31 entries categorized "Legal Regulation"

November 28, 2008

You Must Disclose Expunged or Diverted Convictions to the Indiana Board of Nursing

Although its not specified on the applications for initial licensure and endorsement, nursing school/college graduates and nurses are required to disclose expunged criminal convictions on the applications.

What does this mean? I think most nurses and nursing students would assume as told by criminal court staff that an expungement means you do not have to disclose and I think its fair to say there are a many of nurses and nursing students who will not disclose to the Indiana Nursing Board because the applications do not state "you are required to disclose expunged convictions or participation in a criminal court diversion program."

I have had many clients fail to disclose criminal convictions based on remarks and comments made by a judge, court staff, or even a baliff in a criminal court case.

The criminal case and a licensure matter are not one and the same and you should not rely on the advice of your criminal defense attorney in a Nursing Board licensure matter UNLESS your criminal defense attorney routinely practices before the Nursing Board and is familiar with nursing law and rules and standards of professional practice.  

I think Boards should just come out and say it on the application. You are required to disclose expunged convictions or you are not required to disclose expunged convictions.

Again, if you have a criminal conviction and you are unsure of how to answer the application for licensure, contact the Board or contact a licensure defense attorney in your jurisdiction.

November 15, 2008

Public Hearing and the Ohio Board of Nursing Meeting next week

I am going to try to attend the Ohio Nursing Board meeting next as there are several interesting Agenda items, as usual. The public hearing on proposed changes to Ohio Nursing Board regulations starts at 1pm on Wednesday, Nov. 19th in Columbus, Ohio.

I would encourage you to attend a least one Board meeting a year to find out more about your State Nursing Board. It will open your eyes to the importance of staying abreast of nursing regulation in your state and the types of disciplinary cases before the Nursing Board.

I am moderating the Center for American Nurses legal webinar, the Nurse as a Criminal Defendant on Wed, Nov. 19th from 7pm to 8:15pm EST. See www.centerforamericannurses.org. So I will have to drive to Columbus around 10am and leave no later than 3pm.

I will probably power pack our luggage Wednesday night.

We are also leaving for vacation on Thursday, Nov. 20-Monday, Nov. 24th. We are flying out of Columbus in the afternoon, so I will be driving back to Columbus, Ohio. We are staying at the Venetian Hotel in Las Vegas. We are considering being married on the Wedding Gondola at the Venetian and plan to tour other wedding venues. We have narrowed it down to the Wynn, Venetian, or the MGM Hotel. I am so tired of planning this wedding already, that I wouldn't object to a McDonald's style "drive-thru"wedding in Las Vegas at this point. My sisters called me a Bridezilla the other day, but that's another post.

Next week is going to be off the chain busy, however I am looking forward to a much needed vacation and I promised my fiance, I will check and respond to emails and voicemails messages from clients and prosective clients, only at 12noon and 6pm to ease his worrying. I am self-employed and I run a business, so I am taking a laptop on vacation and if I need to work, then I will work. He doesn't ready my blog.

To see the Ohio Board of Nursing Agenda for the meeting next week, see the Board's website at

 http://www.nursing.ohio.gov/.

October 23, 2008

Professional Boundaries and Professional Sexual Misconduct

Here is my published article in the Kentucky Nurse, the official magazine of the Kentucky Nurses Association.

Download KYNurseprofessionalboundaries.pdf

Professional boundaries and professional sexual misconduct is a growing area of concern in nursing. Personally, I am seeing more boundaries cases and having more legal consultations related to boundaries in my law practice in Ohio.  A few consultations in Kentucky and one in Indiana related to boundaries, and lots in Ohio.

The article also warns nurses about post-termination relationship and asks you consider what is a reasonable cooling-off period. In the future I think we will see more State Nursing Boards (hint, hint, Ohio Board of Nursing) incorporating cooling-off and post-termination relationship language in Board of Nursing regulations.

What do you think about professional boundaries in nursing?

August 17, 2008

Changes in the Kentucky Nurse Practice Act; effective July 15, 2008

There have been changes in the Kentucky Nurse Practice Act effective July 15, 2008 that are significant for Kentucky licensed nurses.

For example, see KRS 314.091

http://162.114.4.13/KRS/314-00/091.PDF.

http://kbn.ky.gov/laws/.

July 31, 2008

I Didn't Think the Nursing Board Would Revoke My License for THIS!

The Nursing Board has the authority to permanently revoke a license.

This is only the 7th month of the year and I have heard this from 4 nurses. I didn't think the Nursing Board would revoke my license for this!

Don't flame me for this remark but there is a tendency in licensure matters for nurses to downplay and downgrade their situation and the substance of the Nursing Board Complaint.

"I did this, but as least I am not one of those nurses stealing drugs"

"This is nothing compared to the nurse who slapped the patient last year"

"I can't believe the Board is coming after me when the nurses upstairs adminster medications without orders"

"This is silly that I am being investigated when I know nurses who snort cocaine and smoke marijuana on the regular"

Its human to downplay our problems. Its a coping mechanism. Talk to a licensure defense attorney in your state if you are being investigated by the Nursing Board.

July 17, 2008

Consensus Model for APRN Regulation

http://www.indiananurses.org/pdf_files/071208_APRN_JointDialogueReport.pdf

Let me know what you think.

July 11, 2008

Ohio Board of Nursing Action Against a License is Available on the Internet

If you are an Ohio nurse and action is taken against your license with the Ohio Board of Nursing the "Board of Nursing Action against your license"  (the actual Consent Agreement or Board Order) can be or will be in the future accessible online via the State of Ohio license verification website. See https://license.ohio.gov/lookup/default.asp?division=86.


May 27, 2008

Nursing License Compact and Indiana Board of Nursing

The Indiana Attorney General's Office has concerns with Nursing Licensure Compact (NLC). What is the Nursing License Compact? https://www.ncsbn.org/nlc.htm.

 For the concerns that the Indiana Attorney General's Office has with the Nursing Licensure Compact click here. Download 2008-Health_Law.pdf

May 16, 2008

Nursing Licensure Compact-Disciplinary Investigations

See this link to the Ohio Board of Nursing website. Its the Meeting from the March 2008 Board Meeting.

View page 197 under National Council of State Boards of Nursing Focus on Group on Interstate Licensing. http://www.nursing.ohio.gov/PDFS/NextMeeting/M1/1.2.1March08DraftMinutes.pdf

There are still unanswered questions regarding the legal authority for investigations across state lines.

What does this statement say to you?

I have been involved in concurrent State Board of Nursing investigations, where a nurse is being investigated concurrently by two State Boards of Nursing. Its complicated because what happens in one case can and will impact the other case.

Some State Nursing Boards do not readily share investigative materials with other State Nursing Boards, although alot of Boards do "share" information regardless of Compact status.

May 12, 2008

2008 LPN Renewal Application from the Ohio Nursing Board

The Ohio Board of Nursing Renewal Application changed this year!

This year, the LPN renewal application asks whether you have been convicted, found guilty, pled guilty to, pled no contest to, etc. of a felony or misdemeanor in Ohio, another state, commonwealth, territory, province, or country.

Nurses in Ohio now have to report ALL criminal convictions, felony or misdemeanor to the Ohio Board of Nursing on the renewal application. This includes DUI/DWI. This also include crimes that have been expunged if the crime has a direct and substantial relationship to nursing practice.

In the past (for example, the 2007 RN Renewal Application) the questions asked about crimes of moral turtitude, gross immorality, gross negligence, etc. In the past DUIs were excluded.

Criminal convictions (felony or misdemeanor) have a ripple effect for licensed healthcare professionals. Not only is it the criminal case, then its the licensure matter, then its employment issues (especially in Ohio with Senate Bill 38 and Senate Bill 160) see http://www.nursing.ohio.gov/pdfs/OHCRC.pdf, then the licensure action is reported to the Healthcare Integrity & Protection Data Bank.

I had a client contact me this week and say how much longer will I be beat over the head for a DUI conviction. The client is a nurse.

In Kentucky, nurses are required to report misdemeanor and felony convictions to the Kentucky Board of Nursing within 30 days of the conviction, plea, etc. However nurses do not have to report expunged or sealed convictions to the Kentucky Board of Nursing.

Should nurses and nursing students be required to report all criminal convictions to the Board of Nursing? What's your opinion?

 

April 25, 2008

Disciplinary Investigations and the Nursing Licensure Compact

It would be sooo nice, if all Nursing Boards were part of the Nursing Licensure Compact. See https://www.ncsbn.org/158.htm. Eventually most states and US jurisdictions in my opinion will be part of the Compact. It makes sense.

In my opinion, maybe one, two, or three of the American Nurses Association's concerns with the Nursing Licensure Compact still have merit. The bullet about using the Compact for strike breaking purposes is amusing. See http://www.needlestick.org/gova/concerns.htm

My concern with the Compact and concurrent Board of Nursing investigations in general as a licensure defense attorney, is the due process provided by state law and regulations in the investigations and the "sharing" of information between Compact States and the sharing of information when nurses are being investigated concurrently by more than one Board of Nursing (non-compact and via licensure by endorsement).

In my opinion, nurses are not afforded with enough rights in licensure defense investigations (which vary of course from state to state) and nurses should be afforded more rights:

1. Statute of limitations for the investigation and prosecution of complaints similiar to civil and criminal actions;

2. Right to receive a copy of the complaint and the investigative material in the Nursing Board's possession;

3. Right to request and subpoena documents throughout the investigative process like the Nursing Board, i.e. a process similiar to civil and criminal discovery;

4. Right to appear before a panel of Board members during at the conclusion of the investigative process;

5. A formal mechanism for mediation or settlement of a complaint that involves the sharing and exchange of information and that is not "one-sided" with the Nursing Board holding all if not most of the cards; and/or

6. The creation of a regulatory agency within a State that is separate and distinct from Nursing Boards that investigates complaints and/or conducts hearings or settlement conferences regarding complaints against nurses. This agency could do the same function for all licensed healthcare professionals within a state. There should be a separation of the investigative and adjudicative functions and the power to investigative complaints and decide the outcome should not be afforded to one agency.

Why? The potential for the abuse of power in State Nursing Boards because of little oversight and the lack of checks and balances seen with other government bodies and agencies.

Where are your national and state nurses association's when you need them? Actually instead of ANA and State Nurses Association (called Constituent Members Associations now) continuing to fight about the non-union and union arms of the ANA and the union and non-union arms within a State Nurses Association, tackle the issue of procedural due process in licensure investigations and adjudications. Tackle a substantive issue for the profession and maybe, just maybe, more nurses would join and support the ANA and State Nurses Associations.

Some Nursing Boards will go "kicking and screaming" into the Compact, but will not have a choice because of the growing concern and pressure from nurses, professional associations, and legislators within the state. Joining the Compact requires the relinquishment of "some power." 

I practice law in Ohio, Kentucky, and Indiana. Kentucky is a Compact state and this information is available on the Board's website. Indiana and Ohio are not Compact states.

Here is the Ohio Board of Nursing's statement regarding the Nursing Licensure Compact. See  http://www.nursing.ohio.gov/PDFS/6.8CompactJan08.pdf. If anyone has a link to the Indiana Board of Nursing position on the Compact, send it to me and I will update this post.

 

April 23, 2008

Board of Nursing Disciplinary Investigations

I spoke this month at the Mid Ohio Nurses Association Job Fair http://www.modna.org/ and The American Association of Nurse Attorneys seminar http://www.taana.org. Both events were held in Columbus, Ohio on April 10, 2008. I also presented at the Licensed Practical Nurse Association of Ohio Annual Student Convention in Columbus this month.

There were lots of questions about disciplinary investigations. Most nurses did not realize that the investigative process was adversarial. Because I represent nurses in disciplinary investigations, I announced at the beginning of the presentation that the content would be presented in a neutral and fair manner with no self-promotion.

Furthermore, the majority of nurses in these types of cases, in my opinion will never seek attorney representation. Therefore the CE presents an awareness of the attending issues in disciplinary investigation and the consequences of action against the license. In my opinion, most nurses don't appreciate the adverserial nature of the proceedings and investigations until well into the process and even then rely on the advice and counsel of friends, family, and nursing colleagues. 

If you have the opportunity to hear an attorney speak in your jurisdiction about Nursing Board investigations, I would suggest that you attend.

April 03, 2008

No Such Title as a Graduate Nurse in Indiana

I am not too far off in left field with this blog.

The President of the Indiana Board of Nursing, Carolyn Slagle in her President's Message appearing in the March 2008 edition of the Indiana Board of Nursing newsletter, Nursing Focus, discusses the history of the graduate nurse and nurse extern in Indiana. See page 4 at http://www.in.gov/pla/files/March2008.pdf.

This title no longer exists and I posted about this here in 2007. I had a nursing student client who worked at a hospital in Indiana as a graduate nurse. Imagine that? When I graduated from nursing school in 1993 with my ASN, I worked as a graduate nurse at Decatur County Memorial Hospital in Decatur, Indiana.

As discussed in the President's Address, there is no longer a need for a graduate nurse or nurse extern role in the licensing scheme with the computerized NCLEX testing. Licenses are issued in a matter of weeks as opposed to months when I took the written exam. I believe we were the last class to take the written and paper exam. I guess I am dating myself now.

See my initial post at http://www.typepad.com/t/trackback/441771/22570314

March 04, 2008

Scope of Practice Laws in Health Care: Rethinking the Role of Nurse Practitioners

I found the link to this document on the Ohio Association of Advance Practice Nurses (OAAPN) website. 

See http://www.chcf.org/documents/policy/ScopeOfPracticeLawsNursePractitionersIB.pdf.

See also http://futurehealth.ucsf.edu/pdf_files/NP%20Scopes%20discussion%20Fall%202007%20121807.pdf.

December 17, 2007

An Unrestricted Golden Ticket

I was interviewed several months ago by the Center for American Nurses, see www.centerforamericannurses.org about board of nursing disciplinary investigations and whether or not nurses need legal representation. Attached is the article. Download centerarticleBOARDofNursinginvestigations.pdf .

Please answer the following:

1. If you were charged with a felony in the criminal justice system; would you retain an attorney? Of course you would.

2. If you were named as defendant in a nursing negligence case; would you retain an attorney? Of course you would.

3. If you were being sued for defamation or libel by a coworker related to a workplace incident; would you retain an attorney? Of course you.

Why is it then that we as nurses question whether or not we need legal representation, counseling, and advising when your "golden ticket" (this is the term used by an Assistant Ohio Attorney General at an Administrative Law Seminar last week to describe a healthcare professional's license) is being investigated by the state board of nursing or attorney general's office? 

I traveled to Indianapolis this weekend to meet with a prospective client, who was concerned about "making the Board mad" if he retained an attorney to represent him before the Board. If I had $39.95 for each time I was asked this, I could.... Oh, I discussed this in a previous post, so I won't go there. See http://advocatefornurses.typepad.com/my2cents/2007/11/angry-nurses-an.html

The general lack of education, training, appreciation, and awareness that we as a profession have regarding professional associations standards of practice, state nursing law and regulations, and employer-specific workplace policies and procedures which ALL impact the ability and suitability of a nurse to carry an unrestricted golden ticket is unacceptable.

Are you concerned about your golden ticket?

October 25, 2007

Kentucky Board of Nursing FY Report

The Kentucky Board of Nursing FY 05-06 Annual Report is available online at http://kbn.ky.gov/board/annualrpt.htm.

For a breakdown of the Kentucky Board of Nursing disciplinary and investigation actions, see page 10.

October 23, 2007

New Board Members Appointed to Indiana Nursing Board

Governor Daniels appointed several new members to the Indiana Board of Nursing. See http://www.indiananurses.org/news/100607_governor_appoints_nursing_board.htm. Several of these appointees are members of the Indiana State Nurses Association.

Do you think all RNs (this includes Advance Practice Registered Nurses (APRN)) appointed to a Board of Nursing should be required to be a member of the American Nurses Association and an ANA-affiliated state nursing association (called constituent members associations or CMAs now)? Should Board appointees be required to belong to a specialty nursing association  (such as the INS, AACN, ENA,  AANA, etc.)?

In your opinion, does it matter?

October 18, 2007

Graduate Nurse Status in Indiana

Do you know there is an Indiana hospital allowing a nursing school graduate to practice and function as a RN under the supervision of a RN preceptor? I won't mention the name of the hospital however the student was told that she could function in this capacity until she received her license and she is being paid RN wages. If the nursing student wasn't a client of mine, I would report this Hospital to the appropriate federal and state regulatory authorities for investigation. 

Hint, Hint! There is no graduate nursing student status in Indiana anymore! There used to be several years ago. This was changed I believe ten years ago, around 1996-1997.

As a matter of fact, when I graduated with my ASN in 1993 and took my nursing board exam (it was a full day pencil and paper exam back then), I worked as a graduate nursing student the summer after my graduation at Decatur County Memorial Hospital in Greensburg, Indiana on a adult and pediatric med-surg floor.

The rationale for the graduate nurse designation was that it took several months to receive your results from the nursing boards. This is no longer true as the NCLEX-RN and NCLEX-PN exams are now offered on a computer and students are informed within days of testing of the pass/fail results.

What's the bottom line here? DO NOT assume that your nursing employer including human resources, your immediate nursing supervisor or mid or executive-level nursing management knows the law, regulations, and standards regarding the practice of nursing in your state.

Nursing students who have completed their initial program should not practice nursing or perform nursing tasks (administering medication, perform nursing assessments, etc.) unless this is authorized by the state nursing law and regulations. Nursing students can assist the licensed nurses with delegated functions and perform the same tasks that an unlicensed technician or nursing assistant performs.

Ask questions if a situation doesn't appear normal or doesn't feel right. Trust your gut instincts. Contact your state board of nursing, state nurses professional association, or a licensure defense attorney for clarification.

YOU as a licensed nurse or nursing student who recently tested, awaiting the authorization to test, etc. are legally responsible and accountable for your actions. As you may know practicing nursing without a license is grounds for disciplinary action with a state board of nursing.

Why is the practice still continuing in this Hospital when it violates the Indiana Nurse Practice Act and subjects nursing students to charges of practicing nursing without a license? Why isn't this Hospital updating its policies and procedures, position description, and practices to comport with state nursing law and regulations? Just imagine if this has "slipped through the cracks" at the Hospital, what else is brewing there?

In my opinion, this Hospital needs to hire an attorney with a nursing background to review its nursing policies, procedures, and practices from top to bottom. What do you think?

October 01, 2007

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.

September 04, 2007

Nursing Licensure in Multiple States

More and more nurses hold an individual nursing license (whether via endorsement or examination) in more than one state. A disciplinary investigation and proposed action against your license in State A may impact your license in State B at some point.

I live in Cincinnati, Ohio and I am fifteen minutes from the borders of Kentucky and Indiana. Although I have an Ohio nursing license, I hold a law license in Ohio, Kentucky, and Indiana. I practice law in all three states and have active cases in each state. Lots of nurses in this area have a nursing licensure in Ohio, Kentucky, and/or Indiana.

This is also true, I have found of nurses who live in Detroit, Michigan because of the proximity to Toledo, Ohio (and northern Ohio), nurses may hold a license in Michigan and/or Ohio. Nurses in Louisville, Kentucky may also be licensed in Indiana because of the short drive to the Indiana border. This is common in various parts of country for a variety of reasons whether it be geographical location, position related, etc.

If you hold a license in more than one state you really need to consider what impact a disciplinary investigation and/or Board of Nursing action against your license (whether through an Agreed Order, Board Order, Consent Agreement, etc.) will have in the State where the action was taken, other states where you hold a license, and on your nursing career.

I am speaking of individual state licensure because only one of the states where I practice nursing licensure defense (Kentucky) is a member of the Nursing Licensure Compact (NLC). See http://kbn.ky.gov/. Ohio and Indiana are not members of the NLC.

Do you hold a nursing license in more than one state? Are you currently practicing in more than one state? What do you think of the Nursing Licensure Compact? For additional information about the Compact, see the National Council of State Boards of Nursing website at www.ncsbn.org.

Also if you are practicing nursing in more than one state simultaneously and concurrently make sure you are keep the different nursing law and rules straight. I had a nurse contact me several years ago who was licensed in Kentucky and Indiana regarding a BON Complaint. She performed IV procedures that were allegedly outside the LPN Scope of Practice in the state where the facility was located. She confused her scope of practice in one state with the scope of practice of the other state because she routinely held nursing positions both states. This is common as many of us work part-time with one employer, part-time with another employer, and maybe prn at one or two other places. Don't let this happen to you.

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