Nursing Law & Order

Ohio Medical Board's Resolution Regarding Prescription Drug Abuse: And So It Begins!

Thanks, Jack "The Smack" Stem at http://www.peeradvocacyforimpairednurses.com/why.html for emailing this to me yesterday.

Everything that has a beginning has an end, Neo. http://www.youtube.com/watch?v=orXDu3Stb-c

The Ohio Medical Board issued a resolution regarding prescription drug abuse last week.

See http://www.med.ohio.gov/pdf/PrescriptionDrug%20Abuse.pdf.

See also http://www.zanesvilletimesrecorder.com/article/20110311/NEWS01/103110309/DeWine-Ohio-medical-board-must-fight-prescription-drug-abuse-harder for an idea of what's coming for licensed healthcare professionals with prescriptive authority like MDs and APRNs.

Why is this important for nurses?

* Nurses who are prescribed controlled substances by their physicians or APRNs and practice nursing. Its a balancing act yet I don't think there is an appreciation of the risks and liabilities for nurses who take "prescribed" controlled substances and then report to work or who take meds while at work; and

* APRNs in private practice or who work for/with docs in private practice and have prescriptive authority. The State Medical Boards and State Nursing Boards go hard in these cases and unfortunately the majority of docs and nurses will represent themselves with the "I didn't do anything wrong" defense.

More about the "I didn't do anything wrong defense" and how it applies to me this week.

Guess what? I saw this coming two years ago and put together a webinar sponsored by the Center for American Nurses titled:

A Balancing Act in the Workplace, Managing the Risks When a Nurse Takes Prescribed Medication

This is one of my fav. Center webinars and I provide this CD to clients.

See http://www.can.affiniscape.com/storelistitem.cfm?itemnumber=13

What are you saying LaTonia? Just give it to me straight without the legal mumbo jumbo.

If you are a nurse (RN, LPN, and APRN) and you are prescribed controlled substances for chronic pain, a nurses back, etc.; is this affecting your nursing practice? What are the risks and potential liabilities for you and your nursing practice? Remember you are your own risk manager on Nursing Law & Order; this isn't Nursing Law & Disorder, not yet anyway.http://advocatefornurses.typepad.com/my2cents/2011/03/the-plan-do-you-need-assistance-with-revising-reviewing-or-developing-the-plan-we-can-help.html

If you are APRN with prescriptive authority, what does this mean for your nursing practice? How can you develop strategies to protect your nursing practice and your nursing license with the "heat" being placed on prescriptive drug abuse?  http://advocatefornurses.typepad.com/my2cents/2011/03/the-plan-do-you-need-assistance-with-revising-reviewing-or-developing-the-plan-we-can-help.html

Allegations involving the inappropriate prescribing of controlled substances are complex because multiple state, federal, and/or national agencies or groups are involved on various levels. The implications for MDs and APRNs who prescribe and for LPNs, RNs, and APRNS who use controlled substances and practice are really starting to take shape in the last 3 years. Get ahead of this issue if this applies to you and your nursing practice, its risk management, baby!

This isn't an issue where you want to be caught with your pants down with the pics on FB and the video U-Tube. Be proactive and manage the risk and if you need assistance managing the risks, seek assistance. This is just how licensed healthcare professionals should roll!

 

 

 

Charlotte's Web and Drug & Alcohol Use, Abuse, and Dependency in Nursing

Are you weaving a web so thick that not even Charlotte could manage to migrate it? http://en.wikipedia.org/wiki/Charlotte's_Web.

I am writing an e-book, the New Charlotte's Web: Deceit, Deception, and Dishonesty, Drugs/Alcohol, and Nursing's Social Policy Statement.

Deceit, Deception, and Dishonesty is part of addiction and use. I get it.

Drug and Alcohol Use, Abuse, Dependency, and Impairment is no doubt an issue in nursing. I get it.

There are alot of nurses who are abusing prescription medication but think its "okay" because I have script. There is a thin line between using prescription medication as prescribed vs. using prescription medication prior to and while at work vs. impairment regardless of whether you are working 4, 8, 12, or 16 hour shift.

However, there are competing forces with drug and alcohol use, abuse, dependency, and impairment in nursing. Yes, there is a recognition that this is disease on one end of the spectrum and on the other end of the spectrum is the public and the State Nursing Board and Law Enforcement.

Guess what's in the middle? IMO, its Personal and Professional Responsibility & Accountability.

http://www.nursingcenter.com/Library/JournalArticle.asp?Article_ID=492769

http://www.nursingtimes.net/nursing-practice-clinical-research/part-51-accountability-autonomy-and-standards/200972.article

http://ajcc.aacnjournals.org/content/19/3/296.full.pdf+html

http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2648.2006.03684.x/full

http://www.aspan.org/AboutUs/PresidentsPage/ArchivedPresidentsPage/PresArchive_102010/tabid/7404/Default.aspx

http://faculty.ksu.edu.sa/hisham/Documents/Medical%20Education/English/Nursing%20Education/90.pdf

How does this apply in the workplace? Examples.

http://www.slhn-lehighvalley.org/docs/pdf/final%20professional%20practice%20model%20nov%2007%20_2_.pdf

So you know what this means? Yes, Alcohol & Drug Use, Abuse, Dependency, and Impairment are medical issues but as a state licensed nurse, you are personally and professionally accountable and responsible for your actions and inactions in accordance with American Nurses Association professional standards of practice and your State Nurse Practice Act and Board of Nursing Regulations.  

So guess what? You are a nurse and you are diverting drugs; you have a medical condition but you are accountable. You are nurse and you are showing up to work drunk; you have a medical condition but you are accountable.

You cannot be a state licensed nurse and NOT be accountable and responsible for your actions or inactions or conduct. This isn't Burger King and you can't have it your way. It works this way for most licensed professionals especially in healthcare, which is HIGHLY regulated.

The accountability and responsibility piece and the foundations for the legal, professional, and self-regulation of nursing practice is lost. This is what frustrates me is this connection is lost somewhere in the transition from nursing student to professional nurse to professional nurse and expert clinician.

Nursing schools are the new puppy and pill mills, teaching to pass the NCLEX and producing graduates who don't understand the role of personal and professional accountability and responsibility in nursing practice and the importance of legal, professional, and self-regulation of nursing practice. (Oh, snap, I guess I won't be invited to present on nursing law and rules for nursing faculty. Tear.)

This isn't picked up in the workplace of course and most nurses don't belong to a nursing professional or specialty nursing associations. So in my opinion the majority of us are showing up to work and just practicing until something happens and we are doing this without a plan for our nursing practice and without a healthy appreciation & understanding of JUST how important the legal, professional, and self-regulation of nursing practice is to our nursing practice and "the plan." 

Sections of the Nursing's Social Policy Statement: The Essence of the Profession (2010) will be required reading for ALL of my law office clients going forward.  http://www.nursesbooks.org/Main-Menu/Foundation/Nursings-Social-Policy-Statement.aspx.

If you are a law office client, take a guess what you will receive on your birthday, my birthday or around the holidays this year!!!

What's your point, LaTonia? Weave it, baby, Weave it! You can weave a web and weave it as thick, as sticky, as murky, and for as long as you can. Regardless of whether you weaved the web because of a medical condition, mental condition, etc. the "why" is a mitigating factor: you are responsible and accountable due to the professional regulation, legal regulation, and self-regulation of nursing practice.

Alcohol Use vs. Alcohol Abuse vs. Alcohol Dependency: State Nursing Board Renewals and DUI, OVI, or DWI. DEATH by Evaluation!

Nurses if you have been charged or convicted of a DUI, OVI, or DWI and you have to renew your Ohio RN license, Indiana RN license, and/or Kentucky nursing license (RN or LPN) this year, consult with an attorney.

Schedule an appt. with a nurse license defense attorney to discuss your situation before you self-report to the Ohio, Kentucky, and/or Indiana State Nursing Boards. This isn't legal advice because you didn't pay me to say this its just plain common sense.

Why would you self-report "anything" to the State Nursing Board without speaking with a nurse license defense attorney? Okay, I know I am biased but really? Would you walk into a police station and "confess" and admit to committing a crime verbally and in writing? Probably not, so why do nurses self-report to the State Nursing Board when anyone and everyone including but not limited to Direct TV  Service Technician to their friends tells them its the right thing to do. Its the good thing to do.

WTH, does that mean anyway? Save right vs. wrong for the 8 hour graduate level symposium on Ethics and Morality and Nursing's Social Policy Statement. Save good vs. evil for Sundays and you are welcome to join me at 8am service at a Baptist church.

You are not Luke Skywalker (actually Luke is here with me. My dog's name is Luke Skywalker and he uses the force on mommy) and the State Nursing Board or Alternative to Discipline Program in Ohio, ISNAP, or KARE does not represent the Dark Side of the Force. Let's turn it down a notch and focus on the issues.

1. You are a licensed nurse.

2. You were charged and/or convicted of a DUI, OVI, or DWI.

3. You may have been charged with other crimes along with the DUI, OVI, or DWI.

4. You are practicing as a nurse.

5. You are receiving more "helpful" advice from family, friends, foes, and strangers than a politician caught in a whorehouse.

Speak with a nurse license defense attorney about your situation. There are license defense attorneys in every state, see www.taana.org.

Don't fire off the 25 page handwritten letter to the Board (that you don't keep a copy of for your records) disclosing everything you have done right vs. wrong and good vs. evil since the 6th grade. 

You need advice and counseling and maybe representation. This is the role of a state licensed attorney just like its the role of state licensed nurse to provide nursing care. Don't bootleg it! 

I offer 40 minute legal consultations for nurses with licensure renewal issues. You can pay for and schedule the legal consultation online. This is for nurses licensed in Ohio, Kentucky and Indiana. I am licensed to practice law in these states only.

Also, a nurse emailed me this weekend and inquired whether I could obtain a license in State C and represent the nurse. The State Nursing Board applications for licensure pale in comparison to the Attorney Licensing Applications and the Character & Fitness Interviews. The Bar Applications make you cry like you are running a 10 mile marathon in a size 5 pump and you wear a size 10, in gym shoes. Yes, we have to interview!!!!

I have NO plans to sit for another bar examination or regurgitate every speeding ticket since age 16, discuss my credit report and score and why I was late 30 days late paying my Spiegel's charge 20 years ago (I loved Spiegels), and disclose every civil, criminal, administrative matter, case, issue, or thought or anything remotely legal (this includes purchasing a hotdog at the food stand next to the court house) and not to mention mental health issues on a State Bar Application for Licensure as an Attorney. 

When I say NO plans, I mean never ever neverland Peter Pan. Three Bar Exams, Three Bar Apps, Three Bar Charter & Fitness interviews, and Three times passing the Bar on the first try. I am stopping while I am ahead.

I am sure you have heard of Death by Meeting? Okay, I am writing an e-book titled DEATH by Evaluation and self-reporting is Chapter 1.  

Why? Hell just from my posts on this blog, I am sure the Bar Examiners if I wanted to apply for a law license in another state would want a psychiatric evaluation (forensic nonetheless) and maybe a fitness for duty  (I am sure my employer would not object:) not to mention maybe a chemical dependency evaluation because of my references to Long Island Iced Tea, Moscato, Bartles & James wine coolers (traditional, berry, or strawberry), Miller Lite and Miller Genuine Draft vs. Bud Light vs. Keystone Light (hint: only if your money "ain't" right this week) and my fav, Martini & Ross Asti Spumante over the years.  Also I have lost 35 pounds since November 2010 so they may want a medical evaluation or a return-to-work evaluation (before I can step foot in my home office or my traditional office) as well. After speaking with one or more of my clients, they may also want a behavioral examination.

Okay, I am just kidding here but you get my point about self-reporting without obtaining objective advice and counseling, right?

Oh, snap, the link for the License Renewal Application consultations:

http://www.bookfresh.com/profile/157503739

The cost of a 45 minute legal consultation (conference call) for 2011 nursing license renewals in Ohio, Kentucky, or Indiana is $225.00.

 

The Good, The Bad, The Ugly, and the Unrepresentable vs. Unforgiven and Unrepresentatble

The Good, The Bad, and The Ugly with Clint Eastwood and Unforgiven are two of my favorite movies.

What is unrepresentable? Well, first it is not an acceptable word but that has never stopped me before....

Nurses when you represent yourself for so long in:

1.  a State Nursing Board investigation, adjudication, or post-disciplinary monitoring;

2. You are involved in a med mal or nursing malpractice cases that transitions to a Board of Nursing investigation, adjudication, or post-disciplinary monitoring;

3. A criminal case that transitions into a Board Alternative Program monitoring and/or Board Disciplinary Action and post-disciplinary monitoring

you may become UNREPRESENTABLE. I can actually see this as nice legal drama and cowboy movie.

Unrepresentable means attorney representation, counseling and/or advising is of no benefit to you because of YOU; its usually not the case because all cases can be worked through, it may take time, but.... You are unwilling to see anything in the case but your own point of view. Most of the time it involves taking a victim approach and that you are being picked on for whatever reason by whomever and "this" is the result.

There is also a tendency to see everything as "Me against the State Nursing Board." Sorry, but you are no Tupac and "Me against the World" has no place or meaning when defending your license in a disciplinary investigation, hearing, or post-monitoring period. http://en.wikipedia.org/wiki/Me_Against_the_World

I am seeing this with nursing students, NCLEX Applicants, LPNs, RNs, and APRNs who have represented themselves over a period of months or years in State Nursing Board cases and who really would have been benefited from legal representation and counseling and advising earlier: days, weeks, months, or years earlier.

I don't think a nurse can appreciate just how much impact these types of cases can have on you until it happens to you. You of course take it personal but its not personal; its a complaint against you in your professional capacity and therefore it should be handled professionally. This is why you don't represent yourself and you have someone helping you.

However, the benefits of representation, counseling, or advising are lost in the present and the "now" as well as in the future because of the past. We all have crap in our closet that we don't want to come out (you are not perfect) but if the crap in your closet is directly or indirectly related to the State Nursing Board complaint, guess what? The closet has to be cleaned up somewhat. I like to use a cleaning combination of bleach, holy water, and baking soda.

I don't have a "S" on my chest. But I do have a pair of red boots and you certainly won't catch me in a Red Cape (at this time of the year anyway in the Midwest) for SUPER Nurse Defense Lawyer. But I will probably wear my red blood red cape to see this movie. http://www.imdb.com/title/tt1486185/.

Sorry, but I cannot fly (I can barely walk in my Red Hot Red Knee Boots) around the State Nursing Board Office at the speed of light and turn back time to the exact point in time where if you knew then what you know now, you would have proceeded differently before the State Nursing Board.

Some nurses do just fine representing themselves in State Nursing Board cases. But how do you know if this will be you? How do you know depending on the allegations in your case if you can adequately represent, counsel, and advise yourself before the State Nursing Board?

You don't know what you don't know until you find out you didn't know.

If you are trying to save a few dollars and you are representing yourself, read up and arm yourself with the knowledge and information you need. But, when you get to that point, where your gut and instinct says:

1. I don't know what the hell I am doing here!;

2. Your license is suspended and you don't know why?;

3. You are signing legal documents from the State Nursing Board faster than you sign and cash your income tax refund check;

4. You feel as if you are backing yourself in a corner;

5. You are unsure of what you need to do next; or

6. You are becoming overwhelmed with the process

Its time to contact an attorney now instead of waiting until you are unrepresentable. Some nurse license defense attorney won't tell you this and hell depending on how the legal fees are structured some will take your case on a hourly basis at $200.00 or $250 an hour with a 5k evergreen retainer and "go as hard as" you can afford to pay if those are your wishes. Go Johnny, Go! http://www.youtube.com/watch?v=uMY5VGYh2Go

If you are struggling in a complaint investigation pending against your licnese, obtain an objective opinion or advise from a license defense attorney about the past, present, and future of your nursing license. Just my two cents!!

You received a Compulsory Order for an Examination from the Nursing Board: Retain a Lawyer, Now!!!

I don't like to beg, but in these cases I will make an exception. Please retain legal counsel ASAP. It does not have to be me but hire a nurse license defense attorney to represent you if you receive:

1. An Order from the Kentucky Nursing Board requiring a Chemical Dependency Evaluation; or

2. An Examination Order from the Ohio Nursing Board.

A.   Schedule an appt. with a nurse license defense attorney immediately after you receive the Order to review the Examination Order and your case from Day 1 until today;

B.   Seriously consider whether or not really should be representing yourself before the Board in this case. Of course you can represent yourself and you have represented yourself up to this point BUT is it in your best interest to represent yourself going forward; and

C. I don't need a lawyer because:

1. Its too expensive.

Call around and obtain a few quotes from license defense attorneys about the cost of representation. If you need to borrow the cash, take a loan from the 401K or 403B, borrow money from your in-laws or parents, etc. just do it!

2. Hiring a lawyer make me look guilty.

Really. I am a nurse and a lawyer and if I am sued, charged, or being investigated for ANYTHING, my lawyer is involved.

Don't ask if you need a lawyer in these cases start with asking yourself why would you not have a lawyer here.

These cases are some of the most serious and priority cases before the Board because the case may suggest impairment, an inability to practice nursing safely, and other issues and you are representing yourself without  a sense of urgency.  

Hell just writing this blog post and the mention of an Examination Order from the State Nursing Board makes me nervous. I always take a deep breath and breathe slowly when I review an Examination Order from the State Nursing Board. Those docs are never nice.

You say hiring a lawyer makes you look guilty well I am honest (unless I am lying) and continuing to represent yourself in some complaints before the Board especially when Compulsory Orders have been issued is mind boggling.

How in the hell can you maintain the objectivity needed to represent yourself when an Order for a Chemical Dependency, Mental Examination, Behavioral Examination, Physical Examination, or Psychiatric Examination has been issued by the State Nursing Board?

In this cases and I am a seeing more and more and more, when I quote a fee I am going to do the following:

1. Take my usual flat fee range and multiple it by 3;

3. Substract $556.55 because the fee looks a little heavy;

4. Add the cost for extra Pepsi and Mountain Dew for 2-5 years; and

5. Divide by 1.5 which is the number of vacation days I have for 2011.  

Verified Response to a Kentucky Board of Nursing Complaint: Why is this a big deal and the real deal?

The Kentucky Nursing Board isn't playing with nurses involved in disciplinary investigation before the Board.

When you open the mail and receive the Notice of Complaint, you won't here a violin in the background and you certainly shouldn't have a picture of you and the Kentucky Nursing Board investigators meeting for afternoon tea if your investigative meeting is schedule after 12noon or chatting about the details of the complaint over coffee if your investigative meeting is scheduled in the morning.

I love it because it out there and in your face. It says Notice of Complaint and it required a Verified Response. The Board requires a Verified Response to a Complaint filed against a license within 30 days of receipt of the Notice of Complaint.

Why is this a big deal?

Well let's see. The rationale for a Verified Response to a Complaint is simply:

1. You have to verify what you are saying to the Board in response to the Complaint is accurate. No more just saying whatever to the Board.

2. The Verified Response must be notarized. This is significant because you are legally attesting to what is stated in the Verified Complaint on the date the response is notarized.

3. If you don't respond or respond with false or inaccurate information, this can lead to other alleged violations of the nursing law and rules.

Why is this a big deal?

1. This tells me as a license defense attorney that some nurses (certainly not all but enough) have been submitting statements to the Kentucky Nursing Board which are not accurate; and

2. This tell me as a license defense attorney that some nurses (certainly not all but enough) have been dishonest, deceitful, and deceptive with the Board in complaint investigations.

Dishonesty, Deceitful, and Deceptive= Dumb, Dumber, and Dumbest IMHO in licensing Board cases. This is why one should really consider having legal representation instead of representing yourself before a State Nursing Board.

Just saying anything and just putting anything in writing doesn't cut with a Verified Response to the Notice of Complaint.

Pardon my french, this is strictly my opinion, and if asked (unless I am asked in a Verified Response to a Notice of Complaint) I will lie about it; a 30 day Verified Response to a Kentucky Nursing Board Complaint, is the first step when differientating the sh*t from the shinola. http://en.wiktionary.org/wiki/you_don%27t_know_shit_from_Shinola

Its my job as a license defense attorney to do the same.

A Verified Response to the Notice of Complaint is fairly new and this isn't something the Kentucky Nursing Board has always done for years or decades prior. As a nurse license defense attorney,

I am actually glad to see the Board take this approach. Why?

a.  It impresses upon the nurse the seriousness of the Verified Response and that you can't just say anything to the licensing Board governing your nursing practice in response to a complaint filed again you with the licensing board;

b. You must respond and the failure to respond can be lead to more problems. This is common with attorney disciplinary investigations; as attorneys we just can't respond to a Bar investigation because the failure to respond is an issue in and of itself.

c. You must respond within a required period of time and the failure to respond within this period of time can lead to more problems. This is the consistent with Bar investigations of attorneys and some other licensing Board investigations.

d. The majority of nurses represent themselves in State Nursing Board complaints and having to respond with a Verified Response may cause a nurse to pause and consider the complaint and what is alleged and before drafting a 29 page handwritten response to the Complaint, seriously consider one's response and whether or not legal counsel would be beneficial; and

e. I like it because its, IMHO, the Kentucky Nursing Board's Miranda Warning who receive a Notice of Complaint. Please tell me you know Miranda. http://en.wikipedia.org/wiki/Miranda_warning.

The Board is saying "here's the complaint, here's what is required, and here's what can happen if you don't do what's required." Its out there and in your face.

Please tell me that you knew these cases, investigations, and adjudications were adversarial?

http://en.wikipedia.org/wiki/Adversarial_system

I love it because this is what a Nursing Board should do when a complaint is filed against nurse. The Board's role should be stated and again "out there and in the face" of the nurse who is being investigated. . 

I however would suggest one minor change to the Notice fo Complaint. It would be nice if the Kentucky Nursing Board ended the Notice of Complaint with "Do you feel lucky?" http://en.wikipedia.org/wiki/Dirty_Harry

Although I am just kidding of course with the Dirty Harry quote and I am adding a little humor, the Notice of Complaint is a big deal and the Verified Response required by the Kentucky Nursing Board is the real deal.

We live in Serious Times and so of course there are Serious State Nursing Board cases

The State Nursing Board cases and the allegations are becoming more complex.

1. Med Mal/Nursing Negligence and the State Nursing Board

If you are or will be named a defendant in med mal case listen up. Hopefully you have your own professional liability insurance to provide for your defense and for your own defense attorney to work with your employer or former employer's defense attorney.

Find an attorney you trust, who you like (somewhat), and you can work with over a period of months or years. If you need to meet with several attorneys then do so.

Also, imagine this. If you are named as defendant in a med mal case or your conduct, actions, or inactions are one of the focuses in a med mal case, chances are you are going to be reported to the State Nursing Board. Talk to a nurse license defense attorney initially.

I am seeing a trend where nurses blame their attorneys for the outcomes of the representation, counseling, and advising.

2. My Attorney Fracked Up My Case!

#1. If you call my office and you start blasting another attorney, red flags, bells, whistles, and fireworks go off in my mind. Why?

You probably won't be working with me because I am not going to be the next target. Also I am pretty good with reading clients and the issues and I know in a few minutes if this is someone I want to work with or refer out to other license defense attorneys , in Columbus. LOL.

#2. If you are not satisfied with the representation then talk to your current attorney, don't call me. I don't like that I will tell you so.

#3. Talk to your attorney and work it out and terminate your attorney and retain another lawyer. I usually don't represent nurses who have been represented by more than one license defense attorneys because this in and of itself tells me alot.

#4. Do your research and find the right nurse license defense attorney for your case. Ask questions and if necessary speak with several attorneys before you retain a lawyer. Ask for referrals from other nurses, your State Nurses Association, and conduct your own research about the attorney and the law firm. Its your license and its just that important.

#5. Just a hint. Don't call my office or any attorneys office and say to an attorney "I don't like, trust, or respect lawyers."

I am a nurse and I am also a lawyer. I was offended another nurse would call my office and be that damn rude. I wasn't surprised because nothing surprises me anymore in a nurse license defense practice. But don't call my office and tell me you don't like lawyers and then ask for my assistance. Why?

I am going to put you on speaker phone, give the phone the middle finger (I know; its so passive aggressive but I am a nurse also), and start reviewing emails. Then after five minutes, I am going to thank you for calling, tell you I cannot assist you, and refer you to the State Bar Association of What-Chu-Ma-Call-It.

This was nurse whose self-representation before the State Nursing Board was a disaster and the nurse was angry, very angry.

3. Criminal Convictions, the State Nursing Board, and Dual Diagnosis, Substance Use/Abuse, or Cognitive Impairments

When I meet with clients who have a combination of the above, I bring a pillow, cover, and Pepsi to the meeting because its going to be a long one and justly so.

You need to have attorney representation in these cases, period. There are just too many issues to consider and too many short and long-term implications for self-representation here.

4. Patient Injury or Death and a State Nursing Board Complaint

Retain a nurse license defense attorney.

5. This is your 2nd, 3rd, or 4th State Nursing Board Complaint

Retain a nurse license defense attorney. Bring your check book and a credit card.

6. APRNs and State Nursing Board Complaint

Don't represent yourself in these cases. Unfortunately I am seeing this more frequently and the consequences of not making informed decisions and thinking about the long-term and the short-term can shorten or kill your nursing career. Retain a nurse license defense attorney.

7. Nursing Students and NCLEX Applicants & Criminal Convictions

a. You don't know what you don't know.

b. Talk to a nurse license defense attorney before you submit your State Nursing Board application, please. I charge a fee for consultations; you may find someone who does not.

c. Don't rely on the advice given to you by nursing instructors, professors, and others which essentially "just submit your application, it will be okay, as you are a different person now." WTH and who in hell says this? You are NOT applying for a job at Diary Queen when you submit a State Nursing Board Application for Licensure by Examination. 

d. NCLEX-Applicants may benefit from attorney representation as well. I know your nursing program or nursing instructors didn't tell you this but I am telling you this. If you have ANY affirmative responses on your Application for Licensure you need to speak with a lawyer and schedule a consultation. Pay a few hundred dollars to find out what you are facing here instead of blindly submitting your App. Last but not least

8. Criminal Convictions and State Nursing Board Renewals

a. Schedule an appt. with a license defense attorney to discuss the renewal application.

b. Consider attorney representation in these cases.

Yes, they are just that serious.

Also if you have falsified your renewal applications with a State Nursing Board, bring your checkbook and 2 credit cards to the meeting with the attorney you retain. Don't represent yourself in these cases; its a recipe for disaster.

The Ohio Nursing Board renewal is fast approaching. We should receive our renewal applications here soon and when I do, I will post the language in the questions.

 

Client Meetings and + 1, 2, 3, or 4 friends or family members present. Where is Waldo and the dirty dirty?

Can I bring someone with me to a legal consultation?

Of course. Who you bring in to the appointment is up to you, ultimately. However, please know that there may be a point during the consultation when the attorney asks your friend or family member to wait separately during part of the consultation because their presence could jeopardize the Attorney-Client Privilege. I retained Ms. Wright. Can I can bring someone with me to my in-person meeting with her? Of course. Who you bring in to the appointment is up to you, ultimately. However, please know that there may be a point during the meeting when the attorney asks your friend or family member to wait separately during part of the consultation because their presence could jeopardize the Attorney-Client Privilege. What is the rationale? The presence of a friend, family member, colleague, partner, or spouse during initial meetings, I have found in general is helpful because these individuals can contribute significant information and details. Also these individuals are just as concerned as you are about your license, the next steps, and how long is this going to take? However, I am finding that its difficult to say "I relapsed LaTonia" to me and of course this is extremely important information in a license defense case when you have a spouse or parent present and the spouse or parent is not aware of the relapse. Its even tougher for a nurse client to say "I started an intimate relationship with Patient B immediately after discharge" and the spouse of my client who is also a RN and works at the same facility in middle management is also present. So for this reason and others (I care not to mention) its my law firm policy (I think this is only my second or third law firm policy; I have to ask Jack) effective NOW that a friend, family member, or spouse will be asked to leave the meeting at some point so that attorney can speak with her client privately. The nurse is my Client regardless of who paid or is paying my flat fee true retainer. I am representing, counseling, and advising the nurse and I don't want my client concerned about his/her responses to me or unwilling to answer my very pointed questions to the best of their ability because +1, 2, 3, or 4 are present. Its not personal but I know when I am being spoon-fed water droplets through a dirty sock during a consultation or client meeting when there is the nurse + one, two, three, or four in the room. For me its not some much of a concern with a one-time legal consultation but with the traditional attorney-client relationship and ongoing representation cases, its unacceptable. I completely understand because the details in some of the State Nursing Board cases are too hot for even cable TV at 3am. But its a waste of your time and my time if you are providing with me fluff and buff because + one, two, three, or four are also in the conference room or my office with us. State Nursing Board complaints are the real deal. The Boards mean business in these cases and I need information, facts, documents, and "the dirty dirty" from my clients so I can provide the best legal representation, counseling, and advising available under the circumstances. I also need to know the "dirty dirty" so we can formulate a plan to become "fresh and clean" or at a min. "dingy but wearable." I have to go to the laundromat and wash our comforters, the bulkier bed linens, rugs, and our dogs linen (I know) this weekend, can you tell?  Seriously Waldo couldn't find the "dirty dirty" through the layers of fluff, buff, and just plain bullsh*t I am sometimes attempted to be fed on a small spoon like its Stage 1 baby food. If you are meeting with me and I: 1. Put my head down on the table; its not because I am tired; or 2. I excuse myself, thank you for meeting with me, and ask Jack to wrap up the meeting; its not good. It takes Jack 15 to 20 minutes to even wind down the meeting, 5 minutes to summarize, 7 minutes to conclude, and another 10 minutes to walk you down or out to the lobby and then resummarize and conclude because he forgot something.  If I want fluff and buff, I go to my stylist. I have an appt. in the morning at 11am. I just revised my medical, substance use/abuse and/or mental health Intake Form for  clients, and legal consultations. This is used in certain cases in additional to a general Client Intake Form. Oh, you didn't know? Although I may not check your blood pressure and do a head to toe physical assessment, I am a nurse and I am performing others assessments in license defense cases because its a necessity.

Do I stand a chance if I represent myself? The Price is WRIGHT

I need help. I am getting screwed over royally by the State Nursing Board. I can't afford to hire an attorney. One attorney wanted 1500+.

Do I stand a chance if I represent myself??

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

Thank you for your comment on my blog. As you can see, I edited your comment as you disclosed alot of information in your original comment.

Guess what?

 You are representing yourself.

You are representing yourself whenever you have a legal matter with a licensing board and you don't have an attorney. You may not realize it, but you are already representing yourself.

You are representing yourself now, you have represented yourself in the past with your dealing with the State Nursing Board, and your representation of yourself had lead to you this point. The here and the now.

Therefore I think you have enough information to answer your question which is: do I stand a chance if I represent myself?

I don't mean to be harsh but I don't think many nurses realize that you are representing yourself before the State Nursing Board anytime you don't have an attorney and you are involved in a disciplinary investigation, complaint, hearing, or application for endorsement or initial licensure and there are affirmative responses which trigger an investigation.

But I asked the Board investigator do I need an attorney and I was told no?

Really? You are not required to have an attorney for ANYTHING because there is a RIGHT to self-representation in this country. So therefore when you ask a Board investigator, do I need an attorney, the answer is no.

But ask yourself this, if you have to ask a Board investigator do I need an attorney, do you need an attorney? Probably so. 

But I didn't do anything wrong?  

This isn't Sundary, you are not at church and we are not talking about moral right and wrong. Nursing Board investigations are about alleged violations of the State Nursing Practice Act and Board of Nursing regulations. If you want to speak of and deal with right and wrong, speak with your spirtual advisor. 

If you want to know whether or not your alleged conduct, actions, or inactions violated the State Nurse Practice Act and/or Board of Nursing regulations, then come on down, you are the first contestant on the Price is WRIGHT. Call me, text me, email me, fax me, or send me a smoke signal.   

Did your actions or inactions violate the Nurse Practice Act and/or Board of Nursing Regulations? Oh, damn, I didn't look at it like that.

There are pros and cons to representing yourself.

The best thing about repping yourself is you save money and who doesn't want to save money.

The worst thing about repping yourself is you fail to be objective, you are biased, you don't see any issues with anything, you see this as a matter of right or wrong, good nurse vs. evil State Nursing Board, east coast vs. west coast rappers, Pepsi vs. Coke (let's not even go there, pumpkin with the Cola Wars today), you rationalize your actions or inactions, you minimize your actions or inactions (what about those nurses who steal drugs?) and /or frankly you can't "see me" i.e. yourself when you represent yourself. Are you Tupac?  

That's why attorneys are told to never represent themselves. An attorney who represents themselves has a fool for a lawyer and a client. We were told this in law school.

I don't have money to hire an attorney?

This is income tax refund season and you can ride through certain neighborhoods (like where I grew up) and see all the new "30 day" temporary tags on vehicles. Why? Tax refund checks. I smile when I hear I am getting "4k", "8k", or "3k" back.

But honestly I love watching the Income Tax Refund Mania from January to April of every year. Your average person goes "willy nilly" with a refund check and buys flat screens, designer clothes, etc.

Are you pimping your ride, your home, or your kids out with your tax refund this year? I have a better idea.

Why not use your income tax refund to hire a nurse license defense attorney? As a bonus, this also helps to stimulate the economy because I am going to Walmart, Big Lots, Bob Evans, and Kenwood Mall for clothes and shoes. I may also gamble a little and help the ecomony in Indiana as well. I may also get a manicure; I can't do tips or any artificial nails because I type alot and hard.

Do you know I type so hard the letters are missing from my most used keys on my external keyboard? I know. I can't wait until Spring so I can start walking outdoors again, kicking trees, breaking sticks and branches, and throwing rocks at passing cars until I am tired again.

No seriously, if I am talking to a client and typing at the same time, I will hear, "oh my God, that's not you typing is it?" I will say no, that's just me eating a ear of corn.

Okay back to my point, you can't afford NOT to hire an attorney at this point. Your attorney can't change the past but the attorney can counsel and advise you going forward on your options so that you are making informed decisions.

If you are going to rep yourself, put your options (oh, you may not know your options because you are repping yourself) in a magic hat and pick one. Or flip a coin, "heads" I met with the State Nursing Board investigator without an attorney "because its just an investigation" or "tails" I bring my best friend who is studying to be a legal assistant with me to the meeting.

This way with the magic hat or flipping a coin, you can blame "everything that happens thereafter" on "chance" and not your decision to retain legal counsel at the beginning or initial stages of the State Nursing Board matter.

In all seriousness, the slightest discipline against the license can have long lasting implications and consequences on a nursing license. Hire an attorney to work with you throughout the process and to be on your team throughout your nursing career. Consider having Nursing Practice Counsel.

We are getting to the point with the legal, regulatory, clinical practice, employment, and other issues in nursing where I think RNs especially APRNS should have their own personal legal counsel for practice issues like physicians. But that's another post.

Boundaries in the Attorney-Client Relationship: Betrayed Trust. Today & Tomorrow

The attorney-client relationship is built on mutual trust. The seeds for trust start either by phone or with an in-person meeting and then develop and mature over time.

I have a client who has been lying to me. Not just white lies, little lies, or your average lie, but lying to the extent that the person doesn't know where the truth stops and the lies start. 

I always establish and maintain boundaries with my law firm clients because being friends with a client is a NO NO because its harder to provide objective advice, unbiased counseling, and give someone the "cold hard facts" and the "low & lovely legal" when you are friends.

Nurse license defense is intense; well it is in my law firm. We work closely with our clients and over the weeks, months, or years (yes, pumpkin, years in some cases) the seeds of a friendly attorney-client relationship are planted. Some of my cases, we are working together just a few weeks or months with phone calls, several meetings, and that's it while others are weekly calls, monthly meetings, emails, and text messages. It just depends.

Also this isn't a law firm factory where we have 500 cases pending at one time and a swarm of lawyers, paralegals, and secretaries servicing a case. You call the office, you speak with the receptionists. Then there is Jack and there is LaTonia. I get to know my clients and their cases.

There are clients with nicknames like Big Lot Betty, and The Jam Lady (who is paying for her legal defense with jars of homemade strawberry jam) and others. I had a client send me a wedding present and the gift sits right next to our wedding certificate in our entryway. I receive Christmas and birthdays cards from the clients. I had one client send cookies (and this person knew I was dieting) on our 1st wedding anniversary last summer. I am a nurse and I represent nurses so it can get a little emotional or personal at times. Its the nature of the beast.  

My husband asked me last week, why don't we have a pool party for your clients here this summer?  I told him by the time, I had everyone sign the appropriate disclosures, waivers, disclaimers, and I had everyone essentially sign a document essentially saying "we are not here and this didn't happen" that it wouldn't be a very fun pool party. I can't imagine a pool party without alcohol and I certainly couldn't serve alcohol at a pool party with nurse license clients. 

Why? Alot of my clients are in Board of Nursing Alternative Programs or have Agreements, Orders, or Contracts which require UDS and prohibit the consumption of alcohol.  

Imagine, a Notice of Opportunity for a Hearing from the Ohio Nursing Board suspending the license of Nancy Nurse for violating her Consent Agreement:

NANCY NURSE in her statement to the Board indicated she attended a party given by her attorney on May 31, 2011. She consumed several fruity colorful and extremely well made beverages shaken, stirred, and/or blended by attorney. NANCY NURSE as she backed out of the driveway of attorney's home at 4am was pulled over by a police officer on a bicycle and was arrested, charged, and convicted of felony OVI in just 3 days.

Also in violation of her Consent Agreement, NANCY NURSE submitted to a UDS on June 1, 2011 and tested positive for alcohol and Tramadol. NANCY NURSE has a history of alcohol dependency. She does not have a legally valid prescription for Tramadol. NANCY NURSE states that someone at the pool party gave her a pill for a headache and NANCY took pill because in the direct sun it resembled "Ibuprofen when wet." 

This is just a hypo folks. But you can see why entertaining clients sounds nice but no, pool party at LaTonia's.

Betrayed Trust.

I was angry. I was upset. However I was angry and upset because I was hurt. But I realized today its more than just hurt feelings or a bruised ego; its betrayed trust. This nurse betrayed my trust and it hurts.

Actually I expect lying, deception, deceit, and dishonestly in PERSONAL relationships with friends, relatives, and others because its human nature. But I guess this is where I struggle to connect human nature with the essence of nurse legal defense and counseling and advising because I do not expect my clients to lie to me; I expect this behavior in personal relationships but not professional service relationships. Yes, it happens but I don't expect it.

Why? I assume my clients want to provide me with helpful information for their defense. 

You tell me but what a##wipe would:

*Intentionally lie, deceive, and/or provide inaccurate, incomplete, or otherwise untruthful;

*Materials, documents, statement, or verbal representations;

* To the nurse license defense attorney;

* Providing legal representation before a State Nursing Board;

* Counseling and advising the nurse on the implications of a complaint and the implications and consequences of The "D" (discipline); 

*When the Advice, Counseling, & Representation provided by said attorney is oh so DEPENDENT on the instructions of the client?

Bottom line:

Attorneys exist to serve the public and provide a service. The case belongs to the client. I tell my clients, its your case and its your license and I explain my role.

An attorney represents, counsels, and advises you based partyly or primarily (it depends of course) on the information you provide. You are paying the attorney for this service. Therefore, why would you lie to the person you are paying thousands of dollars for a service? Are you nuts?

If I did nurse license defense just to pay the bills then I might feel differently. But nurse license defense is more than a job to me just like practicing law in a law firm limited to nursing and nursing law issues is more than a niche to me.

I have a client who betrayed my trust and it hurts. Like anything else, this too will pass but it is what it is today. Today, my feelings are hurt and I feel a pinch in my chest today.

 But because it hurts today, this lets me know that I care about my clients and their case and their license, today and tomorrow.

 

 

 

Bills, Bills, Bills, and more damn Bills: I don't have money to pay for a legal consultation

Okay, January is always a rough month for most of us because credit cards statements come in from the manic shopping sprees not to mention property taxes in some states (like Ohio; we just received the property tax bill for our rental property), grade school or college tuition payments, estimated tax payments (don't even get me started), and other bills.

Its Bills, Bills, Bills, and more damn Bills in January. What a way to start the year, right? But unless you are filthy rich, bills, bills, bills  and more damn bills is part of ordinary life.

However bill, bills, bills should not put on in an "analysis paralysis" and stop you from seeking legal advice and counseling.

How do you know that you need legal advice and counseling and maybe representation despite bills, bills, bills, and more damn bills?

1. You receive a Notice of Complaint from the Kentucky Nursing Board and you slap your husband in the face because you think he mistakenly filed the divorce petition (you have been waiting on) with the Kentucky Nursing Board;

2. You receive a phone call from an Ohio Nursing Board investigator. You return the phone call after you "smoke" because you want to be "loose.";

3. After a bar brawl, which was not your fault, although you have a BAC almost corresponded with your college GPA (non-nursing courses of course)  you tell the arresting officer and every officer in the station that  "I am a RN at ______ Hospital on the ____ unit and I am going to have your badge" so many times that the Chief of Police contacts the State Nursing Board to verify that you are really a nurse because according a bartender you can "throw a mean right hook"; and

4.  You appear for your licensure reinstatement hearing before a Board Hearing Panel with "an attitude."

Even if you have bills, bills, bills, and more damn bills, you may have to go  "cheap and dirty to get the skinny." Get your mind out of the sewer, this is a legal blog.

Cheap and dirty is a legal consultation. Its cheap because you are spending a hundred dollars or so for a consultation vs. several thousands for a retainer or flat fee for traditional representation.

Its dirty, not in the filth sense of the term, but dirty meaning "worse case scenario, best case scenario, and everything in between" that you can obtain in 30, 60, or 90 minutes; almost like a speed date. The skinny = options.

Bite the bullet and seek a curbside legal consultation if you have burning questions or issues related to your nursing practice or license. Yes, it going to cost you money, but your sanity and your piece of mind are: priceless.

I wish I could help everyone who contact me; I really wish I could help everyone. Jack reminds me all the time that we can't "save" everyone. I want to save everyone even if its from themselves; this is the nurse in me. I know it because I want to help everyone who contacts my office.

However I cannot provide legal advice or counseling without establishing an attorney-client relationship: either as a legal consultation or retaining me for a traditional attorney-client relationship. This requires the payment of a fee.

Bills, bills, bills, and damn more bills.

 

 

DUI/DWI/OVI, whether its one, two, three, or four: Seek Assistance

If you are a LPN, RN, or APRN and this is your first, second, three, or fourth DUI, OVI, or DWI charge, listen up.

1. Hire a criminal defense attorney who specializes or "limits" his or her practice to traffic and driving offenses or find an attorney with years of experience in criminal defense including DUI cases.

There are attorneys who practice nothing but traffic and driving law like:

Chuck Strain, the DUI Guy, here in Cincinnati.

See http://www.duiguy.us/

2. Talk to and more importantly listen to a license defense attorney to determine IF there are any licensure or regulatory implications.

3. If you are diagnosed with a chemical dependency, follow the recommendations. If even you were not diagnosed with a CD and you think you have a problem, then you have problem.

4. Its important to talk to friends, family, and colleagues but when you are licensed professional and something legal slaps you in the face, consult with an attorney. Having a state issued license distinguishes you from your neighbor, who has a "good job" but isn't licensed. Licensure is another ball of wax.

Something as simple as the following:

Let's say you are out celebrating and you have too much to drink at a local bar. You are a Respiratory Therapist and RN and you have to be at work at 7am and its 1am. You do this 1x a week and you know your limit. Your plan is to get home by 2am, sleep until 6am, and request a light assignment at work the next day because of your asthma.

You are a good nurse. Recently divorced but in a good relationship now. One child. You were elected to the school board several months ago. You come from a good hardworking middle to upper class family involved in public service and fundraising.

Good student in undergrad. You are a working on your masters in nursing and will finish next semster with your Acute Care NP. You work on an adult med-surg and telemetry unit and have worked on the same unit for 12 years. You also work prn at the local childrens hospital. You are also in the Hospital's elite float pool and you can float anywhere and practice: from the ICU to the ER without issue.  You just received your CNIII and received the Hospital's award for nurse of the year two years ago.

You have to urinate but you are unsteady to go back into the bar and wade through the herd so you decide to urinate outside towards the back of the bar.

You fall asleep while taking care of business. Your friends leave as they assume your cab picked you up because they don't see you. You awake after being handcuffed by two police officers who found you after a report was called in by a bar employee emptying the trash.

You are arrested and charged with:

1. Public Intoxication;

2. Disorderly Conduct;

3. Lewd Conduct; and

4. Incedent Exposure; and

5. Having the tongue on your right gym shoe out and your shoe lace untied in public.

WTH! The County Prosecutor thinks you are a sexual offender and is pissed because her kids elementary school is less than a block from the bar; a bar she and several citizens have wanted to close for years because of bar fights, crime, and a homicide last year. This may be the sensational story needed to revoke the bar's liquor license and campaign is being mounted by a local but very active citizens value group.

The charges made the local newspaper and radio as someone from the bar recognized you as a school board member and a nurse from the hospital.

A complaint is filed with the Nursing Board because of the seriousness of the charges and that you work in a pediatric hospital.

The childrens hospital takes you off the schedule until the case resolves.

At your primary position, you are meeting first with your union rep, the union president, and the union's labor attorney after your release from jail. Later that afternoon you are meeting with HR, your manager, and the CNO.

The School Board has called an emergency meeting and wants to meet with you and your attorney.

You are still in a daze thinking how did it come to this?

 

Is Law School a Losing Game? The Nestea Plunge

If you are a nurse in considering law school or enrolled in law school, please take a look at this article which was published in the New York Times yesterday.

http://www.nytimes.com/2011/01/09/business/09law.html?src=busln

I receive a number of inquiries from nurses considering law school each month and I respond to those inquiries by saying "do your research and consider your options" before you apply and take the plunge.

Law school IMO is a Nestea Plunge. http://www.youtube.com/watch?v=6rqRx__HI9c

Even if you take the Nestea Plunge and there is water or tea behind you, you feel as if you are drowning and you have to come up for air first; then you have to swim to shore or edge of the pool; and this takes sometime as well.

Although it is one of the best decisions I have made, I took the plunge in 1994 and I graduated in 1997. It was not an easy journey from nurse to law student to law school graduate to attorney in a large firm to attorney in her own firm.

Also this is 2011and it is a different market for law graduates not to mention the  cost of legal education vs. your salary as an attorney. Believe it or not, there are nurses who make more money than attorneys.

 If your goal is too make money there are easier and faster ways to make money than a law school degree, especially for nurses. Nurses can get a MSN and do the CRNA or NP route or start a business providing healthcare-related services.

If you want to practice law, then go to law school but here is my advice for nurses:

1. Keep your law school debt to a min; don't MAX out with student loans.

2. Continue to work as a nurse while you are in law school to pay for your education and increase your marketability after graduation;

3. Consider attending law school part-time and working full-time or part-time as a nurse;

4. Network your a** off while you are in law school and attend as many functions as you can, participate in law school clinics for practical experience, and try to clerk during the summers for a law firm or another agency for the experience and extra cash;

5. Choose your law school carefully. There are tiers of law schools and this can be important depending on your plans after graduation and your career path. Consider the tier of the law school vs. your plans for the future. Don't select a law school just because you received a full scholarship. Do your research.;

6. Develop a 5 year plan for law school and post graduation and include this in a law school journal/diary so that you can track your progress.

Don't Black Swan or Black Cob yourself just for the hell of it! http://www.imdb.com/title/tt0947798/

7. Consider other graduate level degrees including an MBA, MSN, MPH and the JD. What are your goals and what is your career plan?

8. Research nurse attorneys and nurse lawyers. Review the blogs and websites and other information;

9. If you want to practice law (criminal, family law, personal injury, med mal, etc.)  spend a day at the courthouse and observe the attorneys and court personnel; and

10.  Ask yourself how do you plan to combine the nursing and the law and then try to find an attorney in your area to mentor you while in law school.

Bottom line: Don't take the Nestea Plunge without a pool of water, tea, or Kool-Aid behind you.

Family Drama and Criminal Convictions and Dispositions: Just Take a Deep Breathe and Repeat "This too shall pass." It works!!!

This has been a very dramatic holiday season like most others in my family but I have learned this is "normal" when you have a large number of immediate and extended family members living within a 10 miles of each other. I have 100+ family members within 15 miles of my home. Its the best of times and it can be the worst of times also.

After this Holiday Season starting with Halloween and ending finally with New Years Day, I can honestly see why Assaults, DVs, Disorderly Conducts, Batteries, Public Intoxs, and other criminal charges occur around the Holiday Season.

So when a nurse tells me a story that ends with an immediate or extended family member being slapped or a swearing match and the police were called around ANY holiday (I use the term holiday loosely to include Valentine's Day, St. Pat's Day, ect.), I as a nurse license defense attorney don't think Oh, God, how could this happen or why did you do this?

I always think, wow! This could have been me. This is similiar to what I wanted to do _____ days, weeks, months, or years ago to my ____ at my _____  5th____ party! 

Life happens and I make a good living because life happens and the person just so happens to have a nursing license or wants a nursing license.

Just take a deep breathe and repeat "This too shall pass", then sit down, take off your shoes and socks, and count all of your toes and repeat this 10 times. After sitting on the floor counting your toes, this calms you down and you will suddenly realize what you have to lose and what all you are risking with this encounter and you will laugh. Everyone else will give you 10-20 feet of space now because they think you have finally lost it.

You are a nurse 24 hours a day/7 days a week/365 days a year.

I am a nurse and an attorney 24 hours a day/7 days a week/365 days a year.

Enough said! Don't blow your stack. Its soooo easy to step in dog crap, but its very difficult to get the crap off your shoes and it takes even longer for the smell to dissipate.

NYE is here and NYD is coming: Write my cell phone number on your arm with a crayon!

I will tell you because I am as honest as a defense lawyer can be (today).

License Renewal (May to August, especially Ohio Nursing Board RN renewals) and NYE/NYD licensure issues are like Christmas for me a nurse license defense attorney because of the number of consultations and clients retained. 513-604-9330

What do I mean by NYD? New Years Day. We all put things off and responding to Nursing Board complaints usually goes on the back burner for most nurses until after the holiday season. So that's means, its on, moving, grooving, and shaking starting January 1st.

But January 1st falls on a Saturday this year. Damn. 513-604-9330

Guess what? I am working this weekend. I mean all weekend.

What do I mean by NYE? New Years Eve; that's today. Oh you know.

1. You are in Board Alternative to Discipline Program for Substance Abuse and you have a few drink or you party like a rock star (including heavy drinking and maybe some snorting or pill popping).

2. You are on probation and monitoring with the Board and have random UDS but you decide to "go hard" anyway and roll on X;

3. You are having a ball with a close group of friends and someone breaks out "the weed." You know you work in a facility that does random screens but you decide to "puff, puff, and pass" the weed anyway; or

4. You are out with friends and your neck, back, stomach, and/or big toe starts to cramp therefore you pop a few of your second cousin's best friend's baby mama's Percs. No big deal right until the Pyxis count or Narc sheet is off and the facility tests UDT (urine drug tests) all of the nursing staff with access. The Medical Review Officer asks do you have a prescription for ______?

Have fun on NYE but don't take it too far. But if you go too far, just call me. I will listen and I will not judge you but you have to pay me; sorry estimated taxes and property taxes are due in Jan.   

If you need a telephone legal consultation because of NYE, I am available but its going to cost you more because I am working on law office case projects this weekend.

Just pay $250.00 for a legal consultation on my website and call my cell phone at 513-604-9330. See http://www.nursing-jurisprudence.com/onlinepayments.html. That's right its 513-604-9330

The number again (like in the commercials selling a product for a limited time for $19.95 in 4 installments billed directly to your credit card) is 513-604-9330. That's my business cell. Again that's 5-1-3-6-0-4-9-3-3-0.

If you were:

1. extremely naughty on NYE and you wake up with a hangover and legal drama with license and practice implications;

2. "balling out of control" on NYE and you have a DUI/OVI/DWI and/or other criminal charges; or

3. if you put off responding to the Notice of Complaint from the Kentucky Nursing Board or the Potential Violation Report from the Ohio Nursing Board until after the holidays and you need to meet with me ASAP; call my cell phone for an appt. Its 513-604-9330. 

One more time as you may have started sipping Barefoot Bubbly Moscato Spumante at noon today, that's 513-604-9330.

http://www.barefootwine.com/our-wines/overview/bubbly/MoscatoSpumante.html.

We served this at my husband's open house for his new business location on Wednesday night. We had maybe 60-80 guests at our open house and we had 18 bottles of Moscato Spumante Bubbly: six toasts. Let's just say, I didn't practice much of any law on Thursday. 

One of my grandmothers said the next day, "Tonda (she doesn't call me LaTonia or Tonia), that was a "party" not an open house.

No, really? I knew it was a party when one of my brothers yelled out at 11pm, "I am Gucci wasted on a Wednesday" and then proceeded to drink champagne and chase it with beer.

I thought an open house was a party!  Yes, we partied on a Wednesday and at 39 y/o (unlike 29 or 19) I am still feeling it on Friday. The open house was 7pm to 9pm and our last guests, my BFF and her fiance left at 2am.

Whether its NYE or NYD license, practice, criminal, or employment issues for you, I am available to assist you. If we are meeting in person at my Cincy office, just bring enough bottled water and McDonald's Apple Dippers for us both as a snack. 513-604-9330

And no, I am not having my cell phone number changed later today:) My son thinks I am lame for keeping the same cell phone number for 10+ years. One of my sisters told me "604" cell phone numbers are not every obtainable anymore. According to my son its fashionable to change your cell phone number every 6-8 months or after a breakup.

Really? I have 5 numbers for some family members and friends saved in my contacts because who has the time to figure out your right number anyway; I don't. I now save the cell phone numbers of certain family and friends as "Jane Doe Dec 2010 cell." I am not kidding because so many people change their cell phone numbers like they change their underwear: once a day, week, month, or year.

I have had the same cell phone number since 1997 and I am pleased to say this. I know its corny but I can still say it on my blog.

In all seriousness, be safe this NYE and have a wonderful NYD!!!! 513-604-9330.

Deuces!

You open the mail expecting a million dollar check from Publisher's Clearinghouse and find a complaint from the State Nursing Board!

Don't panic. The Board is providing you with "notice" which is required by due process that a complaint has been filed against your license with the State Nursing Board.

Go ahead and scream, cry, curse, and put on a pair of steel toe boots and kick the shi% out of your printer. I kick my printer when I am angry; its healthy. Although, I can tell you I am less likely to kick the $800 color laser printer I have now than I was to kick my $100 black/white laser printers.

Then call your mom, BFF and significant other and scream, cry, curse, and rationalize your damage to the printer.

Take a day or two to gather your thoughts and review the information you received from the Board. Okay, now you are ready to proceed. Don't wait until a day or two before a response is due to the State Nursing Board to contact an attorney.

I will tell you what some of the Nursing Boards won't tell you. A complaint has been filed and this is a legal matter and case. This isn't a criminal case or a civil case but it is an administrative law case. It is a legal case.

Anytime you have a legal case, you have two options:

1. You can represent yourself and proceed pro se.

This is always the fastest, easiest, and cheapest way to proceed. If you want it quick and free, just fire off your response and see what happens. OR

2. You can have an attorney to represent you.

In order to proceed with # 2, you need want to investigate whether or not you:

1. Want to hire an attorney; Some nurses know from the beginning that they want and plan to retain an attorney; its just a matter of which attorney.

2. Should hire an attorney; Some nurses suspect they may need to hire an attoreny but are really not sure what are the pros/cons including the fees/costs. 

What are my thoughts?

1. If you are going to hire an attorney to represent you before the Board, research a variety of attorney websites, contact your State Nurses Association, etc.

2. When you speak with the attorney, find out if the attorney has handled cases similiar to yours with the same or similiar issues.

If not, then you should note this and then contact another attorney. You want someone who has experience dealing with your issues especially if those issues will result in discipline whether by agreement or after a hearing.

In some cases discipline is coming like Santa Claus its just a matter of how and when!

3. Going for an attorney who is the cheapest or less expensive isn't necessarily how you want to select your nurse license defense attorney. This isn't the Value Menu at McDonalds.

If an attorney quotes you a higher fee than average, then you should ask why? The attorney should be able to tell you.

4. If you are going to hire a lawyer, hire a license defense attorney who represents and counsels nurses. You want someone who practices before the State Nursing Board regularly.

5. If you are going to represent yourself then do your research and be prepared.

a. Don't later vent on the online nursing forums and chatrooms about how evil the Nursing Board staff and members are if you don't get the result or outcome you want.

b. Its not a good idea to rep yourself before the Nursing Board when you have pending or forthcoming criminal charges.

c. Its not a good idea to rep yourself if you are licensed in more than one state.

6. If you have a pending criminal case and you know it will result in a conviction, diversion, etc., consult with a nurse license defense ASAP. A license defense attorney can discuss the criminal implications with you and also communicate with your criminal defense attorney. Don't wait until the criminal is resolved and you are contacted by the Nursing Board.

7. Don't assume your criminal defense attorney has experience representing nurses before the State Nursing Board. You may need to retain a license defense attorney also.

I have one case in particular where a nurse relied on the advice of his/her criminal defense attorney who was clueless about the licensure issues and this resulted in serious, I mean serious, discipline.

I am upfront. I don't handle criminal defense cases and I don't sue healthcare organizations. I do nurse license defense, nursing law, and health law and admin law cases involving nurses and other licensed HCPs. I routinely refer nurses to criminal defense or employment law attorneys.

This economy ain't the best and some attorneys see license defense as a way to make a quick buck because let's face it: licensed healthcare professionals usually have more disposable income than your average person who may earn $9.00 an hour.  

8. If you have professional liability insurance with a license defense protection benefit, make sure it will allow your attorney to paid monthly as the case progresses. Some attorneys won't accept the assignment of your benefits in license defense cases without some type of payment upfront because the attorney is essentially "bank rolling" your case for months or years until its resolved and then the attorney can submit a bill for payment to the insurance company.

This may not seem like something that is important now but it can be when you are searching for attorney to represent you before the Nursing Board and all of the attorneys you speak with won't accept an assignment of your insurance benefit without some type of payment initially.

Think about it. Can you afford not to be paid for several months or years? Most attorneys cannot either.

I must admit, the majority of my cases are private pay and the nurse doesn't have professional liability insurance. However I do have a number of cases where the nurse has insurance with Marsh Affinity/Chicago Insurance or NSO/HPSO.

9. If you are going to represent yourself at least schedule a consultation with an attorney to discuss the allegations in the case before you proceed. At the most this will cost you a few hundred dollars.

Don't just fire off a 80 page handwritten response to the Indiana Nursing Board complaint, Kentucky Nursing Board complaint or the Ohio Nursing Board potential violation report.

10. Take a deep breath. Its going to be okay. If you received a complaint or potential violation report in the mail, don't panic. Take another deep breath. Take a swing of Pepsi and chase it with a shot of water with a twist of lime. Now that you feel better you can start doing your online research.

 

Ohio Board of Nursing: Notices of Opportunity for Hearing issued November 19, 2010. Is it hot in here or is it just me?

I am looking through the Notices issued at the November 19, 2010 Board meeting last month this afternoon. Holy Moly Batman!

What initially struck me was the number of the Notice cases in which the nurse or DT doesn't have attorney representation. Notice cases are the more serious cases before the Ohio Nursing Board and the majority of the nurses in these cases don't have attorney representation.

Also what struck me more so than in other months with Notices cases were the severity of the allegations in the November 2010 Notices. I haven't seen cases this serious since Sept. 2010 when I believe the Board issued 90 Notices and I posted on this blog.

The November 2010 Ohio Nursing Board Notice cases included:

1. Illegal Processing of Drug Documents and Theft of Drug convictions;

2. Felony convictions which trigger the ever-expanding moral turpitude standard.

If you pass gas in the check out line at Kroger's (a few hours before a major snow storm) and you fan it to the person in the back of you is this considered moral turpitude?

I think it should be as this is what happened to me over the weekend. I didn't appreciate it one bit.

3. Fact intensive misdemeanor convictions;

4. One individual is noticed who allegedly did not graduate from high school but has a DT and RN license.;

5. A "hit and run" or two;

6. Several positive drugs screens with no legally valid prescription;

7. Board of Nursing action in another state;

8. Falsifying renewal and initial applications for licensure;

9. NCLEX Applicants with criminal convictions;

10. Professional Boundaries;

11. Home Health fraud and documentation issues;

12. Professional Sexual Misconduct;

13. Unsafe nursing care allegations; and

14. garden variety practice issues and mishaps which are reported to the Board.

I recognize some names as nurses who have contacted my office. I have a good memory and sometime all it takes is the full name or a glance at the allegations in the Notice. A quick search of our SAAS law practice management system confirms this. I then compare my initial notes and documentation with the information in the Notice. Interesting!

I saw one case in particular that I have been expecting to see. This person contacted my office when already represented by counsel seeking answers to questions. I referred the individual back to his/her attorney of record. Don't try to pay for a $150.00 consult with me (to answer questions the attorney you retained should answer) when you have already paid another license defense attorney a retainer fee. Not here, boo boo.

I quoted the individual a high fee because I knew the case was complex and the nurse was a shopper. By a shopper, I mean a person who contacts multiple attorneys for advice, counseling, and possible representation or a nurse who has been represented by several attorneys.

Shoppers are a red flag for representation because the things they say about their former attorney (1st or 2nd attorney) will be the things they say about me (their 2nd or 3rd attorney) to the attorney they hire after I terminate them or discharge them or they discharge me (3rd or 4th attorney).

Speaking of red flags, I just terminated a client who I spotted as a "red flag" initially but the facts of the case were so very interesting. I take on a limited amount of red flag cases. What are red flag cases? I will post on this later in the week.

Back to shoppers. I can spot these folks a mile away and I quote high fees. I have had more than 10 shoppers this year and I can remember them all by the fact patterns.

Also looking at 2010, I can tell you I am seeing more and more complex cases involving the State Nursing Board(s). I am seeing more issues with falsification of renewal applications, criminal convictions and practice issues with LPN and RNs and I am seeing more complaints being filed against APRNS in Ohio, Kentucky, and Indiana.

Now, back to the Bat Cave!

 

Ain't Nothing Like the Real Thing Baby and its called Legal Advice, Guidance, and Counseling

http://www.youtube.com/watch?v=svAs-6MiqxE

Several singers proclaim "ain't nothing like the real thing" including the Stylistics, Marvin Gaye & Tammi Terrell, the Jackson 5, Elton John, Beyonce, and others.

I spoke with a nursing student last week who had been given different advice by his friends, family, nursing instructors, and a general practice lawyer related to criminal convictions, clinical sites, licensure, and employability.

The advice given wasn't accurate and was all hedged on either " I am not a lawyer but" or "This isn't my area of my practice however." A one hour consult with me answered all of the questions and concerns.

An attorney-client relationship requires the payment of a fee and this is free:

1. If you are considering nursing school and you have concerns about whether or not your background will be an issue, do the following:

a. go to the State Nursing Board website and download the application for licensure by examination.

b. if you have affirmative response, contact a license defense attorney or nursing law attorney.

2. If you are currently a nursing student and you have concerns about whether or not your background will be an issue with licensure and employability, or future career plans, do the following:

a. go to the State Nursing Board website and download the application for licensure by examination.

b. if you have affirmative response, contact a license defense attorney or nursing law attorney.

3. If you are a LPN, RN, or APRN and you have concerns whether or not a recent criminal convictions or other issues will result in a State Nursing Board investigation, do the following:

a. contact a license defense attorney or a nursing law attorney.

b. I am always surprised by the number of nurses as licensed professionals who turn to online boards and forums for legal advice, counseling, and guidance instead of contacting a license defense or nursing law attorney. Yes, it may cost you a bill or two ($100) but you have what you need.

Nurses are licensed and although the debate still lingers about whether or not nursing is a profession (no standard entry level to practice), we consider ourselves professionals. 

 http://www.americannursetoday.com/BlogView.aspx?bl=6268&bp=6960  

Healthcare is highly regulated which is why the healthcare organization you work for has in-house attorneys to focus on the daily needs of the organization and outside legal counsel for overflow and more specialized legal needs of the organization that can't be done efficiently by in-house lawyers.

Lawyers are a must in healthcare now more than ever and this need is slowly trickling down from healthcare organizations and business to business transactions to individual licensed healthcare professionals who practice in or do business in healthcare. 

I put Equal in my coffee yesterday instead of sugar and it just didn't taste right. It was okay and I could get by with it but I knew it wasn't my usual and I questioned why I used Equal. I even told myself it was the same but it wasn't. I had a headache yesterday and I wondered was it because I used Equal in my coffee instead of sugar. I was cranky yesterday and I wondered if it was because I didn't get my coffee fix just how I like it: heavy, heavy. I am drinking coffee with sugar this morning.   

There ain't nothing like the real thing. If you need legal advice, counseling, or guidance, contact a state licensed attorney who practice license defense or nursing law. There is no substitute and as licensed healthcare professionals nurses IMO need to see legal counseling or representation as "a cost of doing business" which is inseparable from the privilege of practicing in a highly regulated healthcare environment and workplace.

I am not advocating nurses keep lawyers and law firms on retainer like healthcare organizations  because this is cost prohibitive however nurses need to understand when legal issues arise, you can't always turn to your employer for "what's in your best interest", this is the role of your OWN personal legal counsel.

The writing is on the wall but you are pretending you can't read it: Is it time for you to develop an "exit strategy" with your current employer?

Sometimes its time to move on and for some of us RNs and also LPNs we adopt a philosophy of the following:

1. Its my unit;

2. Its my hall;

3. These are my residents;

4. I am innocent and I didn't do anything wrong so why should I leave;

5. I will "wait it out" until this DON, administrator, unit manager, CNO, etc. leaves;

6. You are right and they are wrong and you are staying here to prove a point and based on your principles;

7. Any other excuse we make to stay in a position we now isn't working out.

If its not working out for you, then move on. Its just that simple. Apply for other nursing positions with the same, similiar, or better pay, benefits, and hours and move on. Its your nursing license that's important not your employment with a specific facility because they will "term you and report you to the State Nursing Board" faster than you can say "But I have worked here for 10 years as a RN, 3 years a LPN, and 5 years as a CNA."

The writing is on the wall but you are pretending you can't read it.

I know you have friends and colleagues who you have worked with for years or decades but sometimes its time to move on and I see this with alot of nurses I speak with in legal consultations or representation.

You can't spot the signs, then I can for you. Schedule a consultation with my office and we can talk about it. No job (and its essentially what you have with your current employer) is worth being terminated and then reported to the State Nursing Board. You are a nurse and you can nurse anywhere in your state not just with your current employer. I can assist you with your exit strategy and I do it routinely.

Don't adopt a "do or die" or "do or die trying" approach if you are working in a dysfunctional nursing environment. Cut back to part-time or prn to keep your foot in the door and then secure employment elsewhere.

Honestly this is why I never worked as full-time RN with any facility because of the drama and the work environment you experience when you work in a female dominated profession like nursing. Its a roller coaster ride. I always worked part-time or prn with one or more agencies because if I want FT drama and soap opera like behavior I get plenty in my large extended family (the majority of us live within 10 square miles of one another); I don't need drama at work also.

Don't get caught up in the unit drama or if you are caught up in it, then recognize you are caught up and you need to transfer to a different unit or change employers. These types of work environments drain your energy and you are consumed with negativity which then starts to flow in your personal life and personal relationship.

 

 

What's best for my treatment? What's best for my license? What's best for my nursing career?

Okay, from the top, once more....

If you are addicted to prescription medication and/or illegal substances then you need help. Help is such a broad term. What kind of help do you need? I am not a counselor or therapist and this ain't legal stuff but

Door #1. You need treatment to save your life and get you started on the road to sobriety and recovery;

Door #2. You need counseling to help you figure out how and why;

Door #3. You need legal advice and counseling (and maybe representation) if you are a licensed nurse. Period. No conditions such as if, but or maybe. You need legal advice. To obtain legal advice usually means you need to hire a lawyer. No conditions such as if, but or maybe.

Now how you proceed after you are intervened upon by:

a. friends;

b. friends and/or family;

c. your nursing sup. and HR;

d. your unit manager and HR;

e. your nursing sup., DON, and administrator,

f.  your nursing manager and an investigator from the Board of Nursing; and/or

g. your manager, an investigator from the Board, and a detective from the county drug diversion task force

is totally your choice.

Do you proceed with Door # 1, then Door # 2 and then Door #3, Door #2 and then Door #1 and maybe Door #3, Door #1 and then taking a wait and see approach with Door #3 and only do #2 if your significant other threatens you with divorce, Door #1 and Door #2 together, etc.  

I can tell you this. Friends, family, and others (this includes the "medical" folks involved with you who give you "legal" advice) mean the best and I don't think anyone intentionally steers you towards Door #4 while meaning to steer you towards Door #1 and/or Door #2 but trying to tell you what will happen behind Door #3 (but trying to save you the cost of retaining a lawyer) but it happens.

Now you are probably asking LaTonia wt* is behind Door #4? I don't know wt* is behind Door #4 but that's what you will find out and when you find out what's behind Door #4 let me know:) I watched several vampire movies last week and I am scared to open Door #4.

Chemical dependency counselors are not lawyers and lawyers are not CD counselors. I have a typed sign on our one of our back doors which says I am counselor of law not a mental health counselor or therapist. The sign also politely asks you to keep your problems to yourself. (but that's another post. Remind me to tell you about my mother and her handwritten notes).

If you want medical treatment to fight your addiction, seek treatment.

If you want counseling and therapy, seek it.

If you want legitimate advice and counseling on your legal options when you have an addiction, seek out a nurse license defense attorney in your state. Really, you are treatment in Arizona and your Arizona based CD counselor is telling you what's going to happen in the short and long-term with your state nursing licenses in Ohio, Kentucky, Indiana, Florida, Michigan, and New York? Really. You can get better advice by allowing a toddler to pick the proposed answers (given to you by the "medical" person and written on sheets of paper) out of a hat.

Also I am going to tell you what I want for Christmas this year.

Dear Santa:

My Christmas wish this year is as follows: I really wish licensed healthcare professionals who medically treat nurses (who are BTW licensed healthcare professionals also) would function within their job description provided to them by their employer and stick to the "medical" and not try to do the "legal." Santa, please grant me my wish because I have been  "good" this year in a general and broad sense of the word like for example "help."

Seriously. There isn't a horn book, cliff notes or a book titled "License Defense for Nurses with Substance Abuse & Use Disorders in all 50 States for Dummies" when a nurse has a substance use and abuse disorder and there are licensing, employment, career, regulatory, educational, return to work, tort, and/or criminal issues. No sir re Bobbie Jr.  

If you are a nurse and you are depending upon your CD counselor, therapists, and others involved in your treatment and recovery to provide you with counsel and advice regarding licensure, legal, and regulatory issues, slap yourself in face and wake up now because "Hey Dorothy, you are no longer in Kansas anymore."

http://www.amazon.com/Hey-Dorothy-Youre-Kansas-Anymore/dp/1589392388.