My 2 Cents

Nursing Spectrum

I just finished browsing the Feb. 2006 Midwestern Edition of Nursing Spectrum. There were some interesting articles in this edition including Putting the "We" in Team that highlights a program designed to bridge the gap between staff nurses and leadership, A New Look at Older RNs, Magnet Recognition-a Journey, Not a Destination, and Remote Control, an article that discusses electronic ICUs assisting bedside RNs. See Nursing Spectrum. Regardless of your specialty in nursing you may be able to find an article or two of interest in Nursing Spectrum.

Who is Wearing the Pants?

The State of Michigan is on a mission to improve the quality of care being provided in state's assisted living facilities. Proposed changes would require facilities to create two separate employee-staffed committees: one for staffing and one for health benefits. The committees would be required to meet regularly and provide minutes to the state. See the Feb. 2006 edition of Provider Magazine for a discussion of the pros and cons. See the Provider website

So nurses, what do you think? Think about your workplace; regardless of whether its a hospital, nursing home, doctors office, home care agency, hospice, etc. Would an employee controlled staffing committee,that determines appropriate facility staffing and oversees staffing levels and health benefits committee, that identifies and eliminates causes of injuries to workers and patients work? Is this giving too much power to the employees? Is something like this long over do? Does this amount to giving employees control of management and adminstrative responsibilities? Is this an example of over-regulation in healthcare?

Professional Associations

I am pleased to announce that I am the Column Coordinator for TAANA's (The American Association of Nurse Attorneys) Legal column in AJN which will begin this year. I am serving as co-chair of TAANA's Publication Committee. As a member of the American Nurses Association I receive AJN with my membership. ANA website

Do you subcribe to AJN? Nursing 2006? RN Magazine? What journals do you subscribe to, I ask?

As a member of the American Bar Association I receive a number of periodicals that are worth their weight in gold to me (especially the periodicals received from Law Practice Management) and cover the costs of membership, not to mention weekly email newsletters. www.abanet.org

As a member of the Ohio State Bar Association, I receive the Green Book which lists newly published cases in the Ohio and have access to Casemaker, where I can search and review case law from several different jurisdictions. www.ohiobar.org

As a member of TAANA, I receive the Journal of Nursing Law and participate in the Nursing Service Organization referral list. www.taana.org I dropped my membership in the Indiana State Bar Association because I didn't find the periodicals received justified the cost of membership.

The Kentucky Bar Association is a mandatory bar association, so I have to belong in order to practice law in Kentucky. I don't find the KBA periodicals to helpful since my law practice is limited to health law, but its annual Law Update allows me to obtain my required CLE at no cost (Oh, I forgot I do pay dues...) www.kybar.org

I have said it once and I will say it again, joining a professional association has it benefits, along with the burden of dues. Instead of joining a professional association because the renewal application came in the mail, sit down and take a look at what it offers for the dues before signing on the line and paying dues.

By the way, I am considering joining the Academy of Medical-Surgical Nurses and seeking certification as a CMSRN in the near future. www.medsurgnurse.org

Suspected Medication Error

You are a staff nurse in a facility. You suspect a fellow nurse committed a medication error that did not result in patient harm but failed to report complete an incident report. This situation is bothering you. What do you do?

Should this situation "bother" you? Do you mention your suspicions to your nursing supervisor? Do you simply approach your colleague and have a frank discussion? Do you let it ride because "its none of your business" and you don't get paid to do that? Do you consult with nursing policies & procedures to determine the best course of action?

Physician Monitoring

There is an interesting January 2006 article on problem physicians.The article "Problem Doctors: Is There a System Solution?" appears in the January 17, 2006 issue of The Annals of Internal Medicine. According to the authors' estimate, with all factors considered "at least one third of all physicians will experience, at some time in their career, a period during which they have a condition that impairs their ability to practice medicine safely."

See "Monitoring System Needed To Prevent Safety Hazard Of Problem Physicians" at http://www.medicalnewstoday.com/medicalnews.php?newsid=36354

What do you think? Are nurses more closely scrutinized and monitored by regulatory boards and employers than physicians?

Writing for Publication

Do you like to write articles, columns, or commentary? All nurses regardless of education, title, and licensure have experiences worth communicating to colleagues therefore considering writing an article. You don't necessarily have to write to published in national journals. You can write for nursing professional association newsletters, your church newsletter, local nursing magazines, nursing school alumni newsletters, etc.

I love to write, which is probably why I have a blog, website, and constantly submit articles for publication. I started years ago writing for Medical Career Source (www.medicalcareersource.com) and served as Editor of the publication for a year. I also wrote articles for the Center for American Nurses (www.centerforamericannurses.com) and the Ohio Nurses Association (www.ohnurses.org). I also wrote an article for Today's Nurse (healthcareerweb.com) in 2005, a publication provided to nurses in Central Ohio. I am the Editor of the Center for American Nurses new legal monograph, Legal Basics for Professional Nursing Practice available at www.nursingworld.org.

Why am I going on and on about writing? I agreed to Co-Chair The American Association of Nurse Attorneys (TAANA) Publication & Products Committee for 2005. In this role, I will coordinate TAANA members submission of articles and commentary to various nursing journals. If you are a member of TAANA and want to write, contact me.

Ready, Set, Go..... Pull out a pen and get the paper and start creating your outline for your 1st draft.....You have to start somewhere, right? What have been your experiences with writing regarding your nursing experiences and expertise?

Certification and CMSRN

Are you certified in a nursing specialty? I downloaded the information for the Certified Medical-Surgical Registered Nurse (CMSRN) exam. I am considering certification. See this article on nursing spectrum that discusses the CMSRN exam. http://community.nursingspectrum.com/MagazineArticles/article.cfm?AID=12630

If you are certified, why did you become certified? What is your certification? If you are not certified, why not? Is it because we play the "alphabet soup" game with credentials and degrees in nursing?

I am a former pediatric nurse who switched to home health adult med surg and I have not looked back. I never really thought about being certified until I reviewed the American Journal of Nursing 2006 Career Guide and I have been a practicing RN since 1993.

Board of Nursing Meeting

I attended the Ohio Board of Nursing meeting today in Columbus, Ohio. Nurses, if you have never attended a meeting of your state Board, I would suggest that you do to review the Board agenda and see how your state Board conducts its business. Its quite refreshing. The Board Task Force on the Ohio Center for Nursing met today. There was a discussion on the pilot program for Medication Technicians and Community Health Worker training yesterday.

There were graduate students from Wright State University in Dayton, Ohio present today. Did you attend a Board of Nursing meeting as a student? Was it a requirement for a class?

During my ASN (1993) and BSN (1994) studies, I wasn't required to attend an Ohio Board of Nursing meeting as part of a course requirement. Should it be a requirement as part of a professionalism or ethics nursing course? In your opinion would this help socialize student nurses in the practice of professional nursing?

Forensic Nursing

I am excited because I have been asked to present at the Ohio chapter of the International Association of Forensic Nurses (IAFN) meeting on May 8, 2006 in Columbus, Ohio. I will most likely present on Scope of Practice and Professional Boundaries for Ohio Forensic Nurses at the Spring Conference. 

Speaking of forensic nursing, I attended a very informative CE sponsored by the Southwestern Ohio Nurses Association (SONA) last evening on Intimate Partner Violence (IPV) that was presented by Dr. Yvonne McKoy, Ph.D., R.N. who is a nursing professor at Xavier University in Cincinnati, Ohio. The Executive Director of the Ohio Nurses Association (ONA), Gingy Harshey Meade and President of ONA, Barb Nash were also in attendance.

Guess Who?

A nurse answered the door at her residence to find an investigator from the Attorney General's office who wanted to ask her questions about a medication error that occurred several years ago. The investigator did not try to contact her via phone or mail prior to showing up at her home unannounced.

The nurse asked the investigator if she needed an attorney prior to answering questions and was told "no, not at this point." The nurse told the investigator she wanted to contact her professional liability insurance carrier before she answered any questions. The investigator provided the nurse with his business card.

How would you have handled this situation?

Nolo Contendre

A nurse contacted me yesterday. She pled nolo contendre to a criminal charge several years ago. She is applying for licensure via endorsement in another state and wanted to know if her plea to nolo contrendre was a "conviction" for purposes of a licensure endorsement application. She contacted the board and was told to complete her endorsement application to the best of her ability and accurately. What would you do?

This nurse is doing exactly what she needs to do, seeking professional advice to clarify the question before proceeding with the endorsement application. Why? Because not responding truthfully on an endorsement application is grounds for revocation of licensure and may be construed as fraud. Moreover since the nurse is already licensed in State A, any action taken against a nursing license in State B (endorsement state) will eventually be made known to State A through either a reporting databank or licensure renewal in State A.

I referred the nurse to a nurse attorney licensed in the state where she is seeking licensure via endorsement to obtain a professional opinion that she can rely on as legal advice and counseling when completing her endorsement application in State B.

What is Nolo Contendre? It is Latin for "I will not defend it." A statement in a criminal trial where the defendant declines to refute the evidence presented but agrees to the charges presented in the complaint. It cannot be used as an admission in other proceedings. http://www.legal-dictionary.org/legal-dictionary-n/Nolo-Contendre.asp

Practice Deficiencies

I had a meeting with a newly licensed RN today who was reported to a Board of Nursing for unsafe nursing practice. What is unsafe nursing practice? At one point does a violation(s) of an employer's policy & procedure turn into unsafe nursing practice? Is one medication error unsafe nursing practice? Is a pattern of medication errors unsafe nursing practice? Are newly licensed RNs more prone to practice deficiencies than RNs practicing for 5,10,15, or 20+ years?

Should issues related to practice deficiencies and unsafe nursing practice be dealt with "in-house" meaning inside the facility with a corrective action plan, monitoring, and supervision prior to being reported to the Board of Nursing? Where does mentoring and socializing the newly licensed RN into the professional practice of nursing fit into the equation? Should a newly licensed RN work with one, two, or more preceptors on a particular unit/floor/shift/area for orientation and competency assessment and evaluation purposes?

If you haven't done so already, read the Notes From The Field section in the December 2005 issue of Nursing Management (www.nursingmanagement.com); the article is titled Is Employee Discipline the Solution for Patient Safety?

How did you make the transition from student to professional nurse? Was it easy? How much time did it take for you to feel proficient?