How to Protect Your License to Practice

How to Protect Your License to Practice

As a nurse, you likely understand the need to protect your license against claims related to patient care. But did you know you should take similar action to defend your license against complaints made to your state Board of Nursing (BON)?  

With BON complaints, the event may not even be related to patient care. Your state’s Nurse Practice Act (NPA) may include a moral character component, which means the BON can require the nurse to report certain violations, including misdemeanors and even take action for misbehavior, such as a conviction for driving under the influence (DUI) of alcohol or drugs or driving while intoxicated (DWI), use of illicit drugs, or failure to pay child support. Such an action can have far reaching and negative effects, not only on the nurses themselves, but also on those who depend on the nurse for safe, competent care.


Analysis of RN License Defense Claims

According to the National Practitioner Data Bank1 (2018), there were 14,902 complaints filed against registered nurses’ licenses in the U.S. compared to 258 malpractice claims in 2017. That’s 58 times more licensing complaints than malpractice claims.

Further, a claims analysis from Nurses Service Organization and CNA2 (NSO & CNA, 2015) showed that the average cost of a license protection claim is $3,988. Payment reflects the cost of legal representation in defending nurses from BON actions.


How to Reduce the Likelihood of a License Complaint

You can take steps inside and outside of the workplace to protect your professional license. Taking these steps will help to ensure that you can continue to practice as a registered nurse.

General Recommendations

  • Follow established procedures and protocols.
  • Provide clear, timely communication to patients and families.
  • Recognize stressors that can lead to substance abuse and allegations of unprofessional conduct; be proactive in seeking support.
  • Complete continuing education requirements.
  • If you practice as an advanced practice registered nurse, maintain physician agreement documents, and ensure access to up-to-date medication and other reference material.
  • Submit updates to credentials on time.


Improve Communication

Developing effective communication skills is the most important step you can take to protect your license.

  • Patients and families who feel they have a personal connection with a nurse may be less likely to file a complaint.
  • Listen, act with empathy, and don’t lose your temper.
  • Part of good communication is being able to resolve conflicts. If a serious conflict occurs, consider involving a mediator to help work through the situation.

Use Social Media with Caution

Social media is great way to connect with family and friends, but, as a nurse, you need to be cautious. BONs might investigate for one reason, and have your situation made worse by comments you made on Facebook, Twitter or in a text message.

  • Maintain professional boundaries. Do not have a relationship with a patient outside of a professional context—even if your professional relationship has ended.
  • Always maintain patient privacy and confidentiality. 
  • Do not post patient photos or videos of patients or identify patients by name. 
  • Do not refer to patients in a disparaging manner, even if patients are not identified.
  • Never discuss drug and alcohol use.


Keep a Record

Document consistently and in detail. Note your discussions with patients regarding their treatment on the patient’s chart. Also, keep evidence of your competency, professionalism, and public service.

  • Save documents that show your efforts to ensure your competency, such as continuing education classes completed and specialty certifications.
  • File materials that provide evidence of your professionalism, such as letters of recommendation, thank-you letters from patients and families, performance appraisals, awards, and certificates of accomplishment.
  • Include documents that show how you have served the public, such as participation in health fairs.


Understand your State’s NPA

When you are practicing as a nurse, you are responsible for understanding what is contained in your state’s NPA.

  • Periodically visit your state BON’s website, where you can read board news and access information about disciplinary action.
  • The NPA will outline your responsibilities, from patient care to basics such as requirements for notifying the board of address or name changes.
  • If a job description or common practice at your place of employment differs from your state’s NPA, follow the one more stringent. Notify your employer of any differences.
  • Nurses should contact their BON for clarification on licensure requirements with respect to interstate practice.


When a Board Takes Action

If you are notified by your state’s BON that an investigation is being initiated, immediately contact your malpractice insurance provider and retain an attorney. Your attorney will assist you in responding promptly to any requests from the BON during the investigation.

At the end of the investigation, the BON will decide whether to take further action. If disciplinary action is chosen, possible outcomes include a consent agreement, settlement, or stipulation; an informal settlement conference; or a formal hearing.

As a licensed nurse you will want to protect the most important asset you have achieved:  your license to practice professional nursing.  



  1. National Practitioner Data Bank (NPDB). (n.d.) U.S. Department of Health & Human Services. Retrieved from
  2. CNA and Nurses Service Organization. (2015). Nurse Professional Liability Exposure: 2015 Claim Report Update. Retrieved from


This risk management information was provided by Nurses Service Organization (NSO), the nation's largest provider of nurses’ professional liability insurance coverage for over 550,000 nurses since 1976. The professional liability insurance policy is administered through NSO and underwritten by American Casualty Company of Reading, Pennsylvania, a CNA company. Reproduction without permission of the publisher is prohibited. For questions, send an e-mail to or call 1-800-247-1500.

Jennifer Flynn, CPHRM, Risk Manager, Nurses Service Organization (NSO)

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