Your Nurse
Practice Act
and the
Disciplinary
Process
A HANDBOOK FOR NURSES
Second edition
Developed in collaboration with the the Nursing Care Quality Assurance Commission
Contents
Foreword ....................................................................................................1
Overview ....................................................................................................2
Introduction ................................................................................................ 4
Grounds for Disciplinary Action .........................................................................5
Standards of Practice .................................................................................... 6
Violation of Standards of Nursing Practice .......................................................... 8
Case In Point: Practice Beyond Scope ...............................................................10
Mandatory Reporting .................................................................................... 11
Case In Point: Failure to Report Unprofessional Conduct ........................................12
Disciplinary Process ......................................................................................13
Reports / Complaints ..................................................................................13
Early Remediation .....................................................................................13
Investigation ...........................................................................................14
Formal and Informal Actions ...........................................................................17
Settlement or Formal Hearing .......................................................................18
Case In Point: Failure to Renew License ............................................................19
Disciplinary Actions ...................................................................................20
NCQAC Disciplinary Process ........................................................................22
Appendix: Commission or Association? ..............................................................23
© 2012 Washington State Nurses Association
Approved by the WSNA Board of Directors December 2011
Approved by WSNA Professional Nursing and Health Care Council October 2011
Approved by the WSNA Board of Directors March 1997
Approved by WSNA Cabinet on Nursing Practice and Education January 1997
Washington State Nurses Association
575 Andover Park West Suite 101
Seattle WA 98188
206.575.7979 206.575.1908 fax
www.wsna.org
YOUR NURSE PRACTICE ACT AND THE DISCIPLINARY PROCESS
1
Foreword
The primary intent of this handbook is to ensure that you are aware of the disciplinary
process in case you are ever required to appear before the Washington State Nursing
Care Quality Assurance Commission (Nursing Commission). This handbook was
developed in response to the many inquires that have come to WSNA regarding the
issue of the Washington State Nursing Care Quality Assurance Commission’s disci-
plinary process.
Anyone faced with a complaint against their license and their livelihood is experienc-
ing a great deal of emotional stress—anger, guilt, fear, and helplessness. These highly
charged emotions can consume and overwhelm a usually thoughtful, careful person.
The sections of this handbook are designed to help you develop a careful strategy in
order to make an appropriate and timely response.
Before speaking to anyone at the Nursing Commission you have the right to:
• Gather all information you have about the situation
• Not admit guilt
• Get in touch with your professional liability insurance agent
• Seek legal counsel
WSNA hopes this provides you with the necessary information to make choices on
how to interact with the Nursing Commission in Washington State. Your feedback
about the information in this handbook would be appreciated and may be used in
future revisions.
YOUR NURSE PRACTICE ACT AND THE DISCIPLINARY PROCESS
2
Overview
The best defense against a disciplinary action is staying current in your nursing practice.
Every nurse should know the Nurse Practice Act and be aware of other laws and rules
that govern nursing practice. Every nurse needs to be familiar with:
• The laws of Nursing Practice in Washington State RCW 18.79
(http://apps.leg.wa.gov/RCW/default.aspx?cite=18.79)
• The rules, WAC 246840 (http://apps.leg.wa.gov/WAC/default.aspx?cite=246840)
• The Uniform Disciplinary Act (UDA)
(http://apps.leg.wa.gov/RCW/default.aspx?cite=18.130) that guides disciplinary actions
for all health professions, including nurses.
Ignorance of these laws is not an adequate defense in a disciplinary action. Every nurse
has the responsibility to be aware of changes in the Laws of Nursing Practice that may
impact practice. To view the most recent version of the laws and rules, use the website
links. Do not rely on outdated printed materials. Access the Nursing Commission
Website (http://www.doh.wa.gov/hsqa/Professions/Nursing/default.htm) for the
most recent statements on practice and changes.
It is also the nurse’s responsibility to keep abreast of legislative changes that may impact
practice. WSNA helps members by providing information on the WSNA website as
well as through multiple publications and resources. In several studies of disciplinary
action, nurses seem to be most vulnerable for violating the Nurse Practice Act when
they are new to their position or practice setting. All nurses must have an adequate
orientation and must be prepared to take on new responsibilities. Nurses are also
responsible for keeping their knowledge and skills up to date.
During the September, 2010, Nursing Care Quality Assurance Commission (NCQAC)
meeting, the final rules related to Continuing Competency requirements were adopted.
These rules went into effect on January 1st, 2011. Registered Nurses and Licensed
Practical Nurses will be required to begin maintaining documentation/verification of
compliance illustrating at least 531 hours of active practice and 45 hours of continu-
ing education every three years. The three year period began with the nurse’s
2011 birthday date. Audits for compliance begin in 2014. Licensure renewals
will continue to be on an annual basis; however, nurses will be expected to sign an
YOUR NURSE PRACTICE ACT AND THE DISCIPLINARY PROCESS
3
attestation every three years to reflect that they are compliant with the requirements
for both practice and continuing education hours.
To avoid disciplinary action, a nurse must keep current! All must demonstrate compli-
ance with the NCQAC Continuing Competency requirements, review new institutional
policies, and participate in state, national, and specialty nursing organizations.
Being involved in disciplinary action before the Nursing Commission can result in
dire consequences that are personal, professional, and financial. We hope that the
information presented in this handbook will educate nurses about the Nurse Practice
Act and prevent the distressing process of disciplinary action.
YOUR NURSE PRACTICE ACT AND THE DISCIPLINARY PROCESS
4
Introduction
This document gives nurses a description of the disciplinary process used by the
Nursing Commission. The purpose of the Nursing Commission is to establish, moni-
tor and enforce licensing, consistent standards of practice, continuing competency
and discipline of registered nurses, licensed practical nurses, advanced registered
nurse practitioners and nursing technicians in Washington State. Rules, policies, and
protocols developed by the Nursing Commission must promote the delivery of quality
health care to the residents of Washington State.
The fifteen members of the Nursing Commission include seven registered nurses,
three licensed practical nurses, two advanced registered nurse practitioners, and three
public members. The Governor appoints members to serve staggered four year terms.
Members may serve two terms.
Nurses may view the Nursing Commission as an advocate for nursing. In reality,
the Nursing Commission’s primary role is to protect the public from unsafe nursing
practice. The legal basis for licensure rests on the government’s responsibility to pro-
tect the public. The laws and rules of nursing practice define and limit the practice of
nursing. The laws and rules define “unprofessional conduct.” Nurses need to have an
understanding of the role of the Nursing Commission and be able to act accordingly if
involved in disciplinary action.
The State of Washington grants a license to a nurse who earns their trust through
education, examination and a thorough background check. Nurses renew their license
in order to serve the residents of Washington. Nurses must demonstrate Continued
Competency to renew their license in Washington. The Nursing Commission may take
informal or formal action on the license if the nurse does not continue to meet licensing
and practice standards. The Uniform Disciplinary Act (UDA) describes the process and
procedures used for disciplinary actions for all health care providers in Washington
State. The process begins with a report to the Nursing Commission.
A license, because it is granted based on conditions, is not a permanent right. Relatively
few nurses have complaints of poor nursing practice resulting in disciplinary action
on their license. However, on occasion, a nurse may violate a provision of the laws
and/or rules simply out of lack of knowledge. All nurses need to know their rights
and responsibilities when presented with allegations from the Nursing Commission.
We hope this handbook will be used as a resource for you.
YOUR NURSE PRACTICE ACT AND THE DISCIPLINARY PROCESS
5
Grounds for Disciplinary Action
Rules (WAC 246-840-700) describe the Standards of Nursing Conduct or Practice.
The rules give a side by side comparison of the responsibilities of a registered nurse
and a licensed practical nurse using the nursing process. The rules then describe vio-
lations of nursing conduct or practice. Each violation must be supported by evidence
that is clear and convincing. Each charge must bear a direct relationship to a threat
to public safety. Additionally, as mentioned previously, the Uniform Disciplinary
Act also provides guidance related to grounds for disciplinary action against nurses
in the State of Washington.
YOUR NURSE PRACTICE ACT AND THE DISCIPLINARY PROCESS
6
Standards of Practice
Standards of nursing conduct or practice are defined in the Washington Adminis-
trative Code for Registered Nurses (WAC 246-840). The stated purpose for defining
standards “is to identify responsibilities of the nurse in health care settings…” The law
further states that each individual, upon entering the practice of nursing, assumes a
measure of responsibility and public trust and the corresponding obligation to adhere
to the standards of nursing practice.
Included in this section of the WAC are statements that have significant impact for
nurses. They are: “the nurse shall be responsible and accountable for the quality
of nursing care given to clients. This responsibility cannot be avoided by accepting
the orders or directions of another person.” In other words, neither physician orders,
nor supervisory directions, nor the policies of health care institutions can exempt the
nurse from this accountability.
The standards of nursing conduct or practice are as follows:
1. Nursing process
a. The nurse shall collect pertinent objective and subjective data…
b. The nurse shall plan and implement nursing care…
c. The nurse shall provide timely communication with other health care providers
regarding signiicant changes in client status…
d. The nurse shall document…
2. Delegation and Supervision
The nurse shall be accountable for the safety of clients by:
a. Delegating selected nursing functions to others based on their education, creden-
tials, and competence;
b. Supervising delegates.
3. Other responsibilities the nurse shall have include:
a. Knowledge and understanding of laws and rules regulating nursing function within
the scope of nursing;
b. Responsibility and accountability for practice based on scope of education, demon-
strated competence, and experience;
YOUR NURSE PRACTICE ACT AND THE DISCIPLINARY PROCESS
7
c. Adequate instruction and orientation before implementing unfamiliar practice;
d. Responsibility for maintaining current knowledge in ield of practice;
e. Conducting nursing practice without discrimination;
f. Protecting conidential information;
g. Reporting unsafe nursing practice…
Failure to adhere to the preceding standards of practice may be grounds for action
against the nurse’s license.
For the complete reference, go to
http://apps.leg.wa.gov/WAC/default.aspx?cite=246-840-700
YOUR NURSE PRACTICE ACT AND THE DISCIPLINARY PROCESS
8
Violation of Standards of Nursing Practice
Guidelines have been developed by the Nursing Commission as to the acts, practices, or
omissions that are inconsistent with generally accepted standards of nursing conduct
or practice. Examples of such conduct are:
1. Nursing process
a. Failing to assess and evaluate client status, failing to provide nursing intervention
as necessary
b. Willfully and repeatedly failing to report or document…
c. Willfully and repeatedly making inaccurate or unreadable entries in records regard-
ing medications, treatments, …
d. Willfully and repeatedly failing to give medications and/or treatments according to
policies and procedures; … to properly record medication wastage
e. Willfully causing or contributing to abuse of the client
2. Delegation and Supervision
a. Delegating to unqualiied personnel, either by scope of practice, competence, or
knowledge
b. Failing to supervise personnel to whom nursing tasks were delegated
3. Failing to adhere to standards, including:
a. Performing nursing procedures without appropriate knowledge or education,
failure to obtain proper instruction
b. Violating conidentiality of client information
c. Writing prescriptions without authority
4. Other violations
a. Taking medications, supplies, or personal items from the work setting for personal
use
b. Practicing nursing while impaired by any mental, physical, or emotional condition…
c. Abandoning clients by leaving assignment without transferring responsibilities to
appropriate personnel
YOUR NURSE PRACTICE ACT AND THE DISCIPLINARY PROCESS
9
d. Practicing nursing while impaired by drugs or alcohol
e. Conviction of physical or sexual abuse while practicing nursing
Any of these violations will give the Nursing Commission the authority to take action
against the nurse’s license.
10
CASE IN POINT
Practice Beyond Scope
Jennifer, a 20-year experienced labor and delivery RN, was called in to
the hospital at 0300 due to an increase in patients. She was assigned
to a patient in early labor who was scared and writhing all over the
bed. The previous nurse had tried to start an IV twice, without success.
Since the IV had been ordered by the physician, Jennifer felt that it
was imperative to get the IV started. She decided that if she could get
the patient calmed down, she would have a better chance of placing
the IV. Without an order, Jennifer gave the patient an IM dose of pain
medication, and successfully placed the IV. An hour later the physician
came into the hospital and became very upset when it was discovered
that the patient had been given medication without an order. The
physician went to the nursing supervisor and demanded that Jennifer
be reported to the Nursing Commission for giving medication without
an order. Disciplinary action was taken against Jennifer’s license for
practice beyond the scope of practice as deined by law. She was issued
Formal Charges with conditions, as well as a ine. She also had to write a
ten-page paper regarding the legal scope of practice for an RN.
YOUR NURSE PRACTICE ACT AND THE DISCIPLINARY PROCESS
11
Mandatory Reporting
Washington’s Nurse Practice Act requires that anyone knowing of a nurse whose
nursing practice or conduct does not meet accepted standards must report the nurse
to someone in authority so corrective action can be taken. This report should be docu-
mented in writing. Failure of any nurse to report such a potential violation, in and of
itself, may constitute a violation of nursing standards.
The Nursing Commission does advocate that the intention of mandatory reporting is
not to report each and every nursing error. When deciding whether to report or not,
certain criteria need to be taken into consideration, such as:
1. History of the nurse’s performance
2. Demonstration of a pattern of unsafe practice
3. Magnitude of any occurrence for actual or potential harm to the public
The Nurse Practice Act also defines a number of violations that must always be
reported to the Nursing Commission. These are:
1. A nurse imposter
2. Practicing with an expired license
3. Conviction of a crime relating to nursing
4. Being ired due to unsafe practice or conduct in violation of the standards of nursing
5. Client abuse
6. Any single incident which creates serious harm or risk to the client
7. Substance abuse
12
CASE IN POINT
Failure to Report Unprofessional Conduct
Susan was working as the charge nurse on a medical unit. Another
RN working with her took a medication that was meant for a patient
because the patient was allergic to the drug. Susan knew the other
nurse had taken the medication for her own use, even though hospital
policy stated they were to destroy the drug. The Washington law
required that any nurse, knowing of another nurse whose behavior
or nursing practice fails to meet accepted standards, is required to
report that nurse to someone in authority who can institute corrective
action. Failure to report may in itself constitute a violation of nursing
standards. In Susan’s case, since she did not stop the nurse or report the
event, she was disciplined for failure to report an incident to the Nursing
Commission.
YOUR NURSE PRACTICE ACT AND THE DISCIPLINARY PROCESS
13
Disciplinary Process
REPORTS / COMPLAINTS
The Nursing Commission receives reports from several sources: patients, other health
care professionals, self reporting and other state agencies conducting investigations.
A Case Management Team assesses all reports within 21 days. At least three Nursing
Commission members must be on the Case Management Team. The team decides if
the report is within the Nursing Commission’s jurisdiction:
Is this report of an RN, LPN, ARNP or nursing technician?
Is this a report of an incident within the State of Washington?
The Case Management Team closes reports if they are not within their jurisdiction.
EARLY REMEDIATION
In any complaint where the Nursing Commission identifies practice deficiencies, the
Nursing Commission may resolve the matter through the early remediation program.
The Nursing Commission shall use the following criteria to determine eligibility for
early remediation:
a. The identiied practice deiciency(s) could be corrected by remedial education, on-the-
job training and practice monitoring within six months or less, and patient protection
does not require signiicant long-term practice limits
b. The nurse is willing and able to participate in the early remediation program
c. The nurse’s current employer agrees to participate in the action plan
d. The nurse has no current charges or disciplinary history of unprofessional conduct and
has not previously participated in an action plan
e. The degree of patient harm suered as a result of the nurse’s substandard practice is
minor, if any
If the nurse complies with the agreed action plan, the Nursing Commission may con-
sider the nurse’s completion of the action plan as grounds to close the matter without
further action. No “flag” is then placed against the nurse’s license regarding the com-
plaint. However, the Nursing Commission may decide to conduct a full investigation
YOUR NURSE PRACTICE ACT AND THE DISCIPLINARY PROCESS
14
and consider disciplinary action if additional facts become known or circumstances
change such that the nurse is no longer eligible based on the aforementioned criteria.
INVESTIGATION
The reports must be above a threshold to be opened to an investigation. The Nursing
Commission investigates reports of the following:
1. Drug diversion or narcotic abuse with impairment (work related). This includes use of
illegal (street) drugs.
2. Sexual misconduct
3. Harm to patient requiring medical intervention
4. Physical abuse
5. Negligence which leads to patient death
6. Mental incapacity with harm to patient or likelihood of harm
7. Crimes against persons or personal property of a patient
8. Substance abuse aecting ability to practice safely
9. Pattern of gross nursing incompetence.
10. Beyond the scope, to include lack of documentation of clinical competency
11. Pattern of errors or an isolated error, to include judgment errors
12. Practice with a lapsed license for more than 6 months without allegation of unprofes-
sional conduct. Stipulation To Informal Discipline to recover cost of investigation
13. Falsiication of records
14. Inappropriate delegation beyond respondent’s own scope
15. Failure to supervise resulting in an unreasonable risk of harm to a patient or resulting
in serious harm to a patient.
If a nurse believes a report about them may be sent to the Nursing Commission (i.e.,
threats from clients, supervisors, or other medical personnel), the nurse should docu-
ment the details. The details provide the nurse with a written account of the incident,
while the memory is still fresh.
YOUR NURSE PRACTICE ACT AND THE DISCIPLINARY PROCESS
15
In our democracy, all people are considered innocent until proven guilty. The burden
of collection and proving guilt lies with the State. Investigators must collect enough
evidence to clearly convince Nursing Commission members that a violation occurred.
When the Nursing Commission opens the report to an investigation, an investigator
is assigned. The investigator sends a letter to the person who sent the complaint, or
complainant. The investigator develops and follows a plan for the investigation. In most
cases, the investigator informs the nurse of the investigation in writing. In some cases,
the investigator may determine that notifying the nurse would damage the investiga-
tion. The investigator has the right to decide whether this risk exists.
The investigator collects evidence through interviews of people who may be witnesses
to the complaint: co-workers, supervisors, family members, patients. The investigators
may review medical records, personnel records, staffing reports, and medication reports.
The Nursing Commission has nurses and non-nurses as investigators. Many complaint
investigations do not include violations of standards of nursing care. The most frequent
complaint investigated by the Nursing Commission involves substance use and abuse
by nurses. The Nursing Commission can also investigate felonies against people.
The investigator may not find evidence of a violation. In these cases, the investigation
is returned to the Case Management Team for a decision. The Case Management Team
may direct the investigator to other sources or close the investigation. The complainant
and the nurse are informed in writing of the decision.
The investigation phase allows 170 days to collect evidence. The investigator completes
an investigative report. The investigator sends the nurse a letter of allegations. Allega-
tions are potential violations of the regulations. At this point, the nurse is given the
opportunity to provide an explanation of the situation. This is the time when it is
imperative that the nurse seek legal counsel. The attorney should be experienced in
representing health professionals. An attorney provides advice on how best to proceed.
The investigative report and all evidence collected is forwarded to a member of the
Nursing Commission. The Nursing Commission member reviews and evaluates all
the evidence. The Nursing Commission member presents the evidence to three other
Nursing Commission members, or a panel. The panel may decide:
1. Evidence shows probable cause for administrative action (discipline) and sends the
case to the Legal Services Oice for a Statement of Charges or Stipulation to Informal
Discipline
YOUR NURSE PRACTICE ACT AND THE DISCIPLINARY PROCESS
16
2. An immediate threat to the public exists and the nurse’s license is summarily sus-
pended
3. To refer the nurse to the alternative to discipline program, the Washington Health
Professional Services, due to substance use or abuse
4. Evidence is not clear nor convincing and does not substantiate probable cause for
disciplinary action. The panel closes the case.
The Nursing Commission sends a letter to the complainant and the nurse notifying them
of the actions and responsibilities. According to law, the Nursing Commission must
report to the public all actions on nurses’ licenses. The Nursing Commission reports
actions through the Provider Credential Search. If a report to the Nursing Commission
is closed by the Case Management Team, no action is recorded. If a report is opened to
investigation, the Provider Credential Search shows no action. If a statement of charges
or statement of allegations is pursued, the action column states ‘Pending’ and links
to the document. If an order is issued, the action column says “Yes” and links to the
order. If the investigation is closed due to insufficient or lack of evidence, the Provider
Credential Search shows no action.
YOUR NURSE PRACTICE ACT AND THE DISCIPLINARY PROCESS
17
Formal and Informal Actions
The panel of Nursing Commission members may determine the actions necessary are
formal or informal. Formal actions are captured in a Statement of Charges. The
Nursing Commission may decide formal action is necessary according to the sanction
standards and produce a Statement of Charges. Informal actions are captured in
a Stipulation to Informal Discipline. In a stipulation to informal discipline, the
nurse does not admit guilt and agrees to actions defined by the Nursing Commission.
The Nursing Commission uses a set of sanction standards to determine actions. In order
to be fair and objective, the Nursing Commission developed the sanction standards
to apply in cases with similar fact patterns and outcomes. The Nursing Commission
adopted the Nursing Sanctioning Standards in 2004. Nursing Commission members
use the Nursing Sanctioning Standards with the Sanctioning Rules for all Health
Professions to determine priority level of cases and actions to take. The actions are
meant to rehabilitate rather than punish. The philosophy is to take the minimal amount
of action necessary to redirect the nurse to provide safe patient care. There are rare
instances when the Nursing Commission feels there are no rehabilitative measures
that can be used to protect patients. In these cases, the Nursing Commission may
permanently revoke the license.
The nurse is informed of the Nursing Commission’s decision in a legal document. An
Assistant Attorney General prepares the document. The document, or statement of
charges, identifies specific incidents reflectng unprofessional conduct or violations of
the Nurse Practice Act. The precise statutes violated are listed. The document directs
the nurse to decide how to proceed. Every nurse has the right to a hearing and to be
represented by an attorney before the Nursing Commission. To protect this right, the
nurse must respond within twenty days after the document is mailed. The document is
mailed to the address currently on file with the Nursing Commission. It is the nurse’s
responsibility to send all address changes to the Nursing Commission. If no response
is received from the nurse within twenty days, the Nursing Commission assumes the
allegations are not being contested. This results in the loss of the right to an adjudica-
tive hearing. The adjudicative hearing gives the nurse the opportunity for settlement
of the allegations. An order will be entered to possibly reprimand, suspend or revoke
the nurse’s license to practice in the state of Washington.
YOUR NURSE PRACTICE ACT AND THE DISCIPLINARY PROCESS
18
SETTLEMENT OR FORMAL HEARING
The Statement of Charges also instructs the nurse to make a choice between admitting
to the charges, not contesting the charges, or denying the charges. The nurse needs
to have a clear understanding of the document before admitting to anything. When a
Statement of Charges is received, if the nurse had not already done so, the nurse may best
be served by obtaining legal counsel. Legal counsel can help the nurse decide the best
option. The nurse needs to realize the outcome of the Statement of Charges could have
a significant impact on the nurse’s future employment potential and earning capacity.
When a nurse receives a Statement of Charges, several options are available. One is to
request a hearing. The nurse has the right to present supporting evidence and witnesses.
Alternatively, the nurse may seek a settlement through two options:
1. Settlement conference can be requested without the necessity of a formal hearing. The
Nursing Commission sta attorney meets with the nurse to conclude a resolution of
the allegations. If the nurse has legal counsel, they can be present for the conference.
If the nurse agrees to a tentative settlement, this information is sent to the reviewing
Nursing Commission member. If the reviewing Nursing Commission member agrees
to the settlement oer, the agreement is sent to the Assistant Attorney General and the
nurse to become inal.
2. The nurse may also seek a settlement by submitting a written statement and any sup-
porting documents for consideration by the reviewing Nursing Commission member. A
settlement oer may be determined.
In either situation, the nurse does not have to accept the settlement offer and can make
a counter offer or go to a formal hearing. If a settlement offer is agreed upon then it will
be presented to a three member panel of Nursing Commission members for approval.
If the Nursing Commission does not give approval, the process can go on to a formal
hearing or further settlement negotiations. It is highly recommended that the nurse
be represented by legal counsel during these proceedings.
If the decision by the nurse is to go to formal hearing, the date will be scheduled at
the nearest available hearing date. Three members of the Nursing Commission are
the hearing panel members. The Assistant Attorney General prosecutes on behalf of
the state. A health law judge from the Office of Professional Standards conducts the
hearing. The nurse has the right to bring witnesses and any written documentation
to the hearing. The nurse may also cross examine the state’s witnesses. At the conclu-
19
CASE IN POINT
Failure to Renew License
Sarah, a nurse attorney, did not receive her notice to renew her RN
license in the mail. She was very busy at the time getting ready for trial
and just forgot about the renewal. Eight months later Sarah was listed
on a seminar brochure as a speaker and listed as a JD, RN. Someone on
the Nursing Commission sta saw the brochure and knew that Sarah
had an expired license. Therefore, Sarah was in violation of the Nurse
Practice Act and was served with a Statement of Allegations. In order
to obtain a current active license Sarah had to pay a late fee with her
renewal fee.
Another case of failure to renew a license involved an Advanced
Registered Nurse Practitioner. In Washington State if you are a
registered nurse who is also an ARNP, you must have two licenses—one
as a RN and one as an ARNP. The nurse renewed her ARNP license
and assumed that was all that was needed. Because the nurse was
practicing nursing without a valid RN license, she was in violation of the
Nurse Practice Act. The nurse had to pay a late renewal fee with her RN
renewal fee. If she had not renewed her RN license for a period longer
than three years, she would also have been required to complete a
refresher course.
YOUR NURSE PRACTICE ACT AND THE DISCIPLINARY PROCESS
20
sion of the hearing, the Nursing Commission panel members go into closed session.
The Nursing Commission members decide regarding the charges and the evidence
presented by both sides. The decision is sent in writing to the nurse. If the nurse also
filed a grievance related to disciplinary action imposed by the employer, the union
should be aware of any settlement discussions and agreements.
DISCIPLINARY ACTIONS
Disciplinary actions used by the Nursing Commission include:
Stipulation to Informal Discipline: the nurse does not admit to the allegations, but
agrees to complete actions defined by the Nursing Commission.
Probation: the nurse’s license is limited for a defined period and terms to be completed
are listed in the agreed order.
Suspension: the nurse’s license is not valid for a defined time period and the nurse
must meet the terms defined in the order before requesting the Nursing Commission
to reinstate the license.
Summary Suspension: the nurse’s license is not valid for a defined time period and
may not practice until further order.
Revocation: the nurse’s license is removed for a defined time period and the nurse
may not practice in the State of Washington.
Permanent revocation: the nurse’s license is removed and the nurse may not practice
in the State of Washington forever.
Conditions placed on the nurse’s license can be addressed as fulfilling a knowledge
deficit, such as writing a paper or attending a medication course. Other conditions may
affect the ability to practice such as working under the direct supervision of another
Registered Nurse, not being able to work as a charge nurse, or not being able to give
medications. These conditions can significantly impact the nurse’s employment. The
conditions placed on the nurse’s license cannot be taken lightly and must be followed
exactly. Further disciplinary action could result if the terms are not met. Fines are also
set for violations and must be paid in a timely manner. If not, further action could be
taken on the nurse’s license and could result in the fine being forwarded to a collec-
tion agency.
YOUR NURSE PRACTICE ACT AND THE DISCIPLINARY PROCESS
21
Whatever disciplinary action is taken against the nurse’s license, the action is recorded
in the license file at the Department of Health and remains there permanently. This
information is available for public disclosure. Once a statement of allegations or charges
is filed, the information may be released to anyone with a request for disclosure.
If the nurse wants to appeal the Nursing Commission’s decision or disciplinary action,
the nurse can appeal in court. The court examines the Nursing Commission’s decision
and decides if it conducted the hearing properly. The court may agree with the decision
or order the Nursing Commission to rescind the decision. If the Nursing Commission
does not agree with the court decision, an appeal to a higher court may be pursued. The
nurse or the Nursing Commission may appeal for a reversal of the lower court’s ruling.
The importance of obtaining legal counsel cannot be emphasized enough. Most
nurses feel they cannot afford an attorney, but if the disciplinary action significantly
impacts the nurse’s practice and earnings, it is important to look at the long term gains,
despite the costs of legal representation. There are time limits throughout the process
and knowledge of the laws, rules and proceedings are important. The attorney the
nurse selects should be experienced in representing professionals before disciplinary
panels. WSNA can provide a list of attorneys who represent nurses before the Nurs-
ing Commission.
WSNA RECOMMENDS THAT ALL NURSES
CONSIDER OBTAINING PROFESSIONAL
LIABILITY INSURANCE COVERAGE.
Refer to our website
at www.wsna.org for more information.
YOUR NURSE PRACTICE ACT AND THE DISPLINARY PROCESS
Open for Investigation
criteria is in policy:
• Drug diversion/narcotic abuse
w/ impairment; includes use
of illegal (street) drugs
• Sexual misconduct
• Harm to patient requiring
medical intervention
• Physical abuse
• Negligence which leads
to patient death
• Mental incapacity with harm
to patient or likelihood of harm
• Crimes against persons or
personal property of a patient
• Substance abuse aecting
ability to practice safely
• Pattern of gross nursing
incompetence
• Beyond the scope to include
lack of documentation of
clinical competency
• Pattern of errors or an
isolated error to include
judgment errors
• Practice with lapsed
license for > 6 mo.
• Falsiication of records
• Inappropriate delegation
beyond respondent’s
own scope
• Failure to supervise resulting
in an unreasonable risk of
harm to a patient or resulting
in serious harm to a patient
* CMT = Three Commission Mem-
bers, to include: Public Member,
Sta Attorney, Investigator,
Discipline Program Manager.
1. Once documents have been
served, they are available
to the public; they may be
requested according to public
disclosure laws.
2. The decision to notify the
employer is made on a case-
by-case basis. Often they
will be notiied of a summary
suspension. They are sent a
copy of the inal order.
Complaint Registered
Assessment of complaint by Case Management Team (CMT)*
Case Closed
Early
Remediation
(WAC 246840-
583 for criteria);
no lag on license
Case opened for further investigation
by NCQAC Investigators
Nurse is notiied of complaint
& requested to provide written
response i.e. explain what happened;
nurse may request to meet with
investigator; nurse NOT notiied if felt
such would hinder the investigation;
Person making complaint also
notiied of investigation
Case sent to 1 NCQAC member
for review and presentation to
at least 3 members of NCQAC
for Case Disposition
Case closed
Statement of
Allegations
or Charges
Nurse notiied
of charges &
options including
opportunity to
request hearing
Nurse does
not agree with
charges
Nurse agrees
with charge
negotiates
settlement
Request for
full Hearing
Case Settled
(notiication
NCQAC web)
Determination/
Settlement
(notiication
to website
Post-hearing
Monitoring
YOUR NURSE PRACTICE ACT AND THE DISCIPLINARY PROCESS
23
Appendix: Commission or Association?
What’s the difference between the Nursing Care Quality Assurance
Commission (NCQAC) and the Washington State Nurses Association?
NCQAC and WSNA are two Washington State organizations that play a critical role
for the career of every nurse. Although these organizations frequently share common
agendas and agree on similar policy issues, the role and function of each organization
is very different. Frequently there is a great deal of confusion about the differences
between the two organizations, and nurses contact one organization when they really
need to make contact with the other. This document is intended to assist Washington
State nurses by providing some clarifying information about each organization.
Nursing Care Quality
Assurance Commission (NCQAC)
Phone: 360.236.4700
Fax: 360.236.4738
www.doh.wa.gov/hsqa/professions/nursing
Washington State
Nurses Association (WSNA)
Phone: 206.575.7979
Fax: 206.575.1908
www.wsna.org
Structure Legally constituted State of Washington
regulatory agency within the
Department of Health
Professional association for all Registered
Nurses; a constituent member of
the American Nurses Association
MiSSion Section 18.79.010 of the Revised Code
of Washington describes the purpose of
NCQAC as: to regulate the competency and
quality of professional health care providers
under its jurisdiction by establishing,
monitoring, and enforcing qualifications for
licensing, consistent standards of practice,
continuing competency mechanisms, and
discipline. Rules, policies, and procedures
developed by the commission must promote the
delivery of quality health care to the residents
of the state of Washington.
WSNA’S miSSioN StAtemeNt: The Washington
State Nurses Association provides leadership
for Registered Nurses and the nursing
profession and promotes quality health care
for consumers through education, advocacy,
and influencing state health care policy in the
State of Washington.
WSNA’S viSioN StAtemeNt: The Washington
State Nurses Association is the collective and
leading voice, authority, and advocate for the
nursing profession in the State of Washington.
(Approved 03/07)
YOUR NURSE PRACTICE ACT AND THE DISCIPLINARY PROCESS
24
NCQAC WSNA
LeaderShip Members of the Commission are
appointed by the Governor for up to
four year terms. Membership consists
of ifteen members including: 7 RNs, 2
ARNPs, 3 LPNs, and 3 public members.
Members of the Board are elected by
current members of WSNA through a
democratice voting process.
MeMberShip Mandatory licensure to practice
as an RN, LPN, or ARNP (original
education, examination, renewals, and
endorsements).
Voluntary membership through
application and dues; mandatory
membership through various collective
bargaining contract agreements.
roLe Protects the public health, safety and
welfare from unqualiied or unsafe
practitioners.
Informs nurses in WA State about issues
and trends that aect their professional
practice. Promotes the professional
development and advances the economic
and general welfare of all nurses.
poLicy Adopts rules and regulations to implement
its functions; issues interpretations on
practice related issues as relevant to
statute, rules and regulations.
Adopts position statements and
resolutions that advance the profession
and the organization’s mission.
practice
StandardS
Establishes minimum standards for
nursing education and practice.
Promotes ANA standards of nursing
practice; works to ensure adherence to
ANA’s Code of Ethics for Nurses.
YOUR NURSE PRACTICE ACT AND THE DISCIPLINARY PROCESS
25
education Develops reasonable and uniform
standards for nursing practice and
education. Approves and renews approval
for nursing education programs that meet
the Washington Administrative Code
requirements.
Develops, promotes and approves
continuing nursing education as
authorized by the American Nurses
Credentialing Center.
NCQAC WSNA
Workforce
advocacy
Investigates complaints regarding nurses;
issues discipline and monitors disciplinary
actions (Discipline may include
stipulations, revocations, suspensions,
denial of license or limitations on scope
of nursing or nursing related practice
activities.)
Promotes occupational safety for nurses.
Provides workforce advocacy program for
nurses including addressing workplace
issues, e.g., staing, safe lifting, hazardous
exposure, work-place violence.
GovernMent
affairS
Administers Nurse Practice Act and
adopts rules and regulations for its
implementation.
Acts and speaks for nursing profession
related to legislation, governmental
programs, and health policy. Reviews all
bills introduced in the Washington State
Legislature for impact on nurses, nursing
and the health care of the public.
revenue Establishes and collects licensure fees
pursuant to legislative rules.
Membership dues established by
members. Percentage may go to ANA.
