Nursing Law & Order

unemployment compensation and BON complaints

The interplay of the law, legalities, and legal stuff was and still is the collateral implications from criminal pleas and licensure consequences. Unless your criminal defense attorney is also a nurse license defense attorney.....You know the rest.

Criminal law however has two fast approaching challengers with unemployment compensation cases and nursing malpractice cases with nurses as defendants or fact witnesses.

Nurses it is imperative that you seek legal representation before you appear pro se and "wing it" at a telephonic unemployment compensation hearing or a deposition in a med mal case. "I am just a nurse" is not an affirmative defense; maybe in an online nursing chatroom at 4am and only if your legal name is Billy Dee and you just gulped a forty ounce of the cult classic, Colt 45.

It is getting hot in the litigation lunchroom and the roof is on fire in the complaint kitchen (and it ain't because of us lawyers) meaning nurses as educated and licensed professionals who earn a respectable wage are just as likely to be reported, sued, named, indicted and as always termed as others licensed professionals.

Ohio Board of Nursing E*News 03/30/2012 -Advanced Practice Nurses and Schedule II Prescribing

OBN E*News 03/30/2012 -Advanced Practice Nurses and Schedule II Prescribing

Senator Scott Oelslager introduced Senate Bill 83 on February 16, 2011, to expand the authority of certain advanced practice nurses to prescribe schedule II controlled substances. The bill was passed by the Ohio legislature and signed by Governor Kasich on March 9, 2012. The bill becomes law and will go into effect on June 8, 2012. The Board will adopt rules pertaining to an APN's authority to prescribe schedule II controlled substances, and the Committee on Prescriptive Governance (CPG) will recommend revisions to the Formulary pertaining to schedule II controlled substances.

The CPG expects to complete the additions/revisions to the Formulary by June 8, 2012, the effective date of the bill. The Board is beginning the rulemaking process with a planned effective date of November 1, 2012. The Board and CPG welcome recommendations and comments.

The Board will also establish a rule regarding the continuing education course requirements for Certificate to Prescribe (CTP) holders. The Board is planning an effective date of November 1, 2012 to provide ample time for CTP holders to complete the required six hours of continuing education before the renewal cycle ends on August 31, 2013. When you renew your license, you will be required to verify completion of the continuing education course.

The Board encourages APNs and other interested parties to periodically check the Board website for additional information regarding implementation of Sub. SB 83, draft administrative rules, and CPG information. If you have questions or comments, please contact the Board at board@nursing.ohio.gov.

Links to the Bill, an overview and the LSC analysis have been provided on the Board's website. http://www.nursing.ohio.gov/

 

You can now follow the Board on Facebook and Twitter.
http://www.facebook.com/pages/Columbus-OH/Ohio-Board-of-Nursing/151746234862913
http://twitter.com/OhioNursingBd

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http://www.nursing.ohio.gov/subscribe.htm

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Workplace Incident to State Nursing Board Complaint to Career Standstill to Professional Suicide and No Lawyer

The headline above is a worst case scenario but it is a growing reality for a number of nurses who represent, counsel, and advise themselves in legal matters involving their license. I cannot tell you how important it is for nurses, whether you are a LPN, RN, or APRN to seek advise and counseling from a private nursing law attorney when a patient care or other significant issues arises in the nursing workplace. No one, whether it is your nurse manager, nurse supervisor, union rep, risk manager, etc. is going to say to you "You need to consult with your own attorney about this situation." I haven't heard it in my 11 years of solo practice in nurse license defense. Not once. Most of the time, a nurse contacts a nurse license defense attorney or nursing law attorney ONLY AFTER the defecation hits the ventilation: the complaint is filed with the State Nursing Board, your union rep tells you "you may need to resign instead of being fired", your employer terminates you and says "we are required to report this to the State Nursing Board", you receive a letter of Complaint from the State Nursing Board, you are told you are being named as a defendant in a nursing malpractice case, you are contacted by local law enforcement about the "incident three weeks ago", etc.

I often hear nurses say "I didn't know there were nursing practice attorneys or nursing law attorneys that help nurses." Yes, there are nursing practice attorneys and nursing law attorneys whose primary role is to assist nurses and/or other licensed healthcare professionals. See www.taana.org.

It is not the role of your nursing manager, nursing supervisor, nursing union representative, risk manager, or anyone else to counsel and advise you objectively about the seriousness of an incident from a licensure, career, employment, or credentialing perspective. This is the role of a private attorney who has experience in nurse license defense, nursing law, and professional nursing practice matters. And guess what? You can't find an attorney with this type of expertise and experience in the yellow pages usually.

Yes, you can call the attorney who handled your divorce, you call the attorney who has helped your extended family in a number of cases, you can put on a blind fold and open the yellow pages and pick an attorney and call for a "free consultation" about your specific issues which is usually a combination of nursing law, professional nursing practice, employment law, labor law, credentialing, criminal law, nursing negligence, etc. Guess what? That attorney will not PROBABLY NOT give you the answer you need because the attorney does not have experience in the area.

Also I am pleasantly surprised yet again by the number of attorneys who represent nurses before the State Nursing Board just to take a case and make a few bucks and who know little or nothing about what it takes to adequately and effectively defend a nurse before the Board and counsel and advise the nurse on attending matters. Is a nurse a nurse a nurse? Of course not. Therefore an attorney is not an attorney is not an attorney. Why do you want an attorney who practices primarily wills and trust representing you before the State Nursing Board? Is it better to have any attorney (regardless of whether or not the attorney has ever practiced before the Board or has experience advising nurses) as opposed to an attorney who can competently handle your case and assist you?

It is your case, your license, and your livelihood and this is a question you as the nurse should answer and consider when retaining counsel. I only practice in the areas of nurse license defense, nursing practice, and nursing law; no wills, no personal injury, no workers comp, etc. You don't have to retain me in Ohio, Kentucky or Indiana; just retain an attorney who can effectively represent you and who has experience representing nurses. Nurses as licensed healthcare professionals have different legal needs than your average consumer and this is significant in the context of representation. These cases are time intensive and you don't want an attorney to take your case and not work it like it should be worked.

What am I saying? I don't say much on the blog these days because my law practice is keeping me busy but I am getting fired up again because I am seeing where nurses are being TOO TRUSTING and not looking after and protecting THEIR LICENSE, CAREER, CREDENTIALS, and hard earned EDUCATION.

Sorry to say this but I am a nurse first also. Nurses are fungible; just look at how nursing employers terminated and discipline nurses: at the drop of a hat. A healthcare organization will fire a nurse with 25 years of experience and loyalty to the organization just as fast as it will terminate a new employee. If you pass gas (and you are not a CRNA :) on a patient care unit, you will be terminated and reported to the State Nursing Board because it "looks better" from a liability, public relations, and accreditation perspective.

But guess what, more facilities are throwing nurse supervisors, nurse managers, and nurse executives to the wolves and under the bus also. This does make me feel better and it shouldn't please you either because it typifies the harsh reality & environment of nursing practice now. More nurse managers and nurse executives are being terminated and I am receiving more and more of these calls and these nurse managers and nurse executives are also being reported to the State Nursing Board.

What am I saying?

1. You know your practice area, don't you? If something happens and its triggers an investigation in the workplace and you are involved, get your own attorney involved to review the situation with you and give you OBJECTIVE legal advice and counseling. You need to have your own Nursing Practice and Nursing Law counsel you can consult with about situations which happen in the workplace. If you are a nurse supervisor, nurse manager, and nurse executive, are you aware of your exposure?

2. Stop listening to the advice and counseling of everyone and their momma about the seriousness of an incident. It is human nature to underestimate the seriousness of an incident to a friend, colleague, or relative because you don't want the worry the person and you want the best for the person.

If I call one of my grandmother's right now and say "mom, I slapped someone and I may be charged criminally", the response will be "it is going to be okay. You are a good person. Who did you slap?  and "I know you type a lot, did you hurt your hand when you slapped this person?"

This may help me feel better emotionally but it certainly doesn't help me deal with the criminal, licensure, legal, and career implications of pimp slapping someone.

By the way, my little sister's 1 y/o son, open hand slapped me so hard (yes, he pimp slapped me) he knocked my glasses off. My sister says he picked this up this behavior in daycare and/or watching cartoons. Really? This was last month and I still smile about it daily. Thank you Baby Chris for putting a smile on Auntie's face whenever I think of you!!!

3. Nurses don't have the income and prestige of dentists or physicians but nurses certainly have similiar liability just a different context. http://www.nso.com/. Take a look at the report, Understanding Nurse Liability from 2006-2010 from Nursing Service Organization.

The public is more aware than ever that you can be sued and you can be reported to a licensing board. Nurses are not self-employed like most dentists and physicians and therefore USUALLY do not have a personal and private attorney for practice, workplace, and career issues. This should not prevent you from consulting with an attorney even if it is one a time basis.

Most nurse attorneys or license defense attorneys may offer a legal consultation. Pay the money and consult with an attorney. It is only your License, Livelihood, and Career on the line. I receive at least 10-35 calls or emails a month from nurses who need legal services but do not want to pay for a legal consultation or legal services. Attorneys like nurses don't work from free (this one doesn't anyway) and it is worth the money to consult with an attorney for a few hundred dollars rather than gamble with your career, isn't it?

I never represent myself. Why would I because I am biased and I would see the facts as I want to see the facts. This is human nature and this is why now more than ever it is important for nurses, a front-line providers who work as at-will employed nurses or who are part of bargaining unit, to consult with a private nursing law or nursing practice attorney about situations in the workplace. Gone are the days when you could say a hospital, nursing home, or healthcare organizations acted in the best interest of its employees; an organization asks what is in the best interest of the organization, right? It is the role of YOUR ATTORNEY to ask what is in the best interest of YOU, as a licensed nurse.

4. If you can, try to negotiate an individual employment contract with a healthcare organization which afford you the same rights physicians have in the medical staff bylaws. Individuals employment contracts hold power for nurses; it is not at-will employment or even collective bargaining. The future of nursing should be Nursing Staff Bylaws and Individual Employment Contracts for All Nurses.

Yes, I said it and I stand by it. I am on the front lines of representation because my clients are front line and bedside providers. The future of nursing lies in securing power and negotiating a seat at the table in healthcare and in the nursing workplace; this power can be obtained in Nursing Staff Bylaws and Individual Employment Contracts not Collective Bargaining Agreements and certainly not At-Will Employment, which is for the birds. This is my opinion and you should have your own opinion. You can email me until the cows come home baby and I will not change my opinion which has been solidified from years of nurse license defense practice and actual nursing practice in a variety of healthcare settings. I seriously doubt I will see cows in my backyard at my home or my office; maybe deer at my home but certainly not cows. Also I don't eat meat, but I may start again, if I see a cow in my backyard.

 

Five 20s: Transforming My Life and My Law Practice

Happy New Year!

I am not posting as much as I used to on the blog because I am working on new plans for the direction of my law practice and career. It will still involve nurse licensure defense but I am planning to significantly decrease the amount of license defense cases I take and concentrate more on working with nurses who are self-employed and business owners and work on more educational ventures for nurses.

Licensure defense work is stressful for lawyers. However I am a nurse first who also just happens to be a lawyer therefore a 100% nurse license defense law practice for me is akin to triage  with bandaids and bottled water on a battlefield with heavy artillery in a Civil War that never ends.

I describe nurse license defense as administrative law with a twist of family law drama and a lot of criminal law "type implications and consequences." Defense Attorneys whether administrative, civil, or criminal can attest to a everyday law practice; just ask.

After 10 years of license defense practice, I am plotting a new direction with my career in 2012. Right now, I am about 90-95% nurse license defense in my law practice. My goal is:

* 20% license defense;

* 20% consulting;

* 20% working with self-employed LPNs, RN, and APRNs as nurse business owners; and

* 20% coaching; and

*  20% legal risk management and education for nurses.

What does Five 20%'s mean? I know how to make money and run a business, provide services, think outside of the box, and have fun while I am doing it. So for me it means I am going to do what ever the hell (with the grace of God of course) I want to do in my 40s with my degrees, credentials, education, and experience; this is what is means practically.

This case below illustrates to me why I want to do more out of the box services and products in nursing:

See this article:http://www.daytondailynews.com/news/dayton-news/starvation-case-shows-abuse-in-state-system-1309284.html

Nursing in 2012 isn't nursing in 2002 or 1992: there is more potential for nursing malpractice, discilinary action against the license, workplace issues, and criminal implications for us as nurses. We need to educate ourselves on these risks, liabilities, and legal issues to protect ourselves and document the patient care provided.

This year don't think of just New Year Resolutions. Resolve to rethink and then transform your life and your nursing career; this is your next phase of evolution.

Honestly, my nurse license defense law practice is my niche and it is my baby. It really is and I know in my heart it will always be more than 20% and probably more like 40% to 60% of my law practice from now and until I pass away at my computer sending an email. I can dream and I can plan can't I? However I am planning to do more in my law practice to assist nurses and nursing students on the front end and proactively rather than reactively going forward in 2012 and beyond. 

An Attorney, Two Paralegals and Jack: The Roof is on Fire!

I want to jump up like the man did in the Toyota commercials from fifteen years ago. I finally figured out the staffing for my law practice. It only took 3 years of hiring and firing before it clicked. No, my law firm is not set-up like a traditional law firm. I established my law firm in 2001 and I worked then and still now primarily from home. But that is changing also starting new month because of the new me. 

Okay first things first. I am the only attorney in the law practice. Therefore if you retain me or if I am lucky enough to be your lawyer;) then you will be working with me as the only attorney on your case. Sorry, I don't have any plans to partner with or hire an attorneys to work for me or with me. It is hard enough dealing with my own ego, pride, and shortcoming; I don't want to deal with the same with another attorney. You may not know it; in general it can be difficult to work attorneys for whatever reason. 

I have two paralegals working with me. 

Dani works Monday-Thursday 10am to 2pm. Her direct office dial is 513-655-6191. 

Emi works Monday-Thursday 1pm to 5pm and Friday 9am to 3pm. Her dial is 513-655-7986.

If you are interested in contacting my law firm for your legal needs, please call 888-571-1110. 

For over flow work, I work with Tina, who owns a virtual paralegal company in Indiana. Tina did my scheduling and calendaring over the summer before passing out from exhaustion. Most of my clients already know and have spoke with Tina. 

Then there is of course, Jack. Everyone knows Jack. 

I am excited because I have went back and forth whether or not I was going to keep my traditional office in Blue Ash, Ohio and still work primarily from my home office location. However when you have multiple staff coming to your home it can be difficult to maintain a sense of privacy. 

Therefore, starting December 1, 2011, I am FINALLY transitioning out of my large home office. I will maintain a small home office however I am going to for the first time in 10 years of solo practice work primarily in a stand alone office. I need to better divide home and work and this is the final step for me. This is a big step for me however I decided to do everything the opposite of what I have done with some things in the past post-divorce and the strategy works, for me.

I am so happy because my new office space is very nice and a lot larger. I will finally have room for the large conference desk I want and a "I Declare War" Hearing Room. 

I am looking forward to the holidays and the New Year. It is on and popping in 2012: onward and forward! The roof, the roof, the roof is on fire and we don't need no water! 

 

 

 

 

 

State Nursing Board Non-Compliance: If It Ain't Rough, It Ain't Right!

Thank you again to a client who had to remind me three times, yes three times to change the picture on my blog and facebook pages. I have lost a lot of weight (almost 60 pounds) and I am wearing my hair differently, so here is my new picture. 

The law practice has been extremely busy this year and thank you again to those of you who retained my services. I am noticing over the last few months, the Board cases are becoming increasingly more complex with personal, mental health, impairment, practice, or criminal aspects. 

I reviewed and revised my Legal Services Agreement to reflect the changes I am seeing in my law practice. 

1. I fire clients more readily now than in the past for not providing us with the requested information in a timely manner because this slows down the processing and reviewing of information and can lead to me being unprepared for a hearing, investigative meeting, appearance, etc. If you want a lawyer who will forget you were supposed to send in your performance evals, update your prescription meds, etc., then don't retain me. I will remember, there is a task in my project management software, AND it is in my hand-written and barely legible notes. 

2. I have a paralegal who works with me part-time and her role is exclusively Client Service, Management, and Scheduling. This has been wonderful! Thanks, Dani. 

3. I like what I do and I like who I am. Therefore I am announcing: I am a workaholic and I am proud of it. No excuses anymore like "oh, it is the nature of the beast" or "I really don't work that hard." I do work hard and I enjoy it. Therefore I am looking for another part-time paralegal to work Monday, Friday, Saturday, and Sunday in the afternoons. Also my boss is nuts and she keeps giving me work at all times of the day. 

4. Non-compliance, non-compliance, and more non-compliance. Are you non-compliant? Hell, I am non-compliant with my personal monitoring.  

If you are struggling with State Nursing Board probation and monitoring or compliance with an alternative to discipline program, get some help. Retain a lawyer to assist you. I receive more and more calls related to compliance issues than I used to because non-compliance with a contract results in breach of the contract, i.e. the suspension of a license or the inability to practice nursing. 

Why would you hire a lawyer after you have resolved your State Nursing Board case on your own? Because you need help, because you don't really understand why or what you signed and initialed fifty times, or because you have a few extra thousand dollars in your night stand. 

Life happens when you are being monitored by the State Nursing Board. Things will come up and down during a 1 to 5 year period you are being watched by the Board. Who are you going to call for assistance? Your State Nurses Association, Your Union, Your Employer, or Your Cute Lawyer. Look at my current picture and tell me who do you want to call? Call me. 

I revised my legal services agreement because in the future, I am executing another flat fee agreement when patterns of non-compliance emerge. My best friend says "if it ain't rough for some, it ain't right." This should NOT be your Motto during State Nursing Board Monitoring; maybe in other contexts but certainly not in the healthcare licensing setting.  

5. Nurses, Self-Employment, and Private Practice

I am being contacted by more APRNs in Ohio, Kentucky, and Indiana who own their own business or are planning to provide primary health services. Please keep in mind when you open a business providing healthcare services, you will need a general business attorney AND an attorney like cute lawyer to help you with nursing law, regulatory compliance, and risk management. 

I am seeing more self-employed nurses who open shop and just practice. You do so at your own peril because healthcare is highly regulated and you are assuming too much unnecessary risk, exposure, and potential liability. Yes, it costs money for specialized legal services but it is a cost of doing business in healthcare. I see this with Independent Providers, RNs and LPNs in Ohio also as well as CNS and RNs who own businesses. You cannot practice in your business and run your business without some type of risk management and regulatory compliance plan. You can but the consequences for nurses are swift and cold.

 

 

What Do I Need To Do to Get Reported to the State Nursing Board today?

The summer is over and we are moving into fall. It rained so much of the summer it did not feel like summer until we hit the streaks of 100 degree weather. This has been an interesting year to say the least in my personal life as well as in my law practice. The Board of Nursing cases are more complex and nurses are representing themselves in these more complex cases without a real appreciation for the role of the Nursing Board or for just how serious ANY action against a license can be for your nursing career. It is never JUST a public reprimand, baby. My practice averages at least 15-50 inquiries each month from nurses with a pending complaint, post-disciplinary, pre-hearing, or active disciplinary investigation in Ohio, Kentucky, or Indiana. This of course does not scratch the surface for Nursing Board complaints in the tri-state area.

I am seeing a trend of cases involving nursing negligence and malpractice which is utimately reported to the State Nursing Board either directly or by a NPDB-HIPDB report of a settlement involving a nurse. Nothing surprises me anymore in license defense cases but when I see RN and APRNs who are named as defendants or involved in a malpractice case and rely on the advice and counsel of their employer or former employer's legal counsel throughout the matter without question, I ask why? At some point in any nursing malpractice case you have to ask yourself: Is this going to the State Nursing Board? If so, consider consulting with a license defense attorney. This is really why as a professsional nurse you need your professional liability insurance policy with a license defense benefit. It provides for attorney representation before the State Nursing Board, during depositions in a civil matter, and for nursing malpractice cases. I am paying $99 to renew my nursing liability insurance policy this year. I also have legal malpractice insurance and media liability insurance for this blog and the online products and services I am developing this fall and winter. My launch for my new website and blog will be January 1, 2012. I have so much I want to say to the readers of my blog and my clients. First is thank you for supporting me over the years. I started my law practice in 2001 and I have worked with some of the best nurses in my 10 years of law practice. I don't know anyone who goes to work and says "what do I need to do to get reported to the Nursing Board today?" But it happens, life happens, and I think sh*t happens. I hope it never happens to you as a nurse, but if it does, and you are in IN, OH, or KY, call me. Second, thank you for those of you who sent me cards and other well wishes during my divorce. The legal divorce was a piece of cake because well you know....But the emotional divorce is a monster. But I like the new Me. I lost 50 pounds and I have to say, I look good. I feel good. I am still Type A but with a minus and question mark because I am happier and enjoying the ride instead of focusing only, exclusively, and primarily on the destination. I am having fun socializing just to be socializing with old friends, new friends and getting more active and involved in the general business community and a new church. Did I tell you I had a pajama party (12 of us) and it took me two days to recover because I lost my voice from laughing so much. It was a blast! What else is new? I took a concealed and carry course to obtain my permit: yes the Nursing Law Bandit has heat! Not East or West Coast Rapper type heat or Cincinnati First 48 hours type heat but still heat and hot enough for me. I took the course with my Aunt Jules and my cousin refers to us now as Thelma & Louise. I can tell you: we WILL NOT drive MY cadillac off into a Canyon (until it is paid for)! I go to the target range at least twice a month to practice. Jack teases me about a holster: vest or thigh. I am thinking "thigh" instead of vest because I am usually wearing a dress or skirt. I have a 9mm and a 20 gauge shot gun. I am buying a 38 to keep on my person after I receive my permit and to holster. I know. I know. Just exercising my constitutional right to bear my arms: you have to see my new sleeveless red dress from the Limited! Thirdly, my law firm will offer more legal products and services starting January 1, 2012. I think you will be pleased and this has been a dream of my mine for years and I am going to crank it up and out this fall and early winter. I am burning the midnight oil this fall and winter. I am excited and even if I don't make a dollar, I am doing what I do best: talk sh$t. No, I am sorry, I am living and working my passion which is always defending and repping nurses. Fourth and finally, I want to know what do you think nurses need to know about the law, legal issues, and professional nursing practice? What types of products and services do you think an attorney or law firm should provide to individual nurses? Are your legal needs being met as a nurse? What are your legal needs a licensed nurse?

Democratic Nurses: Influencing Public Policy on Saturday, September 17, 2011 in Columbus, Ohio

I have the date on my calendar but not sure if I am going to attend. Let us know if you plan to attend this event. If you are attending and interested in car pooling a group of nurses from a particular area, drop me a line and I will list your email or other contact information for other nurses to contact you.

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 “Democratic Nurses: Influencing Public Policy”

Presented by the Ohio Nurses Democratic Caucus as education for nurses and not candidate endorsements by ONDC.

 A continuing education activity approved by the  Ohio Nurses Association, (OBN-001-91), accredited as an approver of continuing nursing education by the American Nurses Credentialing Centers Commission on Accreditation.  Participants who attend the entire activity and complete an evaluation will earn 3.41 contact hours.

Download Sept. 17, 2011 Invite, Revised with CE hours[1]

 Saturday, September 17, 2011

12:30- 12:40 pm Annual Meeting (Member as of Sept. 1 to vote)

12:45 - 4:30 pm Program

Ohio Democratic Party Headquarters

340 East Fulton Street 

Columbus, Ohio 43215 

 

All Democratic nurses and students are encouraged to attend  

The event is FREE to ONDC Members and Students & $10.00 for non-members payable at the door.  Registration is required.

RSVP to Carol Roe, caroejd@aol.com

Please include name, address, county, email, and phone.

	Purpose:  To provide an overview of public policy initiatives at the state and federal level which impact nurses as both citizens and health care professionals. Describe ways that nurses can be visible in Democratic party politics.		Program: SB 5 – Making it All Go Away Pt. Protection & Affordable Care Act : Implications for patients and nurses Efforts to repeal the Pt. Protection and Affordable Care  Act Strategies for nurses to be involved in 2011 and 2012 elections Understanding the Ohio Supreme Court ONDC is a Caucus of the Ohio Democratic Party and membership is open to any licensed nurse or student.  Additional information about ONDC can be found on our website at www.ohdemnurses.org

 

Nursing 911! for Legal Matters: 24/7/365 for Ohio, Kentucky, and Indiana Nurses. 513-400-4053

Finally!!!!

I have a twenty-four hotline for RNs, LPNs, and nursing students in Ohio, Kentucky, and Indiana who are looking for legal assistance and representation. It is called Nursing 911! for Legal Matters. Not to be confused with Reno 911! Actually, I LOVE Reno 911!

This telephone line is answered by a virtual receptionist 24 hours a day, 7 days a week, and 365 days a year.

What is a virtual receptionist? A trained professional who answers a telephone line and who is usually physicially located in another city or state from the caller.

Nursing 911! for Legal Matters is only available for nurses with nursing law, State Nursing Board, legal, professional practice, and other matters in Ohio, Kentucky, or Indiana. I am licensed to practice law in Ohio, Kentucky, and Indiana only and cannot provide legal representation before other State Nursing Boards.

If you are looking for assistance in the 47 other states, see www.taana.org.

Nursing 911! for Legal Matters: 24 Hour Hotline Number is 513-400-4053

Call the Hotline and you will hear an announcement.

You will then be transferred to a receptionist who is available 24/7/365.

Provide the receptionist with the following:

1. First and Last Name

2. Mailing Address

3. Telephone Number(s)

4. Email Address

5. Information about your legal matter.

This information is then relayed to my staff and we will f/u with you.

 

A. Does this mean you are my attorney?

You are kidding me, right? No. This is your opportunity to provide me with information about your case to determine if I can assist you. It also allows you to determine whether or not you want to retain my services as your attorney.

B. Can I fax you information?

You are kidding me, right? Yes. My fax number is 888-580-1119.

C. I do not have access to a fax machine, what do I do?

You are kidding me, right? You can scan/email documents to my attention at ldw@nursing-jurisprudence.com. Most local print shops, Fed Ex Kinkos, and Staples/Office Depot have fax machines.

D. Is this a free service?

You are kidding me, right? Yes, but there are limitations because it is free and I still haven't paid my Direct TV bill from July. This provides a 15 minute telephone appt. with me to discuss your case/circumstances/issues. Just 15 minutes. After you call and provide your contact information to my receptionist, if you like, you can schedule your 15 minute telephone appt. with me at:

http://www.tungle.me/latoniadenisewright

E. Is this also a cell phone number?

Yes, this is also a cell phone. You can also text your information (the information to be provided to my receptionist) to my office at 513-400-4053,  24/7/365. My office will then f/u with you.

 

Ready or Not: the $2,500.00 State Nursing Board case

http://www.youtube.com/watch?v=W7MUKF2uE6k&feature=related

http://www.youtube.com/watch?v=0GfUPXfw5Mg&feature=related

Lauryn Hill says it best: Ready or Not.....

Ready or not and (regardless of) whether you realize it or not:

1. The State Nursing Board is investigating you if you receive a Notice of Complaint from the Kentucky Nursing Board or Indiana Board of Nursing or if you receive a Potential Violation Report, telephone call, email, or official correspondence from a Compliance Agent (investigator) or Adjudication Coordinator (Juris Doctor (law degree) prepared Staff) from the Ohio Nursing Board.  

a. It is not the role, responsibility, job, or function of the State Nursing Board or anyone who works for the Board to explain to you what this means to you, for you, and what you shoulda, coulda, maybe, or mighta do or do not. The Board's role is pubic protection: no ifs, no ands, and certainly not buts.

b. You are representing yourself anytime you are not represented by an attorney in legal proceeding. YES, Board of Nursing investigations and complaints are legal proceedings. Therefore anything you do or don't do and how you proceed in the legal proceeding before the State Nursing Board, you are representing yourself.

c. Self-Representation in a legal proceeding is a right just like deciding whether or not you want to retain legal counsel (private or have one appointed  in a criminal matter) in a legal proceeding. No, sorry, attorneys are not provided by the State to represent healthcare professionals in licensure matters.

d. You are an educated and licensed healthcare professional i.e. you have something to lose: your employability, your career, your license, your....... Therefore ANYTIME you as a licensed nurse are involved in a legal proceeding, you MUST ask yourself, do I need a lawyer?

No one is going to hold up a sign and walk a picket line in front of your home saying "Retain a Lawyer."

No one is going to tell you "you are required to hire a lawyer."

No one is going to tell you "you are nuts if you attempt to work through this on your own."

Everyone will tell you:

1. Just tell your side of the story and it will be okay (this is my grandmother's favorite that I figured out to disregard at age 9);

2. This is not a big deal as I am sure the Board of Nursing has bigger fish to fry. I love this one because not only do I like to fish for sport but I also like to eat fish: the bigger the better.

3. It is going to be okay. When anyone tells me this, I immediately think "how and why would you know how it is really doing to be or be not for me?"

4. This is just a misunderstanding, just be honest and it will work itself out. Like what, a knot?

Lawyers can be expensive for corporate litigation and other matters but license defense is actually affordable because the fees are quoted to an individual healthcare professional. Most license defense attorneys will quote you a flat fee or a retainer and hourly fee based on your case and the complexities which is actually affordable when you consider your monthly, annual, or lifetime income as a LPN, RN, or APRN.

If you are NOT willing to spend $2,500 to $__________ to defend your license in a Complaint filed against you for whatever reason, what does this mean to you and for you?

This is why I have legal malpractice insurance that covers malpractice and Bar disciplinary investigations of my license. This is why I still maintain my nursing liability insurance. This is why I just purchased media insurance for my blog and online projects. Because I am a professional, I am licensed, and there is always always a chance I can be sued or reported because of legal, professional,and personal accountability, responsibility, duties, and obligations.

I know this isn't explained in school or discussed in the workplace this way but that's a fact Jack and if you are not comfortable or PREPARED for this, get prepared or surrender your license (as a teacher, nurse, lawyer, dentist, physician, PT, etc.) and work in a field that does not require a State issued license and does not have the regulatory complexities of healthcare.

A Notice of Complaint is a Notice of Complaint and a PVR is a PVR from the Nursing Board regardless of whether or not you appreciate the significance, complexities, or law, legalities, and legal issues therein: it is what is it.

The cases I am seeing in 2010/2011 vs. 2003/2004 before the State Nursing Boards are like day and night. http://www.youtube.com/watch?v=hlbQhD2sxz8

The cases now are much more complex than the $2500 fee from yesteryear. $2500 was the standard fee I quoted years ago but very rarely do I quote a $2500 fee anymore because of the issues involved. That's why I do my own initial phone calls to nurses who contact my office because I need to listen, listen, and ask a question or two before I can quote a flat fee for representation because the $2500 standard State Nursing Board case only comes around once every blue moon and every other purple sun. I also need to review a few documents for myself to get a feel for your case because although I understand what you are telling me, I need to see the paper: black and white.

Also do you want an attorney to quote you a fee of $1,110.56 for Nursing Board representation? Do you know how long these cases take to be worked up and eventually resolved? What type of representation do you honestly think the attorney will provide to you for $1,110.56? Does this $1,110.56 include any research or prep work? What is included for $1,110.56?

This is your State Nursing Board LICENSE, not a muni court case or a will. I do not quote low ball fees just to get a case or bring someone on board and then not work up the case or answer client calls. If you want an extremely low fee, I am probably (99.99% of the time) not that nurse license defense lawyer.  

So even when you say, I called Lawyer A and he told me $2500. I called Lawyer B and she told me $5000, don't expect for me to yell out "BINGO, I can represent you for $3,750.53 and a pack of Apple Now Laters."   

I represent my clients how I would want a lawyer to represent me if: my license, my career, my livelihood and my essence was at stake because I am my license. Sorry. I know others will say you are more than what you do for a living and "your job" but not me.  I am RNBSNJD and LDW Law.  I haven't decided which I want to have on my vanity license plates, what do you think? 

I am committed to my law practice, my nursing career, and the nurses I represent. http://solopracticeuniversity.com/2011/07/12/back-to-the-root-of-things-the-role-of-servant-lawyers/.

Also think about this: are you providing the service each and everyday you practice as a nurse that you expect other service providers to provide to you and your family? If not, Houston, we have a problem.....

NO LICENSE or RESTRICTED LICENSE means a lot to you as a LPN, RN, APRN who is LICENSED or a nursing student, NCLEX-PN or NCLEX-RN on the road to licensure. Your license is always at stake in a State Nursing Board case and ready or not, regardless of whether you realize it or not, it is what it is and what it is usually just the beginning because the Nursing Board investigation is a starting point on a dim and winding path and you may not see the forest because of the trees.

Take a look at these articles.

Download BillofRightsforNursespdf

Download Nurselicensedefenseattorney

 

Worst Traffic Jams on I-71 South and North: Blowing Money Fast and a Hot Pickle

I actually wanted to cry yesterday (I am being dramatic) as I sat in traffic on I-71 South. It normally take the Nursing Law Bandit 90 minutes to drive from Cincinnati to the KY Nursing Board office in Louisville, Kentucky. I always give myself 2 hours for the drive because of the "cut in the hill" in Northern Kentucky and construction as there is always construction on either I-71 or I-75.

Well guess what? Once you turn on I-71 in Northern Kentucky it is essentially one-lane to the Speedway because of the construction barrels. Okay this slowed me down by 60 minutes.

Then guess what? Outside of Louisville BEFORE and AFTER exit 14 and 3 miles before the Synder Freeway there were two accidents. TWO. I sat in traffic here for 3 hours. The expressway was closed for almost 90 minutes.

I left Cincinnati for a 1pm meeting at the KBN office around 11am and I arrived at 3:30pm. Oh and my meeting was for 1pm.

Okay, so I had my meeting and left Louisville, KY around 4:30pm and guess what? More traffic. I had a 6:30pm meeting back in Cincinnati.

There was an accident on I-71 North which slowed traffic and there are construction barrels on 1-71 North making most of the drive a one lane highway.  

I made it back to Cincinnati for my meeting around 7:30pm.  I met with a nurse from 7:30pm to 9:15pm and then returned a few calls.  

Do you know what I ate yesterday? I had a Pepsi, a Mountain Dew, 4 bottles of spring water, and a hot pickle. This was how I ate at age 13.

I rushed in the door at home to let my dogs out of the utility room (my son put the dogs in the utility room around 3pm) and Luke ran by me so fast I fell (it does not take much for me to fall anyway).

I took two Tylenol, reviewed a case file, and went to bed at 1130pm. I spent most of yesterday in my car. But guess what? I have a new car and I reallllllllllllllly didn't mind!!!!

I purchased a Cadillac Crossover with all the fixins. It is a present to me for me for behaving and being nice during  my divorce (sort of but not really), for my 40th birthday, and the prequel to my mid-life crisis. I also purchased myself a touchscreen computer for my birthday earlier this month. I also purchased 12 (yes 12) summer dresses (can be dressed up or down) at Macy's sale last Saturday. These dresses are popping. I plan to buy a new matching purse and handbag set from V. Wang, an Android tablet (for video conferences; I cannot do a video conference with my I-Pad), and at least 2 pairs of patent leather sandals this month on or before 31st. I also plan to eat at Cheesecake factory at least once a week until the 31st. I am spending a little but certainly not Blowing Money Fast (BMF).

If you are driving I-71 to Louisville, KY, considering taking I-75 to Lexington and then driving to Louisville, Kentucky. I will consider this next time. I really need a magic carpet, broom, or the ability to fold space and time like the navigators in Dune!

It is Going Down like Charlie Brown: Nursing Students will Sue!

I attended nursing school "back in the day" when nursing students viewed their instructors and professors with admiration, respect, and "awe." This was in the early 90s for me. I received my ASN in 1993 and my BSN in 1994.

Things have changed in the almost 20 years and nursing students are willing to file complaints against instructors and professors with the State Nursing Board, file complaints against their schools of nursing with the Board of Nursing, and sue! That's right baby, litigate!

I tell you there is nothing like a civil law suit and the discovery process.  I tell you a Complaint for Damages smells like a warm strawberry PopTart with sprinkles to a defense attorney. Sometimes I miss med and dental malpractice defense work (only for 3 seconds).

Former Viriginia Western nursing students were awarded damages. http://www.roanoke.com/news/roanoke/wb/291572

I expect more of these lawsuits especially from nursing students are crim-ed out, attend nursing school and spend $30k+, only to find a restricted nursing license and little to "zip" employability because of the restricted license and being crim-ed out.

What is crim-ed out? I picked this up over the weekend while out and about. You know I am a single now and I am out and about and on the loose, 60 to 90 minutes every week now. It is start. But anyway.

It is crim like brim. So crim-ed out. Crim-ed out means multiple criminal convictions, either Misters or Fellows. I picked this up to this weekend also. And no, I did not visit anyone in jail or prison and pick this up and no, I didn't pick this up at a Bar association event.

Personally I think nursing students should be more proactive as adult learners. You are seeing this now with law students who take on 100k to 150k in debt from law school to realize most attorney positions start at 35k to 55k.

http://www.nytimes.com/2011/07/17/business/law-school-economics-job-market-weakens-tuition-rises.html?_r=1

http://www.nytimes.com/2011/01/09/business/09law.html?pagewanted=all

If you are a nursing student or NCLEX-Applicant and you have felonies or misdemeanors, you need to speak with a nursing law attorney before you submit your application for licensure to the State Nursing Board. Anytime you are REQUIRED to make affirmative disclosures on a renewal or initial application for licensure, you should talk to a nursing law, nurse license defense, or administrative law attorney in your state.

Who Made the Potatoe Salad? Indiana requiring FBI Criminal Background Checks for Licensure

I knew it was coming in the good State of Indiana and here it is; the beginning of the end or the end of the beginning (depending on your views) for Initial Applications for Licensure by Examination.

Effective July 1, 2011, the Indiana Board of Nursing requires a national criminal history background check at the cost of the individual. Can you say FBI?

http://www.in.gov/pla/files/Criminal_Background_Checks_PLA.pdf

Maybe this will be a sign for nursing students and NCLEX-Applicants for initial licensure before the Indiana State Nursing Board to really consider their situation, the circumstances, and consult with an attorney before appearing before the Board to respond to affirmative responses for criminal convictions.

The State of Indiana was relying on the self-disclosure of all criminal history by applicants for licensure in healthcare professions which frankly did not work.  http://www.in.gov/pla/3242.htm

The State website also notes that 31 states require a criminal background check for nursing licensure already. Give it another 5 years and it will be close to all 50 states.

Also this may be a money maker for the State of Indiana as $15.00 of the $42.50 goes to the State's general fund. Really? That's nice to tax students who are maxed out with student loans and who may not be able to obtain a license because of the criminal.

This does not apply to renewal applicants in the State of Indiana, yet! I would hope that State Professional Associations representing the various healthcare regulatory boards would "man up" and legally challenge any law requiringbackground checks for licensure renewal with a State Nursing Board as opposed to self-disclosure. Also I don't think healthcare regulatory boards have the manpower to deal with the influx of cases and headaches that would result from mandatory criminal background checks for renewal applicants.

I would probably have to hire an associate attorney (licensed in at least two states) and two paralegals if the Ohio, Kentucky, and/or Indiana Nursing Boards require mandatory criminal background checks for license renewal. Damn maybe I could finally break the sound barrier from the muddy middle class to the murky lower upper but still middle of the middle.

I have always been intrigued with class, income, and education stratifications in the US since high school when my social science teacher named the characteristics of socio-economic depressed neighborhoods and pointed out which neighborhoods were considered economically depressed by definition. Guess what? I lived in what he termed as an economically depressed neighborhood. He described white collar vs. blue collar. He identified poverty level and the characteristics of poverty. He identified the layers between the classes of US society and the definitions and rationales.

I was not offended because I knew we lived good but the concepts, meanings, and implications (I started critically thinking early boo boo) floored me and I wanted to know more.  

This particular lecture by Mr. Brandenburg enlightened and challenged me. Thank you Mr. Brandenburg.  

These were the days when high school teachers could actually offend "you and your mama" and not have to worry about being sued in civil court, workplace complaints, and State DOE complaints. I told my grandmothers and they were very angry and told me about the rich history and sense of family in predominately black neighborhoods. I listened but I knew there was more and I needed to know and to know I needed to read and read and read and I did. I needed to know more about money, business, race, poverty, and economics. Why at age 16? I don't know.

I was interested in astronomy in my preteens and therefore I read up on astronomy. I wanted to be an astronomer and I had at least three telescopes and two microscopes because I went through a biologist phase because I used to fish with my grandfathers. Yes, I can fish!

I mentioned this to my grandmother and she said that's wonderful and purchased more books. I later became interested in Greek mythology and told my grandmother, I wanted to study mythology more. She grinned and purchased more books. I took home ec and started to help more with cooking, cleaning, and ironing and I told my grandmother I wanted to be a housewife. She laughed (I might have to f/u with her about this one now that I think about it!) and she showed me how to cook "soul food" over the years.

Potatoe Salad (from scratch of course) is the key to a long life baby and the movie, Who Made the Potatoe Salad? is real. http://www.imdb.com/title/tt0452706/. I still laugh because regardless of the number of sides, entrees, meats, and desserts we have at one of our many family functions,  someone asks will ask Who Made the Potatoe Salad?

Right before my high school graduation, I told my grandmother, I want to be a lawyer. She frowned, paused (she almost chocked now that I think about it), and then said "There are too many lawyers, you want to be a nurse."

What have I learned since high school and Mr. Brandenburg?

1. Criminal convictions can make a break or person especially one seeking a state license as a healthcare professional today. Got criminal? Talk to a license lawyer like LaTonia before you apply to a technical, trade, vocational, or professional program requiring a state license or certainly before you attempt to "license up."

2. I can be a RN and an attorney; 

3. Knowing how to cook, clean, and iron will never go out of style; 

4. A prenup written cold is better than chocolate served warm; and

5. I will always see myself as the middle of the middle  (like most) regardless of income, class, status, title, or education. 

 

 

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

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

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

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

In Ohio, see ORC 4728.28(G).

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

1. Forensic Psychiatric examination;

2. Medical Examination;

3. Behavorial Examination;

4. Substance Use and Abuse vs. Dependency examination;

5. Neuro-Psychiatric examination; or

6. Psychological examination like a Fitness for Duty

then you need to:

1. Review the document carefully;

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Are nurses supposed to be Perfect Patties?

Are you a Perfect Pattie or a Perfect Pat?

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

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

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

Kimberly Hiatt, R.N. and the Tragedy of her Suicide: Is it Just Culture, "Just" Culture, or "Just" Termed & State Nursing Boarded?

Please read this story about a nurse who committed suicide after committing a medical error resulting in a patient death. The nurse admitted to making the mistake and subsequent events reportedly pushed her over the edge: being fired from the hospital and a State Nursing Board investigation. 

Is is really just culture or it just culture the newest "PC" term for the powers that be, be not, and be gone in healthcare?

http://www.msnbc.msn.com/id/43529641/ns/health-health_care?gt1=43001

http://news.gather.com/viewArticle.action?articleId=281474979517624

http://www.allvoices.com/contributed-news/9514641-kimberly-hiatt-the-nurse-who-killed-herself-after-overdosing-a-baby

http://allnurses.com/washington-nurses/suicide-of-rn-555775.html

http://josephineensign.wordpress.com/2011/04/24/to-err-is-human-medical-errors-and-the-consequences-for-nurses/

http://thehealthcareblog.com/blog/tag/nursing/

Healthcare providers who commit errors are being called "second victims." The patient is the first victim as the person injured or killed by a preventable error and the second victim is the person who has to live with the mistake: Kimberly Hiatt, R.N. Medical errors can be eliminated 100%  in a perfect healthcare system , with a perfect work environment, with perfect staffing, staff and processes, and administration by the perfect nurse.

I am not sure what type of debate this will spark however the pendulum has swung toooo far to the left or right (whichever hand you use) in general. I get "public protection" and "patient safety" as a priority of course as a nurse license defense attorney but how do you balance this with the rights of nurses (as the largest group of HCPs) who:

1.  are at a severe & extremely unfair and "unjust" disadvantage in the investigation of these cases by the State Nursing Board (compare the rights and more importantly the discovery process afforded to criminal defendants and civil litigants with the rights and "discovery" afforded to licensees in State Nursing Board disciplinary investigations in your state);

2. are usually terminated by the healthcare organization with little or no recourse but filing a "wrongful discharge lawsuit" (I said filing a lawsuit not prevailing...);

3. the now former employer then challenges the  claim for unemployment benefits; and

4. there may or not be a medical mal case lurking (depending on the error); or

5. a criminal case (depending on the error) and more state and regulatory investigations forthcoming.

We are talking about nurses; most of us with two year or diploma degrees who are trained now to pass the NCLEX (there isn't much time left for anything else) and then pushed out into practice into the Where is Waldo World and regulatory maze of practicing "safely" in a healthcare system. What is just culture? I don't know because I don't see it from end of the table expect in a very limited cases; it is certainly not the norm and what is a just culture is subject to more interpretations than Purple Pain by Prince (I wanted to the say the Bible here but I can't; my grandmother reads my blog now). Also some of the blog posts ask why is a nurse treated so differently than a physician or a dentist in this type of siuation? What do you think?

The cards are stacked against nurses from Day One: before any error is committed or before anything happens, the facility has a plan to deal with the situation and you as an at-willed employed or nurse under a CBA. I see it every day and I cringe because it is just so "unjust." 20+ years with an employer means nothing anymore and you will be discharged the same as someone working at the facility for 2 weeks.

You are essentially at the whim of HR and management who while having visions of sugar plums, dates, raisins, figs, and Fig Newtons are mesmerized and magnetized by the brillance and effectiveness of the organization's strategic planning.

The nurse is thinking what will happen to my career, my license, my livelihood, how will I pay my bills now? and what about my family? The employer is thinking about JCAHO, leveraging the State Nursing Board complaint in the grievance process and arbitration as a long-term "plans within plans within plans" strategy for finally busting up the union, and appealing your award of unemployment benefits to the State Supreme Court and to infinity and beyond: which means filing formal Motions to "Engage You in Mortal Kombat" or  in the alternative "Pimp Slap You" on Judge Judy. Just how many blows can one take to the head wearing a broken helmet when the opponent is wearing cheap gold plated brass knuckles?

It is the nurse (with limited resources) against the employer (with deep pockets, trade association backing, and enough insurance coverage and legal needs to make most attorneys (plaintiff or defense) want to sip its Kool-Aid. I make my own Kool-Aid thank you very much.

It becomes the nurse against the world (like Pac) because for most of us your career, your licensure, your employment and your title is who and what you are. It is not just a title, a role, or a job: it is your essence. Kimberly Hiatt, RN is a nurse. LaTonia Denise Wright, RN is a nurse. You are _______ and you are a nurse. For some if not most of us are you are your license.

When you pull and tug at the essence it is like pulling flesh from the bone for some. This is the rawness exposed when you term a nurse and report to the State Nursing Board for whatever reason for some nurses because the nurse and her license are one and the same. License defense rivals family law with the sheer emotion and criminal law with the potential loss of livelihood (instead of liberty). 

Everything comes into question: finances, licensure, career, marriage, relationships, health, etc. all at once and it can be overwhelming and actually knock the wind out of you.  It is a professional matter but it is personal because you are your license and it is your license being questioned. How can it not be personal some of us may say? The condemnation of the nursing practice is internalized because how do you separate the nurse from the license if you are your license? The same can be said for any licensed individual if your license affords you benefits you would not otherwise have without the license: teachers, doctors, lawyers, RTs, MTs, PTs, OTs....... 

This is a tragedy for the family who lost a child.  I am so sorry for your lost.

 This is also a tragedy for the family of the nurse who took her own life at age 50. I am so sorry for your lost.

I am sure some of you are saying I am more than my license and I am more than a nurse; I am not defined by my license, education, or title. Of course you are but until your license, livelihood, and identify as a nurse is threatened, I don't think one can appreciate the throws of what it means for some of us as nurses if you are your license. How would you know that you are your license until this happens and then what do you do? Is this normal? Is it acceptable?

I would like to think if my law licenses and nursing license was in jeopardy and I was in the mix of a professional crisis affecting my small business and law practice, my career as a nurse license defense attorney, and which would certainly impact everything else in my life (to say the least) that I would be okay but you don't know until are there.

Nurses if you are terminated by your employer and subsequently reported to the Board reach out for help if you are having trouble coping with your circumstances. Don't be ashamed; you are a helper and there is nothing wrong with needing help when you are in a crisis. You worked hard to finish nursing school and get your license and you may have to work even harder to keep it. There is always hope and the road ahead is never as bad as it seems if you have faith in a higher power or if you believe this too shall pass.

1. Seek assistance immediately from colleagues, family members, neighbors, and friends to be there for you. This isn't the time to be super-woman or superman. You are being offered help so please take it and utilize your resources.

2. If you need medical care, get it before your health insurance lapses. Also you can seek medical services on a sliding scale basis.

3. If you need mental health assistance, get it. Counseling can be a positive and provide you with an outlet for your feelings of despair, hopelessness, and help you manage the pain and sort through your feelings and emotions. If you need counseling, there are facilities which offer it on a sliding scale basis if you don't have insurance. Consider attending a support group at a local church for unemployed workers; it may give you a totally different perspective on your situation and plight. If you are considering suicide, call someone, call 911, and reach out for help.

4. Talk to someone at your State Nurses Association for general information on your options. Let them know you are a nurse and you are in a crisis: someone whether it is the Executive Director or the Nurse Practice Consultant will listen and assist you. See http://nursingworld.org/FunctionalMenuCategories/AboutANA/WhoWeAre/CMA.aspx

5. If you are a member of a nursing union, contact your union rep and your local union president to further discuss your situation.

6. Seek legal advice and counseling and consider representation before the State Nursing Board. See www.taana.org.

7.  Review your finances carefully as you may need to tap an emergency fund, retirement fund, etc. Tighten up your finances and start spending less. If you need a room mate to make ends meet, get a room mate.

8. Consider applying for unemployment benefits if you are having trouble securing employment.

9. Eat right and do some type of physical exercise. Crying isn't physical exercise.

10. Remember you are loved and you are wanted and needed by your family, your friends, your colleagues, and the profession. I don't know you but I love you because we are all nurses and just one nurse committing suicide because of what is perceived and objectively and subjectively mirrors professional, licensure, and career suicide to nurse is unacceptable and unjust.

 God bless you, Kimberly Hiatt, RN and may your soul rest in peace. 

Kudos to the Washington Nurses Association for doing what it does best.

See http://www.wsna.org/education/workshops/Culture-of-Safety/

http://www.wsna.org/Topics/Patient-Safety/Survey/

 

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

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

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

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

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

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

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

a. Go Sour;

b. Take a road you didn't expect;

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

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

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

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

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

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

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

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

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

 

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

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

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

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

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

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

1. LaTonia;

2. My EX-HUSBAND;

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

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

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

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

More later. But...

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

3. Luke (my dog);

4. Leia (my dog); or

5. My son.

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

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

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

So here is the skinny:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Google Business Apps (paid version) is the truth.

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

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

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

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

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

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

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

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

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

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

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