The RN Retaliatory Gross Negligence or Incompetence Complaint to the BRN

Registered nurses assume that if they are careful in their charting, careful giving and wasting medication, fastidious in following doctor’s orders and if they are good nurses loved by their patients, they won’t ever have to worry about the Board of Registered Nursing (BRN). They are wrong. In the last few days, I have received as many calls from nurses telling me that there was an Incompetence Complaint to the BRN made purely out of retaliation or maliciousness by a colleague or supervisor.

One such RN was working at a rehab facility. The medications being ordered and administered are all schedule 2s, 3s or 4s. Because of this, there was an internal policy within the facility that charts were not allowed to be amended under any circumstances. On a verbal order from the doctor, a dose was changed for a patient. The correct dose was given to the patient by the correct route at the correct time, but the nurse could not change the chart to reflect this, because of the internal policy. There were witnesses attesting to the verbal change and correct administration. All of this seems pretty above board, right? Why would this nurse have anything to worry about?

A few weeks prior, the new supervising RN had been questioned by Corporate for patient care issues stemming from her newly implemented policies. Other nurses were questioned as well. The gist of the matter was that the new supervising nurse had instituted a policy that resulted in a number of patient falls and the nurses questioned simply told the corporate team that this policy was causing the falls. The supervising nurse then retaliated against every one of the nurses who were questioned and said- and I quote- “I am going to make sure you lose your nursing license.” Then she complained to the BRN of the RN’s charting “errors”. This is an icompetence complaint to the BRN.

Now for any schedule 3 or 4 medication missing, there is always the possibility that the accused nurse will be reported to the district attorney as well, and investigated for criminal allegations. This occurred in this case. The DA contacted the RN and questioned her about the medication discrepancy, and of course they found nothing and the matter is being dropped entirely without merit. But that is not this nurse’s concern; her concern is the BRN investigation and there will be one.

When the BRN receives a complaint, it is their duty to look into it. The BRN is a branch of the California Department of Consumer affairs and their most important function is to protect the public from dangerous nurses. So, when they receive a complaint about a discrepancy in a schedule 4 med, they are going to assign it to an investigator and the nurse’s charts will be reviewed and an in person interview with the nurse scheduled. Missing medications or charting mistakes if they “fail to exercise that degree of learning, skill, care and experience ordinarily possessed and exercised by a competent nurse” can rise to the level of incompetence. An “extreme departure” can rise to the level of gross negligence. So here is the conundrum that this poor nurse faces: even though she followed facility protocol, followed all the orders and by appearances did everything perfectly, if the BRN can show that she “failed to exercise that degree of learning, skill, care and experience ordinarily possessed and exercised by a competent nurse,” they can still pin an incompetence Accusation on her. (For more on Gross Ngeligence or Incompetance complaints to the BRN, go here.)

We have never had a RN client have their RN license revoked for an incometence complaint to the BRN like this, so I don’t think that the nursing supervisor’s threat of “I am going to make sure you lose your nursing license,” will stand. Personally, I don’t think that this will rise to the level an accusation even being filed, but it is a possibility. What is evident is that because of pure retaliation and maliciousness on the part of an angry supervisor, this good and careful nurse is going to have to defend herself. Simply because she advocated for the safety of the patients in her facility and stated that a policy change was likely causing them to fall, she is going to incur legal fees and stress and uncertainty as this long process plays out.

What’s the moral of this story… I don’t know? It can’t be that you shouldn’t stand up for your patients or decline to speak out against a supervisor if they are in the wrong and causing patient harm, can it? That is fundamentally against everything nursing stands for. The take away cannot be that you don’t work with rehab patients or around controlled substances, because then who would care for these people? It cannot be that you refuse to abide by a verbal order because it may cause harm to you professionally down the road. I suppose the lesson to be learned in this nurse’s story is that every single nurse is a potential target for BRN action because all it takes to get the BRN involved is a complaint alleging a charting mistake and that complaint can be made by anyone, including a vindictive and  malicious colleague or supervisor.

I look forward to helping this nurse through this process and exonerating her completely. I feel like the best possible way to get back at the supervising nurse is to prove her totally wrong.