Nursing Law & Order

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.

Substance Abuse Counselors who give legal advice and counseling: Here we go again!

A Substance Abuse Counselor wrote a nurse was in "very very big trouble" for drug theft. Okay, how do you distinguish very very big trouble from very big trouble from "just plain trouble" in drug diversion. Maybe its Just Plain Trouble like Just Plain Brenda on The Closer. That's Deputy Brenda Lee Johnson. My nephews do the very very very's at ages 6-10.

Its is based on the whether or not is a Felony 1st, 2nd, 3rd, 4th, or 5th degree in O-HI-O or the number of charges in the indictment?

Another counselor writes a nurse felt legal counsel was "necessary" so nurse hired lawyer and then did T, U, V, W, X, Y, and Z. Oh and also AA, BB, and CC.

How is what the nurse decided to do at the advice and counsel of his/her attorney relevant enough to the substance use and abuse treatment that it needs to be mentioned in records that would be provided to the State Nursing Board?

Did you ever think that the information a client conveyed to you as a result of the attorney-client relationship may be something that doesn't need to be shared in treatment records? Why not keep a professional journal with notes that are not appropriate for the treatment records but you want to write somewhere so you don't forget? You fickle frack maybe you need to review your position description that hasn't changed in 8 years, your employee handbook that changes qid, and your facility policies and procedures and guidelines which are located in the basement of "our old building." 

I get this crap all the time by those licensed by the State Board of All Things to All People and who want to dive into providing legal advice and counseling to a nurse who is dealing with substance use/abuse, mental health, or interpersonal issues and have a past, present, or future State Nursing Board complaint in the oven.

You don't have enough to do with addressing all aspects of the medical treatment plan that you need to also provide bootleg legal advice. Is this a professional boundaries issue as well where you are over-involved with this nurse client?

A. Why are you giving legal advice and counseling to someone at one of the their most vunerable times?;

B. Why are you telling nurses they "don't need a lawyer and this is what happens with nurses in our Program." Please go and take a nap.

Are you kidding me? And when you as "counselor" receive a complaint against your license from your Board, you are dialing for an attorney like you are ordering pizza from an office phone and contacting your insurance company related to your license defense protection benefit on your cell phone while trying to email or IM your spouse.

Its good enough for you but not your nurse clients, right?

C. Stick to what you know. I am not writing treatment plans in my law practice for nurses so why the hell are you providing legal advice and counseling to nurses in-patient, IOP, aftercare, or during stage of treatment and counseling?

D. If you don't know your scope of practice and what you can and cannot do, review your State Practice Act and Board regs. Is there any mention of providing legal advice and counseling to clients? Attorneys have a monopoly on the provision of legal services, pumpkin in the US. This may change in the future but not really (I don't want to sound to smug because sh#t happens).

You want your State Board licensees to be able to give legal advice and counseling along with substance abuse advice and counseling and then serve fries with that vanilla shake while wearing skinny jeans and a tank top? Try it.

You would think Coach was giving away free leather briefcases to the first 15,000 card carrying lawyers at the courthouse and statehouse in CMH there would be so many attorneys prepping for mortal combat related to another Board wanting to provide legal services. This would be our rallying cry and an accurate depiction of our "street fighting" skills:

http://www.youtube.com/watch?v=UMf40daefsI

Stay within your scope and your role and keep a summary of the 3 bullet points comprising the entirety of your job description for easy access and reference by you throughout the day as needed.

Your board= therapy, treatment, and recovery.

Lawyers= legal advice (very broad), legal counseling and represention on all things licensure, criminal, employment, etc. when a nurse presents for treatment, counseling, and therapy.  

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.

 

Requesting a Coke from a Lawyer who adores Pepsi; Pepsi, Coffee, or H20 only!

Okay, folks its come to this. There are some lines that just have to be drawn when doing nurse license defense work and this is one of them.

I had a client who requested a Coke during a meeting this week and laughed.

I could tell you about my fascination with Pepsi which started at age 2 but I will not because I am not trying to convert you. There is nothing like an ice cold fountain Pepsi from Speedway with not one but two straws. Try it.

What about hearing the pop on a can of Pepsi at 1am in the morning when I have 2 to 3 more hours of emails and documents to review? Its music to my ears. 

Effective immediately, we only serve Pepsi, Coffee or Water during client meetings.

Please don't ask for tea. If you want tea during our meeting, I probably won't represent you.

Its Pepsi, Coffee, or Water only.

Thank you for your understanding:)

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.

I am Triple X with the State Nursing Board, this is an extreme emergency, and I have a question for LaTonia about a case: Liar, Liar, Pants on Fire!

Triple X called the office and indicated this is Triple X from the State Nursing Board, XXX had a question for me about a case, and it was an extreme emergency. 

My receptionist was excited and in a panic.

Why? I am a nurse license defense attorney who practices before State Nursing Boards; calls from Board staff, Hearing Officers, All Attorneys, and Administrative Law Judges are Priority calls of course.

But guess what, so are calls from clients and prospective clients. This is why I have my own practice and its limited to nurse license defense because my clients are nurses as a nurse all nurses are important.

Okay, I pause:

1. I have never received an "extreme emergency phone call from State Nursing Board staff" EVER, NEVER, EVER. 

Even if its a Summary Suspension case in Ohio, immediate suspension in Indiana, or Immediate Temporary Suspension case in Kentucky, Board staff have never said "this is an extreme emergency and I need to speak with LaTonia now." 

Why? Because LaTonia responds and returns calls, emails, etc. promptly. PERIOD. I am not your previous lawyer or the lawyer your neighbor worked with on her divorce or personal injury case and could never reach.

My law practice isn't structured that way. Its LaTonia, Jack, receptionists, and soon to be a virtual legal assistant. We don't have 80 staff members and we track calls, inquiries, and information coming and going in my law office like a person on a diet trying to look decent and "easy on the eyes" in a tasteful bikini when their swimming pool opens on May 30, 2011 counts calories and carbs.

Yes. I am not on a diet per se; but I have lost 30 pounds! Okay but that's another post and yes I still have a Pepsi a day; just more water and I eat less than 1200 calories per day. I know! Okay, but that's another post.

2. Board of Nursing staff have my direct office dial, my home number, my office fax and my personal fax, and my cell phone. I have Board staff office telephone numbers programmed into my cell phone and also my email on my DROID X.

3.  Also, WTH is an extreme emergency?

An extreme emergency is a matter of life or death.

I am not a death penalty criminal defense attorney so I don't get calls saying "hey LaTonia return this call in 10 minutes or the switch will be thrown or call us back in 20 minutes because we are priming the tubing." I don't receive those types of calls in my practice, sorry.

4. When I saw Triple X my first thought was "there is no one by that name who works with State Nursing Board A,B, or C" however despite the fact that most Boards are having staff furloughs because of state wide budget cuts related to the economy, maybe there is a new Board staff person with this particular Board by the name of XXX.

Then in 5 seconds, I searched by online service as a software law practice management system and saw this nurse had contacted my law firm several months about a pending disciplinary investigation before the State Nursing Board.

Just a few things:

A. Anytime your license is being investigated; its a priority for you and it should be a priority for the attorney you contact. If you contact a license defense attorney its a priority. That's the bread and butter for a license defense attorney.

B. We return all calls within the hour, a few hours, and certainly within the day. My office returns all phone calls and responds to inquiries. PERIOD.

C. You want to reach me fast because you need to respond to a Kentucky Nursing Board Complaint, Ohio Nursing Board Potential Violation Report, and/or Indiana Nursing Board complaint by a DEADLINE. You can do one or more of the following; I don't really don't mind:

1. Call my office at 513-771-7266 or 888-571-1110;

2. Email me at [email protected] or [email protected]. These are my business emails.

3. Complete a form on this blog (those are emailed directly to me);

4. Complete a form on my primary website at www.nursing-jurisprudence.com (those are emailed directly to me);

5. Complete a form on my second website at www.nursing-jurist.com  (those are mailed directly to me);

6. Fax your State Nursing Board complaint to my office. 

My office receives faxes via email and I receive those emails instantly. Our fax number is 888 580 1119;

7. Call and/or text and leave a voicemail for Jack Stem at 513-833-4584. Jack will find me and say "hey, This just came in.....";  

8. Call and/or text and leave a voicemail for me on my cell phone at 513-604-9330; Don't just call and not leave a voicemail.

9. Pay for a Legal Consultation on my website at www.nursing-jurisprudence.com; you need to speak with me immediately and you want me to review documents, right? Click on the online payment icon; If you retain me, we can deduct this from your flat fee true retainer for representation; and/or

10. Go ahead and pay for a legal consultation on my website or with my bookfresh account which allows you to also schedule appts. online; See

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

I receive an email about a payment instantly and I immediately say start to wiggle because I have received a payment of  "the green" and I may be able to go to Big Lots and buy dog treats, cleaning supplies (I like to clean! and that's another post), and start making Valentine cards and baskets for 45 nieces and nephews and decorating my husband's business for Valentines Day.  

I am wired 24/7 and I love it. No burnout here, pumpkin as I am going hard and I love it! 

Although, because I am not a liar I must admit, I probably won't start graduate school for my MSN this summer because of my law firm case load. Also I am doing and enjoying more traditional wife activities like taking an active role in my husband's business and assisting him with his career goals. Hot damn, but that's another post. True, hard core and card-carrying nurse fems stay tuned!

I turn my Droid X on silent now (I can't turn it off; that's another post) at bedtime because my husband gets irritated hearing "DROID" all night with emails and text messages I receive (personal and business); let's not even go there with Facebook updates! DDDD-RRR-OOO-IIII-DDDD! I love to here this. http://www.youtube.com/watch?v=yVZIlmzohbo

I smile because when I hear "DROID" I think its money or its about money and I start to wiggle and its text about one my nieces upcoming birthday party at Chuck E. Cheese. I swear you need take a Flexeril (legally prescribed; this is Nursing Law & Order) at the door before entering a Chuck & E. Cheese for a preschooler or toddler birthday party. Its off the hook madness from the time you enter until you leave.

I actually was "reprimanded" much like a State Nursing Board reprimand (without the fine, CE or publication in the Board Newsletter) for turning over in the morning and reaching for my Droid to the left instead of checking on my husband to the right. I responded I am left-handed and its my natural response to turn to the left in the morning not to the right. I now turn to the right (while I am thinking, I wonder what awaits for me this glorious morning to the left?)

Seriously, don't lie and say you are with the State Nursing Board when you call my office. I have an issue with liars (see my previous blog posts over the years). I do and I am willing to admit it. Why lie? :)

I would rather you take a quarter out of my purse (that's all you will find in my purse because I don't keep any green on me) and steal from me (take the quarter at the bottom of my purse; but if you go into my wallet and take my debit/credit cards I am prosecuting you for theft, reporting you to the State Nursing Board, and putting my hands on you in self-defense of course) than lie to me.

I know, are you reading more aggression in my posts lately? I know; I am working on it (I am lying) and I can't wait until the weather breaks so I can start walking 2-4 miles a day again instead of using gym equip. I really can't wait because walking helps with stress and a sleep better at night after my long walks.

Its casts such a negative net and unnecessarily so when you say this, I am Triple X with State Nursing Board A, this is an extreme emergency, and I am calling LaTonia about a case with a question.

It also makes me think you think I am "slow" because surely if you are contacting a nurse license defense attorney and saying you work for the Board, the attorney would know that you don't work for the Board or the attorney can find out easily whether or not you do work for the Board.

Then I start to wonder, is this a mental case? Is this a red flag client? Do I need to have Jack "background" this person now? Is this person just f'ing with me and my staff just because? Who does this? Then I get angry. Not Incredible Hulk  green angry, but just 2 second Mountain Dew yellow angry, then I say "Code Orange" and I move on.

Code Orange in my law practice means a no way, no client.

So bottomline, I am always accessible to prospective clients. I am also working on current client cases which are important and a priority also. It doesn't take my office DAYS or WEEKS to respond to any inquiries and therefore you don't have to misrepresent yourself and say you work with the State Nursing Board and you have a question about a case to get my attention.

Deceit, Deception, and Dishonesty!

See http://advocatefornurses.typepad.com/my2cents/2009/07/dishonesty-deceit-and-deception-my-name-is-a-i-am-a-nurse-and-i-am-a-liar-.html

Just Sign and Date on the Dotted Line!

There are alot of nurses or NCLEX Applicants who receive a Consent Agreement, Agreed Order, Consent Decree or another legal document from the State Nursing Board and just sign and date on the dotted line.

There is nothing from with just signing and dating on the dotted line but keep this is mind:

1. A Board of Nursing Agreement, Contract, or Addendum is a legally binding document between you and the Board of Nursing;

What is a contract? http://en.wikipedia.org/wiki/Contract

2. Make sure you understand the short and long-term consequences of what you are signing. Understand the who, what, when, why, and where of the Agreement or Contract;

3. Consider reviewing the Agreement and making notes. Then re-reviewing the Agreement and making additional notes and questions. Those questions should be answered (either by discussions with Board of Nursing staff, your own research, speaking with other nurses, or consulting with a license defense attorney) before you sign on the dotted line; and

4. Where do you see yourself in 30 days, 90 days, 6 months, 1 year, and 5 years after you sign on the dotted line?

As nurses, we enter into contracts everyday without a second thought when we sign up for a credit card, refinance a home, purchase a vehicle, etc. We are also accustomed to signing our name on legal documents: the medical record and patient or resident chart is a legal document also.

Just a note of caution. Before you just sign and date a legal document you receive from the State Nursing Board, pause and consider the consequences and implications of your signature.

Also stating you signed the State Board of Nursing Contract while intoxicated or under duress are not affirmative defenses in administrative law and license defense cases to VOID the contract.  

What kind of duress is needed you say?

* you were in a warm, small, and dimly lit room @ the State Nursing Board office for 15 hours which smelled of motor oil;

* you were not offered food or water for those 15 hour; although you were given two Tic Tacs q 15 min x 1 hour; q 30 min x 2, then q 1 hour thereafter;

* you were not permitted to leave the room as staff blocked the exit;

* your requests to use the bathroom were denied but you were given a gently used Chux; 

* you were not allowed to apply lip balm (which for me crosses the line);

* your cell phone was in front of you but you were not allowed to touch it; This drives you insane and you start pulling at your hair (I would anyway) because you received at least 185 emails, texts, IMs, pics, and/or calls (I do) in 12 hours; and

* you are emotionally distraught because you only placed a quarter in a downtown parking meter.

Then you finally scream out in pain (because let's face it no caffeine or Extra Classic Bubble gum for 12 hour is pain) and utter exasperation and despair (because you want to make it home to watch the Walking Dead marathon on AMC) yes, damn it, yes, I did it! I can't live with this anymore!

I can't take it? I will do whatever it takes, to resolve this now?

I confess to violating the State Nurse Practice Act while employed at Crappy & Uncaring Memorial Hospital; just give me the fu*%ing Contract, and I will sign and date on the dotted line.

Happy Holidays from me to you and your family.

 

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!

 

Your State Nursing Board Complaint is coming and just like Christmas its only 3 weeks away!

You work in a very busy ER in the downtown of a mid-size city. You are a seasoned ER nurse and you have worked at this facility for 12 years. The last 2 years have been rough however. You divorced from your spouse of 15 years last year in 2008 and have shared custody with your 5 kids ages 15, 10, 7, 4, and 2. Also your elderly parents live in the area and you take on the primary responsibilities of keeping them in their home through a combination of home care and other social services. You have one sibling, who lives in another country and only returns to the country every three to five years to visit.

You received a verbal warning in January 2009 for being rude to a patient who was in the ER with drug seeking behavior. In May 2009, you were wrote up for the inappropriate remarks and verbal tongue lashing you gave a floater nurse who was "moving to slow" during a code situation.

You written up in July 2010 after being a verbal swearing match that almost turned physical with a nursing house supervisor related to the process of admitting ER patients. There were conflicting accounts of staff of what actually happened but you were viewed as the aggressor and a fitness for duty was ordered. You were evaluated and you followed the recommendations. You return to work after a 3 week paid leave and you are welcomed back by the nurses, docs, and other staff in the ER.

A pregnant woman comes in to the ER with her husband. The women is having chest pain. Within 20 minutes of her arrival to the ER, several of the couples friends, family, and colleagues also arrive at the ER.  This is the couples first pregnancy. They were married two years ago and both have successful careers as pharmacists. The woman is 4 months pregnant.

While you are assessing the woman, she tells you she is nervous and scared. You tell her "Honey, I have 5 kids and this is nothing. Just wait and you will see, this is only the beginning."    

You arrive at work the next day and find the ER Manager, the Assistant CNO, and HR waiting for you. They ask you about your care of the pregnant women. You recount your care and state there was nothing out of the ordinary as the woman was admitted for observation. They ask about your statement about "this is nothing" and you say it was taken out of context and you were only trying to help calm her down.

They tell you that you are being terminated effective today, December 4th for being rude to a patient. They tell you this incident as well as the previous infractions are being reported to the State Nursing Board. They also tell you that the pharmacists are really upset and are also planning to report you to the State Nursing Board.

Its December 4th. You have been terminated from your employment and reported to the State Nursing Board. You don't have your own professional liability insurance policy because you didn't think you needed it. Its Christmas time and you certainly don't want to spend any money on hiring a lawyer because you didn't do anything wrong here as this is ajust a  misunderstanding of the worst kind.

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

1. Should the employer report her to the State Nursing Board?

2. Do you think she violated the State Nurse Practice Act, Board Regulations, or any professional standards?

3. Do you think her termination was fair? She is of course at-will employed.

4. Do you think she should hire a lawyer now to represent her in the State Nursing Board case which is coming just like Christmas?

5. What are the personal issues here?

6. What are the professional issues here?

7. What are the goals for the future?

I consider myself as a license defense defense attorney to be "a clean up woman." http://www.youtube.com/watch?v=vh-2_kdVcyA. No, honey, I am not stealing anyone's man (I have my own) but I am legally responding to what happens when a variety of "shelved" factors collide and the results (whether intended or unintended) are complex and may include but not limited to personal, financial, emotional, professional, licensure, criminal, employment, civil (med mal), mental health, regulatory, workplace, credentialing, or privileging stressors or events.

Sometimes, just sometimes, the license, while the obvious concern in a State Nursing Board complaint investigation and adjudication, is really not "that important" when everything else is considered.

I will give you an extreme example. If you are the Black Swan (which damn it I CAN"T WAIT to see. We may drive to Indy or Columbus to watch next weekend) and you have an active and valid license to practice nursing, the question is not can you practice but should you practice? http://www.imdb.com/title/tt0947798/  Maybe there are somethings you need to do for yourself before you should practice although you can practice now. This is the hallmark of a professional putting the needs of the industry you serve and service before your own needs, wants, and desires.

So what are you saying LaTonia. As a nurse license defense attorney, I will you tell; your license is important but there are always things more important than your nursing license right at this given moment. Sometimes its my role as your attorney to help you see this.

 

 

 

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.

Say it fast before it changes: 100% of my cases involve nursing students, NCLEX applicants, LPNs, RN, and APRNs: Its all about nursing (today) at the Law Office of LaTonia Denise Wright, LLC

Nurses if you are charged with a misdemeanor (unless simple traffic and that doesn't include a DUI, baby!) or a felony hire a criminal defense attorney.

You are also a licensed healthcare professional. Therefore despite what your criminal defense attorney tells you or recommends (unless your criminal defense attorney also has extensive experience representing nurses before your State Nursing Board) you need to obtain a curbside consultation (thank you to Edie Brous for coining this term at the TAANA pre-conference last week) from a nurse license defense attorney. TAANA really needs to reach out to the criminal defense bar on this issue.

Oh and I don't mean a license defense attorney who represents other healthcare professionals and maybe just a nurse or two here and there over the last 20 years. You want to consult with a nurse license defense attorney who practices extensively before your State Nursing Board.

How will you know the level of your attorney's experience? Review their qualifcations, CV, website and then ask questions.

I cannot state the importance of speaking with a license defense attorney when you are charged initially with a crime. I have seen so many cases where nurses are told by their criminal defense attorney that "the criminal case doesn't involve a nursing practice issue", "you didn't kill a patient", or "the conviction is totally unrelated to your practice of nursing."

I have also seen cases in this economy where attorneys who don't normally take these types of cases actually take a case before the State Nursing Board because they need the money or normal practice areas are drying up. If you have litigated civil and criminal cases as a criminal defense attorney, you know that you can handle a little "piddly" complaint with a State Nursing Board, right? Hell its only adminstrative law.

If I had $49.95 for each time this pops up, I would have an outdoor shower and 4-5 person outdoor sauna with a small patio with white columns and roofing to match our front porch off our garage. Hint, Hint. This is our spring project for 2011.

The nurses rely on this advice to their detriment in the licensure matter with the State Nursing Board. Licensure cases are becoming more complex and discipline against a license has short-term and long-term implications. The criminal case IMO is the priority of course (you can go to jail, directly to jail, not pass go, and no collect your $200.00, i.e. the loss of liberty) however your nursing licensure (your golden ticket to fame, fortune, and being fabulous) is huddling close to the right of the criminal case and your current and future employment and career is on the left of the criminal case.

You are licensed nurse and your nursing license is important to you. Are you the job? I hate to admit it but I am and this rings true for most nurses. I heard this "I am the job" on Law & Order SVU. Make sure you are giving your nursing license the attention it deserves when sorting out a criminal case.  

Your criminal defense attorney can work his/her magic on the criminal case as that's their specialty. However in most cases, criminal defense attorney are criminal defense attorneys and your criminal defense attorney does not have the expertise, experience, and knowledge to successfully counsel and advise you on the licensure, employment, and career implications that a plea, convictions, pre-trial diversion, etc. will have on your nursing license. A nurse license defense has the Pixie dust you need to sprinkle on your license. (I watched Peter Pan on my I-Pad this morning).

You need a nurse license defense attorney not an attorney who practices before another licensing boards. Do your research, make the calls, and find someone to counsel and advise you when you have a pending criminal case. Your license depends on it and its just that serious, boo boo.  

For example, I recently referred one of my clients to several of my colleagues who regularly practice before the State Medical Board because my client is seeking licensure as a MT. Could I represent my client (who I have represented before the Nursing Board) before the  Medical Board and charge an addtional fee? Of course but I wanted my client to speak with and retain a medical license defense attorney who practices extensively before the State Medical Board. That's just not me.

LaTonia Denise Wright, RN, BSN, JD

Nurse License Defense Attorney 

My thing is nursing law and my passion is nursing. Don't tell anyone but did you know I blush when I read the Nurse Practice Act and I get a "coffee rush" sensation just from reviewing a complaint from the State Nursing Board? 

I just resolved cases before the Social Work Board, Drug & Alcohol certification board, and professional counselors board, so I am proud to state that 100% of my clients as of today (who knows I may get a call from a RT, PT, LISW, OT in the morning) are LPNs, RNs, APRNs, nursing students, and nursing school graduates.

Its all about nursing (today) at the Law Office of LaTonia Denise Wright, LLC:) 

My Criminal Defense Attorney contacted the State Nursing Board and was told........

If you are a nursing student or a LPN, RN, or APRN and you are charged with a misdemeanor (unless its strictly a traffic infraction. DUI/DWI/OVI ain't just a traffic infraction) or a felony, you probably have an attorney whether its a public defender or a criminal defense attorney you retained to represent you.

I know you probably don't want to spend anymore cash but you need to speak with a nurse license defense attorney also about your situation.

What is a license defense attorney? See Download Licensedefensebrochure

I have had multiple consults with nurses who were convicted of misdemeanor(s) or felony(ies) in the last 3 months who told me "my criminal defense attorney contacted the Board of Nursing attorney and was told" one of the following:

1. Nothing is going to happen with this;

2. The case will be reviewed at a later date;

3. It depends;

4. We may be in touch with the nurse.

The Board staff are not being evasive, IMO. Its not that cut/dry to provide a definitive answer on the spot without a complete picture of the facts, criminal case history, and records. Also its not the role of State Nursing Board staff to tell your criminal defense attorney what can, may, might, should, would, or could happen after you are convicted of a state or federal crime.

Then the nurse receives a Notice of Opportunity for a Hearing from the Ohio Nursing Board or receives a Notice of Complaint from the Kentucky Nursing Board or the Indiana Attorney General Office of behalf of the Indiana State Nursing Board.

This is why you need to speak with a license defense attorney who practices before the Board because a license defense attorney can tell you more precisely where this is going based on his/her experience and what your options are before you accept a plea or after you accept a plea in a criminal case. Criminal convictions, licensure, and employability are the second Bermuda Triangle in nursing IMHO right after the application of nursing law, ethics, and professional standards in the nursing workplace. Did you know I published an article on the same a few years ago? See http://www.ncbi.nlm.nih.gov/pubmed/18524302.

Healthcare licensing boards across the country are asking about criminal convictions on licensing renewal applications and may also require criminal convictions to be reported to the Board within 30, 60, or 90 days of a conviction.

If you want to know "what's up" with your license, then you need to speak with a nurse license defense attorney in your state or jurisdiction. See www.taana.org.

Chemical Dependency Counselors and Mental Health Therapists: Please stop giving legal advice to nurses and stay in your role!

I don't want to be confrontational but okay here it goes, again. http://advocatefornurses.typepad.com/my2cents/2009/06/bootleg-attorneys-chemical-dependency-counselors-therapists-and-evaluators-giving-legal-advice.html

I don't pretend to have the education, credentials, or skills to provide mental health or substance abuse counseling to nurses so why is it that I am finding that more and more mental health therapists and substance abuse counselors want to give legal advice to nurses involved in a State Nursing Board complaint, investigation, and hearing.

Please stay in your role and stick to what you were trained to do.  Your focus is TREATMENT.

Something you see as "simply" a "self-report to your State Nursing Board and appling to the State's Alternative to Discipline Program" is usually much more complex especially if there is criminal or if the nurse is licensed in more than one state.

If you didn't know it then I will tell you: you are not a license defense attorney so stop trying to be one and operate within your job description. Does the position description of a mental health therapist or substance abuse counselor with Progam X or Program Y include providing legal advice and counseling to nurses? I don't think so, pumpkin.

Your recommendation to self-report and apply to the State Nursing Board alternative to discipline program for chemical dependency is "legal advice." Don't stop now. Can you then counsel and advise the nurse on the pros and cons and short-term and long-term legal implications of this decision?

I know you are really only trying to help but if you really want to help suggest to the nurse that she/he really needs to consult with or retain an attorney to navigate the maze of licensure, career, criminal, educational, credentialing/privileging, regulatory, and employment issues involving substance use and abuse disorders or dual diagnosis.

I also love it when someone prefaces the advice with "I am not a lawyer and this ain't legal advice but this is what Nurse A, Nurse C, Nurse D, and Nurse E our program did...."

I will tell you what my buddy Jack Stem told me his role as an OSANA peer advisor is: to save the life of a CRNA struggling with addiction, not to save a career or license. This was debated and discussed at a AANA meeting this year and it was stated of the role of a State Peer Advisor is to save the life of a CRNA struggling with addiction.

Let me add, its the role of a license defense attorney to address the career and licensure issues, NOT a chemical dependency counselor or a mental health therapist. If you really want to help the nurses in your program suggest that they contact a license defense attorney and stop enabling them by giving bootleg and bootstrapped legal advice.

 

Hot Mama will "Just Say It": having a nurse license defense attorney objectively evaluate your case and situation.

Sometimes (okay actual alot) when you are a license defense attorney you have to just say it. My role as a license defense attorney is represent, counsel, and advise and sometime I just have to say it.

I tease my two of my nephews (Jakael and James) and tell them they have to call me "Hot Mama." They call me "Nain-Knee" because when they were little they couldn't say "auntie." They call my mom as "Big Mama." I will tickle them until they call me "Hot Mama." Now, when I ask them jokingly what's my name, they will look at each other, laugh, the other will say "just say it" and both will say "Hot Mama." They just say it. With Christmas approaching I think I will have them call me "Sugar Mama." 

Saying it ain't easy because its not what clients (RNs, LPNs, APRNs, nursing students, nursing school grads, prospective nursing students, etc.) want to hear. But in a professional services relationship (compare and contrast with a personal relationship like a friendship) that's what I am being paid to do: just say it.

I can swim, dance, sing, and play around with it but bottomline I just have to say it. I can preface it will potential outcomes and possibilities but I still have to just say it. Nike says "just do it" and that's what's up but if you are involved in a State Nursing Board complaint or if you are a nursing student who will respond in the affirmative to one or more compliance questions on the State Nursing Board App. for Initial Licensure by Examination, you need an attorney to "just say it"!

I met with a client last month and I actually felt a pang in my chest when I said it. This is one of the most serious cases I have seen in my 9 years of license defense practice involving a nursing school graduate when evaluating the person's suitability for license and prospects for employability.

I said it because it was my role, my job, and my professional obligation as an attorney but I felt a pang in my chest. I really do care about my clients and nurses in general.

I also spoke with a nursing school graduate who appeared before a State Nursing Board and was denied a license because he/she was told by the Board that his/her criminal convictions indicated a "pattern" of misconduct and criminal behavior. This individual looking at his/her own situation didn't see this and proceeded to complete the application for initial licensure and appeared before the Board without any attorney representation IMO totally unprepared and oblivious to the Board perspective when evaluating suitability for licensure.

So what am I saying? Just say it.

If you are a nursing student or considering nursing school, I am going to tell you what your nursing program won't or can't tell you and you don't need to spend tens of thousands of dollars with me.

I will accept a check for tens of thousands of dollars however from you:) Actually I attended an Ohio League for Nursing CE on Competency in Nursing this week at the Greater Cincinnati Health Council and I mentioned this to a nurse educator also from a local nursing program.

If you are considering nursing school or you are currently enrolled in nursing school, PLEASE do the following:

1. Decide where you are planning to sit for a license once you graduate from nursing school;

2. Print out a copy of the State Nursing Board Application for Licensure by Examination. Review the Compliance questions on the Applications to see if you need to make ANY affirmative disclosures.

Ohio Board of Nursing

See

http://www.nursing.ohio.gov/PDFS/Forms/Exam%20App%20Packet%2010.2010.pdf. Take a look at page 5.

Indiana State Board of Nursing

See http://www.in.gov/icpr/webfile/formsdiv/50024.pdf. Take a look at page 2.

Kentucky Board of Nursing

See the Board website at http://kbn.ky.gov/license/.

3. If you are required to disclose any AFFIRMATIVE answers on the application and I mean ANY, schedule an appointment with a LICENSE DEFENSE ATTORNEY asap, like today.

a. You think you might to need to disclose but you ain't sure, call a license defense attorney.

Most attorneys may charge for a consultation but what's a few hundred for a consultation vs. tens of thousands of dollars for your nursing education vs. hundreds of thousands of dollars in lost income related to restricted employability over a 10-30 year nursing career?

I charge $150.00 for a thirty minute consultation. $250 for a 60 minute telephone consultation or a 60 minute in-person meeting. See http://www.nursing-jurisprudence.com/legalconsultations.html. Its actually more economical and a great return on your investment (ROI) to consult with an attorney? Who would have thunk it?

4. If you are planning to apply for a license by examination with the Ohio Board of Nursing, Indiana State Board of Nursing, or the Kentucky Board of Nursing, I can assist you. I am licensed to practice law in Ohio, Kentucky, and Indiana. Call my office to schedule either an in-person or telephone appt. with me at 888-571-1110 and you don't have to call me Hot Mama and I will just say it because its what you need to hear to realistically evaluate your options and decide how to proceed.

5. Don't believe what your nursing school program or instructors tell you about your chances of licensure and employability. These folks mean well but they are not a nurse license defense attorney and its not their job or role to evaluate your suitability for license and your employability. Don't get me started on folks needing to stay in their role and job description!  That's another post.

6. Don't spend 15k to 45k on a nursing school education on the hope, prayer, or expectation that you will receive a restricted or unrestricted license without receiving some legal advice and counseling.

I know your mom, spouse, friends, family members, instructors, etc. are telling you it will be okay (I can call my mom right now and say "mom I robbed an elderly woman of her bingo money last night but I didn't use a weapon, she wasn't injured, and a wore a mask" and at some point in our very long 10 hour conversation she will say "honey its going to be okay") but sometimes "its going to be okay" just ain't enough. 

Extreme example but you get my point. That's what "they" are supposed to tell you (even if they are really thinking you are fracked) because its not their job or role to REALLY provide you with objective advice and counseling.   

7. There is a tendency to review your own situation with rose-colored glasses and to only see the "good" and rationalize the situation. http://www.answers.com/topic/rose-colored

Me, its my role and job to "just say it" because that's what you pay me to do, right? You want to know the good, the bad, and the ugly about your case. Consult with an attorney to objectively evaluate your case and your situation in you have a State Nursing Board complaint and especially if you are a future NCLEX RN or LPN Applicant this includes your suitability for licensure and employability.  

 

Digging a Ditch in a State Nursing Board case: Are you in the trenches and headed towards Middle Earth?

This has been an interesting week at the law office of LaTonia Denise Wright, LLC. I had two nurses ask if we would accept post-dated checks for representation. http://en.wikipedia.org/wiki/Post-dated_check

I cannot accept post-dated checks to retain my services and start to work on a State Nursing Board case. Why?

1. If the check doesn't clear, I will only withdraw from representing you immediately;

2. If the check doesn't clear, I bank at 5/3 which assess a $35.00 fee to my account;

3. If the check doesn't clear I will be plenty p*ssed because I know better than accepting a post-dated check to initiate a professional services relationship;

4. I am not a pay day loan center;  http://en.wikipedia.org/wiki/Pay_day_loan

5. You can retain me when you have the funds;

6. The last time I accepted a post-dated check (4 years ago) I lost the check and I am superstitious:)

7. Its bad business to start a professional relationship with a promise of payment in the future.

Both of the cases where the nurses wanted to pay me with a post-dated check were SERIOUS cases with the Ohio Board of Nursing. The nurses needed representation, counseling, and advising YESTERDAY.

We suggested in both cases that the nurses retain us:

1. when the funds are available; 

2. borrow the funds from a check cashing service, friend or family member or tap into your life insurance, 401K, 403B, etc.; or

3. Ask a friend or family member if you can charge the fee on their credit or debit card.

If you didn't know I will tell you: legal representation, counseling, and advising is a must in some State Nursing Board cases.

Don't believe the hype on allnurses.com and other nursing chatrooms, forums, and boards that you can "rep yourself" with ease before the State Nursing Board. It ain't all cut and dry or all black or white and if you could rep yourself with ease then before the State Nursing Board then there wouldn't be attorneys like me who limit their practice to representing nurses and healthcare professionals in healthcare regulatory board investigations, hearings, and post-discipline matters. http://en.wikipedia.org/wiki/Don't_Believe_the_Hype

State Nursing Board cases are becoming more and more complex depending on the issues involved and navigating the process and procedure alone can be cumbersome. If you are in ditch, you can keep digging in and go deeper and deeper in the trench until you hit Middle Earth. http://en.wikipedia.org/wiki/Middle-earth. Go Frodo!

Or you can seek assistance (whether its legal, spirtual, financial, emotional, mental health, medical, etc.) and climb out of the ditch and get back on the road. You always have a choice and its a decision you have to make. Decide who you need on the team of "you" and move forward.

This isn't a fairy tale and I ain't Cinderella: Is this your 2nd, 3rd, or 4th State Nursing Board Complaint?

I met with a client in Shelbyville, Indiana on Sunday (and took my lovely grandparents and my husband to lunch at the Indiana Live Casino), Jack and I met with a client and her mother on Tuesday in Westerville, Ohio, and today I am meeting with clients in Lexington, Kentucky. No speeding tickets, no speeding tickets. I am road warrioring it this week, baby.

Today is Oct. 1st and last month was a busy one in my law practice. I am seeing more and more cases with nurses who have been investigated more than once by a State Nursing Board.

Just a little practical information here:

1. If you have been reported to the State Nursing Board more than once, then you need to re-evaluate your nursing practice, your behavior, and the environments where you practice. You need an objective evaluation of your nursing practice to answer why and what's up.

2. If this is your 2nd, 3rd, or 4th State Nursing Board complaint, you need legal representation. Seriously. Don't try to wing it with online nursing chat rooms and reviewing info from the State Nursing Board website. You should have retained a lawyer yesterday.

3. If this is your 2nd, 3rd, or 4th State Nursing Board complaint make sure you tell your lawyer this VERY IMPORTANT fact initially. Just say it and practice saying it now with me.

Hi Lawyer, this is my 2nd State Nursing Board complaint and I would like to retain you.

Hi Lawyer, this is my 3rd State Nursing Board complaint and I need you now.

Hi Lawyer, this is my 4th State Nursing Board complaint and I needed you yesterday.

I get upset when I am representing someone and I find out from State Nursing Board staff this is the 2nd, 3rd, or 4th complaint against this nurse. I fire these clients or request an additional true retainer.

Maybe I need counseling and long-term therapy because I have an issue with liars and being lied to as a lawyer. I guess I shouldn't because its not my license on the line when I am lied to repeatedly by a client but it urks me to no end. There are soooooo many other folks you should lie to besides your LICENSE DEFENSE LAWYER who is defending your golden ticket to opportunity i.e. your state nursing license.

Its human nature to lie or put a spin on the truth. What's the truth anyway right? Please. See this post.

http://advocatefornurses.typepad.com/my2cents/2009/07/dishonesty-deceit-and-deception-my-name-is-a-i-am-a-nurse-and-i-am-a-liar-.html

Personally, I love and respect my clients who said "LaTonia I f*cked up and I know it! Now where do we go from here?" Now that's what I am talking about! Keeping it real, putting it out there, being brutally and painfully honest and being accountable for one's actions or inaction professionally and assuming responsibility. But this isn't a fairy tale and you ain't Cinderella, right?

4. If you hire a lawyer be honest with your lawyer. There are plenty of other folks you can do the deception, dishonesty, and deceit cat and mouse games with  like your husband, wife, significant other, kids, friends, family members, collegues, counselors, therapists, etc but not with your lawyer. Please not your lawyer! Don't tell me what you think I want to hear. This doesn't help you and its certainly doesn't help me represent, counsel, and advise you.

5. One complaint can be anything, two complaints could be something but three or four complaints or more could, maybe, or might suggest a pattern. Don't kid yourself. If you are currently being investigated by the State Nursing Board and this isn't your first complaint, here is your sign.

Okay, I feel better just writing this! This blog is my kind of therapy: cheap and available 24/7.  

6,144 Ohio Board of Nursing Complaints in FY 2010: Complaints here and there and everywhere

Okay, I am playing this number in the pick 4 for the remainder of the month.

Attached is part of an Agenda item for the Ohio Nursing Board meeting on Sept. 23rd and 24th. Download 2010fyreportOBN

Its the Compliance and Discipline section of a draft of the FY 2010 Annual Report of the Ohio Nursing Board. I circled a few of the figures on this copy. For a clean copy of the draft go the Board's website.

The majority of complaints involve:

NCLEX Test Applicants     1,568

Miscellaneous   1,166

Practice    854

Drugs/Alcohol   708

Renewal Applicants  446

Criminal    310

Action Taken in Another State/

Jurisdiction 259

Endorsement Applicant    228

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

Wow! Even APRN practice issues increased to 38 complaints. 24 complaints involved psychiatric impairment and 2 involved physical impairment.

NCLEX Test Applicants are leading the pack of course as more and more individuals who apply for licensure have criminal convictions. It used to be several years ago that the majority of complaints involved drugs/alcohol.

Also you can see on page 10, 12% of applicants for licensure by examination (NCLEX applicants) were referred to compliance for review.This is significant and I will bet you $1.99 this number will increase in FY 2011. Again, if you are a nursing student, considering nursing, or graduating from nursing school and you have criminal convictions, you need to speak with a license defense attorney before you submit your app.

On a personal note, I was disappointed when my son decided to change his major from nursing to another healthcare field. However I think he will do much better in healthcare in a non-nursing position. Nurses as frontline workers have it rough in some many facilities and the first response is to term the at-will employed nurse and report to the State Nursing Board. There is little to no due process in facility investigations (unless you are in Texas, you work in a unionized facility, or you work for a government agency) and most times you are left dangling in the wind.

I had a nurse tell me again this week, I don't have my own professional liability insurance policy because my employer said I was covered under its policy. Okay that's true to a certain extent. But let's chew on this:

* If your employer terminates you, reports you to the State Nursing Board, will your beloved employer pay your attorney fees to rep your license before the State Nursing Board? Of course not.

* Does the liability coverage that an employer has for its nurses as staff cover the nurse if a complaint is filed against the nurse with the State Nursing Board? Of course not.

I wouldn't discourage anyone from being a nurse but staff nursing today ain't what it used to be 10 or 20 years ago; this didn't happen to nursing overnight (bullying and violence among nurses, actual and perceived lack of power in the workplace, female-dominated, lack of an entry level to practice, LPN vs. RN, at-will employed, etc.) and it ain't gone change for nursing overnight.  

NCLEX-Applicants and Criminal Charges and Convictions: Did you put your foot in that potato salad!

I have said it multiple times here on this blog and I will continue to say it until I am blue in the face but if you graduated from a LPN or RN training program, there is no guarantee you will receive a license if you have criminal convictions.

What should you do?

If you have criminal convictions and you are graduating from a LPN or RN program, contact a nurse license defense attorney in your state before you submit your application for licensure to the State Nursing Board.

Moreover if:

1. You have to appear before the State Nursing Board r/t to suitability for licensure, i.e. you answered in the affirmative and the Board wants to speak with you;

2. You must meet with State Nursing Board investigators or staff to further discuss your situation; or

3. You are contacted by an attorney from the State Nursing Board related to your application

maybe you need to retain an attorney now instead of waiting until your application for licensure is DENIED. Yes, the State Nursing Board can deny your license and then afford you with a hearing.

Applying for a nursing license with a criminal conviction(s) even misdemeanor can be grounds for the denial of your application for licensure. Retain an attorney who can evaluate your situation and case objectively.

Okay what does NCLEX-Applicants and criminal convictions have to do with potato salad.

Who made the potato salad? You need to watch this movie, its one of my favorite comedy's after Friday with Chris Tucker. I laugh because honestly this is a question asked (even if its whispered) at most of my family and/or friend functions. http://www.imdb.com/title/tt0452706/

I attended a picnic the other day and my cousin remarked "whoever made the potato salad put her foot in it."

Now, my first impression being the nerd I can be at times, was how nasty! I thought to myself I knew I shouldn't have tasted any of the potato salad because everyone can't make potato salad. Buying potato salad from Kroger's, Biggs, Walmart, Sam's, other another grocery and adding items "isn't making potato salad" where I am from, sorry!

Then I had to consider the context because I didn't have my urban dictionary with me and it meant the potato salad was good. http://www.urbandictionary.com/define.php?term=put%20your%20foot%20in%20it

I tasted it and it was dry. How in the hell do you make dry potato salad? As I said not everyone can make potato salad and I don't eat everyone's potato salad, sorry!

If you make potato salad then you know you really need to know what you are doing to get the taste you want. You can't fake the funk with homemade potato salad. http://www.urbandictionary.com/define.php?term=fake-the-funk

Damn the measuring, you need to know how to cut, dice, mix, boil, peel, and add seasoning to get it just right. You have to go for what you know when you make potato salad! That's why its so difficult to make really good and creamy potato salad. I can "make" potato salad. Its a badge I wear proudly, thank you very much.

You don't know if something just ain't right with the potato salad really until the end. The same with licensure with some State Nursing Boards as the Board may not review your suitability for licensure until you graduate from school and submit your application for licensure. You stepped in something mushy and it has a smell: its potato salad.

Some will say I got into nursing school, I didn't have any BIG issues with clinicals and therefore I know I am in the home stretch with obtaining a license from the State Nursing Board. You really put your foot in the potato salad if you proceed on the blind assumption that you will obtain a RN or LPN license even though you have a felony and/or misdemeanor conviction(s) just because you were accepted into a nursing program. Speak with a nurse license defense attorney in your State if you have criminal conviction(s) and you are considering nursing school or if you are in a LPN or RN program. Remember the potato salad.  

Kentucky Board of Nursing and KRS 314.095: Verified Response to the Complaint

The Kentucky Nurse Practice Act, KRS 314.095 states:

A licensee, credentialed holder, privilege holder, or applicant who is the subject of an investigation by or on behalf of the board shall cooperate fully with the investigation, including responding to a complaint or lawful request for information in a materially factual and timely manner.

Effective: July 15, 2010
History: Created 2010 Ky. Acts ch. 85, sec. 25, effective July 15, 2010.

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Wow! What does this tell you? The Kentucky Board of Nursing means business.

1. Its effective July 15, 2010, so this is new.

2. The Board has received false or inappropriate responses.

3. Some individuals have not responded to complaints.

Guess what? A verified response to the complaint is required now by the Kentucky Board of Nursing.

What I am saying and what does this mean?

If receive a Notice of Complaint from the Kentucky Nursing Board, you really need to think about attorney representation before you respond to the complaint in writing.

Personally, I saw this one coming years ago as there were nurses helping other nurses respond to Kentucky Nursing Board complaints, prepping other nurses for investigative meetings with Kentucky Board of Nursing staff, and providing bootleg legal advice and counsel to nurses involved in Kentucky Board of Nursing investigations. Not saying that it doesn't happen in other states but I can only speak on what I know. Just the facts.

These cases are not cookies and cream (I am on a diet but I want a cookies and cream Blizzard, extra thick from Diary Queen) like most nurses think because you don't have to appear in court before a judge and you are not served by a Sheriff with the complaint. Don't rationalize or underestimate the seriousness of a State Nursing Board complaint and the process and procedure involved with the response to the complaint. If you didn't know then I will tell you, Board of Nursing staff and members as nurse regulators take their role of public protection very seriously; now are you taking the complaint seriously?