Nursing Law & Order

Health Law conference in Indianapolis today was nice but what about nursing?

I attended a full day health law conference sponsored by the Indiana State Bar Association today. It was a nice conference with alot of good content. However I wish there was a State Bar Association conference focusing on the law and the issues nurses and other healthcare professionals face in healthcare. Most of the content at the conference today focused of course on hospitals, healthcare systems, and physicians.

Legal issues facing physicians including fraud abuse, medical staff credentialing, disruptive practitioners, DEA licenses, reimbursement, third party payors, employment contracts, medical mapractice, tort reform, and federal and state regulatory issues are big money and high dollar for law firms who work with hospitals, healthcare systems, and physician groups.

Nurses and other licensed healthcare professionals and paraprofessionals are usually not the subject of these types of conferences sponsored by State Bar Associations. I actually attended today because one of my goals is to attend state specific CLE in Ohio, Kentucky, and Indiana focusing on health law or administrative law and there was a session on the basics of licensure defense for healthcare professionals in Indiana. I soon found out the rationale was because more physicians in Indiana are being reported to the Indiana Medical Board after an adverse finding by the medical malpractice panel in Indiana.

The ABA has an annual conference which focuses on legal issues facing physicians. I am still waiting for the ABA conference focusing on legal issues facing nurses and other licensed healthcare professionals. I may juggle my schedule to attend the American Association of Legal Nurse Consultants conference in Pittsburgh, PA because this of course will be legal and nursing-related content. I will also attend one of the NCSBN conferences this year because these conferences focus on the legal regulation of nursing practice. I will attend the Ohio State Bar Association administrative law conference in July this year because there is always good content on the legal regulation and licensing issues involving healthcare professionals.

More Inquiries involving State Nursing Board A and State Nursing Board B and sometimes State Nursing Board C

I am receiving more phone calls and inquiries regarding State Nursing Board investigations with more than one State Nursing Board. We take cases involving issues with the Ohio, Kentucky, and/or Indiana Board of Nursing. 

For example, you are licensed in State A and B. If you are being investigated by State Board A and State Board A takes action against your license whether its a public reprimand, probation, suspension, or revocation, this is going to be reported to State Nursing B at some point. State Nursing Board action against the license is reported to several national databanks and eventually any state where you hold a license will be informed about your discipline in State A.

In the past, I would see more cases with nurses having issues with the Ohio and Kentucky Nursing Board and the Ohio and Indiana Nursing Board. Now I am seeing more issues with the Indiana and Kentucky Nursing Boards. This is the benefit of practicing before more than one State Nursing Board because I can tell you the Ohio, Kentucky, and Indiana Nursing Boards and the licensure by examination and endorsement application process, the complaint investigation, adjudication, and post-discipline process, and Alternative to Discipline Programs for Chemical Dependency are VASTLY different. Like Day and Night. http://www.youtube.com/watch?v=WSWrepLjTKc

If you are licensed in more than one state and you are being investigated by one of the State Nursing Boards, talk to an attorney who is licensed to practice law in one or more of the States where you are licensed to practice nursing. Talk to someone early in the process.

Also if you are licensed in more than one state you really need your own professional liability insurance policy with a license defense benefit. Why? If you are investigated in each State do you want to pay out of your pocket for representation before two, three, or four State Nursing Boards? Of course not. I am licensed to practice law in three states and I have legal malpractice insurance with a high dollar limit for malpractice and Bar complaints. Okay, please don't sue me or report me to the Bar!!

Retaining an attorney for representation before one State Nursing Board isn't cheap and representation before two or more State Nursing Boards can be costly. When I quote flat fees for these types of cases, I always use my calculator:)

Most nurses who are dealing with more than one State Nursing Board for discipline or more than one State Nursing Board in an Alternative to Discipline Program for Addiction are representing themselves which is fine and understandable. But when you get to a point where you start dropping the balls you are juggling in the air then you may need to speak with an attorney.

I am speaking with nurses who have been monitored for 2-10 years with the State Nursing Board in an alternative to discipline program, discipline program, or a combination of both for a variety of issues. Two to Ten sounds like a prison sentence but that's just me and maybe I watch too much Law & Order.

If this is you, maybe, just maybe you need to speak with an attorney to work with you on navigating this process. 

You mean there isn't a statute of limitations in State Nursing Board cases! I didn't know the case from several years ago was still pending until recently....

I spoke with a nurse this morning who is very upset about a pending State Nursing Board case. The nurse spoke with a someone from the State Nursing Board in 2006/2007.

1. First Issue:

The nurse did not realize or understand that a complaint was filed against his/her license in 20062007 until I spoke with him/her today.

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The nurse was told by the person who contacted her from the State Board (who was an investigator) that nothing will probably come out of this issue.

2. Second Issue:

If you want objective legal advice and counseling about a complaint filed against your license with the State Nursing Board, maybe, just maybe you should speak with an attorney.

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The nurse forwarded a written statement to the Board. The nurse later thinking the issue had been resolved threw away all of the documents and correspondence related to the license issue. The nurse assumed the case has been resolved because the nurse had not been contacted or heard anything from the Board in almost 3 years.

3. Third Issue:

Check your State Nurse Practice Act regarding a statute of limitations in State Nursing Board investigations and cases.

If this upsets you, contact your state legislator or your State Nurses Association to voice your concerns.

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The nurse has professional liability insurance with a license defense benefit but did not seek legal representation in 2006 because the nurse didn't think it was necessary.

4. Fourth Issue:

What is the purpose of having professional liability insurance with a license defense protection benefit if you don't use the policy and the benefits when a complaint is filed against your license with the State Nursing Board? You have a policy which most nurses don't have in these types of cases and then you don't use it because you don't think its necessary. WOW!

This is what happens when you represent yourself. There is a tendency to minimize and rationalize the incident or the conduct involved. My favorite is:

Why would I need an attorney? I didn't do anything wrong!

Right and wrong from a moral perspective is a hop, skip, leap and jump well away from violating one of the many provisions of the State Nurse Practice Act and/or the State Nursing Board regulations.

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The State Nursing Board is now proposing action against the nurse's license, probation and monitoring for a period of time. You decide its finally time to consult with an attorney.

5. Fifth Issue:

Sometimes an attorney can work wonders but I must admit my magic wand overheated and is being repaired and I am saving all my Pixie Dust for working out my own personal issues. Just kidding, I have a spare magic wand in the garage and an unlimited supply of Pixie Dust in the basement!!

You have represented yourself, for better or for worse up until this point and now you want to consult with an attorney in the 10th round of a 12th round heavy weight boxing match. You are on the ropes and being beat down and strangely you didn't even know it.

I say its heavy weight boxing match because anything involving your license involves your money which involves your livelihood and its heavy (regardless of whether or not you realized it).

The 11th round is a hearing and the 12th round is an appeal at this point if you challenge the proposed action.

 If you accept the proposed action, the 11th round is probation/monitoring and the 12th round is post-discipline implications of having action taken against your license by the State Nursing Board.

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Long post and I am typing fast on my lunch break so please excuse the typos. What's the bottom line? If you had a complaint filed against you with the State Nursing Board several months or years ago and you have not received correspondence from the Board indicating the case file has been closed or resolved, the case may still be pending.

Nursing Law & Order is Ranked # 1 and my law office is open from 8am to 8pm

Nursing Law & Order is ranked number 1 on this list of nursing blogs. Go Latonia, its your birthday!

http://onlinelpntorn.org/2009/top-50-rn-blogs/

This sites says my blog is "interesting." Thank you for the compliment. I have been told this by many folks which is IMHO a nice way of saying "your blog disturbs me on some level but its okay to read." 

The snow is melting here in Cincinnati and I am working on my law office cases while watching Direct TV. I just watched Reign of Fire and now its time for Predator on the Sy Fy channel.

I am resting up for a busy week. Mondays are always an office day for me because my husband doesn't work on Mondays. Tuesday I will be in Louisville, Kentucky, Wednesday I am meeting with a client in Georgetown, Ohio, Thursday I am attending a health law seminar in Indianapolis, and I have client meetings on Friday.

I changed my law office hours. We have receptionists answering the office phone from 8am to 8pm Monday-Friday to better accommodate the needs of our clients and client base. We are available on Saturday or Sunday by appointment only. I usually schedule go-to-meeting, telephone, or in-person meetings on Saturday starting at 12noon. If you want to schedule an appt. contact my office at 513-771-7266.

That's right 8am to 8pm Monday-Friday. I receive alot of phone calls after business hours and these expanded hours are an attempt to service my clients and my client base.

Professional Associations are Struggling and Begging for Members: Why Do I remain a member of the ABA and the ANA?

Look at this video exclaiming the benefits of ABA membership to attorneys.

http://www.abanow.org/2010/02/new-dues-rates-aimed-at-attracting-solo-practioners/

Okay now review these comments from bloggers about the discounted dues from the ABA for solo attorneys like myself:

http://www.myshingle.com/2010/02/articles/myshingle-solo/who-loves-you-solos-dueling-videos-join-the-aba-v-what-you-dont-know-about-solo-practice-can-hurt-you/

http://buildasolopractice.solopracticeuniversity.com/2010/02/09/why-reducing-fees-and-putting-on-a-pretty-pink-dress-wont-bring-solos-back-to-the-aba/

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I am a member of the American Bar Association and the American Nurses Association and to be honest with you, I have seriously considered dropping my membership in both organizations in the last year. National professional associations go astray when the orgs start to dabble in politics and lobbying which then polarizes the actual and potential membership base. I think there is a need and a role for national professional associations but I think most professional associations are still stuck in the 60s/70s/80s governance models and still haven't figured out how to offer products and services vital to a diverse potential membership base 

I like the American Bar Association publications for law practice management. I am also a member of SOLOSEZ, a list serve sponsored by the ABA for solo practice attorneys. This is why I continue to pay for ABA dues. I am not active in the ABA and will never be active in the ABA unless it forms a "healthcare license defense section or committee."

I do belong to the Ohio State Bar Association, which in my opinion is a keeper because of the products I receive for my membership dues. I joined the Indiana State Bar Association because it was cheaper for me to attend a health law conference next week as a member of the ISBA. I don't belong to the Cincinnati Bar Association.

I continue my membership in the American Nurses Association because I want to be a member of my state nurses association, the Ohio Nurses Association and my district nurses association, Southwestern Ohio Nurses Association and the Center for American Nurses.  I don't agree with some of what goes on at ONA but I support the organization nonetheless because its "on the job" with respect to legislative and regulatory issues in Ohio involving nurses with Jan Lanier, RN, JD and the new legislative specialist, the CE approval unit ran by Zandra Ohri is top notch, Kathy Morris is doing her "thang" with respect to counseling nurses on practice issues across the state, and the labor relations specialist work their tails off with respect to the collective bargaining agreements. I think the organizing unit is still in its infancy however.

When ONA allows its members to belong to ONA or the ONA/ANA, I will be a member of ONA only and drop my ANA membership. I am still disgusted with how the ANA Board handled the issues with the Center and the UAN. You need a graph, pie chart, opinion letters, daily emails, and legal briefs to keep up with the mess now. 

The ABA membership rolls are decreasing but the ABA still remains the largest professional association in the world I believe with almost 500,000 members and alot of those are law students and associate members. The ANA full membership depending on the outcome of various lawsuits is low (I think its between 50,000-120,000) especially when you consider there are 3 million RNs in this country.

These national professional associations are not changing with the times and appear to be out of touch. Yes, you can say "professional association membership is down across the board" but why? Its more than just economics because if I really value something I am going to find the money to pay for it. I am not a Gen Yer, meaning I want it now but I am a Gen Xer, meaning I do want things my way.

For example, I will keep my Direct TV because of Law & Order, Intervention, Hoarders, the Closer, and other shows that I watch. I pay a premium for Verizon Wireless PDA service and laptop internet access anywhere in the country. Did you see Intervention this week? I was in tears.

I also continue my membership in The American Association of Nurse Attorneys (TAANA) because it contributes to my bottom line with Nursing Service Organization (NSO) referrals for nurse license defense work and I receive referrals from TAANA from nurses seekings attorney representation before the Ohio, Kentucky, and Indiana Nursing Boards. Tens of thousands of dollars in fees vs. a $200 membership. I am in like Flynn and I value my membership in TAANA because it contributes to my bottom line. I write the check to TAANA the same day I receive my membership invoice.

What does the ABA and the ANA need to do become this relevant to the majority of the profession?

What do other national, state, and specialty nursing associations need to do become this relevant to the majority of the profession?

Advanced Practice Nurse Practitioners in the Commonwealth of Kentucky need your support!

 

This is an email I received today from the Kentucky Nurses Association:

Subject: SB 75 is Still ALIVE!

We need Action NOW to move it forward! See Download SB75 Comm Sub Description Feb 2010[1]

Despite our having made significant compromises in the language of the Committee Substitute for SB 75, the Kentucky Medical Association continues to be adamantly opposed to this important legislation. If we are not successful in passing SB 75, there will continue to be significant barriers which prevent Kentuckians from accessing healthcare services provided by ARNPs!

OUR WORK IS CUT OUT FOR US! Between now and Tuesday afternoon (2/23), we must generate as many calls as possible to the toll-free legislative line with a simple message urging support of SB 75 Committee Substitute. That message needs to go to ALL Senators, but particularly to the Senate Republicans, since they are in leadership and will determine the fate of SB 75.

STEP #1: Call 1-800-372-7181 and ask that your message go to ALL Members of the Senate. "I am a Nurse (nurse educator, physician, patient, constituent, etc.) and I urge you to support SB 75 Committee Sub to increase access to quality, cost-effective health care." If those making calls are NPs or nurses, they should identify themselves as such since Senators report that they are receiving calls from "nurses" in opposition to the bill.

STEP #2: If you do not know who your Senator is, go to: www.vote-smart.org <http://www.vote-smart.org/> and enter your home address or call 1-888-vote smart (1-888-868-3762).

If you live in the district of one of the Senators on the attached list, it is especially important that you contact her/him to communicate that you are a constituent and that you urge their support of SB 75 Committee Substitute.

You can go to www.lrc.ky.gov <http://www.lrc.ky.gov/> "Who's My Legislator?" for other contact information for that Senator. You can also send an email; be sure to put on the Subject Line: "I Am Your Constituent" and to include your contact information in the body of the email.

You can also fax a letter to the Senator at 502-564-6543.

Remember, that Senator was elected to represent YOU and you have every right - and responsibility - to let her/him know (and hear from you often) that you want support for SB 75 Committee Sub!

STEP #3: Pass on this urgent Call to Action to your family, friends, colleagues, social network, etc. and ask them to call in.

STEP #4: NOW IS THE TIME FOR PHYSICIAN OR PHARMACIST LETTERS OF SUPPORT! If you have - or can get - a brief letter of support for SB 75 Committee Sub from a physician, please do so ASAP and email me [email protected] <mailto:[email protected]> about the best way to get it to key Senators.

CALL THE MESSAGE LINE 1-800-372-7181 TODAY AND MONDAY AND TUESDAY!
SEE ATTACHMENTS FOR LEGISLATOR AND BILL INFORMATION & MAKE CALLS TODAY, MONDAY AND TUESDAY MORNING. See Download SB 75 - Senate Republicans 2-18-10[1]

Thank you for making the voice of nursing heard.

Maureen Keenan, JD, MAT
Executive Director
Kentucky Nurses Association
200 Whittington Pkwy
Suite 101
(502) 637-2546 Option 1
FAX: (502) 637-8236
E-Mail: [email protected]
www.Kentucky-Nurses.org

If the State Nursing Board told me I could have an attorney, I would have hired an attorney!

I am always surprised by the number of the nursing students or graduate nurses with criminal convictions who apply for licensure without giving a second thought to the outcome of the application or serious of the matter even after being contacted by the Board in regards to a hearing, investigative meeting, or appearance with Board Members or Board staff because of the criminal convictions.

Some of the explanations provided to the Board are half-truths and conflict with the facts in the police report. Also what you were CHARGED WITH is important not just what you pled to at some point. Cases are pled down for a variety of reasons and usually its not because the State can't meet its burden of proof.

I will tell you that I am glad and happy to see someone turn their life around after an unfortunate event or a series of unfortunate events. But keep in mind the role of the State Nursing Board is to protect the public and criminal convictions are heavily scrutinized by some State Nursing Boards and some have questioned whether this is fair and necessary. See http://nurseattorney.blogspot.com/2007/08/more-nurses-in-trouble-with-nursing.html

There may also be a pattern of criminal convictions, two or three clusters of convictions 10 years ago then two convictions three years ago. If you have a criminal conviction(s) and you are seeking initial licensure with a State Nursing Board you should speak with an attorney in your state or jurisdiction before you submit your application for initial licensure.

Okay you may say, "she tells everyone to talk to an attorney" and yes I do.

* If a physician has a legal issue or is summoned to appear before the State Medical Board, do you think the physician appears without legal counsel?

* Do you think a dentist would appear with legal counsel before the State Dental Board? 

Of course not so why is it as nurses we tend to marginalize and minimize the legal and regulatory issues in our nursing practice? Your license is your livelihood and its your money maker. Compare the cost of one-time attorney representation to the amount of money you stand to earn as a RN or LPN in your decades of nursing practice.

I had a nurse tell me yesterday "if the Board had told me I could have an attorney appear with me before the Board, I would have hired an attorney." Really? You are appearing before a state licensing board which is a regulatory agency of the state and you need "someone" to tell you that you to consult with an attorney?

Patients are Not Your Friends: There are boundaries in the professional nurse-patient relationship!

The nurse-patient relationship is professional relationship. It is not a friendship, which is a personal relationship. It is a professional relationship and there are always parameters and boundaries in a professional relationship. Take a look at the ANA Code of Ethics for Nurses with Interpretive Statements.

The nurse-patient relationship isn't a gateway or springboard for a financial, sexual, personal, or business relationship wtith a patient or a patient's family. It is a professional relationship and there are just some things you don't do or say in a professional service-oriented relationship.

I am hearing more nurses refer to a patient as "my friend." Really? There are things and actions which are perfectly acceptable in a personal relationship which are not acceptable in a professional nurse-patient relationship. Don't get me started on home health care nursing and professional boundaries.

You are a professional nurse and you are practicing in accordance with your State Nurse Practice Act and State Nursing Board regulations, the ANA Code of Ethics, and your healthcare organization's policies and procedures which ALL address establishing and maintaining boundaries with clients and their families in some form or fashion. 

There are boundaries issues everywhere in nursing and I am seeing more and more professional boundary and professional sexual misconduct issues, inquiries, and cases in my law practice in every nursing specialty and at different education levels from diploma to doctorate. These cases can get ugly very fast and its like stepping into a pile of dog feces; even after you clean off your shoes, sandals, or flip flops (I can't wait to start wearing my $2.00 Old Navy flip flops again), the smell still lingers.

See the National Council of State Boards of Nursing booklet on boundaries in nursing. https://www.ncsbn.org/Professional_Boundaries_2007_Web.pdf

Another example are my law firm clients. I really like most if not all of my clients and could see myself being "friends" with some of my clients if the circumstances were different. However the circumstances are we have a professional attorney-client relationship and its not a friendship or a personal relationship although we are all nurses. I have to maintain my objectivity which is what you are also striving for in a professional nurse-client relationship.

I do establish and maintain professional boundaries with my law firm clients which is why I don't represent family members. It gets too messy and I don't like anyone calling my mother or grandmother to tattle on me.

Falsifying Your State Nursing Board License Renewal Application: Don't Do It!

Falsifying your State Nursing Board renewal application probably isn't a crime in your state but damn it looks bad because:

1. Falsifying your license renewal application is a violation of the State Nurse Practice Act and/or Board of Nursing regulations generally; and

2. The Board then reviews the underlying issues or offense you didn't disclose initially.

In Ohio, LPN Renewal is fast approaching and we are already receiving emails, website inquiries, and phone calls about the 2010 Ohio Board of Nursing renewal application and the disclosure of criminal convictions, disciplinary action or alternative to discipline program monitoring for chemical dependency by another State Nursing Board, and discipline by another healthcare licensing board. I feel like a kid in the dollar store with a crisp $20.00 bill.

There are several license defense attorneys who regularly represent nurses before the Ohio Nursing Board. Call someone and schedule an appointment to discuss your issue. Yes it may cost you a few hundred dollars but at least you will know what you are facing going forward when you renew your LPN license in Ohio. Some attorneys may offer the initial consultations by phone at no cost.

Don't falsify your renewal application, initial application for licensure via examination, or APRN application. If you have doubts about the questions or whether or not you have to disclose information, speak with an attorney in your state or jurisdiction. Don't go to one of the many online nursing forums, boards, or chatrooms and pose a legal or quasi-legal questions.

Alot of the answers I see on the online forums for nurses provided by one nurse to another nurse minimize the seriousness of criminal convictions and disclosures to the State Nursing Board. Alot of folks just aren't being truthful on those online forums, chatrooms, and boards. I know because I have a client who posts in one of these forums and the client is flat out lying about the facts in his/her State Nursing Board case.

A State Nursing Board renewal application, initial application, or application for APRN practice and prescriptive authority are legal documents and there may be consequences for falsification. Its not a defense to say:

* "I didn't know that I had to disclose this on the application" ;

* "If I would have known for sure I would have disclosed it";

* "My nursing instructor said I didn't have to disclose it";

* "Another nurse didn't disclose and I did what he/she did";

* "I didn't review the application, I just checked no, signed/dated, and mailed in a check";

* "The questions are confusing and I didn't understand" and

* "I didn't think it was that big of deal not to disclose this because this is old news anyway."

Talk to a nurse attorney, administrative law attorney, or license defense attorney who represents healthcare professionals if you have ANY questions or concerns about documentation you are submitting to the State Nursing Board. See www.taana.org for a referral to an attorney in your state or jurisdiction.

Compulsory or Mandatory Mental, Chemical Dependency, or Physical Examination from the State Nursing Board

Depending on your State Nurse Practice Act, the Board with sufficient evidence may be able to compel you by virtue of you having a license to be evaluated. This usually happens when a complaint is filed against your license and during the investigation of the complaint.

If you receive an a Mandatory or Compulsory Order for Evaluation from the State Nursing Board contact a license defense attorney ASAP.

I spoke with a nurse over the weekend who failed to submit to a compulsory chemical dependency evaluation ordered by the Kentucky Board of Nursing and his/her license was temporarily suspended. Big Mistake.

If you receive this type of correspondence from your State Nursing Board, contact a nurse license defense attorney or administrative law attorney in your state immediately. By immediately, I mean a day or two after you receive the legal documents from the Board. Don't wait until Day 29 when a response or action is required by Day 30.

Happy Valentine's Day! Home Health Nurses and the Need for Speed: Do you have the tools needed to navigate the potential for liability in your nursing practice?

I practiced as a home health RN for several years when I started my law practice. I am actually planning to transition back into home care at some point when I can:

1. Find a home care agency in Cincinnati, Ohio that will hire me as a RN per diem when I am also an attorney; and

2. Carve out 2-3 weeks for orientation (I will do it unpaid) a few hours a day to transition back into home care.

I am busier than ever and it probably won't happen in 2010. Maybe I need to think about a different type of position in home care as a nurse that fits into what I am doing with my law practice. I smell money:)

Okay, if you are practicing in home care, why don't you have your own professional liability insurance policy with a license defense benefit? Please explain to me why you feel you don't need your own policy. You have the need for speed to purchase your own professional liability insurance policy with a license defense benefit. See

See Marsh Affinity at https://www.proliability.com/

See Nursing Service Organization at http://www.nso.com/

I posted a few months ago about if you are a home health nurse or independent provider nurse and you are practicing willy nilly in Ohio, Kentucky, and/or Indiana that I am looking forward to your call.

http://advocatefornurses.typepad.com/my2cents/2010/01/home-care-isnt-for-everyone-home-care-as-the-next-frontier-for-nursing-liability-related-to-nursing-.html

http://advocatefornurses.typepad.com/my2cents/2009/10/attention-rn-and-lpn-ohio-independent-providers-fraudulent-billing-is-a-legal-nightmare-you-may-neve.html

Its only Feb. 14th of 2010 and already this year I have spoke with 5 home care nurses who:

1. Was named as a defendant as a home care nurse in a nursing malpractice case;

2. Fired from a home health agency and reported to the State Nursing Board for a suspected professional boundaries violation; or

3. Working as an Independent Provider (IP) in the State of Ohio and being investigated by the Ohio Attorney General's Office for Medicaid Fraud;

4. Working as an Independent Provider (IP) in the State of Ohio and being investigated by ODJFS for an issue in the home which will more than likely be subsequently reported to the Ohio Nursing Board; and

5. Working as an Independent Provider (IP) in the State of Ohio and receiving a Proposed Adjudication Order from ODJFS proposing to terminate the IP's provider number for a variety of allegations. This will utimately be reported to the Ohio Nursing Board.

What is an Independent Provider (IP)?

http://allnurses.com/lpn-lvn-corner/independent-provider-lpns-394643.html

http://allnurses.com/entrepreneurs-in-nursing/independent-nurses-providing-35825.html

http://www.ohioip.net/

http://www.ohioip.net/Links.html

The legal risks associated with home care and especially being an IP-RN, IP-LPN, or RN Supervisor for LPN-IPs are mind boggling and I am hearing from more and more nurses who are working in these capacities naked. By naked, I mean "bare" and without their own professional liability insurance policy with a license defense benefit.

Home care and working as a IP is nice because of the autonomy. But with the autonomy comes increased responsibility, accountability, and the potential for legal liability. I know its sounds corny but I am receiving sooo many inquiries and having legal consultations or taking cases involving home care in the last 18 months vs. my 9 years of solo practice. 

I have to post something about Ohio RN-IPs, LPN-IPs, and RN Supervisors for LPN-IPs later this month but I need more coffee and a Pepsi to draft that particular post.

Bottom line:

1. If you are working as a home care nurse or as a independent provider in any state, make sure you have professional liability insurance (written for you as a nurse by a insurance company insuring nurses; not that mess that's written with your homeowners or condo insurance).

2. If you are an IP you are a business owner. You have to think like a self-employed business owner and not like a nurse employee. This is significant because you need an appreciation of the risks, liabilities, and clerical/administrative tasks associated with the business. When you run a business you wear many hats or you hire the staff to wear those hats.

The business involves your nursing license and you must have harmony with your business and your license and you need a risk management plan that includes REGULATORY COMPLIANCE. Why? You are the business and you are providing care. Please remember and please believe you are not working in an agency where the burden of regulatory compliance falls on the employer. You are the employer.

Risk management and regulatory compliance is something I find self-employed nurses struggle with because we are transitioning from the employer-employee mindset into the self-employed, business owner, and entrepreneur mindset. We are NOT provided with the tools for this in our initial training and basic education (nursing schools prepare you for the NCLEX only IMHO) and therefore you need to acquire these tools yourself.

http://independentnursecontractor.com/blog/

http://www.nursingentrepreneurs.com/

http://www.nurse-entrepreneur-network.com/

http://www.independentrncontractor.com/?gclid=COSCsPrS758CFUVn5QodTwQjdQ

Do you have the tools needed to navigate the potential for liability in your nursing practice?

Nursing School Graduate in Florida denied a license because of Senate Bill 1986: 10 Next Steps to Consider

I recently graduated from nursing school and applied to the Florida nursing board to take the NCLEX. I have two felonies but they denied me on my second felony because of a new law as of July 2009 and I didn't know. I applied August 2009. I tried contacting an attorney but no one returned my call. Now i'm trying to look into other states. I don't know what to do?

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I am sorry to hear you have been Senate Bill 1986'ed in Florida. See http://advocatefornurses.typepad.com/my2cents/2009/11/will-your-state-legislature-florida-senate-bill-1986-you-in-the-future-.html

This isn't legal advice just practical information:

1. Figure out one, two, or three other states where you want to seek initial licensure. Don't know if you plan to stay in the South, move North, wander to the West, or travel to the East.

2. Review those State Nursing Board Applications for Licensure by Examination paying close attention to the any questions related to criminal convictions.

3. Review the State Nursing Board website for information about criminal convictions and the impact of those convictions on the Application for Licensure by Examination.

4. If there are disciplinary actions available on the website, take a look at those cases to see if any of the those cases involved NCLEX-Applicants with criminal convictions.

5. If you are still not sure how to proceed and need legal advice and counseling, contact The American Association of Nurse Attorneys for a referral to a nurse attorney in the state(s) where you are considering licensure. See www.taana.org. The nurse attorney referral hotline telephone number is (866) 807-7133.

6. Actually I would STRONGLY recommend you speak with a license defense attorney before you just apply for a license in any other state. Why? See http://www.nursing-jurisprudence.com/legalservices.html. Read the paragraphs addressed to NCLEX Applicants and Nursing Students.

7.You finished nursing school and graduated but there are two more hurdles when you have criminal convictions especially felonies: suitability for licensure and employability. Don't go willy nilly and just start applying for a license any and everywhere.

8. There are nurse attorneys lwho are licensed in multiple states. If you speak with three nurse attorneys licensed and practicing before 2 or 3 State Nursing Boards you have covered alot of ground. Just a thought.

Research nurse license defense attorneys online and schedule appts. with nurse license defense attorneys who are licensed in more than one state. For example:

* Melanie Balestra, NP, Attorney is licensed in California and Arizona. http://www.balestralaw.com/

* Kathleen Murphy Jones and Kevin Murphy are licensed in Nevada and California. http://www.murphyjoneslaw.com/about-us

* LaTonia Denise Wright is licensed in Ohio, Kentucky, and Indiana. http://www.nursing-jurisprudence.com

* Janet Michael, RN, JD is licensed in Maine, New Hampshire, and Massachusetts.

I am sure there are others but these are the nurse attorneys who I know practice before multiple State Nursing Boards.

8a. Its important you contact attorneys whose "bread and butter" cases are license defense, either representing healthcare professionals or representing nurses. You are more likely to get a return phone call and a prompt response. See http://advocatefornurses.typepad.com/my2cents/2010/02/hire-a-license-defense-or-nursing-law-attorney-if-you-have-an-issue-with-your-nursing-license.html

9. You may have to pay for a consultation with the attorney to discuss your case and review your documentation. What is a consultation? See http://www.nursing-jurisprudence.com/legalconsultations.html.

The consultation compensates the attorney for his/her time meeting with you in person or by phone to review your documents and discuss your case. Consultations may cost anywhere from $75.00-$500.00.

10. Have all your documents and correspondence from the Florida Board and criminal court and probation records from the criminal convictions ready to provide to the attorney(s) you consult with about licensure.

I hope this helps you and thank you for your comment on the blog. This is my pro bono work for the month of Feb. 2010:)

Texas Nurse Acquitted in the Criminal Case. HOORAY!!!!!!

See http://news.yahoo.com/s/ap/20100211/ap_on_re_us/us_texas_nurse_acquitted_4

See http://abcnews.go.com/WN/texas-nurse-whistleblower-anne-mitchell-acquitted-harassing-doctor/story?id=9781119

See http://www.startribune.com/nation/84134547.html.

Practicing Outside of the Nursing Scope of Practice: I can get the doctor to cover that order!

Do you know what your scope of practice (SOP) is as a licensed LPN, RN, or APRN? If not there are alot of materials out there (in your workplace and on the internet) to help you figure out if a particular task or procedure is within your legal scope of practice.

Did you know practicing outside of your legal scope of practice is violation of the State Nurse Practice Act and/or Board of Nursing regulations?

You may be thinking okay tell me something that I don't know.

Did you know most healthcare facilties terminate the nurse after the internal investigation of scope of practice allegations and then file a complaint against the nurse with the State Nursing Board?

Its early in 2010 but I have already received four phone calls and inquiries involving scope of practice allegations that have been reported to the State Nursing Boards in Ohio, Kentucky, and Indiana. Most employers terminate the nurse(s) involved in these types of cases and then file a complaint with the State Nursing Board. Some will initiate a corrective action plan in the workplace and continue employment with a Last Chance Agreement or workplace probation (I have seen 30 days, 90 days, 6 months, 1 year, and 2 years. I know). However the employer is still required (especially in mandatory reporting states) to filed a complaint with the State Nursing Board.

I don't know what the economy is like in your neck of the woods but I don't know anyone who wants to be fired or discharged and then reported to the State Nursing Board.

Employers have legitimate concerns with patient safety, the legal exposure, and the potential liability when allegations of practicing outside of the legally permissible boundaries of one's license surface. I had a nurse attorney (who I have known for several years) tell me in her position as in-house legal counsel for a large teaching hospital in a super-sized health system that "its just piss poor practice" for a nurse to practice outside of his/her SOP. She is of course looking at SOP violations from the healthcare organization's perspective.

From your perspective as an individual nurse at the bedside, do you think its just poor practice or do you think there are more compelling reasons why this frequently happens?

The State Nursing Board takes these types of cases serious, employers deal with these types of issues swiftly, and IMHO the only folks who don't take these types of cases and allegations serious are nurses. Its not okay to practice outside of your scope regardless of whether its "customary unit practice", "everyone else is doing it", and/or "you think or know you can get a doctor to cover the order."

For those of you who don't think its serious take a look at this link. http://www.wave3.com/Global/story.asp?S=1469399&nav=0RZEIM3P.  This involved Kentucky nurses who were reported to the Kentucky Board of Nursng.

Before another State Nursing Board, one of my clients got nailed a few years ago with Board discipline for multiple SOP issues as a RN. She/he completed his/her probation and then continued his/her education as a APRN. The SOP issues as a RN reared its ugly head in regard to a hospital credentialing and privileging recently.

There are alot of resources for Scope of Practice and most State Nursing Board have decision trees for scope of practice considerations. For example see

http://www.nursing.ohio.gov/PDFS/Practice/RN-LPN-ScopeofPractice.pdf

http://www.nursing.ohio.gov/PDFS/Practice/RN_LPN_FAQs_6_09.pdf

http://www.nursing.ohio.gov/pdfs/Practice/Decmodel.pdf

http://kbn.ky.gov/NR/rdonlyres/74A5FF75-543D-4E12-8839-720B7623DA87/0/ScopeDeterminGuidelines.pdf

OBN E*News 02/10/2010 - Prescriptive Authority For Out-Of-State Applicants with the Ohio Nursing Board

OBN E*News 02/10/2010 - Prescriptive Authority For Out-Of-State Applicants

 

SB 89 was enacted on December 28, 2009 and will be effective March 29, 2010. Revised applications for prescriptive authority are forthcoming.  SB 89 does not affect in-state applicants who hold a certificate of authority.

 

Senate Bill 89 permits an out-of-state or federally employed advanced practice nurse with prescriptive authority that includes controlled substances to obtain prescriptive authority in Ohio without completing an externship.  To qualify, the applicant will need to meet requirements including the following:

 

-     hold a current, valid certificate of authority in Ohio as a certified nurse-midwife,  certified nurse practitioner or clinical nurse specialist

 

-     evidence of having held, for a continuous period of at least one year during the three years immediately preceding the date of application, valid authority issued by another jurisdiction or  of being employed by the federal government and authorized to prescribe therapeutic devices and drugs,  including at least some controlled substances

 

-     documentation from a licensed physician that the prescribing component of the nurse's practice was overseen or supervised by a licensed physician in the other jurisdiction or a licensed physician employed by the federal government

 

-     completion of a Board approved two-hour course in Ohio laws governing drugs and prescriptive authority

 

Senate Bill 89 also permits an out-of-state or federally employed advanced practice nurse with prescriptive authority that does not include controlled substances to obtain prescriptive authority in Ohio with a limited externship.  To qualify, the applicant will need to meet requirements including the following:

 

-     hold a current, valid certificate of authority in Ohio as a certified nurse-midwife, certified nurse practitioner or clinical nurse specialist

 

-     evidence of having held, for a continuous period of at least one year during the three years immediately preceding the date of application, valid authority issued by another jurisdiction or of being employed by the federal government and authorized to prescribe therapeutic devices and drugs (with the exception of controlled substances)

 

-     documentation from a licensed physician that the prescribing component of the nurse's practice was overseen or supervised by a licensed physician in the other jurisdiction or a licensed physician employed by the federal government

 

-     completion of a Board approved two-hour course in Ohio laws governing drugs and prescriptive authority

 -    completion of 500 hours of direct supervision (externship)

 

** Please note**  Individuals who currently hold an externship certificate will need to complete their      externship.  SB 89 does not apply retroactively to current externship holders. 

 

For questions related to a Certificate to Prescribe application, please contact the Advanced Practice Unit at [email protected] or (614) 995-3680 or (614) 466-6180.            

Its Still Snowing here in Cincinnati, Ohio

Its still snowing here in Cincinnati, Ohio. I have four wheel drive on my truck and my jeep so its business as usual here for me. I was thinking of attending a seminar in Columbus, Ohio on Friday, Feb. 12th sponsored by the Ohio Society of Healthcare Risk Management and an Ohio Hospital Attorney group but I don't want to chance driving to Columbus, Ohio. We were in Columbus, Ohio on Friday, Feb. 5th and the visibility from the snow and rain was scary.

I was disappointed that the Kentucky Nurses Association cancelled its Legislative Day Conference in Frankfort, Kentucky on Tuesday, February 9th but it was a good call because of the weather.

Next week, I have a busy week with client meetings in Newark, Ohio, a hearing in Indianapolis, Indiana, and I am attending the second day of the Kentucky Nursing Board meeting in Louisville, Kentucky. Let's hope the weather improves as I can't road warrior very effectively or safely with 8-10 inches of snow.

What's the weather like in your neck of the woods?

State Nursing Board Complaints: Top 10 Strategies to Prevent a Disciplinary Investigation. Educational and Informational Webinar for Nurses

State Nursing Board Complaints: Top 10 Strategies to Prevent a Disciplinary Investigation

March 31, 2010 from 1pm to 2:15pm ET.

* This is a 75 minute legal webinar for nurses.

* The webinar is a 60 minute presentation followed by a 15 minute Q&A period.

* The cost of the webinar is $12.00.

* No continuing education credit (CE or CNE) is provided.

* Attendance is limited so plan to register early to reserve your space.  

* If you register and you are unable to attend, no refund is provided. You can however opt to receive the presenter's powerpoint presentation or you can also allow someone else to attend in your place.

* The presenter is LaTonia Denise Wright, RN, BSN, JD.

* There is a TWO step registration process:
 
A. You must pay the $12.00 fee via Paypal and then register for the webinar below. Here is the link for Paypal http://www.nursing-jurisprudence.com/nursingboardwebinar.html; or

B. You may also register for the webinar below and then pay the $12.00 fee.

Please keep in mind you will not be approved by the webinar administrator until the registration fee is paid.

* If you have any questions about the registration process, please contact Jack Stem at 513-328-7253 or

[email protected].

State Nursing Board Complaints: Top 10 Strategies to Prevent a Disciplinary Investigation

Join us for a Webinar on March 31, 2010 This is the third webinar in a three part series for nurses in March 2010. There has been an increase in complaints filed against nurses with State Nursing Boards. This 75 minute webinar will discuss the components of a State Nursing Board complaint, the role of the State Nursing Board, mandatory reporting, the types of complaints filed against nurses, and the disciplinary investigation  and adjudicative process involved with complaints. The presenter will also provide the attendees with practical and proactive tips to safeguard one's nursing license. Title:   State Nursing Board Complaints: Top 10 Strategies to Prevent a Disciplinary Investigation Date: Wednesday, March 31, 2010 Time: 1:00 PM - 2:30 PM EDT After registering you will receive a confirmation email containing information about joining the Webinar. System Requirements PC-based attendees Required: Windows® 2000, XP Home, XP Pro, 2003 Server, Vista Macintosh®-based attendees Required: Mac OS® X 10.4 (Tiger®) or newer Space is limited. Reserve your Webinar seat now at: https://www1.gotomeeting.com/register/519592160

 

Hire a License Defense or Nursing Law Attorney if you have an issue with your Nursing License

The practice of law like nursing, medicine, and other professions is becoming more specialized. If you have a child support issues or you are filing for a divorce, then you hire an attorney with experience in family law. If you have been charged with a crime, then you hire a criminal defense attorney. If you injured in a MVA then you hire a personal injury attorney. You need assistance with a will or trust, then hire a estate planning attorney.

The same is true for State Nursing Board disciplinary investigations and hearings. Hire an attorney with experience representing a nurse before the State Nursing Board.

Is a nurse a nurse a nurse? Of course not and an attorney is not an attorney is not an attorney!

This recession and the economy is taking a toll on attorneys and law practices also and you may have an attorney agree to take a State Nursing Board case out of economic necessity thinking "its just an administrative law case how difficult can it be." I was told by a Nursing Board attorney that some nurses are retaining attorneys and the attorneys don't respond or do anything to advocate on behalf of the nurse in the State Nursing Board case.

This is less likely, IMHO to happen if you hire an attorney whose bread and butter is nurse license defense, healthcare professional license defense, or administrative law. Do your research. Get online and research "nursing law" or "license defense" attorneys and nurses on google or some other search engine.

You want an attorney who can provide you with solid legal advice and counseling and representation before the State Board and this comes with years of experience. You can't pick up a book and read a website or blog and learn how to defend a nurse before the State Nursing Board because the actual representation before the Board is only part of the issue.

For example, I don't represent nurses in criminal defense matters. I could but I like limiting my practice to administrative law, nursing law, and professional nursing practice matters. I refer my clients to a criminal defense attorney(s) in their area for represention in criminal matters. Also I don't do wills, personal injury, workers comp, or tax.

Can I as a license defenese attorney draft your trust documents? Of course, but I am sure I will miss something. FYI: I didn't do our own trust documents.

Its a violation of attorney ethical canons for an attorney to take on a client and matter if the attorney is not competent. But you don't want to be in this position in the first place where you are given bad advice, bad representation, and bad counseling by an attorney and your only recourse is filing a legal malpractice civil suit or filing a grievance against the attorney with the Supreme Court.

I often hear well "Attorney B represented my sister in her divorce and we have known him and his family for years. I trusted him." I also hear "Attorney Z quoted me a reasonable fee to handle my criminal case and the State Nursing Board matter."  

When you hire an attorney or law firm and make sure their area of practice, expertise, or experience i.e. the "meat and potatoes" of their law practice corresponds with the reason why you are retaining the law firm or attorney. How would you know this? Research, website, blogs, face book, linked in, referrals from a State Nursing Association, etc.

If nursing law or nursing license defense is the meat and potatoes of the law firm or an attorney's law practice it is more likely you and your case will get the deserved attention. If nursing law or nursing license defense is just a vegetable (unless its fried okra or fried squash and zucchini with red onions) on a large but ornate plate, then you and your case may be picked at, nibbled and sampled but utimately pushed to the side or pitched in the garbage. Okay, I am writing this post and I am hungry, but you get my point!

Criminal Law 101: Implications for Professional Nursing Practice. An Informational and Educational Webinar for Nurses

Criminal Law 101: Implications for Professional Nursing Practice
March 17, 2010 from 1pm to 2:15pm ET.

* This is a 75 minute legal webinar for nurses.

* The webinar is a 60 minute presentation followed by a 15 minute Q&A period.

* The cost of the webinar is $12.00.

* No continuing education credit (CE or CNE) is provided.

* Attendance is limited so plan to register early to reserve your space.  

* If you register and you are unable to attend, no refund is provided. You can however opt to receive the presenter's powerpoint presentation or you can also allow someone else to attend in your place.

* The presenter is LaTonia Denise Wright, RN, BSN, JD.

* There is a TWO step registration process:
 
A. You must pay the $12.00 fee via Paypal and then register for the webinar below; or

B. You may also register for the webinar below and then pay the $12.00 fee.
Please keep in mind you will not be approved by the webinar administrator until the registration fee is paid.

Here is the link to pay for the webinar with PayPal.

http://www.nursing-jurisprudence.com/criminallawwebinar.html

* If you have any questions about the registration process, please contact Jack Stem at 513-328-7253 or [email protected].

Criminal Law 101: Implications for Professional Nursing Practice   Join us for a Webinar on March 17, 2010 This is the second webinar in a three part series for nurses in March 2010. This 75 minute webinar will review criminal law and the criminal law process and procedure in general. Nurses are frontline healthcare providers who have extensive contact with sick and often emotionally and physically compromised pediatric and geriatric patients. This contact often extends into a patient’s home and quite frequently involves their family and may include access to financial and other personal information. For these reasons, the criminal convictions and the criminal history and behavior of nurses, nursing students, and NCLEX-Applicants is becoming highly relevant to healthcare organizations, nursing schools, and State Nursing Boards. Participants will learn about how criminal law and criminal charges and convictions impact suitability for employment, initial licensure or relicensure, and clinical placement for nursing students. Attendees will be provided with practical tips on how to proactively dodge the legal minefields associated with criminal law. Title:   Criminal Law 101: Implications for Professional Nursing Practice Date: Wednesday, March 17, 2010 Time: 1:00 PM - 2:30 PM EDT After registering you will receive a confirmation email containing information about joining the Webinar. System Requirements PC-based attendees Required: Windows® 2000, XP Home, XP Pro, 2003 Server, Vista Macintosh®-based attendees Required: Mac OS® X 10.4 (Tiger®) or newer Space is limited. Reserve your Webinar seat now at: https://www1.gotomeeting.com/register/789501312

Nursing Documentation: Top 10 Legal Disasters. An Educational & Informational Webinar for Nurses

Nursing Documentation: Top 10 Legal Disasters

March 3, 2010 from 1pm to 2:15pm ET.

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* This is a 75 minute legal webinar for nurses.

* The webinar is a 60 minute presentation followed by a 15 minute Q&A period.

* The cost of the webinar is $12.00.

* No continuing education credit (CE or CNE) is provided.

* Attendance is limited so plan to register early to reserve your space.  

* If you register and you are unable to attend, no refund is provided. You can however opt to receive the presenter's powerpoint presentation or you can also allow someone else to attend in your place.

* The presenter is LaTonia Denise Wright, RN, BSN, JD.
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* There is a TWO step registration process:
 
A. You may pay the $12.00 fee via Paypal and then register for the webinar below; or

B. You may also register for the webinar below and then pay the $12.00 fee.

Please keep in mind you will not be approved by the webinar administrator until the registration fee is paid.

If you have any questions about the registration process or if you need assistance with the webinar technology, contact my assistant Jack at [email protected] or at 513-328-7253.

Nursing Documentation: Top 10 Legal Disasters

Join us for a Webinar on March 3, 2010   This is the first webinar in a three part series for nurses in March 2010. This 75 minute webinar will discuss legal issues and pitfalls associated with nursing documentation. Participants will learn the legal requirements for documentation of patient care and the potential legal ramifications of inappropriate or incomplete documentation. Although nursing documentation seems less critical than other client-centered tasks, documentation is essential in everything from planning the best patient care to defending a nursing malpractice lawsuit or preventing a State Nursing Board complaint.   Title:   Nursing Documentation: Top 10 Legal Disasters   Date:   Wednesday, March 3, 2010   Time:   12:00 PM - 1:30 PM EST   After registering you will receive a confirmation email containing information about joining the Webinar.   System Requirements PC-based attendees Required: Windows® 2000, XP Home, XP Pro, 2003 Server, Vista   Macintosh®-based attendees Required: Mac OS® X 10.4 (Tiger®) or newer   Space is limited. Reserve your Webinar seat now at: https://www1.gotomeeting.com/register/786581097