My 2 Cents

Was It Really The Union? A Question Presented by the Kentucky Nurses Association President

This is the question posed by the current Kentucky Nurses Association president in her column in the Kentucky Nurse, Volumber 56, No. 4 October, November, December 2008. See http://www.nursingald.com/uploads/newsletters/KY122008.pdf

Well guess what I am more than happy to provide my opinion and my response to the question posed.

The KNA no longer has a union and President Susan Jones questioned whether if Kentucky nurses who said they would belong to the KNA but for the union, will step up now and join KNA.

This is my opinion. I have a 1st Amendment right to express my opinion on my blog and this is MY OPINION. So don't call me, email me or write me a letter (that I won't read). Submit a response on the blog.

My response is no President Jones, it really wasn't the union, that was just the best excuse at the time. There is a growing disconnect between State Nursing Associations affiliated with the American Nurses Association and the nurses the associations "claim" to represent. I have spoke with nurses who are members of a state nursing association and who are not content with the direction of the association.

Nurses don't support ANA affiliated State Nursing Assciations and this won't change until ANA affiliated State Nursing Associations realize what's the problem. The problem isn't individual nurses, its the associations that purport to represent the profession and nurses.  

ANA affiliated State Nursing Associations that exist without a union and which have never had a union are still struggling for membership. Nurses are not Cinderella and this isn't a fairy tale and in my opinion nurses are not going to become enchanted and magically join an ANA-affiliated state nursing association overnight. Most are going to ask what have you done for me lately because of the disconnect between individual nurses and these associations. http://www.youtube.com/watch?v=4Z0h_c9eH-8

In these lean economics times, its not enough to rest on the mantra of "we represent the profession", its time to implement changes from the  top to the bottom of a professional association and implement grass root strategies, services, and products for nurses.

The three tiered membership used in the ANA enterprise model of national, state, and local membership is fundamentally flawed and will not work in nursing. It may work with other professions and occupations, but it does not work in nursing. Its pitting the national and former national affiliates, against the states against the districts all for a piece of the pie.

Again this is just my opinion therefore don't hate me now because I respect you as a nurse if you have a different opinion or take on the situation than I do. Just my two cents.  http://www.youtube.com/watch?v=_TlKEQ2nIyo

I am a professional and I should be able to pick which level I want to support. I will use the Bar Association for attorneys as an example. Membership in the national, state, and local bar associations are not combined. Each association is its own entity for dues purposes but there is still of course interaction between the associations. I belong to the American Bar Association, Ohio Bar Association, and the Indiana State Bar Association. I don't belong to the Cincinnati Bar Association. Why? The cut and dry response: I don't want to belong to the Cincinnati Bar Association and I don't have to belong to the Cincinnati Bar Association. Its my choice. (I am a Gen X'er if you haven't already guessed and although I am left handed,I lean a little to the right).  

Is there in-fighting and power struggles between the national, state, and local bar associations like what is seen now with ANA-State Nursing Associations, District Nurses Associations or Collective Bargaining Units and National Former Affiliates? Of course not. Why?

Each Bar association handles it own money and there isn't any division or allocation of the dues paid between the national, a national affiliate, state, district, and local. Its all about the benjamins, baby. http://www.youtube.com/watch?v=REycCu49Vvk.

This Blog is listed on the Best 100 Blogs for Nursing Students

See http://www.rncentral.com/nursing-library/careplans/100_best_blogs_for_nursing_students.

Self-Reporting A Violation to the Nursing Board

I was contacted last week by a nurse who was terminated from his position for falsification of a medical record, i.e. charting ahead.

The employer told the nurse before terminating him that it makes your case look better with the Nursing Board if you self-report. The nurse self-reported the incident to the Nursing Board.

Just a hint. Before you decide to self-report an incident to the Nursing Board, contact your state professional association or speak with a licensure defense attorney.

Self-reporting an incident to the Nursing Board may or not be help your case.

My Cousin Vinny is an Attorney and He said that I should.....

I should have posted on this subject a while ago.

I am frequently contacted by a nurse who has a family member who is an attorney. Whether its a spouse, brother, sister, cousin, uncle, mother, etc.

The nurse will then proceed to tell me that this is how their family member suggested that a licensure defense action should be handled or this is their attorney family member's opinion on the issues in the licensure matter.

I have a large immediate family and an even larger extended family here in Cincinnati. When a family member asks me to comment on something their attorney said, I state I can't comment. You retained your attorney and your questions and comments should be directed towards your attorney. I also remark that I am a licensure defense attorney (this is a very narrow specialty) so why would I have an opinion on your personal injury case or your worker's compensation matter.

But that's me.  

I declined to represent another nurse a few years ago who was in the process of retaining me but after each of our discussions who would contact her sister (who was an attorney in another state and worked in a med mal plaintiff's firm) and ask her sister what she thought about my advice and counseling. I think not.

But that's me.

Ohio Nurses Association hires a Labor Organizer and Nursing 2015

This information was published on the Ohio Nurses Association website on June 3rd. ONA has hired a labor organizer. See www.ohnurses.org.

1. The majority of ONAs membership is union and collective bargaining nurses so hiring an union organizer to organize and grow the association probably makes sense.  

2. Ohio is hotbed of healthcare and nursing-focused union activity with the SEIU and California Nurses Association/NNOC. The three C's are hot I am told: Cincinnati, Columbus, and Cleveland. ONA is a union and a professsional association and will attempt to organize RNs.

3. How will this impact ONAs relationship and participation in Nursing 2015, the collaboration between the Ohio Nurses Association, Ohio Hospital Association, and the Ohio Organization of Nurse Executives? See http://nursing2015.wordpress.com/

I must say ONA would not have been able to pull off its work on the Staffing Legislation in Ohio without the buy-in from the Nurse Execs and Hospital Association and Nursing 2015. http://www.ohnurses.org/AM/Template.cfm?Section=Home&template=/CM/ContentDisplay.cfm&ContentID=2849

The hospital association is strong in Ohio. Is the State Hospital Association strong and well-funded in your state?

In Kentucky, there has been a whistleblower law on the books for years but it has no teeth. The Kentucky Nurses Association is making this a legislative priority. See http://www.kentucky-nurses.org/legplatform2008.htm. Will a partnership like Nursing 2015 in Ohio be needed in Kentucky for the Kentucky Nurses Association to successfully lobby for "teeth" in 1998 Patient Safety Act?

In your opinion should state nursing associations, state hospital associations, and state organizations of nurse executives partner and collaborate on projects for nursing and nurses? Is it necessary? Is it needed?

However there are some who nurses and other nursing unions arguing that what's proposed by ONA and the compromises made related to the buy-in are not enough. See http://www.calnurses.org/media-center/press-releases/2008/january/ohio-nurses-to-testify-wednesday-against-hospital-industry-s-fake-healthcare-reform-bill.html.

Personally, and this is my opinion so please no phone calls or correspondence. I think any collaboration between an state association of nurse executvies, state nursing association/nursing union, and state hospital association is "skin-deep."

I am sure that opinions differ and you of course can have a different opinion than mine on Nursing 2015. I respect that and only ask that you in turn respect my opinion. This "implied and expressed waiver of the agreement of a agreement" is needed in nursing circles because for some reason "as nurses we must all agree at all times."

I chuckled when someone mentioned to me last year that another "O" may be brought on board in the future with the collaboration between the Ohio Nurses Association, Ohio Organization of Nurse Executives, and the Ohio Hospital Association; I immediately assumed it would be Oprah.

In my opinion it remains to be seen whether 2015 is the real thing or whether its one of those things that looks good on paper and makes you feel "warm" inside like Martini & Rossi Asti Spumante. http://www.toastwines.com/121299.

But really how does it impact the working environment, employment terms and conditions, and the power and bargaining disparity in the relationship between individual nurses and a nursing employer? This is the sniff test national, state, and specialty nursing associations should use to determine whether a project, partnership, or collaboration is a go or a blow.

Women's Studies and the Struggle to Find the Voice of Nursing

This year's National Women's Studies Association Annual Conference will be held in Cincinnati, Ohio at the Duke Energy Convention Center and the Millennium Hotel, June 19-22.

The conference will engage feminists from across the country in panels, workshops, guided tours, letcutres and performance art presentations.

For additional information see http://www.nwsa.org/myconference/.

I gave $100.00 to the Friends of Women's Studies this year to support the J.D. and M.S. in Women's Studies joint degree program at the University of Cincinnati.

Now if I could do it all over again, I would have obtain a MSN in community health and JD or enroll in the JD and MS in Women's Studies joint degree program at UC.  See http://www.artsci.uc.edu/womens_studies.

I assumed I would work in a large firm for my law career; fast forward 11 years later and I have my own law practice defending nurses; the majority of my clients, like the nursing profession, are women.

I was asked to sit on the Board of the Friends of Women's Studies program at the University of Cincinnati; I am giving it serious consideration because it fits into the big picture of how I see myself as a RN, attorney, and mother and my current path.

My current career path is licensure defense and I enjoy licensure defense but it hurts. It hurts me personally to see so many of us wounded personally, emotionally, and professionally by licensure investigations and Board action. I spoke with a nurse today who has faced licensure actions in Ohio, Kentucky, and Indiana and I could hear the frustration and pain in her voice.

A history of women struggles in the United States could in my opinion begin and end with an account of the past, present, and future of nursing and the inherent struggles and issues in nursing, a female-dominated profession. If you haven't already read, Nursing, Physician Control, and the Medical Monopoly: Historical Perspectives on the Gender Inequality in Roles, Rights, and Range of Practice by Thetis M. Group and Joan I. Roberts. 

Female dominated professions and work environments in your opinion have what factors and traits in common? What are the benefits of being a member of and practicing in a male dominated profession and work environment?

As a profession, are we eating our "young and old" in nursing workplaces, nursing educational settings, and at the state regulatory level with state nursing boards?

Allegations vs. Accusations

Last month was a busy month for me. I received several inquiries from nurses regarding criminal, licensure, employment, labor, and unemployment law issues.

This is a summary of a phone call I received last month.

Nursing Board investigator: I would like to speak with you about issues with your license.

Nurse: What's going on with my license? Do I need an attorney to fight these allegations?

Nursing Board investigator: No, you don't need an attorney. These are accusations not allegations.

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What is an allegation?

A formal accusation against somebody, often in a court of law.

http://www.wordreference.com/definition/allegation

What is an accusation?

A formal charge of wrongdoing brought against a person.

http://www.wordreference.com/definition/accusation

******************************************************

A State Nursing Board complaint is an allegation and accusation.

State Nursing Board investigators are not attorneys and even if the investigator is a state licensed attorney,  the investigator cannot and should not give legal advice or counseling to a licensee being investigated. Its improper and bad form for a State Board investigator to tell a nurse that he/she doesn't need an attorney. But it happens.

I think the most appropriate response for a Nursing Board investigator, would be "you can retain an attorney to represent you" or "I am an employee of the State A and I am investigating a complaint filed against you with the State, I cannot advise you whether or not you need an attorney."

Some State Nursing Boards inform nurses upfront in the correspondence acknowledging the filing of the complaint, that a nurse can retain an attorney and that the Board does not provide legal advice to its licensees. I think this is the fairest approach because it impresses upon a licensee the seriousness of the complaint and the proceedings. The licensee can stop and think, well do I want to hire or consult with an attorney before I proceed? This is the approach all State Nursing Boards should adopt.

If I had $2.99 for each time I have made this statement....Trust your instincts; if you have to ask someone "do I need an attorney?", then you need to consult with an attorney.

What does the future hold for Nursing Unions and Professional Associations?

According to an employment law newsletter published by an Ohio law firm in February 2007, 1.2 million RNs do not belong to a nursing union. The majority of nurses do not belong to a nursing union. See http://www.bricker.com/publications/articles/1053.pdf. I am one of the 1.2 million RNs who don't belong to a nursing union.

What's your opinion? Will we see more RNs attempting to organize in the future? Do you think the interest in unions for RNs will wax and wane in the future?

What does the future hold for the nursing unions and national, state, and specialty nursing professional associations?

Do you belong to a nursing union? Do you belong to a nursing professional association?

Fairness is in the Eye of the Beholder

I attended the first Annual Administrative Law Seminar sponsored by the Ohio Attorney General Mark Dann's office today. It was really a very nice and informative seminar. Healthcare licensing boards were a focus of the seminar and the presenters.

One speaker remarked that Board disciplinary investigations, proceedings, and adjudications are handled in a fair manner for the most part. I would caution however that fairness, like beauty and ugliness is in the eye of the beholder.

Its easy for defense attorneys, judges, hearing officers, assistant attorney generals, and in-house regulatory board attorneys who are trained in the law to conclude that investigations, proceedings, and adjudications are "fair" in the sense of substantive and procedural due process rights afforded by federal and state constitutions, stautory law, regulations, and case law.

Fairness for me as a practicing Ohio registered nurse is more than notice and the opportunity to be heard in sense its expressed in  Ohio Revised Code 119 and Ohio case law. This concept and plea for action was expressed and implied by a few at the seminar; let's hope that the plea is heard and acted upon.

In administrative law, respondent licensees are not afforded the "rights" afforded to litigants in the civil justice system (depositions, discovery, statute of limitations, etc.) and to defendants in the criminal justice system (depositions, discovery,  statute of limitations, etc.). A licensee doesn't know this until he or she becomes involved in a licensure matter and 9 times out of 10 still doesn't know this because he or she is not represented by counsel before a licensing board. Is this fair to licensees?

The definition and practical application of fairness in nursing board disciplinary investigations, proceedings, and adjudications is in the eye of the beholder. The beholder can be a nurse, nurse regulator, board staff, defense attorney, patient, HCO administrator, state nursing association staff, etc.

What's your opinion? Do you think nursing board disciplinary investigations, proceedings, and adjudications are fair? How do you define fair?

Compare the Treatment of an Ohio Educator vs. an Ohio Nurse in Child Welfare Criminal Investigations

I am not sure of whether you are familiar with the case of the Ohio Assistant Principal who left her two-year old child in a hot vehicle for over 7 hours and the child died of hyperthermia. It was documented that she left the 2 y/o child alone in the car on other occassions prior the day when the toddler died. See www.enquirer.com the Cincinnati Enquirer's website for additional information. The mother was not charged with a crime as the prosecutor in the case did not submit the case to the grand jury. This case is receiving alot of national and local coverage by the press and media. Will the Ohio Department of Education investigate and proposed to take action against her license?

A nurse in Ohio who worked a double shift was charged with child endangerment after her 2 and 3/y/o children were found wandering the street, unharmed. Will the Ohio Board of Nursing investigate and propose to take action against her license?

Below is summary from a posting on the Cincinnati Enquirer website today about the disparity in the two cases, one involving an educator (who managed not to forget the $59.00 worth of donuts in the car but left her child in the car) and the other involving a nurse (who worked a double shift):

Recently, a nurse and mother of two children age 2 and 3 was charged with two counts of child endangerment. She had fallen asleep after working a double shift and her two children were found (safely) walking three blocks from their home. In another incident, no charges were filed against an educator who left her daughter in her car after buying doughnuts for a teacher's meeting. Her daughter, tragically, died. One mother works a double shift, her children are alive and well, and she faces charges. Another mother buys doughnuts, her daughter dies and no charges are filed. Can anyone explain this logic to me? See http://news.enquirer.com/apps/pbcs.dll/article?AID=/20070906/EDIT01/709060328/-1/all.

Know Your Rights in a Disciplinary Investigation!

Here is a scenario I hear at least once a WEEK from a nurse who contacts my office:

The nurse receives a letter or a phone call from a Board of Nursing investigator. The investigator tells the nurse, that he/she would like to meet with the nurse to discuss an allegation(s) made against the nurse. The investigation is routine and should only take an hour or so. The nurse meets with the investigator. The nurse is interrogated about an incident that may have occurred months or even years ago. The nurse can't quite recall everything with the particular incident and is nervous of course. The nurse suspects that this may be more than a routine interview however he/she wants to cooperate. Also once the nurse tells his/her side of what actually transpired this entire thing will just go away, right? The nurse submits a handwritten statement after the interview and is not provided with a copy of the statement. Now, fast forward six to thirteen months later and the nurse receives a large mailing the Board. He/She opens the mailing to find a Consent Agreement that will resolve the Complaint filed against the nurse's license.

What would you do? What is a Consent Agreement? How will this Consent Agreement impact my nursing license, career, and future nursing-related goals? Do you contact Board staff to discuss your concerns with the legal document? Do you contact an attorney to discuss your concerns? Do you allow a nurse co-worker who was previously disciplined by the Board to review the legal document? Will I appear in the Board's newsletter?

Hindsight is always 20/20. Seek a legal consultation as soon as you learn that a complaint has been filed against your license and prior to taking ANY action, such as being interviewed, submitting documentation, etc.

Be Your Own Advocate because its YOUR license and YOUR license is your livelihood! 

What Should I Do?

This has been a busy year for me already and this only the third week of January 2007. I usually receive at least 5-15 calls every week from nurses and other healthcare professionals about legal issues in practice, regulatory investigations, terminations, etc. The majority of the calls are from nurses and the majority of my practice involves representing nurses.

On average I receive one or two calls a week from nurses who are being investigated by a State Board of Nursing and who want to know "what should I do" about the complaint against my license?

First all nurses should consider purchasing a professional liability insurance policy that provides for attorneys fees and costs in the event a complaint is filed against your nursing license. The majority of nurses who contact my law office don't have insurance and therefore must pay legal fees "out of pocket."

Second, if you are reported to the State Board of Nursing, consult with a nurse attorney who practices administrative law in your state before you consent to a phone interview, provide a written statement, meet with an investigator, and submit documentation to the Board. A consultation does not mean you are retaining an attorney to represent you. It means you are seeking assistance with sorting out the issues in a privileged setting.

Third, be careful with whom you discuss the complaint and the circumstances surrounding the complaint. Why? Some nurses turn to colleagues for assistance and advice on how to handle the matter and some of these colleagues then tell stories of how someone they know handled a Board complaint and prevailed without an attorney. You may have 3 or 4 different people telling you how to handle the complaint and what's in your best interest.

Happy New Year! Is 2007 Our Year?

Happy New Year Nursing Colleague!

1. Will this be the year that we will be "recognized" as a profession? If we are not a profession, what are we? A craft, occupation, trade, calling, etc. Does it matter? For me, regardless of whether nursing is ever recognized as a true profession, I am LaTonia Denise Wright, R.N., first and foremost.

2. Will this be a year that we will reach a consensus on the entry level to practice?

3. Is this the year that we as a profession will recognize the importance of nursing standing unified, regardless of education, practice area, or union status?

4. Will this be the year that individual nurses recognize the importance and POWER inherent in employment contracts, agency relationships, independent contractor status, and other viable alternatives to at-will employment?

5. Will this be the year that nurses start supporting our nursing professional associations (by joining and paying membership dues of course) which tirelessly advocate for nursing?

6. Will this be the year that as nurses we start following what happens in the state and federal legislatures like we follow what happens on the local evening news?

7. Will this be the year that we as as a profession stop eating our young and discouraging others from considering nursing as a career choice?

8. Will this be the year that RNs and LPNs (and associations and organizations for each) unite on the national, state, and local levels to pursue common goals and interests?

9. Will this be the year that in addition to being one of the most trusted and respected professions by the public that nursing will also be one of the most trusted and respected professions with _____________?

10. Will this be the year that the Sleeper Will Awaken? The Sleeper Must Awaken! This is a quote from Dune written by Frank Herbert.  

It That Time of the Year!!

I love the Holiday Season! For me its a time for reflection on my personal and professional goals and how I want to be a better person in the New Year.

How can I be a better person? A better attorney? A better nurse? A better mother? A better aunt?

Happy Thanksgiving!

Happy Thanksgiving! from one nurse to another nurse. Have you started thinking about your 2007 Resolutions and Goals? I have and I am looking forward to 2007 because 2006 was a good year for me personally and professionally.

The highlight of 2006 was being in business 5 years. I started my law and consulting practices in 2001 and business has increased steadily each year. I originally thought it would be my consulting practice that blossomed; it hasn't but that may change in 2007. Originally I saw myself providing healthcare consulting services to healthcare organizations in my consulting firm, but that has changed also. 

My law practice has blossomed and provided me with lots of opportunities to connect with individual nurses and build a niche law practice tailored to nurses and nursing issues. I love what I do for a living! How about you?

The low point of the year occurred recently when my 5 year old nephew was diagnosed with ASD and Pulmonary Hypertension in October. He was hospitalized for 5 days in November. He is currently taking five medications several times a day and even a former pediatric nurse, its hard to adjust to the chronic nature of his illness.

On a lighter note, my 17 year old son received his driving license, has a vehicle, and was hired this week at Target, pending a negative drug screen and background check. He is a senior in high school.

My 4 toy poodles are doing okay. Still healthy, untamed, and happy.

Now if I could just get my son motivated to take the SAT and ACT..

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).....

Board of Nursing Newsletter

I just received the Spring 2006 issue of the Ohio Board of Nursing newsletter, Momentum. I always read the Momentum and regularly review the board of nursing newsletters from other states for legal issues and trends in nursing.

The next time you receive your state board of nursing newsletter, don't immediately throw it away. Take 20 minutes and review the articles and the commentary written by the Board President and/or Executive Director. You may pick up on one or two pieces of helpful information.

New Year Resolutions

Did you make New Year Resolutions? I did.  I am exercising at least 3-5x week. I had several goals for my law practice and my nursing practice. I am not doing "too bad." How are you doing on your Resolutions?

Credentials

Have you attended a nursing conference lately? Do you see the name and credentials listed on badges? Do you see the degrees and credentials displayed in nursing articles and the page listing the editorial board members of nursing journals, etc?

Are we too focused on degrees and credentials because of our lack of recognition as a true profession in nursing? I subscribe to a number of nursing journals and magazines and the issue was addressed a few months ago by a national journal.

My fiance makes me laugh as times when he refers to me as LaTonia Denise Wright, RN, BSN, JD or LaTonia Denise Wright, Home Health RN, Attorney, and Poodle Owner.

The Ohio Nurses Association started a policy a few months ago of listing its members as RN only because it could not keep up on the degrees and credentials for nurses listed or mentioned in the Ohio Nurses Review. So its LaTonia Denise Wright, R.N. in the ONR.

I am running for election to the ANA Congress on Nursing Practice and Economics and I am listed as LaTonia Denise Wright, J.D., R.N.

Are we too focused on degrees and credentials in nursing because of the lack of a standardized entry level into practice? Degrees and credentials are earned so why shouldn't someone proudly display their accomplishments, right? What do you think?

Advanced Practice Nursing

This is the "fun" part of what I do as a nurse attorney who represents nurses exclusively. I am attending the Indiana Board of Nursing meeting in Indianapolis on Wednesday, April 19, 2006 for the discussion on the National Council of State Boards of Nursing (NCSBN) Vision Paper on APRNs. Next month I will attend the Ohio Board of Nursing APN Task Force meeting on Thursday, May 18, 2006.

If anyone is attending these meetings look for me and let's dialogue on the future of nursing.