Nursing Law & Order

Should I Smoke Marijuana and What Would LaTonia Do?

You were hanging out last week with a group of friends all of whom are successful and educated professionals ranging from nurses to teachers to lawyers to accountants. Someone pulls out a marijuana cigarette and its being passed around the group. You are a nurse and you work in a facility that recently implemented random drug screens.

You ask yourself, what should I do when you are handed the marijuana cigarette? You think to yourself, the chances of you being tested in the next 20-35 days is possible but not very probable and you decide to smoke the marijuana.

Two weeks later you are work at a hospital and there are large amount of missing controlled substances in the Omni Cell. Hospital security, nursing management, and HR are present and request that all staff with access to the Omni Cell proceed immediately (as coverage is lined up for patients) to Employee Health for a mandatory drug screen.

You panic, although you have nothing to do with the missing controlled drugs, you realize you smoked marijuana a few weeks ago and you will probably test positive.

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You don't know when you may have to provide a sample in the workplace related to a random drug screen, for cause drug screen, and reasonable suspicion. Do you feel lucky? Are you willing and able to roll the dice on your employment, nursing career, and license?

I know alot of folks smoke marijuana. I also know there are some of us using cocaine, heroin, crack, or other illegal drugs. Then there are the issues with prescription medication and medication use and abuse by nurses which impact patient safety and the care provided in the workplace. There are also a few of us who are doctor shopping to obtaining medications from several different providers and this is "okay" because you have prescriptions.

If you can't stop using drugs, talk to someone and seek treatment. If you can stop using, then stop before you are busted and when licensed healthcare professionals get busted, we really get busted, and the consequences are long-term, far reaching, and may appear extreme in comparision to what happens to other professionals and paraprofessionals in other occupations.

If I $19.95 for each and every time I have been told, "I know a ________ (your choice of profession or occupation) who was in the same situation and nothing happened with her license or job, I could have a manicure and pedicure at Mitchell's Spa and Salon every Friday for the remainder of the year.

If you are in situation, where you are about to do something you know or suspect is wrong, illegal, unethical, immoral, or unprofessional and you know the situation could have untoward implications and consequences for your employment, license, and career, just think of me, this blog, and ask what would LaTonia do?

Pending Criminal Matter and Your Nursing License

If you have been charged with a federal or state crime, whether it is a felony or misdemeanor, you need to speak with a license defense attorney in your jurisdiction; this includes DUI, DWI, or OVI.

Unless your criminal defense attorney has experience representing nurses before the State Nursing Board, it is imperative that you speak with a nurse license defense attorney. This can be in the form of a consultation (which may cost a few hundred dollars) or retaining a license defense attorney to handle the State Nursing Board complaint.

Don't say, I can't afford it in this economy because the real question is how can you not afford it? Its not all black and white with criminal convictions and nurses and you want to speak with someone who can discuss your options with you beforehand.

I was contacted today by a nurse who was told by her criminal defense attorney last month that a misdemeanor assault conviction would "probably have little or no impact on her nursing license" because the "situation is not related to patient care and involved a personal altercation."

I also spoke with a nurse earlier this month who retained a civil and criminal defense and personal injury attorney to represent the nurse in a criminal case. The attorney also agreed and was retained to represent the nurse before the State Nursing Board. This is the attorney's first Nursing Board case.

Criminal charges and criminal convictions even if unrelated to "direct patient care" can impact your nursing license, your employability, and your nursing career. Talk to someone, a license defense attorney or admnistrative law attorney with experience in nursing matters while your criminal case is pending.

LEAD Summit for Nurses at Disney World in June 2009

Blend your summer vacation with innovative and progressive educational opportunities. The Center for American Nurses is hosting LEAD Summit June 11-13, 2009 at Disney’s Contemporary Resort, Orlando, FL. This is an event you can’t miss!   Learn innovative strategies to embrace conflict and develop conflict competent organizations Explore progressive techniques to design healthy workspaces Examine state of the art approaches to building healthy work environments Session Highlights: Conflict Engagement & Emerging Communities of Practice Debra Gerardi, RN, MPH, JD The Magic of Creative Conflict Engagement Phyllis Beck Kritek, RN, PhD, FAAN Creating Magic:  Engaging and Being Engaged Beth Ulrich, RN, EdD, FACHE, FAAN Creating Excellent Work Environments:  Individual Versus Group Choice William Hudson, BSN, RN, OCN Dennis R. Sherrod, EdD, RN SPEND THE WEEK AT DISNEY - Friends & Family Welcome! The Contemporary is the icon of Walt Disney World with its A-frame design and monorail service passing directly through the hotel. Nestled between Bay Lake and Seven Seas Lagoon, the Contemporary has long reminded us of the vision of Walt Disney. From its futuristic design to its impressive 15-story atrium, the Contemporary lives up to its name and has an undeniable presence. This deluxe hotel features a pool area, white-sand beach, and a complete array of dining and recreational options. The Center for American Nurses has secured a room rate of $199 single/double plus taxes. Call reservations at 407-824-3869 and refer to the Center for American Nurses annual LEAD Summit. The conference rate is available through May 8, 2009.  Early bird registration deadline has been extended to May 15, 2009. Come for the Meeting and Stay for the Magic. Make the most of your free time with Disney’s Special Meeting/Convention Theme Park Tickets. These tickets are designed to accommodate the meeting agenda and are only available to attendees!  Register for LEAD Summit ’09 and purchase Disney World tickets today online at www.centerforamericannurses.org

I am registered to attend LEAD Summit and I am looking forward to the pre-conference seminar on Conflict Management. If you are attending let me know.

FL and OH Licensed Nurse charged with DUI and Felony Child Neglect; Allegedly Abandoned a Disabled Child in the Home

See this article

http://www.tampabay.com/news/publicsafety/crime/article985508.ece

West Virginia Nurses On Strike Win Unemployment Benefits

See

http://blog.aflcio.org/2009/04/17/west-virginia-striking-nurses-win-benefits/

Addiction in Nursing: Where are we now and where are we going in the future?

Kudos to my buddy Jack Stem who was interviewed for this article appearing in RN Magazine.

Drug addiction among nurses: Confronting a quiet epidemicMany RNs fall prey to this hidden, potentially deadly disease.

See http://rn.modernmedicine.com/rnweb/Modern+Medicine+Now/Drug-addiction-among-nurses-Confronting-a-quiet-ep/ArticleStandard/Article/detail/592623?contextCategoryId=47338

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Jack and I are working together on chemical dependency and legal issues in nursing topics for nurses in the Greater Cincinnati, Ohio area.

I see alot of addiction and drug abuse cases in my tri-state law practice and it is troubling to see the road that one travels and the stigma associated with being a nurse and having a chemical dependency.

Sometimes it starts with a single DUI and morphs into something else. Other times it starts with prescription pain medication and gradually erodes into something else. For others its obtaining controlled substances from physician colleagues and prescribers in the workplace and a number of treating physicians and this spirals out of control. For a few it starts out with medicating depression or other issues and leads to a dual-diagnosis.

Criminal charges and convictions, DUI/DWI/OVI, reasonable suspicion drug testing, randon drug testing, criminal defense attorney, license defense attorney, Nursing Board investigations, Alternative Programs, Consent Agreements, Agreed Orders, Recovery Monitoring Agreements, Return to Work Agreements, suitability for licensure, diversion programs for criminal charges, law enforcement, drug diversion task force investigators, pharmacy board investigators, Nursing Board probation and monitoring, Daily Call-Ins for Drug & Alcohol testing, CD evals, psych evals, NA/AA support meetings, criminal probation, criminal parole, license suspension, Nursing Board investigator, Nursing Board attorney, license revocation, limited license, practice restrictions, diversion, permanent practice restrictions, narcotic restrictions, temporary practice restrictions, probation officer, monitoring agent, action against a license, employability, appearance before the Nursing Board, Nursing Board hearing, and others terms that you don't associate with nurses and nursing become common place for those struggling with and fighting drug and alcohol addiction.

For those of us who don't have a chemical dependency, please show some compassion for our colleagues who have a chemical dependency and are actively dealing with it AND prary for our colleagues who have a dependency or abuse issues and who are in denial.

Four Kentucky Nursing Schools Facing Review by the Kentucky Board of Nursing

See http://www.kentucky.com/142/story/743509.html.

I am curious to see what happens at this meeting and what action the Board will propose if any based on the presentations by the nursing programs.

What do you think?

Free Nurses Week offerings from the Center for American Nurses

Free Webinars

10 Tips for Addressing Disruptive Behavior
by Diane Scott, RN, MSN
Thursday, May 7 

Now What?  Retirement Planning During a Market Slump
by Kathy Stokes Murray, BA, MA
Monday, May 11 

Special Nurses Week Pricing

Tele-Seminar - Reducing Nurse Fatigue:  Balancing the Energy Renewal System, by Beverly Bitterman, MSN, ARNP
Friday, May 8                                                   Price $25

Webinars for Nurse Managers & Nurse Executives

Legal Issues with Nurse Fatigue
by Edie Brous, RN, MSN, MPH, JD
Tuesday, May 5                                                Price $25

Legal Issues with Bullying and Horizontal Violence
by Kimberly Thomas, RN, BSN, JD
Tuesday, May 12                                            Price $25

Register Now at www.centerforamericannurses.org or call 1-800-685-4076 for more information.

Narcissistic Personality Disordered Co-Workers and Supervisors in the Workplace

I caught part of this presentation at the Kentucky Coalition of NPs & NMs conference on Friday. It was excellent. It gave suggestions on how to cope with personality disorders of co-workers, supervisors, and colleagues in the healthcare workplace.

A distintion is made of course between high-achievers and those with mild or extreme narcissistic behavior.

I am going to watch "All that Jazz" again. Clips from the movie were played to provide an example of a narcissistic boss. http://en.wikipedia.org/wiki/All_That_Jazz Scenes from Top Gun were also played with Tom Cruise having being a narcissistist, who is self-absorbed and self-indulgent. http://en.wikipedia.org/wiki/Top_Gun_(film). A clip from Sex and City featuring Carrie and Mr. Big was played and the presenter identified Mr. Big as having a narcissistic personality.

I haven't watched the movie, All that Jazz, in over 15 years but its on my to do list for this week.

I am not a psych nurse but I thought Mr. Big was just your typical self-absorbed man. 

Can you add any others from movies?  

National Federation of Nurses: Just What Nurses Need, Another Mother Figure

The National Federation of Nurses has a website. See http://www.nfn.org/.

The Ohio Nurses Association is part of the OFN. Our convention is in October this year and it is going to be interesting yet again. I am a member of the Ohio Nurses Association.

The website exclaims Its a New Day for Nursing. See the American Nurses Association press release related to the NFN. http://www.nursingworld.org/HomepageCategory/NursingInsider/National-Federation-of-Nurses.aspx

Why does the creation of the NFN mark a new day nursing?

ANA affiliated state nursing associations with unions are either members of the UAN or the NFN.

I don't know where this is going, but it provides me with blogging material without a doubt. Just my two cents, but spare me the lecture about a state nursing association knowing "what is best for its members"  as frankly this is the problem. I don't like to regress back to Kindergarten, but I have a mother and "you are not my mom." If I want anything maternal or a mother figure, I can call my mother, my maternal or paternal grandmothers, soon to be mother-in-law, or my great grandmother. Even better, I am a mom and I can talk to myself.

I have been active on the national, state, and local levels and it is the individual nurse by paying dues who support these organizations, whether it is a professional nursing association or a nursing union and it is the "individual nurse" that gets lost in the big picture, power struggles, and mothering. 

Did you learn to play nice in the sandbox?

Nurse Called Out of Surgery for Pink Slip; This was tacky!

http://www.msnbc.msn.com/id/30231451/from/ET/

This nurse was called out of surgery to be given her pink slip. Was it that pressing that it could not have waited?

The business judgment rule that protects facilities in the business decisions made while running an organization (in general) should have a WWJD (what would Jesus Do) component to instill some fairness in decisions.

No this isn't illegal on the part of the facility, but:

1. It is tacky;

2. It shows a lack of class on the part of the manager and a lack of basic respect and dignity for employees;

3. It illustrates the harshness of what it means to be employed at will;

4. It may turn into a public relations headache for the facility; and

5. It will probably will be used by the nursing unions as one more reason why nurses should organize and have a collective bargaining agreement.

Nurse License Defense: Its the Cradle to the Grave Approach for Me

When someone retains me in a license defense case, I am involved from the beginning to the end. Period. No exceptions unless you fire me as your attorney or I term you as a client.

But that's me because I like the extremes of an absolute. There is a thin line between love and hate for me, it is typically all or nothing with me, and a do or die mentality for me related to business and finances (http://en.wikipedia.org/wiki/Do_or_Die_(album); although I don't think in terms of black or white.

Can you tell my zodiac sign is Cancer? TMI.

I spoke with a nurse last week who hired an attorney to represent her before the Nursing Board. The attorney charged a large retainer ($7,500) and billed hourly ($175.00). The case involved a license suspension of several years. The nurse contacted the attorney and the attorney in order to represent the nurse in the reinstatement process requires another large retainer ($10,000) along with an hourly fee ($215.00). This is why nurses should have professional liability insurance with a license defense benefit, but that's another post.

Each attorneys establishes their fees differently and you want to understand what those fees are initially and what is included in the fee prior to initiating an attorney-client relationship.

In license defense cases, I charge a flat fee and I don't bill hourly unless the nurse or healthcare professional has professional liability insurance. I have been doing this long enough where I am comfortable quoting a flat fee for representation. I still track my time on flat fee cases to document the work peformed in my files however I am not bound by the ball and chain of hourly fees.

If I wanted to live in increments of six minutes or dream about time sheets I would have stayed and continued to practice in a large law firm environment. But that's just me. There are cases, typically where I am working for a healthcare organization on a limited basis or I am engaged as a consultant, where I am do bill hourly however it is not the norm for my practice.

What am I saying? Talk to an attorney about his or her fees for representation and obtain an understanding of what is included in the representation. Ask for a legal services agreement to memoralize the arrangement. And lastly if you are not comfortable with a particular attorney, speak with another attorney about your situation until you find an attorney who you are comfortable retaining.

Remember you are the client and it is your case, your license, and your money.

Do You Have to Tell a Licensed Professional, It Is Not Okay to Sleep with A Client?

As an Ohio attorney, I am required to have 1 hour of professionalism, 1 hour of ethics, and .5 hours of substance abuse continuing legal education instruction each biennium.

I attended a video replay for this requirement at the Cincinnati Bar Association and one speaker remarked if you take one thing from this session, its that you cannot as a licensed attorney sleep with clients.

I thought thank you but I would have guessed as much without knowing the exact rule citation and hearing details of attorney discipline cases.

Then at the same time, I thought it is the same type of cases I see in my law practice as a nurse license defense attorney. I have had several cases involving allegations of a nurse having a sexual relationship with a client or patient.

In cases involving sex with a patient or client (depending on how it is defined in the Nurse Practice Act), the nurse is usually looking at a license suspension with terms and conditions for reinstatement that include a psychiatric evaluation and years of Nursing Board probation and monitoring. In some of the more severe cases, license revocation may be an issue.

Professional boundary and professional sexual misconduct cases involving nurses can get ugly in my experience and tend to be more complicated than your average Nursing Board investigation and adjudication.

I will pass on to you what was passed on to me today, under no circumstances, should you engage in a sexual relationship with a client or patient.

If you have questions about a "cooling off" period or other issues involving boundaries, talk to a nurse license defense attorney in your state who has experience in these types of cases. Don't believe the hype, the fiction, and the watercooler advice provided to you by a colleague that "there is no cooling off period because a cooling off period is not explicitly stated in the nursing law and rules", "If I transfer to another unit or floor, its okay", "if I resign and work in another facility, its okay", etc. Talk to someone first before you proceed.

Having sex with a patient or client is a violation of the Nurse Practice Act and grounds for action against your license in most states and jurisdictions and Nursing Boards take these types of accusations and complaints very serious.

Do you want to know more about professional boundaries, professional sexual misconduct, and the legal issues for nurses? I am presenting a legal webinar for the Center for American Nurses on Wednesday, July 15, 2008 from 7pm to 8:15pm ET? See www.centerforamericannurses.org. The title is Emerging Legal Issues with Professional Boundaries & Sexual Misconduct.

Legal Issues with Nurse Fatigue and Legal Issues with Bullying & Horizontal Violence

The Center for American Nurses is presenting to legal webinars for nurses during Nurses Week. These webinars are geared towards nurse executives and nurse managers but would also be of interest to staff nurses, nurse educators, student nurses, and APRNs.

See the attached file. Download CenterNursesWeekPromoFlier1Compressed[1]

Legal Issues with Nurse Fatigue on Tuesday, May 5, 2009 from 1pm to 2pm ET.

Legal Issues with Bullying & Horizontal Violence on Tuesday, May 12, 2009 from 1pm to 2pm ET.

The cost of each webinar is $25.00 per site for registration and an unlimited number of nurses can view and attend the webinar at each site.

To register, go to www.centerforamericannurses.org.

Advanced Practice Nurses and Legal Issues:Trends in My Law Practice

I am starting to see more legal issues, matters, and cases with APRNs in my law practice over the last two years in Ohio, Kentucky, and Indiana.

Although the majority of the cases in my license defense practice involve RNs and LPNs, I have several cases involving NPs, CNSs, and CRNAs. I don't currently have any licensure defense cases involve CNMs (I have in the past but not currently).

I am also seeing cases where action was taken against a nurse as RN and this is affecting licensure, credentialing, and privileging as a APRN. I am also seeing more regulatory and licensure non-compliance issues with self-employed NPs and self-employment RNs. I am also becoming more involved in employment contract review and business contracts for APRNs.

Chemical dependency is an issue in nursing in general and also with APRNs and I also have alot of cases involving addiction and licensure with criminal and employment implications.

Do you think APRNs are more aware of the legal risks associated with nursing practice than RNs and LPNs? Do you think APRNs should be more proactive in managing the legal risks than RNs and LPNs?

NCLEX Applicants, Suitability for Licensure, and the State Nursing Board

If you are graduating from nursing school (LPN or RN), congrats are in order first. Second, if you know that you will have to disclose information whether its a criminal conviction, illegal drug use and treatment, or psychiatric information on a State Nursing Board application for initial licensure by examination, CONSULT with an attorney in your state BEFORE you submit your application.

I spoke with a NCLEX Applicant recently who was told by a nursing instructor at her nursing school that "its no big deal" "just complete the form and you will be okay."

I would say it is a big deal whenever you are applying for licensure before a State Nursing Board. Its your license, your career, your livelihood, and your life. Oh, wait a minute maybe that's just me.

Talk to someone before you submit your application. Consult with a license defense attorney or an attorney who practices before your State Nursing Board. You can google "license defense attorney" and your state or contact The American Association of Nurse Attorneys at www.taana.org.

A consultation may cost you a few hundred dollars but it is worth it so that you are not second guessing yourself and you know what your are options are in the situation.

I know in Ohio, if you look at the FY 2008 Ohio Board of Nursing annual report which is available online, the majority of complaints reviewed by the Board involve NCLEX-Applicants (RN and LPN) disclosing information on the application for licensure by examination. Between 9-10% of all NCLEX-Applicants to the Ohio Board of Nursing disclose information triggering a complaint.

Now, you can take this stat to mean several different things and I will leave that to you to decide. What it says to me as a license defense attorney is different from what this says to me as a registered nurse which is different from what it means to me as a consumer of healthcare services and the aunt of a nephew with a chronic medical condition who is frequently hospitalized vs. what it says to me as a nurse advocate.  

A nurse educator who I respect said to me last year that in general the quality, caliber, and mindset of your typical nursing student has changed from what you see now vs. 10, 15, or 20 years ago. You can see this reflected in the interactions and incivility between nursing students and nursing school faculty, increased Nursing Board monitoring of new nurses related to criminal convictions and other issues, and the tension and bullying issues in the nursing workplace.

Do you agree or disagree with this statement?

UAN, CNA, Mass Nurses vs. SEIU vs. National Federation of Nurses: More Nursing Board Complaints are Coming with EFCA

See this excellent article at http://www.labornotes.org/node/2138  that provides an overview of the nursing unions.

Hospitals and other healthcare organizations really need to start embracing nursing and moving forward now with treating nurses at true partners in the workplace. If you are in the C-Suite and don't know or have an ideas for what it takes to embrace nurses and nursing as true partners in the workplace, call me.

Maybe EFCA will challenge healthcare organizations to take nurse-management relations to the next level. That would be a nice by-product of the "EFCA scare" if it happens.

Nursing union leadership appear to be excited about EFCA (and they should be excited) which provides the first real opportunity to organize the majority of RNs in across the United States. It also provides nursing unions with the ability to do something nursing unions never had the power to do in the past: make the hospital C-suite and management shake in their boots.

I don't know if this is the beginning of the end or the end with a new beginning, but I said before it gives me blogging material anyway and probably additional license defense cases as this dance of Mortal Kombat plays out in hospitals, skilled nursing facilities, community health settings, and other healthcare settings throughout the country. Why?

I am predicting there will be an increase in the number of complaints filed against nurses with State Nursing Boards related to the organizing of nurses and other issues in the workplace if EFCA passes. It is going to be ugly  and messy and unfortunately I think individual nurses (who I represent, counsel, and advise and who I am concerned about) will be lost in the process in the dirty dance of power between nursing unions and healthcare facilities.

Kentucky Coalition of NP & NM Conference in Lexington, Kentucky

I have decided to attend the Friday session of this conference. If you are attending, look for me.

http://www.kcnpnm.org/conference.html

Emerging Legal Issues in EHR for Nurses: April 15, 2009 legal webinar

Are you interested in learning more about the legal issues impacting nurses with Electronic Health Records? See https://m360.centerforamericannurses.org/event.aspx?eventID=7354&instance=0

Webinar for Nurses: Surviving the Economic Crisis

Thursday, April 30, 2009 1pm to 2pm EST

sponsored by the Center for American Nurses and WISER (Women's Institute for a Secure Retirement)

See https://m360.centerforamericannurses.org/ViewEvent.aspx?id=7806&instance=0