Nursing Law & Order

Free Webinar: Retirement Planning for Busy Nurses

My 401K with the American Bar Association took a hit last year and I thought well I guess I will work until I die. Its looking a little better now and so is my IRA.

Are you ready for retirement? When do you plan to retire? Are you planning to retire?

You cannot work forever and working up until you die full-time probably isn't healthy but you are seeing it more and more these days. I am 38 years old now. I don't want to retire at 55 but I would like to be able to down shift around 50 or 55.

My sweetie and I have a monthly financial planning meeting where we review our expenses, income, and goals. It gives us a reason to eat at the Cheesecake Factory and it forces us to discuss money and finances. Before we got married we reviewed each other credit reports and the works because we wanted to approach our marriage as a team (although we have been living together for a number of years anyway).

Its never too late or too early to plan for retirement as a nurse. The Center for American Nurses is sponsoring a free webinar for nurses on retirement. See

https://www2.gotomeeting.com/register/492433170

KY and IN Licensed Nurses: Please Renew Your Nursing License TODAY!

The deadline for renewal is October 31, 2009. But guess what, the 31st falls on a Saturday and State Nursing Board offices are closed on Saturday. If you wait until the 31st, when will your application be processed since the Board offices are closed on the weekend.

I met with Kentucky Nursing Board staff yesterday for an investigative meeting. After the meeting a comment was made about the number of nurses who haven't renewed their license. The deadline for renewal in Ohio was August 31, 2009. I renew my licenses early as I am easy to be distracted. I also calendar the deadlines for renewal of my nursing and law licenses.

Renew your Indiana Nursing Board  and/or Kentucky Nursing Board license today.

Patient Safety and Medical Liability Reform

See http://www.whitehouse.gov/the_press_office/FACT-SHEET-Patient-Safety-and-Medical-Liability-Reform-Demonstration/.

Where does nursing fit into this equation? What do you think?

Negligence to Malpractice: the Professional Practice of Nursing is Evolving

The Center for American Nurses has recently published a new e-book on nursing negligence and malpractice, the title is "Negligence to Malpractice: the Professional Practice of Nursing is Evolving."

http://www.can.affiniscape.com/storelistitem.cfm?itemnumber=22

The e-book can be purchased for $9.95 at the Center for American Nurses website at www.centerforamericannurses.org. Click on the link above or go the Center's website and click on the link for the Online store.

Is it the End of Lawyers? Not this one. Is it the End of Nurses? Not this one.

I ordered a book titled the End of Lawyers by Richard Susskind from Amazon. It should be delivered this week. http://www.susskind.com/endoflawyers.html

Is it the End of Lawyers? Maybe some law firms and attorneys will go the way of the dinosaurs but not this one. Some lawyers and law firms don't want to see themselves as a business and only want to look at the practice of law as profession. The practice of law is a profession and business and both of these concepts are very important.

I remember being told "a law practice representing nurses isn't a viable concept." Really! I did things my way from the beginning for better and for worse and the kinks are rolling out. I am not a traditional attorney and I did not want to have a traditional law practice with traditional clients and a traditional law office. I was told 10 years ago that attorneys shouldn't be consultants and you should focus exclusively on the law. Whatever. I have a law firm and a consulting firm and one of my goals for next year is to grow my consulting practice.

I love working on the marketing, advertising, selling, and business development practices in my law and consulting firms. I started my law practice from scratch like my Mississippi Mud Pie (which is soooo delicious by the way) and therefore I learned early that you have to market yourself, differientiate your law practice from the thousands of other lawyers out there, practice law, and keep your clients happy.

It may be the end for some lawyers but not this one, baby. I am the only RN-JD who practices law in Ohio, Kentucky, and Indiana and represents, counsels, and advises nurses in State Nursing Board and professional practice matters. This didn't happen over night but I have worked hard and I am still working hard to develop my law practice and run my business. I don't have any plans to hire additional attorneys as I like working one or one with my clients because this isn't just a job or something I do to make "a buck."

It depends on your perspective. Are you just here? Are you just living life? Are you just going through the motions and you are oblivious to the path and the destination being plotted? Or are you fulfilling your destiny like Luke Skywalker? Use the force, Luke!!!

Maybe I have watched one too many Sci Fi movies but life is so much more interesting when you are striving to be the person you dreamed you could be and each page that you turn in this massive book called life is a journey.  

Is it the end of nurses? Do you see nursing as a profession and a business? Is the practice of nursing a business? Are nurses prepared by nursing schools/colleges to see the practice of nursing as a business and a profession?

How are you positioning yourself for the nursing workforce of the future?

Wet to Dry Dressing Changes BID: I am one of my grandfather's home health RN's

Guess who is changing her grandpa's abdominal dressing? You guessed correctly. The wound looks good and is healing. I did the dressing changes BID over the weekend and I do the evening dressing changes.

My grandmother is very particular and you know how scheduling goes with home care cases for evening dressing changes. Its the oncall person or a prn nurse or whoever can cover the visit so I am going his dressing changes in the evening.

My grandparents live within walking distance of our home (less than mile) and when I went in the house yesterday evening for his dressing change my grandfather asked me if I had a "paper" for him to sign so I could get paid. How funny and how sweet!

His primary nurse told him to watch his "Percocet" because some nurses may try to pocket the medication. Wow! I am a nurse license defense attorney and I wouldn't even say this. What's really going on here?

Hi Doctor, I don't know you and you don't know me but I need free medical advice and I need it now over the phone!

This is precisely why I don't provide free legal advice or counseling over the telephone anymore. You cannot contact any other professional and request free advice and counseling over the phone without an expectation of payment. I called my doc about my back and she replied "How's my favorite lawyer? Make an appt. and come see me."

I am happy to report that I am close to hiring a legal assistant to work me with 30 hours a week. I conducted my last round of interviews yesterday and my legal assistant is starting work on November 2, 2009. This is my first employee and I am excited and I will work very closely with this person throughout the day on a variety of cases and projects.

My receptionist and assistant will act as gatekeepers. Most attorneys and law firms have receptionists and legal assistants to do the same. You cannot contact an attorney who you don't have any type of relationship with and expect to just start asking this attorney questions. I take calls and speak with my law office clients throughout the day without an issue but these are nurses who have retained me and paid me to be in a professional attorney-client relationship with them. I am always available to speak with my law firm clients.

When my assistant explains the benefits of a legal consultation, most nurses say "I don't have any money" "I thought attorneys do these for free" and make other remarks. My favorite is "I can open the yellow books and get this for free from an attorney." Most do not schedule legal consultations which is fine and we refer to www.taana.org for assistance.

When the day comes that you can open the yellow pages to the attorney section and just randomly pick out an attorney who can competently, adequately, and skillfully provide with you legal advice and counseling and/or representation in a State Nursing Board matter or counsel and advise you on the finer points at the intersection of nursing law, ethics, and professional practice standards and the law, legalities, and legal issues confronting nurses daily in the highly regulated healthcare environment, I will retire.  Until then I am "going hard" with my career because my law and consulting practices are unique and I love what I do for a living, don't you? http://www.urbandictionary.com/define.php?term=going+hard

This week alone I had at least 8 nurses contact me who needed a legal consultation. I guess its the end of the year and its going down (meaning its on and popping) in some facilities! There was an expectation from each of these nurses that they could just call my office, speak with me immediately, and I would answer all of the their questions, and provide with free legal advice and counseling regarding their specific situation for 20-30 minutes. You have got to be kidding, get the f*&% out of here!!

The only exception are nurses who have a forthcoming or pending State Nursing Board matter in Ohio, Kentucky, and Indiana. I take these calls, speak with the nurses for 15 minutes or so to get a feel for the issues, and either mail or email the nurse additional information about the legal services provided by my firm and how I can assist them in the State Nursing Board matter.

I cannot provide free legal advice, representation, or counseling to anyone; our mortgage payment won't let me do it. We happily refer nurses to www.taana.org or to their State Nurses Association for information and to seek the assistance of a pro bono nursing law attorney. 

Do you work for free as a nurse? Do you provide skilled nursing services with no expectation of payment? Of course not. I don't and the same applies to most nursing law attorneys that I know.

Kentucky Holistic Nurses Association Meeting this Month

"Soul Party" Workshop Series with Virginia Drake

Come to our Soul Party!   Come and "Soul"cialize with us at another great Virginia Drake Workshop series!    Dates:  Friday, October 23rd Time:  10 am - 2 pm     Cost:  "From the Heart Pricing Donation"    Locations: Occupational Kinetics, LLC directions:  www.myockn.com     RSVP:  [email protected]   Virginia Drake has worked in the fields of education, social work, counseling, consulting, and motivational speaking for over 30 years.  She holds a Master's Degree in Education from Georgetown College, a TEaching Certificate from Eastern Kentucky Univerity, and a B.S. Degree in Social Work form Murray State University.      In 1998, Virginia had a miraculous healing after a major heart attack and near death experience.  It was then that she became interested in the mind, body, and spirit connection and the impact these forces can have on ones' health and relationship.  She devoted the next 8 years to intensive study of meditaiton, natural healing, and quantum physics and how the electromagnetic field aof the human body works in connection with the healing process.   In addition to her private consulting business, Virginia also teaches workshops on developing strategies to promote a healthy and enriched life.      Virginia's website: www.revisions.us

Nursing Documentation Disasters: My Top 10 for the Funky Stuff

I am hearing about some pretty wild things going on related to nurses and documentation. So here it is, my top ten documentation disasters for the funky stuff (this is a legal term):

1. Charting ahead. Oh you know what I mean. Its only 8pm and you have charted up until 5am the next day for your 7pm-7am shift.

2. Addendums. Making addendums or changes in a medical record or on patient care documentation in violation of your facility policy.

3. Submission of false billing documentation for skilled nursing services provided and you are paid for those services. Why are you submitting notes for services you didn't provide anyway? Have you ever heard of fraud or theft?

4. Signing off documentation, charts, or flowsheets using someone else's signature. WTF, why are you intializing or signing "anything" for someone else anyway?

5. Destroying, concealing, creating, or alterating any type of medical record, flowsheet, competency, etc. after an incident to paint a prettier picture of the incident. What is your intent here?

6. Charting you peformed a task or skill on a flow sheet or in the medical record and you didn't perform the skill or task.

7. Sneaking a peek at the electronic medical records of your neighbors, family, and friends who are admitted to your hospital and you are not assigned to provide care for these individuals.

8. Getting sloppy with your administration, handling, and documentation of controlled substances in a hospital. Its your career and your license on the line. The Pharmacy Board and the police may get involved so don't be surprised.

9. Getting sloppy with your administration, handling, and documentation and counting of controlled substances in a nursing home or assisted living facility. Its your career and your license on the line. The Pharmacy Board and the police may get involved so don't be surprised.

10. The cover-up or a conspiracy (two or more nurses) to cover-up is always worse.

Have you ever heard of monkey see, monkey do?

If a nurse colleague jumped off a bridge, would you do the same just because your colleague did it?

My grandmother would say this to us all of the time growing up. LaTonia, if you saw one of your friends jump off a bridge, would you jump off the bridge? I would always so "no" of course but peer pressure is a "mother" also. Get it, now that's funny.

Trying to cover-up and conceal 1-9 and using deceit, deception, and dishonesty to rationalize your behaviors, actions or inaction when 1-9 occurs or you know that 1-9 is happening on your unit or floor and you do nothing. Remember, there is a Code of Ethics for Nurses and nursing laws and rules governing your practice.

If the funky stuff is happening on your unit, contact your State Nurses Association or a nursing law attorney in your state or jurisdiction to determine what are your reporting obligations.

Are you a charge nurse, DON, ADON, nurse supervisor, or nurse manager? Legal Issues for Nurse Supervisors and Nurse Managers

I am seeing more issues in my law practice involving nursing supervisors and nurse managers. In your opinion what are some of the legal issues facing nursing supervisors? What are some of the legal issues facing nurse managers?

Attention RN and LPN Ohio Independent Providers: Fraudulent Billing is a legal nightmare you may never wake up from, so don't do it!

If you are a nurse and you are working as an independent provider, please make sure you are billing the State of Ohio for the skilled nursing services provided in an accurate, truthful, ethical, and professional manner. Follow the guidelines and regulations for billing home care services. Don't think "Oh no one will know or find out" because chances are someone will and you will be held accountable and responsible for your actions. There is no passing the buck when it comes to being paid for services that you were not legally entitled to be paid for in the eyes of the law in this economy. The State of Ohio takes this cases very seriously because this is taxpayer's money.

There are more and more nurses every year who are working as Ohio independent providers (essentially home care nurses) and who are being investigated for fraudulent billing by the Ohio Attorney General's Office and subsequently the Ohio Board of Nursing.

These cases are complicated and serious because multiple issues and agencies become involved and the consequences of these types of cases can rip your nursing career apart for several years going forward.

Don't let the approaching holidays stress you out! I can feel it coming....

Fall is here and things are moving steady at my law office. I am in the process of hiring a part-time legal assistant and I have a recovery assistant, a former CRNA in recovery for addiction who assists me with my law practice cases involving dependence and controlled substance discrepancies. I am looking at my practice goals for 2009 and starting to plan for 2010.

I am looking forward to the Holidays but I don't know about your family but I have a large extended family and there is a constant and persistent amount of what I call "more drama for your mama" throughout the year. The drama goes to an all high after Halloween, peaks at Thanksgiving, spikes again around Christmas, blows a gasket around New Years Day and slowly trickles downward until the first week in February.

One way I have found to control the madness is to plan for the madness, expect the madness, and embrace the madness. I don't get angry or upset because I know its coming and it too will run its course. I love the Holidays because I use the New Year as way to shed the years past and move forward into a brighter future. I also start planning my financial, professional, and personal goals for the upcoming year about this time of the year.

What are your nursing career goals for 2010?

What would you like to do differently in 2010?

Are you planning to stay with your current employer?

Are you planning to switch to a different floor or unit?

Are you considering certification?

Are you going back to college for a degree?

I would really like to start practicing again as a RN. Maybe a few visits a month as a home health RN again. I need to do my CPR and have a lengthy orientation to get up to speed again. I am also thinking about a nursing refresher course and taking CE online. This is one of my goals for 2010. I miss the hands on nursing and would like to start in home care again.

I would also like to do a law and healthcare related fellowship by 2015 and I am going to start looking around because of course there are none here in Cincinnati. It would be in Chicago or Washington, D.C. Maybe complete a MSN with the fellowship or a Masters in "something."

Don't let the Holidays stress you out. Take stock of your blessing and your accomplishments and your family as we move forward into 2010. Onward and forward....

The Road Warrior is resting today and Happy Sweetest Day!

I am a little tired today. The drive from Cincinnati to Louisville to Cincinnati on Thursday and then the drive from Cincinnati to Columbus to Cincinnati on Friday took its toll on me. I was planning to drive to Independence, Ohio for the Ohio Nurses Association Convention but it "ain't gone happen." I am even trying to bribe my husband into driving me to Independence, Ohio late this evening so that I can particpate in the last day of the convention activities but he is tired also from working long hours.

I am resting today. Sipping a Bartles & James cooler and watching the Boondock Saints, Dune, and Lord of the Rings Return of the King. I have plans this evening with my sweetie. This is our first Sweetest Day being married. We are always looking for an excuse to celebrate something and rationalize having dinner at the Cheesecake Factory.

Happy Sweetest Day!

Firing A Client is Never Easy: What if we lived in a perfect world?

I fired a client yesterday. It wasn't an easy thing to do but it was necessary. I wish that I could make everything all right in these cases for my clients but this is real life, real issues, real drama, and therefore I "keep it real" with all my clients.  

If you are looking for an attorney to just tell you what you want to hear, then don't call LaTonia Denise Wright, RN, BSN, JD. For some of us that's hard. I must admit when I have legal issues (yes attorneys have legal issues that arise) it hard for me to absorb the legal advice provided to me by own legal counsel. Years ago I planned to fight a fine "all the way to the Supreme Court" because I knew I was right. I called my personal attorney. She laughed at me. We are friends so she laughed at me a little more over the phone. She took me out to dinner, laughed at me some more, listened to me, and then gave me legal advice. I paid the fine.

What I have found in 12 years of law practice and 8 years in nurse license defense is its even harder to absorb for some nurses who have been representing themselves over an extended period of time in a State Nursing Board matter(s). I am going to add these types of cases to my red flag list going forward because as I was driving home from Louisville (I also attended part of the Kentucky Nursing Board meeting) yesterday, I kept thinking you should have seen this one coming. Actually I only recently started representing the nurse this month so damn, I guess I did see it coming. But that's what 12 years of law practice and 8 of those years on the legal battlefield performing triage teaches you, baby!

A nurse with a long standing State Nursing Board case may say I know my case, the facts, and the issues better than some attorney who I just retained, right?

I wish we lived in a perfect world. In a perfect world, I wouldn't have a law practice representing nurses before the State Nursing Board because in a perfect world, nurses would not be reported to the State Nursing Board. In a perfect world, all nurses would also be perfect and there would not be a need for mandatory reporting to the State Nursing Board.

Are You Competent? What is the difference between competent and competency?

I moderated an excellent webinar on the past, present, and future of Competence in Nursing. The presenter was Linda Simunek who is a RN, PhD, JD and specializes in developing and accrediting new nursing programs across the country. See www.centerforamericannurses.org.

Ohio Board of Nursing Public Hearing Notice

This is a cut and paste from an email:

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10/14/2009 - Public Hearing Notice

The Ohio Board of Nursing (Board), pursuant to Chapter 119, Ohio Revised Code, hereby gives notice that it will conduct a public hearing for the purpose of considering the adoption, amendment, and rescission of rules.

The public hearing will be conducted on Wednesday November 18, 2009 beginning at 1:00 p.m. in the Boardroom of the Board, located at 17 South High Street, Suite 400, Columbus, OH, and continuing until all parties in attendance have had an opportunity to be heard. Oral or written testimony may be presented by any person affected by the proposed action. A copy of the entire notice is attached.

The link provided below is to the Register of Ohio website where the proposed rules can be found.

http://www.registerofohio.state.oh.us/jsps/PublicDisplayRules/processPublicDisplayRules.jsp?agencyNumberString=4723&actiontype=proposed&doWhat=GETBYFILINGAGENCY&Submit=Search

My Grandfather is Recovering in the Hospital and Going Well

My grandfather had surgery last week and is recovering. Please keep us in your prayers.

Are You Plenty Pissed? You hired a Personal Injury Attorney to Represent You in a State Nursing Board Disciplinary Investigation

I received a phone call from a nurse last week who was plenty pissed (that's a legal term) because his attorney resigned from the practice of law without informing the nurse. The attorney was representing the nurse before the State Nursing Board and filed a notice of w/d with the Board but did not notify the nurse.

The nurse was subsequently notified by the State Nursing Board "your attorney has withdrawn" "you have a right to retain another attorney to represent you" and "we are proposing to take action against your license."

The State Nursing Board didn't do anything wrong or improper here. But this nurse contacted my office and he was extremely upset about the situation. I can understand being upset in this situation because the nurse paid an attorney for representation and then never heard from the attorney. This attorney was a general practice and plaintiff personal injury attorney. And don't send me an email if you are a general practice attorney or PI attorney implying I am saying mean sh&* because I am not.

The nurse had several questions about the proposed action against the license and was furious that he would have to "retain another attorney" or pay for a legal consultation to discuss the proposed action against the license, review his options, and discuss what action against the license meant for his nursing career. Again I can understand his frustration and why he was so upset.

What I am saying here? If you are going to retain an attorney to represent you before the State Nursing Board, contact an attorney who represents nurses and/or licensed healthcare professionals before state licensing boards. Contact your state nurses association for a referral to a nurse license defense attorney. Research attorneys online. Speak with other nurses about an attorney referral. Go to www.taana.org.

1. Why would you hire a general practice attorney to represent, counsel, and advise you before the State Nursing Board?

2. Why would you hire a personal injury attorney to represent, counsel, and advise you before the State Nursing Board?

3. Why would you hire a criminal defense attorney to represent, counsel, and advise you before the State Nursing Board?

4. Why would you hire a family law attorney to represent, counsel, and advise you before the State Nursing Board?

5. Why would you hire an attorney who specializes in DUI cases to represent, counsel, and advise you before the State Nursing Board?

6. Why would you hire an attorney who specializes in estate planning to represent, counsel, and advise you before the State Nursing Board?

Do you get my point? Your license is too precious to play around with having someone represent, counsel, and advise you because "they have a sister who is a nurse and who can help in the case" or "their daughter is a physician and knows people" and the other remarks I have heard over the years.

The economy is forcing some attorneys who typically would not have taken these types of cases years ago to jump on license defense and State Nursing Board disciplinary investigations and hearing cases. I guess the thinking is "its just a nursing license" this can't be to hard, right?

As I have said before its not just representation before the Board that is important but its also counseling and advising on attending matters that it just as important as the actual representation of nurses. License defense is a specialty and a very small niche.

Its your license and if you are going to hire someone, do the research, make the calls, and find a nurse license defense attorney, healthcare license defense attorney, administrative law attorney, or nursing law attorney to represent, counsel, and advise you before the State Nursing Board.

I had a ball presenting yesterday at the Sharonville Convention Center

I really enjoyed the group of nurses I presented to yesterday at the Sharonville Convention Center. The nurses asked alot of good questions and I really wish we had more time for questions and answers.

Pre-Licensure Issues evolve into Post-Licensure Issues for Nursing Students and NCLEX-Applicants

This has been a very interesting year. I am being contacted by more nursing students and NCLEX-Applicants with a variety of legal issues pre-licensure which carry over into post-licensure issues.

I remember being in nursing school. Most nursing students don't have the funds to retain legal counsel. I know I didn't have that kind of money (okay I did in a rainy day fund) to spend on attorney fees. But I was initially licensed in 1993 as a RN and licensure for nurses has changed alot since then.

Pre-licensure issues for nursing students and NCLEX-Appplicants are turning into post-licensure issues for newly licensed RNs and LPNS, which may then carry on and forward into their nursing career, workplace, and may restrict employment opportunities.

I know they don't tell you this in nursing school but I guess its not their "job" to tell you these things. I hear

*  Why didn't my nursing instructors tell me this?

*  I can't find a job with all these restrictions on my license!

*  I didn't know I could contact an attorney!

*  Why wasn't an attorney appointed to represent me?

* What am I going to do now?

Then it gets even more difficult when you want to move out of state and obtain a license somewhere else. If you have pre-licensure issues, retain an attorney. If you don't have the money, talk to relatives or immediate family members. I am seeing nurses who are investing $20-60k in a nursing education (for a diploma, ASN, or BSN) only to find out at the end of the road that there is a licensure dance.

Do you dance by yourself? Or do you retain legal counsel and dance with a partner? The decision is yours of course and economic realities may dictate that you dance alone.