Failure to maintain minimum standards of nursing care in North Carolina occurs when a nurse fails to provide the level of skill and care that a reasonably prudent nurse would provide under similar circumstances, resulting in patient harm. This broad category includes failure to follow safety protocols, improper medication administration, inadequate patient monitoring, poor communication during shift handoffs, failure to initiate CPR timely, sleeping on duty, and failure to assess clients as warranted.
What are standards of care in NC and why are they important?
Standards of care in nursing refer to the general guidelines for how nurses should act, what they should and should not do in their professional capacity. Standards of nursing care outline the professional expectations of nurses, guide nurses on proper protocol, provide consistency throughout the nursing profession, and give nurses an objective standard by which to evaluate other nurses. These standards are important because they recognize the trusted role that a nurse plays and provide a “baseline” for quality care.
Creating and maintaining these standards are one of the ways that Boards of Nursing regulate the practice of nursing in their states. In North Carolina, the NCBON issues licenses to those practicing in the state to protect the public from the unsafe, incompetent, and unethical practice of nursing, and the Nursing Practice Act established the standards of care that all licensed nurses must follow.
However, the standards of care established by the Board are not the only standards that nurses must follow. Additional standards may be based on written policies, procedures, protocols, professional studies, and expert opinions from nursing supervisors. Complaints regarding a failure to maintain standards of care usually allege that a nurse failed to follow a certain policy, procedure, protocol, or even doctors’ orders. Most complaints will state that a nurse was negligent if the patient suffers a loss as a result of a nurse’s actions or inactions.
What qualifies as failing to maintain standards and what could happen?
According to the North Carolina Board of Nursing, one of the most frequently reported practice allegations is the failure to maintain minimum standards of care. However, this is a relatively broad category, and it is important for nurses to understand what this can encompass. A failure to maintain minimum standards of care can be any of the following:
- Failure to follow proper “fall” or other safety protocols established by the health care institution
- Failure to administer medication in a timely and reasonable way
- Failure to monitor equipment
- Failure to warn patients about known harms or to protect patients from known dangers
- Failure to completely and accurately report the assessment or observations made regarding each patient in a timely manner
- Failure to monitor patient’s condition or to be alerted to changes in the patient’s condition
- Poor communication during shift handoffs or failure to share critical information
Examples of violations of the North Carolina NPA and NCAC frequently reviewed by the NCBON related to negligent nursing practice also include:
- Failure to initiate cardiopulmonary resuscitation (CPR) in a timely manner
- Failure to administer prescribed medications or interventions
- Sleeping on duty
- Failure to assess or evaluate a client as warranted or ordered
- Failure to make scheduled home care visits
These are only a few examples, and there are many other actions or inactions that could qualify as failing to maintain a minimum standard of care. It is important for nurses to know what standards the Board expects them to maintain as well as what standards their health care facility expects them to uphold.
Where do these complaints come from?
One of the most common sources comes from employer reports following a termination or disciplinary action. When an employer reports a nurse to the Board, they often include this allegation alongside other claims such as documentation errors, medication issues, or patient care concerns. In many cases, the employer’s report contains substantial detail – but it’s also written in a way that protects the employer’s interests and minimizes their own liability. In other words, the report may paint a one-sided picture. Nurses facing this kind of complaint should expect that the Board will treat the employer’s report as credible unless challenged with evidence, documentation, and context.
On the other hand, some complaints come from patients or family members who may not fully understand the care being provided. These complaints are often emotional, incomplete, or even inaccurate. When the Board receives a vague or poorly supported complaint, it still has a duty to investigate and may use the “failure to maintain minimum standards” category as a broad starting point to collect more information. This can feel like a “fishing expedition,” where the Board is trying to uncover any possible issue to support disciplinary action. Even if the original complaint is unfounded, the investigation process itself can be stressful and time-consuming.
Regardless of the source, once a complaint is filed, the Board investigates and you’ll typically be contacted by an investigator for an interview or written response.
What Happens If You Fail to Maintain Minimum Standards?
If a nurse does fail to maintain the minimum standards of care, he or she may be found negligent if his or her actions caused the patient harm; the nurse could then face a negligence lawsuit, meaning the nurse has been accused of violating a standard of care. In addition to a civil suit, a nurse’s professional license might be impacted. If a nurse did not maintain this minimum standard of care, a complaint could be filed with the Board of Nursing, and the nurse’s professional license may be at risk. Disciplinary actions can range from continuing education requirements to license suspension or revocation, and any discipline becomes part of your permanent professional record and can be reported to the National Practitioner Data Bank.
Because “failure to maintain minimum standards” is open to interpretation, these allegations often carry a higher risk of proceeding to a contested hearing. This is why speaking with a professional license defense attorney before your interview or submitting any written response is crucial – what you say becomes part of the official record and can significantly impact the outcome.
To protect your license, make sure you understand the standards of care required by the Nursing Practice Act and your facility. Document thoroughly, know your facility’s policies, and never face a Board investigation alone. If you have any questions about what your facility requires, make sure to speak with your nursing manager.
Key Takeaway:
At its core, failing to maintain a minimum standard of nursing care means a nurse didn’t provide the level of skill and care that a “reasonably prudent” nurse would have provided under similar circumstances, and this failure led to patient harm. Think of it as professional negligence: the nurse’s action or inaction fell below accepted professional guidelines in a way that harmed the patient.
The phrase itself doesn’t point to a specific act or omission. Instead, it’s used by the Board to describe situations where a nurse allegedly did not meet what it considers the minimum level of care, judgment, or professionalism required of the profession. The problem is that these “standards” can vary depending on the clinical setting, the patient’s specific condition, the nurse’s role and scope of practice, and even the perspective of the person making the complaint.
Because of this variability, nurses often feel blindsided when they’re told they “failed to maintain minimum standards” – especially when they believed they acted appropriately given the circumstances they faced.
3 Key Components Must Be Present:
- Breach of Duty: The nurse didn’t act as a competent, reasonable nurse would have in the same situation
- Standard of Care: The baseline is defined by state nursing boards, facility policies, and professional guidelines
- Causation and Harm: The breach directly caused injury or damage to the patient
Nothing in this blog post is legal advice or establishes the attorney-client relationship. This is for informational purposes only. If you’d like to learn more about professional licensing issues in North Carolina, contact us today. 919-521-8810 is the direct line to North State Law.
