Nursing Law & Order

Like Yesterday, Nursing Board Compulsory Examinations and the definition of Routine, Ordinary, Common, or Mundane

If you look up the words ordinary, common, routine, or mundane in any dictionary, you WILL NOT see "State Nursing Board Compulsory Order for Examination" as an example.

Why? There is nothing ordinary, common, routine, or mundate about a Compulsory Order for an Examination.

It is usually written in the Nurse Practice Act that a State Nursing Board can order a licensee or applicant for licensure by examination for a compulsory examination or order, at the expense of the licensee or applicant being investigated by the Nursing Board may have a physical or mental impairment that MAY affect the ability to practice nursing safely.

In Ohio, see ORC 4728.28(G).

Therefore let's say today you open your mail and you find a Compulsory Examination Order from the State Nursing Board ordering you to submit to:

1. Forensic Psychiatric examination;

2. Medical Examination;

3. Behavorial Examination;

4. Substance Use and Abuse vs. Dependency examination;

5. Neuro-Psychiatric examination; or

6. Psychological examination like a Fitness for Duty

then you need to:

1. Review the document carefully;

a. Sit down and take a cold shot of H20 on the rocks to clear your head;

b. Re-read the document again because I know you didn't read it carefully.

2. If you are represented by an attorney, contact your attorney and discuss; or

3. If you are not represented by an attorney in the Board investigation, you need to speak with an attorney like yesterday.

These Orders for Examination are the real deal. Yes, I know you are a nurse and maybe in one of your nursing roles you were involved in administering, observing, or reviewing these types of examinations for patients, but.....

Ask yourself, what would a reasonable and prudent nurse do at this point in a disciplinary investigation when you receive this type of Order for an Examination/Evaluation?

Do you continue to rep yourself? There is nothing wrong (or wright) about repping yourself before the State Nursing Board. It saves a dollar or two and you can then spend this dollar or two at Walmart, Target, or Lowes. I am all for repping yourself and I advocate repping:

a. Your hood (you can do this with a block party or garage sale. Invite me, please!);

b. Your block (you can do this with a swim party, block party (with a permit), or yard sale); and

c. Your City (next time you are at a professional function, wear a t-shirt saying "I love Columbus, Ohio" or the "Cincinnati Bengals  Superbowl 2020).

But repping yourself in any legal matters can be a train wreck waiting to happen.

You only have one RN or LPN (with State Nursing Board A) and when this license is investigated and you receive an Order for a Compulsory Examination/Evaluation, is saving a dollar or two in the best interest of your nursing career, future employability, future plans for nursing education, and your sanity.

For example, I received three certified letters from the IRS that were not delivered yesterday because of my two horse like dogs which roam the yard stalking birds, bees, and anything that moves. I went into overdrive and contacted the IRS about my estimated taxes for 2011 and whether or not full payment was received for my 2010 tax liability. But I thought about the worse case scenario: Oh frack, I am being audited for 2011! My first thought was will I use my acountant or retain a tax attorney now: like yesterday.  Certified letters from the IRS means "hear ye hear ye" for me as small business owner and attorney just like a Notice of Complaint, Potential Violation Report, or Compulsory Exam Order from the State Nursing Board means "hear ye hear ye" for a RN, LPN, APRN, or RN or PN NCLEX Applicant.

You have to be able to appreciate the best and worst case scenario for any workplace, licensure, legal, or State Nursing Board issue and sometime this requires the assistance of legal counsel for informed decision-making: like yesterday.  I appreciated the best/worst and WTF scenarios from my certified letters from the IRS; the letters are related to my 2010 tax liability and estimated tax payments from 2011.  

When you receive certain items, documents, or information by mail that impact you as a professional and your livelihood as a licensed professional, your natural instincts should flare up and you should go into hyperdrive like the Death Start from Star Wars in less than 10 seconds and start critically thinking about your next steps.

For nurses: it is a medical mal complaint naming you individually as defendant (because you probably do not have your own liability insurance policy), criminal indictments, certified letter from your employer after you have been suspended from work pending an investigation, letters from the State Attorney General's or Department of Health related to a workplace incident, and State Nursing Board Complaints and Compulsory Examinations/Orders.

You have critical thinking skills (if you don't email me and I will send you an invoice to pay me to help you develop those skills) so use those skills to critically think and be objective about your situation. There is nothing routine, ordinary, common, or mundane about receiving a Compulsory Examination Order from your State Nursing Board and the fact that this is "lost" of most nurses and NCLEX Applicants is troubling and speaks volumes to where we are as profession with knowledge and education of the intersection of the nursing law and professional standards of practice and the practical applications in the workplace.

 

 

Legal Duties vs. Moral and Ethical Obligations: The License is 24/7

IMHO, a test of character and integrity is rising above your legal obligations and duties and doing what is morally and ethically correct although you are not legally obligated to do so.

We live in a time where it is all about the law (this blog is Nursing Law & Order) because you can sue for just about anything these days. A kid gets slapped on the playground now it is suspension from school or expulsion, criminal charges, and a civil suit.

Nurses need to know the law and in particular the practical application of the State Nurse Practice Act and Board of Nursing regulations to everyday practice. This is just a starting point; the bare minimum is the legal. From the legal IMO you can then start to decipher the moral and ethical. In Nursing, the bare legal or barely legal is a matter of perspective.

I make a mighty but still muddled & merely middle class living (I am aspiring to be at the Rick James "I am rich bi$ch" level by my 105 birthday (I just turned 40 on Saturday, July 2nd)) because of "the legal", the gap somewhere between the Nurse Practice Act & Board regs and professional standards and practice and the application to nursing practice and "being" a state licensed nurse 24/7. 

24/7 requires thought and understanding and a big picture view.

24/7 means when you see your best friend throw a punch in the bar after the 6th round of beers you do not start swinging and fighting along side of her and the two of you "go out" like Thelma and Louise. http://en.wikipedia.org/wiki/Thelma_%26_Louise

24/7 means when you get pulled over for drunk driving and you are charged with a DUI, child endangerment, possession of drugs, concealed weapon, and possession of drug paraph., you recognize at some point in the process and actually say "this may be my a## with the BON."

24/7 is 24/7; you are a nurse 24/7. I just renewed by nursing license with the Ohio Nursing Board last week and although there is one person I would really really like to slap, I keep my hands to myself because I am a nurse 24/7 and as a RN (in the Big O only) & a license defense attorney (three states baby) I don't NEED or WANT a DV charge or conviction.

One of my girl friends was arguing with a stranger last month (about the price of gas, the Middle East, and how this impact politics in the US. Why?) when we met for Happy Hour (why are there so many angry folks drinking at Happy Hour anyway?) and I told her, "if you are fighting, I will wait in the car." I am also a lawyer 24/7 and lawyer discipline is another matter.

Every license has benefits and burdens. The benefit of a RN license is the income and career diversity afforded to RNs especially with advanced education or additional experience/expertise and certifications. You can literally write your own ticket in nursing; I am.

The burdens are the legal, ethical, and moral responsibilites, duties, obligations, and liabilities and cross the profession still carries from lack of an entry level to practice, being female dominated, collective bargaining, and from being fractured and operating in environments where nurses have little real control or power. It is always about the money, the power, and the ends & means and the profession still struggles with this and will continue to do so.     

On a Law & Order: SVU episode (I love Detective Stabler; he is nuts!!) one of the detectives commented about being a detective and a police officer and being the job 24/7. Police officers are socialized into this circle and we all have heard about the blue line. Where is this socialization in nursing? Are nursing schools churning out soooo many graduates that there is no time for socialization? Just pat your graduates on the head, give them a business card to a local bail bonds chop shop and an outdated copy of the ANA Code of Ethics, and then say "Go Be Somebody."

24/7. This is the responsibility, accountability, and potential liability that you assume when you get your State Board of Nursing issued RN or LPN license. This is what nursing profs need to tell students and what needs to be stressed to practicing LPNs, RNs, and APRNs.

Who role is it to say this anyway? After I complete my Jedi Knight training, I want to assume part of this role in the profession. Which brings me to my next blog post? Nurse, are you just living or are you living by a code and fulfilling your destiny like Darth Vader or Luke Skywalker?

It ain't all peachy or creamy (I want ice cream) in nursing; it is 24/7 with the license.

Why? Look at the State Nursing Board renewal applications questions. Are you a Misdemeanor Mama or the Felony Father? (I am sorry Mom. I had to say it. I am going to Bible Study this Thursday and early morning service on Sunday. One of my grandmother's reads this blog).

Misdemeanors are misdemeanors and a felony is a felony, whether you are on the job or off the job because you are the job when you can care for John Q. Public; you are a nurse 24/7.  

Perfect Pattie: Is Perfection and Perfect Practice Still the Underlying but Unspoken Standard for Nurses?

My son Carlos is working in my law practice with me this summer. He is scanning law files into CLIO, the law practice management software (its SAAS) my law firm uses. He also assist me with project management software I am using for my law firm.

My son has worked in a variety of environments primarily retail as a teenager and young adult (21 y/o) therefore he is accustomed to a very rigid work environment where he is supervised and monitored. He asked me last week do we (meaning him and my sister Jaren who is working with me as my personal assistant; yes it the Family Feud at the Law Office of LaTonia Denise Wright, LLC) have assigned breaks?

After laughing for 5 minutes, I said "no" you don't have assigned breaks in a professional service firm, this isn't Taco Bell. (I was hungry and I wanted a fountain Pepsi from Taco Bell and something with cheese and chicken). If you are waiting for me to tell you to break it just ain't gone happen because I go hard from sun up (okay 0830) to sun down (okay it is almost 5am and I pulled an all nighter again) with running my business and practicing law.

Later we talked about making mistakes and I told him mistakes were a part of any job or position. You just acknowledge the mistakes, learn from the mistakes, and move forward. His response was "OMG, you mean Perfect Pattie makes mistakes."

Wow, my son thinks I am a Perfect Pattie. Before I fire my son (again) we are going to discuss what are the characteristics of a Perfect Pattie? Perfect Pattie to me is a double turkey burger with cheddar cheese or a cookie and ice cream sandwhich.

Are nurses supposed to be Perfect Patties?

Are you a Perfect Pattie or a Perfect Pat?

Is Perfection the unspoken but real standard of practice in nursing?

I am a work horse and I will work but that is how I was reared. You work if you want to have anything: you work for it. Period. Perfection for me was never or cannot be the standard in law practice because you will get absolutely nothing done if you fret over each and every item to point of perfection.

Is perfection really the gold standard and the expectation in healthcare with Just Culture being just another buzz word? What do you think as a nurse at the bedside?  

Where is the "Seat Back" Button for Nurse Licensure and State Nursing matters?

I grew up with my two male cousins (A & B) who were very competitive. Everything was a game: a test of  physical and mental endurance and trying to win.  This was the 70s and 80s and wining meant winning: there is one winner and two losers. It was brutal and little did I know it would shape my personality and who I am and where I am trying to go even today.

Winning was winning not the watered down "everyone is winner" you see now. I perfected my profanity skills at age 8 because of Monopoly. Monopoly ALWAYS ended in crying, a fight, profanity, and/or the board game being thrown across the room with us. I was the only girl but that did not matter here. There was no room for being a girl growing up from age 4 to 13 in a household with competitive boys. I remember taking off my pink nail polish around age 9 before Monopoly games because I did not want to be mocked as being "soft."

I learned from an early age to be very demanding and a little aggressive. My best friend reminded me this weekend when we were five y/o, I told her I would "punch her in the face" if she didn't get out of my neighbor's plastic green swimming pool. The plastic pool wasn't even mine but I was attempting to control the swimming pool and the sandbox at an early age.

We would play a game called "seat back" growing up. My grandfather has relatives in South Carolina which meant a yearly road trip for us. There were three of us in the back seat and only two windows. Do you know how many bloody noses and wrestling matches were started and ended in the backseat because there were only two windows? I am not talking about a pinch or a slap but all out mortal combat type fighting with the sounds from punches and jab.

We developed something called "seat back" which allowed the person sitting by the window to reclaim his or her seat. But you had to call seat back before you left the vehicle or you forfeited your seat next to the window. Do you know how many fights I had because I loved my Pepsi (even as a child) and therefore would be the first one running to the restroom when my grandfather FINALLY stopped at a rest stop (after passing 8  rest stops driving down I-75) and I forgot to call seat back?

There is no seat back in real life and there is certainly no seat back with the State Nursing Board in complaint investigation and adjudicative matters. You cannot submit a 50 page response with exhibits to a complaint and then when things:

a. Go Sour;

b. Take a road you didn't expect;

c. Take a road you thought about but did not really consider;

d. Take a road you were told about online but did not think applied to you;

e. Take a road which looks, feels, and tasts like the worst case scenario; or

f. do not go the way you want it to go

you say "Seat Back" and you return to the beginning or where you initially started.

If anyone finds a seat back button for life  and nurse licensure matters let me know.

Until then I have to cherish my memories of screaming seatback to Cousin A & B on road trips which then transferred to daily driving. I still laugh when another male cousin C drove "down South" with us one year and he was confused and bewildered by "seat back." I took his seat by the window because I told him he forgot to say "seat back" twice and this was a rule. He cried and I smiled. My grandmother looked at me and rolled her eyes, Cousin A laughed because he had a window. Cousin B said I cheated because he was sitting next to the "hump" in the middle and he did not have a window. He called me a cheater so of course, we had a back seat slug fest for 30 seconds until my grandfather opened the car door.

When you are deciding whether or not to represent yourself before the State Nursing Board talk to at least 2-3 attorneys on the cost of representation before you decide to represent yourself because there is no seat back before the State Nursing Board in a disciplinary investigation or in licensure matters.

Oh and for you softies, my Cousin C didn't want the window seat anyway.  I later told him the back door could fly open up anytime. Therefore he agreed to sit in the middle of the back seat and not participate in Seat Back with us.

 

Don't Put Things in Your Mouth and Just Swallow: Think Fast Nurse & Name that Pill!

Get your mind out of the gutter. This is a professional and legal blog for nurses.

I don't know about you but I don't just take any pill given to me by someone, even if it is handed to me by one of my dear sweet grandmothers I have questions. The first being what are you going and why are you handing me meds to take? Do I look like a Paula Pill Popper?

I would be offended if someone gave me a pill to take. Actually I would probably smack the person's hand and the pill out of my personal space. But that's just me and I have "anger" issues (so I have been told by my son, my sisters and my mom).

Why? It is probably no big deal for the vast majority of Americans to take prescription medicine that belong to someone else. What I mean there are more than likely NO legal, career, employment, or licensure ramifications for the average American who pops a pill given to them by their uncle at a cook out.

For example, let's say, at my Fourth of July swimming pool party, I have too much to drink and I want to take something for the headache I know I will have in the morning, I wouldn't send someone in the house to "get me a pill." Why? I keep all the medication in my home in one of the kitchen pantries and the person could give me a pill prescribed for:

1. LaTonia;

2. My EX-HUSBAND;

Yes that's right. The Nursing Law Bandit is single and back on the loose. Actually I am "on the loose" maybe 30 minutes a week because of my work schedule.

But yes, I am no longer married and for that matter was never married: legally or spirtually. Name that legal procedure.

I am actually picking up my engagement, wedding band, and anniversary band today; I had the rings resized to wear on my right hand. My jeweler suggested sizing and wearing the wedding and anniversary bands as thumb rings to break up the set.

Really? I don't think so, pumpkin. My rings are gorgeous.

More later. But...

If you know a single handsome & nice man (mid thirties, early/mid forties) who is small business owner, with real and personal property, no children under 18 y/o,  and a mid-six figure income, and a decent business and personal credit score, skype me.

3. Luke (my dog);

4. Leia (my dog); or

5. My son.

Don't put things in your mouth and swallow unless you know exactly what you are swallowing: think fast and name that pill Nurse! Is it Tylenol, Profen, or Darvocet, Perc, or a Vic?

I keep my medication identifier with my calendar in my briefcase not at the poolside.

Use common sense. Nurses are licensed professsionals and you are a nurse 24/7/365. They actually should tell folks on the applications for nursing school when the schools are bragging about how much money you will make; the schools should also explain the accountability and responsibility that comes along with being licensed in an occupation with easy, easier, and easiest access to controlled substances and the skinny on what this really means now and in the future.

So here is the skinny:

1. Do not take any prescription medication that it not prescribed for you. WTH you say? I know it is a shocker but do not do it! 

2. Do not taken any medication or pills given to you by ANYONE without you viewing the medication container or pill bottle.

Anyone includes me, your mother, your father, your husband, etc.

3. If the prescription container/bottle does not have your name on it, DO NOT take the medication.

4. Do not mix your prescription medication with the prescription meds of any human, animal, or imaginary spirit. You are a nurse damn it, why are you adding different pills to the same container for ease of transportation. Really? It is one more container in your purse, book bag, or pocket book.

I keep my wallet, two prescription meds containers, three pens, small note pad, business cards, and bubble gum lip gloss in my purse along with my cell phone. What's in your pocket book?

5. Stop asking docs you work with or NPs you know to write scripts for you. It is tacky and a red flag. This isn't the 80s, 90s, or even the early 2000s when that type of conduct was tolerated. It is a risk management and compliance issues which can turn into a legal issue. Therefore ask yourself is it really worth it in light of the national spotlight on prescription drug abuse and misuse. Also it is never an issue until something happens and when it happens, it is what it is!!!

I know it happens everywhere (ER, ICU, OR, etc.) and all the time but it is not good practice. Remember you are not working at Burger King and you certainly cannot have it your way!!

5. If you are being monitored by the Nursing Board in an alternative to discipline program for substance use/abuse or in a disciplinary program for substance use/abuse or practice issues related to controlled substance documentation, you need to live and practice by #1-4 each and every day while you are being monitored by the Board and even after monitoring ends.  

The $997.00 retainer plus an Oreo Blizzard from Diary Queen: Nurse-Owned Business

Let's say you are planning to start your own home care agency, consulting practice, medical practice, staffing agency, LNC group, or any other nurse-owned business.

You will need an accountant and book keeper at some point. You may also need a practice advisor. You may also need a business law attorney to assist you with incorporation and other general business issues.

At some point however you are going to need the services of a nursing law attorney to assist with a matter, provide an opinion, or provide risk management and regulatory compliance services. 

There is only soooooo much you can obtain from websites, blogs, chatrooms, forums, and self-help and "for dummies for dummies books." I have my share of "for dummies" books. For dummies provides a general overview of what you or may not need to know on any given topic. But how do you know what you don't know if you don't know what you are doing?

I purchased one for Quickbooks for Law Firms last week. I am still on page 1. I had my personal assistant schedule an appt. with my accountant and I am going to work his book keeper and probably use Quickbooks Online for my law firm going forward. It is not an efficient use of my time to pull my hair out with Quickbooks along with the other projects, tasks, and cases I am working on in my law firm.

Trust me this law firm will not be one of the many law firms you read about that had "a bizillion dollars" stole by ABC a long-term and trusted employee over a 2 year period. How can you not miss hundreds or thousands of dollars in your own cash? I don't even keep "cash" in my wallet because I want to track/trend my spending.

There is nothing wrong with saving a dollar or two but when you are self-employed and a small business owner you have to delegate at some point. You must also pay for professional services for your business. I am a small business owner and I also practice law which means I had to find a system/process for delegation which fit my non-traditional law firm and niche law practice: just nursing.

I finally figured out how to make it work for my law practice. My office manager is Tina. Tina works me virtually M-F, 9am to 3pm. Tina manages my online calendar, schedules my appointments, and assists me with new case intake and processing.

I have two personal assistants. Maya works 0930 to 2pm M-F with me and Jaren works with me from 10am to 5pm M-F. Jaren and Maya work together and directly with me on a variety of law firm, professional, and personal projects/tasks.  We are working with a new project management software which syncs perfectly with Google Business Apps.

Google Business Apps (paid version) is the truth.

Jack works me sometimes a little, sometimes a lot, depending on the caseload and what he has cooking in his own business.

Hiring staff, independent contractors, or retaining professionals to provide professional services costs money.  However the key is reviewing what works for you depending on your business and practice model; it took me 3 years to figure out what works for my law practice and my law firm.

It is worth every penny to have client calls answered promptly, to have client meetings scheduled immediately, and to have a team to really work up and run the lenght of a case that is needed in license defense and a nursing law practice. My overhead with my part-time staff is reasonable and certainly signficantly less than what you see with a traditional law firm staffed with a receptionists, secretaries, paralegals/legal assistants, practice managers, attorneys, etc.

There are only so many "For Dummies" books and manuals you can read. I have Excel for Dummies and I have not opened the book in 3 years. I hate Excel because I was not trained properly and it is not a skill which I need in my knowledge, skills, and abilities to practice as a nurse license defense attorney.  

I am waiting for release of Vegetable & Chicken Noodle Soup (with crackers) for Dummies. I will pre-order my copy on Amazon.com when available.

At some point you have to bite the bullet and hire a professional to assist you in providing specialized services for your business. Also there are soooo many arrangements available now outside of the traditional employer-employee relationship.

During my two and half weeks off in the form of staycation (I am too busy to take an actual vacation this summer) I spoke with a number of nurses involved in State Nursing Board investigations and post-discipline cases. Some retained me and some did not, for whatever reason.

I am not the cheapest attorney and if you are looking for someone who can give you the " K-Mart Blue Light Special" on a flat fee; 99.99% of the time, it will not be me.  There are a number of attorneys who handle these cases (Columbus, Indianapolis, Louisville, and then there is me here in Cinti practicing in all three states) and I quote the fee based on the information I have and the intake interview. If your case is more complex, the fee will be higher.

If you had licensure issues as a LPN, RN, and now again as a APRN, this will be reflected in the fee I quote; your fee will not be $2,500.00. Sorry. Maybe in another practice but not here. I am not just taking cases to take cases; I take cases to work the case for the long run. I am "in it to win it" like Hil Clinton. She is coming back, you know.

Maybe once I hit the lotto, I can advertise that I will accept any licensure case, any case, and represent from investigation to hearing to post-disciplinary monitoring and beyond (head to toe) for $999.97 and a large Oreo Blizzard from Diary Queen, but not today.

Nurses who are small business owners will eventually need the services of a nursing law attorney to assist with some aspect of the business. I am a nurse who owns a small business. Retain an attorney and move forward with your business; it is a cost of doing business and it helps you safeguard your nursing license if you are also practicing in your business.

Legal Consultations: One Ring to Rule them ALL and Ketchup vs. Mustard

I have from 5 to 40 legal consultations in a month usually by phone with nurses throughout Ohio, Kentucky, and Indiana. 

The benefits of a legal consultation for a nurse are:

1. You have an objective attorney reviewing your case;

2. You are able to ask questions and receive solid advice and counseling about your situation; and

3. The cost is $150-$250.00 in my law firm. Some license defense attorneys charge $500-$1,000.00 for legal consultations. For example, there is an attorney who charges $750.00 for a 2 1/2 hour consultation and this is the minimum and includes all his preparation time reviewing your materials and performing research on the issues therein.

What I am a finding however is that I have a lot of nurses who become quite hostile and argumentative with me during legal consulations because I am not telling them what they want to hear, I am not agreeing with them, or I am being "too direct and too blunt."

I think this is why we lawyers get a bad rep because it is our role to "tell it how it is." If you are paying a professional and the professional is telling you exactly what you want to hear about yourself and your situation, then you are wasting your money. 

Objective advise and counseling: this is what an attorney does. However, most nurses involved in a State Nursing Board case are proceeding pro se, most nurses being monitored by the State Board are pro se, and most nurses who are in a Board Alternative to Discipline program are pro se.

Pro se meaning you are representing, counseling, and advising yourself in the matter. It is difficult to be objective and critically review and analyze your own situation from a legal, clinical, and professional practice standpoint. When you are representing yourself it becomes a epic battle for mankind and the fate of the world rests in your hands.

I had a nurse tell me the following in reference to a State Nursing Board investigation and an employment termination, "I now know how Jesus Christ felt when he was prosecuted." No comment.

It emotionally becomes One Little Nurse vs. the Big Bad State Nursing Board (not the Big & Bad, just Big Bad) which is huffing and puffing to blow down everything you  accomplished: your licensure, your career, your family, and your life. 

It is portrayed to colleagues, family, friends, and "anyone who will listen" as serious as the epic battle for Middle Earth and the "Rings of Power" akin to good vs. evil, the Jedi vs. the Sith, and Ketchup vs. Mustard.  

If you are representing yourself before the State Nursing Board consider a legal consultation with a nurse license defense attorney in your state; it may be the reality check you need to place the case in the proper prospective.  

Hello, my name is LaTonia, I am Your Legal Therapist. My office hours are 11:30pm to 11:45pm every 3rd Tuesday of any month ending with the letter "r" or "y"

I terminated my legal representation of a nurse in the past because this nurse was just too difficult to deal work with in a professional relationship. Also the nurse refused to accept any responsibility or accountability for the actions or even acknowledge the obvious.  

We remained professional with the nurse at all times but I should have terminated the representation  earlier. I shook my head when I received the correspondence requesting the client file from the new attorney of the nurse because I would not wish that client on any lawyer.

 The nurse developed a case theory the nurse just knew would work.

I told the nurse in a nutshell even if we pretend, this ain't CSI; it is Nursing Law & Order.

Anything is possible, Neo but let's discuss the probabilities because this ties into the burden of proof and persuasion.

The spouse of the nurse berated me for not "trusting in and believing in" the nurse. FTW, you are kidding me, right?

I trust and believe Jesus died for my sins.

The spouse told me the nurse would be CLEARED of all charges at a Nursing Board hearing with a new attorney who trusted and believed.

I thought to myself: maybe an imaginary hearing with the Snow White as a hearing officer but certainly not a formal adjudication in an administrative law matter.

The nurse was nasty. This nurse was my nastiest client. By the way, I fired my first, second, and third nastiest clients. Life it too short to deal with nasty clients because I love what I do. I don't want to start calling off at work, taking extended FMLA leaves, or start smoking and then disappearing for 2 hour smoke breaks before and after my lunch smoke as a coping mechanism. 

By nasty here I am referring to a aggressive disposition, a disruptive personality, condescending tone with everyone,  emotional and uncontrollable outbursts ranging from excitement to panic to sadness to rage in 15 minutes, etc. I don't know whether to continue to take notes or  make a run to an exit but not before closing the door to lock Jack in the room.

I am a counselor; a counselor at law that is  pumpkin, not a therapist unless you need legal therapy. I guess I am a Legal Therapist. LOL. My office hours are 11:30pm to 11:45pm every 3rd Tuesday of any month ending with the letter "r" or "y" if you need assistance. I see clients, return calls and answer emails or texts and conduct business only during the stated office hours.

Back to Nasty.

Angry Nasty;

Nasty Nasty; and now

Disciplined Nasty. I mean Disciplined Hard.  I had to read and then re-read the discipline. No hearing by the way: settled.

Just a word of practical advice:

1. Allow your license defense attorney to assist you in developing your legal strategy;

2. Be honest with your lawyer; why pay your a lawyer and then lie to your lawyer? 

That's like going to a weight loss clinic and saying you don't want pills; you just came in to be weighed. It makes no damn sense; 

3. Don't watch CSI and try to develop conclusions of law and findings of fact  for your case based on a CSI episode. It is Nursing Law & Order; and

4. I zealously represent my clients and I counsel and advise my clients. But remember I critically think for a living. I make my money critically thinking about nursing and the law. All day. Remember this when you retain me and start to shovel the ......

5. Life is too short to be nasty to anyone trying to help you help yourself.

Even though you were Super Nasty, I wish you the best with:

a. Securing employment during the years your nursing license is suspended;

b. Meeting the terms/conditions for the reinstatement of your nursing license;

c. Securing nursing employment during your Nursing Board probationary period;

d. Meeting the terms and conditions of your Nursing Board probation; 

e. Having the terms/conditions of your Nursing Board probation lifted; and

f. Your nursing career.  

Nursing Bermuda Triangle: Educational & Legal Self-Help Service for Nurses™

Although these are tough economic times nurses need legal counsel and advise AS issues arise.

You know me and my need to offer "bespoke" legal services for nurses. This isn't the End of This Lawyer; Just the Beginning.  

http://www.ignitelaw.com/2011/03/bespoke-legal-services-in-an-off-the-rack-culture/

http://myshingle.com/2011/01/articles/myshingle-solo/ten-solo-and-small-law-firm-trends-2011/

http://www.susskind.com/endoflawyers.html. By the way, I love this book!!

This is why I am offering an Educational & Legal Self-Help Service for Nurses™.  The cost is $500.00.

Never boilerplate just bespoke here because:

1. You pay for the service;

2. You tell me what are your practice and legal issues;and

3. We develop the content for you.

* Don't know what you don't know. We can brainstorm by phone and/or email first.

* Have documents you can't make sense of but you know are important because its from the State Nursing Board?

* Need email consultative services.

* Need a legal opinion.

The service includes a 30 minute telephone or video teleconference with me to review the content with you and discuss your practice, situation, or matter. It may also include articles, podcasts, etc. depending on your comfort with technology. I can also point you in the right direction if you need legal services from a licensed attorney in your state or jurisdiction.

Nursing school and nursing practice does not prepare nurses IMO for strategies to address the Nursing Bermuda Triangle: The Application of Nursing Law, Ethics, and Professional Standards in the Nursing Workplace.  

http://www.ncbi.nlm.nih.gov/pubmed/18524302

This is another service offered to nurses across the country. This service will be expanded in the near future to include other benefits.

Stay tuned because there will be additional products and services rolled out this year along with a redo of my blog and website.

Bespoke baby Bespoke!!!!!

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

 

 

RN and LPN Independent Providers in the State of Ohio: Stop, Look and Listen!

More and more nurses both LPNs and RNs are having billing, nursing practice, and other issues practicing as an Independent Provider.

Home care isn't for everyone and self-employment isn't for everyone. The combination of the two can ring disaster for nurses who just jump into being an Independent Provider without any preparation.

You are a licensed healthcare professional and you are a small business owner as an IP. You cannot just jump and then figure things out as you go. This is recipe for an ODJFS Notice of Deficiency, Plan of Correction, Ohio Nursing Board Complaint, and/or a certified letter from ODJFS saying "you owe us ten million dollars because you failed to...."

What is an Ohio Independent Provider?

 http://ohioip.net/

http://www.ohiohcp.org/provider.html#php1

If you are going to be an Ohio Independent Provider you need to learn the basics of home care before you just jump.

For example, consider taking a home care course to learn about the Ohio Home Care Program. See 

http://ochch.org/associations/11629/files/MarchHC101brochure.pdf

I am actually thinking about registering for this program as a refresher.

Also why not attend a coding and billing CE for home health to increase your knowledge?

See http://ochch.org/associations/11629/files/JuneAdvancedCodingBrochure.pdf. Oh, let me guess, you just have someone "do" your coding? Bullshit. That's like me saying as an attorney "oh, I just have someone do my billing, I don't have to know anything about it."

Nurses as a group do not support and join professional associations for a number of reasons. But guess what? As a Independent Provider, you need the support. You will probably not find it in a general national or state nurses association but you should at least attending CE and training offered by ODJFS and the Ohio Home Care Organizations. Its Risk Management, baby!!!!!!!

https://m360.ochch.org/frontend/portal/viewcalendar.aspx

http://www.ohpco.org/aws/MCA/pt/sp/education_homecare

Also as Ohio IP you should have the following professionals on your team:

1. Accountant;

2. Business Lawyer;

3. More experienced IP in your County; and

4. Nursing Law Attorney (that would be me).

Things are going to come up because you are a self-employed and you want to evaluate the situations as a licensed nurses and a business owner. Also for heaven's sake, BUY Professional Liability Insurance with a License Defense Protection Benefit!!!!!!

As an IP, you can pay it on the front end with risk management, paying for consultative services, etc. or you will pay it on the back end when mistakes (practice, billing, etc.) are made. and you have to retain a lawyer to represent you before the State Nursing Board and/or in an ODJFS matter proposing the termination of your provider agreement.  

Remember this isn't Disney World: you are billing the State for skilled nursing services and you are essentially your own agency: billing for services, scheduling visits, and providing care.

 

 

The Liquor Store: Unemployment Compensation, Nursing Schools, and the Saturation of the Employment Market in Nursing

This is not legal advice because no one paid me to say this but:

 1. If you are a LPN, RN, or APRN and you were terminated from your employment with a healthcare organization, consult with a nursing law attorney BEFORE you apply for unemployment compensation benefits. 

2. By a consult, I mean pay for 30 minutes to 60 minutes of the nursing law attorney’s time and provide the attorney with your documentation to review. This is not the sixty second call you have with a nursing law attorney and the attorney is typing, eating, and listening to a podcast while taking your frantic call.  

3. Why? If you were terminated from your job and you are awarded benefits, your former employer may contest the award. I think someone in HR screams “1, 2, 3, 4, I Declare War” then the healthcare organization receives notice of a former nurse employee request for unemployment compensation benefits. http://boardgamegeek.com/thread/65396/i-declare-war. I loved this game as a kid. I grew up in a very competitive household and this game along with monopoly always resulted in a shouting match, fist fight, profanity (I learned early), or a promise for a rematch for the “title.” 

4. Why? If you terminated from your job, you may or may not be reported to the State Nursing Board if you are in a mandatory reporting state. You won’t know you are reported until you open the mail and “claim your prize” or you receive a phone call from the State Nursing Board.  

5. I had to calm a nurse down by phone yesterday who opened her mail and “claimed her prize.” I opened my own mail two weeks ago and “claimed my own prize.” I am 0.75 CLE short on my Ohio law license renewal. I have to pay $110.00 and take a one hour CLE class by April 31, 2011. This blog is Nursing Law & Order, not Nursing & Law Disorder, so I plan to take my CLE online this evening and mail the check and my CLE transcript in the morning. Yes, I know its horrible and that’s why my walkie talkie handle is the Nursing Law Bandit. http://en.wikipedia.org/wiki/Walkie-talkie. 

6. The interplay of unemployment compensation benefit appeals and procedures and State Nursing Board complaints is something I am seeing in my law practice over the last 2 years. I used to handle unemployment comp. cases (years and years and years ago) and this is where I “cut my teeth” (learned the ropes) with telephonic hearings. 

7. It is a tough job market out here for nurses in certain areas and the proliferation of nursing schools and colleges does not help. Nursing Schools are the new pills mills like law schools. http://thirdtierreality.blogspot.com. 

8. Let’s see there are LPN, RN, RN to BSN, LPN to RN, BSN, MSN, post-MSN, and doctoral programs, schools, and colleges in nursing. Just in the Greater Cincinnati area, there are maybe 20+ programs. You can open a nursing school faster than you can open a liquor store in some states IMO. Nursing Schools are on every corner in some cities like a Pony Keg selling cigarettes, beer, and lottery tickets. Come here and get your nursing education; it is on sale for $35,000.00. http://www.ehow.com/how_4549219_open-drive-through-pony-keg.html.

9. The proliferation of nursing schools and programs across the states result in more and more new grads, new nurses, and not so new nurses competing for the same jobs. This IMO prompts more nurses who are termed from a HCO to apply for unemployment compensation benefits because you don’t know if you are going to get a job. It is not like it used to be when you could get fired today and start working somewhere else on Monday. The nursing employment market (in some areas) is more saturated than my 2 y/o niece’s Pull-Up at 7am.  

10. I attended a nursing function a few months ago and I was asked “where do you practice?” I replied “in a law firm, I am a nurse license defense attorney.” The nurse, who happened to be a “nurse educator” said “Oh, you represent those nurses in the Momentum.” The Momentum is the Ohio Nursing Board newsletter. I replied where you do you practice? She said “Proprietary XYZ Nursing School, Nail Tech, and Plumbing Program.” I said “Oh, you are educating those nurses in the Momentum.”

 11. Most nurses are repping themselves in the investigation of the State Nursing Board complaint as well as the unemployment benefits compensation process. This is a NO-NO.  Guess what? You may be excited and ready to fight the first 5 weeks but guess what you will move on after 2 months and this is the point where your former employer, the HCO has declared war and is ready to fight you to hell and back for those benes, baby. 6 months to 9 months later you are going to say WTF was I thinking? I don’t have the time and energy for this shit. Also you cannot be objective when you represent yourself. You just cannot.  Find an attorney who handles admin. law cases like workers comp and SSDI to represent you in an unemployment comp. matter. I am not taking unemployment comp. cases now because my nurse license defense practice is busy; but I may have to hire a Virtual Paralegal and start taking these cases again. Unemployment comp, workers comp and license defense are all administrative law practices. 

12. Don’t have your unemployment comp. lawyer rep you before the State Nursing Board unless the attorney has experience with this niche. Yes it is all admin law but guess what? I am a nurse license defense attorney and I can take an unemployment comp case but I would not take a SSDI or workers comp. case because I don’t have experience or even an interests in these areas. 

13. If you want to play around and represent yourself, do so in traffic court. You can follow behind me when I am driving to Columbus, Indy, Lexington, or Louisville and I am sure you will get a ticket. The State Patrol are out this month!!!! You can appear and represent yourself there. But don’t do the monkey in an unemployment compensation case and a Nursing Board complaint investigation case.

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!

 

 

 

Legal Audit: Nursing Career Plan™ is a Risk Management, Workplace, and Career Guidance Tool & Service I am offering for Nursing Students, NCLEX-Applicants,LPNs, RNs, and APRNs

Legal Audit: Nursing Career Plan™

The Legal Audit: Nursing Career Plan™ is Your Nursing Care Plan

I know you still remember nursing care plans even though the NCPs are generated by software these days.

 http://www1.us.elsevierhealth.com/MERLIN/Gulanick/Constructor/

I graduated from my ASN program in 1993 and my BSN program in 1994 so NCPs were done the old fashioned way: by hand.

The Legal Audit: Nursing Career Plan ™is similiar to the nursing care plans we developed in our entry level nursing programs.

What is included in your Legal Audit:Nursing Career Plan™ depends on where you are with your nursing career whether its pre-licensure, post-discipline with the State Nursing Board, in an alternative to discipline program, in graduate school, going up (or down) the clinical ladder in a particular institution, etc.

Why do you need a Legal Audit:Nursing Career Plan™? Every nurse needs a Legal Audit: Nursing Career Plan™ because it takes into the risks and liabilities and specifics of your education, licensure, practice area, specialization, certifications, and assists you with the self-regulation of your nursing practice. Essentially you are caring for yourself, your license, your practice, and your career by being your own risk manager and advocate. The Legal Audit: Nursing Career Plan™ involves you reflecting and assessing your practice with the assistance, advice, and counsel of a nursing law attorney.  

What is self-regulation of nursing practice?

http://www.cna-nurses.ca/CNA/documents/pdf/publications/NN_Understanding_Self_Regulation_e.pdf

http://www.cna-nurses.ca/cna/documents/pdf/publications/SelfregulationFeb2001_e.pdf

I have wanted for sometime to offer a risk management product and service for individual nurses regardless of the state of licensure and the Legal Audit: Nursing Career Plan™ is it.

For nurses who are of course, in Ohio, Kentucky, and Indiana, the Legal Audit: Nursing Career Plan™ offered by my law firm can of course include legal advice and counseling.

For nurses in other states, the Legal Audit: Nursing Career Plan™ offered provides workforce and worplace counseling but no legal advice. Sorry, no legal advice but I can offer workplace and career counseling.

How will you benefit from a Legal Audit:Nursing Career Plan?

1. Let's say you are probation and monitoring with the State Nursing Board. The Legal Audit: Nursing Career Plan™ will review with you the strategies to work through this process establish goals, interventions, and tasks, address common issues, and review legal concerns.

2. Let's say you are in a State Board alternative to discipline program. The Legal Audit: Nursing Career Plan™ will review with your the strategies to work through this process, establish goals, interventions, and tasks, address common issues, and review legal concerns.

3. I hear alot, do I need my own professional liability insurance policy? This would be part of your Legal Audit: Nursing Career Plan™ and along with reviewing your practice area, certifications, employment, licensure, and case law in your state to determine the necessary coverage offered by various nursing insurer if you identify this as an issue.

4. Let's say you are ARNP and you have an employment agreement and collaborative physician and a collaborative agreement. Your Legal Audit: Nursing Career Plan™ could entail of a review of these agreements and with plans to review and discuss your areas of concern.

5. Let's say you are planning to start your own nurse owned business. Your Plan could review the basics and address some of the liabilities and legal issues presented.

6. You are a home health RN and you are also self-employed as an Independent Provider in Ohio. Your Legal Audit: Nursing Career Plan™ could focus on the legal issues facing nurses practicing dually as home health nurses and as a IPs. Are you working as nurse for multiple facilities? Are working as a RN here and as a APRN elsewhere? Same for ICU, ER, Telemetry, Skilled Nursing Facilities, Ambulatory Care, Clinic, Self-Employed, Private Practice, etc.

7. Let's say you are work primarily as a charge nurse in a hospital, your Legal Audit: Nursing Career Plan™, will be different from a charge nurse in a nursing home or from unit manager or middle manager in a hospital.

8. The Legal Audit: Nursing Career Plan™ for APRNs will different from LPNs and RNs and certainly the same can be said based on roles such as Clinical Nurse, Nurse Educator, Nurse Manager, or Nurse Expert Clinician.

9. New graduates, Nursing Students, and NCLEX-Applicants. Your transition into professional nursing practice can be alot smoother with a plan because you don't know what you don't know until you know it and its usually the hard way. Why not start your nursing practice with a Legal Audit: Nursing Career Plan™ that identifies the risks associated with your practice area, takes into account your strengths and weaknesses as a new nurse, and assists you with the transition to professional nursing practice and developing your career.

Every Legal Audit: Nursing Career Plan™ will be different and there is no standard plan because the audit is based on the three issues and concerns you identify and is tailored to meet your specific licensure, education, certification, practice areas, etc. and the documents you provide me to review.

The Legal Audit: Nursing Career Plan™ focuses on the three issues you identify and I assist you with addressing, reviewing, identifying, and mitigating legal, licensure, career, and other pitfalls in a 30 minute conference call.

This is a basic risk management service offered to nurses because the majority of nurses don't have a nursing practice counsel or nursing law attorney on retainer to assist the individual nurse with law, legal, workplace, career, or the legalities associated with nursing practice.

Also most nurses don't belong to a professional association which may or may not offer this type of service which is combination of licensure, career, employment, legal, workplace, labor, and "as otherwise identified" issues specific for RNs, LPNs, and APRNs.

Please don't send me hundreds of pages of documents and expect that this can be covered in a 30 minute consultation and video or conference call because I will refund the fee and cancel the appt. Sorry. You need to retain me if you have hundreds of pages of documents you need to be reviewed:)

We can skype your Legal Audit: Nursing Career Plan™ as a video conference call or a just plain conference call.

My law office skype name is: nursinglawattorney

My law office skype number is 513-729-6989.

I am offering the Legal Audit: Nursing Career Plan™ service FREE to my law office clients. Happy Birthday and Merry Christmas to my law office clients.

If interested:

1. Pay for and schedule a date and time for the Legal Audit: Nursing Career Plan™ at  http://www.bookfresh.com/profile/157503739.

2. The cost is $250 for a 30 minute Skype video call or telephone conference call.

3. I will need an updated CV/resume and work history. You will receive an email listing the information and documents I need from you prior to the consultation based on the issues and concerns you identify.

4. If you have legal documents, contracts, or agreement for me to review. Scan/email, mail, or fax to me prior to the consultation please. My fax number is 888-580-1119.

5. Once you pay for and schedule the Legal Audit: Nursing Career Plan™, you will review a packet of information for you to complete and return to my office.

6. Based on the issues/concerns you identified, you will also receive a packet or a package of informational and educational materials and documents by mail and information via email. Yes, there is homework because you will have to "stay the course" after the consultation. I want you to suceed (this isn't a scheme just to take your money) and I am going to provide you the materials to assist you with this process. I will be your Legal Cheerleader!!!

7. After the Legal Audit: Nursing Career Plan™ video call or conference call, you will receive your "plan" as a PDF file from me.

Take charge and grab "self-regulation of nursing practice" by its horns by identifying, managing, and mitigating the legal risks of nursing practice  while plotting the trajectory of your nursing career with your very own Legal Audit: Nursing Career Plan™.  I love it! This sounds so sales like; I am also selling a used car and a tattered blood pressure cuff if you are interested:) Just kidding!

 

 

 

 

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.  

Its Just a Public Reprimand! Thirsty Thursday and One Long Island Iced Tea

Its Just a Public Reprimand is like saying Its Just a Hemorrhoid.

Okay next time you see me ask me to tell you about similarities and differences between a public reprimand and hemorrhoid. I can't do it on the blog; its too offensive and I don't want to receive a private email (which I will have to publish here on the blog) or written correspondence by mail (which I will have to publish here on the blog) from some nurse saying how offended she (its always a she) was by my blog post.

Why am I harping on a public reprimand this week? After all it is the least amount of discipline available and its not probation, suspension, or revocation.

What is a public reprimand?

http://www.rn.ca.gov/enforcement/dispaction.shtml#term

A public reprimand is not a private reprimand.

A public reprimand is a big deal because like Long Island Iced Tea (LIIT), its no big deal initially but give it time. I went out with a group of my girlfriends and I had a LIIT last month; I sipped and danced and sipped and danced a little more. This wasn't a watered down LIIT but a "real long" LIIT made at a serious bar for serious drinkers who seriously want their monies worth.

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

It was 6pm and I met my friends for Happy Hour. I don't get out much because I work 12-16/6. So I am thinking oh this isn't too bad, its 6pm on Thursday, I will hang out until 9pm or so. I also assumed the drinks would not be too stiff because folks have to work the next day, right? I know.

I asked for a glass of champagne or sparkling wine and the bartender at this club laughed. This should have been a clue for me, right?  My BFF said "oh give her a LIIT."

Then, she says "you know its Thirsty Thursday, so drink up." Okay, this should have been my second clue, right? Drink up on a Thursday? Really? I have to work on Friday and to me that's like saying drink up on a Sunday evening.

It was Thursday but I wasn't Thirsty for a beverage.

I am always Thirsty for the big faces (large bill denominations) but never alcohol. Maybe I can have a Thirsty Thursday once a month in my law practice where I charge $75.00 for a 30 minute telephone legal consultation. I may try this next month and set aside one Thursday (9am to 7pm) for legal consultations at $75.00. Stay tuned.

I had ONE LIIT. One LIIT. My husband picked me up and drove me home on a Thursday. On a Thursday. One LIIT. Enough said. Needless to say I am not "allowed" to go to Thirsty Thursdays.

But please invite me if you have a Meaty Monday. I like chicken and turkey.

How about Tired Toes Tuesday? I would love to have a manicure, pedicure, and 45 minute massage.

Before you sign a Public Reprimand, have a nurse license defense attorney review it with you and discuss the implications of the public reprimand with you.

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

This brings me to my next point with APRNs.

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

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

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

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

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

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

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

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

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

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

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

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

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.

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.