Saturday, June 30, 2007

Google ignores Nurses

Google set up a new advisory group on health care, but they failed to include a member of the largest health care providers-- A Nurse. See the press release at google. Lots of doctors, but not one nurse. Nurses continue to be left on the sidelines. This is another example of why nurses need to become politically powerful. Nurses need to join together and become a force to be reckoned with so that when someone is looking for input on health care issues, they automatically think of consulting with a nurse as well as a physician.

Thursday, June 28, 2007

My employer will pay for my legal representation

I just spoke with a nurse who was under the common misconception that the employer will pay for the nurse's legal representation if the nurse is sued or reported to the Board because the employer carries malpractice insurance for the nurse. The glitch is that this nurse no longer works for the employer and the nurse is now without insurance coverage. It is too risky and costly to rely upon your employer's coverage, all nurses should obtain their own malpractice insurance coverage that also covers regulatory/licensure issues.

Recently I spoke with two nurses that were surprised that the malpractice insurance they thought was an unnecessary expense (but one they felt they should go ahead and pay) ended up paying for my representation of them before the Board of Nursing. I read in a forum post that this one nurse thought attorneys would cost around $40 -$100 an hour. However, most attorneys (depending on multiple factors like location, specialty, certification, years of experience etc.) charge $150 - $500 an hour. It is such a relief to be able to afford the legal representation you need and must have. Please get insurance today so that it is there if you need it.

Tuesday, June 26, 2007

You Have To Look At This...

Go have a look at the blog "Running with Scissors". There are some incredible pictures shown on the blog that were taken inside the Nurse's Chapel in Westminster Abbey.

Your Job or Your Conscience?

There is a recent news story about 3 nurses in Mesquite that were fired for refusing to accept patient assignments:

Fired nurses protest at Mesquite hospital

Mesquite: Hospital defends action as ICU patient ratio debated
12:00 AM CDT on Saturday, June 16, 2007
By KIM BREEN / The Dallas Morning News

"Three nurses who say they were fired from a Mesquite hospital after refusing what they believed was an unsafe patient load are trying to bring attention to what they consider dangerous understaffing.
Nurses Diana Sepeda, Nancy Friesen and Sandra Taylor said they were fired this month from Dallas Regional Medical Center – formerly the Medical Center of Mesquite. During a night shift in the hospital's ICU in May, each nurse refused to take on three patients because they did not think they could provide adequate care...."

The article continues with a discussion of what the nurses found, what they did, what others think they should have done and what they are doing now. One of the statements in the article references that the nurses should have invoked "Safe Harbor Peer Review" because this would protect them in the workplace and before the Board. There are multiple problems with this recommendation: Safe Harbor does not protect nurses from lawsuits; the Nurse Practice Act 303.005 also states that nurses cannot be disciplined by the Board while the Peer Review for Safe Harbor is pending, but if the Peer Review committee determines that a nurse's action does not apply or is not related to the Safe Harbor request, the nurse may be disciplined; and although the employer cannot take retaliatory action against a nurse invoking Safe Harbor, the employer tends to wait awhile and then find a reason to terminate the nurse. Safe Harbor may be helpful for nurses, but I have only seen one case where it benefited the nurse: the nurse was still terminated for her actions, but when the Board asked her during a disciplinary proceeding about Safe Harbor, she produced her copy of the form she submitted to the employer and the Board dismissed the case, but the nurse had still lost her job and the problems continued at the facility.

There are multiple problems that need to be addressed for nurses and it is very difficult to do this on your own. Please join nursing associations and then push the associations towards the issues that concern you. See my discussion on why nurses should join nursing associations. This is the only way nurses are going to gain the power required to enact change; nurses must join together and demand better conditions to improve patient safety.

Monday, June 18, 2007

Why Did I Quit Nursing?

I was asked a few days ago why I quit nursing and went into law. The simple answer is that law fits my personality better. I have always had a difficult time remaining quiet when something happens that "'taint fair". When I was in nursing school, I took up the cause of an LVN that had returned to school to obtain her BSN. She was brilliant, but had a horrible case of test anxiety. She knew everything and could explain in person, but the minute she was placed in a test situation, she froze up. So, she was failing. I went to the professors to plead that they find a way to help her overcome the anxiety because society was going to miss out on a great nurse. I compared her to another classmate that made all "A"s, but had no common sense at all. I told them that she was going to graduate, but that she was going to be a dangerous nurse [about 2 years later, I saw that her license had been revoked]. I was told that it was none of my business and to stop interfering. I told them that I had to intervene because the LVN was too scared and embarrassed to step forward and speak for herself.

Even when I was a child, I could never keep myself from stepping forward to advocate on behalf of someone that could not argue for themselves. What my Mom used to call being a "busybody" has now grown into a well suited career. As for quiting nursing, I didn't really quit. What I have done is to channel my work into a way to help nurses. That is why I call myself a "Nurse Attorney."

Friday, June 15, 2007

The Most Aggressive Board

The Star-Telegram has written an article about the Texas Board of Nursing. The article states that "The board is perhaps the most aggressive healthcare regulator in Texas, taking patient safety to heart." I have represented nurses before the Board for over 10 years and before that I interacted with the Board while I worked at the Texas Medical Board, so I have seen the Board change over the years. What I have seen is that the Board has become much more conservative and much more punitive.

Complaints against nurses that used to be dismissed if the nurse could show knowledge of the incident and remediation of the issue. For several years now, those same types of complaints have resulted in increasingly harsher actions by the Board. Whenever the public sees the number of disciplinary orders increasing, they assume that the public is being protected. That is an illusion. Public Safety and high numbers do not go hand in hand. To obtain those numbers, many good nurses that were forced to choose between violating the Nurse Practice Act and caring for their patients are finding themselves under disciplinary sanctions. Yes, they violated the law, but the reality of nursing practice (too many very sick patients and too few nurses) is the cause of the violation, not the competency of the nurse.

I have always believed that all regulatory Boards need to focus on true public safety issues, which means discipline of those licensees that are truly a threat: incompetent without remediation potential, addicts that are not in recovery (although I do believe there needs to be a non-disciplinary, non-public method of monitoring all addicts), and those missing core ethical boundaries. SB 993/HB 2158 seems to be a step in that direction. this legislation defines what conduct by a nurse is subject to reporting. The requirements for reporting are:
1. Violating the law AND contributing to the death or SERIOUS injury of a patient;
2. Substance abuse impairment;
3. Intentional or knowing abuse, exploitation or fraud, violation of boundaries;
4. Incompetency where the nurse's continued practice could harm a patient.

This legislation should stop all the minor reporting of documentation issues and simple medication errors that are not due to incompetency. Perhaps this legislation will slow the reporting of nurses for minor, non-public safety issues and the Board can focus on those nurses that require monitoring by the Board to ensure public safety.

Tuesday, June 12, 2007

First Impressions

I was sitting in the waiting room of the Texas BON today waiting to present a client's case. The room was full of individuals seeking licensure as either a registered nurse or licensed vocational nurse. When one young lady was called back to meet with the Board, as soon as she left the waiting room, the other people in the room began to comment on her appearance. The applicant had shown up to meet with the Board dressed in casual pants, a tight fitting shirt made of t-shirt material, and flip flops. One of the other applicants commented, "She is sending the Board a message that she does not take them or her license seriously." Everyone noticed that when the Board staff member called the girl back to meet with the Board members, that the staff member's face showed that she thought the exact same thing as the other people in the waiting room.

First impressions count so much when meeting with the Board of Nurses. It is important to look and act professional. The Board members/staff do not know the applicants/licensees and so they rely upon information gathering to determine which course is the best for the Board to take. A person's appearance becomes part of that information gathering, even if it is done on a subconscious level.

The girl left in tears and they were not tears of joy, so I would surmise that she was denied licensure.

Friday, June 8, 2007

My Aunt, the Nurse

My aunt Mary Lou died recently and at her funeral a slide show was presented. Her career as a Nursery Room Nurse was presented and this photo of her LPN graduation was shown. It was not until after I went to nursing school that I learned that my aunt was also a nurse (we lived across the country from them and so I did not know very much of their lives). I enjoyed looking at the new nurses in this photo and thought I would share it.

Monday, June 4, 2007

Good Nurses Don't Need Malpractice Insurance

Wrong, Wrong, Wrong. "Good" nurses get sued or reported to the Nursing Board all the time. The biggest excuse I hear from nurses as to why they do not carry malpractice insurance is that they did not think they needed it. Every nurse that does any kind of patient care needs to carry their own malpractice insurance that also covers license defense before the Nursing Board. Once an incident happens it is too late to obtain insurance, so take care of yourself and your career - get malpractice insurance today.