06/04/2026

Changes in Scrutiny of Nurses and Therapists by State Licensure Boards

Elizabeth E. Hogue, Esq.

Historically, disciplinary actions by state licensure boards have focused on clinical outcomes, i.e., whether patients were harmed or suffered injuries as the result of action or inaction by licensed clinicians. It now seems that state boards have shifted their focus to clinical reasoning, as is evident in documentation in patients’ records. Examples of this shift include changes in clinical treatments that are not documented sequentially, and failure to escalate in a timely and appropriate manner.

In light of this shift, it is important for licensees to focus on whether documentation of assessments, differential diagnoses, and plans of care are coherent and in logical sequence. Failure to demonstrate these activities may result in disciplinary action even if there is no harm to patients because there are deviations from the standard of care. A key question is: How did clinicians’ activities progress from assessment and observation to treatment?

State licensure boards are also scrutinizing whether changes in the severity of patients’ conditions were appropriately identified and acted upon. This change once again makes it clear that complete and accurate documentation is essential.

Clinicians should regularly review their documentation in view of this new emphasis by licensure boards and correct, amend or supplement documentation, if needed. There are three types of changes that may be appropriate, depending upon the circumstances:

• Late entries: These supply additional information that was omitted from the original entries. Late entries must include the current date, are added to records as soon as possible, and are written only if clinicians recall the omitted information or have notes to jog their memories. Clinicians must also sign late entries.

• Addendum: An addendum is used to provide information that was unavailable at the time of the original entry. The addendum should be made as soon as possible after the original entry and include the current date and reason for the additional or clarifying information added to medical records. Addendums must also be signed by clinicians who enter them.

• Corrections: When clinicians make corrections to medical records, they should not write over or otherwise obliterate passages when entries to medical records are made in error. Deletions must be signed or initialed and dated, stating the reason for corrections above or in the margins. Correct information should be documented on the next line or space with the current date and time and refer to original entries.

Here is what the Medicare Program Integrity Manual, Chapter 3 – Verifying Potential Errors and Taking Corrective Actions, Section 3.3.2.5 says:

"A. Amendments, Corrections and Delayed Entries in Medical Documentation

…Occasionally, certain entries related to services provided are not properly documented. In this event, the documentation will need to be amended, corrected or entered after rendering the service.

1. Recordkeeping Principles

Regardless of whether a documentation submission originates from a paper record or an electronic health record, documents submitted…containing amendments corrections or addenda must:

- Clearly and permanently identify any amendment, correction or delayed entry as such, and

- Clearly indicate the date and author of any amendment, correction or delayed entry, and

- Clearly identify all original content, without deletion."

Based on changes in scrutiny by state licensure boards, clinicians should use the above methods to address any deficiencies in documentation that are likely to trigger scrutiny, since documentation of care provided is clearly paramount.

©2026 Elizabeth E. Hogue, Esq. All rights reserved.
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