23 entries categorized "Legal Regulation"

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?

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