My 2 Cents

Endorsement Headaches

Nurses if you have had action taken against your license in State A and B or if you have been admitted to the Alternative Program in State A and applied and been given a restricted license in State B and C, don't assume its the same or similiar process, procedure, policies, and outcome in State D. What?

If you have had licensure issues in state A, consult with a nurse attorney or an attorney who represents nurses before the Board of Nursing PRIOR to seeking licensure in State B. This should be an attorney licensed and practicing before the Board of Nursing in State B.

The role of any Board of Nursing is to protect the public from unsafe nursing care. However Boards of Nursing differ from state to state as far as the process, procedure, and policies regarding initial licensure, endorsement, and the disciplinary process.

As nurses we must start taking control of our nursing practice and being proactive in managing legal risks. The majority of nurses involved in Board of Nursing actions do not seek legal consultation or have legal representation.

Having a legal consultation prior to seeking licensure in another state can save you a headache if you have had action taken against your license in another state(s).....

Safeguarding Your License

I spoke yesterday evening at the Licensed Practical Nurse Association of Ohio annual meeting. The topic was Safeguarding Your Nursing License.

I want to thank LPNAO for the invitation to speak. I love speaking to individual clinical nurses on the legal issues involved in providing nursing care. This was a wonderful group with lots of questions!

What steps are you taking to safeguard your nursing license? Do you have professional liability insurance with a licensure defense benefit? Do you periodically review your state nurse practice act and board of nursing regulations? Do you subscribe to and review nursing journals in your practice area? Have you reviewed your employer's nursing policies & procedures lately? What is your scope of practice? Do you seek a advice and consultation with your colleagues or an external source when questions, situations, and concerns arise in your nursing practice? Have you reviewed your Code of Ethics? What are the most common types of disciplinary investigations pending against nurses in your practice area? What the legal minefields for nursing negligence in your practice area? Do you know that criminal convictions can impact your nursing license? Do you review your Board of Nursing newsletter?

These are just a few things you can do to manage the risks associated with nursing practice.

What's in your Employment File?

The credit cards commercials ask What's in Your Wallet? Nurses, What's in Your Employment File?

Alternative Program for Chemical Dependency

If you have a chemical dependency or legal problems (DUIs, drug theft, Board of Nursing or Board of Pharmacy investigations) directly or indirectly related to a chemical dependency, consult with a licensed attorney in your state regarding your options.

Should You Have an Attorney on Retainer?

Imagine my surprise today when a nurse contacted me today and indicated that she wanted to retain me for counseling and advising on an ongoing basis related to workplace issues.

I have never in my 5 years of solo practice had a staff nurse contact me for ongoing counseling and advising. I of course had performed many one-time consultations with individual nurses. I am pleasantly surprised because this is an individual who recognizes based on a series of incidents in a healthcare facility that she needs to have legal advice and counseling related to her nursing practice. This nurse is concerned about her license and the implications these incidents may have on her nursing license and career. Now that's what I am talking about!!!

Normally its physicians, dentists, nursing homes, hospitals, etc. which have outside counsel and attorneys counseling and advising the organization on health law, employment, HR, risk management, and other professional practice issues. Should nurses have an attorney with experience in nursing law and professional practice matters on retainer?

Although its Friday the 13th, I am smiling and I think its going to be a good day......

Non-Compete Clause

I reviewed an employment contract for an ARNP today. Regardless of whether you are an ARNP, RN, or LPN, if you are asked to review and sign an employment contract you should have the contract reviewed by an attorney with experience in healthcare law and nursing issues.

Why? Contracts are legally binding documents that may impact your nursing practice for years to come depending on the provisions, clauses, and terms in the contract.

Some attorneys will charge a flat fee a contract review and consultations while others may bill an hourly rate.

Does your employment contract have a non-compete clause? Is it reasonable? Is there an indemnity clause in the contract? What is an indemnity clause?

I have said it once and I will say it again....No one likes to pay attorney fees however its your nursing practice and aren't you worth it? 

KY ARNP & Controlled Substances

I attended the Kentucky Coalition of NP & NM seminar in Bowling Green, Kentucky on Friday. The topic was prescribing controlled substances. There were over 200 nurses present at the conference. The speakers included staff from the Kentucky Board of Nursing, Office of Inspector General, Louisville Drug Diversion Squad, and more.

The conference was okay. It was a three and half hour drive to and from from the Cincinnati area. It was a long drive however I am glad that I attended. Not because it was an excellent seminar but because the seminar confirmed a point I see everyday in my law practice.

As an attorney who represents, counsels, and advises individual nurses I thought it was unbalanced presentation from regulatory and law enforcement officials. The seminar focused on the responsibilities of ARNPs related to controlled substance prescriptions but not the rights of ARNPs in regulatory and law enforcement investigations. Why not include a session on managing the risks associated with controlled substance prescriptions and ARNP practice?

Professional associations like the KCNPNM advocate for the profession which includes individual members. I think its "nice" when members from regulatory and law enforcement agencies speak at these seminars however there should be limits so attendees can view these presentations in the proper perspective.

Is this one of the reasons why nurses in general represent themselves in regulatory investigations if contacted by the board of nursing, office of inspector general, or office of attorney general? Is this one of the reasons why nurses do not invoke the right to counsel when questioned by law enforcement agents in workplace investigations related to suspected criminal conduct?

The role of a regulatory agency like the board of nursing and office of inspector general is to protect the public, the role of law enforcement agency is to enforce laws and regulations, and the role of the attorney general is to investigate and prosecute violations of the law. Please contrast this with the role of a nursing professional association which is to advocate for the best interests of the profession and its membership. Conference planners need to keep this in mind when developing seminars for ARNPs across the country.

Maybe its just me.....

Nursing Standard of Care during Disasters

The ANA Quadrennial Policy Conference will take place June 20-22, 2007 in Atlanta, Georgia and will discuss the altered standards of nursing care during disasters.

In your opinion, what is the nursing standard of care during a disaster? Remember the nursing standard of care focuses on patient outcomes.

What are the standards of professional performance for nurses during disasters? Remember standards of professional performance focus on the nurse's clinical performance.

This is important because nursing standards of care and standards of professional performance provide a basis for determing the legal standard of care in malpractice and nursing negligence cases and may be utilized by a board of nursing to determine if a licensee practiced in a safe and competent manner in a given situation. This type of information could also be utilized in a criminal proceeding against a nurse depending on the allegations.

I am making plans to attend this conference and I hope to see you there.

For additional information see Legal Aspects of Standards and Guidelines for Clinical Nursing Practice published by the ANA in 1998.