Nursing Law & Order

Nursing Professional Associations Are Struggling for Members: Nursing Associations of the Past Should not be the Nursing Associations of the Future

I supported the Licensed Practical Nurse Association of Ohio (LPNAO) in the past by purchasing a booth, donating products, or buying advertisement in program meeting brochures. LPNAO like many other nursing professional associations is struggling financial because membership is decreasing. See the President's message at http://www.lpnao.org/.

Why are nursing professional associations struggling for membership? Why don't nurses support the very professional associations which purportedly represent them and the profession? Do you feel that the nursing professional associations adequately represent the profession of nursing? Are there too many nursing professional associations? There are national, state, local, and specialty nursing associations around the country and the majority of RNs, some three million, yes 3 million, do not belong to ANY nursing professional association whether its a national, local, state, or specialty association.

I must add in fairness to nursing associations/organizations that membership in all professional associations across the spectrum are down because of the economy.

http://www.asaecenter.org/PublicationsResources/ANowDetail.cfm?ItemNumber=44103

http://www.issociate.com/issociate-101/Postings/Association-Help/How-social-networking-could-end-professional-associations/default.aspx

http://www.canadianmarketingblog.com/archives/2009/05/professional_associations_repo.html

http://www.ammr.com/PayingTheirDues.pdf

http://www.washingtonpost.com/wp-dyn/content/article/2008/12/14/AR2008121401638.html

http://meetingsnet.com/associationmeetings/mag/meetings_associations_aim_generation/

http://blogs.capella.edu/askdoctoraladvising/2009/10/07/professional-associations-do-i-have-to/

http://www.publicrelationsprincess.com/2009/10/are-professional-associations-obligated-to-help-job-seekers.html

http://www3.interscience.wiley.com/journal/114080275/abstract?CRETRY=1&SRETRY=0

http://www.dcardillo.com/articles/assoc.html

http://allnurses.com/nursing-activism-healthcare/ana-membership-388073.html

See

http://www.nursingworld.org/EspeciallyForYou/Links/SpecialtyNursing.aspx

What does that say to you as a nurse? How many nursing professional association do you belong to at this point? Are you planning to continue your membership?

I belong to the American Nurses Association, the Center for American Nurses, the Ohio Nurses Association, and the Southwestern Ohio Nurses Associations. I pay close to $36.00 a month to belong to all four of these organizations. I also belong to The American Association of Nurse Attorneys (TAANA) and I pay $170.00 a year.

I can tell you as one who has been active in nursing professional associations that those who participate in the associations, run the committees, and do the work of the association, don't understand why the majority of nurses don't join. Its almost like "oh those nurses who don't join don't know any better" and "we who do join, belong, and actively participate are doing so because other won't." I have been told that "somone must do the work of the profession even if the majority of nurses don't belong to the association."

Its easy to fall into this self-defeating train of logic and thinking but honestly after participating in several nursing professional associations on the national, state, and local levels for years, I can see why the majority of nurses don't belong to some of these organizations. I don't say this as a slap in the face to any one organization or association but I don't think the powers that be in some associations "get it" or understand what needs to be done or want to do what needs to be done to be appealing to the vast majority of nurses.

What got a small percentage of nurses to join these association twenty or thirty years ago (hell even 10 years ago) is not working. Case in point. Alot of nursing students support the National Student Nurses Association but then don't transition into membership in a nursing professional association. Why?

What do these organizations/associations need to do to get the majority of nurses in the United States to belong to an association/organization?

I look at the American Bar Association. I belong to the American Bar Association and the Ohio Bar Association. There are also a number of specialty bar association like nursing associations. A large percentage of attorneys join the American Bar Association. Don't say its because attorneys have more money because some attorneys make less than what some nurses earn in a year.

I wouldn't part with my ABA membership of the value of the products I receive from the Bar Association and the ABA is involved in everything legal and advocating for attorneys on every topic here in the US and overseas.

With Web 2.0 and online communities and training of a new and the next generation of nurses, the demands of nursing practice and balancing a life outside of your role, the nursing associations of the past should not be the nursing associations of the future.

Conflict Management: Past, Present, and Future legal webinar

https://m360.centerforamericannurses.org/event.aspx?eventID=11011

Free Webinar: Retirement Planning for Busy Nurses

My 401K with the American Bar Association took a hit last year and I thought well I guess I will work until I die. Its looking a little better now and so is my IRA.

Are you ready for retirement? When do you plan to retire? Are you planning to retire?

You cannot work forever and working up until you die full-time probably isn't healthy but you are seeing it more and more these days. I am 38 years old now. I don't want to retire at 55 but I would like to be able to down shift around 50 or 55.

My sweetie and I have a monthly financial planning meeting where we review our expenses, income, and goals. It gives us a reason to eat at the Cheesecake Factory and it forces us to discuss money and finances. Before we got married we reviewed each other credit reports and the works because we wanted to approach our marriage as a team (although we have been living together for a number of years anyway).

Its never too late or too early to plan for retirement as a nurse. The Center for American Nurses is sponsoring a free webinar for nurses on retirement. See

https://www2.gotomeeting.com/register/492433170

Is it the End of Lawyers? Not this one. Is it the End of Nurses? Not this one.

I ordered a book titled the End of Lawyers by Richard Susskind from Amazon. It should be delivered this week. http://www.susskind.com/endoflawyers.html

Is it the End of Lawyers? Maybe some law firms and attorneys will go the way of the dinosaurs but not this one. Some lawyers and law firms don't want to see themselves as a business and only want to look at the practice of law as profession. The practice of law is a profession and business and both of these concepts are very important.

I remember being told "a law practice representing nurses isn't a viable concept." Really! I did things my way from the beginning for better and for worse and the kinks are rolling out. I am not a traditional attorney and I did not want to have a traditional law practice with traditional clients and a traditional law office. I was told 10 years ago that attorneys shouldn't be consultants and you should focus exclusively on the law. Whatever. I have a law firm and a consulting firm and one of my goals for next year is to grow my consulting practice.

I love working on the marketing, advertising, selling, and business development practices in my law and consulting firms. I started my law practice from scratch like my Mississippi Mud Pie (which is soooo delicious by the way) and therefore I learned early that you have to market yourself, differientiate your law practice from the thousands of other lawyers out there, practice law, and keep your clients happy.

It may be the end for some lawyers but not this one, baby. I am the only RN-JD who practices law in Ohio, Kentucky, and Indiana and represents, counsels, and advises nurses in State Nursing Board and professional practice matters. This didn't happen over night but I have worked hard and I am still working hard to develop my law practice and run my business. I don't have any plans to hire additional attorneys as I like working one or one with my clients because this isn't just a job or something I do to make "a buck."

It depends on your perspective. Are you just here? Are you just living life? Are you just going through the motions and you are oblivious to the path and the destination being plotted? Or are you fulfilling your destiny like Luke Skywalker? Use the force, Luke!!!

Maybe I have watched one too many Sci Fi movies but life is so much more interesting when you are striving to be the person you dreamed you could be and each page that you turn in this massive book called life is a journey.  

Is it the end of nurses? Do you see nursing as a profession and a business? Is the practice of nursing a business? Are nurses prepared by nursing schools/colleges to see the practice of nursing as a business and a profession?

How are you positioning yourself for the nursing workforce of the future?

Wet to Dry Dressing Changes BID: I am one of my grandfather's home health RN's

Guess who is changing her grandpa's abdominal dressing? You guessed correctly. The wound looks good and is healing. I did the dressing changes BID over the weekend and I do the evening dressing changes.

My grandmother is very particular and you know how scheduling goes with home care cases for evening dressing changes. Its the oncall person or a prn nurse or whoever can cover the visit so I am going his dressing changes in the evening.

My grandparents live within walking distance of our home (less than mile) and when I went in the house yesterday evening for his dressing change my grandfather asked me if I had a "paper" for him to sign so I could get paid. How funny and how sweet!

His primary nurse told him to watch his "Percocet" because some nurses may try to pocket the medication. Wow! I am a nurse license defense attorney and I wouldn't even say this. What's really going on here?

Nursing Documentation Disasters: My Top 10 for the Funky Stuff

I am hearing about some pretty wild things going on related to nurses and documentation. So here it is, my top ten documentation disasters for the funky stuff (this is a legal term):

1. Charting ahead. Oh you know what I mean. Its only 8pm and you have charted up until 5am the next day for your 7pm-7am shift.

2. Addendums. Making addendums or changes in a medical record or on patient care documentation in violation of your facility policy.

3. Submission of false billing documentation for skilled nursing services provided and you are paid for those services. Why are you submitting notes for services you didn't provide anyway? Have you ever heard of fraud or theft?

4. Signing off documentation, charts, or flowsheets using someone else's signature. WTF, why are you intializing or signing "anything" for someone else anyway?

5. Destroying, concealing, creating, or alterating any type of medical record, flowsheet, competency, etc. after an incident to paint a prettier picture of the incident. What is your intent here?

6. Charting you peformed a task or skill on a flow sheet or in the medical record and you didn't perform the skill or task.

7. Sneaking a peek at the electronic medical records of your neighbors, family, and friends who are admitted to your hospital and you are not assigned to provide care for these individuals.

8. Getting sloppy with your administration, handling, and documentation of controlled substances in a hospital. Its your career and your license on the line. The Pharmacy Board and the police may get involved so don't be surprised.

9. Getting sloppy with your administration, handling, and documentation and counting of controlled substances in a nursing home or assisted living facility. Its your career and your license on the line. The Pharmacy Board and the police may get involved so don't be surprised.

10. The cover-up or a conspiracy (two or more nurses) to cover-up is always worse.

Have you ever heard of monkey see, monkey do?

If a nurse colleague jumped off a bridge, would you do the same just because your colleague did it?

My grandmother would say this to us all of the time growing up. LaTonia, if you saw one of your friends jump off a bridge, would you jump off the bridge? I would always so "no" of course but peer pressure is a "mother" also. Get it, now that's funny.

Trying to cover-up and conceal 1-9 and using deceit, deception, and dishonesty to rationalize your behaviors, actions or inaction when 1-9 occurs or you know that 1-9 is happening on your unit or floor and you do nothing. Remember, there is a Code of Ethics for Nurses and nursing laws and rules governing your practice.

If the funky stuff is happening on your unit, contact your State Nurses Association or a nursing law attorney in your state or jurisdiction to determine what are your reporting obligations.

Are you a charge nurse, DON, ADON, nurse supervisor, or nurse manager? Legal Issues for Nurse Supervisors and Nurse Managers

I am seeing more issues in my law practice involving nursing supervisors and nurse managers. In your opinion what are some of the legal issues facing nursing supervisors? What are some of the legal issues facing nurse managers?

Don't let the approaching holidays stress you out! I can feel it coming....

Fall is here and things are moving steady at my law office. I am in the process of hiring a part-time legal assistant and I have a recovery assistant, a former CRNA in recovery for addiction who assists me with my law practice cases involving dependence and controlled substance discrepancies. I am looking at my practice goals for 2009 and starting to plan for 2010.

I am looking forward to the Holidays but I don't know about your family but I have a large extended family and there is a constant and persistent amount of what I call "more drama for your mama" throughout the year. The drama goes to an all high after Halloween, peaks at Thanksgiving, spikes again around Christmas, blows a gasket around New Years Day and slowly trickles downward until the first week in February.

One way I have found to control the madness is to plan for the madness, expect the madness, and embrace the madness. I don't get angry or upset because I know its coming and it too will run its course. I love the Holidays because I use the New Year as way to shed the years past and move forward into a brighter future. I also start planning my financial, professional, and personal goals for the upcoming year about this time of the year.

What are your nursing career goals for 2010?

What would you like to do differently in 2010?

Are you planning to stay with your current employer?

Are you planning to switch to a different floor or unit?

Are you considering certification?

Are you going back to college for a degree?

I would really like to start practicing again as a RN. Maybe a few visits a month as a home health RN again. I need to do my CPR and have a lengthy orientation to get up to speed again. I am also thinking about a nursing refresher course and taking CE online. This is one of my goals for 2010. I miss the hands on nursing and would like to start in home care again.

I would also like to do a law and healthcare related fellowship by 2015 and I am going to start looking around because of course there are none here in Cincinnati. It would be in Chicago or Washington, D.C. Maybe complete a MSN with the fellowship or a Masters in "something."

Don't let the Holidays stress you out. Take stock of your blessing and your accomplishments and your family as we move forward into 2010. Onward and forward....

The Road Warrior is resting today and Happy Sweetest Day!

I am a little tired today. The drive from Cincinnati to Louisville to Cincinnati on Thursday and then the drive from Cincinnati to Columbus to Cincinnati on Friday took its toll on me. I was planning to drive to Independence, Ohio for the Ohio Nurses Association Convention but it "ain't gone happen." I am even trying to bribe my husband into driving me to Independence, Ohio late this evening so that I can particpate in the last day of the convention activities but he is tired also from working long hours.

I am resting today. Sipping a Bartles & James cooler and watching the Boondock Saints, Dune, and Lord of the Rings Return of the King. I have plans this evening with my sweetie. This is our first Sweetest Day being married. We are always looking for an excuse to celebrate something and rationalize having dinner at the Cheesecake Factory.

Happy Sweetest Day!

Firing A Client is Never Easy: What if we lived in a perfect world?

I fired a client yesterday. It wasn't an easy thing to do but it was necessary. I wish that I could make everything all right in these cases for my clients but this is real life, real issues, real drama, and therefore I "keep it real" with all my clients.  

If you are looking for an attorney to just tell you what you want to hear, then don't call LaTonia Denise Wright, RN, BSN, JD. For some of us that's hard. I must admit when I have legal issues (yes attorneys have legal issues that arise) it hard for me to absorb the legal advice provided to me by own legal counsel. Years ago I planned to fight a fine "all the way to the Supreme Court" because I knew I was right. I called my personal attorney. She laughed at me. We are friends so she laughed at me a little more over the phone. She took me out to dinner, laughed at me some more, listened to me, and then gave me legal advice. I paid the fine.

What I have found in 12 years of law practice and 8 years in nurse license defense is its even harder to absorb for some nurses who have been representing themselves over an extended period of time in a State Nursing Board matter(s). I am going to add these types of cases to my red flag list going forward because as I was driving home from Louisville (I also attended part of the Kentucky Nursing Board meeting) yesterday, I kept thinking you should have seen this one coming. Actually I only recently started representing the nurse this month so damn, I guess I did see it coming. But that's what 12 years of law practice and 8 of those years on the legal battlefield performing triage teaches you, baby!

A nurse with a long standing State Nursing Board case may say I know my case, the facts, and the issues better than some attorney who I just retained, right?

I wish we lived in a perfect world. In a perfect world, I wouldn't have a law practice representing nurses before the State Nursing Board because in a perfect world, nurses would not be reported to the State Nursing Board. In a perfect world, all nurses would also be perfect and there would not be a need for mandatory reporting to the State Nursing Board.

My Grandfather is Recovering in the Hospital and Going Well

My grandfather had surgery last week and is recovering. Please keep us in your prayers.

Pre-Licensure Issues evolve into Post-Licensure Issues for Nursing Students and NCLEX-Applicants

This has been a very interesting year. I am being contacted by more nursing students and NCLEX-Applicants with a variety of legal issues pre-licensure which carry over into post-licensure issues.

I remember being in nursing school. Most nursing students don't have the funds to retain legal counsel. I know I didn't have that kind of money (okay I did in a rainy day fund) to spend on attorney fees. But I was initially licensed in 1993 as a RN and licensure for nurses has changed alot since then.

Pre-licensure issues for nursing students and NCLEX-Appplicants are turning into post-licensure issues for newly licensed RNs and LPNS, which may then carry on and forward into their nursing career, workplace, and may restrict employment opportunities.

I know they don't tell you this in nursing school but I guess its not their "job" to tell you these things. I hear

*  Why didn't my nursing instructors tell me this?

*  I can't find a job with all these restrictions on my license!

*  I didn't know I could contact an attorney!

*  Why wasn't an attorney appointed to represent me?

* What am I going to do now?

Then it gets even more difficult when you want to move out of state and obtain a license somewhere else. If you have pre-licensure issues, retain an attorney. If you don't have the money, talk to relatives or immediate family members. I am seeing nurses who are investing $20-60k in a nursing education (for a diploma, ASN, or BSN) only to find out at the end of the road that there is a licensure dance.

Do you dance by yourself? Or do you retain legal counsel and dance with a partner? The decision is yours of course and economic realities may dictate that you dance alone.

Attorney-Client Relationship Joke from an American Bar Association listserve

A guy wakes up and finds himself in a hot air balloon hovering over a big
green field about 50 feet from the air with no way to get down.  He looks
down and sees someone on the ground.  He calls out and says "Hey, where am
I? What's going on?"

The man on the grounds says:  "You're in a hot air balloon hovering over a
big green field 50 feet above ground with the wind blowing around 10 mph."

Balloon Man says with disgust "You must be a lawyer."

Ground Man says "Why do you say that?"

Balloon Man responds, "Because all you've done is tell me what I already
know and what trouble I'm in."

Ground Man responds "Well, you must be a client.  I did nothing to get you
into the situation you are in and yet somehow now I am responsible for it."

Center for American Nurses: September 2009 Activities for Nurses

Nurses and Retirement Security

Nurses appear to be taking far better care of their patients than they are their financial futures, according to a survey released today by the Center for American Nurses and the Women’s Institute for a Secure Retirement (WISER).   The Nurse Investor Education Survey reveals that nurses may be saving for retirement, but few are planning and investing to meet retirement needs.  In fact, most nurses say they do not know what those needs will be.
                                                                                                                  read more...

Legal Webinar for Nurses:  Nursing License Compact:  Pros and Cons

Presented by Carol Roe, RN, MSN, JD
Wednesday, September 16, 2009, 7:00 – 8:15 pm Eastern Time
CNE Contact Hours:  1.25

• Recall at least of one of concerns with the identified with the Nurse Licensure Compact
• Identify at least two benefits of the Nurse Licensure Compact
• Define the Nurse Licensure Compact
                                                                                                      read more...
  

                                                                                                                                                  

Webinar:  Embracing the Joint Commission’s Leadership Standard on Conflict Management
Wednesday, September 16, 2009, 2:00 pm Eastern Time    
                                                                                                               read more...



For more information call 1-800-685-4076.

Entry level to practice in nursing should be at the BSN level; not ASN or Diploma

I have a ASN and BSN but at some point nursing needs to move forward with a BSN as the entry level to practice nursing in this country. http://www.usatoday.com/money/economy/employment/2009-09-01-jobs-community-college_N.htm

See this article in USA Today where registered nurses are listed as hot jobs not requiring a bachelor's degree. Nurses, we cannot have it both ways; we cannot continue to scream we want and deserve respect but we don't have the educational credentials and qualifications as a profession needed to sit at the table with physicians, physical therapists, occupational therapists, pharmacists, and other healthcare professions. Most healthcare professions have moved to a Masters or Doctor level degree for practice and nursing is still struggling, arguing, and divided over whether the bachelor's degree should be the entry level to practice.

Just my opinion but we need to set the BSN as the entry level to practice starting in 2015, grandfather others in, and move on to something else. If we ever want to be really respected and really valued then we really need the education to elevate the profession as a whole; its not just about the individual nurse.

I would like to go back to school

Are you currently in school? One of my good friends is working on a certificate at a local university. She has a JD, MBA, and is working on a certificate for non-profit administration. She has always worked full-time and attended school and pulled it off without hitch.

I have alot going on now with running my law practice, tying the knot last month, and keeping my eyes on my elderly grandparents but I would love to muster up a real desire to return to school. Maybe for a MSN in education or community health. Or maybe a Masters in Women's Health Studies.

Are you currently in school? If so, how are you managing?  

Please Say a Prayer for My Grandmother, She is Having Surgery Today

My paternal grandmother is having surgery today to have her gallbladder removed. She is in excellent health. I love both of my grandmothers (maternal and paternal) so much and it is a joy for me to be able to be there for them as they are aging because they were there for me as a child, teenager, and as a single mother obtaining ASN, BSN, and JD degrees. Even now both of my grandmothers are still here for me.

I can honestly say I don't how my life would have turned out and I certainly would not be the person who I am today if I didn't have such caring, loving, sacrificing, and gracious grandmothers.

Both of my grandmothers are very special and mean the world to me. My paternal grandmother told me at age of 17 to go to nursing school and not to major in pre-law because there were too many lawyers already. Excellent and very pointed advice some 20+ years ago.  

My grandmothers are a gift from heaven; please say a prayer for my paternal grandmother today.  

I will be in Indianapolis, Indiana on Thursday, August 20th

I am attending the Indiana Board of Nursing Meeting on Thursday, August 20th in downtown Indianapolis. If you would like to schedule an appointment to meet with me in the afternoon or early evening hours, please contact my office at 888-571-1110.

How do you know as a RN if you are working on a crappy floor or unit?

You should smell sh*% if:

1. The facility is offering an extremely high hourly rate for RN new graduates to work on a particular unit or floor;

2. The faclity is hiring new RN graduates in areas were years of med-surg experience is usually necessary;

3. The facility has over 50% turnover on a particular unit or floor;

4. The most senior nurse on the unit or floor has 2-3 years experience and the charge nurse started 6 months before you;

5. There are more changes with front-line nursing management (nursing supervisors, assistant nurse managers, charge nurses, house supervisors, etc.) than the 3rd shift at a Waffle House;

6. Its rumored that the facility reports nurses to the State Nursing Board for any and everything to keep Magnet;

7. There are more travel nurses than staff nurses on the unit or floor and the unit isn't "new";

8. All nurses are expected to perform expertly as a unit clerk, nurse aide, RN, housekeeper, and assist with facility maintenance as time permits;

9. A good portion of the nurses on the unit or floor work per diem there and hold .5 or higher positions elsewhere; and last but not least;

10. On your second day of work you learn there a wager on how long the "fresh meat" will survive in the jungle and the odds are against you.

Suicidal Ideations and Attempts and Nurses: Please get the help you need now

If you are a nurse and you are depressed and/or suicidal, please get the help you need before its too late. Whether its in-patient treatment or out-patient treatment, please contact mental health professionals and get the process started.  

This is just my opinion and it is not legal advice of course but you have to get help to deal with your illness before you resume practicing as nurse. You don't want to be accused of practicing unsafely or with an impairment. Again you need to get help dealing with your illness before you resume practicing as nurse.

I know you have bills to pay like everyone and you need to work but this is multi-faceted issue and you have to consider your mental and physical health and answer the $39.99 question: are you safe to practice nursing?

I am seeing more cases with dual diagnosis and discipline and the State Nursing Board or suicide attempts involving nurses which are reported to the State Nursing Board. You may or may not be surprised how this information gets reported to the State Nursing Board (but that's another post).

Again the role of the Board is to protect the public from unsafe nursing care and one of the many questions considered is whether the nurse is safe to practice nursing. Also things that you may consider personal and involving strictly your personal life (like an attempted suicide, dual diagnosis, or mental or chemical dependency issues) may be examined in the event of a State Nursing Board complaint and disciplinary investigation and adjudication.

Call your county suicide prevention hotline or seek assistance because there are alot of resources and services out there if you want help with your situation. Contact EAP, your State Nurses Association, etc. Contact someone and get the help you need to treat the illness (your health is your first priority; isn't it?) and contact a nurse license defense attorney or administrative law attorney in your jurisdiction.