Attached is the November 2008 newsletter from the Registered Nurse Association (RNA), a local unit of the Ohio Nurses Association. The local unit consists of RNs at University Hospital in Cincinnati, Ohio. I believe there are close to 1,000 nurses in the bargaining unit.
See my article about the Bermuda Triangle of Nursing Practice.
See this article. http://include.nurse.com/apps/pbcs.dll/article?AID=/20080825/PA02/108250085.
Do you think shared governance is the future of the nursing workplace? Do you think collective bargaining agreements and nursing unions are the future of the nursing workplace? What do you see in the nursing workplace of the future?
The article notes the shared governance consists of five councils made up of staff nurses, managers, and staff eduation personnel from around the hospital. The councils are education, quality, diversity, research, and practice.
That's nice but if you really want fairness and balance in the employer-employee relationship with a shared goverance model try a more substantive committee, like a Workplace Mediation and Conflict Management Committee that conducts workplace investigations of said policies and procedures and the employee handbook and mediates in-house disputes between professional disciplines and employees.
I spoke with a nurse this week who indicated that his employer immediately reports anything and everything to external regulatory and law enforcement agenices. The reporting takes place before an internal investigation or before a common sense approach speaking with the nurse initially.
This employer routinely files complaints against licensed healthcare professionals (LPNs, RNs, RTs, Pharms, etc.) with state licensing boards and contacts law enforcement at the slightest hint of an issue.
There has to be a balance. Employees will not come forward and report incidents if there is feeling that everything will be externally reported and prosecuted to the fullest extent of the law (like stealing a candy bar from Walmart).
If you are working at this type of facility or on a unit like this, run as fast you can. Run Forest Run....
I don't know maybe your nursing supervisor or someone in nursing management and HR has watched too many Law & Order episodes or wants to be Deputy Brenda Lee Johnson from the Closer. Deputy Brenda Lee Johnson closes 97% of her cases with confession. Damn she is good!!! When I grow up I want to be Deputy Brenda Lee Johnson and you can always find me at home by 9pm on a Monday watching the Closer.
Don't despair if you work in a facility where HR and nursing management mention "you are employed at-will" in every other sentence and external reporting to "everyone and their mother" is the new norm.
Drop back to per diem and seek full-time employment in a healthier environment. What is a healthy work environment for nurses? You tell me.
A perfect nursing working environment doesn't exist however you should not have to worry about a Nursing Board, law enforcement, Office of Inspector General or Attorney General, and Pharmacy Board investigation just because you failed to document a controlled substance on just 1 of the 10 places where it is required to be documented.
If you read this website then you know in my opinion, ---- rolls down hill in any healthcare facility and its usually the nurses who take the brunt and blame for an incident, occurrence, etc.
See this article on the Cincinnati Enquirer website about an illegal immigrant who was shot and ran over during an alleged robbery attempt. This guy was was shot and is now a parapalegic. He was awaiting trial and because the Sheriff's Office could not provide for his care at the local jail, the resident was being cared for at the Residence of Greystone, a nursing home with the Carrington System.
In all fairness, I must say that I have found that the Carrington System to be one of the few facilities in my opinion that work with nurses as far as workplace issues. Most facilities love the fact that nurses are at-will employed and use this to its advantage. But that's another post....
The resident was released and discharged from custody and its a big stink here in Cincinnati.
Do you think this is common?
Do you think this is more likely to occur in a hospital, nursing home, home care, clinic, out-patient setting, school of nursing, or another setting?
Is practicing nursing without a license a crime in your state? Felony or misdemeanor?
Short staffing is a facility issue that directly impacts your nursing practice. If you are going to work everyday its the same thing call offs, floating, playing musical chairs with patients and residents, you have to ask yourself is this a healthy environment?
I am not saying you should quit on Monday, but you are a professional. Evaluate your options. How can you better manage your nursing practice and your sanity and still make the money you need? Maybe transfer to a less acute and better staffed unit. Maybe go from a .9 to a .5 and work part-time as a agency nurse. Do what you need to do to protect your nursing license, your nursing practice, your income, and your sanity.
There is nothing wrong with standing strong and fighting a good fight, just remember why you are fighting and what you stand to lose and gain when the fight escalates to a war.
Do you work in a nursing home or assisted living as a nurse? If so I am sure you work with CNAs, STNAS, and other nursing assistants.
Be Careful! I have spoke with four nurses this year (two in the last month and half) who disciplined (informally) STNAs or who were perceived as "being hard" on STNAs by encouraging the STNAs "do to their job" and all 4 nurses have been accused of patient abuse or neglect by the STNAs later down the road.
Guess what? STNAs for the most part are not licensed by the State Board of Nursing and even if they are licensed, STNAS and CNAs do not have "as much to lose" as a nurse who is terminated, reported to the State Department of Health or another agency and investigated, and also reported to the State Board of Nursing or Attorney General's office and investigated.
Why don't DONs and ADONs and Administrator give nurses the benefit of doubt in these types of matters and internal investigations? I mean at-will employment is one thing, but what happened to treating a fellow colleague with respect and fairness? Is it too much to ask to be treated fairly if you are a nurse and you work in long-term care?
I don't know but if you are a nurse and you work in a nursing home you know the politics and the complaining that is involved in a typical day of work. Protect yourself and your license. If the environment is too toxic, go per diem and find employment elsewhere or consider working part-time at the nursing home and part-time elsewhere.
Don't sweat the small stuff because as a nurse you can find a position anywhere! You are not licensed by the facility and you have employment options that CNAs and STNAs don't have and will never have.
Don't become so attached to a facility and the residents that you can't see that it is time to move on until its too late. I know you love the residents but you should love your unrestricted nursing license, your livelihood, and yourself even more.
A nurse has been accused on inappropriate conduct in the workplace.
The nurse wanted to know what are his rights. When the nurse asked the employer, what are my rights, the employer (in a meeting with his nurse manager and human resources rep) replied "you don't have any rights and you cannot do anything to defend yourself in this investigation."
The nurse wanted to know if he has a right to know what he is being accused of and who the accuser is in this situation.
What do you think? What are your rights in the workplace? What are your rights, if any, in an internal investigation by a private employer (non-governmental)?
Here is the cut and paste of an article that appeared on the Cinti Enquirer website on Wednesday, June 18, 2008:http://news.enquirer.com/apps/pbcs.dll/article?AID=/20080618/NEWS0107/306180058.
Michael Dowlar looked through his father’s credit card bill and saw something that alarmed him: Forty-four unauthorized transactions totaling $1,042.57.
One of them was a payment to a T-Mobile account in the name of Sarah Alexander.
Sarah Alexander is an aide at the Blue Ash Nursing home where Dowlar’s father, also named Michael Dowlar, is a patient.
The younger Dowlar called police.
Alexander, 26, of East Westwood, was in court this morning, facing a charge of misuse of a credit card and some harsh words from a judge.
“This is despicable,” Hamilton County Municipal Court Judge Ted Berry said about the allegations, “preying on the elderly.”
He set her bond at $2,500 and ordered Alexander to stay away from the nursing home, where she said she no longer works.
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I was relieved after reading the accused in this case isn't a nurse. I wonder if she is a nursing student.
Why in your opinion are we seeing more cases like this where STNAs are misusing and misappropriating client property and funds?
Is it the ecomony, foreclosure crisis, low STNA wages, working conditions for STNAs in nursing homes, or just "good old fashion" greed?
Life isn't fair.
You are what you eat.
Death, Taxes, and Litigation.
Nurses and Doctors are not treated the same when an incident arises in a Hospital.
A hospital investigated an incident involving several hospital employees and behavior that could be considered criminal if you like Law & Order. I love Law & Order. I like the original and Special Victims Unit (SVU); I don't like to watch Law & Order Criminal Intent.
Guess what? Nursing administration and Human Resources decide after its investigation to report the nurse to the State Board of Nursing. The physician is reported internally not externally and the case will be reviewed pursuant the Medical Staff Bylaws.
What the frak? I am a Sci-Fi buff (remember my dogs are named Luke, Leia, Anniken, and Amidala) and I also love the new BattleStar Galatica! http://www.scifi.com/battlestar/
Why would you report the nurse to the Board of Nursing and not report the physician to the Medical Board?
Why are Hospitals so eager to report a nurse to the Nursing Board but the same organization think twice, contacts risk management, outside legal counsel, in-house legal counsel, and does the "death by committee dance" before externally reporting a physician to the Medical Board?
Why don't all Hospitals have Nursing Staff Bylaws and afford nurses the rights and due process afforded to physicians?
Do you think nurses should be afforded the same procedural due process rights afforded to physicians in Hospitals during investigations and when incidents occur?
The Ohio Department of Youth Services (DYS) Settlement has been finalized. This action was filed by Plaintiffs on December 20, 2004. Plaintiffs alleged a system-wide failure regarding conditions of confinement within facilities operated by DYS that endangered Plaintiffs’ physical health and safety.
See http://www.dys.ohio.gov/dysweb/PressReleases/CohenReport/7-3-08%20Stipulation%20for%20Injunctive%20Relief.pdf starting at page 44 for nursing related issues.
This publication was developed by the Ohio Nurses Association and should be available soon on the ONA website at www.ohnurses.org and www.CE4nurses.org. The publication was developed by the Ohio Nurses Foundation's Peer Assistance Program for Nurses.
I am planning to purchase the publication. If you purchase the publication and would like to write an informal review and agree to have it posted on this blog, email me.
An article appears today in the Cincinnati Enquirer about the nursing shortage and how nurses at Mercy Hospitals/Catholic Health Partners want to belong to a union.
See http://news.enquirer.com/apps/pbcs.dll/article?AID=/20080324/NEWS01/803240319.
Are nursing unions the "cure" to the nursing shortage?
Not Just Penalties in a Just Culture. This article appears in the March/April 2008 Midwestern Edition of Nursing Spectrum. I like the new look and style of Nursing Spectrum by the way.
The article notes that reckless behavior, a conscious disregard of an unreasonable risk should be punished and managed through remedial action and disciplinary action. Human error, i.e. inadvertent actions such as a slip, lapse, or mistake should be managed through changes in processes, design, procedures, environment, and training.
Things like this read well in a journal article and look exceptionally nice especially on paper but I would like to know how this applies in the nursing workplace.
Are errors attributable to "human error" still reported to the State Board of Nursing in mandatory reporting states or are only "reckless actions" reported to the State Board of Nursing in mandatory reporting states?
Again these things sound nice on paper and in journal articles but how does it translate to everday nursing practice for nurses. Does a Just Culture provide nurses with more input into the investigation and disposition of workplace investigations of incidents, mishaps, or occurrences? Is this process driven by the human resource department? How does a Just Culture fit into the at-will employment doctrine? As you know most nurses are at-will employees?
Do you work in a facility with a Just Culture? Is the culture really just or is it purely an academic exercise?
I don't think this position exists. However this is the language used in a recent advertisement for a Medical Staff Bylaws Attorney.
Do you think hospitals and other organizations should have nursing staff bylaws? You want to talk about leveling the playing field, then this is the way to do it in healthcare.
Afford individual nurses the same due process rights and privileges afforded to individual physicians in the workplace.
Medical Staff Bylaws Attorney
At least ten years experience in providing advice and counsel to Hospital medical staffs and other peer review bodies.
Areas of expertise must include medical staff self-governance, medical staff-governing body relations, hospital based contracts, by-laws, rules and regulations, consent, credentialing, peer review, fair hearings, exclusive contracts, emergency department on-call and EMTALA issues and hospital operations. Judicial or administrative litigation experience preferred but not required. Applicant must be willing to travel.
Applicant must have excellent verbal and written communication skills and must have actual experience in representing medical staffs and peer review bodies.
+++++++++++++++++++++++++++++++++++++++++++
Nursing Staff Bylaws Attorney
This is a newly created position. Will provide advice and counsel to the Hospital nursing staffs and other peer review bodies.
Will develop an expertise in nursing staff self-governance, nursing staff-governing body relations, hospital based contracts, by-laws, rules and regulations, credentialing, peer review, fair hearings, exclusive contracts, hospital on-call and nursing issues and hospital operations. Judicial or administrative litigation experience preferred but not required. Nursing background helpful. Applicant must be willing to travel.
Are you familiar with the Commonwealth of Kentucky's Patient Safety Act of 1998?
See the following link on the Kentucky Nurses Association website for additional information. The Kentucky Cabinet for Health Services is responsible for enforcement however its interesting to note that to this date (some 10 years later) the Cabinet has not issued any formal direction on the process of filing reports for unsafe conditions. Why?
This is the statement I heard twice this week. These statements were made by a Hospital-employed nurse manager in a supervisory, management, and/or executive level position to a nurse who was terminated from the Hospital.
One nurse manager even went as far as telling one nurse to contact the State Nursing Board, self-report, and "take the high road."
Your manager, supervisory, and/or chief nursing officer in employment incidents and the workplace do not have any jurisdiction regarding your nursing license. Nurses are not licensed at the institutional level. Can you imagine the drama and legal nightmares nurses would face if licensed at the institutional level considering the one-side nature of at-will employment and facility grievances and investigations conducted by Human Resources?
Your manager, supervisor, and/or chief nursing officer can file a complaint with the State Nursing Board; they can even recommend your termination to Human Resources based on an "investigation" however your manager, supervisor, and/or chief nursing officer DOES NOT HAVE ANY jurisdiction regarding your nursing license. Their jurisdiction is the facility-based with Hospital V, Nursing Home F, Home Health Agency M, or Health Center P.
And honestly what's important? Your nursing license is what's important because it is your golden opportunity to employment opportunities. Its hard to see this when you are battling unit or employer-specific issues and you have worked at the facility for years and become entrenched in its culture.
Nurses with 22 years vested in a facility are terminated just as quickly as nurses with 8 months experience. Remember the Alamo and at-will employment employment. You have the real power in the situation. But that's a post for another day.
Don't sweat the small stuff. Your nursing license, not your employment with Hospital A, Nursing Home B, Home Health Agency C, or Health Center D.
You can and will find employment elsewhere. Your nursing license is your key to employment with Hospital Z, Nursing X, Home Health Agency T, and Health Center U.
See http://www.nursing.ohio.gov/PDFS/Mom/2008/MomentumWinter02008.pdf.
On page 15, there is an article about employment law issues and civil liability. The publication notes these are not regulatory issues and not something within the purview of the Ohio Board of Nursing. The article suggests that licensees contact legal counsel for concerns and issues regarding civil liability.
Here is a cut and paste of part of the article:
The following questions are generally civil liability and employment issues, not regulatory ones. However, the Board continues to receive questions seeking clarification of these issues. The questions involve uncertainty regarding an employment role that may not require a nursing license, or may not require a licensee who holds dual licensure or certification to practice to the full extent of their credentials. The decision to accept an employment position that is less than an individual licensee’s scope of practice or does not require a license is a personal decision. An employer may or may not hold a licensee to their highest scope of practice as determined by the
particular terms of employment or the employer’s risk management department. If a licensee has concerns about civil liability issues, the individual would need to consult legal counsel.
I have practiced licensure defense since 2001 as an attorney in private practice. I can tell you there are some nursing employers and these are typically large teaching hospitals that report "everything" to the Board of Nursing. I mean everything. If a nurse drops a vial of saline, its reported. If you slip up and say "shit" on the unit; it gets reported.
Then there are facilties that never report a nurse to the Nursing Board unless it makes the news or a patient/resident threatens to sue or go to the media.
Why is there such a disparity? The underreporting and overreporting both should be addressed; not just one or the other.
Some if not most State Board of Nursing are mandatory reporting states. Look here for an explanation of mandatory reporting. https://www.ncsbn.org/163.htm. This is from the National Council of State Boards of Nursing website.
Some employers report nurses for the wrong reasons. If you want to argue with me on this point, call me. Its a distrubing trend I am seeing in my law practice. I will speak with a nurse or meet with a nurse and think to myself or aloud "this was reported to the State Nursing Board?" Incidents that could have been managed or handled "in house" are being reported to the Nursing Board under the auspices of "mandatory reporting." Is it really mandatory reporting or is there something else going on here?
In some cases, the reporting is not done because of perceived or actual violation of the nursing law and regulations or patient safety, the motive is more sinister and self-serving. After all, who wants to be investigated by the Nursing Board?
I know that when I pick up a home health visit here and there, I don't walk into a patient's home thinking, "I am doing to do something that gets me reported to the Nursing Board!"
Its done to humiliate, upset, and torment the nurse and its works! Why does this happen? Because of the one-sided nature of hiring/firing that benefits the healthcare employer and the perceived and actual lack of fairness, equality, and power of nurses in the healthcare working environment.
The State Nursing Board complaint becomes the healthcare employer's equivalent of giving the nurse one final middle finger "for the road" because usually the nurse has already been disciplined, suspended or terminated by the facility.
I received a frantic call over the weekend from a nurse. The nurse was being asked to violate the Nurse Practice Act and Board of Nursing regulations.
As a nurse you should always trust your instincts and practice in accordance with the law and rules. Don't take a shortcut that doesn't feel right to you. You are accountable for your actions and its your nursing license.
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