Nursing Law & Order

CNA Speaks Out Against OHA-Supported Nurse Staffing Bill

Four nurses from the California Nurses Association and the NNOC (National Nurses Organizing Committee) spoke appeared before a legislative panel, slamming OHA, Ohio hospitals’ commitment to patient safety and an OHA-supported bill requiring hospitals to ensure a voice for direct care nurses when establishing staffing plans. See http://www.ohanet.org/healthenews/default.asp#Wednesday. 

Are you a Nurse?

My grandmother had surgery on Friday and will be hospitalized for 7-10 days. I spend most of my days at the hospital with her. My 6 y/o nephew, who was diagnosed with pulmonary hypertension and ASD is scheduled for a cardiac cath on Friday and will be hospitalized for 3-4 days. I will spend this entire week and two or three days of the following week at Cincinnati Children's Hospital and University Hospital.

When a family member is hospitalized, how do you respond when you are asked, are you a nurse? Maybe I should using legal terms like negligence, licensure defense, liability, and assumption of the risk; do you think someone will ask, are you an attorney?

What is Competency?

I am flying to Silver Springs, Maryland the American Nurses Association Congress on Nursing Practice & Economics (CNPE) meeting on Friday and Saturday. There will be over 60 nurses who practice in variety of settings (hospital, nursing education, public health, home care, nursing management, etc.) across the U.S. at this meeting.

I was elected to the Congress at the ANA House of Delegates in 2006. I am part of a subcommittee working on a definition of Competency.

How do you define competency? Are you competent? How do you measure competency in your nursing practice?

Non-Compete Clause

I reviewed an employment contract for an ARNP today. Regardless of whether you are an ARNP, RN, or LPN, if you are asked to review and sign an employment contract you should have the contract reviewed by an attorney with experience in healthcare law and nursing issues.

Why? Contracts are legally binding documents that may impact your nursing practice for years to come depending on the provisions, clauses, and terms in the contract.

Some attorneys will charge a flat fee a contract review and consultations while others may bill an hourly rate.

Does your employment contract have a non-compete clause? Is it reasonable? Is there an indemnity clause in the contract? What is an indemnity clause?

I have said it once and I will say it again....No one likes to pay attorney fees however its your nursing practice and aren't you worth it? 

LPNs & the Nursing Shortage

Have you read the article in the July 2006 American Journal of Nursing "Can the Use of LPNs Alleviate the Nursing Shortage?"

If not, its a must read regardless of whether you are a LPN or an RN. After reading the article, I wondered how my career path would have changed if a guidance counselor or my grandmother steered me towards a practical nursing program instead of RN training.

My plan after graduating from high school was to start a four year program for prelaw and then apply to law school. It was my grandmother who told me when I was eighteen "there are too many attorneys, go to nursing school", and I did. She worked in a hospital for a number of years and encouraged me to be an RN.

The authors in the article suggest that minorities should be encouraged to start in practical nursing. What do you think? Should we encourage minorities interested in nursing to attend practical or vocational nursing programs or professional nursing programs for RNs at the diploma, associate, or bachelor degree level?

This is for my grandmother. I can't thank you enough for your words of wisdom that you gave me in 1989. Little did I know how your advice and encouragement would shape and influence my career path and life choices. Thank you again for your wisdom and guidance. Thank you for encouraging me to attend nursing school. Thank you for encouraging me to attend law school when others said "you are a nurse, why would you want to be an attorney."

Licensure in Multiple States

You are a LPN who holds licensure in State A and B and you work part-time positions in each state. You work Monday-Wednesday in State A and Thursday-Saturday in State B. Can you safely assume the LPN IV therapy rules for State A are the same as State B?

I live in Cincinnati, Ohio, which borders Northern Kentucky and Southeastern Indiana. Therefore its not uncommon for nurses in these areas to have licensure in Ohio, Kentucky, and/or Indiana. Nurses who live in the Louisville, Kentucky area may be licensed in Indiana or vice versa because of the proximity of state lines and employment opportunites.

Don't assume the nursing law and regulations for State A are the same or similiar to State B. Just because you did XYZ task or procedure in State A does not mean that XYZ task is within your scope of practice in State B.

As a licensed nurse, you are accountable for your nursing practice and have an obligation to be familiar with state nursing law (Nurse Practice Act) and regulations (Board of Nursing regulations) in each state where you practice.

Chain of Command in Nursing

The chain of command in nursing exists for reason. We as nurses know what the chain of command is because we learned about it in nursing school and it was reinforced at nursing orientation as provided in the facility specific nursing policies & procedures.

A nurse contacted me this week after he was fired for not following the chain of command in a nursing home.  He had a complaint about a EMS worker and instead of discussing the issue and complaint with his immediate nursing supervisor in the nursing home, the nurse contacted the supervisor of the EMS worker directly.

What do you think based on the facts given? Is this appropriate?

For a refresher on the basics of the nursing chain of command, click here.

CPR

I completed my CPR class this week.

Did you know there have been instances in Ohio where nurses were reported to the Board of Nursing for not performing CPR correctly, not starting CPR in a timely manner, and failing to perform CPR when indicated. Are you competent to perform CPR and BLS as a licensed healthcare?

See the American Heart Association website for emergency and cardiovascular care.

Suspected Medication Error

You are a staff nurse in a facility. You suspect a fellow nurse committed a medication error that did not result in patient harm but failed to report complete an incident report. This situation is bothering you. What do you do?

Should this situation "bother" you? Do you mention your suspicions to your nursing supervisor? Do you simply approach your colleague and have a frank discussion? Do you let it ride because "its none of your business" and you don't get paid to do that? Do you consult with nursing policies & procedures to determine the best course of action?

Certification and CMSRN

Are you certified in a nursing specialty? I downloaded the information for the Certified Medical-Surgical Registered Nurse (CMSRN) exam. I am considering certification. See this article on nursing spectrum that discusses the CMSRN exam. http://community.nursingspectrum.com/MagazineArticles/article.cfm?AID=12630

If you are certified, why did you become certified? What is your certification? If you are not certified, why not? Is it because we play the "alphabet soup" game with credentials and degrees in nursing?

I am a former pediatric nurse who switched to home health adult med surg and I have not looked back. I never really thought about being certified until I reviewed the American Journal of Nursing 2006 Career Guide and I have been a practicing RN since 1993.

Forensic Nursing

I am excited because I have been asked to present at the Ohio chapter of the International Association of Forensic Nurses (IAFN) meeting on May 8, 2006 in Columbus, Ohio. I will most likely present on Scope of Practice and Professional Boundaries for Ohio Forensic Nurses at the Spring Conference. 

Speaking of forensic nursing, I attended a very informative CE sponsored by the Southwestern Ohio Nurses Association (SONA) last evening on Intimate Partner Violence (IPV) that was presented by Dr. Yvonne McKoy, Ph.D., R.N. who is a nursing professor at Xavier University in Cincinnati, Ohio. The Executive Director of the Ohio Nurses Association (ONA), Gingy Harshey Meade and President of ONA, Barb Nash were also in attendance.

Practice Deficiencies

I had a meeting with a newly licensed RN today who was reported to a Board of Nursing for unsafe nursing practice. What is unsafe nursing practice? At one point does a violation(s) of an employer's policy & procedure turn into unsafe nursing practice? Is one medication error unsafe nursing practice? Is a pattern of medication errors unsafe nursing practice? Are newly licensed RNs more prone to practice deficiencies than RNs practicing for 5,10,15, or 20+ years?

Should issues related to practice deficiencies and unsafe nursing practice be dealt with "in-house" meaning inside the facility with a corrective action plan, monitoring, and supervision prior to being reported to the Board of Nursing? Where does mentoring and socializing the newly licensed RN into the professional practice of nursing fit into the equation? Should a newly licensed RN work with one, two, or more preceptors on a particular unit/floor/shift/area for orientation and competency assessment and evaluation purposes?

If you haven't done so already, read the Notes From The Field section in the December 2005 issue of Nursing Management (www.nursingmanagement.com); the article is titled Is Employee Discipline the Solution for Patient Safety?

How did you make the transition from student to professional nurse? Was it easy? How much time did it take for you to feel proficient?

Time and a Half

I am a home health R.N. and I am seeing patients on Christmas. I am per diem and decided to pick up three visits. I am embarrassed to tell you my "holiday pay" for working on Christmas.

If you are working, are you being paid time and a half for Christmas  and/or New Year's Day? Is the extra pay adequate compensation for time away from family and love one? Are you required to work this weekend/next weekend or are you picking up an extra shift?

Congress on Nursing Practice

I am attending the two day, American Nurses Association, Congress on Nursing Practice & Economics scheduled for September 19th and 20th in Silver Springs, MD. I am a Director on the Board of Directors of the Center for American Nurses (Center), which is an ANA affiliated organization. I am attending the Congress as a representative of the Center.

In your opinion what are the most pressing issues facing registered nurses? licensed practical nurses? I will post highlights of today's meeting on this blog tonight.

State Nurses Association

Do you belong to your state nurses association? I am a member of the Ohio Nurses Association (ONA). I also belong to ANA and a district nurses association, the Southwestern Ohio Nurses Association (SONA). The ONA Convention is October 7th-9th in Perrysburg, Ohio. I received correspondence from ONA today indicating my poster abstract  Procedural Due Process for Nurses was accepted for presentation. I am looking forward to attending the ONA Convention and ran for one of 30+ seats as a SONA delegate at the ONA Convention. I am also running for ONA elected offices, Nominating Committee and as an Unspecified ANA Delegate.

Are you active in your state nurses association? I pay my dues for ANA, ONA, and SONA membership monthly, I believe its $34.00. I spend more than $34.00 a month on coffee (I am an avid White Castle coffee drinker) and therefore I have no problem spending $34.00 a month to support my chosen profession. I also belong to a number of legal professional associations and needless to say, I spend over $1,000.00 a year on professional association dues. Are you supporting your chosen profession?