Nursing Law & Order

Who get's the most respect? An NP or Attorney

I saw this post on this website.

Nurse Practitioner vs Attorney

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Hi everyone!

Which profession do you think earns more respect? Anyone have any info on starting salary and working conditions? I'm considering both careers and am not sure which way to go. Any info would be greatly appreciated!

Thanks!

See http://www.city-data.com/forum/education/170075-nurse-practitioner-vs-attorney.html

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As a nurse and an attorney, I find the post amusing because I asked a physician I was dating during my ASN and BSN program, his opinion on whether I should apply for law school or a NP program. A twist on the very question above.

His comment was offensive so I won't mention it here, but I decided to attend law school. Not because of his remarks about NPs. The law has always fascinated me.

My grandmother when I considered pre-law told me, "There are too many attorneys, be a nurse." 

Anyone considering law school should follow their heart. Despite the attorney jokes and all the bad press the legal profession receives, the practice of law is a profession that has endless career opportunities. I love being an attorney. The training and education you receive are invaluable.  You feel empowered to conquer the world!

Despite all the negative things I heard about the legal profession and law school I attended. It was one of the best decisions I made. Of course its tough, expensive, and then you sit for the Bar. Most things worth having don't come easy and cheap.

A law degree is an investment. Actually so it a nursing degree, because alot of basic nursing students are graduating with "graduate school" type debt anyway. See  http://www.typepad.com/t/trackback/441771/26329466. This particular nursing student was $50,000 in debt from her basic nursing education.

My only regret is that I did not obtain a MSN in conjunction with my law degree. It was possible but I didn't consider it at the time. I can always go back to school I know and I should have when my law practice wasn't as busy maybe five to six years ago. I even considered an LLM in health law several years ago. A MSN would fit better with my law practice and career goals however at this point.

So what I am saying in this post. If you want to be a RN, do it? RN and Accountant, do it! If you want to be a RN/MD, do it? RN and PT? RN and RT? RN and Teacher? RN and EMT? RN and JD? RN and financial planner? LPN and RN? RN and insurance agent? RN and therapist or counselor? RN and MT? RN and a preacher? 

My family thought I was nuts to attend law school. Why on earth would a nurse want to be an attorney?

Write your position description and plot your own course!   

Nursing: A Recession Proof Job Market

This is article that appears in CNNmoney.com. http://money.cnn.com/2008/03/25/news/economy/nurse/index.htm?section=money_latest.

The article discusses how professionals in other fields are considering a career in nursing because of the demand for nurses and recession. A career in nursing because of the multiple entry levels to practice is considered a quick fix. A year or two of additional education, pass the NCLEX, and you are a nurse.  You can make $45,000-100,000 a year or more.

I must admit, I am not one of those folks who wanted to be a nurse since I was 3 years old. When I graduated from high school I planned to study pre-law. My paternal grandmother who had worked in a hospital for decades, said "there are too many lawyers already, be a nurse." I was 17 years old. I did what my grandmother told me. Thank God, for grandmothers. I was a 17 y/o single mother and my grandmother saw nursing as a good fit for me.

I think everyone should consider a career where you have financial stability. I encourage everyone to consider a career in nursing or healthcare as a licensed healthcare professional. (No I am not trying to drum up additional business). 

However student nurses and nurses regardless of their background, education, and career path prior to nursing must be socialized into the practice of professional nursing. I don't think this occurs for the most part. 

In my opinion, we are not being socialized into the professional practice of nursing. If more nurses were familiar with the legal, self, and professional components of nursing regulation as delineated in Nursing's Social Policy Statement, had an awareness of the ANA Code of Ethics, National, Specialty, and State Scopes and Standards of Practice, and actually read the State Nurse Practice Act and Board of Nursing regulations, I might have to find a new position! 

Do you think nurses are being socialized into the professional practice of nursing? Were you? Do you see nursing as a recession proof job market?

South Charleston, West Virginia

I am meeting with several clients who live in the Ashland, Kentucky and Ironton, Ohio area on Sunday, April 20th in South Charleston, West Virginia. We are driving in on Sunday afternoon and departing Monday afternoon.

Any suggestion for activities and sight seeing in Charleston, West Virginia?

Primary Nursing with the Nursing Shortage: Is it still possible?

See this editorial appearing in ADVANCE for Nurses.

http://nursing.advanceweb.com/editorial/content/editorial.aspx?prg=3&cc=110560.

Is primary nursing still possible in today's healthcare system? According to the editorial:

"Her primary nurses on each unit identified themselves as the persons responsible for her care, discussed goals, informed her of what to expect and prepared her for transfer to another unit or for discharge."

My nephew was admitted to Cincinnati Children's Hospital Medical Center in December and my grandmother was hospitalized at University Hospital in Cincinnati. I spent most of December 2007 in Hospital rooms and clinics and I didn't observe any form of primary care nursing. What I observed was survival staffing and the band-aid approach to nursing care.

Which is one of the reasons why anytime my nephew who has an ASD and Pulmonary Hypertension is hospitalized, someone (me, my mother, one of my sisters, or a grandparent) is ALWAYS present at the Hospital. 

What are your experiences with primary care nursing? Is primary care nursing a reality on your unit? Did you observe primary care nursing when your family, friend, or loved one is hospitalized?

Chemically Dependent Nurses: Proceed with Caution

This is post from Jack Stem at APECS (Addiction Prevention Education Consulting Services) in Cincinnati, Ohio. See his website at  http://www.jackstem.com/rants-and-raves.htm. Rev. Stem is  Peer Assistance Advisor for the Ohio State Association of Nurse Anesthetists. This appears on his website.

October 29, 2007

What an amazingly frustrating weekend.

After meeting with the treatment staff and the board members of Glenbeigh Treatment Center in Rock Creek, Ohio, I was feeling pretty darn good about addiction treatment and the progress that has been made over the 17 years since I entered treatment for the first time. But then that good feeling quickly dissolved over the past 24 hours.

I have a friend in treatment at the present time and she is doing well from the information I have received from her family. Unfortunately, the safety net that used to be in place for recovering nurses in the state of Ohio has disappeared. The group that had been following a nurse's progress through treatment and charged with monitoring the nurse's after care activities no longer provides that service. And as yet, I haven't been able to find anyone who has replaced the original organization or even knows of an entity in Ohio that I can contact about considering taking on this important service.

Chemical dependency in health care professionals is no surprise. After all, these dedicated professionals develop cancer, diabetes, hypertension, cardiovascular disease, and all of the other chronic diseases everyone else is subject to in their lifetime. Having an alternative to discipline program available for health care professionals with substance abuse issues and the DISEASE of chemical dependency is essential in discovering those individuals early and getting them into treatment before they can harm others or themselves. A punitive system assures prolonged periods while the practitioner is being investigated but is still practicing. When the loss of licensure is threatened, it prevents the impaired individual from seeking help early, if at all. It also makes it less likely a colleague or family member will report the individual because of fear of reprisal (i.e. lawsuits) or being held responsible for the loss of an individual's career and ability to provide an income for themselves and their family.

With today's "drug war" mentality, individuals who need treatment for this chronic, progressive, ultimately fatal disease will not seek that treatment until a major disaster occurs. Arresting the user and incarcerating them assures they most likely will NOT receive the medical treatment they deserve and need. Hopefully, that disaster isn't the death of a patient or of the practitioner.

Until society changes their view that addiction is a character flaw or moral weakness, the substance abuse/addiction epidemic will continue to grow, and society will continue to lose some of the best and brightest people in our communities.

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State Boards of Nursing vary in how chemical dependency complaints are resolved. I practice law in Ohio, Kentucky, and Indiana and there is a huge disparity just among these three states in how chemical dependency complaints are resolved between the Ohio, Kentucky, and Indiana Nursing Boards.

Some Nursing Boards take a punitive and discipline-oriented approach. The nurses being monitored by these Nursing Boards state its worse than criminal probation and some eventually surrender their nursing license.

Then there are some State Boards of Nursing that recognize chemically dependency is a disease and truly work with nurses in an alternative program type situation to return to practice. Relapses are not punished and the public is still protected.

If you are chemically dependent and you want to seek assistance; consider contacting your State Nurses Association or Specialty Nurses Association for assistance first. Then contact a licensure defense attorney to determine how chemical dependency complaints and the Nurse's Alternative to Discipline Program (if your state has a program) works and should you apply.

Speak with professionals (mental health, counselors, attorneys, etc.) and don't exclusively on the advice you receive from peers. Afterall your license is your livelihood and its becoming more difficult every year to retain an unrestricted and unencumbered nursing license as a chemically dependent nurse in some states.

Nursing Malpractice Case and the Nursing Board

Did you know if you are named in a nursing malpractice case and a settlement is made on your behalf this information is reported to the National Practitioner Data Bank (NPDB) and your State Board of Nursing will be notified? See http://www.npdb-hipdb.hrsa.gov/

This is a summary of email I received from a Nurse who was named as a defendant in a medical malpractice case, the case was settled, and now the nurse is being investigated by the Nursing Board.

I was named in the medical malpractice lawsuit. The case was settled and a report was filed with the NPDB. The Nursing Board has now contacted me to do their own investigation since the insurance carrier had to report my name to the NPDB. I am currently seeking counsel to represent me.

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This nurse had her own professional liability insurance policy with a national insurance company that provided her with her OWN legal counsel, distinct from the Hospital's legal counsel and the Surgeon's legal counsel, in the medical malpractice case. Her insurance company will also cover the costs associated with defending her license before the Nursing Board.

I don't think anyone goes to work and says "I am going to do something that gets me sued today" or "I am going to do something that gets me reported to the Nursing Board."  Consider purchasing your own individual professional liability insurance policy with a licensure defense benefit.

You have medical insurance?

You have dental insurance?

You have life insurance?

You have car insurance?

You have professional liability insurance? Its the same principle.

Nursing Shortage and Nursing Unions: Cincinnati Enquirer article today

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?

Employment Contracts: Beware!

I am seeing some very one-sided and unfair employment contracts here lately. These are downright ugly agreements. I think the majority of nurses sign the contracts without retaining an attorney to review the Contract.

In one case, a former employer is actually suing the nurse in civil court for breach of contract.

Think about it for a minute. Employment contracts are usually written by the facility's attorney with the facility's best interest in mind. I like employment contracts for nurses as a tool. However if a contract is so one-sided where only the employer has real benefits, then you may fare better working as at-will employee than being tied to a contract.

DO NOT sign an employment contract without having your attorney review it first. You can and may be sued for breach of contract for not performing in accordance with the contract.

For example, see:

http://seattletimes.nwsource.com/html/businesstechnology/2004299735_jobsnursing23.html

According to the article:

Interns are hired as hospital employees, but they are also required to attend lectures, lab sessions and work with preceptors. Upon completion of the program, Reese said, they will have a job even if there is not a posted opening at the hospital. Southwest estimates that each intern receives $50,000 worth of training. In return, interns are expected to make a two-year commitment to the hospital after the training is complete.

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$50,000 worth of training in exchange for a two year commitment. I am sure there is a contract or formalized agreement drafted by the Hospital's legal counsel or in-house attorney involved.

Be your own risk manager and have an attorney review ANY document or contract involving your nursing license and your employability as a nurse before you sign it.

Are You Personally What You are Professionally?

I am a member of the ANA Congress on Nursing Practice & Economics. As a Congress member, I received a copy of ANA's Guide to the Code of Ethics for Nurses: Interpretation and Application. See www.nursingworld.org.

I love this guide! I will have enough to post on just from this guide for at least a month.

On page 60, Interpretive Statement 5.3: Wholeness of Character, this question is posed:

Can a person who is a rogue, scoundrel, liar, and cheat in personal life be a virtuous nurse in professional life? It is unlikely.

What we are personally, we are professionally. Our personal and professional identities are neither separate, nor coextensive; they are integrated and deeply commingled, mutually influencing each other. The person who has become "a nurse" as opposed to the person who "does nursing," is the one who has incorporated and integrated the values of the profession with personal values.

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What does this mean to you as a nurse? Do you agree with this statement? Are you a nurse or do you do nursing? Are the values of the profession your personal values? Are you personally what you are professionally? How do you if your professional and personal lives are agreeable and harmonious?

Are some of us living secret personal lives as licensed professionals that will eventually impact, threaten, and destroy our professional lives?

Look at the secret personal life of Eliot Spitzer, the former Governor of the State of New York. Compare and contrast his secret personal life with his professional life as a Governor and former State Attorney General. http://www.nytimes.com/2008/03/10/nyregion/10cnd-spitzer.html?hp

My Pretty Yellow Truck and My Boyfriend Barry

This is a nightmare. My boyfriend Barry had an accident in my 2000 Nissan Frontier last month.

My insurance carrier paid for the repairs. I find out today that between the autobody shop and a Nissan dealer (these folks were replacing the airbags) my truck started having engine problems.

Well guess what? I need a new engine. My truck was leaking oil (closed containment system) and it wasn't caught until the truck started knocking.

Its not covered by the insurance company because its unrelated to the wreck and of course the autobody shop and the Nissan dealer are pointing the finger at each other. No accountability. It would be nice if these folks had a license issued by the state; I would file a complaint!

I am in the same position that I was a month ago when my boyfriend Barry wrecked my truck. I have a truck I can't use. I am disgusted; but I am not upset.

I am an attorney but I don't feel like suing anyone. Why? I will obtain more pleasure tormenting my boyfriend Barry about my pretty yellow truck for the duration of our relationship. Also I am going to parlay this truck situation into all expenses paid Las Vegas vacation for my birthday in July from my boyfriend Barry.

It will cost $4,500 for the rebuilt engine and labor.

My boyfriend Barry is buying me a new car. I want a crossover vehicle, convertible sports car, or a four door jeep. What do you think?

He also wants to eat home-cooked soul food meals again; so he is planning to fix my pretty yellow truck at the end of the summer. I haven't cooked since my boyfriend Barry wrecked my pretty yellow truck.   

A Just Culture: It Always Looks Good on Paper

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?

Nursing Staff Bylaws Attorney: A Position that Decades Overdue

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.
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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.

Continuing Education for Nursing Licensure Renewal

I presented a nursing seminar last week in Illinois. The State of Illinois does not require continuing education for RN/LPN licensure renewal. This will change starting in May 2008 however.

I know Indiana does not require continuing education for RN/LPN licensure renewal. Does your state require continuing nursing education for licensure renewal?

What your opinion? Is there a link between continuing education and competency? Is there a link between continuing education and professionalism? Do you think CE should be required for nursing licensure renewal?

Kentucky Whistleblower Reporting

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?

http://www.kentucky-nurses.org/whistleblower.htm

If you are a Physician, Nurse, Teacher, or Attorney; Your Legal Issues May Be Published and Sensationalized!

See this article about an Ohio physician who had licensed suspended by the Ohio Medical Board and was criminally charged with practicing medicine without a license. Practicing medicine without a license is a felony in the State of Ohio.

Its mentioned on the Cincinnati Enquirer's website on March 14, 2008.

http://news.enquirer.com/apps/pbcs.dll/article?AID=/20080314/NEWS01/303140075.

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I am sure none of us as licensed professionals want to make the news in this fashion. So keep in mind, as a licensed healthcare professional, if you are charged with a crime and have licensure issues with the State Board; it may be splashed across the internet or the newspaper.

I don't know about you but that alone is enough to keep me out of any trouble! I can see the story now:

LaTonia Denise Wright, a Cincinnati, Ohio attorney and registered nurse was charged with having too many pool parties from May 2007-September 2007. Ms. Wright, who is a licensed attorney in Ohio, Kentucky, and Indiana is facing investigations in each state. Ms. Wright may be disbarred in Ohio, Kentucky, and Indiana, and lose her Ohio nursing license and custody of her three poodles and two labs. We contacted Ms. Wright's law office. Ms. Wright was not available for comment and her secretary referred all questions to Ms. Wright's personal counsel.

All jokes aside, its not uncommon for the legal issues (criminal, employment, professional malpractice claims, and/or licensure matters) of teachers, attorneys, physicians, and nurses to be publicized.

Just another incentive for you as a nurse to proactively manage the risks associated with nursing practice.

ANA's Adapting Standards of Care under Extreme Conditions

This is a new publication from the American Nurses Association. See

http://nursingworld.org/HomepageCategory/Announcements/AdaptingStandardsofCareunderExtremeConditions.aspx

Legal CE Track at National and State Nursing Association Seminars

I spoke this week in three cities in Illinois on legal issues in nursing. I am exhausted. I did however meet several wonderful nurses during these presentations.

One nurse asked, why aren't legal presentations scheduled more at conferences and seminars. That is a good question.

I would even propose that national and state nursing associations schedule a legal track at conferences, where nurses have the opportunity to learn about the most current legal issues impacting nursing practice.

I attend several conferences a year and there may be a legal topic here and there, but I have never attended a conference where a track is devoted to legal issues in nursing. In Ohio, Board of Nursing licensees are required to have one hour of CE on Ohio Nursing Law (Practice Act) and Rules (Board regulations) for licensure renewal. Therefore at most conferences for Ohio nurses you tend to see at least one hour of nursing law-related CE.

You might see a clinical track, educational track, pharmacological track, or a management track at a conference; what about a legal track? Do you think this is a good idea? What topics would you like to see covered?

SEIU and Catholic Health Partners

This is available on the Ohio Nurses Association website. See http://www.ohnurses.org/AM/Template.cfm?Section=News&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID=2383

Nine hospitals operated by Catholic Healthcare Partners in Ohio are allowing the Service Employees International Union (SEIU) to hold uncontested union elections on March 12-14.

The RNs at these hospitals did not ask to be represented by SEIU. They did not even know an election was being held until two weeks ago when they received a letter signed by both hospital management and the union. The nurses are not being given the opportunity to choose a professional nurses’ union, such as the Ohio Nurses Association, which would truly represent their interests.

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Wow! Catholic Healthcare Partners and the SEIU. The SEIU is doing "big things" here in Ohio. First the Ohio Independent Providers (IPs); there are over 7,000 IPs in the State of Ohio. Now this uncontested union election with Catholic Healthcare Partners.

Nine hospitals with anywhere from 7,000-8,000 RNs.

What does this mean for the Ohio Nurses Association, which is a union and a professional association? 

My Nephew is My Special Patient

My nephew has an atrial septal defect and pulmonary hypertension. He is seven years old. He was scheduled to have open heart surgery on Tuesday to repair his ASD. Because of a prior engagement I would have been unable to be there for my nephew. I left on Monday for Chicago and will be in Illinois until Thursday.

I felt really bad; my nephews says I am his special nurse. I am his nurse and I refer to him as my special patient. My nieces and nephews call me Nauntie (it Aunt-tie with a N).

He tells the nurses at Cincinnati Children's Hospital that his Nauntie is a nurse also. He is my only patient now because I am not practicing as a home health RN (per diem) anymore. That's another post.

I must admit that I cried because I would not be there for him and my sister. He was scheduled for his pre-op (EKG, Echo, labs, and stress test) on Monday. On Sunday he developed a fever and a rash. On Monday, his surgery is being rescheduled for next month.

I will be there for the pre-op, surgery, and his recovery whenever its scheduled. I am limiting my travel (where I have to stay overnight for more than a day) for the remainder of 2008. No exceptions because it tore me apart to think my nephew would be on a table and I would be six hours away.

Everything happens for a reason and I am not happy of course that my nephew has a virus (he attends daycare for pre-care and aftercare and he is a first grader so he most likely picked up something).

But I am glad that this special nurse will have the opportunity to be there for her special patient.

SEIU Closed-Election with Catholic Health Partners Canceled

This information is posted on the Ohio Nurses Association website (see www.ohnurses.org) and is available on the Cincinnati Business Courier's website. See http://www.bizjournals.com/cincinnati/stories/2008/03/10/daily23.html.

The elections were canceled because of the protests waged by the California Nurses Association and its national arm, the NNOC. Members of the CNA/NNOC were on the Catholic Health Partners campus encouraging nurses not to support the SEIU.

The elections would have involved 8,000 registered nurses and other employees at nine hospitals in Cincinnati, Lima and Springfield. That included Mercy Health Partners, which operates hospitals in Fairfield, Anderson Township, Mount Airy, Western Hills and Clermont County.

Its interesting that Catholic Health Partners filed for the election without any showing of support for SEIU representation.

Ohio for whatever reason is becoming a hotbed for collective bargaining activity. RNs at Catholic Health Partners should have a choice in selecting union representation. There are several unions available to represent the 8,000 RNs including the Ohio Nurses Association, California Nurses Association/NNOC, and the SEIU.

8,000 RNs would essentially double the membership of the Ohio Nurses Association. It would give the CNA/NNOC a "toe hold" here in Ohio and it would add a notch to the SEIU's representation of healthcare workers in Ohio as the SEIU is currently negotiating a contract with the State of Ohio to represent over 7,000 independent providers.

I have a nose for litigation and this is going to be a fight. Yours truly will keep you posted. What is your opinion of unions in nursing? For or against and why?