Nursing Law & Order

Smell My Feet: Customer Service, Staff Nurses, and the Waffle House

My nephews used to ask me to smell their feet. They were only 3 and 4 at the time and we would play a game where I would smell their feet, which were funky of course, and then tell them it was time for a bath.  We even called one of my nephews lovingly  Phat Man "my feet" because of my nephew's focus on his feet. 

IMO making staff nurses be responsible for, be graded for, and be accountable for "excellent customer service" is like one adult asking another adult to smell their feet. It turns your stomach right? You feel indignant right? You get a little angry and wonder did this person have "any" home training or was this person reared by barbarians. 

I understand healthcare and providing nursing care is a business as well as an occupation. 

I understand patient and resident rights in the context of healthcare and providing nursing care as a business as well as an occupation. 

I understand healthcare facilities (hospitals, nursing homes, etc.) want to distinguish their organization from the other organizations providing the same services in a geographical area. 

I understand marketing, advertising, and I also understand customer service. 

But what I don't understand is the emphasis on customer service and customer service training for bedside and staff nurses. 

But I don't get the "customer-service" frenzy of healthcare management which forces staff nurses to "wait on" patients and their families in addition to providing nursing care: administering medication, following up with physicians, collaborating with other healthcare professionals, performing skilled nursing tasks, etc. 

Nurses now feel pressure to be "liked and scored well" by patients and family members who expect to treated like royalty and have water brought to them, food warmed, pillows fluffed, and feet smelled and massaged all in the context of providing excellent customer service. You have got to be kidding me! There isn't enough time in a shift to perform all of the nursing interventions required for a patient care assignment but now you add to that this customer service aspect. Really? 

It is accreditation agencies, doctors, the C-Suite, and facility administrators setting these unreasonable standards because they are not the ones providing the services. If a facility wants excellent customer service, hire "customer service" technicians to assist the nursing staff but don't require nurses to graded like preschoolers on such arbitrary nonsense. What does how fast I brought you a glass of water with lemon have to do with providing safe nursing care in the context of nursing law, rules, and standards? 

Customer service isn't patient safety and certainly isn't required by the State Nurse Practice Act and Board of Nursing regulations or the professional standards of nursing practice. Customer service is required for waitresses/waiters (I have to be PC) at the Waffle House.

Are you working the first, second, or third shift at Waffle House this week? Has the provision of nursing care with your employer with the emphasis on customer services denigrated the environment, atmosphere, and morale of the nursing staff to the point that you feel you are working in fast food?

If I walked into your facility at 3am; would I feel like I am at the Waffle House? I would like to order a sweet tea, scrambled eggs with cheese, raisin toast, grits with cheese, and a large order of hashbrowns with cheese and mushrooms? 

Nothing wrong with working fast food. I worked at Dunkin Donuts on the night shift during high school. Yes, hot mama sold donuts and coffee! Nursing care isn't fast food and if you bring the customer service aspects of fast food to nursing care, do you also bring along the ethics 

I don't know what if anything will cause "the sleeper to awaken" (this is from the movie and book Dune) and for nursing as whole to revolt and "fight the power" but maybe just maybe it might be the emphasis on "customer service." The "customer service" movement in healthcare may actually do the impossible and steer the nurse today and tomorrow to organized labor and unions.  

Law Firm Brochures now available in Candy Land; Email or Text Me Sugar Drop!

I am offering two updated law firm brochures for nurses and these are available to individual nurses and nursing students who need legal assistance. The first brochure discusses the difference between a legal consultation vs. legal coaching vs. traditional legal representation. The second brochure reviews State Nursing Board complaints. 

If you would like a brochure, send me an email at NURSINGLAW@live.com. Include in the email your full name, mailing address, and State of Licensure(s) and I will email the brochure(s) to you. 

These brochures are for nurses who need assistance before the State Nursing Board; my brochures are not for attorneys who are trying to break into the nurse license defense market by poaching articles, website information, and other documents from more established attorneys and their law firms.  

The lyrics in one of Top 10 favorite rap songs says "there is evil in the streets and everybody is starving..." Some attorneys are starving for clients similar to "The Walking Dead" zombies and will do anything to obtain clients. Please don't call me on Sunday from 7pm to 10pm because I am watching The Walking Dead!

What is anything?

IMO, anything is representing a nurse before the State Nursing knowing full well the attorney is not familiar with the process and procedure and cannot adequately counsel and advise or defend the nurse. Anything is taking a case because it is "just a State Nursing Board case" and how difficult can it be anyway as you took an "admin law" course in law school and one of your uncle's babies moms is a physical therapist and in nursing school. Anything is saying you have represented nurses before (implying you have represented nurses before the State Nursing Board) when what you really mean is you have done wills, trust, personal injury, and/or divorce cases for a RN, LPN, APRN, or nursing student. 

I had planned to post my two updated law firm brochures online but I decided not to because there is an attorney who has copied and pasted information from my law firm website, www.nursing-jurisprudence.com to his/her website which IMO shows a lack of ethics, civility and professionalism. Also it is just plain tacky.

Just ask me can you copy and paste the info and I would 9 times of out 10 say "yes" because it is just not that serious and I like to help other attorneys if I can; I am a helper and often I help until it hurts. Oh, snap, of course I help until it hurts, I am a nurse. 

Nurse license defense is very small Bar and niche area of practice in Ohio, Kentucky, and Indiana. I can count 4-8 lawyers in Ohio, 2 in Kentucky, and 1 in Indiana who I know practice from day to day in nurse license defense or health care professional license defense work and who I would have defend me before the State Nursing Board if I accidentally and without specific intent slapped someone in the face for stealing my material.

Bit of Advice: Once you get a "rep" as being a bottom feeder, borrowing material and holding it out as your own, and/or engaging in other questionable behavior in nurse license defense; it follows you for the remainder of your admin law practice.  

I don't stick my feet in criminal defense, wills and trust, personal injury, workers compensation, or other areas because my cup of Lipton tea, bread and butter, and WC coffee heavy heavy is nurse license defense. If you are an attorney and you are taking on your first State Nursing Board case; then say so to a nurse contacting you for assistance and co-counsel with another attorney or at least allow your client to make an informed decision on whether or not retain your services.

Nurse License Defense is a mixture of admin law, civil law, family law and criminal law and the implications for dropping the ball are vast. You can screw up and extinguish the ability to earn a living, pursue higher education (BSN, MSN, etc.), become an advanced practice nurse, and smother their aspirations, dreams and hopes by having a nurse sign Board of Nursing, Consent Agreements, Consent Decrees, and Agreed Orders if you cannot adequately inform the nurse or nursing school graduate of their options and the implications of signing on the dotted line.

These are not CANDY LAND cases, Sugar Drop! Candy Land is described as a simple game. 

http://en.wikipedia.org/wiki/Candy_Landhttp://en.wikipedia.org/wiki/Candy_Land

Nurse License Defense is anything & everything but simple! 

 

I will be in Cleveland, Ohio this month meeting with law firm Clients for three days

I will be in Cleveland, Ohio meeting for three days meeting with several of my law firm clients this month who live in the Cleveland, Ohio area. 

Do you have a pending complaint with the Nursing Board?

 

Has your nursing license been disciplined in another state and you want to know what to expect with the Ohio Nursing Board? 

 

Have you been treated or diagnosed with a substance abuse disorder and you want counseling and advising on your next steps?

 

Do you have a workplace or nursing practice issue you want to receive objective advice and counseling regarding? 

 

Have you been told that you will be reported to the Nursing Board and you want to know what's next? 

 

Are you on probation and monitoring with the Nursing Board?

 

Is your nursing license suspended an attorney to review the terms/conditions for the reinstatement of your license with you? 

Will you have to disclose a criminal conviction(s) on your 2013 RN Renewal in Ohio and you want to know how this will impact your license?

Then you should consider a legal consultation. See the attached document for additional information about legal consultations. A legal consultation is a one-time meeting for us to review your case, situation, and matter and to discuss your options.  Download 2013legalconsultations

There is a charge for a legal consultaiton. I do not offer free legal consultations.

If you want to schedule a date/time to meet with me to discuss or review your case while I am in Cleveland, Ohio please email me at LDW@nursing-jurisprudence.com. 

 

Do You Think I Need An Attorney to Represent Me before the Board of Nursing?

If you have to ask me do you need an attorney then 9 times out of 10 you need a lawyer. 

I can tell you I don't represent myself in anything because I am my own worst enemy and I know it because I have a tendency to rationalize my own behavior, minimize my wrong doing, inappropriateness, or failure to do something, and think it is all going to be okay if I just tell my story. Also I can be a drama queen with respect to my own personal affairs at times. Does this sound familiar? 

I have a nursing license and three law licenses, if I get a speeding ticket, I call my lawyer and let him worry about it; that's his job. I worked hard to obtain my licenses and have been blessed in Christ to have a busy law practice doing what I love. Now why would I want to take on the risk of advising myself in a legal proceeding when I can have the benefit of independent and objective legal counsel. I want to hear what he has to say about my legal matter not what I have to say about my own legal matter. Legal fees are a business expense and an expense that all licensed healthcare professionals especially nurses need to consider. 

Yes, it cost money to retain an attorney and yes you can represent yourself before the State Nursing and counsel and advise yourself by doing your own research, relying on the statements of family, friends, and colleagues about what should happen and what is fair in your situation, and trolling the nursing chatroom and forums for information about legal issues in nursing and then applying this to your own case and situation. 

Spend the money and hire a lawyer to represent, counsel, and advise you. If you can spend a few thousand on Christmas gifts, a vacation, downpayment on a luxury vehicle, loaning family money, or living beyond your means to keep up with the Joneses, why can't you spend a few thousand dollars on legal representation, counseling, and advising with respect to your nursing license which directly impacts your employability in nursing? If you don't have a nursing license, you can't work as a nurse. I really scratch my head when I see APRNs represent themselves before the State Nursing Board. 

In a perfect world, nurses wouldn't need to retain lawyers and we all would have a perfect nursing practice and work in perfect nursing environments. We also would all hold hands and sing....

This isn't a perfect world. There are legal risks, potential liabilities, and action against the license behind almost every door in healthcare in addition to Vampires and Lycans. You counsel and advise yourself at your own peril and I see it everyday especially when nurses appear at hearings without counsel or just sign a Consent Agreement, Agreed Order, or Offer of Settlement with the State Nursing Board without understanding the implications for his/her nursing practice. 

I am not saying you have to retain me but retain an attorney in your state of licensure who practices before the State Nursing Board frequently and move forward. Retain an attorney with experience before your State Nursing Board and then work with your attorney for the best outcome possible and probable in your case. Yes, it cost money to retain an attorney but it may be the best $2,222.22 to $7,777.77 you have spent. Yes, you can afford it; LPNs, RN, and APRNs earn decent salaries and hourly wages; it is just a matter of do you want to pay the costs associated with legal services for defending your license? 

 

 

Change in My Contact Information

Effective today the contact information for my office has changed.

My new office telephone numberand  business cell phone is 513-655-6586.

My new fax number is 855-859-5079.

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.

 

Workplace Incident to State Nursing Board Complaint to Career Standstill to Professional Suicide and No Lawyer

The headline above is a worst case scenario but it is a growing reality for a number of nurses who represent, counsel, and advise themselves in legal matters involving their license. I cannot tell you how important it is for nurses, whether you are a LPN, RN, or APRN to seek advise and counseling from a private nursing law attorney when a patient care or other significant issues arises in the nursing workplace. No one, whether it is your nurse manager, nurse supervisor, union rep, risk manager, etc. is going to say to you "You need to consult with your own attorney about this situation." I haven't heard it in my 11 years of solo practice in nurse license defense. Not once. Most of the time, a nurse contacts a nurse license defense attorney or nursing law attorney ONLY AFTER the defecation hits the ventilation: the complaint is filed with the State Nursing Board, your union rep tells you "you may need to resign instead of being fired", your employer terminates you and says "we are required to report this to the State Nursing Board", you receive a letter of Complaint from the State Nursing Board, you are told you are being named as a defendant in a nursing malpractice case, you are contacted by local law enforcement about the "incident three weeks ago", etc.

I often hear nurses say "I didn't know there were nursing practice attorneys or nursing law attorneys that help nurses." Yes, there are nursing practice attorneys and nursing law attorneys whose primary role is to assist nurses and/or other licensed healthcare professionals. See www.taana.org.

It is not the role of your nursing manager, nursing supervisor, nursing union representative, risk manager, or anyone else to counsel and advise you objectively about the seriousness of an incident from a licensure, career, employment, or credentialing perspective. This is the role of a private attorney who has experience in nurse license defense, nursing law, and professional nursing practice matters. And guess what? You can't find an attorney with this type of expertise and experience in the yellow pages usually.

Yes, you can call the attorney who handled your divorce, you call the attorney who has helped your extended family in a number of cases, you can put on a blind fold and open the yellow pages and pick an attorney and call for a "free consultation" about your specific issues which is usually a combination of nursing law, professional nursing practice, employment law, labor law, credentialing, criminal law, nursing negligence, etc. Guess what? That attorney will not PROBABLY NOT give you the answer you need because the attorney does not have experience in the area.

Also I am pleasantly surprised yet again by the number of attorneys who represent nurses before the State Nursing Board just to take a case and make a few bucks and who know little or nothing about what it takes to adequately and effectively defend a nurse before the Board and counsel and advise the nurse on attending matters. Is a nurse a nurse a nurse? Of course not. Therefore an attorney is not an attorney is not an attorney. Why do you want an attorney who practices primarily wills and trust representing you before the State Nursing Board? Is it better to have any attorney (regardless of whether or not the attorney has ever practiced before the Board or has experience advising nurses) as opposed to an attorney who can competently handle your case and assist you?

It is your case, your license, and your livelihood and this is a question you as the nurse should answer and consider when retaining counsel. I only practice in the areas of nurse license defense, nursing practice, and nursing law; no wills, no personal injury, no workers comp, etc. You don't have to retain me in Ohio, Kentucky or Indiana; just retain an attorney who can effectively represent you and who has experience representing nurses. Nurses as licensed healthcare professionals have different legal needs than your average consumer and this is significant in the context of representation. These cases are time intensive and you don't want an attorney to take your case and not work it like it should be worked.

What am I saying? I don't say much on the blog these days because my law practice is keeping me busy but I am getting fired up again because I am seeing where nurses are being TOO TRUSTING and not looking after and protecting THEIR LICENSE, CAREER, CREDENTIALS, and hard earned EDUCATION.

Sorry to say this but I am a nurse first also. Nurses are fungible; just look at how nursing employers terminated and discipline nurses: at the drop of a hat. A healthcare organization will fire a nurse with 25 years of experience and loyalty to the organization just as fast as it will terminate a new employee. If you pass gas (and you are not a CRNA :) on a patient care unit, you will be terminated and reported to the State Nursing Board because it "looks better" from a liability, public relations, and accreditation perspective.

But guess what, more facilities are throwing nurse supervisors, nurse managers, and nurse executives to the wolves and under the bus also. This does make me feel better and it shouldn't please you either because it typifies the harsh reality & environment of nursing practice now. More nurse managers and nurse executives are being terminated and I am receiving more and more of these calls and these nurse managers and nurse executives are also being reported to the State Nursing Board.

What am I saying?

1. You know your practice area, don't you? If something happens and its triggers an investigation in the workplace and you are involved, get your own attorney involved to review the situation with you and give you OBJECTIVE legal advice and counseling. You need to have your own Nursing Practice and Nursing Law counsel you can consult with about situations which happen in the workplace. If you are a nurse supervisor, nurse manager, and nurse executive, are you aware of your exposure?

2. Stop listening to the advice and counseling of everyone and their momma about the seriousness of an incident. It is human nature to underestimate the seriousness of an incident to a friend, colleague, or relative because you don't want the worry the person and you want the best for the person.

If I call one of my grandmother's right now and say "mom, I slapped someone and I may be charged criminally", the response will be "it is going to be okay. You are a good person. Who did you slap?  and "I know you type a lot, did you hurt your hand when you slapped this person?"

This may help me feel better emotionally but it certainly doesn't help me deal with the criminal, licensure, legal, and career implications of pimp slapping someone.

By the way, my little sister's 1 y/o son, open hand slapped me so hard (yes, he pimp slapped me) he knocked my glasses off. My sister says he picked this up this behavior in daycare and/or watching cartoons. Really? This was last month and I still smile about it daily. Thank you Baby Chris for putting a smile on Auntie's face whenever I think of you!!!

3. Nurses don't have the income and prestige of dentists or physicians but nurses certainly have similiar liability just a different context. http://www.nso.com/. Take a look at the report, Understanding Nurse Liability from 2006-2010 from Nursing Service Organization.

The public is more aware than ever that you can be sued and you can be reported to a licensing board. Nurses are not self-employed like most dentists and physicians and therefore USUALLY do not have a personal and private attorney for practice, workplace, and career issues. This should not prevent you from consulting with an attorney even if it is one a time basis.

Most nurse attorneys or license defense attorneys may offer a legal consultation. Pay the money and consult with an attorney. It is only your License, Livelihood, and Career on the line. I receive at least 10-35 calls or emails a month from nurses who need legal services but do not want to pay for a legal consultation or legal services. Attorneys like nurses don't work from free (this one doesn't anyway) and it is worth the money to consult with an attorney for a few hundred dollars rather than gamble with your career, isn't it?

I never represent myself. Why would I because I am biased and I would see the facts as I want to see the facts. This is human nature and this is why now more than ever it is important for nurses, a front-line providers who work as at-will employed nurses or who are part of bargaining unit, to consult with a private nursing law or nursing practice attorney about situations in the workplace. Gone are the days when you could say a hospital, nursing home, or healthcare organizations acted in the best interest of its employees; an organization asks what is in the best interest of the organization, right? It is the role of YOUR ATTORNEY to ask what is in the best interest of YOU, as a licensed nurse.

4. If you can, try to negotiate an individual employment contract with a healthcare organization which afford you the same rights physicians have in the medical staff bylaws. Individuals employment contracts hold power for nurses; it is not at-will employment or even collective bargaining. The future of nursing should be Nursing Staff Bylaws and Individual Employment Contracts for All Nurses.

Yes, I said it and I stand by it. I am on the front lines of representation because my clients are front line and bedside providers. The future of nursing lies in securing power and negotiating a seat at the table in healthcare and in the nursing workplace; this power can be obtained in Nursing Staff Bylaws and Individual Employment Contracts not Collective Bargaining Agreements and certainly not At-Will Employment, which is for the birds. This is my opinion and you should have your own opinion. You can email me until the cows come home baby and I will not change my opinion which has been solidified from years of nurse license defense practice and actual nursing practice in a variety of healthcare settings. I seriously doubt I will see cows in my backyard at my home or my office; maybe deer at my home but certainly not cows. Also I don't eat meat, but I may start again, if I see a cow in my backyard.

 

Five 20s: Transforming My Life and My Law Practice

Happy New Year!

I am not posting as much as I used to on the blog because I am working on new plans for the direction of my law practice and career. It will still involve nurse licensure defense but I am planning to significantly decrease the amount of license defense cases I take and concentrate more on working with nurses who are self-employed and business owners and work on more educational ventures for nurses.

Licensure defense work is stressful for lawyers. However I am a nurse first who also just happens to be a lawyer therefore a 100% nurse license defense law practice for me is akin to triage  with bandaids and bottled water on a battlefield with heavy artillery in a Civil War that never ends.

I describe nurse license defense as administrative law with a twist of family law drama and a lot of criminal law "type implications and consequences." Defense Attorneys whether administrative, civil, or criminal can attest to a everyday law practice; just ask.

After 10 years of license defense practice, I am plotting a new direction with my career in 2012. Right now, I am about 90-95% nurse license defense in my law practice. My goal is:

* 20% license defense;

* 20% consulting;

* 20% working with self-employed LPNs, RN, and APRNs as nurse business owners; and

* 20% coaching; and

*  20% legal risk management and education for nurses.

What does Five 20%'s mean? I know how to make money and run a business, provide services, think outside of the box, and have fun while I am doing it. So for me it means I am going to do what ever the hell (with the grace of God of course) I want to do in my 40s with my degrees, credentials, education, and experience; this is what is means practically.

This case below illustrates to me why I want to do more out of the box services and products in nursing:

See this article:http://www.daytondailynews.com/news/dayton-news/starvation-case-shows-abuse-in-state-system-1309284.html

Nursing in 2012 isn't nursing in 2002 or 1992: there is more potential for nursing malpractice, discilinary action against the license, workplace issues, and criminal implications for us as nurses. We need to educate ourselves on these risks, liabilities, and legal issues to protect ourselves and document the patient care provided.

This year don't think of just New Year Resolutions. Resolve to rethink and then transform your life and your nursing career; this is your next phase of evolution.

Honestly, my nurse license defense law practice is my niche and it is my baby. It really is and I know in my heart it will always be more than 20% and probably more like 40% to 60% of my law practice from now and until I pass away at my computer sending an email. I can dream and I can plan can't I? However I am planning to do more in my law practice to assist nurses and nursing students on the front end and proactively rather than reactively going forward in 2012 and beyond. 

Nursing 911! for Legal Matters: 24/7/365 for Ohio, Kentucky, and Indiana Nurses. 513-400-4053

Finally!!!!

I have a twenty-four hotline for RNs, LPNs, and nursing students in Ohio, Kentucky, and Indiana who are looking for legal assistance and representation. It is called Nursing 911! for Legal Matters. Not to be confused with Reno 911! Actually, I LOVE Reno 911!

This telephone line is answered by a virtual receptionist 24 hours a day, 7 days a week, and 365 days a year.

What is a virtual receptionist? A trained professional who answers a telephone line and who is usually physicially located in another city or state from the caller.

Nursing 911! for Legal Matters is only available for nurses with nursing law, State Nursing Board, legal, professional practice, and other matters in Ohio, Kentucky, or Indiana. I am licensed to practice law in Ohio, Kentucky, and Indiana only and cannot provide legal representation before other State Nursing Boards.

If you are looking for assistance in the 47 other states, see www.taana.org.

Nursing 911! for Legal Matters: 24 Hour Hotline Number is 513-400-4053

Call the Hotline and you will hear an announcement.

You will then be transferred to a receptionist who is available 24/7/365.

Provide the receptionist with the following:

1. First and Last Name

2. Mailing Address

3. Telephone Number(s)

4. Email Address

5. Information about your legal matter.

This information is then relayed to my staff and we will f/u with you.

 

A. Does this mean you are my attorney?

You are kidding me, right? No. This is your opportunity to provide me with information about your case to determine if I can assist you. It also allows you to determine whether or not you want to retain my services as your attorney.

B. Can I fax you information?

You are kidding me, right? Yes. My fax number is 888-580-1119.

C. I do not have access to a fax machine, what do I do?

You are kidding me, right? You can scan/email documents to my attention at ldw@nursing-jurisprudence.com. Most local print shops, Fed Ex Kinkos, and Staples/Office Depot have fax machines.

D. Is this a free service?

You are kidding me, right? Yes, but there are limitations because it is free and I still haven't paid my Direct TV bill from July. This provides a 15 minute telephone appt. with me to discuss your case/circumstances/issues. Just 15 minutes. After you call and provide your contact information to my receptionist, if you like, you can schedule your 15 minute telephone appt. with me at:

http://www.tungle.me/latoniadenisewright

E. Is this also a cell phone number?

Yes, this is also a cell phone. You can also text your information (the information to be provided to my receptionist) to my office at 513-400-4053,  24/7/365. My office will then f/u with you.

 

Ready or Not: the $2,500.00 State Nursing Board case

http://www.youtube.com/watch?v=W7MUKF2uE6k&feature=related

http://www.youtube.com/watch?v=0GfUPXfw5Mg&feature=related

Lauryn Hill says it best: Ready or Not.....

Ready or not and (regardless of) whether you realize it or not:

1. The State Nursing Board is investigating you if you receive a Notice of Complaint from the Kentucky Nursing Board or Indiana Board of Nursing or if you receive a Potential Violation Report, telephone call, email, or official correspondence from a Compliance Agent (investigator) or Adjudication Coordinator (Juris Doctor (law degree) prepared Staff) from the Ohio Nursing Board.  

a. It is not the role, responsibility, job, or function of the State Nursing Board or anyone who works for the Board to explain to you what this means to you, for you, and what you shoulda, coulda, maybe, or mighta do or do not. The Board's role is pubic protection: no ifs, no ands, and certainly not buts.

b. You are representing yourself anytime you are not represented by an attorney in legal proceeding. YES, Board of Nursing investigations and complaints are legal proceedings. Therefore anything you do or don't do and how you proceed in the legal proceeding before the State Nursing Board, you are representing yourself.

c. Self-Representation in a legal proceeding is a right just like deciding whether or not you want to retain legal counsel (private or have one appointed  in a criminal matter) in a legal proceeding. No, sorry, attorneys are not provided by the State to represent healthcare professionals in licensure matters.

d. You are an educated and licensed healthcare professional i.e. you have something to lose: your employability, your career, your license, your....... Therefore ANYTIME you as a licensed nurse are involved in a legal proceeding, you MUST ask yourself, do I need a lawyer?

No one is going to hold up a sign and walk a picket line in front of your home saying "Retain a Lawyer."

No one is going to tell you "you are required to hire a lawyer."

No one is going to tell you "you are nuts if you attempt to work through this on your own."

Everyone will tell you:

1. Just tell your side of the story and it will be okay (this is my grandmother's favorite that I figured out to disregard at age 9);

2. This is not a big deal as I am sure the Board of Nursing has bigger fish to fry. I love this one because not only do I like to fish for sport but I also like to eat fish: the bigger the better.

3. It is going to be okay. When anyone tells me this, I immediately think "how and why would you know how it is really doing to be or be not for me?"

4. This is just a misunderstanding, just be honest and it will work itself out. Like what, a knot?

Lawyers can be expensive for corporate litigation and other matters but license defense is actually affordable because the fees are quoted to an individual healthcare professional. Most license defense attorneys will quote you a flat fee or a retainer and hourly fee based on your case and the complexities which is actually affordable when you consider your monthly, annual, or lifetime income as a LPN, RN, or APRN.

If you are NOT willing to spend $2,500 to $__________ to defend your license in a Complaint filed against you for whatever reason, what does this mean to you and for you?

This is why I have legal malpractice insurance that covers malpractice and Bar disciplinary investigations of my license. This is why I still maintain my nursing liability insurance. This is why I just purchased media insurance for my blog and online projects. Because I am a professional, I am licensed, and there is always always a chance I can be sued or reported because of legal, professional,and personal accountability, responsibility, duties, and obligations.

I know this isn't explained in school or discussed in the workplace this way but that's a fact Jack and if you are not comfortable or PREPARED for this, get prepared or surrender your license (as a teacher, nurse, lawyer, dentist, physician, PT, etc.) and work in a field that does not require a State issued license and does not have the regulatory complexities of healthcare.

A Notice of Complaint is a Notice of Complaint and a PVR is a PVR from the Nursing Board regardless of whether or not you appreciate the significance, complexities, or law, legalities, and legal issues therein: it is what is it.

The cases I am seeing in 2010/2011 vs. 2003/2004 before the State Nursing Boards are like day and night. http://www.youtube.com/watch?v=hlbQhD2sxz8

The cases now are much more complex than the $2500 fee from yesteryear. $2500 was the standard fee I quoted years ago but very rarely do I quote a $2500 fee anymore because of the issues involved. That's why I do my own initial phone calls to nurses who contact my office because I need to listen, listen, and ask a question or two before I can quote a flat fee for representation because the $2500 standard State Nursing Board case only comes around once every blue moon and every other purple sun. I also need to review a few documents for myself to get a feel for your case because although I understand what you are telling me, I need to see the paper: black and white.

Also do you want an attorney to quote you a fee of $1,110.56 for Nursing Board representation? Do you know how long these cases take to be worked up and eventually resolved? What type of representation do you honestly think the attorney will provide to you for $1,110.56? Does this $1,110.56 include any research or prep work? What is included for $1,110.56?

This is your State Nursing Board LICENSE, not a muni court case or a will. I do not quote low ball fees just to get a case or bring someone on board and then not work up the case or answer client calls. If you want an extremely low fee, I am probably (99.99% of the time) not that nurse license defense lawyer.  

So even when you say, I called Lawyer A and he told me $2500. I called Lawyer B and she told me $5000, don't expect for me to yell out "BINGO, I can represent you for $3,750.53 and a pack of Apple Now Laters."   

I represent my clients how I would want a lawyer to represent me if: my license, my career, my livelihood and my essence was at stake because I am my license. Sorry. I know others will say you are more than what you do for a living and "your job" but not me.  I am RNBSNJD and LDW Law.  I haven't decided which I want to have on my vanity license plates, what do you think? 

I am committed to my law practice, my nursing career, and the nurses I represent. http://solopracticeuniversity.com/2011/07/12/back-to-the-root-of-things-the-role-of-servant-lawyers/.

Also think about this: are you providing the service each and everyday you practice as a nurse that you expect other service providers to provide to you and your family? If not, Houston, we have a problem.....

NO LICENSE or RESTRICTED LICENSE means a lot to you as a LPN, RN, APRN who is LICENSED or a nursing student, NCLEX-PN or NCLEX-RN on the road to licensure. Your license is always at stake in a State Nursing Board case and ready or not, regardless of whether you realize it or not, it is what it is and what it is usually just the beginning because the Nursing Board investigation is a starting point on a dim and winding path and you may not see the forest because of the trees.

Take a look at these articles.

Download BillofRightsforNursespdf

Download Nurselicensedefenseattorney

 

Worst Traffic Jams on I-71 South and North: Blowing Money Fast and a Hot Pickle

I actually wanted to cry yesterday (I am being dramatic) as I sat in traffic on I-71 South. It normally take the Nursing Law Bandit 90 minutes to drive from Cincinnati to the KY Nursing Board office in Louisville, Kentucky. I always give myself 2 hours for the drive because of the "cut in the hill" in Northern Kentucky and construction as there is always construction on either I-71 or I-75.

Well guess what? Once you turn on I-71 in Northern Kentucky it is essentially one-lane to the Speedway because of the construction barrels. Okay this slowed me down by 60 minutes.

Then guess what? Outside of Louisville BEFORE and AFTER exit 14 and 3 miles before the Synder Freeway there were two accidents. TWO. I sat in traffic here for 3 hours. The expressway was closed for almost 90 minutes.

I left Cincinnati for a 1pm meeting at the KBN office around 11am and I arrived at 3:30pm. Oh and my meeting was for 1pm.

Okay, so I had my meeting and left Louisville, KY around 4:30pm and guess what? More traffic. I had a 6:30pm meeting back in Cincinnati.

There was an accident on I-71 North which slowed traffic and there are construction barrels on 1-71 North making most of the drive a one lane highway.  

I made it back to Cincinnati for my meeting around 7:30pm.  I met with a nurse from 7:30pm to 9:15pm and then returned a few calls.  

Do you know what I ate yesterday? I had a Pepsi, a Mountain Dew, 4 bottles of spring water, and a hot pickle. This was how I ate at age 13.

I rushed in the door at home to let my dogs out of the utility room (my son put the dogs in the utility room around 3pm) and Luke ran by me so fast I fell (it does not take much for me to fall anyway).

I took two Tylenol, reviewed a case file, and went to bed at 1130pm. I spent most of yesterday in my car. But guess what? I have a new car and I reallllllllllllllly didn't mind!!!!

I purchased a Cadillac Crossover with all the fixins. It is a present to me for me for behaving and being nice during  my divorce (sort of but not really), for my 40th birthday, and the prequel to my mid-life crisis. I also purchased myself a touchscreen computer for my birthday earlier this month. I also purchased 12 (yes 12) summer dresses (can be dressed up or down) at Macy's sale last Saturday. These dresses are popping. I plan to buy a new matching purse and handbag set from V. Wang, an Android tablet (for video conferences; I cannot do a video conference with my I-Pad), and at least 2 pairs of patent leather sandals this month on or before 31st. I also plan to eat at Cheesecake factory at least once a week until the 31st. I am spending a little but certainly not Blowing Money Fast (BMF).

If you are driving I-71 to Louisville, KY, considering taking I-75 to Lexington and then driving to Louisville, Kentucky. I will consider this next time. I really need a magic carpet, broom, or the ability to fold space and time like the navigators in Dune!

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.

 

 

Legal Duties vs. Moral and Ethical Obligations: The License is 24/7

IMHO, a test of character and integrity is rising above your legal obligations and duties and doing what is morally and ethically correct although you are not legally obligated to do so.

We live in a time where it is all about the law (this blog is Nursing Law & Order) because you can sue for just about anything these days. A kid gets slapped on the playground now it is suspension from school or expulsion, criminal charges, and a civil suit.

Nurses need to know the law and in particular the practical application of the State Nurse Practice Act and Board of Nursing regulations to everyday practice. This is just a starting point; the bare minimum is the legal. From the legal IMO you can then start to decipher the moral and ethical. In Nursing, the bare legal or barely legal is a matter of perspective.

I make a mighty but still muddled & merely middle class living (I am aspiring to be at the Rick James "I am rich bi$ch" level by my 105 birthday (I just turned 40 on Saturday, July 2nd)) because of "the legal", the gap somewhere between the Nurse Practice Act & Board regs and professional standards and practice and the application to nursing practice and "being" a state licensed nurse 24/7. 

24/7 requires thought and understanding and a big picture view.

24/7 means when you see your best friend throw a punch in the bar after the 6th round of beers you do not start swinging and fighting along side of her and the two of you "go out" like Thelma and Louise. http://en.wikipedia.org/wiki/Thelma_%26_Louise

24/7 means when you get pulled over for drunk driving and you are charged with a DUI, child endangerment, possession of drugs, concealed weapon, and possession of drug paraph., you recognize at some point in the process and actually say "this may be my a## with the BON."

24/7 is 24/7; you are a nurse 24/7. I just renewed by nursing license with the Ohio Nursing Board last week and although there is one person I would really really like to slap, I keep my hands to myself because I am a nurse 24/7 and as a RN (in the Big O only) & a license defense attorney (three states baby) I don't NEED or WANT a DV charge or conviction.

One of my girl friends was arguing with a stranger last month (about the price of gas, the Middle East, and how this impact politics in the US. Why?) when we met for Happy Hour (why are there so many angry folks drinking at Happy Hour anyway?) and I told her, "if you are fighting, I will wait in the car." I am also a lawyer 24/7 and lawyer discipline is another matter.

Every license has benefits and burdens. The benefit of a RN license is the income and career diversity afforded to RNs especially with advanced education or additional experience/expertise and certifications. You can literally write your own ticket in nursing; I am.

The burdens are the legal, ethical, and moral responsibilites, duties, obligations, and liabilities and cross the profession still carries from lack of an entry level to practice, being female dominated, collective bargaining, and from being fractured and operating in environments where nurses have little real control or power. It is always about the money, the power, and the ends & means and the profession still struggles with this and will continue to do so.     

On a Law & Order: SVU episode (I love Detective Stabler; he is nuts!!) one of the detectives commented about being a detective and a police officer and being the job 24/7. Police officers are socialized into this circle and we all have heard about the blue line. Where is this socialization in nursing? Are nursing schools churning out soooo many graduates that there is no time for socialization? Just pat your graduates on the head, give them a business card to a local bail bonds chop shop and an outdated copy of the ANA Code of Ethics, and then say "Go Be Somebody."

24/7. This is the responsibility, accountability, and potential liability that you assume when you get your State Board of Nursing issued RN or LPN license. This is what nursing profs need to tell students and what needs to be stressed to practicing LPNs, RNs, and APRNs.

Who role is it to say this anyway? After I complete my Jedi Knight training, I want to assume part of this role in the profession. Which brings me to my next blog post? Nurse, are you just living or are you living by a code and fulfilling your destiny like Darth Vader or Luke Skywalker?

It ain't all peachy or creamy (I want ice cream) in nursing; it is 24/7 with the license.

Why? Look at the State Nursing Board renewal applications questions. Are you a Misdemeanor Mama or the Felony Father? (I am sorry Mom. I had to say it. I am going to Bible Study this Thursday and early morning service on Sunday. One of my grandmother's reads this blog).

Misdemeanors are misdemeanors and a felony is a felony, whether you are on the job or off the job because you are the job when you can care for John Q. Public; you are a nurse 24/7.  

Kimberly Hiatt, R.N. and the Tragedy of her Suicide: Is it Just Culture, "Just" Culture, or "Just" Termed & State Nursing Boarded?

Please read this story about a nurse who committed suicide after committing a medical error resulting in a patient death. The nurse admitted to making the mistake and subsequent events reportedly pushed her over the edge: being fired from the hospital and a State Nursing Board investigation. 

Is is really just culture or it just culture the newest "PC" term for the powers that be, be not, and be gone in healthcare?

http://www.msnbc.msn.com/id/43529641/ns/health-health_care?gt1=43001

http://news.gather.com/viewArticle.action?articleId=281474979517624

http://www.allvoices.com/contributed-news/9514641-kimberly-hiatt-the-nurse-who-killed-herself-after-overdosing-a-baby

http://allnurses.com/washington-nurses/suicide-of-rn-555775.html

http://josephineensign.wordpress.com/2011/04/24/to-err-is-human-medical-errors-and-the-consequences-for-nurses/

http://thehealthcareblog.com/blog/tag/nursing/

Healthcare providers who commit errors are being called "second victims." The patient is the first victim as the person injured or killed by a preventable error and the second victim is the person who has to live with the mistake: Kimberly Hiatt, R.N. Medical errors can be eliminated 100%  in a perfect healthcare system , with a perfect work environment, with perfect staffing, staff and processes, and administration by the perfect nurse.

I am not sure what type of debate this will spark however the pendulum has swung toooo far to the left or right (whichever hand you use) in general. I get "public protection" and "patient safety" as a priority of course as a nurse license defense attorney but how do you balance this with the rights of nurses (as the largest group of HCPs) who:

1.  are at a severe & extremely unfair and "unjust" disadvantage in the investigation of these cases by the State Nursing Board (compare the rights and more importantly the discovery process afforded to criminal defendants and civil litigants with the rights and "discovery" afforded to licensees in State Nursing Board disciplinary investigations in your state);

2. are usually terminated by the healthcare organization with little or no recourse but filing a "wrongful discharge lawsuit" (I said filing a lawsuit not prevailing...);

3. the now former employer then challenges the  claim for unemployment benefits; and

4. there may or not be a medical mal case lurking (depending on the error); or

5. a criminal case (depending on the error) and more state and regulatory investigations forthcoming.

We are talking about nurses; most of us with two year or diploma degrees who are trained now to pass the NCLEX (there isn't much time left for anything else) and then pushed out into practice into the Where is Waldo World and regulatory maze of practicing "safely" in a healthcare system. What is just culture? I don't know because I don't see it from end of the table expect in a very limited cases; it is certainly not the norm and what is a just culture is subject to more interpretations than Purple Pain by Prince (I wanted to the say the Bible here but I can't; my grandmother reads my blog now). Also some of the blog posts ask why is a nurse treated so differently than a physician or a dentist in this type of siuation? What do you think?

The cards are stacked against nurses from Day One: before any error is committed or before anything happens, the facility has a plan to deal with the situation and you as an at-willed employed or nurse under a CBA. I see it every day and I cringe because it is just so "unjust." 20+ years with an employer means nothing anymore and you will be discharged the same as someone working at the facility for 2 weeks.

You are essentially at the whim of HR and management who while having visions of sugar plums, dates, raisins, figs, and Fig Newtons are mesmerized and magnetized by the brillance and effectiveness of the organization's strategic planning.

The nurse is thinking what will happen to my career, my license, my livelihood, how will I pay my bills now? and what about my family? The employer is thinking about JCAHO, leveraging the State Nursing Board complaint in the grievance process and arbitration as a long-term "plans within plans within plans" strategy for finally busting up the union, and appealing your award of unemployment benefits to the State Supreme Court and to infinity and beyond: which means filing formal Motions to "Engage You in Mortal Kombat" or  in the alternative "Pimp Slap You" on Judge Judy. Just how many blows can one take to the head wearing a broken helmet when the opponent is wearing cheap gold plated brass knuckles?

It is the nurse (with limited resources) against the employer (with deep pockets, trade association backing, and enough insurance coverage and legal needs to make most attorneys (plaintiff or defense) want to sip its Kool-Aid. I make my own Kool-Aid thank you very much.

It becomes the nurse against the world (like Pac) because for most of us your career, your licensure, your employment and your title is who and what you are. It is not just a title, a role, or a job: it is your essence. Kimberly Hiatt, RN is a nurse. LaTonia Denise Wright, RN is a nurse. You are _______ and you are a nurse. For some if not most of us are you are your license.

When you pull and tug at the essence it is like pulling flesh from the bone for some. This is the rawness exposed when you term a nurse and report to the State Nursing Board for whatever reason for some nurses because the nurse and her license are one and the same. License defense rivals family law with the sheer emotion and criminal law with the potential loss of livelihood (instead of liberty). 

Everything comes into question: finances, licensure, career, marriage, relationships, health, etc. all at once and it can be overwhelming and actually knock the wind out of you.  It is a professional matter but it is personal because you are your license and it is your license being questioned. How can it not be personal some of us may say? The condemnation of the nursing practice is internalized because how do you separate the nurse from the license if you are your license? The same can be said for any licensed individual if your license affords you benefits you would not otherwise have without the license: teachers, doctors, lawyers, RTs, MTs, PTs, OTs....... 

This is a tragedy for the family who lost a child.  I am so sorry for your lost.

 This is also a tragedy for the family of the nurse who took her own life at age 50. I am so sorry for your lost.

I am sure some of you are saying I am more than my license and I am more than a nurse; I am not defined by my license, education, or title. Of course you are but until your license, livelihood, and identify as a nurse is threatened, I don't think one can appreciate the throws of what it means for some of us as nurses if you are your license. How would you know that you are your license until this happens and then what do you do? Is this normal? Is it acceptable?

I would like to think if my law licenses and nursing license was in jeopardy and I was in the mix of a professional crisis affecting my small business and law practice, my career as a nurse license defense attorney, and which would certainly impact everything else in my life (to say the least) that I would be okay but you don't know until are there.

Nurses if you are terminated by your employer and subsequently reported to the Board reach out for help if you are having trouble coping with your circumstances. Don't be ashamed; you are a helper and there is nothing wrong with needing help when you are in a crisis. You worked hard to finish nursing school and get your license and you may have to work even harder to keep it. There is always hope and the road ahead is never as bad as it seems if you have faith in a higher power or if you believe this too shall pass.

1. Seek assistance immediately from colleagues, family members, neighbors, and friends to be there for you. This isn't the time to be super-woman or superman. You are being offered help so please take it and utilize your resources.

2. If you need medical care, get it before your health insurance lapses. Also you can seek medical services on a sliding scale basis.

3. If you need mental health assistance, get it. Counseling can be a positive and provide you with an outlet for your feelings of despair, hopelessness, and help you manage the pain and sort through your feelings and emotions. If you need counseling, there are facilities which offer it on a sliding scale basis if you don't have insurance. Consider attending a support group at a local church for unemployed workers; it may give you a totally different perspective on your situation and plight. If you are considering suicide, call someone, call 911, and reach out for help.

4. Talk to someone at your State Nurses Association for general information on your options. Let them know you are a nurse and you are in a crisis: someone whether it is the Executive Director or the Nurse Practice Consultant will listen and assist you. See http://nursingworld.org/FunctionalMenuCategories/AboutANA/WhoWeAre/CMA.aspx

5. If you are a member of a nursing union, contact your union rep and your local union president to further discuss your situation.

6. Seek legal advice and counseling and consider representation before the State Nursing Board. See www.taana.org.

7.  Review your finances carefully as you may need to tap an emergency fund, retirement fund, etc. Tighten up your finances and start spending less. If you need a room mate to make ends meet, get a room mate.

8. Consider applying for unemployment benefits if you are having trouble securing employment.

9. Eat right and do some type of physical exercise. Crying isn't physical exercise.

10. Remember you are loved and you are wanted and needed by your family, your friends, your colleagues, and the profession. I don't know you but I love you because we are all nurses and just one nurse committing suicide because of what is perceived and objectively and subjectively mirrors professional, licensure, and career suicide to nurse is unacceptable and unjust.

 God bless you, Kimberly Hiatt, RN and may your soul rest in peace. 

Kudos to the Washington Nurses Association for doing what it does best.

See http://www.wsna.org/education/workshops/Culture-of-Safety/

http://www.wsna.org/Topics/Patient-Safety/Survey/

 

Where is the "Seat Back" Button for Nurse Licensure and State Nursing matters?

I grew up with my two male cousins (A & B) who were very competitive. Everything was a game: a test of  physical and mental endurance and trying to win.  This was the 70s and 80s and wining meant winning: there is one winner and two losers. It was brutal and little did I know it would shape my personality and who I am and where I am trying to go even today.

Winning was winning not the watered down "everyone is winner" you see now. I perfected my profanity skills at age 8 because of Monopoly. Monopoly ALWAYS ended in crying, a fight, profanity, and/or the board game being thrown across the room with us. I was the only girl but that did not matter here. There was no room for being a girl growing up from age 4 to 13 in a household with competitive boys. I remember taking off my pink nail polish around age 9 before Monopoly games because I did not want to be mocked as being "soft."

I learned from an early age to be very demanding and a little aggressive. My best friend reminded me this weekend when we were five y/o, I told her I would "punch her in the face" if she didn't get out of my neighbor's plastic green swimming pool. The plastic pool wasn't even mine but I was attempting to control the swimming pool and the sandbox at an early age.

We would play a game called "seat back" growing up. My grandfather has relatives in South Carolina which meant a yearly road trip for us. There were three of us in the back seat and only two windows. Do you know how many bloody noses and wrestling matches were started and ended in the backseat because there were only two windows? I am not talking about a pinch or a slap but all out mortal combat type fighting with the sounds from punches and jab.

We developed something called "seat back" which allowed the person sitting by the window to reclaim his or her seat. But you had to call seat back before you left the vehicle or you forfeited your seat next to the window. Do you know how many fights I had because I loved my Pepsi (even as a child) and therefore would be the first one running to the restroom when my grandfather FINALLY stopped at a rest stop (after passing 8  rest stops driving down I-75) and I forgot to call seat back?

There is no seat back in real life and there is certainly no seat back with the State Nursing Board in complaint investigation and adjudicative matters. You cannot submit a 50 page response with exhibits to a complaint and then when things:

a. Go Sour;

b. Take a road you didn't expect;

c. Take a road you thought about but did not really consider;

d. Take a road you were told about online but did not think applied to you;

e. Take a road which looks, feels, and tasts like the worst case scenario; or

f. do not go the way you want it to go

you say "Seat Back" and you return to the beginning or where you initially started.

If anyone finds a seat back button for life  and nurse licensure matters let me know.

Until then I have to cherish my memories of screaming seatback to Cousin A & B on road trips which then transferred to daily driving. I still laugh when another male cousin C drove "down South" with us one year and he was confused and bewildered by "seat back." I took his seat by the window because I told him he forgot to say "seat back" twice and this was a rule. He cried and I smiled. My grandmother looked at me and rolled her eyes, Cousin A laughed because he had a window. Cousin B said I cheated because he was sitting next to the "hump" in the middle and he did not have a window. He called me a cheater so of course, we had a back seat slug fest for 30 seconds until my grandfather opened the car door.

When you are deciding whether or not to represent yourself before the State Nursing Board talk to at least 2-3 attorneys on the cost of representation before you decide to represent yourself because there is no seat back before the State Nursing Board in a disciplinary investigation or in licensure matters.

Oh and for you softies, my Cousin C didn't want the window seat anyway.  I later told him the back door could fly open up anytime. Therefore he agreed to sit in the middle of the back seat and not participate in Seat Back with us.

 

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.  

The $997.00 retainer plus an Oreo Blizzard from Diary Queen: Nurse-Owned Business

Let's say you are planning to start your own home care agency, consulting practice, medical practice, staffing agency, LNC group, or any other nurse-owned business.

You will need an accountant and book keeper at some point. You may also need a practice advisor. You may also need a business law attorney to assist you with incorporation and other general business issues.

At some point however you are going to need the services of a nursing law attorney to assist with a matter, provide an opinion, or provide risk management and regulatory compliance services. 

There is only soooooo much you can obtain from websites, blogs, chatrooms, forums, and self-help and "for dummies for dummies books." I have my share of "for dummies" books. For dummies provides a general overview of what you or may not need to know on any given topic. But how do you know what you don't know if you don't know what you are doing?

I purchased one for Quickbooks for Law Firms last week. I am still on page 1. I had my personal assistant schedule an appt. with my accountant and I am going to work his book keeper and probably use Quickbooks Online for my law firm going forward. It is not an efficient use of my time to pull my hair out with Quickbooks along with the other projects, tasks, and cases I am working on in my law firm.

Trust me this law firm will not be one of the many law firms you read about that had "a bizillion dollars" stole by ABC a long-term and trusted employee over a 2 year period. How can you not miss hundreds or thousands of dollars in your own cash? I don't even keep "cash" in my wallet because I want to track/trend my spending.

There is nothing wrong with saving a dollar or two but when you are self-employed and a small business owner you have to delegate at some point. You must also pay for professional services for your business. I am a small business owner and I also practice law which means I had to find a system/process for delegation which fit my non-traditional law firm and niche law practice: just nursing.

I finally figured out how to make it work for my law practice. My office manager is Tina. Tina works me virtually M-F, 9am to 3pm. Tina manages my online calendar, schedules my appointments, and assists me with new case intake and processing.

I have two personal assistants. Maya works 0930 to 2pm M-F with me and Jaren works with me from 10am to 5pm M-F. Jaren and Maya work together and directly with me on a variety of law firm, professional, and personal projects/tasks.  We are working with a new project management software which syncs perfectly with Google Business Apps.

Google Business Apps (paid version) is the truth.

Jack works me sometimes a little, sometimes a lot, depending on the caseload and what he has cooking in his own business.

Hiring staff, independent contractors, or retaining professionals to provide professional services costs money.  However the key is reviewing what works for you depending on your business and practice model; it took me 3 years to figure out what works for my law practice and my law firm.

It is worth every penny to have client calls answered promptly, to have client meetings scheduled immediately, and to have a team to really work up and run the lenght of a case that is needed in license defense and a nursing law practice. My overhead with my part-time staff is reasonable and certainly signficantly less than what you see with a traditional law firm staffed with a receptionists, secretaries, paralegals/legal assistants, practice managers, attorneys, etc.

There are only so many "For Dummies" books and manuals you can read. I have Excel for Dummies and I have not opened the book in 3 years. I hate Excel because I was not trained properly and it is not a skill which I need in my knowledge, skills, and abilities to practice as a nurse license defense attorney.  

I am waiting for release of Vegetable & Chicken Noodle Soup (with crackers) for Dummies. I will pre-order my copy on Amazon.com when available.

At some point you have to bite the bullet and hire a professional to assist you in providing specialized services for your business. Also there are soooo many arrangements available now outside of the traditional employer-employee relationship.

During my two and half weeks off in the form of staycation (I am too busy to take an actual vacation this summer) I spoke with a number of nurses involved in State Nursing Board investigations and post-discipline cases. Some retained me and some did not, for whatever reason.

I am not the cheapest attorney and if you are looking for someone who can give you the " K-Mart Blue Light Special" on a flat fee; 99.99% of the time, it will not be me.  There are a number of attorneys who handle these cases (Columbus, Indianapolis, Louisville, and then there is me here in Cinti practicing in all three states) and I quote the fee based on the information I have and the intake interview. If your case is more complex, the fee will be higher.

If you had licensure issues as a LPN, RN, and now again as a APRN, this will be reflected in the fee I quote; your fee will not be $2,500.00. Sorry. Maybe in another practice but not here. I am not just taking cases to take cases; I take cases to work the case for the long run. I am "in it to win it" like Hil Clinton. She is coming back, you know.

Maybe once I hit the lotto, I can advertise that I will accept any licensure case, any case, and represent from investigation to hearing to post-disciplinary monitoring and beyond (head to toe) for $999.97 and a large Oreo Blizzard from Diary Queen, but not today.

Nurses who are small business owners will eventually need the services of a nursing law attorney to assist with some aspect of the business. I am a nurse who owns a small business. Retain an attorney and move forward with your business; it is a cost of doing business and it helps you safeguard your nursing license if you are also practicing in your business.

Similiarities between Criminal Defense and Nurse License Defense: Doing Time & the Expecations of Representation

I am on a staycation for the next two and half weeks. My first stayaction but certainly not my last. I am taking new cases and scheduling legal consultations and using the "staycation" to work up my cases. I am also taking time off for one week in July and one week in August. I am actually planning to take a one week staycation every month going forward for the remainder of the legal career so that I can make sure I am taking care of myself in addition to my clients, etc. I am also rearranging my work schedule and my life in the process. More on this later.  

I want to introduce you to my personal assistant Maya. Maya works as my personal assistant Monday-Friday 10am to 2pm. I am training Maya to essentially function as my legal assistant and paralegal and to assist me with my cases, marketing, and other law office projects. Maya works with me from my home office and she also works from my traditional office as well. Maya's direct dial and Skype is 513-258-2876.

Why a personal assistant? I do not have a traditional law firm and therefore my attempts to hire someone trained as a legal assistant or paralegal failed miserably because most could not wrap their minds around the setup of my law firm because their background was traditional law firms: punch a time clock, receptionist, paralegal, secretaries, stacks and stacks of paper files, and everyone on one floor in the same building. This is why I hired a personal assistant and I plan to train her to my practice.

Also I want to introduce you to Tina, my Intake Specialist and Scheduler. Tina manages my calendar and schedules all of my appts. Tina's lives in central Indiana and works for my law firm virtually. Tina works Monday-Friday 9am to 4pm . Tina's direct dial and Skype is (765) 588-4304.

I am attending a webinar for criminal defense attorneys. I tell you there are more similiarities between criminal defense and licensure defense than differences.

How do you deal with a client with unrealistic expectations? This was the first question posed by the presenter. I deal with this issue every day, day in and day out. Expectations of the Representation.

The presenter also mentioned that the role of a criminal defense attorney usually boils down to persuading a client to take a miserable sentence vs. a horrible sentence. Wow!!!! Although action against the license isn't a "loss of liberty" or even remotely similiar to jail time or doing time in a state or federal prison, the reality is "action against the license" whether a public reprimand, probation, suspension, non-permanent revocation, or permanent revocation is akin to a professional and career jail sentence in a sense.

Legal Consultations: One Ring to Rule them ALL and Ketchup vs. Mustard

I have from 5 to 40 legal consultations in a month usually by phone with nurses throughout Ohio, Kentucky, and Indiana. 

The benefits of a legal consultation for a nurse are:

1. You have an objective attorney reviewing your case;

2. You are able to ask questions and receive solid advice and counseling about your situation; and

3. The cost is $150-$250.00 in my law firm. Some license defense attorneys charge $500-$1,000.00 for legal consultations. For example, there is an attorney who charges $750.00 for a 2 1/2 hour consultation and this is the minimum and includes all his preparation time reviewing your materials and performing research on the issues therein.

What I am a finding however is that I have a lot of nurses who become quite hostile and argumentative with me during legal consulations because I am not telling them what they want to hear, I am not agreeing with them, or I am being "too direct and too blunt."

I think this is why we lawyers get a bad rep because it is our role to "tell it how it is." If you are paying a professional and the professional is telling you exactly what you want to hear about yourself and your situation, then you are wasting your money. 

Objective advise and counseling: this is what an attorney does. However, most nurses involved in a State Nursing Board case are proceeding pro se, most nurses being monitored by the State Board are pro se, and most nurses who are in a Board Alternative to Discipline program are pro se.

Pro se meaning you are representing, counseling, and advising yourself in the matter. It is difficult to be objective and critically review and analyze your own situation from a legal, clinical, and professional practice standpoint. When you are representing yourself it becomes a epic battle for mankind and the fate of the world rests in your hands.

I had a nurse tell me the following in reference to a State Nursing Board investigation and an employment termination, "I now know how Jesus Christ felt when he was prosecuted." No comment.

It emotionally becomes One Little Nurse vs. the Big Bad State Nursing Board (not the Big & Bad, just Big Bad) which is huffing and puffing to blow down everything you  accomplished: your licensure, your career, your family, and your life. 

It is portrayed to colleagues, family, friends, and "anyone who will listen" as serious as the epic battle for Middle Earth and the "Rings of Power" akin to good vs. evil, the Jedi vs. the Sith, and Ketchup vs. Mustard.  

If you are representing yourself before the State Nursing Board consider a legal consultation with a nurse license defense attorney in your state; it may be the reality check you need to place the case in the proper prospective.  

Hello, my name is LaTonia, I am Your Legal Therapist. My office hours are 11:30pm to 11:45pm every 3rd Tuesday of any month ending with the letter "r" or "y"

I terminated my legal representation of a nurse in the past because this nurse was just too difficult to deal work with in a professional relationship. Also the nurse refused to accept any responsibility or accountability for the actions or even acknowledge the obvious.  

We remained professional with the nurse at all times but I should have terminated the representation  earlier. I shook my head when I received the correspondence requesting the client file from the new attorney of the nurse because I would not wish that client on any lawyer.

 The nurse developed a case theory the nurse just knew would work.

I told the nurse in a nutshell even if we pretend, this ain't CSI; it is Nursing Law & Order.

Anything is possible, Neo but let's discuss the probabilities because this ties into the burden of proof and persuasion.

The spouse of the nurse berated me for not "trusting in and believing in" the nurse. FTW, you are kidding me, right?

I trust and believe Jesus died for my sins.

The spouse told me the nurse would be CLEARED of all charges at a Nursing Board hearing with a new attorney who trusted and believed.

I thought to myself: maybe an imaginary hearing with the Snow White as a hearing officer but certainly not a formal adjudication in an administrative law matter.

The nurse was nasty. This nurse was my nastiest client. By the way, I fired my first, second, and third nastiest clients. Life it too short to deal with nasty clients because I love what I do. I don't want to start calling off at work, taking extended FMLA leaves, or start smoking and then disappearing for 2 hour smoke breaks before and after my lunch smoke as a coping mechanism. 

By nasty here I am referring to a aggressive disposition, a disruptive personality, condescending tone with everyone,  emotional and uncontrollable outbursts ranging from excitement to panic to sadness to rage in 15 minutes, etc. I don't know whether to continue to take notes or  make a run to an exit but not before closing the door to lock Jack in the room.

I am a counselor; a counselor at law that is  pumpkin, not a therapist unless you need legal therapy. I guess I am a Legal Therapist. LOL. My office hours are 11:30pm to 11:45pm every 3rd Tuesday of any month ending with the letter "r" or "y" if you need assistance. I see clients, return calls and answer emails or texts and conduct business only during the stated office hours.

Back to Nasty.

Angry Nasty;

Nasty Nasty; and now

Disciplined Nasty. I mean Disciplined Hard.  I had to read and then re-read the discipline. No hearing by the way: settled.

Just a word of practical advice:

1. Allow your license defense attorney to assist you in developing your legal strategy;

2. Be honest with your lawyer; why pay your a lawyer and then lie to your lawyer? 

That's like going to a weight loss clinic and saying you don't want pills; you just came in to be weighed. It makes no damn sense; 

3. Don't watch CSI and try to develop conclusions of law and findings of fact  for your case based on a CSI episode. It is Nursing Law & Order; and

4. I zealously represent my clients and I counsel and advise my clients. But remember I critically think for a living. I make my money critically thinking about nursing and the law. All day. Remember this when you retain me and start to shovel the ......

5. Life is too short to be nasty to anyone trying to help you help yourself.

Even though you were Super Nasty, I wish you the best with:

a. Securing employment during the years your nursing license is suspended;

b. Meeting the terms/conditions for the reinstatement of your nursing license;

c. Securing nursing employment during your Nursing Board probationary period;

d. Meeting the terms and conditions of your Nursing Board probation; 

e. Having the terms/conditions of your Nursing Board probation lifted; and

f. Your nursing career.