Employment Archives - Page 4 of 24

Did You Report?

February 7, 2019 by LORIE A BROWN, R.N., M.N., J.D. Leave a Comment

I’ve written often about if a nurse has a second license in another state and there is an action in one state, the other state may take action as well. But, did you know in certain states you must affirmatively report an action in a second state?

Some think that if their license is on probation that they can go to work in another state where their license is “free and clear.” Be careful! If you do not voluntarily tell of a license matter in another state and the situation is found out, that may be a violation of that state’s Nurse Practice Act.

If you have a license matter, you should review your state’s Nurse Practice Act in all states in which you are licensed to determine whether you have to report the action in the other states. In fact, even if you don’t have an active license, another state still can take action against your license. Always make sure that all Nursing Boards where you have a license are kept up-to-date with your mailing address to ensure that you don’t miss any important communications from either state Board.

The American Association of Nurse Attorneys has published a position paper on the statute of limitations and retained jurisdiction. The Association does not feel that it is proper to be able to take action against an expired license after the fact, when sometimes it can be years later.

You also can check the Annual Survey of the National Council of State Boards of Nursing to see how each state is set up and who performs their investigation. It makes for interesting reading.

Another source is nursys.com, a public repository of actions taken on nurses’ licenses. As well as checking on yourself, you can look up records on your coworkers as well to make sure there’s nothing there.

The bottom line is that should you have an action in one state and if you have a license in another, make sure that you do not need to mandatorily report that action. It is better to be safe than sorry and report since it is public record anyway.

Is Your Nursing Co-Worker Impaired?

January 31, 2019 by LORIE A BROWN, R.N., M.N., J.D. 3 Comments

Did you know that approximately 10% of the U.S. population has a substance use disorder? Such abuse can affect anyone regardless of age, sex, race, ethnic background or economic class. Although it has not been proven, I suspect that the percentage is higher in the health care professional population due to the ease of access to drugs.

As part of the disease, those with a substance use disorder will lie and deny to hide from others that they have a problem. Therefore, if you have a coworker with a substance use disorder, they will do what they can to protect themselves which can mean blaming other people. Nurses with substance use disorder need help because if this disease remains untreated, it will result in death.

Trying to get someone with a substance use disorder to admit it, can be difficult. But since your license is also at stake, you need to be wary and careful. If you know the signs and symptoms of substance abuse disorder, you may be able to both help your coworker and protect yourself.

What happens to people with substance use disorders, there is a part of the limbic system referred to as “the pleasure center” where dopamine is released and produces a feeling of euphoria when mind altering substances are used. Personally, I think there may be a gene because some people are more prone to substance use than others.

Prolonged use of a chemical causes the brain to stop making the dopamine leading to loss of control. This causes them to go to extraordinary measures to seek out chemical substances to recreate those feelings of euphoria. Since addiction is a disease, it can be successfully treated. However, to get treatment a person must admit that they have a problem.

For those of us who do not have substance abuse problem, it seems easy to judge others as we think “why can’t they just stop?” I assure you, if they could, they would.

Things that contribute to substance use disorder are, first, nurses are knowledgeable, know how drugs work and feel competent to self-prescribe. Secondly, nursing is a very stressful profession leading to the use of substances to relieve that stress.

According to the National Council of State Boards of Nurses, APRNs, who are nurse anesthetists, have the highest rate of substance use disorder while nurses working in pediatrics, women’s health and schools have a lower rate of abuse.

Behavioral changes can clue a nurse in that a coworker may have a problem. Look for these changes:

Absences from the unit for extended periods.
Frequent trips to the bathroom.
Frequently arriving late and/or leaving early.
Excessive numbers of mistakes including medication errors.
Subtle changes in appearance that escalate over time.
Wearing long sleeves in warm weather.
Increasing isolation from colleagues.
Inappropriate verbal or emotion responses.
Confusion, diminished alertness or memory lapses.
Calling in sick after a weekend or a holiday.

Physical signs may include: shakiness, hand tremors, slurred speech, constricted or dilated pupils (diaphoresis), unsteady gait, and runny nose. If you suspect one of your co workers to have a problem, talk to your nurse manager. Two nurses died in the bathroom of the same hospital years apart with a syringe containing fentanyl in their arm. The more alert we become to the signs and symptoms of substance abuse, we can hopefully help our co workers. I know you do not want to falsely accuse someone but you could be saving their life.

Have you worked with an impaired co worker? What did you do? Does your facility have policies and procedures in place for guidance on what to do with your suspicion? I would love to hear your comments below.

A Surefire Way To Get Into Trouble

January 24, 2019 by LORIE A BROWN, R.N., M.N., J.D. 6 Comments

With the opioid epidemic raging right now, hospitals are even more cautious of anything that could be considered abuse. You need to protect yourself and your license so I have some tips to not only keep from endangering your license, but maybe help you avoid criminal charges as well.

1. Do not take controlled substances. If you are asked for a drug test, many facilities will excuse a positive result if you have a prescription. But the Board is concerned about nurses working with controlled substances in their systems. Even if you took something in your off time. Whatever you do, do not take someone else’s prescription even if you are out or have taken that medication before. This is called diversion.

2. Make sure when you take a medication out of the Pyxis that you administer it right away followed by scanning and documenting that the drug was given. Facilities are very leery about lag time between the withdrawal of the medication and its administration. You should not be carrying narcotics in your pockets for any length of time.

3. Be prompt at wasting medications. Again, do not carry any medications in your pocket for any long period of time while trying to find someone to verify your wasting. Make sure that the witness to the wasting actually sees you waste the medication and then immediately signs that the medication was properly wasted. Facilities also do not want to see lag time between the administration of a medicine and witnessing its wasting.

4. If you have an emergency drug kit, make sure that there are policies and procedures in place to count the medication so that if any medication comes up missing, there will be no question that it can be accounted for during that shift.

5. Don’t be the outlier. This means that if you give more narcotics than anyone else, that raises a red flag. There is software in the Pyxis that shows each time a nurse accessed the Pyxis.

There are a lot of time-consuming policies and procedures in place that seem to make your job harder. The truth is that the policies do make it harder but they also protect you. When you do things properly according to the policies and procedures, you can better protect your license. If you are in a position where the proper policies are not carried out, don’t just settle in to the unit culture, do something and say something or leave. How else do you protect yourself? I would love to hear from you in the comments below.

Integrity In Nursing

January 17, 2019 by LORIE A BROWN, R.N., M.N., J.D. Leave a Comment

Nurses are consistently ranked as the most trusted professional group according to a Gallup Poll. Nurses again outpaced other professions for honesty and ethics. They rate an average of 84%, a very high range. The second highest were pharmacists followed by medical doctors.

However, I deal with nurses everyday who have an isolated violation of their ethics or, as I prefer to call it, “integrity.”

Ethics refers to the moral principles that govern a person’s behavior or the conducting of an activity. Integrity refers to the quality of being honest and having strong principles: moral uprightness.

As nurses, we see a side of humanity that few have the privilege in which to be involved. Patients’ lives are in our hands.

Unfortunately, the easiest way to get before the Board is a breach in ethics. Here are some examples:

Covering up something that you don’t want others to know.
Withhold information or the truth.
Lying, cheating, stealing.
Misrepresenting yourself.
Not being true to yourself.
Abusing substances or engaging in compulsive behavior.

When I was a unit manager of a medical surgical unit, one patient’s colostomy was hooked up with the distal end exiting the body and the proximal end sewn shut. Consequently, everything was accumulating in the proximal pouch instead of exiting through the skin to the bag.

We nurses were told by management to be quiet and not inform the patient of the mishap. I felt SO out of integrity with that situation.

Now, I look at ethics as a line in the sand, something that you do not cross. When you are in integrity, you feel better about yourself. You can look in the mirror and know that you have done the right thing.

If you’re not in integrity, it’s hard to keep up with a lie. It leads to low self-esteem, negative expectations, low effort, high anxiety, failure and self-blame.

Nurses also are “pleasers” which means when someone asks us to do something, we want to help but, if we know it is out of integrity for us, it is not worth it.

Nurses want to help and it’s easy to just help someone when it is out of integrity. Such as filling in the holes on the MAR, providing a late entry into a medical record without identifying it as such, not taking vital signs or doing a full neuro check but still charting them, taking supplies from the hospital, giving a pill to someone for whom they have a prescription but they ran out, etc. All are examples of breaches in integrity and, if caught, will put you in front of the Boar

If you get that gut feeling that something doesn’t feel right or that you shouldn’t be doing it, trust your gut. We all know those days where we agree to do something but then get those pains in our stomachs. Really, it is easier to change your mind and say “no” than to follow through with it. Your gut always knows.

When we live in INTEGRITY, life is a lot easier and we have nothing to cover up. We have more energy and life feels much fuller, we feel better ourselves.

Have you been asked to cover up something or do something that you felt was out of integrity? If so, how did you handle it? Please share your experiences and thoughts below.

Should I Stay Or Should I Go?

January 10, 2019 by LORIE A BROWN, R.N., M.N., J.D. Leave a Comment

Many nurses come to me after being terminated from their position and tell me, “I knew I should have left, but I just didn’t.” Nurses get into their comfort zones. They become so loyal to their colleagues and patients that they don’t want to leave. However, I always say, “You can always find another job, but you can’t get another license.”

If you see signs on the wall or get that pain in your stomach that you need to quit … don’t wait. Your license is too important.

If you were terminated from your job, every future job application will require that you put down that you were terminated. I suggest that when you are asked for the reason, simply state that you will discuss it in an interview.

If you fail to inform your new employer by not putting on your application that you had previously been terminated, it is considered to be fraud and material misrepresentation in obtaining a job.

The old adage of it is better to be safe than sorry is never more true than with this requirement. You cannot conveniently omit that job from your application form.

When we are in our comfort zones, we sometimes become complacent. And that could lead to breaches in our judgment.

Here are some warning signs to be aware of that it may be time for you to go.

You dread going to work.
Your job is taking a toll on your health.
You’re always venting to friends about not liking your job.
You feel that you can’t speak up at your job.
The work environment is negative.
The unit environment isn’t a good fit for you.
You don’t like your boss or superiors.
You find yourself having to justify to yourself why you should stay.

Certainly, no one can tell you whether or not to leave your job but I have had so many nurse clients who come for my assistance when the proverbial shoe drops and they get a complaint against their license when they knew they should have left the position.

So, if you see any of those warning signs and feel it is time, make an informed decision on how you would like to handle this situation.

Beware when you find yourself making excuses or justifying why you are staying, “It’s the only place in town,” “No one else is hiring,” “I have seniority here,” etc. These are the type of statements that justify to some why they are staying when the handwriting plainly is on the wall.

I know it’s scary to leave and begin the job hunt. However, I have heard that sometimes the grass is greener on the other side and many later say, “Boy, I wish I had left that job sooner. It is so much better at my new place.”

Are you in a job that you don’t like? How are you protecting your license? What are other signs you may have noticed that it is time to go?

I would love to read comments below.

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