Nurses who familiarize themselves with the nuisances of the Alabama Nurse Practice Act and accompanying Administrative Code often are able to stay out of trouble with the state Board of Nursing. Here are some situations for contemplation:
A Director of Nursing discovers narcotics missing from a storage area. The DON looks at charts and staffing and comes to the conclusion that two RNs and two LPNs had access to the cabinet when the drugs were believed taken. The DON asks all four to immediately submit to a drug screen. One RN, knowing that she did not take any medications and a little angry that after years of dedicated service in which she had access to narcotics, that she would even be asked to take a drug test, refuses out of principle. Later, another employee admits to taking the drugs. Can the RN who refused to take the test be disciplined by the Board of Nursing for her refusal?
The first issue is whether an employer can even require an employee to submit to a drug test. Normally, private employers can require drug tests and public employers can with probable cause. And in this case, the employer no doubt would be justified in asking for the drug screen.
But then could the Board of Nursing discipline a nurse for refusing a screen, even though she did not take any medications? Absolutely, and the Board no doubt would find a rules violation.
Alabama Rules of Administrative Procedure for the Board of Nursing states that a nurse may be disciplined for refusing to take a “for cause” drug screen. Normally, no Board action is in order if a nurse refuses to take a random screen, although the employer might discipline the employee if random screening was included in the facility policy.
When narcotics are missing, certainly the drug screen would be “for cause.” The RN, though innocent and acting out of principle, could and would face disciplinary action from the Board of Nursing if the incident is reported.
A Director of Nursing learns of a records falsification by a young nurse, who is petrified of having made a mistake. The patient suffered no harm, his excellent care unaffected by the error. The DON. fears the young nurse will actually leave the profession if a big deal is made of the incident. The DON debates whether to report the matter to the Alabama Board of Nursing and finally decides against reporting. Can the DON be disciplined for fairing to report?
Yes. The Administrative Code requires licensees to report “illegal, substandard, unethical, unsafe, or incompetent nursing practice directly to the Board of Nursing.” Falsification is serious enough that the Board may well consider failure to report by the DON of a magnitude to warrant disciplinary action.
The young nurse who falsified the records obviously needs to learn better practice habits. Often a chart can be corrected later without necessity of falsification. A wiser route for the young RN would have been to speak with a supervisor before the records were altered.
Directors of Nursing are placed in ever more perilous positions these days. They don’t want to run to the Board with every minor infraction, but they don’t want to get into trouble themselves either. A couple of years ago, the Administrative Code was amended to ensure that the reporting would be directly to the Board of Nursing. Previously, the section stated that unsafe practices were to be reported to the proper “authorities.”
The key is knowledge and education. Know the law and fall back on that knowledge from nursing school and continuing education classes. And if you are unsure whether a particular act is permissible, ask someone who does know.
Knowledge, advice and common sense can keep that precious license safe.
Why I Became a Nurse
To do what nobody else will do, in a way that nobody else can do, in spite of all we go through, that is to be a nurse.
~ Rawsi Williams, RN, BSN, CQRMS-LTC
by Don Eddins, BS, MS, JD
Attorney at Law
Dow Eddins, BS, MS, JD, is a practicing attorney in Auburn, Alabama, and serves as legal counsel to the Alabama State Nurses Association. Every ASNA member is entitled to a one-hour free consultation on any legal matter. Call the ASNA office or e-mail him at firstname.lastname@example.org.
Copyright Alabama State Nurses’ Association Mar-May 2004
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