Blog - Brown Law Office

When Helping Can Hurt You

July 12, 2018 by LORIE A BROWN, R.N., M.N., J.D. Leave a Comment

As nurses, while we really want to help our patients, we sometimes find that our being helpful can get us into trouble. As you know, we are required to follow tons of rules. We have to watch our professional boundaries to make sure we are not overstepping.

For example, if you work at an assisted living facility where one of your patients needs help getting groceries and you agree to get the items for the patient. This is crossing the line. You are there to provide nursing care and not help the patient with something like that.

I’m aware of what you’re thinking, “You know, I’m just trying to help her out.” But still, that crosses the line and can lead you to trouble.professional boundaries nurses nursing patients

Another scenario is you have a patient who perhaps is constipated and requires Milk of Magnesia. The physician normally prescribes that for all his postop patients but let’s say that, for whatever reason, this order got missed. You go ahead and give the Milk of Magnesia to the patient while fully intending to get an order to cover you.

As much as you wanted to help the patient and relieve their suffering from constipation, this would be practicing medicine without a license.

Don’t fall into the trap; your license is too valuable. It’s a true privilege to be a registered nurse but don’t mess up your career because you felt compassion toward a patient.

Here’s another example: your boyfriend is in pain and you give him one of your own pain medications left over from a surgery you had. As much as you would like to ease his pain, this too is considered practicing medicine without a license.

How about if you were working on a cancer unit and when a patient passes away, the medications are left and not wasted. If you save these for other patients who may not be able to afford these medications, even if ordered, is considered diversion.

If any of these situations cause you concern, I would suggest taking continuing education on ethics and professional boundaries to make sure you are complying with the law. Each one of these nurses thought they were helping people and it turned out to hurt them. Have you run across similar situations? What did you do? I would love to here your thoughts below in the comments.

Top Ten Things To Never Do In Nursing

July 5, 2018 by LORIE A BROWN, R.N., M.N., J.D. 2 Comments

You’ve heard of the “never” events where the government will not pay for certain things that happen in a hospital that shouldn’t have happened. This list includes things such as decubitus ulcers (stage III and IV), vascular catheter associated infection, catheter associated urinary tract infections, administration of incompatible blood, falls, air embolism and foreign object intentionally retained after surgery.

I decided to come up with my own NEVER-DO list in nursing.

NEVER pre-chart anything in the medical records. You can never know what will happen. I’ve seen so many nurses get in trouble with the Board because they pre-charted and then something different happened to the patient.
NEVER prearrange medications and take them out of the packaging if you are not going to administer them right away.
NEVER remove medications from the Pyxis early and carry them around with you. While it’s great to think ahead, the delay in administration is a red flag.
NEVER keep medications in your pocket if you find the patient is asleep or if they refuse to take the medication. Always make sure you return it.
NEVER sign that you witnessed a waste of narcotics if you actually did not do so.
NEVER document anything that you did not do.
NEVER omit any of the jobs you’ve held when applying for a job on an employment application.
NEVER forget to document the name of anyone else who provides care to a patient, such as starting an IV, inserting a catheter or calling a physician.
NEVER act outside the scope of your practice. If the policies and procedures does not support your actions, then don’t do it. For example, nurses in one hospital may be allowed to draw blood from the Quinton catheter but those in a separate hospital may not be allowed to do that same task. A hospital may allow a nurse to remove a central line but denied doing that at another facility.
NEVER forget to renew your license. Practicing nursing without a license is a criminal event.

This is not meant to be a complete list but only as a starting point.

What other things can you think of that nurses should never do? I would love to read your list in the comments below.

I Don’t Know Is Not A Defense

June 28, 2018 by LORIE A BROWN, R.N., M.N., J.D. 2 Comments

“I didn’t know,” is a common response when a nurse comes to my office for legal consultation and I’ve just informed them of something of which they were previously unaware. However, if they have erred on some issue, “I don’t know,” will not be a defense.

Here is a list of perhaps the 4 most frequent things that nurses will admit that they did not know.

An educational teaching is a reprimand. If you are asked on your license renewal if you’ve ever been reprimanded, disciplined or terminated, you must respond with a, “yes.”
Taking someone else’s prescription is practicing medicine without a license and giving one of your prescription pills to someone else is diversion. As nurses, we know what medications are used to treat what conditions. In my experience, I have dealt with nurses who took pain medications belonging to their spouse or a friend. When they were asked to do a drug screen, the result obviously came up positive for that medication. Even if you have a valid prescription for that medication in the past, it is still considered diversion. Let’s say you were prescribed pain medication after the removal of a wisdom tooth but took it later for another type of pain, that is considered practicing medicine without a license. Take only medications prescribed strictly for you, not for anyone else, and take them for ONLY that specific purpose and time, not later or for some other pain. If you have leftover medication, dispose of them properly at a prescription destruction location.
If you were terminated from a position, you must include that information on all subsequent job applications. You cannot omit it for, if you do, it would be considered fraud and misrepresentation in obtaining a job. At the bottom of most applications, you will see a statement that you are affirming under the penalty of perjury that you have disclosed all of your nursing positions. Therefore, if you leave out one, that is fraud.
I have heard from nurses who took CBD oil, had brownies or chocolate which they claimed contained THC saying that follow up urine drug screens came up positive. You are responsible for what goes into your body. If you don’t know the person who gives you a brownie or chocolate, play it safe. DON’T eat it.

Many nurses did not know these problems and find themselves before the Board. Now you know! Did you know these things before reading this? I would love to hear your comments below.

Anything You Say Can And Will Be Used Against You

June 21, 2018 by LORIE A BROWN, R.N., M.N., J.D. Leave a Comment

There probably is no one in the country who has not heard the phrase “Anything you say can and will be used against you.” I’ve been familiar with that saying seemingly forever. I always thought that referred only to criminal matters but apparently it now applies to nursing as well.

I have had cases where a nurse jested with an off the cuff remark about something at work. Whether or not it was made as humor, employers seem to be taking these quips seriously resulting in the nurses being terminated.

Many of us have said to ourselves something like “If that patient pushes their call light one more time, I’m going to punch them out!” If you say something like that out loud, you could get yourself into a lot of hot water. Of course, none of us would attack a patient but even saying something like “if I have to take care of that patient again, I’m going to jump off the roof” can and will be used against you. Or “If that charge nurse gives me that assignment again, I’m going to dump my lunch all over her!” Any such off the cuff remarks can and will be used against you.

It’s hard enough to be a nurse with everything we have to deal with, and many times we say things that’s in fun. But, I am here to tell you … be careful!

It is sad that we can’t use our humor in the workplace (nurses certainly have a unique sense of humor) but still, be careful. You never know who is listening or who is going to repeat something that you said, possibly even take it out of context, which will come back to bite you.

It is a shame that we can’t just be ourselves in our jobs, let alone having to be careful with every step we take, everything we do and guard against every word that comes out of our mouth. But, as nurses, we do.

Do you feel that you must be careful of what you say at work? Do you feel that you can speak your mind? Do you feel that you can joke around? I’d love to hear your comments below.

Nurses With Substance Abuse Problems

June 14, 2018 by LORIE A BROWN, R.N., M.N., J.D. 6 Comments

Recently, an article in The Atlanta Journal Constitution detailed how the Georgia Board of Nursing secretly handles more than half of its disciplinary cases. What I gather from the article is that nurses who are put into a monitoring program, as long as they are compliant, will have not have discipline against their license.

The article pointed out that in 2017, the Board has 333 new disciplinary orders. Of that number, 54% were private with just under half of that group being alcohol or drug related. In order for the Board to issue an emergency suspension, the Georgia Attorney General’s office says the nurse must be an imminent threat to the public.

By the time the complaint reaches the Board, the accused nurse has usually already entered rehab and has been viewed as safe.

At one time in Indiana, if a nurse entered into a monitoring program, then no action would be taken against their license as long as they were compliant with the program. However, since that time, the Board has gone 180 on that position and now feels that anyone with a substance abuse problem should be disciplined and have their license placed on probation or suspension. Also, that discipline should be public record for all to see.

Substance abuse is a medical issue. I don’t believe that anyone wakes one morning deciding to abuse drugs. I think there is a part of the brain that craves these substances and there are some people who are more susceptible to substance abuse than others which may indicate the problem could be genetic.

The article continues in discussing other types of Boards and what are considered private vs. public. The Board of Physical Therapy in Georgia, almost all of their orders are private, whereas the Medical Board has only 18% considered to be private.

It would be nice to see some consistency among Boards and states. Just because someone is lucky enough to live in Georgia when they develop their substance abuse problem, versus their peer in Indiana, why should each be treated differently?

I believe everyone deserves a second chance. If a nurse develops a substance abuse problem, is able to successfully participate in the monitoring and is active in their recovery, is it necessary to disclose their medical condition to the public?

However, if they have a relapse, at least they have the initial opportunity and then it can become public record.

Do you believe the public has a right to know if a nurse had a substance abuse problem and is in recovery? Do you think these matters should be private? I would love to hear your thoughts in the comments below.

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