Filing a Complaint

The American Nurses Association states it is the ethical responsibility of nurses to report incompetent, unethical, illegal, or impaired practice observed in other nurses.

Every state provides a process for any person to report a health care provider for unethical or illegal behavior as well as suspected impaired, unsafe or incompetent care. The state will investigate complaints that are received in writing, signed by the complainant, legally sufficient and mailed to the proper agency. Common grounds for discipline include: drug related issues, DWI charges, impairment on duty, theft, boundary violations, breach of confidentiality and inappropriate access to patient information.

Every nurse is responsible for compliance with their state Nurse Practice Act (NPA). State law is dynamic; this requires regular review of your NPA.

The following states require nurses to report signs of impairment in colleagues:


Other states, require an administrator, such as the Vice President of Nursing for a healthcare institution to report impaired healthcare workers who are either currently employed or terminated because of impairment.


The following states provide immunity from civil suits against those who report impaired nurses in good faith.


2017 Florida Statutes Title XXXII Chapter 456.073

(11) A privilege against civil liability is hereby granted to any complainant or any witness with regard to information furnished with respect to any investigation or proceeding pursuant to this section, unless the complainant or witness acted in bad faith or with malice in providing such information.

(12)(a) No person who reports in any capacity, whether or not required by law, information to the department with regard to the incompetence, impairment, or unprofessional conduct of any health care provider licensed under chapter 458, chapter 459, chapter 460, chapter 461, chapter 462, chapter 463, chapter 464, chapter 465, or chapter 466 shall be held liable in any civil action for reporting against such health care provider if such person acts without intentional fraud or malice.

It is imperative that nurses are familiar with their State Board of Nursing reporting requirements and methods. States that have mandatory reporting requirements may impose a fine or disciplinary action against a nurse who fails to report an impaired colleague. The boards generally do not require the reporting of harmless errors that are caused by system issues or are rare occurrences.

Types of disciplinary actions available to the Board of Nursing for any professional practice violation

  1. Refusal to certify, or to certify with restrictions, to the department an application for licensure;
  2. Suspension or permanent revocation of a license;
  3. Restriction of practice;
  4. Imposition of an administrative fine for each count or separate offense;
  5. Issuance of a reprimand or letter of concern;
  6. Placement of the licensee on probation for a period of time and subject to such conditions as the board, or the department when there is no board, may specify;
  7. Corrective action;
  8. Imposition of an administrative fine for violations regarding patient rights;
  9. Requirement that the practitioner undergo remedial education.

Most states provide an online form and instructions to record the information required to submit a legally sufficient complaint. A complaint is legally sufficient if it contains facts that indicate an identifiable individual violated the practice act related to the profession, or any law identified in the governing statutes or rules adopted by the licensing department or board.

N.B. State forms can change. If links are not active, use your search engine to find the specific complaint form for your state board.

The Florida Health Care Provider Complaint Form is located at

Florida Mandatory Impairment Reporting Law,
(Title XXXII. Section 464.018 (k))

In Florida, a licensed nurse may be disciplined for failing to report to the department any person who the licensee knows is in violation section 464.018 or of the rules of the department or the board. However, a person who the licensee knows is unable to practice nursing with reasonable skill and safety to patients by reason of illness or use of alcohol, drugs, narcotics, chemicals, or any other type of material, or as a result of a mental or physical condition, may be reported to a consultant operating an impaired practitioner program as described in s. 456.076 rather than to the department. The Intervention Project For Nurses is an Florida approved impaired practitioner program.

The state of Georgia allows any person who has knowledge of conduct by a licensed nurse that may violate the Georgia Nurse Practice Act, Board Rule or related state or federal law may report the alleged violation to the Georgia Board of Nursing. A complaint may be submitted online using the online complaint form or by mailing the complaint to the Georgia Board of Nursing.

Washington state has mandatory reporting of healthcare practitioners who commit unprofessional conduct or are unable to practice safely.

Washington Administrative Code 246-16-220 Mandatory reporting

(1) Reports are submitted to the department of health. The department will give the report to the appropriate disciplining authority for review, possible investigation, and further action. (a) When a patient has been harmed, a report to the department is required. A report to one of the approved impaired practitioner or voluntary substance abuse programs is not a substitute for reporting to the department. (b) When there is no patient harm, reports of inability to practice with reasonable skill and safety due to a mental or physical condition may be submitted to one of the approved impaired practitioner or voluntary substance abuse programs or to the department. Reports of unprofessional conduct are submitted to the department.

(2) The report must include enough information to enable the disciplining authority to assess the report. If these details are known, the report should include: (a) The name, address, and telephone number of the person making the report. (b) The name, address, and telephone number(s) of the license holder being reported. (c) Identification of any patient or client who was harmed or placed at risk. (d) A brief description or summary of the facts that caused the report, including dates. (e) If court action is involved, the name of the court, the date of filing, and the docket number. (f) Any other information that helps explain the situation. (3) Reports must be submitted no later than thirty calendar days after the reporting person has actual knowledge of the information that must be reported.

Instant feedback:

In Florida a nurse must report an impaired colleague to the Department of Health or the Intervention Project For Nurses.

Workplace programs and approaches

Substance use disorders (SUD) are a significant category of health care worker impairment. McCabe, Cranford & West (2008) estimate 90% of all nurses with substance use disorders are likely to be unidentified, unreported, untreated, and continuing to care for patients.

The National Council of State Boards of Nursing (NCSBN, 2016) encourages Nurse managers to ensure that staff receives educational programs that:

    1. Inform staff of the manager’s responsibility to identify nurses with signs of SUD
    2. Dispel myths and misconceptions surrounding SUD
    3. Identify SUD as a treatable disorder and our impaired colleagues as being entitled to confidentiality, respect and treatment.
    4. Encourage constructive discussions regarding professional performance
    5. Identify the performance issues that indicate impairment, including the warning signs of SUD
    6. Identify the legal responsibility of employer and staff to report colleague impairment
    7. Discuss the process of reporting suspected impairment and whether reporting is mandatory in your state.
    8. Discuss disciplinary process and specific requirements for reporting
    9. Discuss types of discipline and alternative discipline
    10. Discuss the fitness for duty evaluation and return-to-work monitoring

Employers often find it cost-effective to provide Employee Assistance Programs (EAP) that help employees deal with life problems, including impairment issues or those that may lead to impairment.

EAP services should be confidential. Such counseling may include:

    1. Juggling work and life issues
    2. Anger management
    3. Experiences with violence in the workplace
    4. Lateral/horizontal bullying
    5. Health issues
    6. Legal and financial counseling
    7. Child care help
    8. Stress and anxiety
    9. Relationship issues at home and/or work
    10. Grief and loss
    11. Substance use disorders

Americans with Disabilities Act of 1990 (ADA)

The managers should also be aware of the ADA requirements related to nurses with substance abuse disorders, mental health disorders, and physical disabilities. These issues can be complicated.

According to the government’s Equal Employment Opportunity Commission (EEOC), a person is an individual with a disability under the ADA when he or she: (1) has a physical or mental impairment that substantially limits one or more major life activities; (2) has a record of a substantially limiting impairment; or (3) is regarded (treated by an employer) as having a substantially limiting impairment.

One of the examples the EEOC describes is whether individuals who are alcoholics or engage in illegal drug use are considered to have a disability. Here is their response about someone with alcoholism.

Under the ADA, someone with alcoholism is an individual with a disability if the alcoholism currently substantially limits a major life activity, was substantially limiting in the past, or is regarded as substantially limiting. An employer may not discriminate against, and may need to accommodate, a qualified applicant or employee with past or present substantial limitations relating to alcoholism who can competently perform his job and can comply with uniformly-applied employer conduct rules prohibiting employees from drinking alcohol at work or being under the influence of alcohol at work.

Drug use

However, someone currently engaged in illegally obtained drugs is not an individual with a disability. That person can be denied employment, disciplined, or fired. That would include nurses who are diverting drugs from patients. Someone not using illegal drugs but with a history of past drug use is an individual with a disability if the disability limits a significant life activity. If the nurse can competently perform the job and comply with drug use policies of the institution and state, the employer may not discriminate against her or him.


Throughout the course, there have been numerous articles and websites referenced for additional information.
EEOC website is an additional one for more information about specific situations that do not qualify under the ADA and amendments.


McCabe, S. E., Cranford, J. A. & West, B. T. (2008). Trends in prescription drug abuse and dependence, co-occurrence with other substance use disorders, and treatment utilization: results from two national surveys. Addict Behav.33(10),1297-305.

National Council of State Boards of Nursing (NCSBN). (2016). A Nurse Manager’s Guide to Substance Use Disorder in Nursing. Accessed 8/12/2017

National Council of State Boards of Nursing (NCSBN). (2011). Substance use disorder in nursing: A resource manual and guidelines for alternative and disciplinary monitoring programs. Chicago, IL: National Council of State Boards of Nursing, Inc.