Nurse Practitioner Case Studies: State Board of Nursing matters involving allegations of a clinical and non-clinical nature

Advanced Practice Registered Nurses and License Protection Case Studies with Risk Management Strategies, Presented by NSO

A regulatory board complaint may be filed against an advanced practice registered nurse (APRN) or nurse practitioner (NP) by a patient, colleague, employer, former employer, and/or regulatory agency. Allegations in these matters may be directly related to the APRN or NP’s clinical responsibilities and professional services, although they may be of a nonclinical nature as well.  For example, such complaints may assert unprofessional behavior, substance abuse, or billing fraud. Complaints are subsequently investigated by the State Board of Nursing (SBON), leading to outcomes ranging from no action against the APRN or NP to revocation of their license to practice. The following scenarios highlight the risks posed to an APRN or NP’s license apart from clinical practice issues.

Summary – Case Study

This case involves an NP working as a primary care provider (PCP) at a family practice clinic in one state and living in a neighboring state. The insured was privileged to practice nursing in states which were a part of the Interstate Nurse Licensure Compact as registered nurse and was licensed to practice as an NP in two of those adjoining states. 

The insured was off-work and attending a sporting event for one of his children. During the event, the NP was approached by another parent who worked in the billing department of the clinic. The two were sitting together in the stadium when they began discussing clinic patients’ protected health information (PHI).

Unbeknownst to the insured NP and the clinic employee, a family member of one of the patient’s discussed (Patient A) was sitting close enough to hear the information they were discussing. While no disparaging remarks were made, the family member overheard information that had not been disclosed to anyone within the family.

Patient A was contacted by the family member and disclosed the healthcare information overheard from the NP and clinic employee as well as the information on other patients (Patient B, Patient C, Patient D, Patient E, Patient F, and Patient G). The patient, upset with the PHI breach, reached out to the other patients via social media and notified them of the information that had been shared. Three of the patients contacted the clinic’s office manager requesting an investigation into the incident and appropriate disciplinary actions to be taken against both employees. All seven patients transferred their primary healthcare to other PCPs in the area and collectively reported the breach in privacy to the SBON. 

The NP had been employed at the clinic for more than eight years and a practicing NP for over 20 years. Prior to the incident, the NP had a positive online clinical reputation and was highly regarded among colleagues. The decision was made to terminate the NP’s employment at the clinic due to the unauthorized disclosure of PHI. The SBON opened an investigation into the NP’s action based on the complaint filed by the patients and the employment termination.

The NP was able to produce letters of support and recommendation from colleagues attesting to his professionalism. The NP also worked with his attorney to formulate a letter expressing his regret regarding the incident, including other mitigating circumstances in this case.

The SBON found sufficient evidence that the NP had violated patient confidentiality and acted in a manner that was unprofessional. For the purpose of avoiding further administrative action, the NP agreed to voluntarily surrender his NP certificate in the state where the clinic is located as well as the multistate privilege to practice as a registered nurse. The NP was assessed a civil penalty to be paid in full within 24 months for each patient whose PHI was improperly disclosed and ordered to pay the SBON’s investigation expenses and any court cost the board incurred. Expenses paid to defend the insured NP in this matter totaled more than $7,000.

Risk Management Comments and Recommendations

Below are some proactive concepts and behaviors to include in your practice to help mitigate the risk of SBON matters:

  • Know state requirements regarding protected health information.
  • Hold all conversations with or about patients in a secure area. Never discuss protected health information in an area where a conversation could be heard by passersby (i.e., elevators, cafeterias, public areas).
  • Practice within the parameters of your state nurse practice act, in compliance with organizational policies and procedures, and within the standard of care.  If regulatory requirements and organizational scope of practice differ, comply with the most stringent of the applicable regulations or policy. If in doubt, contact your SBON or specialty professional nursing association for clarification.
  • 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.
  • Finally, immediately contact your professional liability insurer if you:
    • Become aware of a filed or potential professional liability or license protection matter against you.
    • Receive a subpoena to testify in front of the SBON.
    • Have any reason to believe that there may be a potential threat to your license to practice nursing.
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