My new client, Katie, sits across from me because of a situation that happened at work and resulted in a complaint before the Nurse Licensing Board. She’s scared and crying. I can tell by talking to her that she is a very compassionate nurse and does a great job. Yet, she doesn’t understand why this is happening to her.
Like most of my nurse clients, few ever thought that they would be called before the Board. But it happens every day: 7,000 nurses have their licenses charged before the nursing boards across the country.
I reassured Katie that almost no client who has come to me ever thought that they would find themselves before the board. But, there are ways we can protect ourselves from having a matter reported.
When we take a driver’s license test, we are tested on “the rules of the road.” We’ve learned them and have to show we know them in order to get a driver’s license. But, one reason that a nurse gets into trouble is because she typically doesn’t know the laws she needs to follow. On the NCLEX exam, the questions are based on how to be a nurse rather than on the laws we must abide by to be a nurse.
Even if we do read the laws, they are written by attorneys and are difficult for lay people to understand. Another thing is that the laws are sometimes subject to interpretation which can further complicate our knowledge of them.
The laws you need to follow as a nurse are found in your State’s legislation in what we can call a “Nurse Practice Act.” The goal of this Act is to protect the citizens of the State by ensuring that a nurse is safe to practice. The American Nurses Association has published a model nurse practice act to guide the States in creating and maintaining such laws. https://www.ncsbn.org/12_Model_Act_090512.pdf
The laws empower the State to appoint a board of nursing which has the authority to develop administrative rules and regulations to assist in setting the standards for the practice of nursing.
Each nurse practice act includes the following:
- COMPOSITION OF THE BOARD OF NURSING
- EDUCATIONAL PROGRAM STANDARDS
- STANDARDS AND SCOPE OF NURSING PRACTICE
- TYPES OF TITLES AND LICENSES
- PROTECTION OF TITLES
- REQUIREMENTS FOR LICENSURE
- GROUNDS FOR DISCLIPARY ACTIONS, OTHER VIOLATIONS AND POSSIBLE REMEDIES
Russell, K., 2012, “Nurse Practice Acts Guide And Government Nurse Practice,” Journal of Nursing Regulation, page 37.
Katie explained how she was working in a sub acute long term care ventilator facility. The patients were being weaned off the ventilator. There were alarms for the call light and alarms for the ventilator which both sounded similar. The only difference was that the alarm for the ventilator was in quicker, shorter bursts. The ventilator alarm would go off if the device had become disconnected, was not working properly or the pulse oximeter probe came off.
The unit where Katie and the others worked was oval shaped. She was sitting at the nurse’s station looking towards the five rooms of patients she was responsible for when the alarm went off. Looking to see if it was one of her patients, she found that it was not.
The alarm kept sounding and Katie turned around to ask her co-worker if she needed help. The co-worker replied, “No” and said she was taking care of it.
The alarm stopped and shortly thereafter, another alarm erupted. Once again, Katie looked down here hall and once more confirmed that it was not one of her patients. As the alarm continued to ring, Katie got up and saw the nurse whose patient’s alarm was ringing still sitting at the nurse’s station. Katie addressed the other nurse saying, “Let’s go see what’s going on.” They found that everything was fine with the patient.
The following day, Katie was surprised to be called into the manager’s office and told that there was a ventilator alarm that went off and no one promptly responded. Katie was shocked to find herself fired and, more to her dismay, she received a complaint from the Board of Nursing. She was beside herself. It wasn’t even her patient.
Katie told me that all of the people at the nurse’s station that night and did not promptly address the ventilator alarm were terminated and reported to the Board of Nursing.
I asked Katie what where the policies and procedures for the facility in answering ventilator alarms. She replied that she did not know. Just as it is important for nurses to know the Nurse Practice Act, it also is important that they know and follow their facility’s policies and procedures.
Then I proceeded to share with Katie a tool that she could use to protect her license. I call it GIFTS, an acronym well worth remembering. Brown, L., 2014, Law and Order For Nurses: The Easy Way to Protect Your License and Your Livelihood,
“G” Is For Giving
The “G” stands for giving. As nurses, we are always giving to our patients but we may not necessarily be as giving to our co-workers and ourselves. Although Katie’s actions seemed innocent because it was not her patient and she was busy documenting on her patients, she was not being giving to her co-worker and the patient whose ventilator alarm was sounding.
“I” Is For Integrity
The letter “I” stands for integrity which is being honest and forthright and being in line with your core values and what matters to you. Katie had a core value of making sure that all the patients at her facility received good care. She was not in line with her core value by not providing care to a patient that was not hers.
“F” Is For Focus and Follow Through
“F” is for focus and follow through. This is so important in nursing and usually one of the more common areas where nurses tend to get in trouble.
We are programmed to go on “autopilot” at times. When we are on autopilot, we can miss important things. Have you ever driven home and missed your turn because your mind was focused on something else? That’s how easy it is to lose our focus and fail to follow through on what’s required of us.
It is imperative for nurses to follow through. When we give a medication, we need to follow through and make sure it was effective. It is part of the Nursing Process to evaluate so the follow through portion cannot be neglected.
Also, because of being so involved in organizing their work load and thinking about what’s next, nurses sometimes are not focused on what’s happening in the moment. Here, Katie was concerned about getting her charting done rather than focusing on the most important issue at hand which was responding to a sounding ventilator alarm.
It took a little while before she realized that her co-worker was not responding to the alarm and asked if the co-worker was handling it.
“T” Is For Trusting Your Gut
Trust your gut is the meaning with the letter “T”. Katie’s gut was telling her that there’s an alarm going off and we need to take care of it. Rather than responding immediately and making sure that her co-worker was going to answer the alarm, Katie ignored her gut and continued to chart.
We seem to have a heavy reliance on technology but our gut is really our best guide. When something doesn’t feel right, rather than ignoring your gut and talking yourself out of the situation, it is important to act on what your gut is telling you.
“S” Is For Source
And the letter “S” stands for “source.” You are the source of everything that happens in your environment. As the source, you are not at fault or to blame, but it is a position to stand in. If you are the source, it means you have the power to do something about it or change it. Katie was not being the source when she did not immediately respond to the ventilator alarm.
If you think of any situation in your career that is not working, you will find that one or more of the GIFTS are not present. It goes to reason that if you use your GIFTS, you will be surprised how quickly the situation improves.
However, the GIFTS take practice. It’s not natural for smart confident nurses to trust our gut. We think through problems rather than trust our instincts. But our instincts can be very strong. Have you ever walked into a patient’s room and knew the moment you entered the door that something was wrong? You couldn’t see it or put your finger on it but you just knew. Chances are, you were right!
Although Katie was disheartened by being fired from work and being reported to the Board, she was grateful to have learned about the GIFTS and became committed to using them in her practice to protect her license thereafter.
Learn about the GIFTS and practice them so they can become a permanent way of your life. They just may be the thing to keep your license safe in the future.
About the author: Lorie A. Brown, RN, MN, JD is a Nurse Attorney and President of Brown Law Office, a National Law Firm for Nurses. She is licensed to practice law in Indiana and Illinois and has co counsel relationships with nurse attorneys and other attorneys nationwide. www.brownlaw1.com Ms. Brown is also the founder of Empowered Nurses. An organization designed to teach nurses how to speak their mind, stand in their power and be a change agent to improve patient care. www.empowerednurses.org