Contact Information Discipline: Lisa Shiltz her Direct Line: 304-205-8683 Email: Lisa.M.Shiltz@wv.gov between 8:00 A.M.-4:00 P.M.
Consent Agreement Monthly Payments:
You will now MAKE YOUR OWN PAYMENTS: Effective APRIL 1st 2024.
You must hold your mouse over discipline tab to see the payments white box, then put in your nursing license number in, your monthly payment amount due, and Discipline CA in reason box.
Then it will take you to a different page to put your name, address, phone, email (receipt to send to), Name on Card, Payment card info (Do NOT us Tab button or you will have to redo the form again.)
The day of the month is your choice, as long as the board receives it by the last day of the month (If you need to make a change or are having financial difficulty call the board at 304-558-3572 and ask for discipline.
Criminal Convictions all must be reported immediately to the Board of Nursing when they occur (Self-Reporting is always more favorable)
Mark your application with convictions and upload the court documents to your nurse portal to support the conviction to help move the licensure process forward.
In the message center of your nurse portal please complete: A letter of explanation to include: What happened? What court did? Where you are now? where you want to be in the future?
AUDIT FAILURES
- A consent agreement will be done with a monetary penalty of $30.00 per missing continuing education and $250.00 fee to create the consent agreement.
- If you have previous discipline your monetary penalty is doubled
- The discipline will be on NURSYS for public view and the discipline will remain on your license.
- Once you sign the consent agreement will then be sent to discipline review committee (DRC) board members and Executive Director to review and sign.
- Once all terms of the consent agreement are met, then a completion letter will be uploaded to NURSYS website.
LAPSED/EXPIRED LICENSE
If you worked July 1, 2024 to present date on lapsed/expired license and you need to complete the work attestation form attached and upload to portal message center by replying to the enforcement message. *Blank Work Attestation: 
Blank work attestation.pdf
A consent agreement will be done with a monetary penalty of $100.00 per month you worked on a lapsed/expired licensed and $250.00 fee to create the consent agreement.
This discipline will be on NURSYS for public view and will remain on your license.
Once you sign the consent agreement will then be sent to discipline review committee (DRC) board members and Executive Director to review and sign.
Once all terms of consent agreement are met, then a completion letter will be uploaded.
SUSPENSION OR PROBATION OF LICENSE
Discipline Applicable Legislative Rules 10-02.pdf
Your license could be SUSPENDED first from 3 months to several years, or permanently depending on your infraction. The BOARD's job is to PROTECT the PUBLIC from HARM.
If you have been disciplined with probation: Probation can be from 6 months to several years.
The nurse will be required to have RN, MD, or dentist supervise them. The Board must have a SIGNED supervisor's agreement from your employer before the PROBATION can begin!!
Blank Supervisor Agreement.pdf
The nurse must have supervisor submit work performance sheets bi-monthly on the 15th and 30th of each month directly to the board: fax: 304-558-4367 or email: lpn.board@wv.gov
Work Performance Form.pdf
Complete an addiction specialist evaluation by a licensed psychiatrist or psychologist with drug addiction certification and Enroll in random urine drug screening with daily call-ins with negative results if related to substance abuse, drug diversion, or DUI
You will need to Enroll in Random Urine or Hair Follicle Drug Screening and Daily Call-ins for all Substance Abuse, Drug Diversion, and/or Driving Under the Influence (DUI) through Vault: https://www.vaulthealth.com/
Drug Screen Observation Request 2024.pdf
Drug Screen Vault new enrollment Form 2024.pdf
If you are required to attend counseling: Counseling Reports submitted at least monthly monthly or more frequently depending on Psychiatrist/Psychologist recommendations
Counselor Report 2024.pdf
If you are ordered to attend AA or NA then you must submit the form below:
AA NA Form 2024.pdf
If you are ordered to complete the Nurse Practice Act (NPA) course and exam: The Board can offer this for free if you are struggling. If you want to do it online or if you are ordered to complete specific continuing education for substance abuse/professionalism/ethics/boundary invasion then you need to go through NCSBN: Click on ICRS: https://www.icrsncsbn.org/ <then choose Courses>, then choose <Continuing Education>