Nursing Standards of Care Issues


Page Contents:

Standards of care in nursing are guidelines that provide a foundation as to how a nurse should act, and what they should and should not do in their professional capacity. These policies and procedures are guidelines that all nurses must follow.

Having these protocols in place helps to establish a baseline of quality patient care and provides an objective standard of accountability within the profession. The goal of having established standards of practice is to provide consistency throughout the profession. If a nurse has special knowledge or skill, the standard is to evaluate that nurse by the same standard of a nurse with similar skill and knowledge in similar circumstances. 

The California Board of Registered Nursing (BRN) measures and evaluates a nurse’s practice against this standard to comply with their mission statement of protecting patients from nurses who may engage in unsafe practices or who simply fail to do their job in a way that impacts patient safety. If a nurse does not meet the accepted standard of care, he or she may be found to have deviated from the standard of care and their conduct may be found to be negligent — regardless of patient harm.

Complying with standards of care also serves to protect nurses. If a nurse follows protocols set forth by law, regulation, policies, and procedures at a hospital and/or facility, and a patient is injured or dies, they may be less likely to face discipline if there is an investigation by the BRN.

On the other hand, if a nurse fails to uphold these standards of care, they may be disciplined for failing to adhere to the nursing standard of care. This type of violation can lead to disciplinary action — and potentially affect their ability to perform their job. If you are under investigation for a standard of care violation or an accusation has been filed against you, an experienced San Diego nursing license defense attorney can defend you and work to protect your license.

What Is a Standard of Care Violation?

After undergoing rigorous education, training, and testing to receive their licenses, nurses are held to specific standards of care. These standards are set forth by nursing laws, regulations, policies and ethical codes. In certain situations, a nurse may be accused of violating the standard of care dictated by these laws and policies.

In California, the Nursing Practice Act (NPA) governs nursing. If a nurse violates these practice standards, then a hospital, nursing care employer, patient, family member, coworker, employer or member of the public may file a complaint against them with the BRN. The Board consists of 9 members and is in charge of all aspects of nursing in California, including disciplinary action.

Under California Business and Professions Code Section 2750, the BRN has the authority to discipline a Registered Nurse for a violation of the NPA. The discipline will be based on a number of factors, including evidence of rehabilitation, current ability to practice safely, severity and recency of offense, mitigating factors, and past disciplinary history.

A standard of care violation may arise in one of several ways:

  1. Gross Negligence: An extreme departure from the standard of practice for RNs. An extreme departure means the repeated failure to provide the required nursing care or failure to provide care or exercise precaution in a single situation which the nurse knew or should have known, could result in patient harm.
  2. Simple Negligence
  3. Incompetence: Lack of knowledge or skill in discharging professional obligations as an RN.
  4. Unprofessional Conduct

These types of cases may come up due to problems with medication administration, record-keeping, or the failure to provide the level of care required under the circumstances. For example, if a patient is administered the incorrect dosage of medication during a hospital stay, regardless if the patient is harmed, a violation may be filed against the nurse who gave the medicine to the patient. A failure to document vitals or administering/wasting medication may be deemed a deviation as well. However, it is important to remember that even good nurses make mistakes.

The Complaint and Disciplinary Process

After receiving the complaint, the Department of Consumer Affairs Division of Investigation and/or BRN nursing consultants then start an investigation. If no violation is found after an investigation, then the case is closed.

However, if there is evidence that the NPA has been violated, then the BRN moves to the next step: discipline and/or sanction by citation. For minor violations, a citation and fine may be warranted. A Citation is an administrative fine, and not considered discipline by the BRN. Moreover, Citations are not published online. 

Gross negligence, unprofessional conduct, and/or incompetence are generally not considered minor violations by the BRN. An Accusation may be filed by the BRN, which are the formal charges against the nurse. These matters will be sent to the Office of the Attorney General for review and discipline, and if there is criminal conduct at issue, such as the unlicensed practice of nursing, it may be referred to the local district attorney for prosecution.

If an Accusation is filed, our office will present evidence, to the DAG, either refuting the allegations or mitigating the claims to secure an Agreement (also known as a Stipulated Settlement) which is acceptable to the nurse. During this process, we gather the necessary evidence and build a team of experts, if necessary, to defend our nurses and achieve the best possible outcomes under the given fact scenario. While preparing the above-referenced mitigation, at the same time, we actively prepare the matter for an administrative hearing before the Office of Administrative Hearings (OAH). 

Defending Against Standard of Care Actions

If a standard of care complaint has been filed against you, then you may be facing the loss of your professional license — and your livelihood. Defending against this type of disciplinary action requires strategy, as well as the assistance of a skilled  San Diego nursing license defense attorney.

The defense strategy will depend on the facts of the case.  Your matter will be evaluated to determine the best approach to protect your interest. The office will create a team that may include an expert and gathers evidence to demonstrate that you did not deviate from the standard of care. 

Protect Your License and Your Livelihood

If you have been accused of violating the standards of care for nurses in California, then you will need an experienced San Diego nursing license defense attorney to defend you. At the Law Office of Nicole Irmer, we develop and execute defense strategies for healthcare professionals who have been accused of professional wrongdoing or are under investigation by the licensing board.

We are dedicated to defending your license throughout the disciplinary process and take pride in crafting a defense that is tailored to your unique circumstances. To discuss your case, please contact us at (619) 237-6130.