Nursing Disciplinary Action Explained

Nurses are trained to keep safety and professional ethics front of mind, and the public notices: in Gallup's annual honesty and ethics poll, nurses have ranked the most trusted profession in the country for 23 straight years, with 76% of Americans rating their honesty and ethics high or very high. Disciplinary action is rare, but you should understand it. Fewer than 1% of nurses face it in a given year, and most cases involve professional conduct, scope of practice, or documentation. State boards handle the complaints, investigations, and penalties, which range from probation and fines to suspension or revocation. The best protection is knowing your state's nurse practice act, documenting accurately, and following reporting rules.

Almost all nursing misconduct is handled either through disciplinary action by the state board of nursing or through civil lawsuits. That is why the RaDonda Vaught case drew national attention. A fatal medication error led to felony convictions, and many nurses protested, and some quit, alarmed at the criminalization of medical mistakes. She was sentenced to three years of probation and lost her license.

What is nursing disciplinary action?

The National Council of State Boards of Nursing (NCSBN) defines disciplinary action as an outcome that affects your licensure status and your ability to practice. Because state boards issue licenses, they also investigate complaints. A nurse's mistake or misconduct can bring other consequences too, including employer reprimands, termination, civil suits, or criminal charges, but disciplinary action specifically targets the license. Beyond suspension or revocation, a board may issue fines or warnings or require continuing education.

How common is it?

In 2021 there were 18,145 adverse actions against nursing licenses, according to the National Practitioner Data Bank (NPDB), across registered nurses, licensed practical nurses, and nurse practitioners. The NCSBN puts that at less than 1% of all nursing licenses. For scale, the Bureau of Labor Statistics counted about 3.4 million registered nurses in 2024.

The disciplinary process

Disciplinary action moves through six phases.

1. Filing a complaint. Anyone who knows of a violation of the state's nurse practice act, unethical conduct, or behavior that endangers patients can file with the board. Other healthcare professionals are mandatory reporters, so failing to report a violation is itself grounds for a complaint against their license. Nurses can also report themselves. A criminal conviction triggers a review as well. (Fear that the Vaught verdict would chill self-reporting and reporting of colleagues was one reason nurses protested it.)

2. Initial review. The board first decides whether the complaint falls under its jurisdiction, meaning whether it involves the nurse practice act. This does not judge the complaint's validity, only whether the board has authority over it.

3. Investigation. The depth depends on the nature and seriousness of the complaint. It can involve interviews with the nurse, patients, and witnesses, a written response, and review of documentation and other evidence. Investigations can take several months.

4. Board proceedings. After investigating, the board may close the case if the complaint is unfounded. Otherwise it may hold a settlement conference or hearing, file formal charges, or refer the nurse to an alternative-to-discipline program.

5. Board actions. Outcomes include fines, reprimands, or required remedial education. They also include restricting the license so the nurse practices under specific conditions, suspending it for a set period, or revoking it permanently.

6. Reporting and enforcement. The board reports any disciplinary action to Nursys, the national database of nursing licenses and their status, and to the NPDB, which tracks licensing actions and malpractice claims for all healthcare professionals.

The most common reasons

Complaints tend to fall into these categories: failing to follow nursing practice, substance misuse, sexual misconduct, boundary violations such as soliciting or accepting valuable gifts, abuse of patients, fraud, and a positive criminal background check.

According to the CNA and NSO Nurse Professional Liability Exposure Claim Report (2020), the most common allegations are professional conduct (32.5% of primary allegations), scope of practice violations (24.8%), documentation errors or omissions (9.7%), treatment and care failures (9.3%), patient abuse (8.8%), and medication administration (6.2%). Within those, drug diversion or substance misuse made up 42.3% of professional conduct allegations, and failure to maintain standards accounted for 58.9% of scope of practice allegations.

The best defense is knowing and following your state's nurse practice act and raising questions with a supervisor. Accepting money or valuable gifts from a current or former patient violates most practice acts, but few nurses want to offend a patient who offers a small, low-value gift. Knowing exactly where the line sits helps you respond.

The most common forms of disciplinary action

Disciplinary action may include a reprimand, probation (the nurse keeps practicing, but any further validated complaint brings tougher action), limited or restricted practice (for example, no access to controlled substances), suspended practice (loss of license for a set period), revocation (permanent loss of license), fines, or mandatory remedial education. Nurses often hire a lawyer, especially when suspension or revocation is on the table.

Frequently asked questions

What are the most common reasons for disciplinary action? Professional conduct violations lead at 32.5% of primary allegations, followed by scope of practice violations at 24.8%, documentation errors or omissions at 9.7%, and treatment and care failures at 9.3% (CNA/NSO, 2020).

How likely is it that a nurse loses their license? It is rare. The NCSBN reports that fewer than 1% of nurses face any adverse action in a given year. The NPDB recorded 18,145 adverse actions against nursing licenses in 2021, against roughly 3.4 million registered nurses counted by the BLS in 2024.

When can a nurse get a lawyer? At any stage, from the initial complaint through the board's final action. Some law firms specialize in medical disciplinary cases.

Can a nurse appeal? Yes. Nurses can appeal a disciplinary action and, depending on the action, may later petition to restore a revoked license.

Does disciplinary action ever include fines? Yes. Fines and civil penalties apply to several violations and are common when a nurse committed fraud or otherwise profited from the violation. Nurses also pay for any required remedial education or substance misuse treatment.

Sources

• Kelman B, et al. (2022). Why nurses are raging and quitting after the RaDonda Vaught verdict. KFF Health News.
• NCSBN. Board action.
• NPDB analysis tool.
• CNA and NSO. Nurse Professional Liability Exposure Claim Report (2020).
• Gallup. Nurses continue to lead in honesty and ethics ratings.
• AACN. Nursing Workforce Fact Sheet.
• Bureau of Labor Statistics. Registered Nurses, Occupational Outlook Handbook.