Nursing Law & Order

Nursing Law & Practice

Series II, Webinar 1: Legal Issues with Chemically Dependent and Chemically Impaired Nurses     Cynthia A. Mikos, BSN, MBA, JD      Date:  February 18, 2009 Time:  7:00 - 8:15 pm Eastern Time Series II: Patient Safety and Medication Use & Abuse with Nurses (2 part series) Chemical dependence among nurses raises many legal and ethical questions.  Impaired practice results in financial implications such as absenteeism, quality of care issues such as preventable errors, and its impact on staff morale affects nurse retention.  This series will discuss the relationship between chemical dependency, criminal conduct, and nursing licensure.  Legal Issues with Chemically Dependent and Chemically Impaired Nurses Presented by Cynthia A. Mikos, BSN, MBA, JD — February 18, 2009  A Balancing Act in the Workplace: Managing the Risks When Nurses Take Prescribed Medication Presented by Kimberly M. Thomas, BSN, JD — March 18, 2009 CE credit: 1.25 contact hours / session Register for an individual session: Center Members Non-Members $49.95 per session               $69.95 per session             Register for both sessions in Series II: Center Members Non Members $85.00  $125.00 Mark Your Calendars : Series III: Emerging Legal Issues in the Nursing Workforce (4 part series) April 15, 2009    Emerging Legal Issues in Electronic Health Records for Nurses May 20, 2009    Emerging Legal Issues in Nursing Education June 17, 2009    Emerging Legal Issues for Nurse Practitioners July 15, 2009    Emerging Legal Issues with Professional Boundaries and Professional Sexual Misconduct       Nurses Service Organization Attend a total of 6 contact hours of eligible Risk Management Courses including the Center for American Nurses Legal Webinar Series and get a 10% non-cumulative credit applied to your annual Nurses Service Organization (NSO) professional liability insurance premium for up to three years. The course(s) must be 6 contact hours in a subject related to the insured's area of specialization. Must provide a certificate of attendance showing course name, number of hours and course date. Course must have been completed within the last 12 months in order for the discount to be applied. Each legal webinar includes 60 minutes of lecture and 15 minutes of question and answer for a total of 75 minutes.  The Center for American Nurses is co-providing this activity with Anthony J. Jannetti, Inc. (AJJ).  Anthony J. Jannetti is accredited as a provider of nursing continuing education by the American Nurses Credentialing Center's Commission on Accreditation. Register at www.centerforamericannurses.org For more information: Contact Laurel Blaydes at 301-628-5063 or 1-800-685-4076

Midwife Advocates Challenge the Status Quo

See this article that appeared in the Cincinnati Enquirer. It should come as no suprise as some doctors are resistant to home births with certified nurse midwives let alone lay midwives.

Cut and paste of part of the article:

The states are now evenly split on legal recognition of certified professional midwives (CPMs) - those who lack nursing degrees and who account for most midwife-assisted home births.

Half the states have procedures allowing CPMs to practice - including five which have taken such steps since 2005. The other 25 - including Ohio and Kentucky - lack such procedures and CPMs are subject to prosecution for practicing medicine without a license.

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

What do you think about the use of certified nurse midwives (CNM) vs. certified professional midwives (CPM)?  

http://news.cincinnati.com/apps/pbcs.dll/article?AID=/20090129/LIFE07/901290347

Three Hurdles: More State Nursing Boards are conducting Criminal Background Checks for Licensure

I read in article published in 2008 in the Journal of Nursing Law that some vocational counselors suggest nursing (either RN or LPN) for individuals with a criminal history and criminal convictions for a variety of reasons. One reason I am assuming would be the ability to attend school for one year (LPN or LVN) or two (RN with a diploma or ASN)and make a decent living.

I told you about a corrections nurse who approached me last year and asked me what should she tell the female inmates. This nurse  works with incarcerated female inmates in vocational groups and counseling sessions and the women are interested in being a nurse.     

Nothing surprises me anymore as a licensure defense attorney.

More State Nursing Boards are conducting criminal background checks for licensure. Although there are still a handful of states that do not require a criminal background check but still inquire about criminal convictions on the licensure application. For example, Indiana. Which only makes me wonder, how many are failing to disclose criminal convictions becausea criminal background check isn't being performed and the Board relies on self-disclosure.

See this chart from the National Council of State Boards of Nursing.

https://www.ncsbn.org/CBC_SxS.pdf

With criminal convictions, being admitted to nursing school and clinical sites is Hurdle One; this is the easiest hurdle. 

Hurdle Two is suitability for licensure depending on the State Nursing Board where you apply for a licensure.

Hurdle Three is employability. Employability is an issue and I am seeing more and more newly licensed nurses who have a license, most of the time with restrictions and probation, who are having trouble finding and securing employment as a nurse. Even if you have an unencumbered and restricted nursing license (clear), employability may still be an issue in some states if not most because of criminal background checks in healthcare and some healthcare organizations will not and some cannot hire you with certain felony and/or misdemeanor convictions.

Having a "S" on your chest and being able to leap easily over Hurdle One and Two is meaningless if you hit a wall at Hurdle Three. Do your due diligence before you apply to nursing school if you have criminal convictions. Don't assume you will be able to find a job because "there is such a demand for nurses."

Don't waste your money. You are an adult and you should do your own due diligence and research before pursue a certain educational course. If you have criminal convictions, a career as a licensed healthcare professional may not be your best option.

Legal Issues with Chemically Dependent and Chemically Impaired Nurses

Do you want to know more about the legal issues associated with chemical dependency and impairment in nursing? Do you want to learn more about the professional practice and workplace issues involved with chemical dependency and nursing? What are some of the most common signals and signs that a nurse may be impaired or have a chemical dependency? What are your ethical responsbilities if you suspect that a co-worker has a chemical dependency? What is an State Nursing Board Alternative Program for Chemical Dependency?

The Center for American Nurses is sponsoring a legal webinar for nurses titled Legal Issues with Chemically Dependent and Chemically Impaired Nurses on Wednesday, February 18, 2009 from 7pm to 8:15pm ET.

The presenter is Cynthia Mikos, BSN, MBA, JD who is a Florida licensed attorney with years of experience in nursing licensure defense and health care law.

For additional information or to register online see www.centerforamericannurses.org.

Two RNs will be awarded 4.9 million dollars in a whistleblower lawsuit

See

http://www.abajournal.com/news/record_24.7m_qui_tam_settlement_in_medicare_case

2009 RN Licensure Renewal in Ohio and OH, KY, and IN Law License Renewal

Ohio RNs, get ready, set, and go! We will renew our RN license this year. The Renewal Applications are typically mailed in the late spring/earlier summer, if my memory serves me correctly.

I always renew my license before the 1st deadline because its less expensive. I think this is also the year I have to renew my Ohio, Kentucky, and Indiana law licenses. If so, I will spend at least $700.00 renewing my Ohio RN license and my law license in Ohio, Kentucky, and Indiana.

I am curious to see if the RN Renewal Application questions for 2009 will be identical to the LPN Renewal Application questions from 2008.

RN Renewal Years are usually busy for me starting in the Spring and running through the Summer with legal consultations because renewal apps typically ask questions regarding criminal convictions, action against a license in another state, etc.

Is there a correlation between pre-licensure criminal convictions and post-licensure disciplinary action in nursing?

What do you think? Does having criminal convictions prelicensure make one more likely to engage in behavior or actions that are grounds for Nursing Board disciplinary action?

See https://www.ncsbn.org/Charlene_Kelly_05_Project.pdf.

Did You know 21% of all RNs are Organized?

Thank you to my buddy up yonder for sending me this powerpoint presentation that was presented at the November 2008 Constitutent Assembly of the American Nurses Association.

Did you know 21% of RNs are organized? I thought the number was somewhere between 12-15%.

See this file and tell me what you think about this focus and interest in organizing RNs. In your opinion, are the majority of RNs interested in being union members or part of a collective bargaining unit?

We are living in interesting times as RNs and my only comment is there are more appropriate and better "wars" to be waged and fought for individual nurses and on behalf of the professional practice of nursing in the United States than this focus on organizing RNs into collective bargaining units and the formation of yet another national RN union.

Download CA12.0NOV08NatlLaborEnvironREVISED110108[1]  

Release Your Inner Writer and Author!

Do you like to write?

Do you want to publish an article?

The Center for American Nurses is seeking Nurse Writers and Authors to its Nursing That Works Series.

See http://centerforamericannurses.org/associations/9102/files/NTW_Writer%20Guidelines.pdf.

I started writing in 2000 and I haven't stopped.

One of my practice goals for this year is to update my blog and write a post at least 25 days out of the month. Are you planning to submit an article(s) for publication this year? Do you have any goals related to writing and publication for 2009?

Illegal Processing of Drugs Documents is a Felony and Ohio Nurses Are Being Charged

Dear Ohio Nurses,

Regardless of how busy you are, how short staffed you are, or how how the patient acuity is on a particular unit, you have a professional and legal obligation to accurately document your administration, handling, and waste of a controlled substance.

http://www.sconet.state.oh.us/Communications_Office/summaries/2003/0618/020230.asp

You can be investigated by your employer and terminated, reported to the Nursing Board and investigated by the Nursing Board, and reported to local law enforcement and criminal charged and indicted for illegal processing of drug documents. Its happening all to frequently to Ohio nurses in cases where theft of drugs can't be proven beyond a reasonable doubt. 

Do not underestimate or blow off the importance of adequate and appropriate documentation of medication administration. 5-10 years ago, prosecutors weren't touching these types of cases because these cases weren't being reported by healthcare organizations.

Healthcare organizations know their reporting obligations and are taking steps to minimize their liability by reporting. Also there is a war on drugs and multiple county, state, and federal agencies are involved with combating illegal drug use. The paper trail or lack thereof will be there in these cases. The Prosecutor doesn't have to prove theft of drugs, just the failure to document in accordance with facility policy and laws and regulations.  

If you want to gamble, go to one of the Indiana Casinos. I would be willing to meet you there to gamble with you. Do not gamble with your nursing license; its your livelihood at stake and being charged with a drug related felony may, can, and/or will ADVERSELY impact your license, your career, and your life.

If you need help with a chemical dependency or addiction, get help ASAP.

If your issue is not dependency and just sloppy nursing practice, get out the mop and broom and clean up your nursing practice because you can be charged and convicted of Illegal Processing of Drug Documents for not documenting the administration and waste of a "dangerous drug" in accordance with the Ohio law, facility policy, and professional practice standards. Slow down and document. There is no excuse for not protecting yourself by and through documentation in today's highly regulated healthcare environment. Document as if your life and your license depended on it because in a way it does.

Mortal Kombat! Unions vs. US Chamber of Commerce and Health Care Organizations and the Employee Free Choice Act (EFCA)

Its going down! http://www.youtube.com/watch?v=s2Qi_KR8eCc

I read an article in Provider Magazine, the official magazine of the American Health Care Association and the National Center for Assisted Living (January 2009) titled Firestorm Brewing over Labor Bill: Union Membership Could Rise Under Legislation.

The ERCA could eliminate a secret ballot election and mandate a union is certified when a majority of workers have signed authorization cards designating a particular union for representation.

Its amusing, the US Chamber of Commerce, which was soo busy and preoccupied with blaming everything on trial lawyers, has pledged 10 million dollars to combat ERCA.

The SEIU which represents 140,000 nursing facility employees (according to the article in the Provider) has likewise pledged $10 million dollars to press the new administration and Congress to pass the measure in the first 100 days after the inauguration. http://www.seiu.org/employeefreechoice/

Nurses in general don't support unions and many see union membership as being unprofessional. However it remains to be seen whether a fundamental change in how nurses view unions will occur especially when you consider the working conditions in some healthcare organizations.

Healthcare organizations (most but not all) have not made the necessary strides to embrace nurses as true partners, like physicians in the workplace. Until this happens, there will always be a place for unions in healthcare and some RNs, LPNS, and APRNS will organize. ERCA tips the scales in favor of unions and if this passes there may be an increase in the organizing of RNs nationally.  

Don't believe the hype about democracy and secret voting, the skinny with EFCA boils down to declining union membership and allowing unions to organize workers without all the red tape. Healthcare organizations and big business of course, don't like this because it is a fundamental shift in power.

Change is never easy and President Obama supports EFCA! Do you support EFCA? Do you think its a step in the right direction for nursing? EFCA vs. At-Will Employment? EFCA vs. Shared Governance? EFCA vs. Employment Contracts?

Is EFCA legislation slated to become the next chapter in a book titled Chicken Noodle Soup for the American Workers Soul?

http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2008/11/15/BU7B1436S5.DTL.

http://seattletimes.nwsource.com/html/nationworld/2008489028_labor10.html

You can debate whether this is good or bad but as I said, if nurses were embraced as true partners in the workplace and not treated as fungible at-will employees at the bottom of a long and rusty wooden ladder, there would be no need for unions in nursing.

Will this be a fight to the end, a business and cleaner version (but still cut throat of course) of the ever popular game and movie, Mortal Kombat?

Don't know but I am looking forward to seeing where this goes. Its provides me with blogging material either way, pass or fail.

http://www.youtube.com/watch?v=UMf40daefsI

Law School Debt is Rising!

See this article in Forbes on the Great College Hoax.

http://www.forbes.com/forbes/2009/0202/060.html?feed=rss_news

http://www.abajournal.com/news/divorcing_law_grads_stressed_over_190k_in_debt_victims_of_education_hoax/

This lawyer couple divorced in part because of the law school and undergraduate loans.

If I had to do it all again, I would have borrowed less for my undergraduate education and law school but I am pleased with the outcome, having a nursing degree and license and a law degree and three law licenses.

Having an education is what you make out of it and you have to work hard to forge ahead. Having an undergraduate degree and a graduate professional school degree is not an automatic and guarantee of success, happiness, or a high paying career.

Charges Against Lawyer who advised SentosaCare Nurses in New York

A lawyer facing criminal charges for advising 10 nurses they could quit their jobs at a Long Island, N.Y., nursing facility gave "objectively reasonable" advice and cannot be prosecuted, a Brooklyn appeals panel has ruled.

See

http://www.law.com/jsp/law/sfb/lawArticleSFB.jsp?id=1202427548151

See also

http://www.nylawyer.com/adgifs/decisions/011609eng.pdf

Has anything changed from 2007 to 2009 in this post? Do You Anticipate Any Change?

See this post of mine from January 2007. http://advocatefornurses.typepad.com/my2cents/2007/01/happy_new_year.html

Here is the cut and paste:

Happy New Year Nursing Colleague!

1. Will this be the year that we will be "recognized" as a profession? If we are not a profession, what are we? A craft, occupation, trade, calling, etc. Does it matter? For me, regardless of whether nursing is ever recognized as a true profession, I am LaTonia Denise Wright, R.N., first and foremost.

2. Will this be a year that we will reach a consensus on the entry level to practice?

3. Is this the year that we as a profession will recognize the importance of nursing standing unified, regardless of education, practice area, or union status?

4. Will this be the year that individual nurses recognize the importance and POWER inherent in employment contracts, agency relationships, independent contractor status, and other viable alternatives to at-will employment?

5. Will this be the year that nurses start supporting our nursing professional associations (by joining and paying membership dues of course) which tirelessly advocate for nursing?

6. Will this be the year that as nurses we start following what happens in the state and federal legislatures like we follow what happens on the local evening news?

7. Will this be the year that we as as a profession stop eating our young and discouraging others from considering nursing as a career choice?

8. Will this be the year that RNs and LPNs (and associations and organizations for each) unite on the national, state, and local levels to pursue common goals and interests?

9. Will this be the year that in addition to being one of the most trusted and respected professions by the public that nursing will also be one of the most trusted and respected professions with _____________?

10. Will this be the year that the Sleeper Will Awaken? The Sleeper Must Awaken! This is a quote from Dune written by Frank Herbert.

CAPTASA Conference in Lexington, Kentucky focuses on Chemical Dependency and Addiction

I am registered to attend this conference in Lexington, Kentucky. Its a highly rated chemical dependency conference.

Although its a two day conference, I am only attending on Friday as I scheduled appts on Saturday forgetting it was a two day conference.

See the conference website at http://www.captasa.org/

With increased autonomy comes increased responsibility, accountability, and potential liability. Are we ready?

See this article.

http://www.mycentraljersey.com/article/20090102/NEWS/901020350/1003/newsfront

Barbara DiCicco-Bloom is quoted as saying "The thing that needs to change for nurses is the respect they have. There's a need for them to have the authority, the autonomy and the capacity to really meet their potential as a professional, which I think, in the end, would be very beneficial for patients," she said. "Every paper that I've written has that at its core."

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

With the increased authority and autonomy, an increase in accountability, responsibility, and potential liability follows. 

Is the profession ready for the increased accountability, responsibility, and potential liability that flows from increased authority and autonomy in your opinion?  

As a licensure defense attorney on the front line and in the battlefield with cases involving licensure, employment, regulatory, criminal, and civil implications, my answer may differ from your answer.

Criminal Convictions and the 2009 RN Licensure Renewal in Ohio: To Report or Not to Report

Its RN licensure renewal time in Ohio this year and I am already receiving phone calls and emails about expungements, sealing criminal records, and what has to be reported on the Ohio Board of Nursing RN licensure renewal form.

In a nutshell and this isn't legal advice, if you have been convicted of crime and you are a licensed Ohio RN and you are renewing your license in 2009, it is highly likely (more likely than not) unless the crime is strictly a traffic offense (DUI and DWI are not considered traffic offenses) the conviction, even if you received diversion or it was expunged or sealed, you are required to report and disclose the conviction to the Ohio Board of Nursing.

Do you want more specific advice and counseling about your specific circumstances and situation? Consider the following:

1. Contacting the Ohio Board of Nursing to determine if a criminal conviction has to be reported;

2. Contacting an Ohio licensure defense attorney to determine if a criminal conviction has to be reported and schedule an appointment (either in-person or a telephone appt.); and/or

3. Contacting the Ohio Nurses Association and ask for Jan Lanier, RN, JD, who is the Associate Executive Director or Kathy Morris, MS, RN, who is the Director of Nursing Practice.

See this brochure published by the Ohio State Legal Services Association.

http://www.ohiolegalservices.org/public/legal_problem/criminal-matters/expungement/sealing-a-criminal-conviction/sealing-criminal-records-0808.pdf

You will be missed, Circuit City!

This might sound corny, but I will miss Circuit City. I had this feeling when McAlpins changed to Dillards. http://en.wikipedia.org/wiki/McAlpin's

I still miss the midnight sales and markdowns at McAlpins. My grandmother would take us several times a month when we were growing up to TriCounty Mall where we would browse or purchase things at McAlpins. Dillards is no McAlpins.

I must admit, I wasn't a hard core Circuit City shopper but I always purchased my DVD movies from Circuit City for $14.99 the week of a release. Circuit City usually beat Walmart pricing for new releases.

Although we purchased our laptop computers from Dell, our last two flat screens from Best Buy, our washer and dryer from HHGregg, our fridge from Lowes, and I have Walmart tatted on my arm (just kidding, but I am in a Walmart at least once a week), you will be missed Circuit City. http://www.circuitcity.com/closed.html

Minnesota Nurses Association correspondence related to severance of ANA relationship

This information is available on the Minnesota Nurses Association website.

See http://mnnurses.org/vertical/Sites/%7B41671038-B8D0-4277-90A9-50B10F730CBD%7D/uploads/%7BF790F9F6-D9CA-472A-8E60-ADDCE109C4D4%7D.PDF. 

Do You Want Professional Assistance with your Nursing Career? Consider a Career Coach

See http://centerforamericannurses.org/displaycommon.cfm?an=1&subarticlenbr=217.

Pam Williams, ACC, is the Chief Innergy Officer and Internationally Certified Coach at Innergized! and is working closely with the Center for American Nurses for career coaching designed especially for nurses.

 The Center for American Nurses is offering a series of informational tele-forums to learn more about career coaching on:

• 2/12       1:30 - 2:15 PM ET
• 2/18       8:00 - 8:45 AM ET
• 2/24       7:00 - 7:45 PM  ET 

 To participate in an informational tele-forum, call (218) 844-8230 at the appointed time. The participant access code for these calls is 875498#.