Are Boards of Nursing Contributing to The Nursing Shortage?

Are Boards of Nursing Contributing to The Nursing Shortage?

The Boards of Nursing (BONs) serve as regulatory bodies entrusted with safeguarding public health by ensuring nursing practice meets established standards. Ideally, these boards should function as fair, impartial entities that balance professional accountability with the rights of individual nurses. However, mounting evidence suggests that some BONs exercise their authority in ways that raise serious concerns about abuse of power, procedural fairness, and ultimately, the impact on patient care.

At Expert Nurse Consultants, we specialize in nurse advocacy and provide dedicated advocacy for nurses facing disciplinary actions. Darlene Nelson, R.N., Nurse Advocate, and her team work directly with nurses to ensure their rights are protected and their voices heard during the often intimidating process of dealing with a state Board of Nursing. With years of experience, she understands how these boards operate and how their decisions can affect both individual careers and the overall nursing workforce.

This essay examines how the abuse of power by Boards of Nursing through inequitable disciplinary proceedings, limited due process protections under administrative law, and the absence of constitutional safeguards creates a system that not only harms individual nurses but potentially compromises the quality and availability of patient care across healthcare systems. Nurses are often removed from practice for remedial or minor errors, intensifying the nursing shortage.

Abuse of Sovereign Power and Its Impact

Source: Patient Safety and Quality: An Evidence-Based Handbook for Nurses

The sovereign power granted to Boards of Nursing creates an environment where procedural fairness often becomes secondary to regulatory enforcement. This power imbalance manifests in several concerning patterns that directly impact patient care.

First, the disciplinary process employed by many BONs lacks transparency and consistency. Research by Zhong et al. (2018) found significant disparities in how different state boards handle similar infractions, with some boards imposing severe penalties for minor violations while others show leniency for more serious offenses. This inconsistency creates a climate of uncertainty among practicing nurses, who may become hesitant to make critical decisions in patient care situations for fear of arbitrary punishment.

Nurses also fear to self-report due to the threat of being over-punished and having their name permanently displayed on Nursys, the database operated by the National Council of State Boards of Nursing. Nursing is the only profession that maintains a free, publicly searchable database that shows the nurse’s name and the complete Board order and charges. The Board’s court order is often written with egregious language that reflects badly on the nurse, regardless of context.

At Expert Nurse Consultants, Darlene Nelson, R.N., Nurse Advocate, guides nurses through negotiating more accurate and fair language in posted orders to help protect their professional reputations. This form of advocacy for nurses is essential to ensuring fairness in a process that too often stigmatizes rather than supports.

Limited Due Process and Disproportionate Punishments

Unlike defendants in criminal proceedings, nurses facing disciplinary action by BONs are not automatically entitled to constitutional protections such as the presumption of innocence, the right to  jury trial, the right to remain silent, the right to review the evidence early or the right to legal representation. The administrative hearing process typically favors the board, with lower standards of evidence required for disciplinary action.  The standard is not “beyond a reasonable doubt”, but is instead “more likely than not.” This creates what Russell (2020) describes as a “guilty until proven innocent” paradigm.

Minor documentation errors, unintentional medication miscalculations, or even personal issues outside the workplace can trigger severe professional consequences, including license suspension or revocation. A study by the Journal of Nursing Regulation found that nearly 40% of disciplinary actions involved infractions that posed no direct threat to patient safety, yet resulted in significant practice restrictions. Such disproportionate actions remove qualified nurses from patient care, worsening staffing shortages and jeopardizing patient safety.

Financial and Professional Consequences

The financial burden placed on nurses defending themselves against board actions can be devastating. Legal representation often costs tens of thousands of dollars, forcing many nurses to represent themselves or accept punitive consent agreements regardless of culpability. This unequal access to justice highlights the critical need for nurse advocacy programs, where experts like Darlene Nelson, R.N., Nurse Advocate, step in to guide nurses through the complex and often biased system.

Beyond financial hardship, disciplinary actions permanently damage nurses’ reputations. With Nursys making records indefinitely public, many nurses are left unemployable despite remediation, continuing education, or years of subsequent safe practice. This “scarlet letter” effect strips the healthcare system of experienced professionals, directly worsening the nursing shortage.

A Call for Reform

The abuse of power by Boards of Nursing through inequitable disciplinary proceedings and limited due process protections creates a cascade of negative consequences that ultimately harm the very patients these boards are meant to protect. As nursing shortages reach crisis levels globally, the removal of qualified practitioners through disproportionate or unfair proceedings represents an avoidable loss to healthcare capacity.

Reform of the regulatory framework is urgently needed. Independent oversight, fair representation, consistent standards across jurisdictions, and alternative remediation pathways for minor infractions would help restore balance. Strong advocacy for nurses is essential in pushing these reforms forward.

At Expert Nurse Consultants, Darlene Nelson, R.N., Nurse Advocate, continues to fight for fairness and transparency in Board of Nursing proceedings. Through strong nurse advocacy, we aim not only to protect individual careers but also to safeguard the stability of the nursing profession itself. Ultimately, patients deserve both protection from unsafe practices and access to an adequate, experienced nursing workforce, goals that cannot be met when regulatory systems operate without fairness and accountability.

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