What Happens at a Board of Nursing Hearing: Everything You Need to Know

You received the notice. Your nursing board complaint is proceeding to a formal hearing. A formal hearing is a trial held in an Administrative Law Court room. 

Your stomach drops. Questions flood your mind. Who will be there? What will they ask? Can I lose my license?

Board of Nursing hearings decide your professional future. Understanding the process reduces fear and helps you prepare effectively.

This guide walks you through every stage of a BON hearing. You'll learn what happens before, during, and after. You'll understand who attends, what evidence gets presented, and how to maximize your chances of keeping your license.

Nurse receiving expert advice during a board complaint consultation

What Is a Board of Nursing Hearing?

A Board of Nursing hearing is a formal administrative proceeding where evidence is presented about alleged violations of your state's Nurse Practice Act.

Think of it as a trial, but not in criminal court. It's an administrative law process. The board (or an administrative law judge) hears evidence from both sides and determines whether you violated nursing standards.

The hearing decides three questions:

• Did you violate the Nurse Practice Act?

• If yes, what discipline is appropriate?

• Should your license be suspended, revoked, restricted, or allowed to continue with conditions?

According to 2024 National Council of State Boards of Nursing (NCSBN) data, approximately 12,000 nursing board hearings occur annually across all states. The average hearing takes 4-6 hours, though complex cases can span multiple days. 

Nurses historically do not fare well in Administrative Hearings or trials. The system is heavily stacked against them from the outset. The Board holds a significant financial and procedural advantage, with the resources to retain expert witnesses and present a well-funded case. Moreover, under Administrative Law, even when an Administrative Law Judge issues a Proposed Decision based on the evidence and applicable law, that decision is not final. The Board retains the authority to reject the Judge’s Proposed Decision, particularly if it favors the nurse. Consequently, even when a nurse successfully proves their case by the “preponderance of the evidence” standard, meaning it is more likely than not that they are innocent, the Board can still choose to disregard the findings, impose discipline, and effectively destroy the nurse’s career.

Why Your Complaint Reached a Hearing

Not every complaint reaches a formal hearing. Most complaints resolve through:

• Dismissal after investigation (35% of complaints)

• Consent agreements or settlements (40% of complaints)

• Informal conferences or pre-hearing resolutions (15% of complaints)

• State Office of Hearing Mediation

Only about 10% of complaints proceed to formal hearings.

Your case reached a hearing because:

You rejected a settlement offer: The board proposed a consent agreement but you declined, choosing to contest the allegations. Your case failed at mediation which I have found is rare.

The board rejected settlement: The evidence was strong enough that the board refused to settle and proceeded with formal charges.

Disputes over facts or law: Significant disagreement exists about what happened or whether it violates the Nurse Practice Act.

Severity of allegations: The complaint involves serious allegations (patient harm, substance abuse, criminal conduct) that require formal adjudication.

Types of Board Hearings

States use different hearing structures:

Administrative Law Judge (ALJ) Hearings

States like California, Texas, and Florida use administrative law judges from separate state agencies.

The ALJ conducts the hearing independently. They don't work for the nursing board. After hearing evidence, they issue a "proposed decision" or "recommended order."

The nursing board then reviews the ALJ's recommendation and issues a final decision. The board can accept, reject, or modify the ALJ's findings.

Board Panel Hearings

States like Ohio and New York use board members themselves to conduct hearings.

A panel of 3-5 board members (typically including nurses and public members) hears the evidence directly. They ask questions, evaluate credibility, and deliberate.

The panel then votes on findings and discipline.

Hearing Officer Model

Some states appoint hearing officers (often retired judges or attorneys) to conduct hearings.

Like ALJs, hearing officers issue recommendations. The full board makes the final decision.

Timeline: From Charges to Hearing

Notice of Charges (Month 0)You receive formal charges listing specific Nurse Practice Act violations. The notice includes hearing rights and response deadlines.

Response/Answer (Weeks 2-4)You file a written answer admitting or denying each charge. You may assert defenses and request specific hearing procedures.

Discovery Phase (Months 1-4)Both sides exchange evidence:

• Documents

• Witness lists

• Expert reports

• Deposition transcripts

Discovery rules vary by state. Some states allow extensive discovery. Others limit it significantly.

Pre-Hearing Conference (Month 3-5)A settlement conference or scheduling hearing occurs. The parties discuss:

• Settlement possibilities

• Procedural issues

• Witness lists

• Exhibit lists

• Hearing dates

Hearing Preparation (Month 4-6)Your legal team prepares:

• Witness preparation

• Exhibit organization

• Opening statements

• Cross-examination plans

• Expert witness coordination

Formal Hearing (Month 6-12)The hearing takes place. Length varies from half a day to multiple days spread over weeks.

Post-Hearing Briefs (Month 7-13)After the hearing, both sides submit written arguments summarizing evidence and legal positions.

Decision (Month 8-18)The ALJ or board issues a decision. Timeline varies significantly by state.

Who Attends Your BON Hearing

The Presiding Officer

Either an ALJ, hearing officer, or board panel chairs the hearing. They control procedures, rule on objections, and ultimately decide your case.

The Prosecutor

The state (usually represented by an Assistant Attorney General or board staff attorney) prosecutes the case against you. They present evidence showing you violated the Nurse Practice Act.

You and Your Attorney

You have the right to attend and testify. Your attorney represents you, cross-examines witnesses, presents your defense, and makes legal arguments.

Some nurses attend hearings without attorneys. This is almost always a terrible mistake. Administrative law is complex. Self-represented nurses rarely achieve favorable outcomes.

Witnesses

Both sides present witnesses:

State witnesses typically include:

• Board investigators

• Patients or family members

• Former employers or supervisors

• Coworkers

• Expert witnesses (often nurse educators or experienced RNs)

• Law enforcement (if criminal conduct alleged)

Defense witnesses often include:

• Character witnesses (colleagues, supervisors)

• Expert witnesses who support your practice

• Factual witnesses who contradict allegations

• Treatment providers (if substance abuse alleged)

• Employers showing current good performance

Court Reporter

A court reporter creates a verbatim transcript of all testimony and proceedings. This transcript becomes the official record for any appeals.

Board Staff

Board investigators, executive directors, or legal counsel may attend to support the prosecution or provide information to the board.

Public Observers

Board hearings are generally open to the public unless you request a closed hearing for specific reasons (medical privacy, etc.). Family members, media, or interested parties may attend.

Most hearings have few if any public observers, but high-profile cases sometimes attract attention.

What Happens During the Hearing

Opening the Hearing

The presiding officer opens by:

• Stating the case name and number

• Confirming all parties are present

• Explaining hearing procedures

• Swearing in the court reporter

• Addressing preliminary motions

Opening Statements

Each side presents an opening statement outlining what they intend to prove.

State's opening: The prosecutor summarizes the charges and previews evidence showing you violated nursing standards.

Your opening: Your attorney explains your defense, previews favorable evidence, and frames the case from your perspective.

Opening statements aren't evidence. They're roadmaps of what each side expects to prove.

The State's Case-in-Chief

The prosecution presents its evidence first. They call witnesses who testify under oath.

Direct examination: The prosecutor questions their witness, establishing facts that support the charges.

Cross-examination: Your attorney questions the witness, challenging their testimony and credibility.

Common state evidence includes:

• Medical records showing documentation failures or care issues

• Policy and procedure manuals establishing standards you allegedly violated

• Witness testimony from patients, family, or coworkers

• Expert testimony explaining why your actions fell below standards

• Investigation reports from board investigators

• Previous discipline showing patterns of violations

According to Maria Santos, JD, RN, a nursing defense attorney with 18 years of experience: "The state's case lives or dies on documentation. If the medical record is incomplete or the witness testimony contradicts documentation, we can create reasonable doubt about what really happened."

Your Defense Case

After the state rests, you present your defense. Your attorney calls witnesses and introduces evidence supporting your position.

Direct examination: Your attorney questions your witnesses.

Cross-examination: The state questions your witnesses.

Defense strategies vary based on the allegations:

Challenging the Facts: Evidence often demonstrates that the alleged incident did not occur as described—or did not occur at all. In most cases, the strongest evidence in your defense is the medical record. Unfortunately, Boards frequently misinterpret electronic medical records (EMRs) or overlook clear documentation that supports the nurse’s account. This is why it is critical to thoroughly review all records in direct comparison to the specific allegations. Your documentation, along with Pyxis or medication dispensing records, may in fact prove your innocence.

Request that the Board issue subpoenas for all relevant records, including the controlled substance logs generated by the hospital pharmacy for every Pyxis machine. These records are maintained for years and document every transaction on every shift—often providing objective proof that can exonerate the nurse.

Challenging the standard of care: Your retained Expert testifies and establishes that your actions met acceptable nursing standards. And was consistent with what a reasonable and prudent nurse would do in the same or similar circumstances.

Providing context: Evidence shows mitigating circumstances (Emergency situation with other patient, violent patient in next bed.).

Demonstrating rehabilitation: Evidence of treatment completion, continuing education, or exemplary recent practice.

Character evidence: Witnesses testify to your competence, professionalism, and good character.

Rebuttal Evidence

The state may present rebuttal evidence responding to new issues raised in your defense.

You may then present sur-rebuttal addressing the state's rebuttal.

Closing Arguments

Each side summarizes the evidence and makes final legal arguments.

State's closing: The prosecutor argues the evidence proves violations and requests specific discipline.

Your closing: Your attorney argues the evidence fails to prove violations or, alternatively, that minimal discipline is appropriate given mitigating factors.

State's rebuttal: The prosecutor responds to your closing arguments.

Board Deliberation

What happens next depends on your state's hearing model:

ALJ hearings: The ALJ deliberates privately and issues a written proposed decision weeks later.

Board panel hearings: The board may deliberate immediately in closed session, or they may deliberate at a later date after reviewing hearing transcripts.

Evidence Presented at BON Hearings

Board hearings follow relaxed evidentiary rules compared to criminal trials, but evidence must still be relevant and reliable.

Documentary Evidence

Medical RecordsComplete patient charts showing your documentation, assessments, interventions, and outcomes.

Employment RecordsPerformance evaluations, disciplinary records, training documentation, and credentialing files.

Policies and ProceduresFacility policies establishing standards for medication administration, documentation, scope of practice, etc.

CommunicationsEmails, text messages, incident reports, or other written communications about the alleged violations.

Expert ReportsWritten opinions from nursing experts analyzing whether your conduct met standards.

Testimony

Fact Witnesses People with direct knowledge of the events testify about what they saw, heard, or experienced.

Expert WitnessesQualified nurses or healthcare professionals testify about nursing standards of care and whether your actions met those standards.

Expert testimony often determines hearing outcomes. Strong expert support can overcome weak defenses. Poor expert testimony can destroy otherwise strong cases.

Physical Evidence

Medication RecordsAutomated dispensing records, waste witness logs, or narcotic documentation (especially in diversion cases).

Videos or PhotosSecurity footage, patient photos, or other visual evidence.

EquipmentRarely, physical equipment may be introduced to demonstrate proper use or malfunction.

Common Defenses at Board Hearings

Factual Disputes

"The alleged incident didn't happen as described."

You present evidence contradicting the complaint's version of events. Documentation, witness testimony, or electronic records show a different sequence of events.

Standards of Care Defense

"My actions met acceptable nursing standards given the circumstances."

Expert witnesses testify that your judgment and interventions fell within the range of acceptable nursing practice, even if they weren't perfect.

Due Process Violations

"The board violated my procedural rights."

You challenge the investigation process, lack of notice, denial of discovery, or other procedural errors.

Statute of Limitations

"Too much time passed between the incident and the complaint."

Some states have limitations periods for filing charges. If the board waited too long, you may have a defense.

Lack of Evidence

"The state failed to prove violations by a preponderance of the evidence."

You argue the evidence is insufficient to meet the state's burden of proof.

Mitigation

"Even if violations occurred, discipline should be minimal given mitigating circumstances."

You present evidence of:

• No prior discipline

• Years of excellent practice

• Isolated incident

• Completion of remedial education

• Changed circumstances eliminating future risk

Possible Hearing Outcomes

Board hearings result in one of several outcomes:

Dismissal

The board finds no violation occurred. Your license continues without restriction. This is the best possible outcome but occurs in only about 15% of contested hearings.

Reprimand or Censure

The board finds violations but imposes only a written reprimand. Your license continues without practice restrictions. The reprimand becomes public record.

Probation

The board places your license on probation for a specified period (typically 1-5 years) with conditions:

• Regular reports to the board

• Practice monitoring

• Continuing education requirements

• Substance abuse testing (if applicable)

• Supervisor oversight

Probation allows you to continue practicing but with oversight.

Suspension

The board suspends your license for a specified period (typically 30 days to 2 years). You cannot practice during suspension.

Suspensions may be:

• Stayed: Held in reserve. If you complete probation successfully, the suspension never takes effect.

• Immediate: You must stop practicing immediately.

• Delayed: You have time to transition patients or employment before suspension begins.

Revocation

The board permanently revokes your license. You can no longer practice as a nurse in that state.

Some revocations allow reinstatement petitions after a specified period (typically 3-5 years).

Surrender

You voluntarily surrender your license in lieu of contested discipline. Surrenders are typically permanent.

Fines and Costs

The board may impose fines (500−10,000+) and require you to pay investigation or hearing costs.

What to Expect After the Hearing

Waiting for the Decision

ALJ hearings: Proposed decisions typically issue within 30-90 days. The board then has 30-120 days to review and issue a final order.

Board panel hearings: Decisions may issue within days or take months, depending on board meeting schedules.

Some states require decisions within specific timeframes. Others have no timeline requirements.

Receiving the Final Order

The board sends a written order detailing:

• Findings of fact

• Conclusions of law

• Discipline imposed

• Effective dates

• Appeal rights

Read it carefully. Note appeal deadlines. Understand exactly what restrictions or requirements apply to your license.

Compliance with Board Orders

If the board imposes probation, suspension, or other discipline, comply immediately and completely.

Non-compliance results in additional charges and often license revocation.

Track all requirements:

• Continuing education deadlines

• Report submission dates

• Drug testing schedules

• Supervisor evaluation due dates

Appeal Rights

You can appeal unfavorable board decisions. Appeals go to state courts, typically the intermediate appellate court.

Appeal deadlines are strict (often 30 days). Miss the deadline and you lose appeal rights.

Appeals are expensive (

• The board violated your due process rights

• No substantial evidence supports the board's findings

• The board applied the law incorrectly

Courts give significant deference to board expertise. Appeals are difficult but sometimes necessary.

How to Prepare for Your BON Hearing

Hire Experienced Representation

Board hearings are not DIY projects. Administrative law is complex. Nursing regulations are technical. You need someone who understands both.

Look for attorneys or consultants who:

• Specialize in nursing license defense

• Have extensive hearing experience

• Know your state's board procedures

• Have relationships with board staff

• Understand nursing practice standards

Gather All Documentation

Collect every document related to the allegations:

• Complete medical records

• Your personal notes

• Policies and procedures

• Training materials

• Performance evaluations

• Communications (emails, texts)

Organize chronologically. Create an index. Make your attorney's job easier.

Prepare Your Testimony

If you testify (and you usually should), prepare thoroughly:

Practice answering questions. Review your documentation. Understand the timeline. Anticipate cross-examination.

Never memorize answers. Speak naturally and truthfully. If you don't remember something, say so.

Identify Strong Witnesses

Think about who can support your case:

• Supervisors who can attest to your competence

• Coworkers who witnessed the incident

• Patients or families you've helped

• Experts who understand the clinical situation

Good witnesses are:

• Credible and professional

• Knowledgeable about relevant facts

• Prepared and confident

• Consistent in their testimony

Understand the Board's Perspective

Boards exist to protect public safety. They ask: "Does this nurse pose a risk to patients?"

Frame your defense around demonstrating that you're safe to practice. Show:

• Understanding of what went wrong

• Steps taken to prevent recurrence

• Current competence

• Commitment to professional standards

Dress Appropriately

Hearings are formal proceedings. Dress professionally:

• Business suit or conservative professional attire

• Minimal jewelry

• Professional grooming

First impressions matter. Look like the competent professional you are.

Control Your Emotions

Hearings are stressful. You may feel angry, scared, or defensive.

Control your emotions. Stay calm. Speak respectfully. Never argue with the judge or prosecutor.

If you need a break, ask for one. Your attorney can request recesses.

Protect Your License Before It Reaches a Hearing

Most cases never reach hearings. Smart early intervention often resolves complaints favorably before formal charges.

If you receive a board complaint letter, act immediately:

• Consult with defense experts

• Craft a strong written response

• Consider settlement if appropriate

• Build your defense from day one

Expert Nurse Consultants helps nurses avoid hearings through effective early defense strategies. When hearings are necessary, we prepare comprehensive defense cases that maximize your chances of license preservation.

Contact us for a confidential case review:

Phone: (210) 200-9660Website: www.expertnurseconsultants.com 

Chat with Board Buddy - Our AI Agent: https://www.expertnurseconsultants.com/board-buddy Board Buddy AI is our intelligent assistant designed to help nurses quickly get accurate, supportive information when facing board-related questions or concerns.

Don't face a board hearing alone. Your license is too important.

Frequently Asked Questions

Can I bring a lawyer to my BON hearing?

Yes. You have the right to legal representation at board hearings. You can represent yourself, but this is rarely advisable. Administrative hearings involve complex procedures and evidence rules that self-represented nurses struggle to navigate effectively.

Are board hearings public or private?

Generally public. Most state administrative procedure acts require open hearings. You can sometimes request a closed hearing for specific portions (medical testimony, etc.), but the default is public access. Media and observers can attend unless the board orders otherwise.

What is the burden of proof at a BON hearing?

Preponderance of the evidence. The state must prove violations are "more likely than not" to have occurred. This is a lower standard than criminal cases (beyond a reasonable doubt) but the same as civil lawsuits.

Can I settle my case after charges are filed but before the hearing?

Often yes. Many states allow pre-hearing settlement agreements. Your attorney can negotiate with board staff or the prosecutor. Settlements avoid the uncertainty and expense of hearings but require you to accept some discipline.

How long does it take to get a decision after the hearing?

Weeks to months. ALJ hearings typically produce proposed decisions in 30-90 days. The board then takes another 30-120 days to issue final orders. Board panel hearings may decide immediately or take months depending on meeting schedules. Some complex cases take over a year for final orders.

What happens if I don't show up to my BON hearing?

The hearing proceeds without you. The board considers the state's evidence with no defense presented. This almost always results in license suspension or revocation. Never skip your hearing. If you can't attend for legitimate reasons (medical emergency, etc.), your attorney must request a continuance immediately.