Was the Dressing Change Done or Wasn’t it? Court Doubts RN’s Integrity

A nurse licensee has the right to challenge a board discipline by filing an administrative review case in court.

In the following unpublished opinion, an RN appealed the state board of nursing disciplinary subcommittee’s order. The order resulted in a one-to-two year probation and a $250 fine.

The subcommittee found the RN violated sections of the nurse practice act that governed negligence or failure to exercise due care, incompetence, and lack of good moral character.

Details of the Case

A nursing staff member in a long-term care facility discovered a patient’s daily dressing change had not been done for three days, even though there was a physician’s order that the dressing change occur daily.

The RN who was caring for the patient, allegedly admitted to the staff nurse that she had changed the dressing. The staff nurse informed their supervisor, who also questioned the RN. The RN allegedly told the supervisor that she believed she had not changed the dressing.

The RN was terminated from her position, reported the termination to the board of nursing, and requested a hearing.

The Administrative Hearing

According to some of the hearing testimony:

  • The RN did not remember having a conversation with the staff nurse.
  • The RN told her supervisor that she was not sure whether she had changed the dressings.
  • The RN frequently had trouble logging out of the EMR.
  • The RN stated someone may have made entries under her name.
  • The director of nursing verified there were no problems with the EMR system and detailed the sign-in process, which required the user name and password of staff members.

The administrative law judge held the RN ‘s violations of the nurse practice act were proven by a preponderance of the evidence. In other words, she failed to change the patient’s dressing and falsely documented that she had done so in the EMR.

The judge also found the RN’s testimony was less credible than that of the staff nurse who discovered the unchanged dressings. In addition, the judge held there was no evidence that the EMR system was “…compromised or not functioning correctly.”

The disciplinary subcommittee adopted the judge’s recommendations, and the RN was disciplined.

The RN appealed this decision to the appellate court.

The Appellate Court’s Ruling

The RN challenged the administrative hearing on several fronts, including that “competent, material, and substantial evidence” did not support the hearing officer’s decision.

She further argued that inadmissible evidence was used and the hearing officer improperly determined the staff nurse was “more credible” than she was.

The RN also raised her contention that no direct or eyewitness evidence or testimony was presented during the hearing. As an example, she asserted the director of nursing’s testimony that the RN made the EMR’s entry was not credible because she did not see the RN make the chart entry.

The RN further argued the staff nurse should have “retained the stale dressing” as direct proof that it had not been changed.

The appeals court rejected all of these arguments and cited legal cases and state statutes that supported the administrative hearing decision.

The court also pointed out that neither the …read more

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