The Ways a Nurse Can Lose Their License in North Carolina

Few things are more unsettling for a nurse than receiving notice of a complaint from the North Carolina Board of Nursing. Regardless of the source of the complaint or the facts alleged, the Board’s investigators and legal staff are ultimately focused on one question: does the conduct constitute a violation of the North Carolina Nursing Practice Act?

To impose discipline, the Board must establish a statutory violation by clear and convincing evidence, a higher standard than mere suspicion but lower than criminal proof. The Board’s disciplinary authority is set out in N.C. Gen. Stat. § 90-171.37, which lists the grounds on which a nurse’s license may be disciplined, restricted, suspended, or revoked.

Below are the most common ways nurses face discipline in North Carolina—and how these issues typically arise in practice.

Providing False Information or Withholding Material Information from the Board

The North Carolina Board of Nursing relies heavily on honesty during licensure and renewal. Any false statement or omission (intentional or not) can form the basis for discipline if the information would have mattered to the Board’s decision.

Common situations include failing to disclose a prior criminal charge or conviction, omitting discipline from another state, misrepresenting employment history, or answering “no” to questions about substance use or mental health treatment when disclosure was required.

These cases often surface years after licensure, when background checks, employer reports, or reciprocal licensure applications reveal inconsistencies. Importantly, nurses are frequently disciplined not for the underlying issue itself, but for the perceived lack of candor. The Board treats omissions as seriously as affirmative misstatements.

Criminal Convictions That Indicate Unfitness or Deception

A criminal conviction does not automatically result in discipline, but the Board evaluates whether the offense reflects poor judgment, dishonesty, or a risk to patient safety.

Offenses commonly reviewed by the Board include drug-related crimes (such as possession or DUI), theft or fraud offenses, assault or domestic violence charges, and felony convictions—particularly those involving controlled substances or violence.

The Board considers the nature of the crime, how recently it occurred, whether it relates to nursing practice, and evidence of rehabilitation. Discipline may occur even when the offense happened off-duty or many years earlier, especially if it was not timely reported to the Board.

Inability to Practice Nursing Safely Due to Impairment or Condition

Patient and public safety is the Board’s central concern. Any condition—temporary or chronic—that interferes with a nurse’s ability to practice with reasonable skill and safety can trigger disciplinary action.

These cases often involve substance use disorders, medication diversion, untreated or poorly managed mental health conditions, or physical conditions that impair alertness or motor function. They frequently arise from employer reports, failed drug screens, or observable workplace behavior.

The Board often emphasizes remediation through treatment, monitoring programs, or practice restrictions. However, failure to comply with required evaluations, monitoring, or recovery plans can quickly escalate discipline.

Conduct That Endangers Public Health

Some disciplinary cases focus less on individual error and more on systemic risk. Conduct that creates a broader threat to public health—even without actual patient harm—may fall under this provision.

Examples include failure to follow infection-control protocols, working while knowingly ill or impaired, repeated medication errors, or falsifying patient records in a way that compromises continuity of care. Patterns of unsafe practice can be particularly concerning to the Board.

Deliberate or Negligent Acts Showing Unfitness to Practice

Nurses are expected to exercise sound clinical judgment and adhere to established standards of care. Discipline may occur when conduct falls below those standards, even if no patient injury is proven.

Common allegations involve failure to assess or monitor patients appropriately, ignoring physician orders or facility protocols, medication errors due to lack of verification, or failure to escalate care when warranted. Repeated negligent acts, even if individually minor, often lead to Board action.

Conduct That Deceives, Defrauds, or Harms the Public

The Board also protects the public’s trust in the nursing profession. Conduct involving deception or fraud is treated particularly seriously.

This may include falsifying documentation for billing or reimbursement, misrepresenting credentials or scope of practice, providing services outside licensure authority, or falsifying continuing education records. These cases often arise from audits, employer reviews, or whistleblower complaints.

Unprofessional Conduct or Ethical Violations

Professional discipline does not require technical incompetence. Nurses may be disciplined for conduct that violates professional ethics or accepted standards of behavior, even when no patient is harmed.

Examples include boundary violations with patients, inappropriate use of social media, breaches of confidentiality, or abusive or disruptive conduct in the workplace. Social media-related complaints are increasingly common under this category.

Dishonesty, Injustice, or Immorality—Including Off-Duty or Out-of-State Conduct

The Board expects nurses to demonstrate integrity both professionally and personally. Acts of dishonesty or immoral conduct—whether on or off duty—may support discipline if they reflect poor judgment or untrustworthiness.

These cases often involve lying to employers or investigators, forging records, theft from patients or employers, or criminal conduct occurring outside North Carolina. Off-duty behavior can still affect licensure when it raises character concerns.

Prior Discipline in Another Jurisdiction

Discipline in another state frequently leads to action in North Carolina. License suspensions, probation, consent orders, or voluntary surrenders in response to an investigation are all considered disciplinary actions.

The North Carolina Board of Nursing may rely on the factual findings of another jurisdiction and impose reciprocal or independent discipline. Failure to timely report out-of-state discipline often worsens the outcome.

Failure to Respond to Board Inquiries

One of the most avoidable grounds for discipline is failure to respond to the Board. Ignoring correspondence, missing deadlines, or failing to appear for required interviews can independently justify sanctions—even if the underlying complaint is weak.

The Board expects prompt, complete, and professional communication. Non-response is often viewed as disrespect for the regulatory process.

Violations of the Nursing Practice Act or Board Rules

Finally, the Board may discipline nurses for violating any provision of the Nursing Practice Act or the Board’s administrative rules. This includes practicing beyond scope, failing to maintain continuing education, violating supervision requirements, or failing to comply with prior disciplinary orders.

This provision often functions as a catch-all and is commonly charged alongside more specific violations.

Protecting Your Nursing License in North Carolina

Many nursing disciplinary cases involve multiple overlapping allegations, and early missteps—particularly unguarded statements or missed deadlines—often shape the final outcome. Understanding how the North Carolina Board of Nursing evaluates these statutory grounds is critical to protecting your license and your livelihood.

If you are facing a complaint, investigation, or disciplinary action, speaking with Brooks Peterson PLLC can help. Schedule a consultation today or call (919) 616-3317.  

This is not legal advice. If you do need legal representation call the office at: (919) 616-3317