminated, go get another job as soon as possible. Your employment and performance is truly your best defense against adverse action from the BRN in the future. Also, at this point there is nothing on your RN license that precludes you from working, so take the opportunity while your license is still free and clear and unencumbered.
- Have RN Guardian on speed dial for when the BRN contacts you asking you for an interview or requesting an Authorization for Release of Records.
- This one sounds overtly self-serving, but please talk to an attorney before you go to the BRN interview or sign the release. Once you’ve spoken to the BRN investigator, the case is over and done with and there isn’t anything we can do to help you other than save your license from being revoked down the line.
If you are reading this post after having been notified that you’re being investigated by your employer, you have a leg up on most nurse practitioners. You know the reality of the situation with your employer. You know that you are probably going to be reported to the BRN and you know to how to prove that you didn’t divert medications.
If you would like to speak with me about your case, please give me a call or fill out the form below and I will be in touch for a confidential and complimentary consultation. We have made it our career to protect yours.