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Nursing Management:
doi: 10.1097/01.NUMA.0000412224.40765.10
Department: Leadership Q&A

Reporting an incompetent nurse; identifying barriers to Magnet® recognition

Murray, Kathleen MSN, RN, CNA

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Vice President of Patient Care Services, Baptist Medical Center Downtown, Jacksonville, Fla.

Q I recently terminated a nurse because of professional practice issues and reported it to our state board of nursing. I received a letter from the board stating that it was taking an action against the nurse's license. I really believe this nurse is incompetent and a patient safety threat. Is there anywhere else I can lodge a complaint against the nurse?

Before you lodge a complaint with another regulatory body, you need to make sure that you've followed your organization's policies regarding mandatory reporting of unsafe or substandard nursing practice or conduct. You've started your state's mandatory reporting process by reporting the nurse to the board of nursing. Without a doubt, you filed the complaint as soon as you substantiated or otherwise had reason to believe that a violation of the Nurse Practice Act occurred.

The investigator assigned to the case probably scheduled an interview with you to review the written documentation you submitted. This is a crucial component of the investigation and a time for you to voice your concerns and provide one-on-one verbal substantiation of your submitted written report. Timelines for investigations can range from 7 to 12 months, depending on the complexity of the complaint. However, some high-risk/high-harm investigative cases have been completed within 4 weeks or less.

From your question, it's clear that the board of nursing took your complaint seriously and has taken action against the nurse's license. The possible sanctions may include remedial education, a fine, a warning, a reprimand, suspension, probation, or license revocation. The board decisions are public information and permanent designations in the licensure records of the nurse. I would recommend that you visit your state board of nursing's website to review what sanction was lodged against the nurse.

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If you're unsatisfied with the board's decision, you should schedule a meeting with your chief nurse executive and the human resources and legal departments to discuss next steps in the reporting process for an incompetent nurse who has been terminated from your organization.

Q I've heard that more organizations applying for Magnet® recognition are being turned down. Has something changed in the application process?

Magnet recognition status is granted to hospitals that meet or exceed established sources of evidence designed to measure the strength and quality of their nursing department. Implemented in 2008, the new sources of evidence consist of five model components: transformational leadership; structural empowerment; exemplary professional practice; new knowledge, innovations, and improvements; and empirical outcomes. The model has evolved from one that concentrated on structures and processes to one focused on outcomes.

Every organization pursuing the initial Magnet designation or redesignation journey must commit to the five model components, inclusive of the infrastructure to support professional development; new knowledge and innovation through research, evidence-based practice, and new technology; and empirical outcomes. Achieving above the national benchmark scores for patient and nursing satisfaction and nursing-sensitive indicators is key to the success of any organization in achieving or sustaining Magnet recognition.

There are several key initiatives that hospitals need to have in place in preparation for a successful Magnet journey. First, complete your gap analysis to assess where your facility might not be meeting benchmarks for empirical outcomes. The requirement is that every organization is to have 2 years of data that are above the national database median or mean the majority of the time for clinical measures for nursing, patient satisfaction, and nurse satisfaction. The paradigm shift for obtaining or sustaining an organization's Magnet recognition is clearly focused on outcomes. If you don't have the outcomes, your organization may not achieve or maintain its Magnet designation.

© 2012 by Lippincott Williams & Wilkins, Inc.

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