They'll Take Your License! A Nursing Board Myth Families Can't Afford

When Declan came home from the hospital, he needed round-the-clock care—24 hours a day, every day.

Here’s the math people don’t want to do: a full-time worker puts in about 1,960 hours a year (40 hours/week, minus vacation and holidays). A year has 8,760 hours. That means caring for Declan required 4.47 full-time employees, every year.

Even in Minnesota’s highest-acuity cases, coverage is essentially capped—typically no more than 20 hours per day. So families are expected to cover the remaining 4 hours per day themselves (28 hours/week), plus be the backup when shifts go unfilled. To staff the covered hours alone still requires 3.72 full-time nurses—and in today’s workforce, that “team” often exists on paper more than in real life.

This article isn’t about the cruelty of that math—though it is cruel. It’s about what happens next: how shortages shape the culture of home nursing, and how they quietly change what “accountability” looks like when something goes wrong.

A 2023 systemic review on pediatric home healthcare access found an average gap of 40 hours per week between hours allotted and hours actually received—on top of what parents were already expected to cover. Another utilization report (Virginia) found that fewer than 46% of families received more than 79% of their allotted nursing hours.

Put that into the earlier math: for high-acuity kids like Declan who are “covered” 20 hours per day, families are still responsible for 28 hours per week at baseline. But when the system fails to staff what it authorizes, families end up covering far more. With a 40-hour weekly shortfall, a “baseline” 28-hour family burden becomes 68 hours per week—nearly two full-time jobs—before you even count the overnight vigilance and the constant anxiety of “who’s showing up today?”

It’s a lot.

How anyone is expected to hold down a job while serving as the backup nurse and the regularly scheduled part-time nurse, I will never understand. But this article isn’t about employment. It’s about the nursing board—and about the myth families and providers alike cling to when something feels unsafe.

“I could lose my license for that.”

Early on, I heard the same phrase again and again: “I could lose my license for that.”

It came up around medication administration without clear physician orders, scope-of-practice questions, and mistakes that should have triggered real caution. That sentence carried weight. It implied there was a line—and that crossing it had consequences.

I believed it, because I assumed oversight worked like people think it does: report a serious violation, the board investigates, and unsafe providers are removed.

Over time, I learned the gap between the myth and the system.

What I reported—and what happened

Over the course of Declan’s life, I reported multiple incidents to the nursing board. The only time I saw meaningful action was after we captured deliberate harm on camera by a nurse who was later convicted of a felony. Prior to conviction, his license status was changed (suspension). After conviction, his license was revoked—yet the disciplinary terms still allowed the possibility of reapplication after a twenty-year period.

Twenty years is a long time. And still: how is there ever a path back for someone who intentionally harmed a patient?

Every other time I reported something, nothing seemed to happen. No acknowledgement. No follow-up. No questions. No “we received your complaint.” Just silence.

Here are examples of what I reported:

• Sleeping on shift while alarms sounded. Declan desaturated while a nurse slept in our living room and his machines alarmed. We intervened. I reported it. I never received follow-up.

• Vent settings changed against orders. A nurse increased my infant’s ventilator settings beyond prescribed parameters. I reported it as a safety violation. No response. Later, a physician told me it could have caused catastrophic injury.

• Feeding intentionally altered for convenience. A nurse knowingly overfed him (she told me she did this) as an infant because she didn’t want to deal with the leftovers.

  
  

Eventually I stopped reporting. Not because the incidents became acceptable, but because reporting started to feel like throwing my voice into a void.

“Regulation” across agencies can feel the same

Recently I had lunch with a mom of a disabled adult who was severely abused in her day program. Her daughter came home with a handprint bruise on her breast, significant compression bruising around her arms (documented by the physician who examined her), and bruising on her back. The program told the mother her daughter “did it to herself.” She reported it to the Department of Human Services—and never heard back.

DHS isn’t the nursing board. They regulate different things: DHS regulates programs and facilities; the nursing board regulates individual nurses. But in practice, families can run into a similar wall: reporting that produces little transparency, little communication, and no visible consequence.

It’s hard not to conclude that the system is designed more to absorb complaints than to resolve them.

Why this happens (and why “they’ll take your license” is a myth)

I can’t claim to know every reason oversight fails. But there’s at least one explanation that fits the reality families are living: when staffing collapses, accountability collapses with it.

In a world that is chronically understaffed—where agencies are desperate for anyone with a pulse and a license—disciplining the people who show up becomes harder to do. Not just practically, but culturally. The pressure shifts. The threshold shifts. The silence becomes the path of least resistance.

So when a nurse says, “I could lose my license for that,” families are supposed to hear a deterrent. What many families actually experience is something else:

The idea of oversight is powerful. The enforcement of it often isn’t.

And families like mine are left to fill the gaps—in staffing, in safety, and in consequences.

What should be done about it

We, as a society, have to decide: How much do we care? Because sooner or later, the conversation always circles back to the same thing:

Money.

If skilled nurses and caregivers could earn a decent living doing this work—and if agencies could staff safely without burning people out—more people would stay. Home care, group homes, and day programs are hard to staff because the work is demanding, the stakes are high, and the pay is often insulting for what’s being asked.

Yes, the nursing shortage is bigger than pay alone. Training pipelines matter. Clinical placements matter. Support, scheduling, and working conditions matter. But burnout isn’t a mystery when people are asked to do the work of two or three people, shift after shift, and then told it’s “just part of the job.”

And when staffing collapses, everything else collapses with it: safety, consistency, accountability—and the ability of any oversight system to function as a real deterrent.

I don’t trivialize money. Someone has to pay. But we should at least be honest about what we’re choosing. If the funding isn’t there, it’s not because the need doesn’t exist—it’s because we’re making a values decision about who deserves protection and how much protection they get.

And here’s the part that shouldn’t depend on funding at all:

Licenses, boards, and oversight should mean something.

It should be a privilege to hold a license—not an entitlement. Accountability should be the norm, not the exception.

So if we’re serious, “do better” needs to look like actual policy and actual process:

• Pay that matches the responsibility in home care and direct-care settings, so skill doesn’t have to choose between purpose and survival.

• Staffing models that reflect reality, so parents aren’t silently drafted as the default workforce.

• Transparent complaint handling: acknowledgement of reports, clear timelines, and plain-language outcomes when possible.

• Real consequences for serious violations, regardless of staffing pressures.

• Better coordination between agencies so families aren’t bounced between “not our jurisdiction” and silence.

  
  

Because right now, families are being handed a myth as a safety plan—and fragile people are paying the price.