Nurse Misconduct and Impairment: What Home Health Agencies and Nursing Staffing Agencies Need to Know About Reporting
When a nurse’s behavior raises concerns about safety, judgment, or substance use, the nurse’s colleagues and employer have an ethical and legal responsibility to take action. For licensed home health agencies and nurse staffing agencies, understanding the difference between a performance issue that can be addressed internally and a situation that requires reporting to regulatory authorities is essential.
The Ethical Foundation: The ANA Code of Ethics
The American Nurses Association (“ANA”) Code of Ethics provides a clear foundation for how nurses and employers should respond to misconduct and impairment.
- Provision 3.3 emphasizes the duty to promote patient safety, reduce errors, and establish and sustain a culture of safety by, in part, reporting incidents that risk patient health.
- Similarly, Provision 3.4 calls upon nurses to report practice concerns to appropriate external authorities if such concerns cannot be remedied internally.
- Provision 3.5 underscores the nurse’s responsibility to identify the signs of impairment in a colleague, and report the colleague, if necessary.
Together, these provisions establish that reporting misconduct and impairment is not just a regulatory requirement – it is a professional and ethical obligation that protects both patients and the reputation of the nursing profession.
Understanding Mandatory Reporting
Many states have mandatory reporting laws requiring licensed healthcare professionals, home health agencies, and staffing agencies to report suspected violations of nursing laws or standards of practice. Reportable events generally include:
- Patient abuse, neglect, or abandonment
- Drug diversion or on-duty impairment
- Falsification of patient records
- Boundary violations or sexual misconduct
- Conduct that demonstrates gross negligence or reckless disregard for patient safety
While the specific requirements vary by state, generally intentional or reckless conduct that places patients at risk should be reported to the appropriate licensing authority.
Addressing Impairment and Supporting Recovery
Many states recognize that nurses struggling with substance use or mental health issues benefit from early intervention and treatment. To that end, several have established confidential assistance or rehabilitation programs for nurses.
Participation in such a program may, in some states, exempt the nurse or employer from mandatory reporting – provided that the nurse is actively engaged in treatment and poses no immediate risk to patients.
Employers should review their state’s laws and alternative-to-discipline programs to understand when confidential reporting or referral is appropriate. These programs can help preserve nursing careers while maintaining public safety.
Building a Culture of Safety and Compliance
Home health and staffing agencies can reduce risk – and improve staff retention – by fostering an environment where nurses feel safe to report mistakes, concerns, or personal struggles without fear of immediate punishment. Key strategies include:
- Training supervisors in principles consistent with the ANA Code of Ethics;
- Developing clear, written policies on mandatory reporting and impairment response;
- Encouraging self-reporting and early intervention; and
- Maintaining partnerships with peer assistance programs or rehabilitation services.
Takeaways
Home health and nurse staffing agencies share both a moral and legal responsibility to protect patients and support nurses in practicing safely. By aligning policies with the ANA Code of Ethics and understanding each state’s reporting and rehabilitation requirements, agencies can strike the right balance between accountability and compassion.
If you have questions about mandatory reporting obligations in your state, please contact Evan Sampson, Counsel in the firm's Health Care Practice Group, at 856.301.2561 or esampson@postschell.com.
Disclaimer: This post does not offer specific legal advice, nor does it create an attorney-client relationship. You should not reach any legal conclusions based on the information contained in this post without first seeking the advice of counsel.
About the Author
Evan M. Sampson is Counsel in the firm’s Health Care Practice Group, where he advises health care providers and organizations on a broad range of regulatory, transactional, and litigation matters.