Nursing Law & Order

Kentucky Nurse Aides Being Investigated for Criminal Conduct; Nine Nurse Aides Fired

See this article. I am sure I will receive comments from nursing students who work as nurse aides pointing the finger at RNs and LPNs, but here is the article and the cut and paste. I just hope none of the nurse aides who will be charged are also nursing students.

Also why in the hell is this women smiling on her booking photo?

http://www.kentucky.com/176/story/631088.html

Former Richmond nursing home aide is charged with neglect

By Valarie Honeycutt Spears - [email protected]

Jaclyn Dawn VanWinkle, a former nurse's aide at Madison Manor Nursing Home in Richmond, who was arrested in connection with actions caught on a hidden video camera, denies charges that she neglected an 84-year-old former resident of the home.

"I think I took very good care of Mrs. (Armeda) Thomas," VanWinkle, 25, said in a telephone interview Thursday. "I've done nothing wrong."

Jaclyn Dawn VanWinkle

• Read the nursing home's statement (PDF)
  
• Videotape at nursing home records abuse
• Compare nursing homes using Medicare's site

VanWinkle was arrested Wednesday and charged with wanton neglect. She said an investigator from Attorney General Jack Conway's office told her that as many as eight of her former co-workers — none now work at the facility — also face criminal charges.

"I was charged with neglect because the videotape showed me singing and dancing," VanWinkle said. "They said it looked like I was taunting her. They said I was being disrespectful."

Shelley Johnson, a spokeswoman for the attorney general's office, said the criminal investigation is continuing.

Armeda Thomas' family members hid a video camera in her room without the nursing home's knowledge for three weeks after they discovered 36 bruises all over her body and didn't get satisfactory answers from the staff.

The videotape shows nursing assistants at Madison Manor physically abusing and taunting Thomas, of Irvine, and failing to feed and clean her, according to state records.

VanWinkle is not charged with physically abusing Thomas. State records concerning the investigation refer to an occurrence in which a nursing assistant danced in front of Thomas while one other staff member held the resident's arms.

Cindi Simpson, a spokeswoman for Extendicare, the Wisconsin-based company that owns Madison Manor, said that nine nursing assistants have been fired and that there have been other staff changes, as well as retraining, since the incidents were filmed.

"We have terminated any employees seen acting inappropriately toward this resident," said Simpson, "We don't condone this kind of behavior."

'Part of daily routine'

VanWinkle said the singing and dancing showed on the videotape was neither disrespect nor neglect and might have been misunderstood because it was not accompanied by sound.

"It was part of my daily routine with her, to get her to get up, get dressed, go to the rest room."

VanWinkle did not have her certified nursing assistant's license at the time of the alleged incident, she said, although she had completed her training.

Under state regulations, she was allowed to work at the nursing home for a certain time period without passing a competency test. Nursing home officials said she passed her test Sept. 8.

An investigator from Conway's office also told VanWinkle that her failure to use a safety belt, called a gait belt, when transferring Armeda Thomas from her bed to a wheelchair also constituted neglect, she said.

However, VanWinkle said supervisors should have told her to use the gait belt.

"I like working with the elderly. I like taking care of people," said VanWinkle, who took the job at Madison Manor in the spring and began classes at the facility to get her license.

VanWinkle said she was suspended in October and fired in November.

The arrest came as a shock, she said.

"My grandmother is in a nursing home," VanWinkle said. "She has Alzheimer's and dementia. I visit her every day."

Cared for at home

Thomas, of Irvine, died in November of complications from Alzheimer's disease. Family members cared for her at home after they discovered how she was treated.

Deb Hamilton, Thomas' granddaughter, said Thursday that nursing home workers should be held accountable for their behavior.

"There need to be consequences," Hamilton said. "Maybe it's a facility that fostered an environment where they didn't have adequate training and quality of care. Co-workers didn't feel comfortable coming forward."

VanWinkle, of Richmond, was released Wednesday night on $7,500 bond. She said she is scheduled to appear in court Monday.

In March 2007, she pleaded guilty to a charge of public intoxication with a controlled substance, a misdemeanor, and paid $177 in court costs, according to Madison Court records.

In October she was charged with public intoxication, but the charge was dismissed.

Wrongful-death suit

In a separate case, the family of Teresa Kay Ritter, who died in September 2007 after a two-month stay at Madison Manor, filed a wrongful-death lawsuit against the nursing home on Oct. 22. The lawsuit alleges that poor care at the facility resulted in the amputation of her left foot, renal failure and ultimately, death. Ritter also sustained unexplained bruising and lacerations, according to the lawsuit.

Lisa Circeo, the Lexington attorney who represents the family, said the Cabinet for Health and Family Services found violations of mandatory regulations with regard to Ritter and that Adult Protective Services substantiated neglect.

Circeo said her law firm had represented clients in at least eight other wrongful death lawsuits that have been filed against Extendicare facilities in Kentucky since 2006.

In the Thomas case, Madison Manor received the most serious citation a nursing home can receive. State officials say that the most serious problems have been corrected.

Pharmacy Board article in USA Today: Questions the Line between the Regulators and the Regulated

Take a look at this article about Pharmacy Boards.

http://www.usatoday.com/money/industries/health/2008-12-30-pharmacies-boards-mistakes-prescriptions_N.htm?loc=interstitialskip

Is this an issue in nursing with State Nursing Boards?

2nd Criminal Investigation launched last month involving Birchaven facility

I reported on the first criminal and Nursing Board investigation in the fall in another post. A second criminal investigation has been launched. If the allegations involve nursing care, then the Nursing Board will be involved in the second complaint also.

Nursing Board and Attorney General Office investigations are pending in the first case.

Anytime you as a nurse are asked to meet with an Ohio Nursing Board investigator, an Ohio Attorney General Office investigator, and an investigator from the Ohio Dept. of Health, the allegations are serious, you think!

http://74.125.47.132/search?q=cache:PRxikWij4-4J:dev.findlayinternet.com/articleredirector.asp%3Fd%3D110708_story3%26c%3Dn+Birchaven+nurses+and+Attorney+General+investigation&hl=en&ct=clnk&cd=3&gl=us

Here is the cut and paste from a newspaper article published last month:

Friday, November 07, 2008

State office investigates Birchaven complaint

By MARY KATE MALONE

Staff Writer

The state Attorney General has opened a second criminal investigation into Birchaven Village nursing home in Findlay, state officials said.

The Attorney General's Medicaid Fraud Control Unit will not disclose who or what it is investigating, but the unit has the authority to examine and prosecute cases of abuse and neglect at nursing homes.

Since August, the Attorney General has been investigating the treatment of a female dementia unit resident at Birchaven who developed an open wound due to a hand condition. Eight nurses were fired and nursing home officials said all problems had been resolved.

Last week, the Attorney General received a case from the state Department of Health regarding an incident at Birchaven involving pressure sores, also known as bed sores, according to a health department spokeswoman.

Attorney General investigations are unusual at nursing homes in Hancock County and could end with criminal charges being filed.

In the last six years, only five investigations have taken place, including the two under way at Birchaven, according to the Attorney General.

Birchaven "self-reported" the latest incident to the state health department, said Barb Lockard, Blanchard Valley Health System's director of marketing and public relations. Birchaven is part of the health system.

Lockard declined to comment about what happened or who was responsible, but said, "The patient received appropriate treatment and is recovering nicely."

Pressure sores, also known as bed sores or pressure ulcers, develop when sustained pressure cuts off circulation to certain areas of skin, usually on the backside, hips and heels, according to the Mayo Clinic.

Birchaven was cited by the state Health Department in January for failure to properly prevent pressures sores and heal existing ones.

"There seems to be a systemic problem with the facility as to how they are assessing pressure sores," said Beverley Laubert, state Long-Term Care Ombudsman.

"It concerns me that a facility cited in (January) would still be having problems in November of that same year. I would have hoped a more substantial correction would have been made," Laubert said.

Her agency, an arm of the state Department of Aging, is a watchdog for enforcement of federal and state nursing home regulations.

She advised families of Birchaven residents and other nursing homes to visit frequently and check the resident's skin often, especially if they are thin and immobile.

Malone: 419-427-8417,

Attorney Alleges his client, an Ohio Nurse was Coerced into a Confession

I recently published an article titled Miranda v. Arizona and the Nursing Workplace of the Past, Present & Future, which discusses the issue of Miranda warnings as applied to nurses in a variety of settings. The article was published this month in Nurses First, the online journal of the Center for American Nurses. To obtain the article, see www.centerforamericannurses.org.

See the article below published by a Cleveland newspaper. Notice how at the end of the interrogation, the nurse finally realizes and says, I am going to need a lawyer.  You would be surprised to know how many times this type of scenario involving nurses actually happens and plays out with different factual allegations.  

http://www.cleveland.com/newsflash/index.ssf?/base/news-43/1230134954251070.xml&storylist=cleveland#continue

Here is the cut and paste:

Attorney: Nurse coerced into confession

12/24/2008, 2:02 p.m. EST The Associated Press

SANDUSKY, Ohio (AP) — Two detectives grilled a former nightshift nurse and pressed him to take responsibility for allegations that he sexually abused patients at a nursing home, according to a videotaped interrogation that a defense attorney wants kept out of an upcoming trial.

John Riems, who was videotaped telling authorities that he abused about 100 patients since the 1980s, was coerced into the confession by aggressive detectives who used threats of prison and public shame if Riems did not cooperate, defense attorney Troy Wisehart said.

Riems, 50, also suffers from a mental disorder that makes him vulnerable to being coerced, Wisehart said.

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Erie County Common Pleas Judge Tygh Tone, who watched the videotape during a court hearing Tuesday, will decide whether it will be used during Riems' trial, which is set to begin Jan. 20.

Riems, who worked at 12 nursing homes and hospitals in Ohio, is charged with 15 counts of rape, three counts of sexual battery and other charges. He's pleaded not guilty.

Erie County Sheriff's Detective Jared Oliver and former Perkins Township police Detective Al Jenkins interrogated Riems on Jan. 21 after authorities were contacted about an abuse case at Concord Care and Rehabilitation Center, where Riems worked.

At one point on the videotape, which was shown in court, Oliver told Riems he "would kill" him if Riems had done to Oliver's father what he is accused of doing to the patient at Concord Care. Oliver also called Riems a "cold-blooded rapist" during the interview and threatened to plaster Riems' face on billboards to help him find more victims.

Throughout the videotape, Oliver told Riems to admit to his crimes and take responsibility.

"This is your chance to put it out on the table. You need to take the opportunity you are being given," Oliver said.

When Riems began writing out a list of victims, Oliver told him, "This is your way of saying you are sorry."

Authorities have said Riems could remember specific information on only about two dozen victims. The victims included men and women, most were older, and some were physically or mentally unable to tell others what had happened, authorities said.

Oliver and Jenkins were aggressive in their questioning of Riems, but they had to be to get at the truth, Erie County Prosecutor Kevin Baxter said.

"I think they were aggressive, definitely," Baxter said. "You have to put in yourself in their shoes. They sensed from experience and even common sense he wasn't being truthful. They had to ask him some tough questions, and that's what they did."

At the end of the videotape, Riems is shown alone in a windowless concrete office where he was interviewed. He pulled out a cell phone, and the phone beeped as he punched in numbers. A ring tone sounded, and a female voice answered.

"I'm going to need a lawyer," he said.

---------------------------------------------------------

See also http://www.toledoblade.com/apps/pbcs.dll/article?AID=/20081224/NEWS02/812240395/-1/NEWS

To Hire An Attorney or Not to Hire An Attorney...Attorney Fees in Licensure Defense Cases

Our country is in an economic state of shock because of the housing crisis. My 401K and IRA have both taken a beating. I am scared to open my statements now.

I am being contacted by more nurses who need and want attorney representation but who state they simply cannot afford attorney representation.

1. Purchase professional liability insurance with a licensure defense protection benefit NOW. These policies while not perfect will assist with your legal defense in a State Nursing Board case. You don't need it until you need but when you do need it, you really need it.

2. Borrow money whether its from a friend or family member or a banking institution. Cash in stock, borrow from your 401K, 403B, IRA, etc.

LPNs, RNs, and APRNs make decent money and therefore I am always surprised by the number of nurses who are not saving a dollar or two for a rainy day.

There is nothing wrong with living from paycheck to paycheck as a nurse. I read somewhere that the majority of Americans live from paycheck to paycheck. Everyone has different circumstances.

However, what do you do when there is a State Nursing Board complaint that threatens your ability to work and earn that paycheck when you are living from paycheck to paycheck?

When you open the mail and find a complaint from the State Nursing Board it is a rainy day. You can represent yourself before the State Nursing Board or you can retain an attorney.

After 8 years of licensure defense, countless cases, and hundreds of consultations with nurses, I have learned this. There is a perception that there is no value in hiring an attorney in a State Nursing Board disciplinary investigation or hearing.

You are a professional, a licensed professional and being a licensed professionals has its risks. As a licensed professional there is always a risk that someone will file a complaint against your license. Regardless of whether the complaint has merit or is baseless, there is a process and procedure for the investigation of complaints filed against licensed professionals.

Attorneys like other service professionals expect to paid for services rendered. Attorneys like nurses have mortgages, car payments, and financial responsibilities.

You don't work as a RN, LPN, or APRN for free so don't expect an attorney to defend YOUR nursing license for free.

Faculty Members Beware; Student Will Sue and may Prevail!

http://www.abajournal.com/news/dismissed_dental_student_wins_1.72m_verdict_against_profs

This dismissed dental student sued, won the case, and was awarded more than a million dollars.

Emails from Nurses Contemplating Law School; Law School is What You Make Out of It. Go for the Gold

I would never discourage anyone from attending law school. Law school opened and continues to open doors for me that would not have opened without a law degree and law licensure.

Now with that said, I receive several emails each month from nurses contemplating law school, in law school, or who have graduated from law school.

Nurses contemplating law school want to know is it worth it? For me, yes it was worth every quarter paid and I will say the same for my nursing education. However, gone are the days where you attend law school because you don't know what you want to do. Law school is expensive and it will consume your entire life for a period of time. Also its tougher to secure employment after law school. Don't believe the hype about the $120,000-$160,000 a year jobs. Most lawyers don't make this type of money after graduation and usually start in the $40,000 to $50,000 range (I know this is less than what you make as a RN, but read on....) 

See this article and the comments from the ABA Journal. http://www.abajournal.com/news/law_grad_32_dont_do_what_i_did

Your higher education is what you make of it and as a RN if you decide to attend law school:

1. Have a Plan A, Plan B, Plan C, and Plan D related to your plans after graduation; start developing your business and marketing plan now and keep updating it;

2. Borrow the least amount of money as possible;

3. Work during the summers and school year if not in a paid position, in an externship or internship for the experience;

4. Take the Bar exam and get a law license even if you don't plan to practice law; you are more marketable. Personally when someone tells me they completed law school but are not licensed to practice law, I assume the worst. Take the Bar, pass it, and move on to something else;

5. If you are interested in healthcare law, you have alot of options as a RN to volunteer in legal settings. Think outside the box while you are in law school because the job market is tighter than a pitbull in size 2 panties;

6. Research what other nurse attorneys, RN-JDs, and health law attorneys do by reviewing the internet;

7. Plan D should always be hanging your own shingle; starting your own law or consulting practice. Develop a marketing plan for your Plan D while you are in law school. I jumped to Plan D after being miserable in Plan A;

8. Research your law school carefully. Knows the pros and cons of the school before you start, become best friends with the career placement folks, and study your ass off. Grades and class rank are extremely important;

9. As a non-traditional student with a previous career, use your career as a advantage. Attend Bar Associations meetings, network, volunteer in the community, etc. to get your name out there and meet attorneys and other legal professionals. Securing employment after graduation is a job in and of itself and you want to start thinking about this in your first year of law school, not the third year of law school; and

10. Keep a journal that you update once a week at least. I did this and when I need a pick me up, I read my law school journal. As I read, I think "you were nuts", "now this is stress", etc. It will also allow you to follow your progress and keep track of your employment leads.  

Merry Christmas

Merry Christmas to you and your family.

Ohio Board of Nursing Committee on Practice next meeting is Jan. 15, 2009

Board Committee on Practice Meeting
January 15, 2009

The Board of Nursing is convening a Board Committee on Practice at 12:00 p.m. Thursday January 15, 2009, at the Board offices located at 17 South High Street, Suite 400 in Columbus. The Board Committee, chaired by Vice President J. Jane McFee, LPN, will begin its review and discussion of Chapter 4723-17 OAC, Intravenous Therapy Courses for Licensed Practical Nurses. This chapter of the administrative rules is available for review and download from the Board of Nursing website: www.nursing.ohio.gov in the "law and rules" section. The rules are listed in numerical order.

The Board Committee on Practice, comprised of Board members, is a public meeting convened by the Board on an as needed basis to review and discuss practice issues and to make recommendations to the Board for its consideration.

See the Board's website at http://www.nursing.ohio.gov/.

Nursing Rights & Responsibilities in the Workplace

The Center for American Nurses January 2009 webinar is the last in the first series, Centered on the Nurse. The last webinar in the series, Nursing Rights & Responsibilities in the Workplace is receiving alot of interest.

The webinar will take place on Wednesday, January 21, 2009 from 7pm to 8:15pm EST.

The presenter is Edie Brous. Edie is a nurse attorney in New York in private law practice focusing on nursing licensure, nursing malpractice, and health law. Edie is a published author and a dynamic speaker on nursing law issues. For additional information about Edie, see her firm's website at http://ediebrous.com/.

For additional information or to register for the legal webinar, see www.centerforamericannurses.org.

State Nursing Board Complaints Against Newly Licensed Nurses

I am being contacted by more and more New Grads and Newly Licensed Nurses (practicing for less than one year) who have been reported to the State Nursing Board for a variety of issues. Most of the time its practice related issues.

Does this point to a flaw in nursing education?

Does this point to a flaw in nursing orientation at a particular facility?

Does this point to a lack of bridge and adequate transition from student to professional nurse?

What do you think?

How do you make the transition more smoothly?

1. Research your employer. Don't just accept a position because the pay is good. Look at nursing staff turnover and the workplace environment. If its a unit full of new grads and the most senior nurse outside of management has been there only a few years, ask yourself why?

2. Some workplaces are just plain dysfunctional and toxic and its not your job to "fix" the problem. Don't get caught up in the drama, just move forward whether its to a different unit, floor, or area within the same facility or a different facility. A perfect work environment does not exist however you are not looking for perfection, just an environment where you are comfortable.

2. Ask questions and be engaged while you are working. Nursing is not just a job where you show up and work. If you have this mindset, you are headed for trouble.

3. If something feels wrong, even if everyone else is doing it, don't do it. If you know its wrong (violation of policies and procedures, standards of safe nursing practice, Code of Ethics, Nurse Practice Act, etc.) don't do it although it may be considered routine, custom, common place, or acceptable on the unit, floor, area, etc by other nurses.

Joanne Sheehan and the Nurse as a Civil Defendant

Joanne Sheehan's presentation was very informative. She is a very experienced plaintiff's malpractice attorney and a RN and she gave very insightful comments on the Nurse as a Civil Defendant.

For additional information about Joanne, see her bio on the firm's website at http://www.fnlslaw.com/joanne_sheehan.html

Joanne and I had a conversation before the webinar and she discussed this also during the question and answer period whether nurses concern about being named as defendant in a nursing malpractice case is misplaced considering that a nurse is more likely to be reported to the State Nursing Board and investigated than the nurse is to be named as defendant in a malpractice case. Yet the focus for nurses tends to be on nursing negligence and nursing malpractice.

She also discouraged nurses from keeping journals of patient care activities because this information may be discoverable in a lawsuit unless its protected by the attorney-client privilege. Some nurse attorney recommend nurses kept their own journals and logs outside of the medical record. I don't recommend this from my younger years as a med mal defense attorney. Say it in the medical record and you don't need to keep a contemporaneous record. Also you are more likely to write subjective comments and off color remarks in this journal.  

There were nurses from around country as interest in the legal webinars is growing. For additional information about the legal webinars, see www.centerforamericannurses.org.

My son's first quarter grades; If Assault Wasn't A Crime.......

My son didn't do well in his first quarter of college which of course we paid for out of pocket. He was taking his prereqs for nursing school.

We will continue to help with books however if he wants to continue his education he will have to apply for loans, etc.

$3,000.00 dollars down the drain; his grades were horrible. I told him he reminds me of several of the nursing students who I went to school with at Xavier University who had their parents footing the bill. Well the buck stops here because I work too hard for my money. Don't you?

Also it aggravates me because I paid for ALL of my nursing and law school tuition (the part that wasn't covered by grants and scholarships) with no financial assistance from family as a single parent. I can remember having him in the law library with me and I still remember the extreme stress and fatigue of studying for my first bar exam day in and day out and my son telling me I was a zombie because of the circles under my eyes and my blank stares. 

I love my son dearly, but if assault wasn't a crime....

Congrats to the Illinois Nurses Association and its Commission on Workforce Advocacy

The Illinois Nurses Association launched its Commission on Workforce Advocacy for members of the Illinois Nurses Association who are not members of collective bargaining units.

See http://www.illinoisnurses.com/associations/4741/files/pdf/WFA_News0408.pdf

and

http://www.illinoisnurses.com/displaycommon.cfm?an=1&subarticlenbr=235

This is no big deal, I've seen worse complaints filed against nurses come across my desk

I am paraphrasing what a State Nursing Board investigator allegedly told a nurse who was being investigated.

Anytime you are being investigated whether its in the workplace, a criminal investigation, State Nursing Board investigation, regulatory investigation, ect. and the investigation is directly or indirectly related to your nursing license or has the potential to impact your nursing license, it is a big deal.

What is a big deal? A big deal doesn't mean it will rain for forty days and forty nights after you receive notice of a Nursing Board Complaint or another investigation. A big deal means your spidey sense (my nephews were over here for the weekend and we watched Spiderman I, II, and two and half) should be tingling and you need to proceed with caution and make informed decisions.

Your license is your livelihood and protecting your license should be a big deal to you.

My nursing and law school education wasn't cheap or easy. I don't know about you but I didn't put a quarter in a bubble gum machine and out came my nursing degree and license and I didn't slide a dollar into a soda machine for my law degree and law license in three states for seventy five cents.

I worked hard for my nursing license and my law licenses and both are a big deal to me.

Is your nursing license a big deal to you?

1 out of 3 ain't bad, right? Ohio Nurses Association is hiring for 3 positions and 2 of the positions are union-related

I am a member of the Ohio Nurses Association. The Ohio Nurses Association is a union and a professional association. The majority of ONAs members are members as a result of being in a local unit/collective bargaining unit/union. Practically this means if you work at a certain facility that has a ONA union contract, then you pay dues.

In my opinion and you are free to disagree with me, what this really means are the majority of the membership are paying dues because they made a choice to work in a particular facility, not because they really wanted to belong to the association. This distinction is critical.

ONAs heavy union oriented membership is not reflective of the working environment of the vast majority of RNs in Ohio because the majority of RNs in Ohio work in non-unions workplaces.

There are almost 200,000 RNs in Ohio and only 8,000 RNs (plus or minus) belong to the Ohio Nurses Association. 2,000 +/- of those nurses are like me, non-union members.

Logically and rationally an organization should promote services and products which are tailored to meet the needs of the majority of its current members NOT the minority members or prospective or potential members, right?

Therefore under this rationale the ONA should spend the majority of its resources and staff FTEs on collective bargaining and union activities because the majority of its members and money flows from collective bargaining/local unit/union members.

I am a non-union nurse member of the Ohio Nurses Association and I am glad to see my hard earned dues money (I work hard for my money, don't you?) contributing to ONA hiring for the following positions posted on ONA's website:

1. Director of Union Organizing;

2. Union Organizer; and

3. Director of Health Policy.

http://www.ohnurses.org//AM/Template.cfm?Section=Home

1 out of 3 ain't bad, right?

Nursing Licensure with a Criminal History

There is a forum on allnurses.com under nursing career and career advice regarding nursing licensure with a criminal history. See

http://allnurses.com/forums/f334/

What do you think of the threads?

Here is a cut and paste of a response of an administrator from the forum:

 

Questions we seem to be encountering more and more often have to do with the effects of a criminal history on nursing licensure:

• Is it possible to become licensed as a nurse if you have a criminal history and if so, can I get a job?
• Is it possible to become licensed as a nurse if you have a MIP, DUI, or other related charges?
• What happens if you are charged or convicted of a crime after licensure?
• Can I go to nursing school and/or be licensed/be employed if my record has been sealed or expunged?
• Will I be able to go to nursing school and/or attend clinicals with a criminal record?
• What can happen if I receive a MIP/DUI/DWI or other charge while still in school?

As I have said many times before and I will continue to say, if you have these questions, contact a licensure defense or administrative law attorney in your state and schedule a legal consultation. You want the "down and dirty" and the "skinny" on the answers to these questions and an attorney who practices before the Nursing Board can answer these questions for you, your meeting with the attorney is confidential, and you will know what your options are going forward. Being an attorney, of course, I am biased.

Of course you can

1. Contact the Board (the Board can't provide you with legal advice and counseling);

2. Contact your State Nurses Association;

3. Contact your nursing school or college; or

4. Do a combination of 1, 2, and 3, which in my opinion are the same as winging it; or

5. Contact a nursing licensure defense attorney in your jurisdiction.

This is in part one of the reasons why I think nurses and nursing students represent themselves in licensure and disciplinary investigations before the State Nursing Board because of the casual manner in which others are always willing to provide legal counseling and advising about nursing law, standards, and practice matters. Just my two cents.

Nursing Law Trinity: Practicing Without a License, Nurse License Compact, and State Nursing Board Endorsement

Living on a border state has its benefits. For example, I live in Cincinnati, Ohio and I have an Ohio nursing license. I am 15 minutes after from healthcare facilities and possible employment in Indiana or Kentucky as a nurse. I am licensed only in Ohio as RN however I can obtain a RN license via endorsement in Indiana or Kentucky. However, I practice law in Ohio, Kentucky, and Indiana.

Lots of nurses work in more than one state because of the diversity and benefits of geography, employers, and the economics. Nurses in Toledo, Ohio may also work in Detroit, Michigan. Nurses in Youngstown, Ohio may also work in Pennsylvania. Nurses in Ashland, Kentucky may also work in the Ironton, Ohio or West Virginia.

Not all states are part of the Nursing Licensure Compact (NLC). See https://www.ncsbn.org/158.htm

Kentucky is a compact state but Ohio and Indiana are not. Tennessee is a compact state. West Virginia isn't a compact state and neither is Pennsylvania or Michigan. See https://www.ncsbn.org/158.htm

Do your own due diligence to determine if you need a nursing license in state before accepting and starting employment in a neighboring state. DO NOT rely on the assertions of your employer, meaning your nurse manager, nursing colleagues, HR, etc.

Always err on the side of caution and consider obtaining a license BEFORE you work in a healthcare related position in a neighboring state.

If not, you as a LPN, RN, or APRN may find that you are being investigated by the State Nursing Board for practicing nursing without a license in the state, which in some states is also a crime. You talk about a headache, those cases are monsters and legal vampires that suck the life out of you (and your attorney) because of all the parties and state agencies involved especially when its a nurse who is licensed in one state and allegedly practicing in another state without a nursing license. (I watched Interview with a Vampire last night).

Its an added layer of federal and state laws, regs and a regimen of Motrin and Tylenol for me if the cases involves a APRN and prescriptive authority and scripts are involved.

Whether its a LPN, RN, or APRN with these particular allegations, everyone and their mother gets involved because of pubic protection and safety.

Remember its YOUR license and its your job to protect your license which is YOUR livelihood.

Did you renew your Kentucky Nursing License? Check the Kentucky Board of Nursing website

In the Commonwealth of Kentucky, nursing license renewal is annual. The deadline was October 31, 2008 for renewal. Have you renewed your nursing license? I surely hope you have renewed your license because practicing on a lapsed license is a violation of the Kentucky Nurse Practice Act.

You cannot practice nursing and perform nursing related tasks and functions without a valid license to practice in a particular state.

It never fails, I will receive several phone calls from nurses who failed to renew a license and who realize they are practicing nursing without a license and have done so for a period of weeks or months or who responded in the affirmative to a question on the renewal application and are now being investigated by the Nursing Board. This happens with nurses before the Indiana Nursing Board, Kentucky Nursing Board, and Ohio Nursing Board because the renewals are different for each state.

If you are a Kentucky nurse, please check the Board's website and make sure you renewed your Kentucky nursing license in 2008. See https://secure.kentucky.gov/kbn/bulkvalidation/basic.aspx.

My Spidey Sense isn't working; Why Didn't the Nursing Board tell me I could hire an attorney!

This varies from State Nursing Board to State Nursing Board. Some Nursing Boards will mail you correspondence indicating a complaint has been filed, state the allegations to the complaint, indicate your opportunity to respond, and mention you can of course consult with or retain attorney.

I practice law before the Ohio Nursing Board, Indiana Nursing Board, and Kentucky Nursing Board and the process for providing a nurse with notice of the allegations in a State Nursing Board complaints varies between these three states.

I spoke with a nurse this week who felt "tricked" and "deceived" by the Nursig Board investigator. The nurse said the Board investigator should have told the nurse about the availability of attorney representation in these types of cases and informed the nurse of his/her rights in this types of cases.

Nursing Board investigators are doing their job  and quite frankly its not their job to inform you of your rights and responsibilities. Its their job to investigate the allegations. Remember these cases are adverserial in nature. You don't meet with a Nursing Board investigator in the context of an investigative meeting over tea to discuss the latest nursing news.

In general, we as nurses are not very familiar with our legal rights in administrative, civil, criminal, regulatory, employment, and credentialing matters. You have a right to retain or consult with an attorney in licensure and disciplinary investigations and hearings. However you must exercise that right by seeking assistance and take the first step.

Use a common sense approach and your spidey sense. If you think you might need an attorney or something just doesn't feel right, then talk to someone before proceed with speaking with a State Nursing Board investigator, submitting a response to the complaint, appearing before the Board, etc.