My 2 Cents

A Just Culture: It Always Looks Good on Paper

Not Just Penalties in a Just Culture. This article appears in the March/April 2008 Midwestern Edition of Nursing Spectrum. I like the new look and style of Nursing Spectrum by the way.

The article notes that reckless behavior, a conscious disregard of an unreasonable risk should be punished and managed through remedial action and disciplinary action. Human error, i.e. inadvertent actions such as a slip, lapse, or mistake should be managed through changes in processes, design, procedures, environment, and training.

Things like this read well in a journal article and look exceptionally  nice especially on paper but I would like to know how this applies in the nursing workplace.

Are errors attributable to "human error" still reported to the State Board of Nursing in mandatory reporting states or are only "reckless actions" reported to the State Board of Nursing in mandatory reporting states?

Again these things sound nice on paper and in journal articles but how does it translate to everday nursing practice for nurses. Does a Just Culture provide nurses with more input into the investigation and disposition of workplace investigations of incidents, mishaps, or occurrences? Is this process driven by the human resource department? How does a Just Culture fit into the at-will employment doctrine? As you know most nurses are at-will employees?

Do you work in a facility with a Just Culture? Is the culture really just or is it purely an academic exercise?

Nursing Staff Bylaws Attorney: A Position that Decades Overdue

I don't think this position exists. However this is the language used in a recent advertisement for a Medical Staff Bylaws Attorney.

Do you think hospitals and other organizations should have nursing staff bylaws? You want to talk about leveling the playing field, then this is the way to do it in healthcare.

Afford individual nurses the same due process rights and privileges afforded to individual physicians in the workplace.

Medical Staff Bylaws Attorney

At least ten years experience in providing advice and counsel to Hospital medical staffs and other peer review bodies.

Areas of expertise must include medical staff self-governance, medical staff-governing body relations, hospital based contracts, by-laws, rules and regulations, consent, credentialing, peer review, fair hearings, exclusive contracts, emergency department on-call and EMTALA issues and hospital operations. Judicial or administrative litigation experience preferred but not required. Applicant must be willing to travel.

Applicant must have excellent verbal and written communication skills and must have actual experience in representing medical staffs and peer review bodies.
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Nursing Staff Bylaws Attorney

This is a newly created position. Will provide advice and counsel to the Hospital nursing staffs and other peer review bodies.

Will develop an expertise in nursing staff self-governance, nursing staff-governing body relations, hospital based contracts, by-laws, rules and regulations, credentialing, peer review, fair hearings, exclusive contracts, hospital on-call and nursing issues and hospital operations. Judicial or administrative litigation experience preferred but not required. Nursing background helpful. Applicant must be willing to travel.

Continuing Education for Nursing Licensure Renewal

I presented a nursing seminar last week in Illinois. The State of Illinois does not require continuing education for RN/LPN licensure renewal. This will change starting in May 2008 however.

I know Indiana does not require continuing education for RN/LPN licensure renewal. Does your state require continuing nursing education for licensure renewal?

What your opinion? Is there a link between continuing education and competency? Is there a link between continuing education and professionalism? Do you think CE should be required for nursing licensure renewal?

Kentucky Whistleblower Reporting

Are you familiar with the Commonwealth of Kentucky's Patient Safety Act of 1998?

See the following link on the Kentucky Nurses Association website for additional information. The Kentucky Cabinet for Health Services is responsible for enforcement however its interesting to note that to this date (some 10 years later) the Cabinet has not issued any formal direction on the process of filing reports for unsafe conditions. Why?

http://www.kentucky-nurses.org/whistleblower.htm

If you are a Physician, Nurse, Teacher, or Attorney; Your Legal Issues May Be Published and Sensationalized!

See this article about an Ohio physician who had licensed suspended by the Ohio Medical Board and was criminally charged with practicing medicine without a license. Practicing medicine without a license is a felony in the State of Ohio.

Its mentioned on the Cincinnati Enquirer's website on March 14, 2008.

http://news.enquirer.com/apps/pbcs.dll/article?AID=/20080314/NEWS01/303140075.

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I am sure none of us as licensed professionals want to make the news in this fashion. So keep in mind, as a licensed healthcare professional, if you are charged with a crime and have licensure issues with the State Board; it may be splashed across the internet or the newspaper.

I don't know about you but that alone is enough to keep me out of any trouble! I can see the story now:

LaTonia Denise Wright, a Cincinnati, Ohio attorney and registered nurse was charged with having too many pool parties from May 2007-September 2007. Ms. Wright, who is a licensed attorney in Ohio, Kentucky, and Indiana is facing investigations in each state. Ms. Wright may be disbarred in Ohio, Kentucky, and Indiana, and lose her Ohio nursing license and custody of her three poodles and two labs. We contacted Ms. Wright's law office. Ms. Wright was not available for comment and her secretary referred all questions to Ms. Wright's personal counsel.

All jokes aside, its not uncommon for the legal issues (criminal, employment, professional malpractice claims, and/or licensure matters) of teachers, attorneys, physicians, and nurses to be publicized.

Just another incentive for you as a nurse to proactively manage the risks associated with nursing practice.

ANA's Adapting Standards of Care under Extreme Conditions

This is a new publication from the American Nurses Association. See

http://nursingworld.org/HomepageCategory/Announcements/AdaptingStandardsofCareunderExtremeConditions.aspx

Legal CE Track at National and State Nursing Association Seminars

I spoke this week in three cities in Illinois on legal issues in nursing. I am exhausted. I did however meet several wonderful nurses during these presentations.

One nurse asked, why aren't legal presentations scheduled more at conferences and seminars. That is a good question.

I would even propose that national and state nursing associations schedule a legal track at conferences, where nurses have the opportunity to learn about the most current legal issues impacting nursing practice.

I attend several conferences a year and there may be a legal topic here and there, but I have never attended a conference where a track is devoted to legal issues in nursing. In Ohio, Board of Nursing licensees are required to have one hour of CE on Ohio Nursing Law (Practice Act) and Rules (Board regulations) for licensure renewal. Therefore at most conferences for Ohio nurses you tend to see at least one hour of nursing law-related CE.

You might see a clinical track, educational track, pharmacological track, or a management track at a conference; what about a legal track? Do you think this is a good idea? What topics would you like to see covered?

SEIU and Catholic Health Partners

This is available on the Ohio Nurses Association website. See http://www.ohnurses.org/AM/Template.cfm?Section=News&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID=2383

Nine hospitals operated by Catholic Healthcare Partners in Ohio are allowing the Service Employees International Union (SEIU) to hold uncontested union elections on March 12-14.

The RNs at these hospitals did not ask to be represented by SEIU. They did not even know an election was being held until two weeks ago when they received a letter signed by both hospital management and the union. The nurses are not being given the opportunity to choose a professional nurses’ union, such as the Ohio Nurses Association, which would truly represent their interests.

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Wow! Catholic Healthcare Partners and the SEIU. The SEIU is doing "big things" here in Ohio. First the Ohio Independent Providers (IPs); there are over 7,000 IPs in the State of Ohio. Now this uncontested union election with Catholic Healthcare Partners.

Nine hospitals with anywhere from 7,000-8,000 RNs.

What does this mean for the Ohio Nurses Association, which is a union and a professional association? 

My Nephew is My Special Patient

My nephew has an atrial septal defect and pulmonary hypertension. He is seven years old. He was scheduled to have open heart surgery on Tuesday to repair his ASD. Because of a prior engagement I would have been unable to be there for my nephew. I left on Monday for Chicago and will be in Illinois until Thursday.

I felt really bad; my nephews says I am his special nurse. I am his nurse and I refer to him as my special patient. My nieces and nephews call me Nauntie (it Aunt-tie with a N).

He tells the nurses at Cincinnati Children's Hospital that his Nauntie is a nurse also. He is my only patient now because I am not practicing as a home health RN (per diem) anymore. That's another post.

I must admit that I cried because I would not be there for him and my sister. He was scheduled for his pre-op (EKG, Echo, labs, and stress test) on Monday. On Sunday he developed a fever and a rash. On Monday, his surgery is being rescheduled for next month.

I will be there for the pre-op, surgery, and his recovery whenever its scheduled. I am limiting my travel (where I have to stay overnight for more than a day) for the remainder of 2008. No exceptions because it tore me apart to think my nephew would be on a table and I would be six hours away.

Everything happens for a reason and I am not happy of course that my nephew has a virus (he attends daycare for pre-care and aftercare and he is a first grader so he most likely picked up something).

But I am glad that this special nurse will have the opportunity to be there for her special patient.

SEIU Closed-Election with Catholic Health Partners Canceled

This information is posted on the Ohio Nurses Association website (see www.ohnurses.org) and is available on the Cincinnati Business Courier's website. See http://www.bizjournals.com/cincinnati/stories/2008/03/10/daily23.html.

The elections were canceled because of the protests waged by the California Nurses Association and its national arm, the NNOC. Members of the CNA/NNOC were on the Catholic Health Partners campus encouraging nurses not to support the SEIU.

The elections would have involved 8,000 registered nurses and other employees at nine hospitals in Cincinnati, Lima and Springfield. That included Mercy Health Partners, which operates hospitals in Fairfield, Anderson Township, Mount Airy, Western Hills and Clermont County.

Its interesting that Catholic Health Partners filed for the election without any showing of support for SEIU representation.

Ohio for whatever reason is becoming a hotbed for collective bargaining activity. RNs at Catholic Health Partners should have a choice in selecting union representation. There are several unions available to represent the 8,000 RNs including the Ohio Nurses Association, California Nurses Association/NNOC, and the SEIU.

8,000 RNs would essentially double the membership of the Ohio Nurses Association. It would give the CNA/NNOC a "toe hold" here in Ohio and it would add a notch to the SEIU's representation of healthcare workers in Ohio as the SEIU is currently negotiating a contract with the State of Ohio to represent over 7,000 independent providers.

I have a nose for litigation and this is going to be a fight. Yours truly will keep you posted. What is your opinion of unions in nursing? For or against and why?