Nursing Law & Order

I am your Lawyer not Your friend. I don't do boilermakers: mix personal and business

Okay, here it is folks. I am a nurse and therefore I will do whatever I can for any nurse (if you pay me).

The attorney-client relationship is a professional relationship. Its not a personal relationship like a friendship.

I love what I do for a living and it is my passion but I maintain boundaries between my law practice clients, my professional nursing and colleagues, and my personal life.

What are professional boundaries?

http://www.andrewskurth.com/pressroom-publications-SetYourProfessionalBoundaries.html

I was always told you shouldn't mix light and dark liquor, you shouldn't mix beer and liquor, and do boilermakers and therefore I apply the same principles to my professional and personal life.

http://en.wikipedia.org/wiki/Boilermaker_(beer_cocktail)

My stomach turns when I read law practice management and marketing articles which encourage lawyers to be "friends" with their clients to increase sales, etc. Guess what? Being friends with a client IMHO causes you to lose your objectivity and to get too personal, emotionally invested, and lose sight of your professional obligations to a client.

I know alot about professional boundaries. Guess what if you have a professional boundaries complaint before the Nursing Boards in OH, KY, and/or IN, you should think about hiring me.

https://m360.centerforamericannurses.org/event.aspx?eventID=7426

http://www.nursingcenter.com/library/JournalArticle.asp?Article_ID=680674

http://www.nursingcenter.com/library/JournalArticle.asp?Article_ID=633454

http://www.americannursetoday.com/article.aspx?id=4686&fid=4662

http://advocatefornurses.typepad.com/my2cents/files/KYNurseprofessionalboundaries.pdf

http://www.spsscs.org/meeting2009/program.php

Also, why I may adore you as a nurse and as a client, you are paying me for a service not to be your friend, right? Do you pay someone a friend thousand dollars to be your friend? I would hope not.

More importantly because I am your lawyer, not your friend, I tell you things you may not want to hear about your case, your nursing practice, or your nursing company. But that's my role as your lawyer; I am not your friend.

I am not being mean but I am giving it to you directly in a world of political correctness and "friending" as one dually licensed professional to another licensed professional.  

Have you been socialized into the professional practice of nursing or Are you just practicing to be practicing and clocking/signing/swiping in for your next paycheck?

I haven't posted as much the last week or so because my grandfather is hospitalized and between my law practice and my hospital visits my hands are pretty full. My grandfather is doing better. He is hospitalized at the University of Cincinnati in the Surgical Intensive Care Unit with COPD, pneumonia, and a bowel perf.

Thank you to the staff at UC Hospital for taking such good care of my papa including but not limited to GI, Pulmonary, Interventional Radiology,  and ICU docs as well as the PT/OT and of course the nursing staff.

I have received two inquiries this week from nurses who were busted at work doing really unprofessional acts. Keep it professional at work. Do you know what is means to be a professional nurse? What is professionalism in nursing? Have you been socialized into the professional practice of nursing or are you just practicing from paycheck to paycheck?

My papa is hospitalized and I can't imagine one of the nurses taking a digital picture of his "tally wacker" and showing it to other nurses. This was an allegation pending against a nurse. I am not kidding.

Keep it professional at work. What is professionalism? If you don't know take an online CE, read a few articles, perform a little internet research, and observe other healthcare professionals and their interactions with patients and family members. Read the classics: the ANA Code of Ethics for Nurses, Nursing Scope and Standards of Practice, and the Nursing's Social Policy Statement.

If you still don't know what it means to be a professional nurse and what is means to be part of a profession, then just ask yourself would you want a nurse caring for your papa, mother, child, or dear friend who behaved, performed, or acted in such a manner?

Personally, I think there are some of us working as nurses who shouldn't be nurses because for some its just a paycheck or a job and this is eventually reflected in the care provided and the behavior, attitude, or work ethic of the nurse which of course can sour and impact the entire unit, floor, wing, or hall.

This is the real world not nursing school and of course its okay to do what you do just for a paycheck, to practice only from paycheck to paycheck, and to practice and to work not because you like what you do but because it affords you with a decent living....We see this of course in every profession or occupation.

Are you a blue collar nurse, pink collar nurse, or a white collar nurse?

http://en.wikipedia.org/wiki/Blue-collar_worker

http://en.wikipedia.org/wiki/White-collar_worker

http://en.wikipedia.org/wiki/Pink-collar_worker

CNMs, CRNAs, and Nurse Practitioners and the Credentialing and Privileging process

Don't fudge your credentialing and privileging applications. I know this sounds easy and should be obvious when in fact you may think that you are just telling your story with the facts you consider important to you, the Medical Staff Committee may see this is dishonesty, falsification, and downright wrong.

Don't downplay the facts or misstate what transpired in a particular situation or incident. If you have any questions about an application, contact a health law or nurse license defense attorney in your state or jurisdiction about your application. Also you can't complete privileging and credentialing applications with selective memory and while "winking one eye" like some of us do when completing an employment application.

An application for credentialing and privileging  with a healthcare employer is NOT the same as an employment application with  a healthcare employer.

If you have blemishes and a less than a perfect employment, license, or criminal history talk to someone, a health law attorney or a license defense attorney in your area before you submit your application to a particular facility. You would be surprised how much time and aggravation this may save you beforehand. Yes, it will cost a few hundred dollars but at least you will have someone to provide you with objective advice and counseling on how to proceed. Its better to pay a few hundred dollars up front and receive advice and counseling than pay several thousand dollars to representation in a Medical Staff Hearing.

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

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

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

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

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

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

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

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

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

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

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

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

Dishonesty, Deceit, and Deception: My Name is A, I am a nurse, and I am a liar

My grandmother used to tell us "there is nothing worse in the world than a thief and a liar" growing up and she still says this, alot. I smile because I know there are worse folks in the world than "thieves and liars" and it was just a saying impressing upon us as kids the importance of telling the truth. Her saying scared me straight alot of times as a child.

This isn't legal advice of course but:

Don't tell a story. Even now at age 38, I can't bring myself to use the word "lie" because we were not allowed to say the word growing up. Don't tell my maternal grandmother on me, please!

Don't lie when something happens in the workplace and things will happen. The nursing workplace and clinical practice is not perfect and things will happen. Have the intergrity to own up to what has transpired because LYING ALWAYS make it worse especially when you get caught LYING.

Notice, that I did not say "if" you get caught; I said "when you get caught.

When you lie in the workplace, one questions your ethics, your credibility, your competence, and who you are as a nurse and who are you as a person. It depends on the facts of course and whether this was a "little lie", "the lie", a "big lie", or a "series of lies." You will hear things like "I thought I knew her" and "I guess you don't really know anyone you work with."

Did you know that a lie can take human form, grow, become all consuming, and destroy everything that you have worked, cried, and sweated so hard to obtain? Lies in your personal life can wither into your professional life and vice versa. Lies can become the boogie monster, baby.

Can you say State Nursing Board investigation for the LIE and the conduct, actions, and behaviors LIED about in the nursing workplace?   

Deceit, Deception, and Dishonesty sounds like a wayward romance novel nowdays but it should not be used to describe your nursing practice or your behaviors and conduct in your personal and professional life. Remember what you do personally can impact you professionally as a licensed nurse. Some would say you are professionally what you are personally and what you are personally is what you become professionally.

Take a look at the ANA Code of Ethics for Nurses for guidance.  http://www.nursingworld.org/mods/mod580/cecde03.htm  

What happens if you know of or suspect illegal conduct in the workplace? Legal, Ethical, Moral, and Professional Duties and Obligations

I was contacted by a nurse who knew of and/or suspected the use of illegal billing practices by a physician employer and did not report the conduct to a regulatory board, licensing board, or a law enforcement agency.

There may be of code of silence in healthcare, a "don't ask and don't tell" philosophy towards certain conduct in the military, and a "no squeal" rule in the criminal underworld but you need to determine what are your mandatory reporting obligations if any: legally, ethically, morally, and professionally in this type of situation as a nurse.

Call it whistleblowing, call it "tattle telling" or whatever, but you need to make sure as a licensed nurse that you have met your legal, ethical, and professional obligations under the circumstances. As a state-licensed nurse, you are not a "Joe Blow" working at a local fast food parlor. You are a licensed nurse practicing in accordance with legal, professional, moral, and ethical frameworks.

You have to determine if it is legal, ethical, professionally, or morally okay for you to just turn your head and not to report this type of conduct.

What should you do if you know of or suspect illegal conduct in the workplace? This of course is not legal advice but you need to determine your next course of action and you can consider one or more of the  following:

1. You need to look at your State Nursing Practice Act and State Nursing Board regulations;

2. You need to look at your ANA-affiliated State Nurses Association guidelines and standards;

3. You need to look at the American Nurses Association Code of Ethics for Nurses;

4. You need to contact your ANA-affiliated State Nurses Association and speak with the Executive Director or a Nursing Practice Consultant;

5. You need to contact your nursing union and speak with a Labor Relations Specialist or an elected Nursing Union official; and/or

6. You need to contact a nursing license defense attorney who represents nurse.

Speak to someone about the situation but don't just turn your head and remain silent because healthcare is highly regulated and the situation may come back to bite you...

  

Are You Personally What You are Professionally?

I am a member of the ANA Congress on Nursing Practice & Economics. As a Congress member, I received a copy of ANA's Guide to the Code of Ethics for Nurses: Interpretation and Application. See www.nursingworld.org.

I love this guide! I will have enough to post on just from this guide for at least a month.

On page 60, Interpretive Statement 5.3: Wholeness of Character, this question is posed:

Can a person who is a rogue, scoundrel, liar, and cheat in personal life be a virtuous nurse in professional life? It is unlikely.

What we are personally, we are professionally. Our personal and professional identities are neither separate, nor coextensive; they are integrated and deeply commingled, mutually influencing each other. The person who has become "a nurse" as opposed to the person who "does nursing," is the one who has incorporated and integrated the values of the profession with personal values.

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

What does this mean to you as a nurse? Do you agree with this statement? Are you a nurse or do you do nursing? Are the values of the profession your personal values? Are you personally what you are professionally? How do you if your professional and personal lives are agreeable and harmonious?

Are some of us living secret personal lives as licensed professionals that will eventually impact, threaten, and destroy our professional lives?

Look at the secret personal life of Eliot Spitzer, the former Governor of the State of New York. Compare and contrast his secret personal life with his professional life as a Governor and former State Attorney General. http://www.nytimes.com/2008/03/10/nyregion/10cnd-spitzer.html?hp

Walking the Tight Rope: HIPAA vs. Nursing Board Reporting

You are a staff nurse in a small rural hospital. You are working from 7am to 7pm today. You enter the conference room only to find you are caring for a fellow nurse who was admitted for a suspected drug overdose. You don't know this nurse however its the talk of the unit. This nurse tested positive for several illegal drugs including marijuana and heroin. The nurse-patient is not an employee of the hospital.

Are you morally, ethically and/or legally required by the State Nurse Practice Act to report this nurse to the State Board of Nursing or does HIPAA and state privacy laws prohibit the reporting? What does the ANA Code of Ethics mandate in this situation? What would you do in this situation? What are your concerns?

RN Renewal in Ohio

I am a RN in Ohio and I have to renew my license this year. I have the required continuing education for renewal. The RN Renewal Application in Ohio asks a series of questions that may trigger a disciplinary investigation:

1. Have you been convicted of a felony?

2. Have you been convicted of a misdemeanor in the course of nursing practice?

3. Have you received intervention in lieu of conviction (treatment in lieu of conviction for a chemical dependency where a nurse has stolen medication)?

4. Have you been been convicted of any crime that involves moral turpitude or reckless conduct? This is not the exact wording however its close. Moral turpitude is interpreted very broadly under Ohio case law.

5. Have you had any action taken against a professional license in any other state or jurisdiction?

Nurses if you are not sure on whether or not you should respond in the affirmative seek assistance. You can contact the Ohio Board of Nursing for clarification. Or you can seek legal advice and counseling in the form of a legal consultation from an administrative law attorney who practices in this area.

Don't guess if you have questions related to an incident, occurrence, conviction, etc. Make sure you are responding truthfully and accurately to the Ohio RN Renewal Application. 

Going Bare: Is it Ethical?

The majority of nurses (RNs and LPNs) don't carry their own professional liability insurance policy. I have professional liability insurance to cover my consulting firm and my practice as a home health RN and I also have a separate policy for my law firm.

Why? The same reason why I purchase medical, dental, and other insurance. I want the coverage to protect my myself.

I had a meeting with a prospective client last week, who later retained me to represent her before a state board of nursing. She cancelled her policy two years ago after being told by hospital risk management staff that the policy was unnecessary because nurses are covered by the hospital's policies.

Going bare in this post refers to a nurse not having his or her own professional liability insurance policy. In this post, relying on your employer's policy is not considered "insurance" unless you are provided with a copy of the policy(ies), you are provided with updates on the status of the policy(ies) whenever renewed, modified, etc., and your name and your title with your employer is specifically mentioned in the policy.

Is is ethical not to have your own professional liability insurance policy? Or would you say that it has nothing to do with ethics and it is strictly a business decision whether or not a nurse purchases his/her own professional liability insurance? What do you think?

Unprofessional Conduct

What is unprofessional conduct for nurses? Do you know how your state Nurse Practice Act (NPA) and state Board of Nursing regulations define unprofessional conduct or misconduct? You should.

In my experience, I have found the majority of unprofessional conduct from nurses in the workplace stems from dsyfunctional and unhealthy work environments. This happens when unhealthy and borderline conduct is tolerated over a period of months or years until The INCIDENT happens. This INCIDENT is allegedly so offensive and degrading that the nurse(s) may be terminated and reported to the state board of nursing or other regulatory agencies for a variety of alleged offenses.

The bottom line is to keep it professional in the workplace. I am all for making work wonderful and having fun in the workplace, but there are boundaries.

How do you draw the line between joking and playful behavior in the workplace and unprofessional conduct. Please keep in mind that what is considered "normal behavior" on a particular unit, floor, wing,  or setting may not be the norm for professional nursing.

There will always be nurses who press the boundaries of normal behavior and conduct in the workplace because there will always be the "the good, the bad, and the ugly" behaving in every occupation and profession. However, you don't have to be that individual.

You are a professional, so keep it professional in the workplace, please. Tell me, are you working in an unhealthy and dysfunctional environment?