Over the course of more than four decades representing nurses in licensing and regulatory matters, I have heard an increasingly troubling statement from thoughtful and dedicated nurse professionals: “Perhaps it is time to leave the practice of nursing.” These words are rarely spoken lightly. They are often expressed by nurses who entered health care with a deep commitment to patients but who now feel overwhelmed by regulatory scrutiny, a heightened fear of disciplinary action, and the natural perception that every clinical decision may later be second-guessed.
Having observed the regulatory process over five decades from both sides - first while serving as a Deputy Attorney General for approximately eight years representing the California Board of Registered Nursing (“BRN”), along with numerous other regulatory agencies (MBC, BBS, PTB, RCB, BOP, etc.). Since that time representing nurses, as well as other health care professionals in private practice for over forty years, including matters involving Psychiatric-Mental Health Nurses (“PMHN”) and/or Psychiatric Nurse Practitioners (“PMHNP”) in California. As such, I have gained a deep appreciation for two equally important principles: protecting the public and fairly evaluating the professional judgment of conscientious Registered Nurses as well as Advanced Practice Nurses. When approached thoughtfully, these principles should reinforce one another. RNs. NAs, NPFs, PMHNs, and PMHNPs today practice in an environment that often feels very different from the one in which many entered the profession years ago.
Stories about regulatory investigations, patient complaints, malpractice, and disciplinary actions circulate quickly among colleagues and can create understandable anxiety about whether far too many clinical decisions might later be questioned. Yet, perspective is essential. The overwhelming majority of Nurses continue to practice responsibly every day without disciplinary action, and when accusations arise, they are often resolved once the full clinical context is reviewed and carefully analyzed by an accomplished Nurse License Defense Lawyer.
Medical care has never been purely mechanical. It is not only a science, but also an “art.” We know that a thorough history and physical and/or mental health examination, thoughtful and complete professional judgment, a provisional diagnosis followed by a differential diagnosis to reach a definitive assessment and diagnosis, evolving knowledge, and a careful balancing of risks and benefits are all essential to serving the best interests of the patient.
Standard Nursing Practice along with Nurse Practitioners, and other health care professionals, frequently encounter patients suffering from chronic pain, inflammatory conditions, and other severe and unrelenting medical conditions that do not always respond to conventional therapies, whether prescribed by a physician or a psychiatric nurse practitioner. In such situations, responsible health care may reasonably include consideration of supportive or adjunctive treatments, integrative medicine, and/or multidisciplinary approaches that are non-invasive and carry a lower risk profile.
Whether the modality involves lifestyle interventions, physical therapies, holistic medicine, acupuncture, nutritional support, movement therapy, integrative medicine, multidisciplinary medicine, or emerging treatments, the guiding principle should remain constant: the ultimate objective is to enhance the patient’s well-being (comfort) and relief, while exercising careful and balanced clinical judgment and transparency regarding the limits of current scientific evidence.
Exploring such approaches responsibly - with informed patient communication, appropriate monitoring, collaboration with physicians and other medical specialists, and thoughtful and complete documentation - is not a departure from good medicine. It is often an expression of a Registered Nurse as well as a Nurse Practitioner’s commitment to improving the patient’s quality of life through understanding and meaningful communication - when conventional treatments alone may not be sufficient.
Beyond the regulatory framework and the day-to-day realities of Psychiatric Nursing and health care practice, there is a broader societal dimension that should not be overlooked. Many individuals today struggle to find reliable guidance when confronting illness, chronic pain, or uncertainty about their health, personal status, or position in life. When legitimate Psychiatric Nursing and medical care appears constrained by fear or misunderstanding, some patients may feel alienated or lose confidence in professional care and instead turn to unreliable or misguided sources of attention, advice, or treatment. Both enlightened Psychiatric Nurses in particular and responsible Registered Nurses in general can play an essential role in preventing or marginalizing this negativity or outcome.
When nurses are able to practice thoughtfully, communicate honestly with patients and their respective families (within the boundaries of HIPAA laws and other statutes, rules, and regulations), and consider reasonable approaches aimed at improving the well-being of patients, they provide something that cannot be replaced by misinformation or false promises: trusted guidance, relief, and comfort by Psychiatric Nurses utilizing proper tests, protocols, and procedures, along with effective treatments grounded in both science and good professional judgment.
Helping even one patient regain clarity, hope, comfort, and/or relief can make an extraordinary difference. Health care has always advanced one patient, one thoughtful decision, and one act of compassionate care at a time. Standard Nursing Practice in general and Psychiatric Nursing in particular has always required integrity, reasoning, compassion, and dedication to patient welfare. Nurses who approach patient care with honesty, transparency, and thoughtful professional judgment should remain confident in the value of their work, now and in the future.
Health care ultimately exists for one purpose: enhancing the well-being of the patient. Protecting health care professionals who act responsibly in pursuit of that goal ultimately protects the patients and communities who depend on them, thereby improving human well-being and society. Even helping a single patient regain clarity, confidence, hope, or relief can make an extraordinary difference that reaches families and communities in ways that are often immeasurable.
In future articles, I will discuss how California Board of Registered Nursing investigations actually unfold and how nurses can navigate the regulatory process while continuing to practice thoughtful patient-centered health care.
One Person Inspiring Another – The Endless Thread
Graduating from Loyola Law School in Los Angeles was an education in itself. Although I was not Catholic, my years at Loyola Law School taught me an important lesson in my life: while others may believe a lawyer has the power to perpetuate a dispute, to be a pillar of society, on the other hand, is to master the skill of commitment to resolve disputes. Early in my legal career, I had the privilege of working as a Deputy Attorney General (“DAG”) representing the BRN under extraordinary lawyers, including Ronald M. George, who would later become the 27th Chief Justice of The Supreme Court of California. Seeking to emulate him and other brilliant Senior Deputy Attorneys General, I learned principles, values, and ethics that expanded upon my legal education and taught me that good writing is rarely the product of the first draft. Their expectations were never simply that our work be legally correct. They expected it to be precise, balanced, carefully reasoned, and worthy of the public trust. Those lessons stayed with me throughout my career.