Protecting Your Nursing License: Learn Why Nurses Lose Their Licenses and What to Do About It

Congratulations on earning your nursing license! You are now a member of an elite profession that involved jumping many hurdles to reach your goal:

• Getting accepted to nursing school is extremely competitive. The American Association of Colleges of Nursing (AACN) reports that in 2019, 80,407 qualified applicants were turned away from programs. You were accepted!
• The Nursing Standard and Health Foundation found that since 2006, 25% of nursing students quit or suspended their studies. You stuck with it!
• Nursing is one of the most difficult baccalaureate degrees. The curriculum involves mastery of sciences, social sciences, and extensive clinical practice. You succeeded!
• Even with intense study, not every graduate nurse will pass their NCLEX . The National Council of State Boards of Nursing (NCSBN) releases NCLEX passing rates every year. In 2020, the average passing rate for U.S. educated candidates is 85%. You did it!

You will be a healthcare professional for the rest of your life. Now you can turn your attention to safeguarding your status and livelihood. Remember that your license is a revocable privilege, so protect it from the very first day you earn it.

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Getting started: Do these right away

It’s important to lay the foundation to protect your nursing license. These four actions will set up your “safety net” for the future. Once they’re in place, all you have to do is maintain them.

Professional Liability Insurance: If you haven’t already purchased it, apply today. Perfection in clinical settings is impossible and even experienced nurses can make mistakes. Even if you’re not guilty of an allegation, you must defend yourself if you are accused. You’ll need an attorney skilled in representing nurses. The average malpractice claim is $164,586, while professional liability insurance is about $110 per year.

Nursing Portfolio: Begin to gather and organize all relevant documents pertaining to your education, employment, certifications, and skills. Ideally, you started your portfolio before your graduation and will continue to add to it throughout your entire nursing career. It’s never too late to create a nursing portfolio; it’s evidence that you have followed all standards and have continued to obtain training over the years.

State Board of Nursing: Become familiar with your state’s Board of Nursing (BON) website. You are responsible for knowing and understanding the BON requirements, so it’s wise to check the website every six months—put it on your calendar. The BON website will tell you:

• Nurse Practice Act
• Scope of Practice
• Definition of professional misconduct
• Self-reporting obligations
• Posted disciplinary actions
• Proactive alerts and announcements
• FAQs

NURSYS: Create an account at NURSYS.com to monitor your license. It’s free and easy to enroll. You’ll be notified about your license status and renewal date. It helps with instant verification for employers and when applying in other states. NURSYS was established by NCSBN. It’s the only national database for verification of nurse licensure, discipline and practice privileges for RNs, LPN/VNs and APRNs licensed in participating jurisdictions, including Nurse Licensure Compact (NLC) states. NOTE: California, Michigan, and Pennsylvania do not participate.

On the job: Be proactive and transparent

No matter what area of nursing you choose, you should be as passionate about protecting your license as you are about providing excellent care. Being proactive can help you sidestep some risky situations. Some examples:

• Know the Nurse Practice Act (NPA) for your state. It will guide you if you’re faced with a task or a conflict that could jeopardize patient safety.
• Don’t hide or deny mistakes. Nursing is a complicated profession and clinical errors happen. Lying can be considered an indication of poor moral character, something your BON can discipline. Your liability insurance provides coverage and legal defense.
• Be assertive with managers and physicians. If you have a concern, don’t be timid.
  • Engage the chain-of-command
  • Pursue your concern until it’s resolved
  • Document, document, document
• Monitor the performances of your assigned delegatees. The nurse retains responsibility for the patient, so they should be aware of the scope of practice and competencies of staff when making assignments. (Read the National Guidelines for Nursing Delegation)
• Recognize fatigue, as well as your physical limits. Exhaustion—both mental and physical—can compromise patient care, cause mistakes, and lead to accidents. The American Nurses Association (ANA) states, “…nurses are accountable for their practice and have an ethical responsibility to address fatigue and sleepiness in the workplace…”
• Stay educated in your specialty and on current nursing topics. Learning doesn’t end with your degree. In fact, it only begins when you enter the workforce. You must be able to prove that you have the knowledge, skills, and competencies to provide safe care.
• Check for or seek advisory opinions. Your BON develops interpretations of the requirements of a law; an advisory opinion does not replace a law, but it is more than a recommendation about what is (or is not) permissible in a situation. If there’s a conflict between your employer’s policies/expectations and your state’s NPA, your BON’s advisory opinion will prevail.

Off the job: You’re still a nurse

Even when you’re off duty, your behavior and actions are under scrutiny. The BON can initiate discipline measures for “professional misconduct” for activities that aren’t related to your job. If your conduct suggests impaired judgment or a lapse in moral character, the BON can decide you could be a threat to the safety and welfare of the public and start an investigation. Some examples:

• Criminal activity: Depending on the state, this could mean ANY conviction means you won’t be licensed. Even if you’re on a vacation and get a DUI/DWI, this constitutes criminal activity.
• Using recreational or illegal drugs can be considered criminal activity by a BON. Some BONs have the authority to mandate an alcohol/substance abuse evaluation with a BON-approved professional, at your expense.
• Failure to pay child or spousal support, on time and as ordered.
• Failure to pay taxes, student loans, or other debts.
• Accusation of child or elder abuse.
• Sexual misconduct: any non-consensual behavior of a sexual nature that is committed by force or intimidation, or that is otherwise unwelcome. The term includes sexual assault, sexual exploitation, sexual intimidation, and sexual harassment.
• Inappropriate use of social media: Even if you use your own device at home, you can violate nursing ethics, as well as compromise your own character or the nursing profession. (Read NCSBN’s A Nurse’s Guide to the Use of Social Media.) Your BON can initiate an investigation if it receives a complaint about any of the following:
  • HIPAA or other privacy violation
  • Violating employer policy
  • Offending or insulting colleagues or employer
  • Bullying or threatening someone
  • Posting or sharing lewd photos or graphics

Your best bet: Outstanding interpersonal skills

Nurses are held to a higher standard than other professions; the public views nurses highest in honesty and integrity. That’s why they’re ranked first every year in Gallup’s “Most Trusted Profession” poll—and also why they are sued less than other medical colleagues.

Developing effective interpersonal skills is your best action when it comes to protecting your nursing license. Also called “soft skills” or “people skills,” you probably already know what some of them are, and how to use them.

1. 1

   Managing relationships, including conflict.

   Job stress is inevitable. We must be able to work together under all circumstances. Disagreements should be resolved and never interfere with providing outstanding care.

2. 2

   Understanding others’ feelings.

   Empathy allows us to develop strong relationships. Others are more comfortable and sense they are being understood.

3. 3

   Cooperation.

   When we collaborate, we’re all more productive. We can deliver better outcomes for our patients and for each other.

4. 4

   Great attitude.

   We generate positivity, even in difficult situations. A positive attitude makes others and the workplace pleasant and harmonious.

5. 5

   Showing respect.

   Every person is different. When we honor that person—patients and colleagues--without bias or judgment, we demonstrate respect.

6. 6

   Appropriate contact.

   We understand and maintain professional boundaries. All contact is professional and therapeutic, never personal.

7. 7

   Active listening.

   One of the cornerstones of communication, this skill allows us to learn from others and respond appropriately, whether at work or at home.

Your nursing license is a treasure—guard it carefully!

It took a lot of hard work to earn your license. The work doesn’t stop when you finally pass your NCLEX. You’ll need to continue to protect it throughout your career, no matter where you live or work. Following these steps will ensure you honor your commitment to the nursing profession, and help keep nursing at the top spot of the “Most Trusted” poll.

About the Author

Winona Suzanne Ball

Nursing Adviser, RN | MHS, Governors State University, IL
Full member of the American Nurses Association. Learn more