Nursing is a profession that comes with many challenges. There are often numerous patients with competing needs, not enough staff to assist, and increasing amounts of paperwork that needs to be completed, all within a short time frame. Nurses work hard for many years to obtain a nursing license and unfortunately, circumstances and events that threaten the ability to practice in the profession can occur in the blink of an eye. Here are 5 steps nurses in New York can take to protect their nursing license:

1. Maintain meticulous documentation.

The age old saying “if it’s not documented, it wasn’t done” is here to stay. One of the best ways a nurse can protect his or her license is to document everything. Often, when it comes to licensing discipline because of professional misconduct, the events at the heart of the matter will be at least a year old, if not older. Your future self will thank you that you kept thorough records because recalling the most important details a year or more later will be difficult. Ensure that your documentation is thorough by brainstorming all of the documentation tasks you will need to complete during your shift and check them off as they are done. If you are unable to contemporaneously chart, keep a notation for yourself of when your different care tasks occurred so you can then accurately identify this time in your charting. Having a checklist handy regarding your physical assessment findings can help make sure you are not missing anything. Writing a comprehensive note about what you have done for your patient, any unusual events, your attempts to reach a doctor, education you have provided to a patient or family member, and their response are important to include.

2. Know your facility’s policies.

Knowing and understanding the policies and procedures your facility or hospital has in place is an important guide to ensure you are aware of the expectations placed on you as a nurse. Organizations spend many hours developing policies and procedures which serve as a road map and practical resource to keep patients safe and organizational practices uniform. The greatest asset to your practice is knowing where these policies are located and reading and understanding them. Where possible, you should read, in advance or when you have a spare moment of time, all the policies relevant to your practice. Knowing what types of policies exist will not only help you when you encounter a problem, but it may also help you identify what issues are not addressed by policies. When you encounter an issue that is not addressed by a policy, you should confirm with your manager or supervisor how to address the issue and document any instructions you were given.

3. Know when to ask for help.

When it comes to caring for a sick or vulnerable patient, there is no room for uncertainties. Nursing is a profession of lifelong learning and a commitment to providing quality care; these are things that quite simply cannot be done alone. Whether you are a new nurse, a nurse floated to an unfamiliar unit, or a nurse encountering a new situation for the first time, reaching out to your colleagues, manager, supervisor, or consulting with a doctor is the safest way to ensure that you are not making a mistake that may put your professional license and livelihood on the line. Having a colleague double check your insulin syringe units or your IV pump setting when it comes to high-risk medications, is a small favor to ask to protect your license. When you are incredibly busy, asking a secretary to call the pharmacy to have the right medication dose sent instead of trying to cut a corner to administer a medication with a mix of doses that are available is worth it to protect yourself from having to explain your reasoning to the New York State Education Department Office of Professional Discipline. Be comfortable asking questions and know when to ask them.

4. Maintain professional boundaries.

As nurses, we work closely with members of our community providing them with medical care. Year after year, nursing tops national polls for the most widely respected and trusted profession. These results reflect the special therapeutic nurse-patient relationship and bond between nurses and those under their care. Even after a patient’s care has concluded, the nature of a nurse’s professional role may require that boundaries with former patients be maintained, i.e. it may be viewed as unprofessional conduct by the New York State Education Department Office of Professional Discipline for a nurse to engage in a friendship or romantic relationship with a former patient.  The power of the nurse comes from the nurse’s professional position and access to sensitive personal information. Excessive personal disclosure by the nurse, spending more time than is necessary with a particular patient, meeting a patient in settings besides those used to provide direct patient care or when you are not at work, are all behaviors that can be construed as professional boundary violations.  These issues can result in professional discipline. It is always the nurse’s responsibility to delineate and maintain boundaries with patients and these healthy boundaries ultimately protect you and your nursing license.

5. Consult with an attorney.

When it comes to matters that may jeopardize your professional license, there is no better investment that you can make than consulting with and being represented by an attorney who is experienced in licensure defense. Nurses who represent themselves can find themselves at a serious disadvantage. An experienced attorney who handles matters involving nursing discipline will know how to best advocate for you and your livelihood and what the best strategy will be to facilitate the process of resolving your matter. Consulting with an attorney who handles professional discipline matters will also ensure that you understand all of the potential collateral consequences of potential discipline which can include reciprocal discipline in other states where you hold a license, other regulatory or administrative agencies which may become involved such as Medicaid or the New York Justice Center, which could result in inclusion on an exclusion list where a nurse will be barred from working directly or indirectly for any employer who participates in Medicare or Medicaid. If there was ever an expense that is worth the investment, aside from nursing school, it is consulting with and retaining an experienced professional discipline attorney, such as a nurse attorney who has handled these types of cases.  Profession discipline, including nursing licensing issues, have devastating consequences.  As such, hiring an attorney who has handled these types of cases and has some medical knowledge is a must.  The sooner you retain an attorney when a potential allegation arises, the better. Attempting to navigate these waters yourself may ultimately foreclose opportunities or defenses that might have been available to you if you had sought advice earlier.