Discipline and Complaints - How to Submit a Complaint
Questions & Answers to Properly Submit Complaints to the Arizona State Board of Nursing
1. Who can submit a complaint?
Complaints related to licensees/certificate holders most commonly are received from:
Coworkers or other healthcare professionals
Patient or family members
Law enforcement and/or other regulatory agencies
Complaints related to applicants for licensure/certification, including renewal, most commonly include responses to questions asked on the application, information related to a current or prior investigation and discipline in another state, and/or information received as a result of a criminal background check.
Anyone can submit a complaint; however, the law mandates certain individuals and institutions report information to the Board. Pursuant to 32-1664 (B):
“A licensee, a certificate holder, and a health care institution as defined in §36-401 shall, and any other person may, report to the board any information the licensee, certificate holder, health care institution or individual may have that appears to show that a licensee or certificate holder is, was or may be a threat to the public health or safety.”
ARS 32-1601(18) (k) defines unprofessional conduct, in part, as “failing to report to the board any evidence that a professional or practical nurse or nursing assistant is or may be:
(ii) Guilty of unprofessional conduct
(iii) Mentally or physically unable to safely practice nursing or perform nursing related duties”
2. What is mandatory reporting & what conduct should be reported?
Mandatory reporting assists the Board in protecting the public through the discovery of unsafe or substandard nursing practice or conduct. The law does not require, and the Board does not intend, every minor nursing error be reported.
Conduct or practice that should be reported:
Information that a nurse or certificate holder may be mentally or physically unable to safely practice nursing or perform nursing related duties
Conduct involving practicing beyond the scope of practice of the license or certificate. Examples include knowingly giving a medication not authorized by a treating provider, obtaining laboratory or other tests not authorized by a treating provider, unauthorized adjusting of dosage
Conduct which leads to the dismissal for unsafe nursing practice or conduct or other unprofessional conduct
Conduct that appears to be a contributing factor to high risk/harm to a patient and required medical intervention
Conduct that appears to be a contributing factor to the death of a patient
Conduct involving the misuse of alcohol or other chemical substances to the extent that nursing practice may be impaired or may be detrimentally impacted
Actual or suspected drug diversion
Pattern of failure to account for medications; failing to account for wastage of control drugs
Falsification of medical or treatment records
Pattern of inappropriate judgment or nursing skill
Failing to assess or intervene in behalf of patient(s)
Conduct involving sexual contact with a patient, patient family member or other dual relationships
Conduct involving physical/verbal patient abuse
Conduct involving misappropriation, theft or exploitation of a patient
Practicing nursing without a valid nursing license
Violation of a disciplinary sanction imposed on the nurse’s license by the board
Conduct that deceives, defrauds or harms the public
In addition to the mandatory reporting, individual licensees are required to report the following:
Criminal charges, felony and misdemeanor, which may affect public safety within ten days from when the charge(s) are filed
Felony conviction(s) must be reported within ten days of the conviction
The above list is not intended to cover all conduct that must be reported to the Board as there may be other conduct which should be reported to the Board. Please call the Board to discuss any other conduct that may place the public welfare at risk.
3. What conduct is not typically reportable to the Board?
Examples of low risk issues not involving patient care, professional judgment or wrongdoing that do not require reporting to the Arizona Board of Nursing may include:
rudeness to peers, co-worker disputes, personality conflicts, absenteeism, tardiness, labor-management disputes such as work schedules/wages/wrongful termination, resignation without notice whereby a patient assignment has not been accepted.
4. When should a report be made?
Emergent matters involving a RN, LPN, or CNA who may represent an imminent threat to patient/public safety should be reported immediately. The complaint may be submitted online, by email at email@example.com, by US Mail to the address listed below or telephonically by calling the complaints department at 602-771-7845. The call should be followed with a written complaint/statement describing in detail “who, what, where and when” of the events.
Emergent matters involving RN or LPN with suspected drug diversion or substance abuse may be reported immediately to the CANDO Consultant, Jan Kerrigan, by calling 602-771-7864. The call should be followed with a written complaint/statement describing in detail “who, what, where and when” of the events. In the event that you recommend a person self report to the Board, the self report should be followed up by the person directing the self report with a written statement providing collateral information.
Complaints should be reported as soon you have substantiated or otherwise have reasons to believe that a violation of the Nurse Practice Act has occurred and you have followed the policies within your facility regarding mandatory reporting. If the facility or agency’s administrators decline or delay reporting, it is appropriate for a staff nurse or nurse manager to take responsibility for reporting to the Board.
5. How do I file a complaint?
Although telephonic complaints are accepted, it is preferable that complaints be in writing except for emergent matters involving high risk for patient harm such as suspected impairment on duty or sexual abuse, in which an initial telephonic complaint, followed then by a written complaint should be made.
When submitting the complaint information, provide as much detail as available. Identify the nurse or certified nursing assistant involved, including the name, license or certificate number, or other identifying information such as name of employer, date of birth, social security number to assist in identifying the correct individual. If available, provide last known address and phone number of the individual.
Provide a detailed summary of the incidents or complaint including dates and location of each alleged incident. If a patient was involved, provide the medical record number or name of the patient involved. Supplying the medical record number or name of the patient to the Board of Nursing is not a violation of confidentiality or HIPAA. Provide a list of any witnesses who have first hand knowledge or observations and if available, legible copies of relevant records or other information. Include your contact information as there may be additional information or clarification required during the Board’s investigation of the complaint.
Reporting forms are not required, but are available on our website at www.azbn.gov, RN/LPN/CNA Complaint Form can be sent to you via mail or fax by calling 602-771-7843 or by emailing a request to firstname.lastname@example.org.
6. Where should the complaint be sent?
Online: Submit a Complaint Online
Arizona State Board of Nursing
4747 North 7th Street
Phoenix, AZ 85014-3655
7. Is a failure to report those who may be a risk to the public a violation of the Nurse Practice Act?
Yes. In addition to the mandatory reporting law, A.R.S. §32-1664(B) and 32-1601(18) (k), failure to report a nurse or certificate holder who may be a risk to patient/public safety is a violation of the nurse practice act. Per A.A.C. R4-19-403 (10 and 11)
A.A.C. R4-19-403 “For the purposes of A.R.S. §32-1601 (18) (d), a practice that is or might be harmful of dangerous to the health of a patient or the public includes the following:
10) Failing to take action in a health care setting to protect a patient whose safety or welfare is at risk from incompetent health care practice, or to report such practice to employment or licensing authorities;
11) Failing to report to the Board a licensed nurse whose work history includes conduct, or pattern of conduct, that leads to or may lead to an adverse patient outcome;”
8. Will the person know who filed a complaint?
The subject of the complaint may be furnished with a copy of the complaint upon request. However, if disclosure of the identity of the complainant will pose a risk to the person making the complaint, a copy of the complaint with redacted indentifying information may be provided. If in the Board’s discretion, there is a risk of identification even with redacting information, the Board reserves the right to withhold furnishing a copy of the complaint.
9. Will the public be aware a complaint or self-report has been received?
Once a complaint is received, the license/certificate verification status will reflect “complaint/self report received”. Although it is public information that a complaint has been received, is being investigated and the date received, specific information regarding the allegation is not provided to the public. The Board outcome of a complaint investigation is public information.
10. What happens with the complaint?
When a complaint or self-report is received by the Board, it is first reviewed to determine jurisdiction. If the Board has jurisdiction, the license/certificate or application is flagged with a status of “Complaint/Self Report”, an investigator and a case number are assigned. Notification letters are sent to the complainant and to subject of the complaint and the investigative process begins. The subject of the complaint (“respondent”) is made aware of the specific allegations and is required to respond in writing. The investigator collects objective information from a number of sources, interviews the complainant, witnesses, and the respondent. The information is compiled into an investigative report to present at a board meeting for the Boards’ review and decision. The board meeting is open to the public. The complainant and the respondent may choose to be present and make a statement to the Board but neither is required to do so. The board meeting is not a hearing but rather is forum for the Board to determine based upon the investigative findings, if probable evidence exist that a license or certificate holder has violated the Nurse Practice Act.
11. Can the subject of the complaint obtain legal representation?
At any stage of the investigative process, the subject of the complaint may obtain independent legal representation.
12. How long does the investigative process take?
Investigations currently take an average of seven months to complete, depending on the complexity and seriousness of the alleged conduct. Some high risk/ high harm investigative cases have been completed in 1 month or less.
13. Can the license/certificate holder or applicant work while they are under investigation?
The ability to work as a nurse or CNA is unrestricted during the investigation as long as the license or certificate remains active. However, applicants are not issued a license/certificate until the conclusion of the investigation.
14. What can the subject of the complaint or people making the complaint do to assist in the investigative process?
If you are the subject of the complaint: keep the board apprised of any changes in your address and phone number, and respond promptly to any requests for information or documents. You will be required to submit a written response to the complaint and will be requested to meet with the assigned investigator for an interview and to review information obtained during the course of the investigation. Your input and participation is important in understanding what occurred.
If you have filed a complaint: submit all written documentation regarding your concerns, observations and impressions concerning the incident. Providing detailed information at the onset is important in assisting the Board to understand risk of harm and in facilitating the investigative process.
15. What happens when the case is presented to the Board?
The board meeting is an open public meeting where investigative reports related to complaints that have been received and investigated by staff are reviewed by the Board members to determine, based upon evidence in a case, whether there is probable evidence of a violation of the Nurse Practice Act. Board members will deliberate and make a motion, stating what action should occur.
16. Who can address the Board members?
If you have submitted a complaint or you have had a complaint submitted against your application or your license/certificate, you are welcome to attend the board meeting to hear the discussion and Board decision. The board meeting is not a hearing but you may choose to give a verbal presentation (up to 5 minutes), providing information you feel is pertinent for the Board to consider. You may also choose to just be available to respond to their questions, or you may be present and not speak at all. Information that is relevant to the complaint and investigation should have been provided to the assigned investigator in advance of the board meeting.
17. What are the possible Board members decisions or actions?
Board actions are categorized as: Dismissal, Non-disciplinary Action, Disciplinary Action, and Administrative Violations. Once the case has been reviewed by the Board, the complaint/self report status is closed and the licensee/certificate holder’s record updated to reflect the Board’s action or pending action.
Dismissal – Evidence does not support there has been a violation of the Nurse Practice Act.
Letter of Concern – A letter from the Board expressing concern that a licensee, certificate holder or applicant may have been engage in questionable conduct that is considered low risk or harm to the public. A letter of concern issued by the Board is non-discipline and is not an appealable agency action
Civil Penalty – A monetary fine issued by the Board, not to exceed $1,000, given singly or in combination with any disciplinary action for a violation of the Nurse Practice Act.
Decree of Censure – This is an official discipline by the Board that the individual’s conduct violated the Nurse Practice Act but does not represent a continued risk to the patient/public.
Probation – This action allows the nurse to continue working during the period of probation subject to compliance with the terms and conditions. During the period of probation the nurse must be supervised in their practice and complete certain requirements which are aimed at rehabilitation or educating and remediating the nurse in his/her area(s) of practice deficit. For example, a nurse with a substance abuse issue may be required to enter and complete treatment, attend AA/NA meetings, abstain from alcohol and other drug use along with other requirements. A nurse who lacks sufficient knowledge of medications or safe administration may be required to take a pharmacology course, etc.
Suspension – A person who has been suspended may not practice during the period of suspension. A person who has been suspended has terms and conditions which must be fulfilled during the period of suspension and before being allowed to resume practice. Examples of terms and conditions may include completing a refresher course, psychological or substance abuse treatment in addition to other requirements. A licensee/certificate holder that has been suspended often has a period of probation or monitoring following successful completion of the terms of suspension.
Revocation – This action prohibits the nurse/certificate holder from practicing for a minimum of five years, pursuant to A.A.C. R4-19-404. When a license/certificate has been revoked, the applicant for re-issuance must provide detailed information to the Board that the reason for revocation no longer exists and that the issuance of a license/certificate would no longer threaten the public health or safety. A.A.C. R4-19-404 or R4-19-815) The individual whose license/certificate has been revoked may not practice or otherwise indicate to the public that they hold a license/certificate.
Denial – A person (applicant) who has been denied a license/certificate may not practice and is not eligible to reapply to the Board for a period of five years.
Voluntary Surrender – A Consent Agreement has been signed in which an APRN, RN, LPN, CNA has voluntarily surrendered their license or certificate.
Administrative Penalty – A penalty/fine given to a licensee or certificate holder who has worked on an expired license/certificate, or failed to notify the Board of an address change within 30 days. It is not reportable to NCSBN or other national data centers.
18. When is the Board decision final?
For discipline to be final and in effect, a person must either consent to the discipline as voted upon by the Board by signing a “Consent Agreement” or if not signed, the person has had an opportunity for a hearing. Hearings are conducted at the Office of Administrative Hearings and the person conducting the Hearing is an Administrative Law Judge (ALJ).
Following the hearing and based upon the evidence presented, the ALJ submits recommended “Findings of Fact, Conclusions of Law and Order” to the Board. Transcripts of the hearing are reviewed by the Board members prior to voting on the appropriate disciplinary actions (if any) to be taken. The Board has final authority to determine discipline and can adopt, modify or reject the ALJ recommendation. If discipline is determined to appropriate by the majority of the Board Members, a “Board Order” is issued. If the respondent disagrees with the outcome, a request for rehearing must be filed within 30 days of the mailing of the Board’s decision and Order, otherwise, the matter is final.