My 2 Cents

Ohio Staffing Bill (HB 346)

This information appeared in the Ohio Nurses Association Member updated tht I received yesterday:

On Wednesday, February 6, 2008, Substitute HB 346, the Hospital Nurse Staffing Plan, gained momentum as the House Health Committee, chaired by Rep. Lynn Wachtmann, unanimously reported the bill favorably to the House of Representatives.

Lisa Rankin (ONA Lobbyist) and Bianca Miller testified on behalf of ONA.  Bianca Miller, a registered nurse for twenty years, testified regarding her personal experience with the impact that recent staffing changes have made to the qualify of care she provides and morale of staff at her hospital.  Ms. Miller further testified that her support for HB 346 rested on the hope that it was a “first step” in a different direction as bedside nurses have a voice in staffing decisions.  Ms. Miller powerfully stated, “In order to feel respected and valued, an organization needs to include the nurses in everyday operations…A committee with bedside nurses, hospital administration, and nursing management needs to be established.  An ongoing evaluation of the ANA [American Nurses Association] Staffing Principles needs to occur with established bench marks.”

The next step for Substitute HB 346 will be presentation to the full House to vote on, and, if passed, then the whole process begins again in the Senate.

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The American Nurses Association (ANA) believes staffing ratios need to be required by legislation but the number itself must be set at the unit level with RN input, rather than by the terms of the legislation. See http://www.safestaffingsaveslives.org/.

How do you feel about nurse staffing legislation? Should nursing staffing be legislated in your opinion? Do you support mandated nurse-patient staffing ratios or staffing principles like ANAs?

Do Nurses See Attorney Fees as a Necessary Expense?

Nationally there are alot of nurses being monitored by a Nursing Board. Just a word of advice, nurse to nurse, this isn't legal advice of course.

If you are being monitored by a Nursing Board, you must STRICTLY comply with the terms and conditions listed in the Board Order, Consent Agreement, Consent Decree, Agreed Order, etc. Substantial compliance or partial compliance isn't enough.

If you have any questions about a Nursing Board document, consult with a licensure defense attorney in your jurisdiction. The attorney can assist you by explaining the document and what's required by the document.

Its not the job or role of the Nursing Board staff (this includes attorneys, monitoring agents, adjudication coordinators, investigators, etc.) to advise and counsel you regarding licensure issues and monitoring. In my experience, I have found that as a group, we as nurses turn to any and everyone except for attorneys for legal advice and counseling.

My son is 18 years old and my estate planning documents needed to be revised. I can't imagine if I passed suddenly what my son (who lives at home, sleeps until 2pm, and is underemployed) would do with the insurance money. Can you say trustee? I contacted an attorney and retained an attorney to revise these documents. I am not an estate planning lawyer. Of course I would rather have spent this money on something else but it was a necessary expense.

Do you think we as nurses view attorney representation, counseling, and advising in licensure, criminal, civil, employment, business, and professional practice matters as a necessary expense?

Walking the Tight Rope: HIPAA vs. Nursing Board Reporting

You are a staff nurse in a small rural hospital. You are working from 7am to 7pm today. You enter the conference room only to find you are caring for a fellow nurse who was admitted for a suspected drug overdose. You don't know this nurse however its the talk of the unit. This nurse tested positive for several illegal drugs including marijuana and heroin. The nurse-patient is not an employee of the hospital.

Are you morally, ethically and/or legally required by the State Nurse Practice Act to report this nurse to the State Board of Nursing or does HIPAA and state privacy laws prohibit the reporting? What does the ANA Code of Ethics mandate in this situation? What would you do in this situation? What are your concerns?

Its Due Process Alright! Its Just Watered Down and Caffeine Free

I support my State Bar Associations. Membership is voluntary but I do belong to the Ohio State Bar Association and the Indiana Bar Association. Kentucky is a mandatory bar, so I don't have a choice. But that's another post.

One of the benefits of OSBA membership is the Ohio Bar Report, the green book which includes litigated cases including attorney discipline.

In Discipline Counsel v. Heiland, 116 Ohio St.3d, 2008-Ohio-91, an attorney was charged with violating the Code of Professional Responsibility. One of the attorney's argument's was that his right to due process was violated because the charging agency was allowed to amend its complaint 20 days before a scheduled hearing.

The Ohio Supreme Court stated "the standards of due process in a disciplinary proceeding are not equal to those in a criminal matter. A disciplinary proceeding is instituted to safeguard the courts and to protect the public from the misconduct of those who are licensed to practice law, and is neither criminal nor a civil proceeding."

Do you think licensed professionals and licensed healthcare professionals including of course nurses should be afforded the same rights afforded to criminal defendants and civil litigants in administrative disciplinary investigations?

In my opinion, due process is due process. Why should we as licensed professionals be afforded less due process when its your license and your very livelihood at issue? Its another licensed professional this time, but it may be you next time or in the future.

Maybe state nursing associations and other organizations that advocate for nurses should tackle this issue. What do you think?

Las Vegas Here I Come, Again!

I love Las Vegas! If I win the Mega Millions lottery today, I would buy a vacation home in Henderson, Nevada and say goodbye to this Midwest weather from November to April every year.

The National Black Nurses Association is having its annual meeting and conference in Las Vegas this year and I never need an excuse to stay at the Mandalay Bay. See http://www.nbna.org/conferences/conf08/conference_registration_form.pdf.

The conference is August 4th-8th. My fiance's (no, I am not engaged but it sounds better than boyfriend) birthday is July 28th. My b-day is July 2nd. I am thinking about surprising him with a trip to Las Vegas for his birthday. What do you think?

I don't that we will stay at the Mandalay Bay; its located at the far end of the strip, near the Luxor and Excalibur. I prefer to stay in the middle of the strip at the either the Flamingo, Bellagio, Treasure Island or Paris Hotel.

Where do you stay when you travel to Vegas? Oh and what you say on this blog, stays on this blog!

Are All Nursing Board Complaints Filed in Good Faith?

I have practiced licensure defense since 2001 as an attorney in private practice. I can tell you there are some nursing employers and these are typically large teaching hospitals that report "everything" to the Board of Nursing. I mean everything. If a nurse drops a vial of saline, its reported. If you slip up and say "shit" on the unit; it gets reported.

Then there are facilties that never report a nurse to the Nursing Board unless it makes the news or a patient/resident threatens to sue or go to the media.

Why is there such a disparity? The underreporting and overreporting both should be addressed; not just one or the other.

Some if not most State Board of Nursing are mandatory reporting states. Look here for an explanation of mandatory reporting. https://www.ncsbn.org/163.htm. This is from the National Council of State Boards of Nursing website.

Some employers report nurses for the wrong reasons. If you want to argue with me on this point, call me. Its a distrubing trend I am seeing in my law practice. I will speak with a nurse or meet with a nurse and think to myself or aloud "this was reported to the State Nursing Board?" Incidents that could have been managed or handled "in house" are being reported to the Nursing Board under the auspices of "mandatory reporting." Is it really mandatory reporting or is there something else going on here?

In some cases, the reporting is not done because of perceived or actual violation of the nursing law and regulations or patient safety, the motive is more sinister and self-serving. After all, who wants to be investigated by the Nursing Board? 

I know that when I pick up a home health visit here and there, I don't walk into a patient's home thinking, "I am doing to do something that gets me reported to the Nursing Board!"

Its done to humiliate, upset, and torment the nurse and its works! Why does this happen? Because of the one-sided nature of hiring/firing that benefits the healthcare employer and the perceived and actual lack of fairness, equality, and power of nurses in the healthcare working environment.

The State Nursing Board complaint becomes the healthcare employer's equivalent of giving the nurse one final middle finger "for the road" because usually the nurse has already been disciplined, suspended or terminated by the facility.

ANA Releases New Guide to the Code of Ethics for Nurses: Interpretation and Application

The American Nurses Association release a new 200 page publication is for RNs and ithe publication refers to and utilizes the ANA Code of Ethics for Nurses with Interpretive Statements as a guideline for putting the core values expressed in the Code into everyday practice. See http://nursingworld.org/HomepageCategory/NursingInsider/ANAReleasesNewPublication.aspx.

I am planning to purchase this guide next week and I will post my review on this blog in the next few weeks.

Any Licensed Attorney Can Handle a Nursing Board Defense Case, Right?

Taralynn Mackay, a nurse attorney in Texas who represents nurses in licensure matters has an excellent post on her blog about attorney representation in nursing licensure defense cases. See http://nurseattorney.blogspot.com/.

I agree with Taralynn. You have to ask questions before you retain an attorney. Practicing law is a profession but its also a business. Nursing licensure defense cases are not "big money"  or "large retainer" cases for law firms for the most part. Therefore you may find that your case, which generates a few thousand dollars in fees is considered "small child sized fries" for the law firm although its your license, your livelihood, and a "super-size fries" case for you.

You may retain an attorney only to find that your matter is not a priority for the attorney (your phone calls are not returned, your emails are not answered, you are not provided with copies of motions filed with the Board, email discussions and negotiations with Board staff are not forwarded to or you are not provided with a hard copy, etc.) and that the attorney does not have any experience with administrative law and nursing licensure issues.

Ask have you worked with nurses before? Its nice to know that the attorney's aunt, uncle, and second cousin are nurses; but you still need to know if the attorney has experience before the Nursing Board?

Don't quiz your attorney. If I am asked how many nurses sit on the Indiana, Kentucky, and Ohio Nursing Boards, I will find and refer to my cheat sheet. Ask substantive questions to determine if an attorney is competent to handle your case.

Ask the attorney questions. Ask for a copy of his or her CV. Ask about experience and education. Ask what percentage of the attorney's practice involves nursing licensure defense. Its your license, its your case, and you are the client. Without clients like nurses, the legal profession would not exist.

I don't take criminal defense, personal injury, workers comp, or medical malpractice cases because I limit my law practice to nursing licensure and professional practice matters. I can tell you from having practiced in this area where the licensure defense attorneys are located in Ohio, Kentucky, and Indiana.

Most licensure defense attorney represent other licensed healthcare professionals also lincluding dentists, pharmacists, physicians, etc. Just the other day, I referred a physician to an attorney colleague in Columbus, Ohio who needed representation before the Ohio Medical Board.

If you need to retain a licensure defense attorney, contact your state nurses association for a referral. Then "google" the attorney's name to see what information you find. Do your research before retaining an attorney to represent you in a licensure matter.

Nursing Student and Nursing Faculty Relations

I received a phone inquiry this week from a nursing student. The Nursing School/College is taking steps to expel the student from the program. This isn't the first of such calls I have received from nursing students who are being expelled from a nursing program for whatever reason.

Do you think nurse educators and nursing faculty are too tough on nursing students? Are programs designed to fail students? Are the policies and procedures used by nursing schools and colleges to grieve issues (attendance, exams, grades, practice issues, etc.) that occur with nursing students fair?

We have all heard about nursing eating its young. Does this ugly behavior start in nursing schools and colleges (faculty and educators to nursing students) and then continue into the practice environment (nurse to new nurse/former nursing student)?

State Boards of Nursing should devote more time to investigating nursing student complaints involving nursing schools/colleges and nursing faculty. This should be included in determining whether or not the school/college maintains its status with the State Board of Nursing.

Patients in the healthcare environment can turn to nursing administration to hold nurses accountable and also the State Board of Nursing. Nurse educators and faculty are practicing nurses also. Who can and should nursing students look to for holding nurse educators and faculty accountable? The nursing school or college.

The Ohio Board of Nursing allows nursing students and other interested parties to file complaints against a nursing school/college via a Nursing Education Dissatisfaction Form. See http://www.nursing.ohio.gov/PDFS/Forms/NrsgEdReportform.pdf. 

This particular student is over $50,000 in debt from her undergraduate nursing education and less than 10 weeks from completing the program. I didn't accumulate that kind of debt with nursing and law school combined.

I can't discuss the specifics but in my opinion this student is not being treated fairly. But again, fairness is in the eye of the beholder and in this case the Dean of the College.

We have all heard about the nursing faculty shortage and nursing shortage. Have you ever heard of a lawyer shortage? Okay, I made myself laugh with that one.

Is the environment in the nursing workplace (both for staff nurses and nursing faculty) the reason why there is a nursing shortage? A shortage in a field is indicative of something in my opinion. The shortage of nurse educators and nurses is indicative of "what" in your opinion?

 

What is the Role of a Nursing Board Investigator?

I was contacted by a nurse regarding a pending disciplinary investigation and complaint filed against her license with a State Nursing Board.

According to the nurse, a Nursing Board Investigator indicated that attorney representation was not necessary.

Magical Moment. If you have to question whether or not you need an attorney in any given situation, then you need to speak with an attorney. As a professional nurse, you shouldn't need or require an affirmative response from anyone (your nursing supervisor, law enforcement agent, drug diversion task force officer, attorney general investigator, regulatory enforcement agent, nursing board investigator, etc.) on whether or not you need to seek legal counsel to protect your nursing license and your livelihood.

Trust your instincts! If you instincts tell you need an attorney, then invoke your right to attorney representation.

I found this on the internet and its a public document. Its the State of Ohio, Department of Administrative Services (DAS), job description for a Nursing Board Enforcement Agent. See http://www.das.ohio.gov/hrd/cspecs/classpdf/2162.pdf.

Read the job description and you will know the role of a State Board of Nursing Investigator or Enforcement Agent if and when you are contacted regarding a complaint filed against your license.