A State Board of Nursing (SBON) complaint may be filed against a nurse by a patient, a patient’s family member, colleague, employer, and/or other regulatory agency, such as the Department of Health. Complaints are subsequently investigated by the SBON to ensure that licensed nursing professionals are practicing safely, professionally, and ethically. SBON investigations may lead to outcomes ranging from no action against the nurse to revocation of the nurse’s license to practice. Therefore, when a complaint is asserted against a nurse to the SBON, the nurse must be equipped with the resources to adequately defend the matter. Being unprepared may represent the difference between a nurse retaining or losing their license. This case study involves a registered nurse (RN) who had been working on an adult medical surgical unit of a regional hospital.
Summary
The insured registered nurse (RN) typically worked as the Charge Nurse on the nightshift (7:00 p.m. to 7:00 a.m.) on an adult medical surgical unit. When he arrived at work, he was notified that the nightshift would be short staffed by two nurses until 11:00 p.m. at which point two agency RNs were scheduled to arrive. While the hospital did not have a standardized staffing policy, this unit’s staffing was typically one nurse per six patients, Typically, charge nurses were not assigned direct patient care, but due to the unit being short of staff, the insured assigned himself eight patients from 7:00-11:00 p.m. The agency nurses, who had previously worked on the unit, arrived at 10:45 p.m. Once the agency nurses received patient report, they assumed care of their assigned patients.
While documenting the 11:00 p.m. vital signs and assessment findings, one of the agency nurses noticed that many of the required patient assessment fields in the electronic health record for 11:00 p.m. had already been completed. The timestamps for both the 7:00 p.m. and 11:00 p.m. assessment fields were 8:45 p.m. and entered by the insured. The agency nurse relayed her findings and concerns regarding the pre-charting to the insured in the presence of other staff. Their conversation quickly escalated with both individuals raising their voices and engaging in personal attacks.
Several staff reported the event to management which led to the agency nurse losing her subsequent shifts at the hospital and the insured receiving a written reprimand. The insured responded to the written reprimand positively as he knew pre-charting was against hospital policy. He reported that he only pre-charted due to being short-staffed and to help the nurses that would take over for him when other staff arrived. He agreed that he let his emotions get the best of him during the conversation with the agency nurse. He agreed to attend a conflict management course to improve his management skills.
Risk Management Comments
A few months after the incident, the insured received a letter via his email from the SBON regarding a complaint against the insured nurse regarding his documentation practices. The letter stated that the insured had fabricated and falsified information in the medical records of several medical/surgical patients. The SBON requested the insured provide the following information within three weeks of receiving the SBON’s letter:
- A current job signed description
- Most recent employment evaluation
- Provide any personal communications to you from your employer regarding this allegation
- Complete a Declaration Statement Form by detailing his explanation to the allegations
Resolution
After reviewing the complaint, the SBON closed the investigation without any action taken against the insured. However, the SBON’s investigation lasted over two years and the total incurred to defend the RN in these matters exceeded $8,000.
(Note: Figures represent only the defense expense payments made on behalf of the insured nurse.)
Risk Control Recommendations
Nurses may utilize the following risk control recommendations to evaluate their current practices:
- Review and follow the American Nurses Association’s Code of Ethics. Nurses have an ethical and moral duty to maintain and improve the ethical environment of the work setting that affects nursing care and the well-being of nurses.
- Follow documentation standards established by professional nursing organizations and comply with your facility’s standards. The healthcare information record should accurately reflect the care of the patient.
- Document your patient care assessments, observations, communications and actions in an objective, timely, accurate, complete, appropriate, and legible manner. Always use complete, objective descriptions of nursing assessments and observations.
- Conduct a comprehensive patient assessment. If an assessment cannot be completed, document the interventions taken. Document patient complaints or concerns in the patient’s healthcare information record, as well as all steps taken to resolve them.
- Communicate in a timely and accurate manner both initial and ongoing findings regarding the patient’s status and response to treatment.
- Initiate additional steps, if necessary, to ensure timely patient care. These measures may include, among others, escalating to the supervisor/nurse manager, administrators, attending or covering physician, licensed independent practitioner, and/or medical staff leadership until patient care concerns are addressed.
- Maintain files that can be helpful with respect to your character. Retain copies of letters of recommendation, performance evaluations, thank-you letters from patients, awards, records of volunteer work and continuing education certificates.
References:
American Nurses Association. (2025). Code of Ethics for Nurses. Silver Spring, MD: American Nurses Association.
Disclaimers
The information, examples and suggestions presented in this material have been developed from sources believed to be reliable as of the date they are cited, but they should not be construed as legal or other professional advice. CNA, Aon, Affinity Insurance Services, Inc., NSO, or HPSO accepts no responsibility for the accuracy or completeness of this material and recommends the consultation with competent legal counsel and/or other professional advisors before applying this material in any particular factual situations. This material is for illustrative purposes and is not intended to constitute a contract. Please remember that only the relevant insurance policy can provide the actual terms, coverages, amounts, conditions and exclusions for an insured. All products and services may not be available in all states and may be subject to change without notice. Certain coverages may be provided by a surplus lines insurer. Surplus lines insurers do not generally participate in state guaranty funds, and insureds are therefore not protected by such funds. The claims examples are hypothetical situations based on actual matters. Settlement amounts are approximations. Certain facts and identifying characteristics were changed to protect confidentiality and privacy. Any references to non-CNA, non-Aon, AIS, NSO, and HPSO websites are provided solely for convenience, and CNA, Aon, AIS, NSO and HPSO disclaim any responsibility with respect to such websites. “CNA” is a registered trademark of CNA Financial Corporation. Certain CNA Financial Corporation subsidiaries use the “CNA” trademark in connection with insurance underwriting and claims activities. This material is not for further distribution without the express consent of CNA. Copyright © 2025 CNA. All rights reserved.
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