Five Ways to Lose Your Job, License, or Both

Nurses work hard to get through school and pass boards, and then we spend another few years gaining hard-won experience and probably collecting certifications that necessitate going above and beyond in terms of money and time. We put up with being the new kid on the block and are often nearly hazed. We get off work exhausted for the first year because it’s just hard work, particularly when you’re not efficient at it yet. So it’s probably a good idea to keep your license intact. Here are some ways to lose your license and maybe also your job (not counting idiocy like this nurse who is in trouble for doing her job), and no, I’m not recommending them.

1. Show up to work drunk or high. Sounds obvious that you’d want to avoid this, but I’ve seen it happen. It’s best to avoid a problem with drugs or alcohol just on general principles, but if you have one, deal with it outside work and don’t clock in with substances on board.
2. Steal narcotics. Again, this sounds obvious, but apparently it needs to be stated. I’ve been a nurse for only a few years, and I’ve seen two nurses get into deep trouble for doing this. They were both pretty creative about it, too. The state board will usually give you your license back after you go through their program, but try getting a job with a narcotics diversion on your record.
3. Do stuff outside your scope of practice. I’ve said it before, and I’ll keep saying it: read your state’s Nurse Practice Act. Then read your hospital’s policies for iffy areas. If you find yourself in front of a peer-review board being asked, “What made you think this was a good idea?” it’s best to have an answer. Example: at my first job, we pulled PICC lines daily. At this hospital, it’s not in an RN’s scope unless she is infusion-certified, which I am not, so if I pulled a PICC line and something went wrong it would be a much bigger problem than simply harming the patient (which is bad enough).
4. Violate HIPAA. Hospitals aren’t kidding about HIPAA. Patients ultimately cannot bring complaints against you; it’s against the institution you work for. So they will come down on you like a ton of bricks. This does not mean never talk about your job or patients. It means never talk about your patients in ways that other people can identify them, and while you’re at it it’s probably a good idea to avoid bashing your job publicly by name—that isn’t a HIPAA issue, but I’ve noticed that these issues tend to go hand in hand, and both will get you fired. Depending on the egregiousness of the violation, your state board can get involved, and it’s a good rule of thumb to avoid having to deal with the state board.
5. Do something wrong that injures or kills someone, AND display a lack of remorse. It’s a sad fact that nurses are human and will make mistakes. Of those mistakes, some cause harm to patients. The discipline generally depends on the egregiousness of the harm caused, but it also seems to often depend on the degree to which the nurse in question is honest about the error and commits to remediation to avoid repeating it. Getting defensive and lying about the errors you make is a really, really bad idea (see “avoid dealing the state board,” above). If you make a mistake, tell your charge nurse and/or nursing supervisor and do what they say to take care of it.