Nursing Law & Order

Cynthia Mikos, BSN, Attorney at Law is presenting the April 10, 2013 webinar: APRN (Advanced Practice RN) Complaints with the State Nursing Board

Nursing Law & Order is sponsoring a cutting edge webinar for Advanced Practice RNs (Nurse Practitioners, CRNAs, CNMs, and CNSs) and APRN students. The webinar is titled APRN State Nursing Board Complaints, Discipline and the Legal Implications for  Nursing Practice. 

Nursing Service Organization (NSO), a division of AON Affinity, and their insurance carrier CNA released a healthcare industry resource, Nurse Practitioner Liability Update 2007-2011: A Three-Part Approach on November 13, 2012. The Update contains an analysis of nurse practitioner malpractice and license defense claims over a five-period. 

The Update noted 61% of licensing board actions against Nurse Practitioners resulted in "no action", while 3.1%of the licensing complaints resulted in the end of the nurse practitioner's career. This leaves 35.9% of licensing Board complaints resulting in some form of discipline of the license of a NP. See https://www.nso.com/pdfs/db/NSO_Claim_Study_PR_FINAL.pdf?fileName=NSO_Claim_Study_PR_FINAL.pdf&folder=pdfs/db&isLiveStr=Y 

APRNs which of course include Nurse Practitioners face a variety of legal issues in clinical practice which may result in a State Nursing Board complaint being filed against the APRN. This webinar will review the types of complaints filed against APRNs (CRNAs, CNMs, NPs, and CNSs) and the discipline implications for APRNs with respect to future employability, multi-state licensure, credentialing and privileging, and specialty certification. 

This is a 90 minute webinar presented by Cynthia Mikos, Attorney at Law with Allen Dell, P.A. There will be plenty of time alloted for questions and answers depending on the number of attendees. 

Wednesday, April 10, 2013 from 6pm to 7:30pm 

APRN State Nursing Board Complaints, Discipline, and the Legal Implications for Nursing Practice

The cost of the webinar is $20.00. No CE credit is provided. You can register online for the webinar at: http://nursinglaw.enterthemeeting.com/m/1ITTLHOK. 

Cynthia A. Mikos is a graduate of West Virginia University (B.S.N., 1977), University of Baltimore (M.B.A. 1983 with honors) and Stetson College of Law (J.D., 1993 with honors). She is rated AV Preeminent by the Martindale-Hubbell Law Directory.

Ms. Mikos is Board Certified in Health Law by the Florida Bar Board of Legal Specialization and Education and represents licensed health care professionals and facilities throughout Florida. Her practice focuses on licensure, fraud and abuse advice, Medicare, Medicaid and other payer disputes, Florida and federal regulatory compliance, and business issues for health care clients.

Ms. Mikos represents a broad spectrum of health care providers, including physicians, advanced registered nurse practitioners, physician assistants, nurses, mental health therapists, hospitals, durable medical equipment companies, home health agencies, pharmacies, sleep laboratories, rehabilitation agencies, long term care facilities, providers of services to the developmentally disabled and independent diagnostic testing facilities. As a former nurse and executive of a Fortune 100 health care company, Ms. Mikos values her prior health care experience as an adjunct to her legal advocacy.

Ms. Mikos currently serves as the Chair for the Executive Council of the Health Law Section of The Florida Bar and has participated as a member of its Executive Committee since 2003. She is a member of the American Health Lawyers Association, the Florida Association of Hospital Attorneys, the Hillsborough County Bar Association Health Law Section, The American Association of Nurse Attorneys (President 2006) and the Florida and Hillsborough Association for Women Lawyers.

Ms. Mikos can be reached at 813-223-5351. For additional information about Ms. Mikos, see

 http://www.allendell.com/our-attorneys/cynthia-a-mikos/. 

To download a complete copy of the NSO Claims Study for Nurse Practitioners see: 

https://www.nso.com/pdfs/db/NP_Claims_Study_2012.pdf?fileName=NP_Claims_Study_2012.pdf&folder=pdfs/db&isLiveStr=Y

 

APRNs and the Pill Mill Bill Spill in the Commonwealth of Kentucky:House Bill 1 was effective July 20, 2012

See the attached. Download KBNPillMillBillSpill

I would encourage APRNs in Kentucky to submit written comments to Nathan Goldman, Acting Executive Director and General Counsel for the Kentucky Nursing Board. Comments are accepted until October 1, 2012.

So what do you think? Do you think the Pill Mill Bill Spill Legislation is necessary or is it overkill?

 

Ohio Board of Nursing E*News 03/30/2012 -Advanced Practice Nurses and Schedule II Prescribing

OBN E*News 03/30/2012 -Advanced Practice Nurses and Schedule II Prescribing

Senator Scott Oelslager introduced Senate Bill 83 on February 16, 2011, to expand the authority of certain advanced practice nurses to prescribe schedule II controlled substances. The bill was passed by the Ohio legislature and signed by Governor Kasich on March 9, 2012. The bill becomes law and will go into effect on June 8, 2012. The Board will adopt rules pertaining to an APN's authority to prescribe schedule II controlled substances, and the Committee on Prescriptive Governance (CPG) will recommend revisions to the Formulary pertaining to schedule II controlled substances.

The CPG expects to complete the additions/revisions to the Formulary by June 8, 2012, the effective date of the bill. The Board is beginning the rulemaking process with a planned effective date of November 1, 2012. The Board and CPG welcome recommendations and comments.

The Board will also establish a rule regarding the continuing education course requirements for Certificate to Prescribe (CTP) holders. The Board is planning an effective date of November 1, 2012 to provide ample time for CTP holders to complete the required six hours of continuing education before the renewal cycle ends on August 31, 2013. When you renew your license, you will be required to verify completion of the continuing education course.

The Board encourages APNs and other interested parties to periodically check the Board website for additional information regarding implementation of Sub. SB 83, draft administrative rules, and CPG information. If you have questions or comments, please contact the Board at [email protected].

Links to the Bill, an overview and the LSC analysis have been provided on the Board's website. http://www.nursing.ohio.gov/

 

You can now follow the Board on Facebook and Twitter.
http://www.facebook.com/pages/Columbus-OH/Ohio-Board-of-Nursing/151746234862913
http://twitter.com/OhioNursingBd

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State Nursing Board Non-Compliance: If It Ain't Rough, It Ain't Right!

Thank you again to a client who had to remind me three times, yes three times to change the picture on my blog and facebook pages. I have lost a lot of weight (almost 60 pounds) and I am wearing my hair differently, so here is my new picture. 

The law practice has been extremely busy this year and thank you again to those of you who retained my services. I am noticing over the last few months, the Board cases are becoming increasingly more complex with personal, mental health, impairment, practice, or criminal aspects. 

I reviewed and revised my Legal Services Agreement to reflect the changes I am seeing in my law practice. 

1. I fire clients more readily now than in the past for not providing us with the requested information in a timely manner because this slows down the processing and reviewing of information and can lead to me being unprepared for a hearing, investigative meeting, appearance, etc. If you want a lawyer who will forget you were supposed to send in your performance evals, update your prescription meds, etc., then don't retain me. I will remember, there is a task in my project management software, AND it is in my hand-written and barely legible notes. 

2. I have a paralegal who works with me part-time and her role is exclusively Client Service, Management, and Scheduling. This has been wonderful! Thanks, Dani. 

3. I like what I do and I like who I am. Therefore I am announcing: I am a workaholic and I am proud of it. No excuses anymore like "oh, it is the nature of the beast" or "I really don't work that hard." I do work hard and I enjoy it. Therefore I am looking for another part-time paralegal to work Monday, Friday, Saturday, and Sunday in the afternoons. Also my boss is nuts and she keeps giving me work at all times of the day. 

4. Non-compliance, non-compliance, and more non-compliance. Are you non-compliant? Hell, I am non-compliant with my personal monitoring.  

If you are struggling with State Nursing Board probation and monitoring or compliance with an alternative to discipline program, get some help. Retain a lawyer to assist you. I receive more and more calls related to compliance issues than I used to because non-compliance with a contract results in breach of the contract, i.e. the suspension of a license or the inability to practice nursing. 

Why would you hire a lawyer after you have resolved your State Nursing Board case on your own? Because you need help, because you don't really understand why or what you signed and initialed fifty times, or because you have a few extra thousand dollars in your night stand. 

Life happens when you are being monitored by the State Nursing Board. Things will come up and down during a 1 to 5 year period you are being watched by the Board. Who are you going to call for assistance? Your State Nurses Association, Your Union, Your Employer, or Your Cute Lawyer. Look at my current picture and tell me who do you want to call? Call me. 

I revised my legal services agreement because in the future, I am executing another flat fee agreement when patterns of non-compliance emerge. My best friend says "if it ain't rough for some, it ain't right." This should NOT be your Motto during State Nursing Board Monitoring; maybe in other contexts but certainly not in the healthcare licensing setting.  

5. Nurses, Self-Employment, and Private Practice

I am being contacted by more APRNs in Ohio, Kentucky, and Indiana who own their own business or are planning to provide primary health services. Please keep in mind when you open a business providing healthcare services, you will need a general business attorney AND an attorney like cute lawyer to help you with nursing law, regulatory compliance, and risk management. 

I am seeing more self-employed nurses who open shop and just practice. You do so at your own peril because healthcare is highly regulated and you are assuming too much unnecessary risk, exposure, and potential liability. Yes, it costs money for specialized legal services but it is a cost of doing business in healthcare. I see this with Independent Providers, RNs and LPNs in Ohio also as well as CNS and RNs who own businesses. You cannot practice in your business and run your business without some type of risk management and regulatory compliance plan. You can but the consequences for nurses are swift and cold.

 

 

APRNs and Self-Representation before the State Nursing Board and in Nursing Practice Matters

Advanced Practice Registered Nurses have an expanded scope of practice, more responsibility, more accountability, and potentially more liability for a general RN or LPN.

Also APRNs have the same issues for general RNs and LPNs and also prescriptive authority, credentialing, certification, and other issues generally not associated with RNs and LPNs.

If you are a APRN and you are representing yourself before the State Nursing Board in a complaint filed against your license, listen up. Here is my Top 10 like Letterman:

1. Everyone thinks a PERM; that's permanent revocation. Let me tell you there is "discipline" where you don't get a perm but it damn sure feels like it for APRNs; a public reprimand IS NEVER just a public reprimand for a APRN. Trust me on this one pumpkin;

2. Discipline, ranging from a public reprimand and up to a suspension can be the kiss of death for a APRN if you just sign on the dotted line (and have notarized in some cases) without considering the short-term and the long-term implications. Remember its never JUST a public reprimand. Also I want to know what SOBunny started saying "its just a public reprimand" because I am sure it wasn't a nurse license defense attorney;

3. Things are never just the way you see it; so that's why you need an bitter but objective attorney (like myself) to work with you;

4. Retain an attorney who practices before your State Nursing Board and who has handled more than one or two cases before your State Nursing Board.

Its nice the attorney practices is a pharmacist and practices before the Pharmacy Board and takes Nursing Board cases or practices primarily before the Medical Board (big dollar cases for physician representation) and will take on your case. Do your research and find an attorney, it can be a non-nurse but an attorney who practices before your State Nursing Board.

Why? Cases proceed differently before different licensing boards and while its all administrative law, you want someone who is going to take your case and work it not just take your case, take your money, and settle it without considering the short and long-term implications of any proposed discipline.

In a State Nursing Board case, you always want the best case scenario. In some cases the best case scenario is discipline, just a matter of how much. In others it may be resolving the case without discipline.

That's why I quote a flat fee for representation because I know this time next year if I am alive, guess what I will be doing. Two years from now; Five years from now. You guessed it and I work with my clients even after resolving a case throughout their nursing career.

5. APRN cases are complex. I charge more for APRN cases because APRN cases are complex. No ifs, No ands, and certainly no butts.

I was told by a APRN who is involved in a State Nursing Board complaint that the APRN spoke with several other APRNs who stated the care provided was consistent with the collaborating agreement and therefore the APRN would respond to the complaint without attorney assistance.

That's great, but you contacted me; I don't just call nurses around the state and say "hey this is LaTonia from CVG. I know what you did last summer? Have you received a complaint from the Board yet? No, your kidding me?"

I have been doing this for a long-time and if you can have a nurse license defense lawyer to review your statement, provide legal advice and counseling to you, and spend 25-40 minutes on the phone or in-person with you, then hop on that train. With APRNs, there are just too many documents I need to review and you can't just tell me "my SCA or collaborating documents are okay", I need to review those myself. Sorry.

This brings me to my next point with APRNs.

6. APRNs in general can and do make more money than general RNs and LPNs. I said in general okay. APRNs especially CRNAs have the means to pay for legal advice, counseling, or representation however most don't see a benefit to legal representation because "I didn't do anything wrong."

I think everytime I hear this on the phone, I willl place my speakerphone on mute and pimp slap myself in the face.

I think everytime I hear this during an in-person meeting, I will excuse myself and go to the men's restroom and just sit on the floor and smoke a cigar (I don't smoke), chug a tall boy of Colt 45 (I sip slow so I may need 4-6 hours to finish a tall boy without background music), and pop a Perc (I have a legally valid script for Perky from dental work in 1989).

7. APRNs this ain't legal advice but don't go to an investigative meeting (that's where you meet with a State Nursing Board investigator(s) without legal counsel). Be unNike and just don't do it! If you want to do it and you plan to do it; don't do it! You can thank me later.

8. APRNs if the complaint involves the State Nursing Board, State Pharmacy Board, or the State Office of Inspector General or Law Enforcement, call a nurse license defense attorney and don't say do I need representation just say "oh frack, we just paid property taxes, how much is this going to cost me?"

I immediately perk up when I hear someone else complaint about property taxes. I will say "really we did too! I hate paying property taxes, SOBunnies, but I don't mind paying federal, state or local income taxes. I like you and I will work with you on payment."

Hint, Hint. I am a solo and its my law firm. I don't have a laminated fee chart covered with dried ketchup from eating Chick-fil-A waffle potato fries and mouth watering droppings from an extra chicken Chipotle burrito in my law firm. No sir re, Bobby Junior, I threw it out yesterday.  I am hungry now!

I set the prices quoted for legal representation and I pull the number out of my magic hat. I can say that will cost you "one dollar, sir." No seriously, I quote "blue light special" and "bottom basement" type fees if I am drinking Pepsi and chewing Extra sugarless gum and you make me smile or laugh.

9. APRNs if you are abusing your prescriptive authority and its reported (writing scripts for friends, family members, other nurses, etc.) to the State Nursing Board, you need legal representation. Oh, you didn't now that may be construed as abusing your prescriptive authority? Snap, you need a consult. Complaint involving your prescriptive authority? You need to be repped.

10. Last but not least, scope of practice and/or unsafe practice complaints or allegations of drug diversion. Long and complex cases. You need to be repped.

This is what an APRN needs. Assistance with the licensure matter and also an attorney who can essentially serve as "outhouse" counsel for the APRN when issues arise and issues do arise.

If you are a APRN regardless of whether you are self-employed, employed by a hospital, employed by a physician, or employed by a pharmacy chain, you need to have your own Nursing Practice Legal Counsel.

OBN E*News 09/07/2010 - Committee on Practice Scheduled for Thursday September 23, 2010 at 12:00 p.m.

OBN E*News 09/07/2010 - Committee on Practice Scheduled for Thursday September 23, 2010 at 12:00 p.m.

The Board of Nursing (Board)  will convene a Committee on Practice at 12:00 p.m. Thursday September 23, 2010 at the Board's offices located at 17 South High Street, Suite 400 in Columbus, OH  43215.  The Board's Committee on Practice, comprised of Board members, is meeting to discuss the use of the title “Advanced Practice Registered Nurse” to replace “Advanced Practice Nurse” and review scopes of practice for the certified nurse practitioner and the clinical nurse specialist. The Board invites licensees and interested parties to attend this public meeting and to provide commentary on the committee subjects of title and scopes of practice.  

Written comments may be sent by either email to [email protected] or by regular US Mail at the above address. Please place "Board Committee" in the subject line of the email or on the mailed envelope.   Written comments received by the Board by the close of business Monday September 20, 2010 will be forwarded to the Committee members for their review prior to the meeting.  

The Board convenes a Committee on Practice as needed to discuss specific practice issues and to make recommendations to the Board concerning the nursing practice.

 

A Little Here, A Little There: when you hire an attorney to represent you before the State Nursing Board, hire an attorney with experience

There is plenty of license defense work representing nurses in three states for me. I am not a player hater or a lawyer hater for that matter.

What is a player hater? http://www.urbandictionary.com/define.php?term=player+hater

I have reviewed several Ohio Board of Nursing Consent Agreements this year where the nurse was represented by an attorney who does not routinely practice before the Board and frankly it showed.

If you are going to hire an attorney to represent you before any State Nursing Board:

1. Research the attorney and the law firm; and

2. Ask questions about the attorney's experience in nurse license defense matters.

We just had our estate plan prepared and there is no way in hell that we would have an attorney with no experience or practices "here and there" and "a little here and some there" in estate planning to assist us. You should feel the same way if you need to hire an attorney to represent you before the State Nursing Board.

Its not hard to find the nurse license defense lawyers in your State. Google, contact your State Nurses Association, ask other nurses, research "nurse license defense" or "attorney for nurses" and your State, etc. There are usually a handful of nurse license defense diehards in every state or jurisdiction. See also www.taana.org. You can also email me or call my office and we point you in the right direction if you need someone outside of Ohio, Kentucky, and/or Indiana.

Its very important you get someone on your team who knows what they are doing in these types of cases. Consider hiring someone who full-time law practice involves license defense not someone who dibbles and dabbles in nurse license defense. Mistakes or missteps in these cases if not recognized turn ugly.

This is especially true for APRNs: NP, CNM, CNS, and/or CRNA.  You have alot of the line and even more so usually than a general RN or LPN (no offense here because I am a general RN by licensure also). If you are an APRN and you are involved in a State Nursing Board complaint, hire a license defense attorney who has represented other APRNs. You don't want to be the first APRN the attorney represents before the State Nursing Board, do you?

Also its nice you have an attorney in your family who is offering you general advice on the State Nursing Board matter but hire a nurse license defense attorney to represent you. Don't have your BIL (brother in law) who practices tax law at a large law firm represent you before the Board.

If you are going to hire a lawyer make sure your lawyer knows nurse license defense and how to counsel and advise you going forward, backwards, and sideways about nursing practice issues. State Nursing Board cases are not resolved overnight and you want a lawyer who is by your side throughout this period of time.

When a nurse retains me, I tell them especially if its a substance use and abuse case or a complex case, "we are going to be working together for the next several years." Period.

APNs Barriers to Practice Survey by the Ohio Association of Advanced Practice Nurses (OAAPN)

See Download 5.2.2.1%20OAAPN%20Survey.

Just my two cents but the cumbersome law/rules agreed to for APRN prescriptive in authority as a "foot in the door approach" and truce between dueling medical and nursing professionals associations here in O-HI-O are more difficult to amend than initially imagined. Sometimes just "getting a foot in the door" isn't the best approach to legislation and opening the Nurse Practice Act and in hindsight maybe a "do or die" , "do it or die trying" , or "all or nothing" approach to prescriptive authority was needed here in O-HI-O.

Just compare and contrast prescriptive authority for APRNs (excluding CRNAs who of course did it the right way initially for the most part. CRNAs and their national and state prof. associations are on the ball I tell you!!!) in Ohio, Kentucky, and Indiana. Its like comparing fresh spring water and sweat tea to flat and warm Pepsi. You can drink the Pepsi if if you have to but its nothing to look forward to consuming. 

 

 

 

May 11, 2010 Rally for APRNs in Columbus, Ohio

Save the Date!!

 

Nurses, Physicians and Patients!!  Join the Ohio Association of Advanced Practice Nurses and the Ohio Nurses Association on May 11^th for a statehouse rally to support advanced practice nurses efforts to improve access to quality healthcare with the passage of HB 206!!

 

 

Ohio Association of Advanced Practice Nurses

www.oaapn.org

 

What:   Statehouse Rally

 

Where:     Ohio Statehouse, South Lawn (Front Street)

 

When:   Tuesday, May 11th at 2 p.m.

 

Who:     Nurses, physicians and patients, nursing organizations, advocacy groups, legislators, media and the general public

 

Information:   The Ohio Association of Advanced Practice Nurses and the Ohio Nurses Association are holding a rally to show support for nurses and the ever-increasing role they play in the health care delivery system. With a shortage of primary care physicians and the extension of health care coverage to tens of millions of currently uninsured Americans, nurses will play a vital role in providing care to the increasing number of patients who will be seeking medical services.   HB 206 will enhance the  APN’s ability to treat patients with schedule II controlled substances.

 

HB 206 passed the House Health Committee 14-3 last October.  It is time for the bill to be voted out of the House– all Ohioans should have access to prompt and appropriate health care!

 

* Wear your clinical attire and bring signs of support (but no signs on poles or sticks)

 

Elise Geig

Director Health Policy

Ohio Nurses Association

4000 E. Main St.

Columbus, OH 43213

PH: (614) 448-1024

Cell: (614) 371-7554 ***Please note this is a new number

Fax: (614) 237-6074

[email protected]

CRNAs Make More Than Some Family Docs and Some Paralegals Make More than Attorneys: So What!

I don't like this article. I haven't commented yet because I am swamped with work but you should comment and encourage other nurses, both APRNs and RNs to comment on this article.

A paralegal in NYC make gross more than a solo practitioner attorney here in Cincinnati. But what does this have to do with the price of corn today?

See http://money.cnn.com/2010/03/11/news/economy/health_care_doctor_incomes/index.htm

KY Coalition of NP & NM Update and Alert-3/5/10

KCNPNM Legislative Update & Alert - 3/5/10

GOOD NEWS!!   HB 556 passed out of the House Health and Welfare Committee yesterday.

Now, HB 556 moves to the House floor for a vote by the full House. This will most likely happen next week. We must generate as many calls, e-mails and faxed letters as possible to ALL Representatives.  Also, ask Representatives to sign on as co-sponsors to HB 556

There are a little more than 3 weeks left in the legislative session - plus 2 concurrence days. There is time to pass our bill, but we must keep up the calls and letters.

You can also talk with your Representatives.  Contact information is at www.lrc.ky.gov  Click on "Who's My Legislator".

Below is a list of House Health and Welfare Committee members and how they voted on the bill.  Please send a note of thanks to those who voted for the bill.

*************************************************************************************

HOUSE HEALTH & WELFARE COMMITTEE

Title	First Name	Last Name	County	Party	Vote
Rep	John A	Arnold, Jr.	Daviess, Henderson, Union	D	YES
Rep	Scott	Brinkman	Jefferson	R	PASS
Rep	Thomas J.	Burch	Jefferson	D	YES
Rep	Bob	DeWeese*	Jefferson	R	NO
Rep	Jim	Glenn	Daviess	D	YES
Rep	Brent	Houseman	McCracken	R	NO
Rep	Joni L.	Jenkins	Jefferson	D	YES
Rep	Mary Lou	Marzian	Jefferson	D	YES
Rep	Tim	Moore	Hardin	R	PASS
Rep	Darryl T.	Owens	Jefferson	D	YES
Rep	Ruth Ann	Palumbo	Fayette	D	YES
Rep	David Allen	Watkins*	Henderson	D	NO
Rep	Susan	Westrom	Fayette	D	YES
Rep	Addia	Wuchner	Boone	R	PASS

Note: Co sponsors are in blue type

Rep. Mary Lou Marzian is chief bill sponsor

*Reps. DeWeese and Watkins are physicians

*************************************************************************************************

Talking Points and Summary of HB 556:

The bill improves access, especially in underserved areas, to quality, cost-effective health care provided to Kentuckians by Nurse Practitioners (NPs) and Nurse Midwives (NMs) 

Makes NO Changes in Any Current Laws Governing ARNP Scheduled Drug Prescribing

Removes the Requirement for a Collaborative Agreement for ARNP Prescriptive Authority for Nonscheduled Drugs (CAPA-NS)

· Nurse practitioners in Kentucky have never been required to practice under the supervision of a physician. They are considered licensed independent providers. However, Kentucky statute enacted in 1996 has required NPs to have a collaborative prescribing agreement with a physician in order to prescribe nonscheduled (legend) medications. The agreement applies only to prescribing.

· There are 2 separate prescribing agreements: one for non scheduled drugs and one for controlled drugs. This bill would delete only the requirement for the agreement for non scheduled drugs. If talking to your Representative, it would be helpful to provide examples of non scheduled drugs.

· Nurse practitioners have been safely writing prescriptions for non-controlled substances since1996.

· Nurse practitioners provide care in 116 of the 120 counties in Kentucky, showing a willingness to practice in underserved areas. However, their ability to do so has been adversely affected by the difficulty in finding a physician to sign a collaborative prescribing agreement. Thus, NPs and NMs are increasingly limited in improving access to care, particularly for rural Kentuckians.

· Some nurse practitioners own their practice and must pay a physician a monthly fee to enter into a collaborative prescribing agreement. In some cases, this fee is very high.

Amends a limited number of statutes which currently require a signature, report, examination or order by a physician to allow NPs to perform these functions.

• Nine specific statutes which require a physician to sign, report, examine, order or certify such things as a child's immunization record, ordering and reporting HIV tests and results, certifying a family child care home provider's good health, the need for a telephone for the deaf, and reporting communicable diseases would now allow those functions to also be performed by ARNPs.

 

• These statutes currently limit patient access to services and limit the ability of nurse practitioners to provide continuity of care to their patients, consistent with their education and training. By amending these specific statutes, some of those limitations and barriers will be removed, and nurse practitioners will be able to make a greater contribution to protecting the public health of Kentuckians.

 

CALL EVERY DAY – The message line is open until 11PM – 1-800-372-7181

It is extremely important that Representatives hear from ARNPs, nurses, and the general public. Call each day until further notice and ask others to do the same. Tell the operator that you want to leave your message for your Representative and all Representatives

The message:"I am a Nurse Practitioner (nurse, physician, patient, constituent, etc.). Please support HB 556 to increase access to health care. Please co sponsor this important bill.”

Message line number:  1-800 372-7181

FAX LETTERS

In addition to your calls, FAX letters to Frankfort to all Representatives asking them to support HB 556. Address your letter to "Dear Representative”. On the fax cover sheet, ask that the letter be distributed to all Representatives. You can use talking points from this message, to help with your letter. Limit your letters to one page.

Frankfort fax number: 502 564-6543

PLEASE SHARE ANY FEEDBACK

If you receive feedback from Representatives on HB 556, please let us know. This will help us "count votes".

Also, let us know if you have questions.

Thanks for all your efforts,

Beth Partin [email protected]    Sheila Schuster [email protected]

An Update on HB 556 for Kentucky Nurses

I just received this email from the Kentucky Nurses Association:

----------------------------------------------------------------------------------------

Please see the latest updated on HB 556 below -- your support is needed.  Thank you. 

 

Legislative Update 3-2-10

HB 556 is moving quickly in the House and time is short!!

 

The bill will be heard in the House Health and Welfare committee this Thursday, 3/4/10, at Noon EST.

If the bill passes the committee, it will then go before the full House for a vote – possibly as early as next Monday.

We must generate as many calls as possible to ALL members of the House Health and Welfare Committee all day on Wednesday and Thursday morning.

The number of calls received can make the difference between success and failure, so please call and urge others to call.

Below are the members of House Health and Welfare Committee. If any of these members are your Representative, it is especially important that they hear from you.

We need 8 votes to pass HB 556 out of the committee.

 

HOUSE HEALTH AND WELFARE COMMITEE

Title	First Name	Last Name	County	Role on Committee	Party
Rep	John A.	Arnold, Jr.	Daviess, Henderson, Union	Member	D
Rep	Scott	Brinkman	Jefferson	Member	R
Rep	Thomas J.	Burch	Jefferson	Chair	D
Rep	Bob	DeWeese	Jefferson	Vice Chair	R
Rep	Jim	Glenn	Daviess	Member	D
Rep	Brent	Houseman	McCracken	Member	R
Rep	Joni L.	Jenkins	Jefferson	Member	D
Rep	Mary Lou	Marzian	Jefferson	Member	D
Rep	Tim	Moore	Hardin	Member	R
Rep	Darryl T.	Owens	Jefferson	Member	D
Rep	Ruth Ann	Palumbo	Fayette	Member	D
Rep	David Allen	Watkins	Henderson	Vice Chair	D
Rep	Susan	Westrom	Fayette	Member	D
Rep	Addia Kathryn	Wuchner	Boone	Member	R

 

 

CALL WEDNESDAY & THURSDAY MORNING

The message line takes calls until 11 PM

It is extremely important that Representatives hear from ARNPs, nurses, and the general public. Call each day and ask others to do the same. Tell the operator that you want to leave your message for your Representative and all Members of the House Health and Welfare Committee.

If the HB 556 passes out of the committee on Thursday, we will once again need to direct our calls to ALL Representatives. An update will be sent out on Thursday afternoon to let everyone know the outcome of the committee vote.

The message:"I am a Nurse Practitioner (nurse, physician, patient, constituent, etc.) and I urge you to support HB 556 to increase access to quality, cost-effective health care.”

Legislative Message line number: 800 372-7181

FAX LETTERS

In addition to your calls, FAX letters to Frankfort to all Representatives asking them to support HB 556. Address your letter to "Dear Representative”. On the fax cover sheet, ask that the letter be distributed to all Representatives. You can use points from the message sent out last night  and the talking points on HB 556, which are available on the KCNPNM web site under "Legislative Updates". Limit your letters to one page.

Legislators' fax number: 502 564-6543

PLEASE SHARE ANY FEEDBACK

If you receive feedback from Representatives on HB 556, please let us know.

Also, let us know if you have questions.

Thanks for all your efforts,

Beth Partin [email protected]Sheila Schuster [email protected]

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

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.            

CRNAs and Prescriptions in Ohio

SB 200 would authorize nurse anesthetists in Ohio to issue prescriptions and write orders in some cases. See http://www.toledolegalnews.com/articles/index/id/5812.

http://www.legislature.state.oh.us/bills.cfm?ID=128_SB_200

http://www.ohnurses.org/AM/Template.cfm?Section=Home&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID=5247

CRNAs, the State Nursing Board, and Addiction: the Pedal to the Metal

I don't know where to start with this post so I will  begin and end by saying if you are a CRNA and you are stealing medications, self-administering medications, abusing alcohol, or diverting medications:

1. You may have a chemical dependency and you should be evaluated ASAP;

2. You may need a criminal defense attorney if you are stealing medications; theft of drugs is usually a felony in most states and jurisdictions; and

3. You may need a nursing license defense attorney to assist you with the State Nursing Board. Talk to your license defense attorney about your State's Alternative to Discipline Program for Chemical Dependency.

If you are a CRNA and you are stealing drugs or impaired at work, then the State Nursing Board will be involved at some point because of patient safety issues and public protection. This is a no brainer.

Local law enforcement and the State Nursing Board really go through these types of cases with a fine tooth comb for public protection and safety.  Some states and counties really "go hard and play hard" when licensed healthcare professionals (whether its a nurse, physician, or pharmacist) steal medication. The disease of addiction takes a back seat or gets placed in the trunk of a fast moving Chevy and protecting the health, safety, and welfare of patients and the public is in the driver's seat with the pedal to the metal. I watched the Fast and Furious last night on DVD!  

CRNAs, addiction, and the State Nursing Board. These cases can be much more complicated than your typical (if there is a such thing as a typical case before the State Nursing Board) nurse dependency case because CRNAs have much more autonomy and prescriptive authority than RNs and other advanced practice nurses. With CRNAs more autonomy means more money (CRNAs can do the money dance because most are making the big bucks) AND also more responsibility, accountability, and the potential for more liability.

Take the bricks out of your shoes and do one of more of the following:

1. Contact your Anethetists in Recovery (AIR) or state peer advisors for AANA. See http://www.aana.com/Resources.aspx?ucNavMenu_TSMenuTargetID=154&ucNavMenu_TSMenuTargetType=4&ucNavMenu_TSMenuID=6&id=191

 Call the Peer Assistance Hotline at (800) 654-5167

2. Get yourself evaluated by an CD evaluator or an addictionologist and get treatment ASAP;

3. Talk to a criminal defense attorney in your state or jurisdiction and confess your soul because whatever you say is confidential;

4. Talk to a nursing license defense attorney in your state or jurisdiction and confess your soul because whatever you say is confidential; and/or

5. Call Jack at 513-328-7253 and confess your soul. Jack loves to talk and he will listen. Jack is former CRNA who is in recovery and works with me as a Recovery Assistant. Whatever you say to Jack is confidential because he is working at the direction of an attorney. Jack is not an attorney and cannot provide you with legal advice but he will listen and provide alot of hand holding and referrals.

Call someone or do something but get the help you need now. Today can be the first day of the rest of your life and the best day for your nursing career, license, and livelihood.  

Scope of Practice and Nurse Practitioners

This is an excellent article.

See http://www.osbn.state.or.us/OSBN/pdfs/KleinMedscapeArticle.pdf

The State Nursing Board complaints and APRNs: More Accountability, Responsbility, and Potential Liability

I am receiving more emails and phone inquiries related to the legal and practice involvings involving the State Nursing Board and APRNs. APRNs include CRNAs, NPs, CNSs, and CNMs.

If you are an APRN and you are being investigated by the State Nursing Board, your case may be more complicated "off the jump" which is street lingo for initially because you are a RN practicing at an advanced level, with an expanded scope of practice, prescriptive privileges, DEA license, etc. In a nutshell and in my opinion, the greater the scope of practice and autonomy, the more responsibility, accountability, and potential liability.

If you are a APRN and you are being investigated by the State Nursing Board for ANYTHING you should have an attorney representing you. "No if, and, or but."  

If you are a APRN and you are involved in a State Nursing Board investigation for allegations of drug theft, you need a license defense attorney AND a criminal defense attorney.

If you are a APRN and you are licensed in more than one State and you are having license issues in one state, you need an attorney.

If you are a APRN, before you sign on the dotted line of an employment agreement, State Nursing Board Agreed Order, Consent Agreement, Recovery Contract or Monitoring Agreement, or Return to Work Agreement, you need an attorney.

I always assumed that APRNs more so than RNs and LPNs would seek legal counsel and representation in professional practice and licensure matters and these issues although not covered in detail in the basic diploma, ASN, or BSN programs were stressed in the MSN and Doctor level programs in nursing.

You should never assume and I assumed wrong. Nursing education at the diploma, ASN, BSN, and MSN levels really needs to step up and turn it up a notch with educating nurses on the law, legalities, and legal issues in nursing practice. Stop training nurses to be the next generation of employees and start educating, training, and guiding nurses to be the next generation of independent contractors and business owners providing services to hospitals and healthcare facilties like physicians.

APRNs and Legal Counsel: Why would I need an attorney? My facility has an inhouse attorney, outside attorney, and risk manager who is also an attorney

When you are practicing as a APRN, you of course have an increased scope of practice, increased responsibility, increased accountability, increased risk, and the potential for increased liability. You don't have to be a rocket scientist to know this, do you?

If you are an APRN, you should be more mindful of the legal risks associated with your practice and seek assistance if an issue arises. First and foremost, you should not just sign an employment agreement or contract without having it reviewed by an attorney. Second, you should seriously consider having your own personal counsel or attorney on retainer. Why? So when an issues arises (professional practice, clinical, employment, workplace, legal, ethical, criminal, State Nursing Board, and/or regulatory matters may pop up), you can contact your attorney without having to come up with thousands of dollars for a retainer on the spot and ASAP. 

There may be somethings that occur that you don't want to take to your facility administrator, risk management, or legal counsel and where you may benefit from independent legal counsel. There may be a conflict or it just may be next to impossible to speak with these individuals in your facility about your issue and besides they are concerned about the facility and its risks, not necessarily you.

Just a thought but APRNs are practicing at a higher level and should think of themselves as business owners and your license and your nursing practice are an important part of your business.

Seriously consider establishing a relationship and fee structure to reflect your practice with an attorney in your jurisdiction now and you will know that when you need advice and counseling, you can contact the attorney or law firm to have your questions answered.  

I am seeing more cases involving Clinical Nurse Specialists and Nurse Practitioners who need legal representation, counseling, and advising on a variety of issues but do not proceed because of attorneys fees and not valuing attorney representation. The APRNs may contact several attorneys to obtain tidbits of information to assist with self-representation. Sometimes successfully, Sometimes not. 

I have been in practice long enough to tell when someone is interested in proceeding or when someone is on a fishing expedition and contacting as many attorneys as possible to gather information for self-representation.

Always consider legal representation, counseling, and advisng when an issue arises in your nursing practice or when a issue arises with the State Nursing Board.

Emerging Legal Issues for Nurse Practitioners

The Center for American Nurses Presents

Emerging Legal Issues in the Nursing Workforce Series 

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

Emerging Legal Issues for Nurse Practitioners 

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

   Register

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

CNE Credits per Webinar:  1.25. 

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

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