Bailie Anne Preston, a registered nurse from Emerson, Iowa, was fired from four separate hospitals between 2023 and 2024 for allegations including patient neglect, unauthorized drug possession, and charting medications as administered when patients hadn't received them. Her Iowa nursing license remained active through every termination. In August 2025, she was hired by a fifth facility — Shenandoah Medical Center in Page County, Iowa.
Within weeks of starting at Shenandoah, Preston was criminally charged with theft and felony possession of a controlled substance for allegedly stealing ten vials of injectable morphine sulfate. According to a police report, she concealed the box under her clothing, exited the building to her vehicle, and discarded the packaging in a dumpster. A criminal trial is scheduled for May 26, 2026 in Page County District Court. The state Board of Nursing has scheduled a disciplinary hearing for June 30, 2026.
A Pattern That Should Have Stopped Her Years Earlier
The Iowa Capital Dispatch documented the sequence of Preston's employment history. She began at Nebraska Medicine in Omaha in January 2023 and was fired in July 2023 for failing to respond to a patient with critically low blood pressure, unexcused absences, and extended departures from her assigned post. She then worked at Johnson County Hospital in Iowa, where she allegedly charted two morphine doses as given to a patient experiencing pain. That patient told a colleague she'd never received the medication; staff found an empty syringe in a bathroom where Preston had been. Preston was fired.
She subsequently worked at a facility in Pottawattamie County and at Community Medical Center in Falls City, Nebraska, where a December 2024 drug inventory found four missing Benadryl vials. Facility records showed Preston was the only person with access during the relevant time window. She was fired.
Nebraska's Board of Nursing filed disciplinary charges in November 2025, citing unprofessional conduct and failure to report her firings within the 30-day window required by state law. Preston agreed to a two-year minimum revocation of her Nebraska license and paid a $2,000 civil penalty. Her Iowa license, however, was not suspended before she was hired at Shenandoah Medical Center.
The Licensing Gap That Let It Happen
Interstate reporting of nurse disciplinary actions is supposed to flow through the Nursys national database, which the National Council of State Boards of Nursing (NCSBN) maintains. Employers can query Nursys to see a nurse's license status and reported discipline across compact and non-compact states. The system works when disciplinary actions are reported — but there's consistent lag between a hospital firing a nurse and a formal BON charge, and between a BON charge and a Nursys update.
Preston's Nebraska revocation wasn't recorded until November 2025, more than two years after her first documented termination. A facility doing a routine Nursys check in August 2025 would have seen a clean Iowa license. Standard reference-check policies at hospitals typically require prior employment verification but don't always surface informal personnel records from prior employers who may decline to share details due to liability concerns.
Why This Matters for Nurses
In over 12 years in nursing — including time in correctional settings where controlled substance accountability is audited at shift-change — I've seen both ends of this problem. Hospitals are often reluctant to provide substantive employment references because of fear of defamation suits, even when the reason for termination was patient safety-related. That silence creates the exact gap Preston exploited: five hospitals, years of red flags, and a licensing system that wasn't updated fast enough to stop a sixth hire.
The June 30 Iowa BON hearing will determine whether her Iowa license is revoked — something that should have happened considerably earlier. If you're in a charge nurse, unit manager, or HR role, this case is a reminder that a clear Nursys result is a floor, not a ceiling. Call prior employers directly. Ask open-ended questions. The system is better than it used to be, but it isn't foolproof.