Most people are hardworking and often pretty good folks, and then there are the others like those caught up in a scheme uncovered in January where several people allegedly faked diplomas and transcripts and sold them to nurses—many of whom had allegedly used them to sit for their licensing and work as nurses.
The thought that this could happen is absolutely horrific.
Daily Nurse interviewed Jennifer Flynn, CPHRM, Risk Manager, Nurses Service Organization (NSO), to learn how it could affect nurses who have done nothing wrong and how they could protect themselves in the future.
What follows is our interview, edited for length and clarity.
What was the scheme for nurses who haven’t heard about the scandal? Why were people doing this? How could they pass the national nursing board exam if they didn’t have diplomas/credentials?
Earlier this year, the Justice Department announced it had uncovered a scheme involving the sale of more than 7,600 fake diplomas and transcripts from several now-shuttered nursing schools in Florida. These alleged actions allowed individuals who aspired to become nurses to bypass the courses and clinical work required to sit for the National Council Licensure Examination (NCLEX). Since then, 25 individuals have been charged for their involvement in the fraud scheme.
The alleged scheme sold fake and fraudulent nursing degree diplomas and transcripts from accredited Florida-based nursing schools to those wishing to seek licensure as Registered Nurses (RNs) and Licensed Practical/Vocational Nurses (LPN/LVNs).
The individuals who allegedly acquired the fake nursing credentials used them to qualify to sit for the NCLEX. If they successfully passed the exam, they became eligible to obtain licensure in various states to work as an RN or an LPN/LVN. According to a representative from the HHS Office of the Inspector General, about 2,800 people— or 37 percent of those who bought fake documents — passed the test. Many individuals who passed the NCLEX and obtained licensure could then secure employment in the healthcare field.
State Boards of Nursing (SBONs) from Delaware, New York, New Jersey, Texas, and Florida, have launched their investigations into individuals tied to the scheme.
However, attorneys representing nurses now linked to the scheme said that not all students attending those Florida nursing schools purchased fraudulent documents. An attorney representing several affected nurses in New York has stated that many affected nurses are immigrants who assert that they attended classes and may also have completed training or education to become nurses in their home countries before coming to the U.S.
Additionally, according to The National Council of State Boards of Nursing, many individuals who allegedly paid for the fraudulent documents had experience working in healthcare as certified nursing assistants or other positions, which may help explain how so many were able to pass the NCLEX.
Licensing boards are investigating nurses who graduated from the schools allegedly involved in the scheme. If nurses received their diplomas/credentials ethically, why must they protect themselves? As in defending themselves?
Yes, nursing students who attended the identified Florida schools are worried about their careers. In some cases, the SBONs sent letters to licensees who attended those schools allegedly tied to the scheme and their employers, asking them to submit proper documentation or surrender their licenses. In New York state alone, the SBON identified more than 900 nurses asking them to prove their credentials are legitimate or surrender their licenses.
There are potential liability issues on both the employer and individual sides. Depending on the unique facts of the case, and state law, healthcare facilities that employed these nurses could face medical malpractice actions from patients who these individuals treated. Further, they could face allegations of improper hiring practices as they employed improperly credentialled providers. Healthcare employers must verify a nurse’s competence in performing essential functions — and are vicariously liable for anything that happens under their facility name.
For individual nurses, if a patient injury occurred during treatment, the patient could bring a claim against them related to professional negligence. The patients cared for by one of these nurses could claim the care they received was negligent because the nurse was not properly licensed. Again, these cases would depend on the patient’s allegations of injury, the unique facts of the case, and state law.
Why would they need lawyers if they haven’t done anything wrong?
Any nurse who receives a letter from the SBON should have an attorney to help them defend themselves against allegations or complaints against their license. The SBONs’ missions are to protect the public, and they have the authority to enact sanctions that range from fines up to and including more severe actions such as license probation, surrender, or revocation
When a complaint is made against a nurse to the SBON, nurses must be equipped with the resources to defend themselves adequately. Being unprepared may represent the difference between a nurse retaining or losing their license. Therefore, NSO’s policies include license defense protection which reimburses insured nurses up to the applicable limit for their defense of disciplinary charges and other covered expenses arising out of a covered incident if a complaint is brought against you before a state licensing board.
What can nurses do to protect themselves in the future? Aren’t they covered under their employers’ insurance? If not, why not?
According to the National Practitioner Data Bank, nursing professionals were more than 43 times more likely to have an adverse licensing action reported to the NPDB than a medical malpractice payment in 2022.*
Further, an SBON complaint can be filed against a nurse by anyone–for example, a patient, a patient’s family member, a colleague, or an employer. You may or may not know the identity of your accuser, and the complaint may be filed anonymously.
Nurses should ask their employers about the coverage afforded to them as an employee to identify if there are any gaps in coverage. If employers do not cover you for complaints made against your license to the SBON, they may wish to purchase professional liability insurance that includes coverage for license protection and safeguards nurses against licensing board complaints.
*Division of Practitioner Data Bank, Bureau of Health Workforce, Health Resources and Services Administration. Generated March 31, 2021, using the Data Analysis Tool at https://www.npdb.hrsa.gov/analysistool.
Data source: National Practitioner Data Bank (2022): Registered Nurse and Practical Nurse State Licensure/Certification Adverse Action and Medical Malpractice Reports (January 1, 2022 – December 31, 2022).
What most surprised you about this scheme?
As of today, from what I read about these cases, the SBON is not differentiating nurses who did attend these schools while they were accredited from those nurses who purchased fraudulent documents. The notices/letter sent to nurses by their SBON asking them to prove their credentials are legitimate were given very short response times to engage with an attorney, review the allegations, gather the required documents, and still meet this compliance deadline, which may raise questions about due process and their ability to be heard in these cases.