Nursing Law & Order

Suicidal Ideations and Attempts and Nurses: Please get the help you need now

If you are a nurse and you are depressed and/or suicidal, please get the help you need before its too late. Whether its in-patient treatment or out-patient treatment, please contact mental health professionals and get the process started.  

This is just my opinion and it is not legal advice of course but you have to get help to deal with your illness before you resume practicing as nurse. You don't want to be accused of practicing unsafely or with an impairment. Again you need to get help dealing with your illness before you resume practicing as nurse.

I know you have bills to pay like everyone and you need to work but this is multi-faceted issue and you have to consider your mental and physical health and answer the $39.99 question: are you safe to practice nursing?

I am seeing more cases with dual diagnosis and discipline and the State Nursing Board or suicide attempts involving nurses which are reported to the State Nursing Board. You may or may not be surprised how this information gets reported to the State Nursing Board (but that's another post).

Again the role of the Board is to protect the public from unsafe nursing care and one of the many questions considered is whether the nurse is safe to practice nursing. Also things that you may consider personal and involving strictly your personal life (like an attempted suicide, dual diagnosis, or mental or chemical dependency issues) may be examined in the event of a State Nursing Board complaint and disciplinary investigation and adjudication.

Call your county suicide prevention hotline or seek assistance because there are alot of resources and services out there if you want help with your situation. Contact EAP, your State Nurses Association, etc. Contact someone and get the help you need to treat the illness (your health is your first priority; isn't it?) and contact a nurse license defense attorney or administrative law attorney in your jurisdiction.  

Foster mom-nurse charged in baby’s death

http://www.thestate.com/local/story/777440.html. Here is the cut and paste

Foster mom-nurse charged in baby’s death

By Lee Higgins - [email protected]

 

A foster mother who is a neonatal intensive care nurse was arrested Wednesday, accused of taping a pacifier to the mouth of a 9-month-old boy who suffocated.

Angela Deniece Dukes, 30, of St. Andrews Road, is charged with unlawful neglect of a child, SLED spokeswoman Jennifer Timmons said.

Dukes is accused in the death of Curtis Williams, of Cayce, whom she found unresponsive on an adult bed at her St. Andrews Road apartment, authorities said.

Angela Dukes

Richland County Coroner Gary Watts had said earlier that the boy was found face-down amid sheets and a fluffy comforter, and that there was a crib in the home where the child should have slept.

SLED said no other adults or children were home at the time.

Curtis was pronounced dead at Lexington Medical Center at 9:59 a.m. on Feb. 8 of asphyxiation, Watts said Wednesday.

The Department of Social Services took Curtis into custody Feb. 7 and placed him in the foster home after he tested positive for THC, the active ingredient in marijuana, Cayce police have said.

Preliminary autopsy reports found the anti-allergy medication Benadryl in his system.

The foster home was licensed, DSS spokeswoman Virginia Williamson said Wednesday. She said no other children have been placed in Dukes’ care since the boy’s death.

DSS has been working with SLED and continues an internal investigation into the incident, Williamson said.

DSS officials are examining everything about how the case was handled including the removal of the child, his placement, any licensing issues and the care of the child, Williamson said.

Dukes was working as a neo-natal intensive care nurse at Palmetto Health Richland at the time, SLED said.

She has been suspended, pending the outcome of the investigation, hospital spokeswoman Tammie Epps said Wednesday night. She had worked there less than three years, Epps said.

Curtis tested positive for THC at Lexington Medical Center after police found him and his mother about 4:23 p.m. on Feb. 7 in a Cayce motel room filled with marijuana smoke.

His mother, Katrina Jivers, 22, was charged with unlawful conduct toward a child, contributing to the delinquency of a child and possession of marijuana.

Jivers’ 2-year-old daughter later tested positive for cocaine and was placed in a different licensed foster home.

In that case, Jivers was charged with unlawful conduct toward a child and contributing to the delinquency of a child, involving her daughter.

Dukes is at Richland County jail and faces up to 10 years in prison if convicted.

Reach Higgins at (803) 771-8570.

CNN coverage on the Doctor Shortage and the use of Nurse Practitioners

http://money.cnn.com/galleries/2009/news/0907/gallery.healthcare_nurses/index.html

I will be in Lexington, Kentucky on Wednesday, August 5th

I am meeting with a nurse in Lexington, Kentucky on Wednesday, August 5th at 12noon.

If you would like to schedule an appt. with me in the afternoon while I am in Lexington, Kentucky, please contact my office at 888-571-1110.

Its Not Just About Hospitals: Nursing Unions are organizing in home care and hospice also

See http://www.minurses.org/news/press/2009/071309_Hackley.shtml.

Xavier University in Cincinnati, Ohio awarded $1.5M for nursing education

See

http://triangle.bizjournals.com/triangle/othercities/cincinnati/stories/2009/07/27/daily9.html

Hot Damn! You received an Order for a Psychiatric, Chemical Dependency, or Physical Evaluation from the State Nursing Board

Let's discuss a hypothetical. I am a licensed attorney in Ohio, Kentucky, and Indiana. Let's say I go out to our mail box to pick up the mail at 6pm. I am walking down the driveway sipping my Bartles and James orginal cooler (I had to say something to catch your attention and I like BJ coolers).

We have alot of mail today. I receive something from the Kentucky Supreme Court saying I am being ordered to have an Evaluation. Hot damn! 

Although this is just a hypo, the point is anytime you receive this type of ORDER from a State Licensing Board you should be concerned. Lights, sirens, bells, and horns should go off in your head and you should think hot damn, this just might be serious.

If you receive an:

* Order for a Chemical Dependency Evaluation;

* Order for a Psychiatric Evaluation; and/or

* Order for a Comprehensive Physical Evaluation

from your State Nursing Board there is an accusation or complaint pending questioning your ability to practice nursing safely.  Don't get it twisted and think its no big deal because it is serious. I am always surprised (even after 8 years of license defense as an attorney) how nurses are overly confident and cocky (I am a nurse, I have years of experience, I know A&P and Psych, and I will pass this with flying colors!!) and blow off these Orders as just routine.

There is nothing common place, routine, customary, usual, and/or ordinary about receiving an Order for a Chemical Dependency, Physical, or Psychiatric Evaluation from a state licensing board.

Its Just a DUI, OVI, or DWI !

I heard this again last week, "Its just a DUI."

Its nursing license renewal time in Ohio, Kentucky, and Indiana and this blog is popping up in searches related to DUI and nurses and criminal convictions and license renewal for Ohio, Kentucky, and Indiana.

Don't be offended but I have to keep it real on this blog; nurse license renewal time is like Christmas time without the snow at my law firm.

This isn't legal advice but consider it an early Christmas present.

Each State Nursing Board looks at "just a DUI" differently because each State Nursing Board is different. There isn't an "Across the State Nursing Board" rule for OVI, DUI, and DWI convictions. 

For example, I practice law in Ohio, Kentucky, and Indiana and each State Nursing Board in the states where I practice look at DUIs,OVIs, and DWIs differently based on the State Nurse Practice Act, Board of Nursing regulations, and Nursing Board investigation and discipline policies.

Some Boards don't have the authority under the Nurse Practice Act to propose discipline on "just a DUI" while other State Nursing Boards have the authority to propose discipline on "just a DUI."

How do you know how your State Nursing Board looks at DUIs? You can contact:

1. Your State Nursing Board;

2. Your State Nurses Association; or

3. An administrative law, nursing law attorney, or nurse license defense attorney in your state.

If you call my office and want to schedule a consultation to discuss a DUI, I need to see the court documents, traffic ticket, and other records because sometimes "its just a DUI." 

Sometimes its more than "just a DUI" and its a litany of charges and convictions with the DUI like possession of marijuana, possession of drug paraphernalia, resisting arrest, disorderly conduct, possession of crack cocaine, child endangerment, etc.

I actually have nurses schedule and pay for meetings (phone or in-person) with me related to DUI charges and convictions and their nursing license in Ohio, Kentucky, and/or Indiana and don't provide me with any of the requested documents to review and evaluate their situation. Okay?

Some attorneys may be willing to say "Oh its just a DUI (without reviewing docs), and it means this for your license...." but not the kid.

 C-O-U-R-T   D-O-C-U-M-E-N-T-S and

C-O-N-S-U-L-T-A-T-I-O-N

In other cases it is a felony DUI charge because of past DUIs.

In other cases it is one of two or three pending DUI charges and alcohol related offenses in a more than one county or state.

In other cases it is a pending DUI and other issues and circumstances involving a nurse's practice that make it more than "just a DUI."  

In other cases it is "just a DUI" but the nurse is participating in a State Nursing Board Alternative to Discipline program for Chemical Dependency. Is it "just a DUI" in this situation?

In other cases it is "just a DUI" for a nurse in recovery who signed a Return to Work agreement or Last Chance Agreement with a healthcare employer. Is it "just a DUI" in this situation?

In other cases it is "just a DUI" and the nurse is on probation with the State Nursing Board?

In other cases it is "just a DUI" and the nurse is on criminal probation for something else and the judge requires a self-report to the State Nursing Board?

Then sometimes just sometimes "it is just a DUI." Do you get my point?

Alternative Program for Chemical Dependency in California in the hot seat now!

http://www.propublica.org/feature/loose-reins-on-california-nurses-in-drug-abuse-program-725.

Does your State Board of Nursing have an Alternative to Discipline Program for Chemical Dependency?

Look at these comments related to the California Board of Registered Nursing article

http://www.latimes.com/news/local/la-me-nurse12-2009jul12-gb,0,2745582.graffitiboard

I will be in Louisville, Kentucky for a meeting at the Kentucky Nursing Board office

I will be in Louisville, Kentucky on Thursday, July 30th for a meeting at the Kentucky Nursing Board office. If you would like to schedule a legal consultation with me on this day, please contact my office at 1-888-571-1110.

I have conference room space I utilize near the Board's office and I am available to meet with nurses on July 30th in the late afternoon and early evening.

I have been charged with a felony. What are my next steps?

I have been asked this question three times this month. Being charged with a felony is serious!!!!

If you are a nursing student, NCLEX-Applicant, RN, LPN, or a APRN and you have been indicted or charged with a felony, consider retaining a criminal defense attorney with significant experience practicing before the court in the jurisdiction where your case is pending. You can contact your local Bar association for an attorney referral or you can search online for a criminal defense attorney. You can also contact your State Nurses Association or the Center for American Nurses. www.centerforamericannurses.org.

Don't try to represent yourself in a criminal case. Retain a private attorney and if you cannot afford a private attorney, then try legal aid.

You also need to speak with a nurse license defense attorney ASAP. Don't wait until the criminal case is resolved. Talk to a nurse license defense attorney who practices before your State Nursing Board ASAP.

See www.taana.org and contact the Nurse Attorney Referral Line.  

Hospice Nurse in Ohio charged with stealing medication

See

http://www.cleveland.com/newsflash/index.ssf?/base/national-39/1248378882214790.xml&storylist=health

Here is the cut and paste:

Hospice nurse charged with stealing medicine

7/23/2009, 3:12 p.m. EDT The Associated Press

(AP) — NEW CASTLE, Del. - New Castle County police have charged a 30-year-old hospice nurse with stealing prescription drugs from a dying woman.

Jennifer Williams of Delaware City is charged with stealing morphine and a marijuana derivative from the 81-year-old woman, who died early Wednesday.

Investigators said Williams was assigned to the woman's home Tuesday night and immediately began acting strangely, prompting family members to spend the night at the home.

After the woman died, a second nurse called in to pronounce her dead noticed that Williams was incoherent and unable to stand.

Police said Williams, who is seven months pregnant, had ingested the drugs. She was admitted to a Wilmington hospital.

 

Indiana State Board of Nursing sets the record straight regarding License Renewal

Nursing Focus is the official publication of the Indiana State Board of Nursing. I received my copy of the publication in the mail this week. 

In the July 2009, Vol. 5, No. 2 issue there is an article on Renewal Questions and Answers on page 11. See http://www.in.gov/pla/2489.htm.

You are required to disclosed pending State Nursing Board investigations, pending criminal charges, and criminal convictions that were expunged or resolved through criminal diversion.

The application also asks if you have been terminated, reprimanded, disciplined, or demoted in your scope of practice as a nurse or as another healthcare professional.

Nurses are encouraged in the article to err on the side of disclosure because Renewal Fraud is grounds for disciplinary action in Indiana.

My law offfice represents, counsels, and advises nurses before the Indiana Nursing Board and if you need assistance or if you would like to schedule a legal consultation to discuss your self-disclosure to the Indiana State Nursing Board on the 2009 Application for Renewal contact my office at 888-571-1110.

Professional Liability Insurance: Pros & Cons legal webinar for nurses

What's New at the Center   Do you want to know more about professional liability insurance?   Are you debating purchasing your own professional liability insurance policy?

Legal Webinar:  Professional Liability Insurance:  Pros & Cons

August 19, 2009, 7:00 - 8:00 PM  Eastern Time
1.25 contact hours
(Can't make the time?  Buy the webinar and get the recorded broadcast for one week)

Respect:  Do Nurses Get What they Deserve? 
Read the Article
Take the Survey

New!  Visit our Online Store

Pretty and Perfect: American Nurses Associations and Nurse Driven TV Shows like Nurse Jackie and HawthoRNe

I keep receiving these emails from the ANA (I am a dues paying member) about the nursing TV shows and how the shows do not reflect the practice of professional nursing. See this latest press release. Download Ethics_Books_press_release_7-22-09[1]

Does the American Medical Association issue these press releases about House and ER? I love House and I watched a mini-marathon yesterday evening.

Does the American Bar Association issues these press releases about Law & Order and the other multitudes of legal and law-related TV drama series ?

Are these press releases necessary? What do you think about the nurse driven TV shows? What is your opinion? 

Nurses deal with a lot of issues in practice, the healthcare working environment can be cruel and ugly, and for some nurses its not a pretty picture (if everything was perfect and smelled like a perfume and there were violins playing in the background, I wouldn't be as busy as I am now as a nurse license defense attorney).

I don't watch Nurse Jackie or HawthoRNe RN but maybe I will now to see what the fuss is about.

Should TV shows paint a pretty and perfect picture of nursing practice or a realistic picture of nursing practice?

Marital Mayhem: a Marriage, a Nurse, and a License. Keep Your Hands to Yourself

I am married now so I will post on this subject as I am receiving more inquiries, consultations, and cases involving a marriage, a nurse, and a license. I have more nurses contacting me regarding domestic disputes with a spouse or partner that go postal for whatever reason and reports start being made to the State Nursing Board or criminal charges and convictions pop up that will utimately be reported to the State Nursing Board. This is in addition to the divorce and custody battles that the nurse is dealing with on a daily basis. 

You don't want to be in criminal court, family court, and before the State Nursing Board at the same time, do you?

My husband has a state issued license also. Maybe I am still in my honeymoon bliss stage but I can't imagine us getting to the point where we are filing complaints against each other licenses and taking our relationship to the dark side of the force with criminal charges, battling in court over who gets the dogs (our kids are adults), etc.

I am a counselor at law, not a clinical counselor but if things are getting to that point, you need to talk to someone or consider exiting the relationship. Get some help and move forward.

Domestic violence (DV) charges and convictions can really put a damper on your employment options and impact your nursing license. I am seeing convictions involving assault, stalking, menacing, tampering with evidence, restraining orders and restraining order violations, domestic violence, telephone harassment, destruction of personal property, theft of personal property, etc.

All of these convictions can have a impact on your nursing license, depending on the State(s) where you practice.

Keep in mind these three things if you are a nurse and you are in a situation that escalates:

1. I learned this in preschool and I know it can be a hard rule to follow but keep your hands to yourself. Put your hands in your pockets or keep your arms crossed if needed.

2. You always have options; you may not like your options, but you have options with any and every situation; and

3. Criminal convictions involving violence against person or property can impact your nursing career, employment, and your license.

Anesthetic Agent Diprivan and the American Association of Nurse Anesthetists statement

For Immediate Release
July 9, 2009

Turning a Harsh Spotlight on Propofol Misuse 
Dangerous drug linked to Michael Jackson sparks concern over abuse potential and non-anesthesia professionals providing to patients 

How unfortunate that it took the tragic death of a famous celebrity to sound the alarm on propofol, a potentially dangerous anesthetic drug that can turn deadly when used for the wrong purpose or administered by anyone other than a qualified anesthesia professional.

Used as intended—for surgical or diagnostic procedures conducted in an appropriate healthcare setting by a qualified anesthesia professional such as a Certified Registered Nurse Anesthetist (CRNA) or physician anesthesiologist—propofol is fast-acting, short-lived, and very safe. But when used for other purposes, in other settings, by anyone other than a CRNA or anesthesiologist, the risks can be significant. Unfortunately, until now regulatory agencies, insurance companies, and various non-anesthesia professionals have downplayed the dangers of propofol, virtually treating its use as “so easy, anyone can do it!” It is far from that.

The American Association of Nurse Anesthetists (AANA), representing 40,000 members who deliver more than 30 million anesthetics to patients each year, has taken a strong stance on the dangers of propofol misuse. Through extensive lobbying, testimony, and education, the AANA has continually emphasized two main concerns.

First, propofol can be very addictive. Abuse of the drug is becoming more common among anesthesia professionals and other healthcare providers who have easy access to it. To help address this growing concern, on June 22—just days before the media exploded with reports linking alleged propofol use to pop star Michael Jackson—the AANA became the first anesthesia professional association to publish a position statement, recommending that healthcare facilities keep propofol in a secure environment to reduce the risk of its diversion and abuse by providers. Patients, however, should not needlessly worry about becoming addicted after receiving propofol for a surgical or diagnostic procedure. The risk of this happening is the same as with any other anesthesia/sedation drug received for these purposes—miniscule.  Patients who have questions or concerns about their anesthesia care should never hesitate to ask their anesthesia professional during their preoperative consultation.

Second, the package insert for propofol, which is approved by the U.S. Food and Drug Administration (FDA), requires that the drug be administered by healthcare professionals trained in the administration of general anesthesia—in other words, CRNAs and anesthesiologists. Despite the fact that a patient sedated with propofol can slip into general anesthesia and stop breathing, this potentially dangerous drug which has no antidote is administered in many outpatient facilities by healthcare providers other than CRNAs or anesthesiologists, particularly for colonoscopies and related procedures. Even though mishaps  are rare, would you want a loved one to be sedated with this powerful drug by  someone who is not trained to recognize all the signs and symptoms of general anesthesia, and who is not an expert in patient rescue in the event of drug overdose and emergency?

So why then is this allowed to happen? One big reason should come as no surprise: Insurance companies are not reimbursing for propofol delivery by anesthesia professionals for diagnostic procedures such as colonoscopies because it is considered to be too expensive. Patient safety and comfort, which should be the real drivers of healthcare practice, once again are merely an afterthought.

The AANA and the American Society of Anesthesiologists feel so strongly about this risky business that the two organizations published a joint statement (http://www.aana.com/jointstmt_propofol.aspx) in 2004 stating that whenever propofol is used for sedation/anesthesia, it should be administered only by persons trained in the administration of general anesthesia and who are not simultaneously involved in the surgical or diagnostic procedure. The statement adds emphatically that “failure to follow these recommendations could put patients at increased risk of significant injury or death.” Consistent with the joint statement, on May 28, 2009, the AANA testified at an FDA hearing that propofol administered by healthcare providers who are not expert in general anesthesia, resuscitation, and the use of emergency equipment is highly dangerous.

The bottom line is that propofol is not a sleep aid, is not for recreational use, and is potentially addictive and dangerous in the wrong hands. While the reason for the sudden interest in propofol is indeed sad, we can only hope that the long-overdue attention now being paid to this drug will lead to heightened awareness of its high abuse potential and an increased adherence to the FDA requirement that it be administered only by those qualified to do so.

http://www.aana.com/News.aspx?ucNavMenu_TSMenuTargetID=62&ucNavMenu_TSMenuTargetType=4&ucNavMenu_TSMenuID=6&id=22278

Why Doesn't My State Nurses Association Provide Attorney Representation Before the Board!

If I receive an email or phone call from a nurse and its strictly a nursing practice issue, then I refer the nurse to the State Nurses Association or the State Nursing Board for assistance. Often times a State Nursing Association or a State Nursing Board can provide you with the informational and educational literature or references so that you can answer your question. Some State Nursing Associations offer free practice or workplace consultations for members and charge non-members for this service.

I had someone recently ask me why doesn't the Ohio Nurses Association have attorneys to represent nurses before the Ohio Nursing Board.

The Ohio Nurses Association is a nursing union and a nursing professional association and its mission is to advocate for nurses and the profession of nursing here in Ohio. http://www.ohnurses.org/AM/Template.cfm?Section=Vision_and_Mission&Template=/CM/HTMLDisplay.cfm&ContentID=2838

The ONA has attorneys on staff to assist with labor relations and collective bargaining agreements of union members. Even during the grievance and arbitration process, the union attorney is representing the union pursuant to the collective bargaining agreement, not the individual nurse.

It would not be appropriate for a nursing professional association such as the Ohio Nurses Association, Kentucky Nurses Association, or Indiana State Nurse Association to provide attorney representation to individual nurses (regardless of whether the nurses are members of the association or non-members) being investgated by the State Nursing Board. This would present a conflict on multiple levels.

If there is a State Nursing Association which provides attorney represention to nurses before the State Nursing Board as a member benefit, then I stand to be corrected and will include a link.

I complain about nursing professional associations but I can complain because I pay my dues. However how can you complain about the services your state nurses association does not provide if you are not a member?

If you have concerns about the products and services your state nursing association provides or does not provide, contact the State Nursing Association Executive Director. I am sure he or she will be more than willing to answer your questions and mail you a membership application.

Attorneys and the legal profession, which I am a part of:) have a monopoly on the practice of law (except the mess with unemployment claims and workers compensation here is Ohio) and if you want legal representation for the most part then you are going to have a hire a private attorney.

Law unlike nursing (LPN vs. RNs, LPN vs. RNs. vs. Medication Techs, etc.) doesn't part with open up and part with sections of its scope of practice without a fight. Now you talk about litigation....

Self-Representation and Self-Help for Nurses in This Economy: Who Can I Call? Nursebusters

Okay, you know now I grew up watching Ghostbusters and singing the Ghostbusters song. Who can you call? Ghostbusters.

We will file this post under the economy because more and more are recognizing the need for guidance, counseling, and advise in the highly regulated and at-will employed healthcare environment but do not necessarily know how to go about getting the information and advice needed.

1. You can of course speak with nurses you know or nurses you work with to see if you can obtain the information needed;

2. You can contact a national, state, or specialty nurses association for the information you need. I would suggest that you consider contacting your State Nurses Association.

For example, there is Kathy Morris, RN, MS, Nursing Practice Director and Jan Lanier, RN, JD at the Ohio Nurses Association and Maureen Keenan, JD at the Kentucky Nurses Association. They may be able to provide you with the information that you need;

Some State Nursing Associations offer workplace consultations for members at no-cost and charge a fee for workplace consultation for non-members;

3. You can contact the Center for American Nurses, which is a national professional association focusing on the nursing workforce at www.centerforamericannurses.org;

4. You can contact your State Nursing Board for assistance and the information you need; and/or

5. You can contact a nurse license defense or nursing law attorney for a consultation.  Contact the nurse attorney referral line at www.taana.org. TAANA is The American Association of Nurse Attorneys.

You may find an attorney who does not charge for a nursing law consultation. Most attorneys however will charge a fee for a consultation. My law firm offers legal, workplace, and career consultations for nurses. By all means if you can obtain the information you need, do so without paying a fee.

But if you need a legal opinion, legal advice, or you don't want to contact several places to get the info or advice you need, the consider a legal, workplace, or career consultation with my firms.

I offer legal consultations for nursing matters involving the states of Ohio, Kentucky, and Indiana where I am licensed to practice law. I provide legal advice and counseling in the context of the consultation.

I offer workplace and career consultations through my consulting firm, the Healthcare Risk Aversion Group, LLC. This are not state-based and I offer this service to nurses throughout the country.  

See my website at http://www.nursing-jurisprudence.com/consultations.html. Also scroll to the bottom of the page and see the handout on the difference between Legal Representation vs. a Consultation.

If you would like to schedule a legal, workplace, or career consultation, contact my office at

888-571-1110.