Nursing Law & Order

Keep your Personal Life out of your Professional Life: More Drama for Your Mama

This is a busy week for me this week. I will be in Louisville, Kentucky on Tuesday at an investigative meeting with the Kentucky Board of Nursing with a client. On Wednesday, I will appear before the Indiana Board of Nursing with a client in Indianapolis, Indiana. I will be in Columbus, Ohio on Thursday and maybe Friday for the Ohio Nursing Board Meeting. If you need to reach me, I am accessible via email at [email protected] or you can call my office at 513-771-7266 or Jack Stem who works with me at 513-328-7253.

I will probably start shopping this weekend for Thanksgiving dinner. I have a large extended family and we are having dinner at our home this year. The holiday drama has started already but as a client of mine told me who doesn't have any relatives living, "having a large family is a blessing." So I am guess I am blessed to have a large extended family and a large immediate family who can "get the party started right" as I call it, with holiday drama. Why are the holidays so stressful? I knew it was coming. I could feel it starting a week or two before Halloween. I am looking forward to the holidays because this is our first Thanksgiving and Christmas together as a married couple:)

Holiday mayhem and "more drama for your mama" brings me to my post. Nurses, we have got to keep the personal drama out of our professional and worklife and we have to get our house in order. By house, I mean our personal and professional lives. Why?

1. It makes for a miserable workplace when everyone is bringing the negative to work each and everyday. I don't know about you but I have worked with nurses in hospitals and home care whose entire life is open book and they bring each and everything detail to work with them. TMI and start keeping somethings to yourself. Everyone is dealing with issues and its okay to seek support from co-workers and colleagues but don't take it to the extreme. No one wants to work in a toxic workplace as nurse. Why do you want your co-workers to know all your "business" anyway? Are you working and practicing at the nursing equivalent of Chernobyl? http://en.wikipedia.org/wiki/Chernobyl_disaster

2. Criminal crap that happens in your personal life like a DV, theft, assault, disorderly conduct, telephone harassment, stalking, menancing, public intoxication, DUI/OVI/DWI, possession of drugs, and other charges and convictions may impact your nursing career, current and future employment, and your license. If you are a hot head and you tend to explode on others, what can you do differently to keep yourself safe and stay out of trouble? If  you party, club it, or you "go hard" with the alcohol, try to anticipate what you will need to do to keep yourself safe and stay out of trouble. Who wants to get arrested? I don't because I have too many licenses to worry about what will happen if .... Its not worth it.

I will say it again (because I am repeating it to myself this holiday season), keep your hands to yourself. Remove yourself from the situation. Calm down, think of your kids, yourself, and whatever else is important to you and the reason why you went to nursing school and count to 50 slowly. Counting to 10 isn't long enough.

3. Some of us are taking a boat load of medications to function. No it doesn't make it okay that you have a cocktail of meds that you are taking morning, noon, and night just because you have scripts and the meds are "legally" prescribed. Some of us are having suicidal ideations and trying to commit suicide. We then go to work and tell everyone how many benzos, narcs, and other meds we take and how out of control our life has become and then we question or become irrate when an employer suggests EAP, a psych eval, and gets the State Nursing Board involved. The bottomline is patient safety. Honestly, are you safe to practice nursing? Are you practicing impaired? You can be practicing impaired from prescription meds. Let me say this again. Its not just about diverting and illegal drugs; you can be practicing impaired as a nurse with prescription medications. Impairment can be physical, mental, or chemical.   

You don't work as a greeter at Walmart (if you do, can I use your discount?) as a nurse. You are making critical decisions and assessments throughout your shift, documenting the care provided, and communicating with others on the healthcare team. Alot is riding on you because you are on the front lines of the battlefield baby. As nurse and you need a clear and focused mind and body to work as a nurse in today's healthcare environments. No "ifs", no "ands" and damn it no "buts."  

4. There has to be a balance. You are professionally what you are personally. You can't be a liar and thief in your personal life and away from the bedside and still be an excellent nurse professionally because at some what you do personally will like water, start to flow or trickle into your nursing practice and career. No one is perfect and this will be a work in progress. But you can't have chaos and TV-like drama in your personal life and then be surprised when your work performance slips and incidents start to happen at work.

Are you personally what you are professionally? Are you professionally what you are personally? Does your personal life mirror your nursing career and practice? Does your nursing practice and career mirror your personal life? 2010 is coming (I say 2012 this weekend and it was excellent!) and you can start with a clean slate of goals for how you want to improve your personally and professionally.

Can I Be Mandated to take the H1N1 Vaccination? What happens if I refuse?

Oh, the joys of at-will employment and healthcare organizations.

See the Ohio Nurses Association website at:

http://www.ohnurses.org/AM/Template.cfm?Section=Health_Care_and_Nursing_News&CONTENTID=5042&TEMPLATE=/CM/ContentDisplay.cfm

See the American Nurses Association website at:

http://www.nursingworld.org/H1N1

Mandatory Vaccination of Nurses in Healthcare Facilities: Take the Stick or You are Fired?

The Washington State Nurses Association, whether you agree with the actions or not, is taking a stance and filing suit related to the mandatory vaccination of nurses. See   http://www.wsna.org/Documents/Injuction%20Against%20MultiCare%20-%20WSNA%20Press%20Release.pdf  

See also http://www.wsna.org  

Some nurses are being told either "get the vaccination or you will be fired."  What do you think? Do you think about mandatory vaccination? Are you going to be vaccinated? Do you think we will see more litigation in this area filed by State Nursing Association, Nursing Unions, or individual nurse plaintiffs?

Free Article: Nurses Perception of Conflict in the Workplace

Availble at http://www.navigatenursing.org/PDFs/Nurse%20Perceptions%20Conflict.pdf.

See also http://www.navigatenursing.org.

One Sided Employment Contracts from Hell: How Can You Be So Heartless?

I have been meaning to post on this for a while. I am seeing some very one-sided employment contracts and agreements that nurses are signing either as a contract nurse, APRN, independent contractor, or some other alternative work arrangement.

These agreements are so one-sided because the obligations, duties, and liability fall on the nurse and the employer can still term at will.  These agreements turn my stomach because the agreements lack any type of fundamental fairness and in my opinion prey on unsuspecting nurses who just want to start work and move forward.

Yes, we are professionals but how many of us actually hire an attorney to review an employment contract?

I am all for alternative work arrangements for nurses because frankly the traditionally employer-employee relationship and at-will employment stinks. It sucks and its not until an incident happens to you in the workplace that you realize that you essentially are "rightless." Once HR gets involved, its a wrap most of the time, magnet or no magnet.

Healthcare Facilities will term a nurse who has worked at the facility for 15 years the same as they will term a new nurse not doing well in orientation. How can you be so heartless? http://www.youtube.com/watch?v=gWzlD7Lc6w8. Okay, I know folks are mad at Kanye West, but this song is tight. 

This isn't legal advice its common sense:

1. Don't just an employment contract;

2. Pay a few hundred dollars and have your contract reviewed by a healthlaw attorney or nursing law attorney; and

3. Don't ask your supervisor to explain the contract to you. You need objective information, counsel, and advice.

Navigate Nursing-Where Every Nurse is a Leader

Greetings! I am pleased to announce the launch of Navigate Nursing - Where Every Nurse is a Leader.  Here you'll find the latest information, nursing news, career tips, innovative products, and an online community to assist RNs create healthy work environments.  Navigate Nursing will help you navigate Professional Success Patient Care Environments Personal Development

Stop Bullying in the Workplace:  8 Tips Before You Quit    Free Webinar September 22, 2009  2:00 pm (ET)   Bullying in the workplace (sometimes referred to as lateral violence) can be found in many organizations, however its prevalence in healthcare environments is extremely concerning.  Growing numbers of nurses are experiencing lateral violence as a daily occurrence.   This 60-minute webinar will discuss the implications of bullying in healthcare environments and offer individual and organizational strategies to eliminate bullying and lateral violence in the workplace.   Register Now! Nurses Describe Conflict in the Work Environment    A study conducted by the Center for American Nurses descibes the distress nurses are experiencing as a result of workplace conflict.  In addition,  nurses desire better work environments in which conflict can be addressed more effectively.   read more....

I invite you to explore the new Navigate Nursing website and use the valuable resources created to make your workplace healthier and happier.  Please send us your feedback at [email protected]      www.NavigateNursing.org

Nursing Workforce: Past, Present, and Future-Center for American Nurses legal webinars

Series V: Nursing Workforce:  Past, Present and Future (4 parts) 

Webinar 1:  Competence:  Past, Present & Future (October 14, 2009)
Webinar 2:  Conflict Management:  Past, Present & Future (November 18, 2009)
Webinar 3:  Scope of Practice:  Past, Present & Future (December 16, 2009)
Webinar 4:  Delegation:  Past, Present & Future (January 20, 2010)

• CNE Credits per Webinar:  1.25. View Accreditation Statement
• Cost:  Member price:  $49.95; Non-member $69.95. 
• Buy the 4 webinar series:  Member:  $170; Non-member $235.00 
• Cost is per site.  Any number of nurses can attend per site. 
For more information, call 1-800-685-4076.

Webinar 1:  Competence:  Past, Present and Future (October 14, 2009)

Course Objectives:

• Define competence in nursing
• Contrast nursing competence with nursing competency
• Discuss the literature on continued competency in nursing

Content Outline:

• Definition of competency as described in the nursing literature
• Review of ANA and NCSBN literature related to competence
• Discussion of continued competency, patient safety, and the future of nursing
• Discussion of the following roles in competence: individual nurse, employer, nursing association, nursing board, public, etc.
• What is continued competency?

See https://m360.centerforamericannurses.org/event.aspx?eventID=11010

Look at the Behavior of this Surgeon! If this was a nurse.....This is why nurses need Nursing Staff Bylaws

See

http://www.tampabay.com/news/courts/criminal/article1028210.ece.

Medical staff bylaws protect physicians and provide several layers of due process in a hospital even with this type of conduct. If this was a nurse, the nurse would of course be prosecuted, the nurse would be terminated, and the nurse would be reported to the State Nursing Board without hesitation. Why? Because most nurses are employed at-will. Even when a nurse is part of nursing union, the due process afforded in the grievance process falls way short of the due process provided to the medical staff under the medical staff bylaws.

This is what nurses need, NURSING STAFF BYLAWS similiar to Medical Staff Bylaws.

So instead of pushing nursing unions, shared governance, and Magnet, why aren't organizations and associations pushing for and implementing nursing staff bylaws? Instead of making glowing recommendations about shared governance and Magnet, give nurses the same legal rights and procedural due process afforded to physicians and other providers under the Medical Staff Bylaws.

Look at How This Nurse is Being Treated: Could This Be You?

Nurses are so trusting of everyone and we always assume that everyone has our best interest at heart including our employers. Take a look at this article that appears in Cincinnati Enquirer today and see how this poor nurse is battling with her employer for benefits.

"I'm left wondering why Good Samaritan hasn't been a good Samaritan to me," she said. "I wish I knew."

Could this be you?

Nurse Fights Hospital Over Small Pox

http://news.cincinnati.com/article/20090711/NEWS01/907120329/-1/NEWS010703/Vaccine+leaves+nurse+disabled

Narcissistic Personality Disordered Co-Workers and Supervisors in the Workplace

I caught part of this presentation at the Kentucky Coalition of NPs & NMs conference on Friday. It was excellent. It gave suggestions on how to cope with personality disorders of co-workers, supervisors, and colleagues in the healthcare workplace.

A distintion is made of course between high-achievers and those with mild or extreme narcissistic behavior.

I am going to watch "All that Jazz" again. Clips from the movie were played to provide an example of a narcissistic boss. http://en.wikipedia.org/wiki/All_That_Jazz Scenes from Top Gun were also played with Tom Cruise having being a narcissistist, who is self-absorbed and self-indulgent. http://en.wikipedia.org/wiki/Top_Gun_(film). A clip from Sex and City featuring Carrie and Mr. Big was played and the presenter identified Mr. Big as having a narcissistic personality.

I haven't watched the movie, All that Jazz, in over 15 years but its on my to do list for this week.

I am not a psych nurse but I thought Mr. Big was just your typical self-absorbed man. 

Can you add any others from movies?  

Nurse Called Out of Surgery for Pink Slip; This was tacky!

http://www.msnbc.msn.com/id/30231451/from/ET/

This nurse was called out of surgery to be given her pink slip. Was it that pressing that it could not have waited?

The business judgment rule that protects facilities in the business decisions made while running an organization (in general) should have a WWJD (what would Jesus Do) component to instill some fairness in decisions.

No this isn't illegal on the part of the facility, but:

1. It is tacky;

2. It shows a lack of class on the part of the manager and a lack of basic respect and dignity for employees;

3. It illustrates the harshness of what it means to be employed at will;

4. It may turn into a public relations headache for the facility; and

5. It will probably will be used by the nursing unions as one more reason why nurses should organize and have a collective bargaining agreement.

What Would You Do if Your Employer Worked You for 28 hours straight with No Relief in a Private Duty Case?

I spoke with a nurse yesterday who works private duty. Her relief called off on several shifts and she worked 28 hours on a private duty case with no relief.

28 hours ladies and gentlemen.

Does it matter in your opinion that this is private duty? What if it was a hospital or nursing home? 

What would you have done?

How would you handle this situation if it happens to you?

At-Will Employment as an Ohio Nurse

Do you want to know what is at-will employment and what it means for you as an Ohio nurse in the workplace? 

The nurse alleged causes of action for breach of implied contract, breach of the duty of good faith and fair dealing, breach of fiduciary duty, negligent infliction of emotional distress, and intentional infliction of emotional distress. A motion for summary judgment was entered for the defendants.

See this case

http://www.sconet.state.oh.us/rod/docs/pdf/2/2006/2006-ohio-2824.pdf

Be Careful Working More Hours in This Economy as RN: Nurse Fatigue and Voluntary Overtime

I like cnn.com. I saw this article yesterday about the economy. One man mentioned he is laid off and his wife is a RN and works 50 hours a week as a RN and is completing a NP program. This is voluntary overtime, not mandatory overtime.

http://money.cnn.com/galleries/2009/news/0903/gallery.living_on_unemployment/5.html

We all have to do what we have to do to make in this hard times but as nurses, patient safety is a priority. Alot of us are working 50+ hours a week and multiple positions to stay afloat and I am not judging anyone.

However you have to practice nursing safely and there is a ton of literature out there on nursing fatigue and its impact on patient safety. If you are fatigued at work and make an error where a patient is harmed, there can be all sorts of investigations: employment, Nursing Board, and criminal, not to mention a a possible malpractice or negligence lawsuit.

Take care of yourself, get the rest you need in between jobs, and make sure you are well rested before you return to work.

Nurses, Patient Safety, and Prescribed Medication

I would encourage you to consider attending the Center for American Nurses legal webinar next month on March 18, 2009 from 7pm to 8:15pm regarding nurses, prescription medication, and patient safety. See www.centerforamericannurses.com

As a nursing license defense attorney, I see cases where a nurse's ability to practice safely is questioned because of the use of prescription medication for a medical diagnosis. I am not saying nurses cannot take any prescribed medication. If you are taking prescribed medication however you are still accountable for nursing practice and you have to stay alert to indications whether the medication you are taking outside of work for depression, anxiety, or any other diagnosis is affecting your nursing practice.

I am looking forward to next month's webinar.

1 out of 5 Nurses Quit in the 1st Year; Are You Surprised?

See this article that appeared in USA Today. Also review the comments at the end of the article which are even more interesting:

http://www.usatoday.com/news/health/2009-02-15-nursing-shortage_N.htm

Nursing Rights & Responsibilities in the Workplace

The Center for American Nurses January 2009 webinar is the last in the first series, Centered on the Nurse. The last webinar in the series, Nursing Rights & Responsibilities in the Workplace is receiving alot of interest.

The webinar will take place on Wednesday, January 21, 2009 from 7pm to 8:15pm EST.

The presenter is Edie Brous. Edie is a nurse attorney in New York in private law practice focusing on nursing licensure, nursing malpractice, and health law. Edie is a published author and a dynamic speaker on nursing law issues. For additional information about Edie, see her firm's website at http://ediebrous.com/.

For additional information or to register for the legal webinar, see www.centerforamericannurses.org.

State Nursing Board Complaints Against Newly Licensed Nurses

I am being contacted by more and more New Grads and Newly Licensed Nurses (practicing for less than one year) who have been reported to the State Nursing Board for a variety of issues. Most of the time its practice related issues.

Does this point to a flaw in nursing education?

Does this point to a flaw in nursing orientation at a particular facility?

Does this point to a lack of bridge and adequate transition from student to professional nurse?

What do you think?

How do you make the transition more smoothly?

1. Research your employer. Don't just accept a position because the pay is good. Look at nursing staff turnover and the workplace environment. If its a unit full of new grads and the most senior nurse outside of management has been there only a few years, ask yourself why?

2. Some workplaces are just plain dysfunctional and toxic and its not your job to "fix" the problem. Don't get caught up in the drama, just move forward whether its to a different unit, floor, or area within the same facility or a different facility. A perfect work environment does not exist however you are not looking for perfection, just an environment where you are comfortable.

2. Ask questions and be engaged while you are working. Nursing is not just a job where you show up and work. If you have this mindset, you are headed for trouble.

3. If something feels wrong, even if everyone else is doing it, don't do it. If you know its wrong (violation of policies and procedures, standards of safe nursing practice, Code of Ethics, Nurse Practice Act, etc.) don't do it although it may be considered routine, custom, common place, or acceptable on the unit, floor, area, etc by other nurses.

Bermuda Triangle of Nursing Practice: Application of Nursing Law, Ethics, and Professional Practice Standards in the Workplace

Attached is the November 2008 newsletter from the Registered Nurse Association (RNA), a local unit of the Ohio Nurses Association. The local unit consists of RNs at University Hospital in Cincinnati, Ohio. I believe there are close to 1,000 nurses in the bargaining unit.

See my article about the Bermuda Triangle of Nursing Practice.

Download November_NewsletterRNA.pdf

Shared Governance vs. Collective Bargaining Agreement vs. Please Tell Me There is Something Else

See this article. http://include.nurse.com/apps/pbcs.dll/article?AID=/20080825/PA02/108250085.

Do you think shared governance is the future of the nursing workplace? Do you think collective bargaining agreements and nursing unions are the future of the nursing workplace? What do you see in the nursing workplace of the future?

The article notes the shared governance consists of five councils made up of staff nurses, managers, and staff eduation personnel from around the hospital. The councils are education, quality, diversity, research, and practice.

That's nice but if you really want fairness and balance in the employer-employee relationship with a shared goverance model try a more substantive committee, like a Workplace Mediation and Conflict Management Committee that conducts workplace investigations of said policies and procedures and the employee handbook and mediates in-house disputes between professional disciplines and employees.