Edie Brous wants nurses to protect their livelihoods.  

While working on her master’s degree, Edie Brous, JD, MSN, MPH, RN, took a course on collective bargaining in healthcare institutions just because it fit her schedule. That class served as an inspiration when she decided to attend law school. In 2005, after working in medical malpractice litigation and class action pharmaceutical defense, she opened her own practice concentrating in professional licensure, education, and liability reduction for nurses. The American Nurses Association (ANA) spoke with Brous, an ANA member, about how nurses can protect themselves from legal and licensure issues.

How can leaders help nurses avoid legal challenges?

The most important thing, for all nurses, is to know the rules. Practicing RNs should periodically refer to their state nurse practice act to understand the mandatory requirements. Nurse leaders should know their state or territory’s definition of professional misconduct, and they must be aware of every member of the nursing team’s scope of practice so that they delegate properly. Nurse managers need to understand labor law, employment law, and licensure requirements—things that can keep them out of trouble.

What kind of legal issues have resulted from the COVID-19 crisis?

The problem of short staffing has intensified during the pandemic. Whenever you have critical shortages, you have practice breakdowns, which can lead to patient harm that may result in discipline by the nursing board or a malpractice case. Scope-of-practice issues can arise when nurses are asked to do things that normally would be outside their scope.

We’re seeing increased mental health issues and substance use disorders among nurses because they’re traumatized. Trauma affects the brain’s ability to process and retain information. Nurse leaders and managers should be serious about promoting self-care. Look to the Code of Ethics for Nurses with Interpretive Statements. Provision 5 is all about self-care.

Another risk is spreading misinformation about COVID-19, which can put a nurse’s license in jeopardy. The National Council of State Boards of Nursing, ANA, and other nursing organizations issued a policy brief that says, “When nurses identify themselves by their profession, they are professionally accountable for the information they provide to the public.”

How can nurse leaders guide their staff when licensure investigations arise?

First, strongly advise independent counsel. An employer’s legal department may not have the licensure defense expertise or obligation to successfully represent the nurse.

Employers often discourage liability insurance. However, if legal action is brought against a nurse outside the course of their employment, they will not be covered by their employer, nor will they have coverage for licensure defense, which nurses are 62 times more likely to encounter than malpractice lawsuits.

Managers should encourage nurses to create portfolios that include performance reviews, evaluations, letters from patients, awards, certifications, and other documentation of their career. If investigated or named in a suit, the licensing board or the jury will be able to see the nurse’s error in a broader context.

What else should leaders know?

Depending on your state, mandatory reporting exists for some things but not for others. If you’re not required to report, and it’s not necessary to protect patients, please try to avoid it. Reporting creates a cascade of collateral damage that can affect the rest of the nurse’s career. Try instead to remediate, correct, and educate. The goal should be performance improvement, not punishment.

When a nurse is suspended, try to hold their job for them. Most nurses, with support from management and co-workers, can come back from a licensing issue and have long and successful careers.