What is a valid reason for revoking a nurse's license?

A nurse's license can be revoked for serious professional and ethical violations that threaten patient safety and the integrity of the nursing profession. Drug or alcohol abuse is a well-established, legally recognized basis for license revocation in all U.S. states because it directly compromises the nurse's ability to practice safely, impairs clinical judgment, and endangers patients. State boards of nursing have clear statutory authority to revoke, suspend, or place conditions on a license when substance abuse is identified. Refusing to take an extra shift is not grounds for license revocation; nurses have the right to decline additional work beyond their contractual obligations, and this does not constitute professional misconduct. Lack of continuing education may result in license non-renewal or lapse in some states, but it is an administrative issue rather than a conduct-based reason for outright revocation. Patient refusal of care is a patient right protected under informed consent and autonomy principles; a nurse honoring a patient's right to refuse treatment is acting ethically and legally and cannot be penalized with license revocation. Therefore, drug or alcohol abuse remains the only choice among those listed that constitutes valid grounds for license revocation.