Introduction:

A nurse should never allow themselves to be manipulated by a care reimbursing agency into advocating for substandard care.  However, it can and does happen.  When it does and the nurse does not seek to reverse this tragedy, an ethics complaint to the State Board of Nursing may be warranted.  How should you proceed?

The complaint should focus on the unethical behavior of a nurse who knowingly advocates for less care than an injured person medically needs. This action demonstrates a deliberate disregard for the patient’s well-being, prioritizing cost-saving measures for an insurer over the patient’s medical needs.

Key Language to Include:

1. Breach of Ethical Duty:
   • Highlight the nurse’s obligation to provide care that aligns with the patient’s best interests and medical needs, as established by state nursing laws and professional ethical standards.
   • Emphasize that the nurse’s advocacy for reduced care, despite awareness of the patient’s medical needs, represents a clear violation of the ethical duty to “do no harm.”
2. Negligence and Recklessness:
   • Assert that the nurse’s actions constitute negligence, as they knowingly recommended inadequate care that could exacerbate the patient’s condition.
   • Argue that this behavior reflects reckless disregard for the patient’s health and safety, putting the patient at risk of further injury or complications.
3. Violation of Standards of Care:
   • Reference the established standards of care within the nursing profession, which require that patient care decisions be based on medical necessity, not financial considerations.
   • Point out that the nurse’s conduct violates these standards by allowing financial interests to override clinical judgment.
4. Consequences of Reduced Care:
   • Document the potential and actual harm that could arise from providing less care than medically necessary, including the risk of deterioration in the patient’s condition.
   • Provide any evidence of harm or worsening of the patient’s condition as a result of the nurse’s advocacy for reduced care.
5. Intent to Deceive or Mislead:
   • Argue that the nurse’s actions could be seen as intentionally misleading the patient and their representatives by advocating for care that falls below medical standards, potentially hiding the true extent of the patient’s needs to align with insurer interests.  If other misrepresentations are present, including the improper usage of regulatory standards, this must be in the complaint dialogue.

Potential Consequences from the State Board of Nursing:

1. Disciplinary Actions:
   • The state board may impose disciplinary actions such as suspension or revocation of the nurse’s license for unethical conduct and failure to meet professional standards of care.
   • The nurse may be required to undergo remedial education or training in ethical decision-making and patient advocacy.
2. Fines and Penalties:
   • Monetary fines may be levied against the nurse as a penalty for the violation of state regulations and professional standards.
3. Reprimand and Probation:
   • The nurse may receive a formal reprimand, which would become part of their professional record.
   • Probationary periods might be imposed, during which the nurse’s practice is closely monitored.
4. Reporting to National Databases:
   • The nurse’s misconduct may be reported to national databases, such as the National Practitioner Data Bank (NPDB), which could affect future employment opportunities.
5. Legal Liability:
   • Depending on the severity of the consequences suffered by the patient, the nurse could also face civil litigation for malpractice or negligence.

Conclusion:

This complaint should emphasize the gravity of the nurse’s unethical conduct, and the potential risks posed to the patient. It should call for thorough investigation and appropriate disciplinary actions by the state board of nursing to uphold the standards of the nursing profession and protect patient welfare.

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Another Blog Post by Direct Care Training & Resource Center, Inc. Photos used are designed to complement the written content. They do not imply a relationship with or endorsement by any individual nor entity and may belong to their respective copyright holders.

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