Nursing Law & Order

OBN E*News 04/11/2013 - Important OARRS Registration Information for CTP Holders

OBN E*News 04/11/2013 - Important OARRS Registration Information for CTP Holders

It is important that all Certificate to Prescribe (CTP) holders register for OARRS (Ohio Automated Rx Reporting System) to be in compliance with the legal requirements for the use of OARRS. Rule 4723-9-12, Ohio Administrative Code (OAC), requires that under certain circumstances APRN prescribers use the OARRS information in their practice when prescribing controlled substances or tramadol. You can access Rule 4723-9-12, OAC, “Standards And Procedures For Review of OARRS,” via the link below.

To register for OARRS and to obtain additional information about OARRS, go to https://www.ohiopmp.gov/Portal/Brochure.pdf. The Board encourages you to register immediately so you are in compliance with this legal requirement. Because it is important for APRN prescribers to register for OARRS, you will also be reminded to register during renewal this year.

The rule, Chapter 4723-9-12, OAC can be found on the Lawriter website …http://codes.ohio.gov/oac/4723-9

TaraLynn Mackay, RN, JD (Texas) is presenting 3 webinars in April 2013 for Nursing Law & Order

TaraLynn Mackay is a Texas licensed attorney. Taralynn represents nurses before the Texas Board of Nursing. Download TaraLynn Mackay CV. 

Taralynn R. Mackay, RN, JD, is a founding partner in the law firm of McDonald, Mackay & Weitz, LLP where her practice focus since 1997 has been administrative/regulatory law, health care law, and professional licensing issues with a primary focus on representing nurses before the Texas Board of Nursing (formally known as the Texas Board of Nurse Examiners). Ms. Mackay is Board Certified in Administrative Law by the Texas Board of Legal Specializations and she has practiced Administrative Law since 1994.

See http://www.healthlicensedefense.com/TaralynnMackay.html

The Nursing Law & Order webinars are scheduled for 90 minutes. The cost is $20.00 for each webinar. No CE credit is provided.

Ms. Mackay is presenting the following webinars for Nursing Law & Order:

Are You Pro Se? The Pros and Cons of Representing Yourself before a State Nursing Board

Wednesday, April 3, 2013 at 6pm-7:30pm 

Registration Link: http://nursinglaw.enterthemeeting.com/m/XT5H1MNR

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State Nursing Board Probation & Monitoring: What Does It Mean and Am I Employable? 

Monday, April 15, 2013 at 6pm-7:30pm

Registration Link: http://nursinglaw.enterthemeeting.com/m/I89NXNMP

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State Nursing Board Alternative to Discipline Programs for Substance Use: Do I Just Sign on the Dotted Line? 

Monday,  April 22, 2013 at 6pm-7:30pm 

Registration Link: http://nursinglaw.enterthemeeting.com/m/DFKU8ACU

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Taralynn's can be reached at: 

Direct Line: 512-281-5999
Private Fax: 512-281-9559
Email: Mackay@healthlicensedefense.com

OBN E*News 02/11/2013 - Interpretive Guidelines Scheduled for Review

OBN E*News 02/11/2013 -  Interpretive Guidelines Scheduled for Review 

Five of the Board of Nursing (Board)'s approved Interpretive Guidelines are scheduled for review by the Board at its March 21 & 22, 2013, meeting.  The Board will consider re-approval of the Interpretive Guidelines in addition to any needed revisions to the Interpretive Guideline content.  In preparation for the review, the Board is seeking public comment concerning the respective Interpretive Guidelines.  To facilitate timely provision of public comments to the Board, written comments should be received at the Board office by the close of business Friday March 8, 2013.  Comments and supporting material may be sent by email to:  practice@nursing.ohio.gov, or by U.S. Mail to the Board's office located at 17 South High Street, Suite 400, Columbus, Ohio 43215.  The subject line of the email or the U.S. Mail envelope should specify "Interpretive Guideline."  The Board will review and consider written comments received by the aforementioned date. 

The Interpretive Guidelines scheduled for review and attached to this eNews are:

1.  Guidelines for Intrapartum Monitoring of  Obstetrical Patients Receiving Epidural Infusions

2.  Guidelines for the Care of Patient's Receiving Intramuscular, Subdermal, or Subcutaneously Injected Medications for Cosmetic/Aesthetic Treatment

3.  Guidelines for Registered Nurse Performance of a History and Physical Examination for Purposes of Providing Nursing Care

4.  Guidelines for Monitoring and Management of Epidural Infusions

5.  Guidelines for Conservative Sharp Wound Debridement

These Interpretive Guidelines are also available for review on the Board's website:  www.nursing.ohio.gov in the "Nursing Practice" section.  Also available in that section is the companion document "Introduction: Utilizing Interpretive Guidelines."  In approving or re-approving Interpretive Guidelines the Board is not introducing a new policy but is giving licensees specific instruction regarding their obligations under existing law and rules.  An Interpretive Guideline is not a regulation of the Board, and does not carry the force and effect of law.  An Interpretive Guideline is adopted by the Board as a guideline to licensees who seek to engage in safe nursing practice.

You can now follow the Board on Facebook and Twitter.

http://www.facebook.com/pages/Columbus-OH/Ohio-Board-of-Nursing/151746234862913

http://twitter.com/OhioNursingBd

State Nursing Board Complaints: The Who, What, When, Why & Where? Webinar

Nursing Law & Order is offering a webinar for nurses and nursing students to learn more about State Nursing Board complaints. 

Do you want to know more about State Nursing Board complaints? 

Are you involved in a State Nursing Board complaint against your license?

What is a State Nursing Board Complaint? 

Am I more likely to be sued for nursing malpractice or reported to the State Nursing Board? 

Monday, April 1, 2013 at 6p.m. EDT

The cost of the webinar is $20.00. 

You can register online at:

Registration Link: http://nursinglaw.enterthemeeting.com/m/YSCWIDRP

No continuing education credit is provided. However you can be emailed a certificate of attendance to include in your own nursing portfolio. 

Ohio Board of Nursing E*News January 14, 2013

OBN E*News 01/14/2013 -Emergency Facility Opioid and Other Controlled Substances Prescribing Guidelines – Please Implement

As you are probably aware, the Ohio Emergency and Acute Care Facility Opioid and Other Controlled Substances Prescribing Guidelines (OOCS Guidelines) were issued in May of 2012.  The OOCS Guidelines were developed through a collaborative effort of health care/medical professional associations, individual medical professionals and state agencies that were brought together under the Professional Education Work Group of the Governor’s Cabinet Opiate Action Team (GCOAT). 

These guidelines along with the accompanying patient handout and pocket card guide were distributed to all hospitals and emergency physicians in Ohio in August 2012.  The OOCS Guidelines, patient handout, pocket cards and background information can be accessed at this link: http://www.healthyohioprogram.org/ed/guidelines. 

Please share this information with emergency medical professionals and emergency and acute care facilities in your area and encourage them to implement these guidelines.  A limited quantity of the pocket cards is still available.  To request pocket cards please send an email to: BHPRR@odh.ohio.gov  

   

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You can now follow the Board on Facebook and Twitter.

http://www.facebook.com/pages/Columbus-OH/Ohio-Board-of-Nursing/151746234862913

http://twitter.com/OhioNursingBd

APRNs and the Pill Mill Bill Spill in the Commonwealth of Kentucky:House Bill 1 was effective July 20, 2012

See the attached. Download KBNPillMillBillSpill

I would encourage APRNs in Kentucky to submit written comments to Nathan Goldman, Acting Executive Director and General Counsel for the Kentucky Nursing Board. Comments are accepted until October 1, 2012.

So what do you think? Do you think the Pill Mill Bill Spill Legislation is necessary or is it overkill?

 

I Can Feel It! Living, Sweating, Breathing, and Bleeding Nurse License Defense for $995.95?

My law practice keeps me very busy. I love what I do for a living and it is my passion. Nurse license defense is still and has always been my dream job. Being on the frontlines in nurse license defense has shown me there is a need for additional services for nurses and nursing students related to the law, legalities, and legal issues. This is phase II for my practice and I am sooooooo excited that I am finally able to move forward with consulting practice while continuing with my bread and butter, nurse license defense in the context of my law practice.

Nurses just a few pointers however, attorneys provide a service to the public just like nurses provide a service to the public. The difference being that nurses are typically paid an hourly wage or salary by an employer for the services provided while most attorneys quote the fee or the amount for the service being provided to the public.

Why is this important and what am I saying? After 11 years of nurse license defense NOTHING surprises me anywmore in the context of my law practice; I am seen the worst in the profession and the arguably some of the best in the nursing profession also. I am not surprised but just puzzled by the number of nurses who need legal representation before the State Nursing Board but decide for "cost" not to retain ANY attorney.

You spend anywhere from $15,000 to $60,000.00 on undergraduate and graduate school nursing education for an ASN, BSN, MSN, or PhD. LPN or LVN programs cost $10,000-$20,000 now.

After spending tens of thousands of dollars on a nursing education, the majority of nursing students and NCLEX Applicants with affirmative responses on a State Nursing Board application will roll the dice and apply for a license without consulting with an attorney on the responses to the application questions. "My nursing instructor said this isn't a disqualification so I should just apply", "I am a different person than I was 5 years ago when I committed those 4 felonies and 3 misdemeanors and the Nursing Board will see this." You don't say?

A LPN, RN, RN-BSN, RN-MSN, or RN-PhD has an income potential of several hundreds of thousands of dollars or several million over the course of a lifetime of nursing practice. That's money. Nurses, as LPNs, general RNs, or APRNs don't earn server wages plus tips. Yet this is the disregard I see with respect to the severity and seriousness of a State Nursing Board complaint and the possible implications on licensure, employability, and the nursing career. You don't say?

I hear all the time "I don't have that kind of money for a lawyer", which is usually anywhere from $3,500 to $9,500.00 with most cases being at the $3,500 to $5,500 range (excluding probation and monitoring with the State Nursing Board) and the most complex cases ranging from $7,500 to $9,500.00. Even APRNs, with advanced education and who certainly earn more and have more scope of practice and more autonomy than LPNs or general RNs will frown at representation and proceed pro se. I quote a few cases over $10,000.00 but usually not because how I can structure my flat fees on case milestones. I don't quote low ball fees; I don't have to do this and it isn't a sound business practice. I quote a fee based on me working your case and we have to work license defense cases, in my law practice anyway. We go hard in my practice, just ask my paralegal.

I am even seeing cases where APRNs and RNs start their own businesses providing nursing services and maybe billing the government for services and fail to consult with and work with a nursing law attorney on the business basics before opening the doors. This is a recipe for disaster. Just look at the number of Independent Providers who have their license suspended and are indicated for fraudulently billing the State of Ohio for home care services. Why don't these IPs, both RNs and LPNs consult with a nursing law attorney? How can you bill for services and also practice in your business as a nurse with advice and counsel of a nursing law attorney? Not the corporate or general practice attorney who did your LLC, but an attorney who can assist you with the nitty gritty practice and operational issues like job descriptions, scope of practice, etc.  

Most nurses spend thousands of dollars on a vacation or two in a year, a bathroom remodel, or some other expense or luxury but will frown at the investment into representation, counseling, and advising in a State Nursing Board complaint which can silence, stop, end, terminate, or unfashionably cramp, crop, and crimp a lifestyle with its career and employability consequences. 

I can't represent you for $995.95 in ANY case and certainly not one where the Board has issued a Compulsory Psychiatric Evaluation (these cases are akin to doing that old school dance "the fight", Cabbage Patch, the Snake, and the Humpty Hump to slow music if you get involved late in the game. See http://www.youtube.com/watch?v=3suw_vb6-fY) and you are licensed as a APRN in Ohio, Kentucky, Indiana, West Virginia, Michigan, and Illinois. Sorry.

Nursing malpractice and nursing negligence don't end careers baby; State Nursing Board complaints and discipline of the license are the career enders pumpkin pie. Don't believe what you were told in nursing school or what you were lead to believe by colleagues. The issues isn't malpractice or negligence it is State Nursing Board discipline. This is why I am so excited about Phase II to my business, it only took me 10 years to get here but I am ready finally to offer additional services and products for nurses and nursing students on understanding the law and the practical implications for nursing practice. Better late than never applies to me and maybe you.

I am also planning to start volunteering as a nurse later this year to get my hands back in nursing practice. If you know where I can volunteer as a nurse here in Cincinnati, email me or call my office. Just a few hours a month.

Do yourself a favor and retain an attorney if a complaint is filed against you with the State Nursing Board and not necessarily the least expensive or cheapest attorney. Do your homework and retain an attorney who practices primarily before the State Nursing Board, there are usually several in any given state. I get calls from nurses who go with an attorney just because the initial fee was so cheap only to find the representation, counseling, and advising isn't that great. Retain an attorney who lives, breathes, sweats, and bleeds license defense and has represented  a lot of nurses. License defense is a cross between criminal defense and family law because the stakes are high and the emotions run even higher. Criminal law, family law, and license defense are intense but guess what Hot Mama (that's me) is intense also.

Also, I can't spend an hour in-person or by phone with a prospective client; unless you are paying me for my time. I offer legal consultations.

Nurses, you don't work for free as a nurse so don't expect me or any other attorney to review a shitload of documents (35-45 minutes plus any research time) and tell you your options and next steps on how to proceed and what to expect over 45-60 minutes "at no cost" as an attorney. Just the facts: this isn't a solid business model for a solo attorney and although I have found my passion, I am in business to make money (I have to pay bills too) and provide needed and necessary services to nurses.

I receive on average 35-60 calls and emails from nurses in Ohio, Kentucky, and/or Indiana who have pending issues with the State Nursing Board MONTHLY. If I (or my paralegal) spent 1 hour with each prospective client (who may or may not retain me) how could I work for my clients who actually pay me to provide them services? Just between Ohio, Kentucky, and Indiana, there are over 11,000+ complaints filed in a fiscal year, every year. Nursing malpractice and negligence complaints "go to your room" and take a nap because State Nursing Boards complaints are "in the house."  

We have free will and if you decide to proceed pro se in a State Nursing Board complaint, I sincerely hope and pray things turn out all right and okay for you. I pray for myself, my clients, and all of us as nurses.

Sometimes it turns out okay for nurses who represent themselves in State Nursing Board cases; others are not so lucky. The landscape is changing before State Nursing Boards in Ohio, Kentucky, and Indiana; I can feel it like DMX.    http://www.youtube.com/watch?v=I0nAjxPV-E8      

I see it and I am living, breathing, bleeding, sweating and practicing it daily; you can't say the same when you represent, counsel, and advise yourself in a matter which can/may break your nursing career.

 

OBN E*News 04/17/2012: Interpretive Guidelines Scheduled for Review

OBN E*News 04/17/2012 -Interpretive Guidelines Scheduled for Review

Three of the Board of Nursing (Board)'s approved Interpretive Guidelines are scheduled for review by the Board at its May 17 & 18, 2012, meeting.  The Board will consider re-approval of the Interpretive Guidelines in addition to any needed revisions to the Interpretive Guideline content.  In preparation for the review, the Board is seeking public comment concerning the respective Interpretive Guidelines.  To facilitate timely provision of public comments to the Board, written comments should be received at the Board office by the close of business Monday May 14, 2012.  Comments and supporting material may be sent by email to:  practice@nursing.ohio.gov, or by U.S. Mail to the Board's office located at 17 South High Street, Suite 400, Columbus, Ohio 43215.  The subject line of the email or the U.S. Mail envelope should specify "Interpretive Guideline."  The Board will review and consider written comments received by the aforementioned date prior to determining re-approval of the Interpretive Guideline.

The Interpretive Guidelines scheduled for review and attached to this eNews are:

1.  The Registered Nurse's Role in the Care of Patients Receiving Intravenous Moderate Sedation for Medical and/or Surgical Procedures
2.  Registered Nurse's Role in Emergent Intubation Performed by a Physician
3.  Role of the Registered Nurse in Providing Bariatric Care by Filling and Unfilling a Client's Surgically Established Gastric Banding System

These Interpretive Guidelines are also available for review on the Board's website:  www.nursing.ohio.gov in the "Nursing Practice" section.  Also available in that section is the companion document "Introductions: Utilizing Interpretive Guidelines."  In approving or re-approving Interpretive Guidelines the Board is not introducing a new policy but is giving licensees specific instruction regarding their obligations under existing law.  An Interpretive Guideline is not a regulation of the Board, and does not carry the force and effect of law.  An Interpretive Guideline is adopted by the Board as a guideline to licensees who seek to engage in safe nursing practice.

 

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You can now follow the Board on Facebook and Twitter.
http://www.facebook.com/pages/Columbus-OH/Ohio-Board-of-Nursing/151746234862913
http://twitter.com/OhioNursingBd

State Nursing Board Non-Compliance: If It Ain't Rough, It Ain't Right!

Thank you again to a client who had to remind me three times, yes three times to change the picture on my blog and facebook pages. I have lost a lot of weight (almost 60 pounds) and I am wearing my hair differently, so here is my new picture. 

The law practice has been extremely busy this year and thank you again to those of you who retained my services. I am noticing over the last few months, the Board cases are becoming increasingly more complex with personal, mental health, impairment, practice, or criminal aspects. 

I reviewed and revised my Legal Services Agreement to reflect the changes I am seeing in my law practice. 

1. I fire clients more readily now than in the past for not providing us with the requested information in a timely manner because this slows down the processing and reviewing of information and can lead to me being unprepared for a hearing, investigative meeting, appearance, etc. If you want a lawyer who will forget you were supposed to send in your performance evals, update your prescription meds, etc., then don't retain me. I will remember, there is a task in my project management software, AND it is in my hand-written and barely legible notes. 

2. I have a paralegal who works with me part-time and her role is exclusively Client Service, Management, and Scheduling. This has been wonderful! Thanks, Dani. 

3. I like what I do and I like who I am. Therefore I am announcing: I am a workaholic and I am proud of it. No excuses anymore like "oh, it is the nature of the beast" or "I really don't work that hard." I do work hard and I enjoy it. Therefore I am looking for another part-time paralegal to work Monday, Friday, Saturday, and Sunday in the afternoons. Also my boss is nuts and she keeps giving me work at all times of the day. 

4. Non-compliance, non-compliance, and more non-compliance. Are you non-compliant? Hell, I am non-compliant with my personal monitoring.  

If you are struggling with State Nursing Board probation and monitoring or compliance with an alternative to discipline program, get some help. Retain a lawyer to assist you. I receive more and more calls related to compliance issues than I used to because non-compliance with a contract results in breach of the contract, i.e. the suspension of a license or the inability to practice nursing. 

Why would you hire a lawyer after you have resolved your State Nursing Board case on your own? Because you need help, because you don't really understand why or what you signed and initialed fifty times, or because you have a few extra thousand dollars in your night stand. 

Life happens when you are being monitored by the State Nursing Board. Things will come up and down during a 1 to 5 year period you are being watched by the Board. Who are you going to call for assistance? Your State Nurses Association, Your Union, Your Employer, or Your Cute Lawyer. Look at my current picture and tell me who do you want to call? Call me. 

I revised my legal services agreement because in the future, I am executing another flat fee agreement when patterns of non-compliance emerge. My best friend says "if it ain't rough for some, it ain't right." This should NOT be your Motto during State Nursing Board Monitoring; maybe in other contexts but certainly not in the healthcare licensing setting.  

5. Nurses, Self-Employment, and Private Practice

I am being contacted by more APRNs in Ohio, Kentucky, and Indiana who own their own business or are planning to provide primary health services. Please keep in mind when you open a business providing healthcare services, you will need a general business attorney AND an attorney like cute lawyer to help you with nursing law, regulatory compliance, and risk management. 

I am seeing more self-employed nurses who open shop and just practice. You do so at your own peril because healthcare is highly regulated and you are assuming too much unnecessary risk, exposure, and potential liability. Yes, it costs money for specialized legal services but it is a cost of doing business in healthcare. I see this with Independent Providers, RNs and LPNs in Ohio also as well as CNS and RNs who own businesses. You cannot practice in your business and run your business without some type of risk management and regulatory compliance plan. You can but the consequences for nurses are swift and cold.

 

 

Like Yesterday, Nursing Board Compulsory Examinations and the definition of Routine, Ordinary, Common, or Mundane

If you look up the words ordinary, common, routine, or mundane in any dictionary, you WILL NOT see "State Nursing Board Compulsory Order for Examination" as an example.

Why? There is nothing ordinary, common, routine, or mundate about a Compulsory Order for an Examination.

It is usually written in the Nurse Practice Act that a State Nursing Board can order a licensee or applicant for licensure by examination for a compulsory examination or order, at the expense of the licensee or applicant being investigated by the Nursing Board may have a physical or mental impairment that MAY affect the ability to practice nursing safely.

In Ohio, see ORC 4728.28(G).

Therefore let's say today you open your mail and you find a Compulsory Examination Order from the State Nursing Board ordering you to submit to:

1. Forensic Psychiatric examination;

2. Medical Examination;

3. Behavorial Examination;

4. Substance Use and Abuse vs. Dependency examination;

5. Neuro-Psychiatric examination; or

6. Psychological examination like a Fitness for Duty

then you need to:

1. Review the document carefully;

a. Sit down and take a cold shot of H20 on the rocks to clear your head;

b. Re-read the document again because I know you didn't read it carefully.

2. If you are represented by an attorney, contact your attorney and discuss; or

3. If you are not represented by an attorney in the Board investigation, you need to speak with an attorney like yesterday.

These Orders for Examination are the real deal. Yes, I know you are a nurse and maybe in one of your nursing roles you were involved in administering, observing, or reviewing these types of examinations for patients, but.....

Ask yourself, what would a reasonable and prudent nurse do at this point in a disciplinary investigation when you receive this type of Order for an Examination/Evaluation?

Do you continue to rep yourself? There is nothing wrong (or wright) about repping yourself before the State Nursing Board. It saves a dollar or two and you can then spend this dollar or two at Walmart, Target, or Lowes. I am all for repping yourself and I advocate repping:

a. Your hood (you can do this with a block party or garage sale. Invite me, please!);

b. Your block (you can do this with a swim party, block party (with a permit), or yard sale); and

c. Your City (next time you are at a professional function, wear a t-shirt saying "I love Columbus, Ohio" or the "Cincinnati Bengals  Superbowl 2020).

But repping yourself in any legal matters can be a train wreck waiting to happen.

You only have one RN or LPN (with State Nursing Board A) and when this license is investigated and you receive an Order for a Compulsory Examination/Evaluation, is saving a dollar or two in the best interest of your nursing career, future employability, future plans for nursing education, and your sanity.

For example, I received three certified letters from the IRS that were not delivered yesterday because of my two horse like dogs which roam the yard stalking birds, bees, and anything that moves. I went into overdrive and contacted the IRS about my estimated taxes for 2011 and whether or not full payment was received for my 2010 tax liability. But I thought about the worse case scenario: Oh frack, I am being audited for 2011! My first thought was will I use my acountant or retain a tax attorney now: like yesterday.  Certified letters from the IRS means "hear ye hear ye" for me as small business owner and attorney just like a Notice of Complaint, Potential Violation Report, or Compulsory Exam Order from the State Nursing Board means "hear ye hear ye" for a RN, LPN, APRN, or RN or PN NCLEX Applicant.

You have to be able to appreciate the best and worst case scenario for any workplace, licensure, legal, or State Nursing Board issue and sometime this requires the assistance of legal counsel for informed decision-making: like yesterday.  I appreciated the best/worst and WTF scenarios from my certified letters from the IRS; the letters are related to my 2010 tax liability and estimated tax payments from 2011.  

When you receive certain items, documents, or information by mail that impact you as a professional and your livelihood as a licensed professional, your natural instincts should flare up and you should go into hyperdrive like the Death Start from Star Wars in less than 10 seconds and start critically thinking about your next steps.

For nurses: it is a medical mal complaint naming you individually as defendant (because you probably do not have your own liability insurance policy), criminal indictments, certified letter from your employer after you have been suspended from work pending an investigation, letters from the State Attorney General's or Department of Health related to a workplace incident, and State Nursing Board Complaints and Compulsory Examinations/Orders.

You have critical thinking skills (if you don't email me and I will send you an invoice to pay me to help you develop those skills) so use those skills to critically think and be objective about your situation. There is nothing routine, ordinary, common, or mundane about receiving a Compulsory Examination Order from your State Nursing Board and the fact that this is "lost" of most nurses and NCLEX Applicants is troubling and speaks volumes to where we are as profession with knowledge and education of the intersection of the nursing law and professional standards of practice and the practical applications in the workplace.

 

 

Don't Put Things in Your Mouth and Just Swallow: Think Fast Nurse & Name that Pill!

Get your mind out of the gutter. This is a professional and legal blog for nurses.

I don't know about you but I don't just take any pill given to me by someone, even if it is handed to me by one of my dear sweet grandmothers I have questions. The first being what are you going and why are you handing me meds to take? Do I look like a Paula Pill Popper?

I would be offended if someone gave me a pill to take. Actually I would probably smack the person's hand and the pill out of my personal space. But that's just me and I have "anger" issues (so I have been told by my son, my sisters and my mom).

Why? It is probably no big deal for the vast majority of Americans to take prescription medicine that belong to someone else. What I mean there are more than likely NO legal, career, employment, or licensure ramifications for the average American who pops a pill given to them by their uncle at a cook out.

For example, let's say, at my Fourth of July swimming pool party, I have too much to drink and I want to take something for the headache I know I will have in the morning, I wouldn't send someone in the house to "get me a pill." Why? I keep all the medication in my home in one of the kitchen pantries and the person could give me a pill prescribed for:

1. LaTonia;

2. My EX-HUSBAND;

Yes that's right. The Nursing Law Bandit is single and back on the loose. Actually I am "on the loose" maybe 30 minutes a week because of my work schedule.

But yes, I am no longer married and for that matter was never married: legally or spirtually. Name that legal procedure.

I am actually picking up my engagement, wedding band, and anniversary band today; I had the rings resized to wear on my right hand. My jeweler suggested sizing and wearing the wedding and anniversary bands as thumb rings to break up the set.

Really? I don't think so, pumpkin. My rings are gorgeous.

More later. But...

If you know a single handsome & nice man (mid thirties, early/mid forties) who is small business owner, with real and personal property, no children under 18 y/o,  and a mid-six figure income, and a decent business and personal credit score, skype me.

3. Luke (my dog);

4. Leia (my dog); or

5. My son.

Don't put things in your mouth and swallow unless you know exactly what you are swallowing: think fast and name that pill Nurse! Is it Tylenol, Profen, or Darvocet, Perc, or a Vic?

I keep my medication identifier with my calendar in my briefcase not at the poolside.

Use common sense. Nurses are licensed professsionals and you are a nurse 24/7/365. They actually should tell folks on the applications for nursing school when the schools are bragging about how much money you will make; the schools should also explain the accountability and responsibility that comes along with being licensed in an occupation with easy, easier, and easiest access to controlled substances and the skinny on what this really means now and in the future.

So here is the skinny:

1. Do not take any prescription medication that it not prescribed for you. WTH you say? I know it is a shocker but do not do it! 

2. Do not taken any medication or pills given to you by ANYONE without you viewing the medication container or pill bottle.

Anyone includes me, your mother, your father, your husband, etc.

3. If the prescription container/bottle does not have your name on it, DO NOT take the medication.

4. Do not mix your prescription medication with the prescription meds of any human, animal, or imaginary spirit. You are a nurse damn it, why are you adding different pills to the same container for ease of transportation. Really? It is one more container in your purse, book bag, or pocket book.

I keep my wallet, two prescription meds containers, three pens, small note pad, business cards, and bubble gum lip gloss in my purse along with my cell phone. What's in your pocket book?

5. Stop asking docs you work with or NPs you know to write scripts for you. It is tacky and a red flag. This isn't the 80s, 90s, or even the early 2000s when that type of conduct was tolerated. It is a risk management and compliance issues which can turn into a legal issue. Therefore ask yourself is it really worth it in light of the national spotlight on prescription drug abuse and misuse. Also it is never an issue until something happens and when it happens, it is what it is!!!

I know it happens everywhere (ER, ICU, OR, etc.) and all the time but it is not good practice. Remember you are not working at Burger King and you certainly cannot have it your way!!

5. If you are being monitored by the Nursing Board in an alternative to discipline program for substance use/abuse or in a disciplinary program for substance use/abuse or practice issues related to controlled substance documentation, you need to live and practice by #1-4 each and every day while you are being monitored by the Board and even after monitoring ends.  

Charlotte's Web and Drug & Alcohol Use, Abuse, and Dependency in Nursing

Are you weaving a web so thick that not even Charlotte could manage to migrate it? http://en.wikipedia.org/wiki/Charlotte's_Web.

I am writing an e-book, the New Charlotte's Web: Deceit, Deception, and Dishonesty, Drugs/Alcohol, and Nursing's Social Policy Statement.

Deceit, Deception, and Dishonesty is part of addiction and use. I get it.

Drug and Alcohol Use, Abuse, Dependency, and Impairment is no doubt an issue in nursing. I get it.

There are alot of nurses who are abusing prescription medication but think its "okay" because I have script. There is a thin line between using prescription medication as prescribed vs. using prescription medication prior to and while at work vs. impairment regardless of whether you are working 4, 8, 12, or 16 hour shift.

However, there are competing forces with drug and alcohol use, abuse, dependency, and impairment in nursing. Yes, there is a recognition that this is disease on one end of the spectrum and on the other end of the spectrum is the public and the State Nursing Board and Law Enforcement.

Guess what's in the middle? IMO, its Personal and Professional Responsibility & Accountability.

http://www.nursingcenter.com/Library/JournalArticle.asp?Article_ID=492769

http://www.nursingtimes.net/nursing-practice-clinical-research/part-51-accountability-autonomy-and-standards/200972.article

http://ajcc.aacnjournals.org/content/19/3/296.full.pdf+html

http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2648.2006.03684.x/full

http://www.aspan.org/AboutUs/PresidentsPage/ArchivedPresidentsPage/PresArchive_102010/tabid/7404/Default.aspx

http://faculty.ksu.edu.sa/hisham/Documents/Medical%20Education/English/Nursing%20Education/90.pdf

How does this apply in the workplace? Examples.

http://www.slhn-lehighvalley.org/docs/pdf/final%20professional%20practice%20model%20nov%2007%20_2_.pdf

So you know what this means? Yes, Alcohol & Drug Use, Abuse, Dependency, and Impairment are medical issues but as a state licensed nurse, you are personally and professionally accountable and responsible for your actions and inactions in accordance with American Nurses Association professional standards of practice and your State Nurse Practice Act and Board of Nursing Regulations.  

So guess what? You are a nurse and you are diverting drugs; you have a medical condition but you are accountable. You are nurse and you are showing up to work drunk; you have a medical condition but you are accountable.

You cannot be a state licensed nurse and NOT be accountable and responsible for your actions or inactions or conduct. This isn't Burger King and you can't have it your way. It works this way for most licensed professionals especially in healthcare, which is HIGHLY regulated.

The accountability and responsibility piece and the foundations for the legal, professional, and self-regulation of nursing practice is lost. This is what frustrates me is this connection is lost somewhere in the transition from nursing student to professional nurse to professional nurse and expert clinician.

Nursing schools are the new puppy and pill mills, teaching to pass the NCLEX and producing graduates who don't understand the role of personal and professional accountability and responsibility in nursing practice and the importance of legal, professional, and self-regulation of nursing practice. (Oh, snap, I guess I won't be invited to present on nursing law and rules for nursing faculty. Tear.)

This isn't picked up in the workplace of course and most nurses don't belong to a nursing professional or specialty nursing associations. So in my opinion the majority of us are showing up to work and just practicing until something happens and we are doing this without a plan for our nursing practice and without a healthy appreciation & understanding of JUST how important the legal, professional, and self-regulation of nursing practice is to our nursing practice and "the plan." 

Sections of the Nursing's Social Policy Statement: The Essence of the Profession (2010) will be required reading for ALL of my law office clients going forward.  http://www.nursesbooks.org/Main-Menu/Foundation/Nursings-Social-Policy-Statement.aspx.

If you are a law office client, take a guess what you will receive on your birthday, my birthday or around the holidays this year!!!

What's your point, LaTonia? Weave it, baby, Weave it! You can weave a web and weave it as thick, as sticky, as murky, and for as long as you can. Regardless of whether you weaved the web because of a medical condition, mental condition, etc. the "why" is a mitigating factor: you are responsible and accountable due to the professional regulation, legal regulation, and self-regulation of nursing practice.

I surrendered my Nursing License __ years ago. Can I get it back?

I receive several emails each month asking this question.

I am not sure if you can get your license back however here is good start and this ain't legal advice because you didn't have to pay me for it:

1. Find the documentation you received from the Nursing Board from the license surrender and read the document;

2. If you can't find the document surrending your nursing license, request a copy from the State Nursing Board;

3. Once you have the document and you have read it you can do any of the following:

a. Nothing. It's self-explanatory what needs to be done to have my license reinstated;

b. Nothing. It's self-explanatory that I can never have my license reinstated as my license surrender was essentially a permanent revocation;

c. Contact a license defense attorney in your State to review the document and answer your questions. See www.taana.org to find a nurse license defense attorney in your state.

d. If you need assistance with reviewing a document from the Ohio, Kentucky, or Indiana Nursing Boards, I am available. You will have to pay for and schedule a legal consultation with me however as I do not review documents and provide legal advice and counseling without entering into an attorney-client relationship. It protects me and you as also compensates me for providing a service. I cannot legal advice and counseling for free. See www.nursing-jurisprudence.com. Click on legal consultations.

You can also pay for and schedule a legal consultation with me online via my Bookfresh account. See

 http://www.bookfresh.com/index.html?id=d17ccb653369ca681a27c3aba4413d6a&view=buyer_flow

See also http://www.bookfresh.com/profile/157503739.

The costs of the consultation are self-explanatory.

1. If you live in the Greater Cincinnati area and you want to meet with me in my office. You can pay for and schedule an in-person appt. with me. The cost is $250.00 per hour.

However, if you:

1. have complaints pending in more than one state;

2. this is your second or third Nursing Board complaint (be honest please);

3. You are currently on probation or being monitored with the Board and there is another issue;

4. You are licensed in multiple states (like Ohio, Kentucky, and/or Indiana);

5. You are a APRN and there are multiple issues involved; 

6. You have a pending state or federal criminal case plus a Nursing Board case

7. You are self-employed (Independent Provider, owner of a home care agency, etc.) and you have a licensure issue

I am not trying to get more money out of you however we may need to spend more time together like: 90 minutes or 120 minutes.

No I am not going to kick you out of my office exactly at 60 minutes and I certainly don't watch the clock during consults. However I may start winding down the meeting as I may have other appts. scheduled after yours.

These are items to be considered when scheduling as my assistant or my receptionist schedules my appts. one hour apart usually. If you have a complex case or there is alot of information and background for us to cover, then pay for and schedule more time so we can plan accordingly.  

Ain't Nothing Like the Real Thing Baby and its called Legal Advice, Guidance, and Counseling

http://www.youtube.com/watch?v=svAs-6MiqxE

Several singers proclaim "ain't nothing like the real thing" including the Stylistics, Marvin Gaye & Tammi Terrell, the Jackson 5, Elton John, Beyonce, and others.

I spoke with a nursing student last week who had been given different advice by his friends, family, nursing instructors, and a general practice lawyer related to criminal convictions, clinical sites, licensure, and employability.

The advice given wasn't accurate and was all hedged on either " I am not a lawyer but" or "This isn't my area of my practice however." A one hour consult with me answered all of the questions and concerns.

An attorney-client relationship requires the payment of a fee and this is free:

1. If you are considering nursing school and you have concerns about whether or not your background will be an issue, do the following:

a. go to the State Nursing Board website and download the application for licensure by examination.

b. if you have affirmative response, contact a license defense attorney or nursing law attorney.

2. If you are currently a nursing student and you have concerns about whether or not your background will be an issue with licensure and employability, or future career plans, do the following:

a. go to the State Nursing Board website and download the application for licensure by examination.

b. if you have affirmative response, contact a license defense attorney or nursing law attorney.

3. If you are a LPN, RN, or APRN and you have concerns whether or not a recent criminal convictions or other issues will result in a State Nursing Board investigation, do the following:

a. contact a license defense attorney or a nursing law attorney.

b. I am always surprised by the number of nurses as licensed professionals who turn to online boards and forums for legal advice, counseling, and guidance instead of contacting a license defense or nursing law attorney. Yes, it may cost you a bill or two ($100) but you have what you need.

Nurses are licensed and although the debate still lingers about whether or not nursing is a profession (no standard entry level to practice), we consider ourselves professionals. 

 http://www.americannursetoday.com/BlogView.aspx?bl=6268&bp=6960  

Healthcare is highly regulated which is why the healthcare organization you work for has in-house attorneys to focus on the daily needs of the organization and outside legal counsel for overflow and more specialized legal needs of the organization that can't be done efficiently by in-house lawyers.

Lawyers are a must in healthcare now more than ever and this need is slowly trickling down from healthcare organizations and business to business transactions to individual licensed healthcare professionals who practice in or do business in healthcare. 

I put Equal in my coffee yesterday instead of sugar and it just didn't taste right. It was okay and I could get by with it but I knew it wasn't my usual and I questioned why I used Equal. I even told myself it was the same but it wasn't. I had a headache yesterday and I wondered was it because I used Equal in my coffee instead of sugar. I was cranky yesterday and I wondered if it was because I didn't get my coffee fix just how I like it: heavy, heavy. I am drinking coffee with sugar this morning.   

There ain't nothing like the real thing. If you need legal advice, counseling, or guidance, contact a state licensed attorney who practice license defense or nursing law. There is no substitute and as licensed healthcare professionals nurses IMO need to see legal counseling or representation as "a cost of doing business" which is inseparable from the privilege of practicing in a highly regulated healthcare environment and workplace.

I am not advocating nurses keep lawyers and law firms on retainer like healthcare organizations  because this is cost prohibitive however nurses need to understand when legal issues arise, you can't always turn to your employer for "what's in your best interest", this is the role of your OWN personal legal counsel.

Kentucky Board of Nursing and KRS 314.095: Verified Response to the Complaint

The Kentucky Nurse Practice Act, KRS 314.095 states:

A licensee, credentialed holder, privilege holder, or applicant who is the subject of an investigation by or on behalf of the board shall cooperate fully with the investigation, including responding to a complaint or lawful request for information in a materially factual and timely manner.

Effective: July 15, 2010
History: Created 2010 Ky. Acts ch. 85, sec. 25, effective July 15, 2010.

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Wow! What does this tell you? The Kentucky Board of Nursing means business.

1. Its effective July 15, 2010, so this is new.

2. The Board has received false or inappropriate responses.

3. Some individuals have not responded to complaints.

Guess what? A verified response to the complaint is required now by the Kentucky Board of Nursing.

What I am saying and what does this mean?

If receive a Notice of Complaint from the Kentucky Nursing Board, you really need to think about attorney representation before you respond to the complaint in writing.

Personally, I saw this one coming years ago as there were nurses helping other nurses respond to Kentucky Nursing Board complaints, prepping other nurses for investigative meetings with Kentucky Board of Nursing staff, and providing bootleg legal advice and counsel to nurses involved in Kentucky Board of Nursing investigations. Not saying that it doesn't happen in other states but I can only speak on what I know. Just the facts.

These cases are not cookies and cream (I am on a diet but I want a cookies and cream Blizzard, extra thick from Diary Queen) like most nurses think because you don't have to appear in court before a judge and you are not served by a Sheriff with the complaint. Don't rationalize or underestimate the seriousness of a State Nursing Board complaint and the process and procedure involved with the response to the complaint. If you didn't know then I will tell you, Board of Nursing staff and members as nurse regulators take their role of public protection very seriously; now are you taking the complaint seriously? 

Ohio Independent Providers (IPs) RNs and LPNs, ODJFS, and Ohio Nursing Board complaints: Holding your feet to the fire! Really?

If you are working as an IP in the State of Ohio, then I would suggest the following regardless of whether you are new to the field or you have worked as a IP for 10+years:

1. Network with other IPs in your area;

2. Develop a relationship with other IPs who you can discuss practice, billing, documentation, and other issues with as the issues arise;

3. You should have a CPA to assist you with your taxes, your legal business entity and other financial issues;

4. Watch your billing; Medicaid Fraud and theft convictions are increasing and the short-tem and long-term consequences aren't pretty; and

5. Retain an attorney to assist you with regulatory compliance, practice, and legal issues as the issues arise in your practice because the issues will arise.

I am seeing a number of cases involving IPs, both RN and LPN which involve the failure to have a regulatory compliance or risk management plan for their business. You are essentially a home care agency and directly billing the State for home care services is a legal minefield as a "solo" act. Home health agenicies have outside legal counsel and some of the large home health agencies have an attorney(s) on staff "in-house." As a IP-RN or IP-LPN, do you have an attorney on retainer to assist you with practice issues?

Also I really think Nurse IPs should have their own "group" to focus on the issues facing nurse IPs. By a group I don't mean a union. A professional association for Ohio Nurse IPs was attempted several years ago but there wasn't enough interest.

Oh and also: if you are being asked questions, receiving correspondence via certified mail, on a conference call with individuals from one or more State agencies in response to an incident, and being asked to submit records and documents for review: you are under investigation, pumpkin. My nephew calls me pumpkin still at times and I have lost 20 pounds this summer. The next 10 pounds is going to be tough! I am combining water aerobics with my daily walks now.

Also as an IP if you are being investigated for an incident by Carestar and ODJFS stop rationalizing and minimizing the conduct in question.

"My husband said this is silly." Attorney response: Really!

"I can't believe they are so concerned about just paperwork." Attorney response: Really?

"I may have overbilled but I earned that money." Attorney response: Really?

"What's the big deal with boundaries? The patient got the care needed." Attorney response: Really.

Retain an attorney to assist you initially. I am seeing a number of the cases where IP-RNs and IP-LPNs represent themselves in an ODJFS hearing and then don't contact an attorney until they receive a Notice of Opportunity for a Hearing from the Ohio Board of Nursing based on the termination of their provider number.

If you didn't know this then let me tell you: an adverse action taken by ODJFS is reported to the Ohio Board of Nursing because you are licensed to practice nursing by the Board. This then starts another investigation by the Ohio Board of Nursing.

This is why its extremely important for IP-RNs and IP-LPNs to:

1. Have an individual professional liability insurance with a license defense benefit that will cover attorneys fees and costs in ODJFS and Ohio Nursing Board complaints, investigations, and adjudications; and

2. Contact an attorney initially whenever an incident is reported.

Its your nursing license, its your provider number, its your business, and YOU as a professional should manage the risk. Taking a wait and see approach isn't managing the risk.

Are you at the Point of No Return (PNR) in your State Nursing Board case?

I said this to a client the other day. We are at the point of no return in your State Nursing Board case and these are your options.

What is the point of no return? http://en.wikipedia.org/wiki/Point_of_no_return.

In a State Nursing Board case IMO its a irreversible action or decision where you must continue on the current course of action because turning back is legally and practically impossible.

I talk about the PNR in cases where:

1.   I suspect or know my client is not being completely upfront and forthcoming with me;

2.   Is just outright lying about the circumstances  and facts in their situation; or

3.   In cases where a client is in an extreme state of denial.

I saw Predator at the movies on Friday. So I watched the original Predator, Predator II, Predator Requiem, and Alien v. Predator Friday morning and afternoon while working on my laptop. The PNR is mentioned  also in AVP.

The Point of No Return is also a pretty decent movie. See http://en.wikipedia.org/wiki/Point_of_No_Return_(film)

When the State Board of Nursing Calls: a two part article series

See http://centerforamericannurses.org/displaycommon.cfm?an=1&subarticlenbr=202

Winging It: I received a certified letter from the Ohio Nursing Board and its a Notice of Opportunity for a Hearing

The Ohio Board of Nursing met last week and Notices for an Opportunity for a Hearing were issued. The Notices are sent by certified mail to the nurse and if represented by legal counsel, to the attorney of the nurse. I receive one Notice already this week, how about you?

If you were "noticed" you will receive the certified letter this week by mail or next week by mail. If you were noticed you should seriously consider retaining legal counsel to represent you before the Board and at your hearing.

You need to seriously consider retaining a nurse license defense attorney. What is a Nurse License Defense Attorney? See this brochure from the Center for American Nurses (www.centerforamericannurses.org) at Download Nurselicensedefenseattorney.

I know I say this a few times a week or several times a month but nurses if you are involved in a State Nursing Board complaint you really need to consider retaining an attorney to represent you before the Board of Nursing at the beginning of the investigation. You can retain an attorney two weeks before a scheduled hearing if you like or you can retain an attorney after your license has been disciplined. Its your decision and its a decision that shouldn't be made lightly.

I have already spoke with three nurses this week who received Notices from the Ohio Board of Nursing.

State Nursing Boards cases are becoming more and more complex depending on the nature of the complaint and the attending circumstances. Far to many nurses fail to appreciate just how adversarial these types of cases are before a State Nursing Board and decide to "wing it." Wing it means you represent, counsel, and advise yourself or seek "legal" advice and counseling from peers, online nursing forums, and others.

Just a few words from someone who defends these cases for a living and loves it, I mean "loves" it:

1. There is a tendency to minimize and rationalize the behavior, actions, or inaction involved in a State Nursing Board case when you represent yourself because "you can't see the forest because of the trees." If you can't see the forest because of the trees how in the hell are you going to develop legal strategies for the defense of your license? Just something to consider;

2. The State Nursing Board staff may be nurses and the State Nursing Board members may also be nurses but remember their role is to protect the public from unsafe nursing care; its not to advocate for nurses, to advise you on your options, or tell you what you need to do in your case. Its not the role or job of Nursing Board staff to tell you "hey, you might need to hire a lawyer to assist you in your case." Don't get it twisted!!

3. You are way out in left field (and I am left handed)  if you don't realize the State Nursing Board has staff including nurse investigators, nurse attorneys, attorneys, and others involved in investigation, prosecuting, and the adjudicating  complaints. State Nursing Boards are not small "mom and pop" operations; State Nursing Board are state regulatory agencies with multi-million budgets and lots of staff to support the work and charge of Board Members. From DAY ONE when your complaint is being processed the Board is investigating the allegations and looking at this case from a legal and nursing perspective. So please please please rethink the "if I hire an attorney it makes me look guilty" line. If you have a complaint filed against your license you are "playing in the big leagues" whether you realize it or not as the State Nursing Board has attorneys in-house and outside legal counsel related to the investigation and adjudication of State Nursing Board complaints.

APNs Barriers to Practice Survey by the Ohio Association of Advanced Practice Nurses (OAAPN)

See Download 5.2.2.1%20OAAPN%20Survey.

Just my two cents but the cumbersome law/rules agreed to for APRN prescriptive in authority as a "foot in the door approach" and truce between dueling medical and nursing professionals associations here in O-HI-O are more difficult to amend than initially imagined. Sometimes just "getting a foot in the door" isn't the best approach to legislation and opening the Nurse Practice Act and in hindsight maybe a "do or die" , "do it or die trying" , or "all or nothing" approach to prescriptive authority was needed here in O-HI-O.

Just compare and contrast prescriptive authority for APRNs (excluding CRNAs who of course did it the right way initially for the most part. CRNAs and their national and state prof. associations are on the ball I tell you!!!) in Ohio, Kentucky, and Indiana. Its like comparing fresh spring water and sweat tea to flat and warm Pepsi. You can drink the Pepsi if if you have to but its nothing to look forward to consuming.