My 2 Cents

A Job and a Paycheck vs. Professional Nursing Practice

How do you characterize professional nursing practice? Do you think the majority of nurses practice in accordance with the standards of professional nursing practice? Do you think the majority of nurses think in terms of a job, paycheck, and only in terms of unit or facility-based issues?

I admit its hard to see the forest from the trees from ground level when you are in the trenches. I can remember having a job and paycheck mentality at various stages of my career as a nurse and as an attorney. The paycheck mentality for me stemmed from my unhappiness with the work environment.

Where are you in your career?

Dues Increase Passed by ONA House of Delegates!!

I attended the ONA Convention this weekend. A dues increase was passed by the House of Delegates today. The Association will be able to hire additional staff and "do the work" of the profession with the increase in dues revenue.

I was elected by my colleagues as a delegate to the American Nurses Association House of Delegates and Center for American Nurses Membership Council both which meet in June 2007 in Washington, D.C.

If you have never attended a state nurses association convention, I would encourage you to attend. The energy throughout the convention is dynamic and there are lively discussions and debates of current nursing issues. A group of us talked to 1am this morning about current nursing issues. 

Are You a Perfect Nurse?

I received this comment today from a nurse:

I carry malpractice ins. against the advice of most all my RN co-workers. I believe in it.....but I was sad to hear Susie Orman on her show this past Saturday night tell a nurse, that private malpractice insurance was NOT necessary, as long as the nurse was covered under her employer & the nurse followed all policies perfectly. Thoughts?

Thank you for contacting me. I don't follow the Susie Orman show. All licensed professionals need liability insurance insurance, especially licensed healthcare professionals.

A healthcare facility insurance policy is meant to protect the facility and it may cover you as a employee of the facility. Do you have a copy of employer's liability insurance policies? Are you provided with a copy of your employer's liability insurance policy(ies) whenever changes are made to the policy? Of course not, because the policy is not meant to protect you, its meant to protect the facility.

Also I don't know of any perfect nurses who follow all policies perfectly and who practice in a perfect nursing work environment. Nurses are held to an ideal of perfection and angelic like behavior which is unrealistic.

All nurses should consider having their own professional liability insurance policy written by a major insurer that insures nurses and licensed healthcare professionals. See www.nso.com  and www.proliability.com.

Your own professional liability insurance policy will protect you in the event you are named as defendant in medical malpractice case and in the event a complaint is filed against your license with the Board of Nursing or another regulatory board. Your employer's insurance will not assist you in defending your license. Why? Most of the time its the employer reporting the nurse to the Board of Nursing and the policy is written to protect the facility.

Considering the majority of nurses practice in mandatory reporting states (see  https://www.ncsbn.org/Discipline(1).pdf at page 29) i.e. employers are required to report suspected or alleged violations of the Nurse Practice Act and/or Board of Nursing regulations to the Board of Nursing, it makes since that all NURSES consider purchasing his or her own professional liability insurance.

Most nurses don't have professional liability insurance which I think is the reason why most nurses don't retain legal counsel in Board of Nursing disciplinary investigations. Professional liability insurance for nurses is inexpensive and I pay less than $100 a year for my professional liability insurance that covers my nursing practice (as a home health RN) and my consulting practice. I have another policy that covers my law practice.

Also I can tell you as a licensure defense attorney who has represented nurses who work in a variety of settings from hospitals to home care to independent practice to nursing homes, employers don't operate from a "let's do what's best for the nurse or our nursing employees" point of view; Business decisions and judgments are made and fairness is in the eye of the beholder.  Its your role to be your own risk manager and protect your license and livelihood. Professional liability insurance should be part and parcel of your portfolio as a professional.

Drug-Testing Options in Healthcare

An article in Provider, the journal of the American Health Care Association and the National Center for Assisted Living, October 2007, suggests that providers take a stronger stance against use of the illicit drugs and alcohol by drug testing employees. See www.providermagazine.com.

The four major options for drug-testing include:

1.  Post-Job-Offer Testing;

2.  Suspicion Drug Testing;

3.  Random Drug Testing; and

4.  Post-Accident Drug Testing.

Positive drug tests by nurses in the workplace, especially for illicit drugs or medications that were not prescribed by an authorized prescriber, can have licensure implications. Most states pursuant to the Nurse Practice Act and Board of Nursing regulations requires employers to report the positive drug test to the State Board of Nursing. This triggers a disciplinary investigation.

What are your opinions regarding drug testing?

Kentucky and West Virginia Nurses on Strike!

Kentucky Nurses Association and West Virginia Nurses Association Nurses are on strike at Appalachian Regional Healthcare  (ARH) over the current contract, which expired Sunday. See http://www.inform.com/related_content/42395678,0 and http://www.kentucky.com/news/state/story/191488.html.

ARH officials declined to say how many job openings there are at the seven hospitals in Eastern Kentucky and two in West Virginia affected by the strike.According to Pat Tanner, the lead negotiator for the Kentucky and West Virginia nurses associations, at least 650 registered nurses walked out when their contract expired at 12:01 a.m. Monday.

Is It Fair to Base Union or Professional Association Dues on the Gross Income of Members?

I obtained this information from the SEIU 1199 website. See http://ltc.seiu1199.org/HCFaq.aspx

Dues in SEIU District 1199 are 1.75% of gross pay, or $1.75 for every $100 you make.

So for every $1,000.00 grossed, the dues will be $17.50. I have several clients who are Ohio IPs and these nurses can gross from $50,000 to $80,000.00 a year or more.

An Ohio IP Nurse with SEIU labor representation who grosses $50,000 year may pay $875.00 a year for labor dues. This is speculative at this point but based on the figure provided on the SEIU 1199 website, which doesn't mention a cap.

This is expensive and there should be a cap, i.e. a maximum amount on which the SEIU figures dues for Ohio IP union members. A cap at $30,000 would yield $525.00 in dues.

In the spirit of full disclosure, I should note that I am member of the Ohio Nurses Association. The Ohio Nurses Association (ONA) is a union and a professional association. I do not belong to an ONA collective bargaining unit. In addition to being self-employed as an attorney, I am employed as a home health R.N. The home care agency where I am employed is unorganized (no union).

As a RN and a licensure defense attorney I support the rights of individual nurses to determine what's best for them in the workplace:

1. Working pursuant to a collective bargaining agreement;

2. Working in a non-union setting and utilizing workforce advocacy tools (see the Center for American Nurses at www.centerforamericannurses.org) ; or

3. Negotiating with an employer and having an individual employment contract or agreement.

The Ohio Nurses Association is proposing a dues increase for its membership which will be decided at the Convention next week and its only 0.8% of a stipulated salary. ONA Union and Non-Union Members have different stipulated salaries.

I can't imagine an attorneys union. Even more unimaginable, would be a union of attorneys proposing to base dues on a gross percentage of attorney members income. You can say of course, I am comparing apples to oranges my comparing attorneys to nurses and other healthcare professionals.....

Should unions and professional associations base membership dues on the salary of its membership? I can assure you, the American Bar Association, The American Association of Nurse Attorneys, or the state Bar Association that I belong to would NEVER propose such a concept.

Can you explain why this is occurring? What's your opinion? If you want to express your opinion and would like for me to post the comment without your name and email address, just let me know.

Ohio IPs Vote for SEIU

This information is posted on the SEIU 1199 website:

Congratulations Ohio Independent Providers!  Friday September 28^th, the American Arbitration Association counted ballots in your Home Care Election and you won by a big margin: 1726 voted to be represented by SEIU 1199.  Only 328 people voted against forming a union.  That’s almost 85%!  And while we should all feel good about this victory, there’s still A LOT of work to do.   Negotiations with the state will probably begin in January, which means we’ve got about 3 months to elect our negotiating committee and put together our proposals.  To help bring it all together we’ll be hosting an Independent Provider conference in Columbus on November 29^th and 30^th, so make sure you save the date. See http://ltc.seiu1199.org/blogs/we_won_1726-328/archive/2007/09/28/1726-to-328.aspx.

There are several hundred and may a thousand or so, Ohio IPs who are registered nurses and licensed practical nurses and function as small business owners essentially.

Do you think SEIU representation will hurt, hinder, or help the professional practice of nursing in the State of Ohio?

Do you think a union like the SEIU that includes a variety of occupations does a better job with adminstering a Collective Bargaining Agreement (CBA) and addressing the workplace and professional practice needs of its membership than a union devoted exclusively to one occupation or profession? For example, the UAN (see www.uannurse.org) and the Ohio Nurses Association (www.ohnurses.org) only represent RNs.

Do you think it matters? Or is a union a union a union in your opinion? Do you think RNs should only be represented by a RN union and LPNs by a LPN union? Do you think RNs and LPNs should be represented by a nursing union?

Regardless of how you feel about healthcare unions and nurses, this is a significant step for the SEIU and the organized healthcare labor movement in Ohio. Will we see more healthcare organizing efforts of nurses in central, southern, or northern Ohio?

Update: Nursing Scope of Practice vs. Practice of Law

I posted last month on whether it was permissible for nursing instructors, professors, and faculty to counsel and advise nursing students on completion of a Board of Nursing Application for Licensure by Examination. I submitted my question for consideration to the Ohio Board of Nursing.

The Ohio Board of Nursing's General Counsel, Holly Fischer replied (via email) that the question raised is whether advising an individual in answering license application questions constitutes rendering legal advice. She also referred me to the Ohio Supreme Court's Board on the Unauthorized Practice of Law. See http://www.nursing.ohio.gov/PDFS/NextMeeting/M2/1.3EDReport.pdf.

Ohio Board of Nursing staff are preparing an article to be published in the next edition of Momentum, the Board's quarterly newsletter, on this issue. The Ohio Board of Nursing, Executive Director, Betsy Houchen, in her report to the Board at its meeting last month, noted that "applicants are responsible to how they complete the application. Our response to questions is that if in doubt, report and disclose all information, contact the Board for clarification, or contact an attorney for legal advice." (I added the emphasis here).

I did not follow up with the Ohio Supreme Court Commission on the Unauthorized Practice of Law. As a licensure defense attorney, my goal is to create an awareness of this issue. An article in the Board's Newsletter will facilitate a discussion and most certainly publicize this legal minefield for consideration by nursing schools, faculty, and nursing students.

Practicing law without a license can be a crime (depending on the state) and can subject a nurse to civil penalties and the State can seek injunctive relief. Moreover if a nurse is accused of the UPL, the State Board of Nursing will most likely investigate the nurse. What nurse would want to be involved in a concurrent civil (UPL investigation), criminal (law enforcement to determine if a crime has been committed), and/or administrative (Board of Nursing investigation) cases? This type of case would most likely receive some media coverage as well.

Furthermore its not beneficial for nursing students and NCLEX-Applicants to rely on lay advice in a matter of such professional and financial significance- their license and nursing career.