The 5 Biggest Traps That Can Cost a Nurse Their License

1. Ignoring a DNR or Invalid Advance Directive

The Trap: Starting CPR or aggressive care despite a valid DNR — or honoring an unsigned “living will.”

Why It’s Dangerous: Violating patient autonomy can legally count as battery.

Avoid It: Verify validity (signatures, dates, physician order). If unsure, pause and clarify before acting.

2. Delegating Beyond Scope

The Trap: Letting a UAP or LPN handle unstable patients, assessment, or teaching.

Why It’s Dangerous: The RN remains accountable for all delegated tasks.

Avoid It: Only delegate predictable, routine care for stable patients.

Never delegate: assessment, evaluation, teaching, or IV push meds.

3. Breaching Confidentiality (HIPAA Violations)

The Trap: Discussing patient details in elevators, texting info on personal phones, or sharing passwords.

Why It’s Dangerous: Violations can lead to termination, fines, or board discipline.

Avoid It: Keep all PHI private; use secure systems only. Never deny patients access to their own records.

4. Poor Documentation After an Error

The Trap: Writing “incident report completed” in the chart or trying to hide a mistake.

Why It’s Dangerous: The incident report is not part of the legal medical record — referencing it creates liability.

Avoid It: Chart only objective facts and patient care provided. File internal reports separately for quality improvement, not punishment.

5. Failing to Report or Escalate

The Trap: Not reporting abuse, communicable disease, or an impaired coworker.

Why It’s Dangerous: Failure to report is a criminal offense in many states and violates the nurse’s duty to protect patients.

Avoid It: Report immediately to the correct authority (CPS, infection control, or board). Do not confront suspects directly.

🩺 Bonus Trap: Skipping Trend Recognition

Missing a pattern like rising heart rate + falling blood pressure → delayed recognition of shock.

Avoid It: Always look for trends, not single numbers — early intervention saves lives and protects your license.

🩺 Summary Notes

1. Advanced Directives

Living will = specifies what treatments (ventilator, dialysis, feeding tubes).

Durable Power of Attorney (POA) = specifies who decides if patient can’t.

Never assume spouse or child is automatic proxy — document required.

Unsigned forms have no legal force. Educate family on proper process.

Nursing Pearl: The POA document trumps relationship status.

2. Do Not Resuscitate (DNR)

Nurse must honor a valid DNR, even with family protest.

Starting CPR against documented wishes = battery.

If DNR validity is unclear → pause, verify, educate.

Provide comfort care per patient’s wishes.

3. Patient Rights & Refusal of Care

Competent adults can refuse any treatment, even life-saving.

Nurse’s role: document refusal verbatim, notify provider, educate.

Never coerce or persuade.

4. Confidentiality & HIPAA

Common breaches: talking in elevators, texting on personal phones, sharing passwords.

Patients can request copies of their records within 30 days.

Never deny access without legal cause.

5. Prioritization

Use ABCs (Airway, Breathing, Circulation) to guide priorities.

Unstable trumps stable every time.

Look for patterns (rising HR + falling BP = possible shock).

Act immediately—don’t wait for one “bad number.”

6. Delegation

UAPs: routine, predictable care for stable patients. RN retains accountability.

LPNs: stable patients, routine meds, reinforce teaching.

RN: initial assessment, IV push meds, unstable clients.

Never delegate assessment or teaching.

7. Case Management & Discharge Safety

Case manager ensures safe transitions.

Example: post-hip replacement living alone = unsafe discharge → rehab.

Use SBAR for structured communication (Situation, Background, Assessment, Recommendation).

Refer to social services for financial or literacy barriers.

Use teach-back method to verify understanding before discharge.

8. Handoff & Communication

Use iPASS (Illness severity, Patient summary, Action list, Situation awareness, Synthesis by receiver).

Always include contingency plans (what to do if condition worsens).

9. Ethical Decision-Making

Respond to suffering with empathy + professional boundaries.

Offer palliative care or chaplain consult — never suggest ending life.

Mandatory reporting: child/elder abuse, communicable disease, gunshot wounds, impaired coworkers → report immediately to correct authority.

10. Incident Reports & Quality Improvement

Never mention “incident report” in chart.

Document only facts and patient care actions.

QI uses RCA (Root Cause Analysis) → identify system issues, not blame individuals.

Use PDSA Cycle (Plan-Do-Study-Act) for continuous improvement.

Tools: Fishbone Diagram for cause analysis.

11. Informed Consent

Provider obtains consent; nurse witnesses and verifies understanding.

If confusion arises → stop and notify provider before signing.

12. Core Takeaway

Understanding why these legal and ethical rules exist keeps both patients and nurses safe. It’s the foundation for safe, effective, low-stress nursing practice.

Need to reach out? Send an email to Brooke at [email protected]