Nursing Law & Order

Mixed and Messy Means More Money: State Nursing Board Action & Parachuting into another Attorney's case

The month of June has been off the rack busy (street lingo for really busy) for me between my law practice, my consulting projects with the Center for American Nurses, yard work, and the upcoming wedding.

First in State Nursing Board matters, like any other matter involving a federal, state, or local government, court, or agency, you can represent yourself. Self-representation is a right in our justice system and lots of individuals represent themselves and study up on the law and procedures and do just fine proceeding pro se.

The majority of nurses in State Nursing Board matters do not have attorney representation; I think its because of attorney fees, not seeing value in attorney representation, and a failure to appreciate the adversarial nature of these matters. Its not just about attorney fees because nurses make good wages.

Some nurses hire attorneys when involved in a State Nursing Board matter whether its a license defense attorney, criminal law attorney, general practice attorney, ect.

Attorney-client relationships are professional and for whatever reason don't always work out and the attorney and/or the client can terminate the professional attorney-client relationship. I have fired many clients and I have had two clients fire me in my 8 years of solo law practice. It is not that uncommon.

However I always see red flags when I am approached by a nurse who was/is represented by another attorney in a pending license defense case, has bad and/or very negative things to say about that attorney, and is seeking my assistance. Why? I don't want to become the next "shitty attorney" on the client's laundry list of legal practitioners. http://www.thefreedictionary.com/shitty

I value my reputation.

Its mixed and messy when you parachute into a pending case and pick up a file that another attorney has worked. When I first started practicing as a solo in 2001 and for the first few years, I would roll up my sleeves, place the Ibuprofen 800mg next to my can of Pepsi, and take these types of cases without blinking twice.

But at age 37 and with 12 years of law practice and 8 of those in my own firm now and practicing primarily in nursing license defense and nursing matters, I pause, review the file, meet with the client, and charge a hell of a lot more money than I usually would because I know its going to be mixed and messy, baby. 

In my firm, mixed and messy means more money.

 http://robertplattbell.blogspot.com/2007/10/problem-clients.html

From the Nursing Law Bandit: If you a Nurse and you are charged with a DUI, DWI, or an OVI, hire a Traffic Law Attorney or DUI defense attorney

I enjoyed the material from the two "one" hour presentations at the Cincinnati Bar Association. Most of the attorneys present were criminal defense attorneys and several were traffic law and DUI specialists, i.e. these attorneys limit their practice to traffic law and DUI cases.

If you are a nurse and you are charged with a OVI, DWI, or DUI, you want to hire a criminal defense attorney. I would suggest that you take it step further and hire a criminal defense attorney who limits their law practice to DUI cases and/or traffic law cases. You want a specialist even though the attorney may not be able to call him or herself a specialist under the ethical canons.

You want an attorney who knows DUI and traffic law front and backwards and sideways from the arrest and investigation stage to the sentencing and post-sentencing phases. Like Chuck Strain in Cincinnati, Ohio, who calls himself the DUI Guy.  http://blog.lawinfo.com/2007/02/21/cincinnati-dui-lawyer-chuck-strain-is-a-frequent-speaker-at-dui-seminars-2/

This is my 4th DUI course in a less than a year (I don't miss these) and I don't practice criminal law. I am certainly not a DUI or traffic law practitioner but I am seeing so many cases in my license defense practice involving DUI the last 2 years that I have to get a better feel for the issues involved with these cases because nurses with DUIs are required to self-report this information at some point to the Nursing Board, depending on the State, of course.

Can I refer to myself as the Nurse License Gal? Its not as catchy.

Maybe Nurse Attorney for a Nurse License? Too wordy.

I personally like my handle (no I don't have CDL license or drive trucks on the side for additional income) and codename, Nursing Law Bandit. What is your handle, code name, or alias?

10-4, good buddy. http://answers.yahoo.com/question/index?qid=20080704221419AAde0ha. I am sure you have watched Smokey & the Bandit or was it just me growing up?

Kentucky Holistic Nurses Association July 2009 Program

KYANA Holistic Nurses Association July Program
You're Invited!   RSVP [email protected]
More Events   Aug 17: "The Hakomi Method of Healing" with Daniel Lally & Dr. Sean Brady   "Soul Party" Workshop Series with Virginia Drake  Aug 22, Sept 19, Oct 23   Sept 21:  2010 Health & Healing Conference Planning Meeting   Dec 14:  Annual Holiday Party     KHNA Leadership Council   Network Leader: Carol Ryan RN, MSN  [email protected]   Co-Leader:  Kim Evans ARNP, CNS-BC,  AHN-BC  [email protected]   Membership:  Cedaliah Melton RN, MSN, ARNP, FNP-BC  [email protected]   Treasurer:  Mary Corbett RN, BSN [email protected]      Secretary: vacant                  "Planting the seeds for Holistic Health & Healing"       Quick Links KYANA Holistic Nurses Association  www.khna.net American Holistic Nurses Association  www.ahna.org Occupational Kinetics LLC  www.myockn.com Daniel Lally www.bodycenteredsolutions.com  Virginia Drake  www.revisions.us Rainbow Spiritual Education Center www.rainbowspiritualeducationcenter.org		"How To Develop A Safe & Healthy Home Environment"   DATE: Monday, July 20th TIME: 7-8 pm LOCATION: Occupational Kinetics 13100 Magisterial Drive Suite 100 - Education Center Louisville, KY 40223  (502) 245-0767    Eric M. DeYoung, OTR/L, CES, ICFE, CDA, FABDA, HHP, NPRS, NDc   5 Basic Principles to Consider: Clean Air Clean Water Clean Environment Healthy Food/Supplements Safety I will discuss: The Myths and Facts regarding cleaning supplies What does "natural" really mean (not always safe) Organic foods vs. conventional foods Latest news reports about environmental health and supplemental awareness (there are 41 OTC vitamins that are highly toxic) Provide references and web links for more homework on chimicals in your baby shampoos, make-ups, hair colors, etc!   Eric M. DeYoung, OTR/L, CES, ICFE, CDA, FABDA, HHP, NPRS, NDc is experienced as a board registered and licensed Occupational Therapist in Kentucky and Indiana, doctoral training as a Traditional Naturopath practicing Homeopathy and Traditional Chinese Medicine, a certified Holistic Health Practitioner and a Neuro Physical Reprogramming Specialist through the California College of Natural Medicine. Additional training includes certification and competency in manual medicine such as Myofascial release/mobilization, Cranial sacral therapy, Reiki, Acupressure, Meridian therapy, Body reading, and Neuro-Muscular Therapy.   Practicing as an Occupational Therapist, Eric is also certified as an Ergonomics Specialist, Disability Analyst, International Certified Functional Evaluator and Fellow of the American Board of Disability Analysts. He has taught adjunctively graduate and doctoral level students Introduction of Occupational Therapy, Applied Kinesiology, Gross Anatomy, Ergonomics and Industrial Rehabilitation at the Spalding University Aurbach School of Occupational Therapy, Jefferson Community College (Junior College of the University of Kentucky) and Indiana University.   In 2003, Eric opened Occupational Kinetics at the Center for Alternative Medicines in Louisville, KY as a fully integrated complimentary and alternative medicine center incorporating allopathic as well as naturopathic healing principles for patients interested in natural non-prescriptive medicine modalities. The center features Naturopathy, Homeopathy, Traditional Chinese Medicine, Physical Medicine & Rehabilitation, Occupational Therapy, Physical Therapy, Massage Therapy, Exercise Physiology, Pediatrics, Holistic Dentistry and offers a variety of homeopathic remedies invented by Dr. Theresa Dale as well as nutritional supplementation and natural skin care products.   Eric's treatment philosophy is rooted in the field of Functional Medicine which believes that the core clinical imbalances that underlie various disease conditions arise as environmental inputs such as diet, nutrients (including air and water), exercise, and trauma processed by one's body, mind and spirit through a unique set of genetic predispositions, attitudes and beliefs.

Can I borrow $350? I will pay you back next Tuesday

I received my Supreme Court of Ohio 2009-2011 biennium certificate of registration in the mail yesterday. This is the year where I have to renew my Ohio RN license and my Ohio, Kentucky, and Indiana law licenses. I may need a second job just to pay my license registration fees.

The fee to register and renew my law license is $350.00 every two years in Ohio. The fee is due September 1, 2009 and I have it on my paper and e-calendars.

If I didn't have to pay my fee, what would I do with the $350?

* spend $75.00 at Walmart;

* spend $75.00 at Lowe's;

* spend $75.00 at Old Time Pottery;

* spend $75.00 at Dillards (I need a new pair of black patent leather open toe pumps and one or two tubes of Fashion Fair lipstick and lipgloss); and

* spend $50.00 to renew my tags on my truck. My birthday is next week and I am not doing my usual which is driving until the end of July or the beginning of August on expired tags because I don't want to go to the BMV.

I am going to the BMV on my birthday this year. I have to go to the BMV and can't do this online because I didn't renew my tags last year (my truck which has a rebuilt engine was in the repair shop most of 2008). I finally have my yellow truck back and I can't wait to drive it.

I did it, I did it, I violated the Nurse Practice Act!

I presented an Ohio nursing law and rules program for VITAS this week at Drake Hospital and after the presentation I was approached by several nurses. Download CenterarticleBOARDofNursinginvestigations. Since I represent nurses before the Ohio Nursing Board and with any CE presentation, the material is presented in a balanced and neutral fashion of course.

One nurse asked about legal nurse consulting, another asked about professional liability insurance, one was involved in a pending investigaiton before the Ohio Nursing Board, and one was being monitored by the Ohio Nursing Board.

The nurse involved in the pending investigation before the Board is representing herself and not doing so well at representing, counseling, and advising herself. She has provided inconsistent statements: one to the Nursing Board and one to her employer and has taken some other actions which really cast a shadow on her credibility. She met alone with the Nursing Board investigator who really grilled her on her lack of documentation of controlled substances. A criminal charge may be forthcoming.

I think the nurse is looking at being disciplined by the Ohio Nursing Board at some point in the future and if she contacts me and schedules and pays for a consultation, I will tell her this. But what struck me from my brief conversation with the nurse was the failure to grasp the seriousness of the allegations in the pending Nursing Board matter,the impact the accusations can and will have on her nursing career, and the real possibility of a criminal indictment. You cannot play around with the documentation of controlled substances.

The nurse being monitored by the Board told me she was tricked into the signing the Ohio Nursing Board Consent Agreement. I don't know how one as a professional can be tricked into signing a document and mailing it back to the State Nursing Board (which is over 80 miles away) but I explained to her that she is a professional and as a professional, she is accountable for her practice and actions.

If she had concerns about signing the Consent Agreement, she should have considered her options and spoke with an attorney before signing the Agreement, which is a legal and binding contract. Saying she was tricked into the signing the Agreement makes what is a professional matter sound like a personal matter and is not an accurate statement in my opinion. 

You can't be tricked into signing a Consent Agreement, Agreed Order, Settlement Offer, Recovery Monitoring Agreement, etc.; either you sign it or you don't. In general, State Nursing Board staff (attorneys, compliance agents, investigators, monitoring agents, etc.) are not police officers or law enforcement officials and do not hold you a room for hours on end, questioning you in a warm and dark room with a single light bulb hanging from the ceiling until you cave in and sign an agreement and scream "I did it, I did it, I violated the Nurse Practice Act."

Bootleg Attorneys: Chemical Dependency Counselors, Therapists, and Evaluators Giving Legal Advice to Nurses

I spoke with a nurse this week who was ordered to evaluated for chemical dependency evaluation by the State Nursing Board in response to the complaint involving allegations of impairment and suspected drug diversion.

The chemical dependency evaluator told the nurse, "if you are guilty, you don't need an attorney, but if you are really innocent, then you should hire an attorney."

What the frack does that mean? I think this evaluator has watched too many episodes of Law & Order or CSI. Guilt and being innocent are terms more relevant in a criminal case, not a State Nursing Board matter.

I hear this all the time from nurses who then rely on this "I am not an attorney but...." type advice.

I really wish chemical dependency counselors, therapists, and other folks without a law degree and a state law license would stick to their scope of practice, do what they were trained to do, and stop giving legal advice to nurses and stop trying to counsel and advise nurses on their legal options in these types of cases.

Also nurses, stop asking for and soliticing this type of advice from evaluators, counselors, and therapists because most of it is not accurate anyway in my opinion.

Yes, I am a little hot under the collar because these therapists, counselors, and evaluators wouldn't pull this crap with a physician or dentist. They would stay in their place and provide the services they were asked to provide.

What is it about nurses and a nursing license that makes everyone and their mother qualified to be a bootleg attorney and ready and willing to provide legal advice and counseling on something so important as the life, livelihood, and career of a nurse? http://en.wikipedia.org/wiki/Bootleg

Although working in some healthcare facilities may feel like jail, nurses you are not in a prison environment where you need to rely on the advice of a bootleg attorney. Talk to a license defense attorney about a State Nursing Board matter.

Hiring an Attorney before the State Nursing Board: costs of legal services and the location of the attorney

I spoke with a nurse this morning who had some concerns about an attorney the nurse retained. This is important; if you are having issues with your attorney (your attorney is not returning calls, you don't know what's going on with your case, etc.) you should address those issues with your attorney. I never comment on another attorney because that is not professional and its is not my place.

This nurse decided to retain the attorney because the attorney's fees were cheaper than the fees of other license defense attorneys the nurse intially spoke with (including my fee) and the attorney's office was closer to the nurse; the other attorneys were based in other cities (including my office).

First, don't hire an attorney based on the cost of legal services alone, cheaper isn't always better and more expensive isn't always better but you have to find an attorney that you are comfortable with and who you trust to handle your matter. Cost alone should not be the deciding factor and you also want to look at how promptly does the attorney return calls, communicate with you, how accessible is the attorney, experience of the attorney, etc.

Second, with technology and in license defense cases, its doesn't really matter whether your attorney is 5 miles away or 250 miles away for the most part. This isn't a criminal case or a civil case, it is an administrative law case. This is an important distinction. Just because your attorney lives around the corner doesn't necessarily mean you are going to see your attorney more frequently in a license or that your attorney will be more accessible in a license defense case.

Geography isn't an issue in license cases. For example, I live in Cincinnati, Ohio and I represent nurses throughout Ohio, Kentucky, and Indiana. The State Nursing Boards in Ohio, Kentucky, and Indiana are a 75 to 100 minute drive for me. I can drive to Columbus with my eyes closed and I can drive to Louisville backwards; I have to pay attention driving to Indy because of deer and patrol cars however.

I schedule in-person clients with clients and do phone meetings, emails, text, fax,  and whatever is needed to be accessible to clients. I have had client meetings as far Evansville, Indiana (we packed a lunch), Bowling Green, Kentucky (you lose cell phone reception driving there and its a different time zone), Youngstown, Ohio, Gary, Indiana, and Ashland, Kentucky (We stay in West Virginia and I meet with clients from Ashland and Ironton, Ohio). I like to play the 25 and 50 cent slot machines so if you live near a casino and you retain me, I will be coming to see you.  

I know money is tight and the majority of nurses don't have an individual professional liability insurance policy with a license defense benefit. Therefore if a complaint is filed with the Nursing Board and the nurse wants attorney representation, the nurse has to retain a private attorney and eat the costs associated with attorney representation.

Do your research before you retain any attorney and speak with more than one attorney. The cost of representation and the location of the attorney who be a consideration of course but you also want to take into account other factors.

The Center for American Nurses has information in its legal portal related to selecting an attorney. See www.centerforamericannurses.org.

What is the Connection between Hi, I am Al, welcome to Walmart, ignoring the State Nursing Board, and "paying some attorney"

I know this seems obvious and like a no brainer but if you are being investigated by the Board, don't blow off the Nursing Board. What is blowing off the Nursing Board? This includes but is not limited to:

1. Not responding to the accusations in the complaint;

2. Not opening correspondence from the Board;

3. Moving and not updating your address through the proper Nursing Board channels during an investigation and adjudication;

4. Not returning phone calls from Nursing Board staff related to the investigation or adjudication; and last but certainly not least

5. Not responding to a Order for a Chemical Dependency Evaluation, Order for a Mental Health Evaluation, or an Order for a Physical Evaluation.

I am speaking with more and more nurses who are failing to appreciate the seriousness of the State Nursing Board investigation and adjudication process and who assume a very carefree and laid back approach and attitude in these cases until its crunch time.

I don't know about you but my licenses in addition to being my livelihood are my life and my identity, I am a RN and an attorney, and I would not ignore or blow off anything I receive from the Ohio Nursing Board or the Ohio, Kentucky, or Indiana Supreme Court.

There is a benefit to having attorney representation in these cases as your attorney can advise you of the substantive and procedural issues in these cases and represent, counsel, and advise you.

I know you have better things to do with your money than "pay some attorney" (as a nurse told me this morning) but "paying some attorney" depending on the allegations in the complaint and the evidence gathered and uncovered by the State Nursing Board, may make the difference between you being able to say "I am Nurse Al and I will be your nurse from 7pm to 7am" vs. "Welcome to Walmart, my name is Al."

Today is the second day of summer and its going to be a long and hot summer at my law practice with very interesting cases with nail bitting twists, factually intensive scenarios with lots of left and right turns because its usually not very straightforward, legal maneuvering and excitement, and good old fashion "defecation hitting the ventilation."

The End of Lawyers? Not I says the Ohio Nurse Attorney and who is California Dreamin'

At the American Bar Association Techshow 2009, Dr. Richard Susskind gave the keynote address, The End of Lawyers? Rethinking the Nature of Legal Services. Although I was not able to attend (I have already registered and paid to attend three conferences this year and did not attend a single one for whatever reason; from this point forward its pay at the down for me only) I downloaded this keynote address to my blackberry and I have listened to it several times.

He remarked that clients want attorneys who are and act like a fence before you reach a steep cliff, not attorneys who act and who are the ambulance and clean up crew after you go over the cliff. According to Dr. Susskin, risk management is part of the future of legal services.

Managing risk is not something that nurses are trained and accustomed to doing in practice because legal issues are not front and center in the practice of nursing. Most of us as nurses are not in tune with legal issues and the risks associated with practicing in a highly regulated healthcare environment.

I feel invigorated after listening to Dr. Susskind's keynote because I am a dreamer and I dream of the possibilities for my niche practice. I see professional and personal freedom and maybe a four person sauna in the backyard. I really want a sauna, but Barry says no!

Stay tuned because I am rolling out a something new for my firm along with something old, borrowed, and blue.

What you are dreaming about and planning to make happen in your nursing career? http://en.wikipedia.org/wiki/California_Dreamin'

Its back on like Donkey Kong! 07/08/09 is our special day.

We leave the Las Vegas for our wedding in exactly two weeks. We are getting married and yes, the wedding is on like Donkey Kong. I have received so many calls from concerned clients and colleagues asking if everything was okay because we postponed the wedding initially. Thank you for your words of support and encouragement. I didn't know that many folks followed the blog!!

We have some friends and family traveling with us to Las Vegas for the wedding and we will have a cake and champagne reception at our home the Sunday we return. We are going to have a blast. My birthday is July 2nd and my fiance's birthday is July 28th. Our anniversary will be on July 8th which gives us a reason (as if you really need a reason to entertain) to have more pool parties and card games during the month of July.

I am taking my laptop and cell phone with us to Las Vegas and I plan to do some work early mornings and respond to emails and client phone calls as needed. My grandfather had surgery in May and he is still recovering therefore he may not be able to make the flight to Las Vegas but both of my grandmothers will there at my side (I was raised primarily by my grandparents) along with my son and of course my man.

Onward and Forward!

Emerging Legal Issues in Nursing: Professional Boundaries and Professional Sexual Misconduct

The Center for American Nurses Presents Emerging Legal Issues in the Nursing Workforce Series  Emerging Legal Issues with Professional Boundaries & Sexual Misconduct  Wednesday, July 15, 2009      7:00 - 8:15 PM Eastern Time Presented by LaTonia Denise Wright, RN, BSN, JD   Register What are professional boundaries? Nurses role in establishing and maintaining boundaries Types of professional boundaries cases; common scenarios; statistics Boundary Crossings and Boundary violations Overview of professional boundaries and professional sexual misconduct literature What is professional sexual misconduct? National Council of State Boards of Nursing and professional misconduct research and articles State Boards of Nursing and professional boundary/PSM investigations and adjudications Future implications for the nursing workforce with professional boundaries 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]

Hot, Heavy, & Heated: Criminal Convictions and State Nursing Board Investigations in Two or More States

Hot, heavy, and heated is not a reference to White Castle's coffee!

If you are convicted of crime and you are licensed to practice nursing in more than one state, pull out the checkbook or complete the 401K or 403B withdraw form, because you are going to need a few thousand dollars.

First of all, if you are a RN, LPN, or APRN and you have been charged with ANY crime from a simple assault to a DUI, DWI, OVI to theft of drugs regardless of whether its a felony or misdemeanor, chances are you need to retain a criminal defense attorney and license defense attorney. 

I have been told six times this year "my criminal defense attorney said this was a good deal." This was and is still probably true but your criminal defense attorney isn't looking at your case from a license perspective. Your criminal defense attorney is trying to keep you out of jail and assisting you with navigating the criminal justice system.

But guess what? Just when you think everything is over,  you can move forward and its safe to go in the water, here comes the State Nursing Board reviewing the criminal conviction and surrounding circumstances.

I find nurses do hire a criminal defense attorney for representation in criminal matters but then represent, counsel, and advise themselves (some nurses do a  good job, some do okay, and some do a very poor job and really screw things up) before the State Nursing Board in State A; then here comes State Nursing Board B because the action from State A was reported to State B.

By the time, this nurse gets around to contacting a license defense attorney in State A or B, the matter is hot, heavy, and heated.

I charge a flat fee for representation and I charge more for hot, heavy, and heated! Attorneys who bill by the hour will bill (and probably kill to have) more hours for the hot, heavy, and heated also because its more complicated and it takes longer to review and swim to the bottom of a pool of paperwork. Can you tell our swimming pool is open?

We are all professionals and you have a right to represent yourself in any matter involving the government or a govermental agency. Remember you are making decisions that will impact your life and career in nursing and after a criminal conviction, you will still have a life but you may need a second career outside of nursing.

My Nursing License was Suspended! What do I do now? How do I make a living? Where do I start?

I am receiving more phone calls and emails from nurses who have had their license suspended. Don't walk away from your nursing license!

I know its tough but don't just say "frack it, I don't want to ever deal with a Nursing Board again." The key is finding someone like me, who loves to deal with the Nursing Board to assist you.

I don't know your situation of course, but I know that there is help out there for you if you want to avail yourself to the resources and services out there for nurses in your situation. Yes, its going to cost money, especially to retain an attorney, but what is your license worth to you as nurse?

1. If your license is suspended there may be terms and conditions for the reinstatement of your license. You should receive a copy of this terms and conditions from the Board. If you don't have a copy or can't find your copy, then request another. It is very important that you review the terms and conditions for reinstatement of your license.

2. Consider contacting a license defense attorney in your state or jurisdiction to discuss your options. See www.taana.org. Attorney representation, counseling, and advising is important here also.

Attorney representation is not just for the disciplinary investigation and hearing process because if you license is suspended, there will be terms/conditions for reinstatement, and most likely some type of probation and monitoring by the Nursing Board.

Nursing Board probation is no joking matter and it requires strict compliance with the terms and conditions for probation; you don't get to pick which terms you want to abide by when on probation. I see sooooo many cases where nurses are non-compliant with Nursing Board probation and this leads to additional issues.

I spend alot of my time working with my clients who are currently on Nursing Board probation (which can range from 6 months to 5 years depending on the State Nursing Board and the allegations in the complaint(s).

I am also being retained by more nurses who are suspended, seeing reinstatement, or being monitored and who need assistance with not only the Nursing Board process and procedure but also the professional, employment, ethical, workplace, and sometimes criminal issues that arise.

Remember, the Nursing Board staff works for the Board and are not there to hold your hand or provide you with legal advice or counseling. That is not their role.

Some of the Nursing Board staff are nurses but they are there to protect the public. Don't take it personal as they are doing their job and you need to do your job. Its not a friendship; it is a professional relationship.

They are not their to be your friend and this should not be an expectation that you have anyway in your dealings with Nursing Board staff related to your nursing license.

Also being angry with Nursing Board staff doesn't help. Cursing and swearing at Nursing Board staff is counterproductive. Again if you can't maintain your composure because of everthing that has transpired, retain an attorney, who is an objective third party, to represent you.

3. You cannot practice nursing but that does not mean you cannot work especially in this tough economic times. This is where a license defense attorney, your State Nursing Association, peer support group, or nurse colleagues come in handy. Talk to other nurses about employment options which utilize your nursing background but don't require a nursing license. You cannot work in a position requiring a nursing license and you cannot practice nursing.  

If you are reading this post and your license is suspended or you know a suspension is forthcoming, start preparing yourself now! You can dig yourself out of this hole but you have to take the first step. Start climbing!

DUI,OVI, & DWI Seminar this week at the Cincinnati Bar Association

I am registered to attend to a one hour DUI program this week at the Cincinnati Bar Association. Although I don't defend nurses in criminal cases, I have found that criminal law and procedure impacts my representation of nurses in licensure matters in Ohio, Kentucky, and Indiana. Also criminal law and procedure continuing legal education programs are very interesting and informative. I will let you know how it goes.

I also need additional CLE to renew my law licenses this year in Kentucky and Indiana. I don't believe this is a renewal year with my Ohio law license.

To Endorse to Not to Endorse: Talk to Someone Before You Complete the Application for Licensure

The practice of nursing is going global as more nurses are working for an employer which has multiple locations which may require nurses to become licensed in one or more states. Now if you live in a Nurse License Compact state like Kentucky you can practice in other NLC states without going through the endorsement process.

The majority of states in this country however do not participate in the Nurse License Compact and if you want to practice in a state where you don't have a license, you have to complete an endorsement application.

Okay, this may not be a big deal for the majority of nurses but for a growing percentage it is an issue if you have to disclose a criminal conviction, action against a nursing or other healthcare license, chemical dependency, mental health diagnosis, etc.

If you need a nursing license(s) in another state and you know that you will have to respond in the affirmative to one or more questions on the Endorsement Application for State Nursing Board licensure in State A, State B, State, C, or State D, talk to someone before you submit the application. Each State Nursing Board reviews this issues differently and you don't want to go in to this process with a false sense of hope that I typically see, which is "this is no big because State Nursing Board X knows and didn't do anything."

What's Your Mt. Everest?

See this nice article about an attorney who along with his son scaled Mt. Everest. http://www.abajournal.com/news/climbing_everest_also_tested_lawyers_practice_management_skills

I like his comment "I personally didn't want to get to the end of my career and have sat at my desk for 30 years," he says. "If there's something you want to do, you need to do it."

So what's your Mt. Everest? Here are six of my mini-Everests:

1. I want to purchase a vacation home in a state with warm weather year around and live there part of the year and continue my law and consulting practice from here and there;

2. I want to go back to graduate school for a MSN in community health or nursing education and complete an LLM in health law with a special focus on nursing and women studies. Maybe in Chicago, Washington, D.C., or Indianapolis, IN;

3. I want to travel by car and visit different cities (not just the convention centers and hotel conference rooms that you see when you attend a conference) and go to museums, zoos, botanical gardens, etc.;

4. I want to review and maybe publish the poems I wrote as a junior and senior in high school;

5. I want to clean up my Barbie Dolls and my five tier Doll House (it was sooo pretty) from my childhood and display a few of my favorites tastefully somewhere in our home (I was spoiled rotten as a child and I have over 200 Barbie Dolls, some of course which are missing a body part or two); This way I could play with my dolls without it being considered too weird; and

6. I want to start a professional or trade association which would appeal to all nurses.

Health Care Lawyers are Hot Property!

See this article in the American Bar Association Journal website, which quotes an article from the National Law Journal. http://www.abajournal.com/news/health_care_lawyers_are_a_hot_property/

My law practice is very active in this economy because State Nursing Board complaints don't stop or decrease during recessions and nurses for the most part are employed and employable even if it means thinking outside of the box for employment options. My law practice involves a cross between health care and administrative law.

I have one case where I am representing a counselor and once this case resolves, 100% of my clients will be nurses and nursing related organizations.

What nursing specialities would you say are hot in this economy?

Ohio RNs: Renew Your Nursing License, Don't Forget this a Renewal Year

If you haven't renewed your Ohio RN license yet, don't forget to do so before August 31, 2009. If your license isn't renewed by this date and you continue to practice, you are practicing on a lapsed license.

Is Your Address and Telephone Number Current with the State Nursing Board? If not, how will you receive notice of a pending investigation, complaint, or renew your license!

There is a reason why you are probably required by your State Nurse Practice Act to keep your mailing address current with the Board. In the event that a complaint is filed against your license, the notice of the complaint is mailed to your address on file with the State Nursing Board. The Board is required to "serve" you with the complaint and this service is perfected via your current mailing on file with the Nursing Board.  

If the Board is contacting you related to a complaint and you are not responding, the Board can move forward with proposing action against your license because it has afforded you with due process (notice of the complaint, an opportunity to respond to the complaint, right to legal counsel of your choice, opportunity for a hearing to dispute the accusations in the complaint, and fundamental fairness in the investigative and adjudicative proceedings).

Make sure you keep your CORRECT mailing address and telephone numbers current with the State Nursing Board. This is important for the license renewal application process also in some states.

Certified Medication Aides and the Brick Wall for Nurses: Delegation is an Academic Exercise for Folks Like Me, Not for those at the Bedside

I have remained quiet about certified medication aides in long term and the role of nurses in this process. I was skeptical (that's my nature) but waited to see what would evolve.  

The Ohio Board of Nursing in the Spring 2009 Momentum has an excellent article, Delegation of Medication Administration to Medication Aides in Nursing.

The way job description are written in long-term care and patient care assignments are made there is no true delegation. Nursing homes in my opinion and how they are managed have attributed to the failure for most to understand the distinctions between the RN scope of practice and the LPN scope of practice because patient care is scheduled by halls, units, etc.

Now here comes the certified medication aides and nurses are utimately accountable and potentially liable for the failure to delegate in accordance with the Nurse Practice and Regulations. That's nice. Most of us are nurses are not comfortable with delegation because healthcare is provided along the lines of job descriptions and patient care assignments for efficiency and the role of the RN in delegation has become academic.

Academic meaning folks such as myself (who are not at the bedside) will research and publish on the delegation but the real world application of delegation in daily clinical practice requires a firm grasp on the Nursing Board law and rules, employer policies and procedures, and the job descriptions, scope of practice, and roles of RNs, LPNs, and Certified Medication Aides. How many employers are providing this type of intense inservicing and training on delegation? Exactly.

I can understand the rationale and economics driving the use and regulation of certified medication aides, but if you are going to create a new class of paraprofessionals who can administer medication, let those individuals be exclusively accountable, responsible, and potentially liable for their actions without adding nursing delegation to the mix. I also understand there is a need for other licensed or regulated paraprofessionals to do some of the tasks traditionally associated with nursing for a variety of reasons, but damn.

Nurses are already assuming too much risk and potential liability in healthcare without adequate safeguards to manage the risk and the sad part is the majority of us are not aware of this risk and legal liability until we hit the brick wall at 90 mph.

I know the use of certified medication aides in expanding with several states already having aides purportedly with low medication error rates, but we do things differently here in O-Hi-O and things that work in other states for some reason don't work here, so I would like to see if plaintiff attorneys bite at this in Ohio nursing home negligence case (again things that folks like me monitor who are not at the bedside) or what types of Ohio Nursing Board complaints and discipline for RNs and LPNs not delegation in accordance with the law and rules (folks like me monitor this as well) will follow this.

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