Nursing Law & Order

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.

 

 

I am returning to graduate school in the Spring of 2011 for my MSN

I have been playing and toying with this for several years: LLM in health law or a MSN. My husband gave me the green light and I am returning to college in the Spring of 2010 for my MSN. Part time, of course.

I haven't decided on a track. I need to do some research on my options. I am planning to do the traditional route as opposed to online or maybe a program that allows a combination of online and traditional classes. I also need to look at the costs.

Do you have any suggestions on where I should apply? We have several programs in our area: University of Cincinnati, Xavier University, Mt. St. Joseph, Northern Kentucky University, Wright State University near Dayton, Ohio, etc.

I do like the idea of being a psychiatric CNS or NP. This would fit nicely with my law practice and I could work part-time in private practice as a CNS/NP. However the psychiatric CNS/NP track at University of Cincinnati College of Nursing is online only. I really wanted to attend traditional classes.

I am also considering adult or family NP. Personally, I think I would really like to work in home care as a NP and I am seeing more positions advertised in the Greater Cincinnati area for home health NPs. What do you think?

I have no plans to leave my law practice (I plan to take 2-3 classes a quarter). I see aMSN as professional development and enriching the services I will provide to my law and consulting practice clients. I am excited.

What is my goal? Primarily self-enrichment and professional development.

I am presenting to Senior Level BSN Students: Nursing Law & Order

I kindly accepted without any hesitation. I do these pro bono because its giving back to the profession and some of these nursing students may be clients in the near future:) Just kidding, calm down.

This isn't a slap in the face to nursing education. Okay yes it is but I will say it nicely. Too many programs are training nursing students to pass the NCLEX but not giving them the tools and skills needed to successfully navigate in a legally treacherous and highly regulated healthcare environment. I understand the importance of the NCLEX but what about the Law, Legalities, and Legal Issues in Nursing Practice?

What about socializing nurses into the professional practice of nursing? I am seeing too many new graduates from 0-2 years out who are having serious legal issues including complaints filed against them with the State Nursing Board.

What is covered anyway in the Legal and Ethical Issues in Nursing for Accelerated nursing degrees and  ASN, BSN, and diploma students? Please tell me its more than negligence, malpractice, advance directives, and the "feel good" stuff I learned back in my programs in 1993 and 1994.

I had an LPN who is 4 years out tell me last week she was not prepared to face the legal issues she is facing now because of not charting controlled substances in a LTC facility.  She exclaimed that no one told her that the failure to document the administration of controlled substances on the NAR and MAR could be construed as illegal processing of drug documents in Ohio.

What is illegal processing of drug documents? See http://codes.ohio.gov/orc/2925.23

See also State of Ohio v. Peeler. Peeler is a nurse.

 http://caselaw.lp.findlaw.com/data2/ohiostatecases/2003/2003-ohio-2903.pdf

http://www.supremecourt.ohio.gov/rod/docs/pdf/2/2002/2002-Ohio-109.pdf

I am seeing new graduates who don't understand the nursing scope of practice and then practice outside of scope based on unit or facility practices. Do you honestly think your DON, Preceptor, or Unit Manager is going to say "yes, State Nursing Board investigator, we know our nurses practice outside the scope and its an acceptable practice here." Hell no because I had a client who was 2 years out and worked in the ICU of a Cincinnati hospital disciplined by the Ohio Nursing Board for this. And guess what NO ONE came forward on her behalf from the Hospital. NO ONE.

As professionals it is important for nurses to have a basic understanding of the professional and legal regulatory underpinnings of professional nursing practice. At a min, know what's in your State Nurse Practice Act and/or Board of Nursing Regulations, National or Specialty Nursing Association guidelines applicable to your practice, and your employer's Nursing Policies & Procedures. This a must.

Felony Convictions and Nursing: Talk with Someone Before You Dive into a Concrete Swimming Pool with No Water

I am having more in-person, telephone, and email consultations with individuals considering nursing school and who have a felony conviction(s) or misdemeanor convictions. I am also having more consults with nursing students about criminal convictions, licensure, and employment.

I applaud those who are asking the tough questions upfront instead of forging ahead "willy nilly" and then finding out that there are issues with licensure and employability. In some states, there may be issues with clinical sites depending on the conviction(s).

Okay, so here is the skinny:

1. If you have a felony conviction even if its not an automatic bar for licensure with a State Nursing Board, talk to a nurse license defense attorney. I am seeing nurses with so many restrictions on a license because of a felony convictions that finding employment, which is already limited because of the conviction, is like Mission Impossible.

2. Even if you are granted a nursing license, ask yourself what are your employment options.

Nursing is not for everyone and sometimes just sometimes you may need an objective and neutral person to tell you this. I am seeing folks who have spent tens of thousands of dollars on a nursing degree but then hit a wall with licensure and employment. The nursing degree is worth less than a bubble gum wrapper.

If you decide you really want to be a nurse in spite of and despite all obstacles related to felony and/or misdemeanor convictions, then do your thing but at least make sure you are making an informed decision.

3. There are other opportunities in healthcare where you can work and provide hands on care and it doesn't have to be nursing. There are lots of other licensed healthcare professionals and unlicensed healthcare professionals. Do your research before you commit to nursing in spite of and despite all the obstacles you face.

There are more and more proprietary and for-profit nursing schools appearing across the country to ease the "nursing shortage." I have heard (from nurses who teach in these programs) that some of these proprietary schools take any student as long as you can pay the tuition and fees which are of course expensive.

Actually I guess I should thank some of the schools because I am receiving more calls from new graduates and nurses with 0-2 years experience who are being reported to the State Nursing Board for a variety of complaints and alot of these are graduates of the proprietary programs.

Thank you proprietary nursing schools for the business! You are the best!

Okay again what is the skinny? If you want to be a nurse bad enough you can find a nursing school to accept you somewhere. But again think about clinicals, licensure, and employment post graduation if you have a felony and/or misdemeanor convictions. If you are willing to take your chances then dive in just please please please check and make sure there is a little water in pool and don't take this type of leap on faith, hope, or empty promises.

Do you think there are too many nursing schools? See this article about law schools

The legal community is buzzing (at least online anyway) about this commentary which states there are too many law schools. See http://www.latimes.com/news/opinion/commentary/la-oe-greenbaum8-2010jan08,0,1467294.story.

See the comments at http://temporaryattorney.blogspot.com/2010/01/la-times-no-more-room-on-bench.html

and

http://lawprofessors.typepad.com/law_librarian_blog/2010/01/turning-law-school-accreditation-over-to-the-corrupt.html

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As a nurse, do you think there are too many nursing schools or not enough nursing schools? Do you think we have the same or similiar issues in nursing with respect to education and work placement after graduation that lawyers have or is this comparing apples to collard greens? Do you think we have hit a market saturation with nurses and entry level diploma, ASN, and BSN nursing programs? What about LPN programs? What about graduate level programs in nursing?

Blogging Nursing Student at a Louisville, Kentucky nursing school Reinstated

See http://www.hollandharthealthcare.com/healthcare/2009/08/vulgar-myspace-bloging-nursing-student-ordered-reinstated-by-federal-court.html.

See also http://blog.ericgoldman.org/archives/2009/08/nursing_student.htm.

See the decision at Download Yodervlouisville[1].

See the complaint at http://www.pageonekentucky.com/wp-content/uploads/2009/03/yodercomplaint.pdf

Don't try this boys and girls and don't try this at home if you are in nursing school because you may not prevail depending on your nursing school's policies and procedures and how the court's interpretation. Also you should assume Big Brother and his Bad Sister are always watching when you twitter or blog.  

See also http://www.abajournal.com/news/medical_students_say_too_much_online_about_patients_and_themselves/

http://jama.ama-assn.org/cgi/content/short/302/12/1309?home

http://www.nydailynews.com/lifestyle/health/2009/09/24/2009-09-24_facebook_twitter_myspace_sites_for_big_mistakes_by_medical_students_ucla_study_f.html

This case brings up a host of issues that I will discuss later next month. Where does patient confidentiality begin and where does the First Amendment stop? Should nursing students blog about clinical experiences?

Is this something that the State Nursing Board can, will, or should consider when reviewing an application for licensure at some point in the future when a nursing student applies for the NCLEX examination in a particular state? 

"Long live the RN, BSN, JD and nurse license defense attorney in CVG who practices in Ohio, Kentucky, and Indiana" because I may have stumbled upon an additional revenue stream of cases here the way nurses and nursing students are blogging and twittering like crazy!!! I just love nursing licensure defense work and what I do for a living:)

Xavier University in Cincinnati, Ohio awarded $1.5M for nursing education

See

http://triangle.bizjournals.com/triangle/othercities/cincinnati/stories/2009/07/27/daily9.html

Nursing Professional Development: Scope & Standards of Practice

See the draft for public comment: 

 http://www.nursingworld.org/DocumentVault/NursingPractice/Draft-Nursing-Professional-Development-pdf.aspx

Emerging Legal Issues in Nursing Education webinar on May 20, 2009

The Center for American Nurses Presents

Emerging Legal Issues in the Nursing Workforce Series 

Webinar 1:  Emerging Legal Issues in Electronic Records for Nurses (April 15, 2009)
Webinar 2:  Emerging Legal Issues in Nursing Education ( May 20, 2009) 
Webinar 3:  Emerging Legal Issues for Nurse Practitioners (June 17, 2009)
Webinar 4:  Emerging Legal Issues with Professional Boundaries & Sexual Misconduct (July 15, 2009)

Emerging Legal Issues in Nursing Education (May 20, 2009)

• Address legal dilemmas facing nursing educators and instructors: documentation specific to nursing education, for example of clinical record notes, conference forms, and documentation related to student failing and corrective action, students filing claims with Office of Civil Rights or initiating civil litigation alleging educational malpractice or breach of contract, student misconduct, unsafe student in clinical, criminal convictions and nursing students and clinical sites and privacy of the information, student absenteeism,  and grievances filed by nursing students.
• Examine the various sources of law that directly impact nursing education such as constitutional law, torts, contract law, and employment law.
• Discuss legal issues facing nursing students: criminal backgrounds checks for licensure and clinical sites, chemical dependency, Student Rights, FERPA, HIPAA, discrimination and harassment in nursing education, ADA and reasonable accommodations, Student Handbook and grievances.

CNE Credits per Webinar:  1.25. 

Cost:  Member price:  $49.95; Non-member $69.95. 

Cost is per site.  Any number of nurses can attend per site. 
For more information, call 1-800-685-4076

Four Kentucky Nursing Schools Facing Review by the Kentucky Board of Nursing

See http://www.kentucky.com/142/story/743509.html.

I am curious to see what happens at this meeting and what action the Board will propose if any based on the presentations by the nursing programs.

What do you think?

Faculty Members Beware; Student Will Sue and may Prevail!

http://www.abajournal.com/news/dismissed_dental_student_wins_1.72m_verdict_against_profs

This dismissed dental student sued, won the case, and was awarded more than a million dollars.

Nursing Student Incivility in the Classroom, Clinical Setting, and On-Line

There is an excellent article in the Journal of Nursing Law, Vol. 12, Issue 2 (2008) I received in the mail yesterday titled:

Managing Nursing Student Incivility in the Classroom, Clinical Setting, an On-Line

There are a number of nursing students who frequent this blog, so please tell me, is this an issue? Are today's nursing students more hostile towards nursing faculty? Why is Nursing Student Incivility such a hot topic at nurse educator CE meetings and seminars?

Are the nursing students of today less civil than the nursing students of yesteryear?

As a nursing student, do you think nursing faculty treat students fairly? Are the generational issues between boomers, Ys, and Xs, etc. the issue here or is it something more?

Core Competencies for Nurse Educators from the National League for Nursing

See http://www.nln.org/facultydevelopment/pdf/corecompetencies.pdf.

Do you know what the core competencies are for your specialty of nursing practice?

Nursing School Textbooks are Expensive

My son started his prereqs for a RN program here in Cincinnati this week. I paid $340.00 for his textbooks.

Why aren't nursing programs moving towards e-books and using more economical means of educating students? I have been a RN for 15 years and I remember paying this kind of money for my textbooks in the early 1990s.

How much did you pay for nursing school textbooks?

My law school text books each semester where between $400 to $600 and this was in 1994-1997.

My Son is Attending Nursing School

My 19 year old son has decided to attend nursing school!!!!! I am so excited. He was interested in journalism initially however I told him you can combine nursing with journalism at some point.

He is starting next week full-time at a nursing college here in Cincinnati taking his pre-reqs. I don't know if I would have had this type of joy if he told me he wanted to practice law.

I guess he was listening to me all along when I thought he was not paying attention. First the AS then the BSN like mommy.

He doesn't have any criminal issues or convictions therefore licensure won't be a problem in any state. I am going to steer him clear of some faciities here in Cincinnati because you know that I know the "problem facilities."

Oh and for you nurses, who like to belittle nursing students, do the nurse on nurse violence thing, and treat new graduates especially male nurses like shit; pick your battles carefully, because this is my baby and I am not having it! 

Why Didn't I Learn About This in Nursing School?

I met with a nurse last week who was upset about her Nursing Board case. Her license has been permanently revoked. She retained an attorney who told her he understood nursing issues when in fact this was the attorney's first Nursing Board matter.

The nurse remarked that she didn't learn much about legal issues in nursing school.

What about you? Did you receive a well-rounded education in nursing school about the law, legalities, and legal issues in nursing?

I remember a catch all ethics course that included a discussion on the Nurse Practice Act.

Nursing Students, Criminal Convictions, and Clinical Sites

I am glad to see that more and more nursing students and future nursing students are researching their options before applying to nursing school when the nursing student has criminal convictions.

A nursing student to be (Jane) informed that her friend (Sally) has an assault conviction and was admitted into nursing school however a pediatric hospital would not allow her to do clinicals at the hospital because of the assault conviction.

Jane is concerned. Jane has several misdemeanor convictions some more than 5 years old. One is for assault and one is for possession of marijuana. Jane wanted to know will her criminal convictions impact her ability to enter nursing school, her ability to complete clinical rotations, and her ability to obtain a license. All perfectly legitimate questions and concerns.

Have you been admitted into nursing school, fully disclosed your criminal convictions, but you are having problems with clinicals?

What is Missing in Nursing Education?

See this Nursing Education Redesign proposed for the State of California:

http://www.cinhc.org/programs/documents/NERCWP_FINAL.pdf.

What do you think? Do you think changes are needed in nursing education?

Nursing Students filing Complaints with the Office of Civil Rights

This post is overdue. This is a long post but its interesting because it touches on nursing education and the legal risks involved with being a nursing educator in today's litigious and complaint-happy world.

I have been contacted by more than one nurse educator or instructor who is involved in an Office of Civil Rights (OCR) investigation. See http://www.ed.gov/about/offices/list/ocr/complaintprocess.html.

OCR enforces several Federal civil rights laws that prohibit discrimination in programs or activities that receive Federal financial assistance from the Department of Education. These laws prohibit discrimination on the basis of race, color, and national origin, sex, disability, and on the basis of age. These laws extend to all state education agencies, elementary and secondary school systems, colleges and universities, vocational schools, proprietary schools, state vocational rehabilitation agencies, libraries, and museums that receive U.S. Department of Education funds. OCR also has responsibilities under Title II of the Americans with Disabilities Act of 1990 (prohibiting disability discrimination by public entities, whether or not they receive federal financial assistance). See http://www.ed.gov/about/offices/list/ocr/know.html.

What does this mean?

1. Nursing students can file complaints against nursing instructors and faculty for allegations of discrimination with the OCR. Nursing students can and some do file complaints with the State Board of Nursing against nursing faculty and instructors for alleged violations of the Nurse Practice Act and Board of Nursing regulations, and against the Nursing College/School. For example in Ohio, nursing students can file complaints against a nursing college/school. See the Nursing Education Dissatification Form available at the bottom of the page. http://www.nursing.ohio.gov/education.htm

2. Nursing instructors and faculty may find themselves needing personal counsel in this matters whether its before the OCR , civil suit, or the State Board of Nursing.

A nursing school or college attorney represents the nursing school or college. The "client" is the organization and you as a faculty member or instructor are included as a employee or independent contractor of the organization.

Nursing instructors and faculty need to make an independent decision at some point in these investigations whether or not to hire, at their own expense, personal counsel for legal representation, counseling, and advising.

I have been involved peripherally and know of several cases where a Nursing School/College attorney represents a nursing instructor/faculty before a Board of Nursing.....Nursing Instructors/faculty are licensed nurses and as such need to consider retaining independent legal counsel familiar with the State Nurse Practice, Board of Nursing regulations, and nursing practice standards for full scale and comprehensive legal representation, counseling, and advising in any matter involving nursing licensure and professional nursing practice. 

I have also been contacted in cases where a nursing educator, instructor, or faculty are involved in civil litigation and question the nursing school/college attorney's ability to represent the nurse educator, instructor, or faculty as an individual.

I simply remind the nurse of the role of the attorney defending the civil suit, Is NOT providing legal representation, counseling, and advising to the individual nurse on how the civil suit may impact his/her licensure, professional nursing practice, career, etc.

Guess what? You have to retain your own personal counsel in the civil litigation if that's your expectation and its not an unreasonable or unrealistic expectation. Retaining personal counsel, who is your private attorney involves paying money, which is the reason why I suspect most nurse educators, faculty, and instructors, like nurses in general, don't hire their own legal counsel.

I am an attorney and I don't want to pay legal fees. I don't have a slush fund for "legal defense." However I recognize the risks of being a licensed professional. That's why I have professional liability insurance for my nursing practice, legal malpractice insurance for my law firm, another policy for my consulting firm, an umbrella policy, and an insurance coverage for a little bit of everything else (pets, cars, house, medical, dental, disability to name a few). That's the benefit of insurance; your insurer will pay legal fees and costs associated with defending you and pay a judgment entered against you.    

3. Nursing Schools and Colleges should consider educating faculty and instructors on the legal risks associated with nursing education. Documentation is very important in nursing education and alot of things that should be documented are not documented. Nursing students of today are different than nursing students of yesteryear. Ask any nursing instructor, professor, or faculty.

Nursing students are more likely to file administrative complaints, file civil suits, pursue criminal charges, etc.  I posted this case last month. This is case where a nursing student pursued criminal charges against an instuctor for assault and filed a civil suit against a proprietary nursing school here in Ohio. See http://www.sconet.state.oh.us/rod/docs/pdf/2/2008/2008-ohio-993.pdf

 

Legal Seminar for Nursing Students

An article appears in the latest edition of the Journal of Nursing Law, which is the official publication of The American Association of Nurse Attorneys (TAANA). See www.taana.org. Its Journal of Nursing Law, Vol. 11, No. 4, 197-208.

The article is titled Current Legal Changes: Innovative Legal Seminar for Nursing Students. The article notes the exposure of nursing students to legal content is limited and suggests that schools and colleges of nurses offer a legal seminar for nursing students taught by a nurse attorney to fill in the knowledge gaps. What do you think? Good idea or Bad idea?

I like the article however I don't agree that the learning modules proposed are the most applicable to nurses. The article was co-authored by a hospital nurse attorney and this is obvious from the learning modules proposed:

1. Care of the Emanicipated Minor

2. Hospital Lawsuits

3. Nurse Malpractice and the Attorney

4. Liability of Nurse Managers

5. Physician Orders

6. Nursing Charting and Technology

7. End of Life Authorizations

Nursing care takes place in settings other than hospitals and as a nursing licensure defense attorney I would suggest and propose the following modules for nursing students:

1. Legal Regulation of Nursing Practice: Board of Nursing and Nursing Licensure Compact

2. Professional Regulation and Nursing Malpractice

3. Criminal Law 101 for Nurses

4. Employment Law 101 for Nurses

5. Nursing Documentation and the Medical Record

6. Pros and Cons of Professional Liability Insurance

7. Self-Regulation of Nursing Practice: Managing the Risks

What topics would you suggest for a nursing student legal seminar? Also this article illustrates in my opinion how nurse attorneys can have different and opposite perspectives on legal issues in nursing.

The client of a hospital nurse attorney is the HOSPITAL, not the individual nurse and the modules proposed above address HOSPITAL liability concerns more so while the modules I propose are centered around the individual nurse, not the place of employment.