Nursing Law & Order

What is a Consent Agreement? What Am I Consenting To Anyway?

I love what I do for a living and I hope you do too because if you are reading this post, you are probably a nurse also. I have been involved in license defense for 8 years and I am very accessible to my clients. I can be reached at work, via business cell phone, email, fax, in-person meetings, I have a few clients who text me, etc. I do not however provide clients with our home telephone number. 

I received a frantic phone call on my business cell phone last night a 10pm on Saturday night from a prospective client. I did alot of yard work and cleaned our pool and hot tub so I was in the bed on Saturday by 9pm (I know, I live such an exciting life!) and didn't answer the phone.

I listened to the voicemail this morning. The nurse was crying throughout the message about how unfair this entire ordeal has been, she did everything she was told by everyone to do and her reward was receiving a Consent Agreement in the mail from the Ohio Board of Nursing.

She ended the voicemail message by saying "What is a Consent Agreement?"

What is a Consent Agreement? A Consent Agreement is a legal document tendered by the Nursing Board to resolve the pending complaint against your license.

One misconception I have found is that nurses assume if they hire an attorney after they receive a Consent Agreement or some other legal document from the Nursing Board to resolve the complaint, that the complaint will just disappear. Oh yeah?

Do you honestly believe the complaint will disappear after you have submitted 3 twenty page responses and statements to the Board (that you didn't keep a copy of by the way), and been interviewed twice for 90 minutes by a Nursing Board investigator (who are very proficient at what they do for a living, I must add)?

If you receive a Consent Agreement in the mail (if you receive it in the mail this means you are representing yourself before the Board), contact a license defense attorney to see what your options are at this point. You always have options although you may not like what your options are at this point. Talk to an attorney. 

Depending on what is being proposed in the Consent Agreement, attorney representation, counseling, and advising may still be beneficial.   

  

Free Ohio Law and Rules CE on June 24, 2009 at Drake Hospital in Cincinnati

I am presenting "Ohio Board of Nursing Disciplinary Investigations: What Nurses Need to Know" on Wednesday, June 24, 2009 at Drake Hospital on behalf of VITAS. This course satisfies the Ohio nursing law and rule CE needed for license renewal.

See the attached flyer. This is a free Ohio law and rules CE program and dinner and beverages are provided. Download OhioNursinglawandrulesCE

I presented yesterday evening for VITAS on Navigating Ohio Nursing Law and Rules and there was a nice turnout. The food served was delicious and dessert was provided after a tour of the VITAS inpatient unit at Drake Hospital.

Emerging Legal Issues for Nurse Practitioners

The Center for American Nurses Presents

Emerging Legal Issues in the Nursing Workforce Series 

Webinar 1:  Emerging Legal Issues in Electronic Records for Nurses (April 15, 2009)
Webinar 2:  Emerging Legal Issues in Nursing Education ( May 20, 2009) 
Webinar 3:  Emerging Legal Issues for Nurse Practitioners (June 17, 2009)
Webinar 4:  Emerging Legal Issues with Professional Boundaries & Sexual Misconduct (July 15, 2009)

Emerging Legal Issues for Nurse Practitioners 

Wednesday, June 17, 2009      7:00 - 8:15 PM Eastern Time
Presented by Melanie Balestra, RN, MN, NP, JD

   Register

• Overview of the 1994-2004 Nurse Practitioner Claims Study and its risk management implications for nurse practitioners
• Review the most common claims identified, claims by risk, state, severity, etc.
• Risk Management considerations identified in the Study include: scope of practice, health information records, documentation, diagnosis, cancer screening, treatment, medication, equipment, and informed consent.
• Legal dilemmas include: employment contracts and agreements, collaborative practice agreements and arrangements, privileging and credentialing, licensure investigations, criminal conduct and criminal convictions, billing, medical malpractice, scope of practice, and professional liability insurance and insurability, interplay of state and federal investigations and reporting.
Consensus Model for APRN Regulation: legal implications for NP practice.

CNE Credits per Webinar:  1.25. 

Cost:  Member price:  $49.95; Non-member $69.95. 

Cost is per site.  Any number of nurses can attend per site.  Webinar time inconvenient?
All registrants have access to the recorded webinar upon request.  For more information, call 1-800-685-4076 or email [email protected]

No Holds Barred; More Private Sector Employers Fighting Union Organizing

See http://www.americanrightsatwork.org/publications/general/no-holds-barred-the-intensification-of-employer-opposition-to-organizing-20090520-758-116-116.html

Nursing Professional Development: Scope & Standards of Practice

See the draft for public comment: 

 http://www.nursingworld.org/DocumentVault/NursingPractice/Draft-Nursing-Professional-Development-pdf.aspx

Being There as a Nurse for Aging Parents and Grandparents: The Essence of Being a Nurse

My paternal grandfather had surgery 10 days ago for a left leg popliteal aneurysms. Can you guess the name of his home health nurse? LaTonia Wright, RN.

After my wedding (which he refuses to miss of course), he will have surgery for his abdominal aneurysms. I of course will not be traveling for 10-14 days after his surgery and working from their home, which is walking distance (if you don't smoke) from where we live anyway.

Later this fall, he will have surgery for his right leg popliteal aneurysms. Yes, he is a smoker although he is trying to quit. He is a very difficult patient but I love him none the less.  

Both sets (maternal and paternal) of my grandparents are getting older and I plan to be there for them as much as possible because they have been there for me and my son and this is what it means to be a nurse to me.

Ohio, Kentucy, and Indiana Nursing Boards, Client Meetings, and My Tom Tom

I attended the Indiana State Nursing Board meeting this week. I had a matter before the Board with a RN client.

My client's eyes glazed over when during a break I spoke with her about the differences between the complaint investigation and hearing process before the Indiana, Kentucky, and Ohio Nursing Boards, which is exciting to me.

I like having a tri-state law practice and the travel involved with meeting with clients throughout three states. Trust me, my first two years of law practice involved office and library time with very little meaningful client contact. I told myself then, I wanted a law practice where I would meet with and work directly with my clients and be out of the office.

On Thursday I drove to Indianapolis from Cincinnati, which is 1 hour 45 minute drive. I was at the Board Meeting most of the afternoon. I meet with a prospective client for an early dinner at the Indiana Live Casino outside of Indianapolis. I then drove back to Cincinnati. On Friday, I drove to Columbus in the morning, to meet with a prospective client and a current client and then drove back to Cincinnati in the later afternoon in time for a 3pm meeting here.

If I am driving to Indianapolis, Columbus, Lexington, or Louisville, within my one to two hour comfort zone, its a piece of cake. Now if I am driving to Cleveland, OH, Evansville, IN, Toledo, OH, Bowling Green, KY, Ashland, KY, etc., anywhere outside of my "normal driving areas", I enlist my fiance.  

If you have never attended a State Nursing Board meeting, I would highly suggest that you do sometime in the near future. It provides you with insight on what is the Nursing Board and a perspective on just how important the Nurse Practice Act is to your nursing practice.

APRNs, Hospital Privileges, and the Affirmative Responses

Have you seen the applications for privileges at a Hospital? These apps remind me of the Bar applications for attorney licensure because of the scope and detail of the information requested and required to be disclosed in the application process.

I will never (and you are supposed to never say never) apply to sit for another Bar exam in this lifetime. Its not the Bar exam for me because I do well on standardized tests; its the application and recalling every parking ticket you had since age 16.

If you have to answer in the affirmative on one or more questions or if you are unsure of how to answer a question(s), talk to someone before you complete and submit the application.

Talk to a licensure defense attorney or an attorney with experience with hospital privileging and credentialing matters. The denial for hospital privileges follows you for the remainder of your career and you want to make informed decisions on how to proceed and be absolutely sure and comfortable with your application before you move forward.

The Unthinkable Happens: A Patient Dies or Is Severely Injured While in Your Care and Negligence is Alleged

If a patient dies and is injured while under your care as a nurse and allegations of negligence surface (you didn't do this correctly, you did not follow this procedure, you should have done this, you did not recognize this, you failed to assess this, you failed to process this which would have resulted in that, etc.) you need to make careful and informed decisions on how to proceed.

This is probably one of the worst things that can happen to you as a nurse. You are dealing with a variety of issues and emotions and trying to decide the best way to proceed in light of a terrible event.

Remember, the healthcare facility attorney or risk manager is the healthcare facility attorney or risk manager. Their role and job description involves protecting the interests of the facility first and foremost. Their primary concern is protection of the facility which may include of course dealings with you as an employee, former employee, or independent contractor, etc. in this incident.

This is very important to remember because unfortunately some nurses when these types of serious cases arise mistakenly follow the advice the healthcare facility attorney or risk manager as opposed to seeking independent legal counsel with a private attorney not associated with the facility.

The facility attorney or risk manager may be thinking about malpractice and mitigating the risks of possible medical malpractice/nursing negligence, federal or state regulatory agency investigations, root cause analysis, sentinel events,  accreditation, public reaction to this event, etc.  

As a nurse you should also consider and prepare for the probability of being named in a med mal or negligence lawsuit. However MORE importantly you should also think about your license and the forthcoming Nursing Board investigation and adjudication and the possibility of a criminal investigation and indictment related to the criminalization of a medical error.

Talk to someone from your state nurses association, a license defense attorney or criminal defense attorney as soon as possible. This is not the time to follow the watercooler advice provided by other nurses in an online chatroom or the advice of well meaning family membes and colleagues.

State Nursing Board Alternative Program for Chemical Dependency

These are voluntary programs and are an alternative to discipline where a nurse with a chemical dependency enters into a program for monitoring (3-5 years) in lieu of formal action being proposed or taken against the nursing license related to addiction issues (diversion, theft of drugs, impairment in the workplace, etc.).

These are wonderful programs! However you should make sure that you understand the terms and conditions in the program Contracts and Agreements before you sign on the dotted line. Why? You have to comply strictly with the terms and conditions in the contract, not substantial or partial compliance but strict compliance as these are legal documents and there are consequences for non-compliance.

Although Nursing Board or Nursing Association (depending on who administers the program) staff review the contracts with nurses prior to entering into the program, I would suggest that you meet with a license defense attorney to review the Agreement with you. Don't just sign on the dotted lines and date without understanding the terms and conditions in these contracts.

I have spoke with several nurses this year in State Nursing Board Alternative to Discipline programs who are struggling with complying with the contracts for a variety of reasons. It helps to talk to someone before you sign the Agreement so that you know what your options are before you sign and who can walk you through the Agreement. It may also help to have attorney representation throughout your monitoring so that you have someone to counsel and advise you on the employment, workplace, and licensure issues presented with monitoring.

If you need a licensure defense attorney, see www.taana.org. Call the Nurse Attorney Referral Hotline for a nurse attorney or licensure defense attorney in your jurisdiction.

Two Caretakers Indicted for Allegedly Stealing Drugs in a Warren County, Ohio Nursing Home

The caretakers ere charged with theft of drugs, illegal processing of drug documents, and aggravated possession of drugs, which are all felonies. The Enquirer refers to the former nursing home employees as caretakers and although I could not verify the Ohio Nursing Board license of both of the accused (I did for one online), I am assuming both of these women are nurses because of information recounted in the story.

http://news.cincinnati.com/article/20090512/NEWS0107/305120013/1163/Caretakers+accused+of+stealing+drugs

Nurse as a Custodian vs. Nurse as a Clinician Malpractice Lawsuits

I love this CNA Claims Study for Nurses! See page 36 of the Study which discusses the difference between the Nurse as a Custodian vs. the Nurse as the Clinician law suits. https://www.nso.com/pdfs/db/rnclaimstudy.pdf?fileName=rnclaimstudy.pdf&folder=pdfs/db&isLiveStr=Y&refID=rnclaim

As I have said before on this blog, with increased scope of practice, comes an increase in responsibility, an increase in accountability, and the potential for an increase in liability.

Nurses are more likely to be seen by plaintiff attorneys now as clinicians exercising professional judgment rather than custodians following physician orders from decades past.

This Blog Made the Top 50 Nursing Blogs from Online Nursing Degree Guide Blog!

See

http://onlinenursingdegreeguide.org/2009/top-50-nursing-blogs/

Lexington GYN loses his medical license in Kentucky

See this post:

http://nky.cincinnati.com/apps/pbcs.dll/article?AID=/AB/20090514/NEWS0103/305140020

Nurses Get Sued for Malpractice and Negligence! You Need Professional Liability Insurance

See this CNA Claims Study from 1997-2007, where $85 million in claims were paid related to nursing malpractice and negligence. Don't believe the hype when you are told "you don't need your own professional liability insurance policy."

https://www.nso.com/pdfs/db/rnclaimstudy.pdf?fileName=rnclaimstudy.pdf&folder=pdfs/db&isLiveStr=Y&refID=rnclaim

Is It Not All About Physicians with Healthcare Reform: What about nursing and other healthcare professionals?

The President of the United States has the president of the American Medical Association and CEOs of healthcare insurance companies and others at the podium but where was nursing? I didn't see the president of the American Nurses Association in the background and on stage along with the president of the American Medical Association.

Will President Obama include nursing and advanced practice nurses in the push for healthcare reform?

See this well written commentary available on cnn.com

http://www.cnn.com/2009/POLITICS/05/13/christensen.doctors/index.html

Nurses and professional associations who represent nurses and advanced practice nurses are not in the lime light along with the American Medical Associations.

Is it all about physicians in healthcare reform? What about nursing and nurses and other healthcare care professionals?

This is problem because nurses and other healthcare professionals don't have a seat at the table inhouse (how common are Nursing Staff Bylaws compared to Medical Staff Bylaws?) and may not have a seat at the table along with physicians in healthcare reform at the White House?

Underemployed and Unemployed Attorneys Encouraged to Consider Nursing

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

What do you think?

If you are an attorney and you want to be a nurse, then of course, go to nursing school.

Why one becomes a nurse is a personal decision, just like why one becomes an attorney.

Nursing is an evolving profession with its own set of ethics, laws, regulations, and professional standards of practice. Some nurses see nursing like the law as a calling while others view nursing as a way to make decent money with a few years of schooling.

I am a nurse who is also an attorney. Just my two cents, but don't go to nursing school because you don't have a job now as an attorney or you are underemployed as an attorney; go to nursing school because you are an attorney and you want to be a nurse also.

Emerging Legal Issues in Nursing Education webinar on May 20, 2009

The Center for American Nurses Presents

Emerging Legal Issues in the Nursing Workforce Series 

Webinar 1:  Emerging Legal Issues in Electronic Records for Nurses (April 15, 2009)
Webinar 2:  Emerging Legal Issues in Nursing Education ( May 20, 2009) 
Webinar 3:  Emerging Legal Issues for Nurse Practitioners (June 17, 2009)
Webinar 4:  Emerging Legal Issues with Professional Boundaries & Sexual Misconduct (July 15, 2009)

Emerging Legal Issues in Nursing Education (May 20, 2009)

• Address legal dilemmas facing nursing educators and instructors: documentation specific to nursing education, for example of clinical record notes, conference forms, and documentation related to student failing and corrective action, students filing claims with Office of Civil Rights or initiating civil litigation alleging educational malpractice or breach of contract, student misconduct, unsafe student in clinical, criminal convictions and nursing students and clinical sites and privacy of the information, student absenteeism,  and grievances filed by nursing students.
• Examine the various sources of law that directly impact nursing education such as constitutional law, torts, contract law, and employment law.
• Discuss legal issues facing nursing students: criminal backgrounds checks for licensure and clinical sites, chemical dependency, Student Rights, FERPA, HIPAA, discrimination and harassment in nursing education, ADA and reasonable accommodations, Student Handbook and grievances.

CNE Credits per Webinar:  1.25. 

Cost:  Member price:  $49.95; Non-member $69.95. 

Cost is per site.  Any number of nurses can attend per site. 
For more information, call 1-800-685-4076

If you are an Advanced Practice Nurse in Ohio, Take Your Time with the Renewal Applications

Don't wait until the last minute and don't rush; take your time if you are an Advanced Practice Nurse in Ohio as you might have to review one or more of the following:

1. Your RN license;

2. Your COA (certificate of authority); and/or

3. Your CTP (certificate to prescribe).

Starting this year, we will no longer receive a wallet renewal card in Ohio therefore it is important now more than ever to make sure everything is renewed because practicing after August 31, 2009 in Ohio when your RN license, COA, and/or CTP has not been renewed is a violation of the Ohio Nurse Practice Act and can subject you to an investigation and discipline by the Board.

I am going to miss my card! My 2007-2009 card was stolen when some bastard stole my purse, which is why you cannot verify my RN license status online in Ohio.

I am receiving calls from RN in Kentucky who failed to renew their license in the Fall of 2008. Yeah, your employer should check to make sure you are not but its not your employer's license, so save yourself the frustration, extra cash, and legal headaches and renew your license and certifications (APRNs make sure your state required certifications are valid if needed for licensure) in a timely manner and before the deadlines.

Are You Attending Any Nursing Conferences This Year?

I spoke at a Skin Care Conference in Las Vegas last week. I took my laptop and worked a few hours each day to respond to emails and mail documents. The Skin Care Conference attendance was down this year and the conference was in Las Vegas.

I don't know about you but if you want me to attend a conference, have it in Las Vegas where the airfare is responsible, the climate is usually warm to broil, and I can attend shows, party, gamble, and learn. But that's just me.

I have been told that conference and seminar attendance is down across the board because of the economy and employer's are tightening the purse strings. I am attending the Center's LEAD Summit next month in Orlando, Florida and this will be my last national conference for this year. My airline ticket and conference registration was reasonable and I am flying out of Cincinnati on a direct flight with Delta to Orlando for $79.00. The hotel registration is expensive at $199.00 a night for three nights and I am rooming alone.

I will not attend TAANA's conference this year however I will make the TAANA conference in 2010 when its in Lexington, Kentucky. I did attend the Ky Coalition of NP & NM Conference in Lexington, Kentucky this year; I attended one day.