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You are here: Home / Archives for License Protection

What Can You Do About Understaffing?

August 14, 2014 by LORIE A BROWN, R.N., M.N., J.D. Leave a Comment

I have heard from many nurses that where they are working is understaffed which is not safe for the patients. Those nurses put in a lot of overtime because they are concerned that if they didn’t, there would be fewer staff available to care for the patients. They also expressed concerns that if the facility is able to get staff from an agency, those people would not know the patients. This is a difficult situation.

Many nurses want mandatory staffing requirements. However, I am not necessarily sure that this is the answer. I think staffing needs to be based on acuity. There are times when you can get by with a certain number of staff when the acuity is low while, at other times, where there may be a bunch of fresh post-ops or critical patients in ICU where the normal staffing number will not work. If we had mandatory staffing requirements, there would still be times when it would not be adequate.

We all want to provide safe patient care to have enough staff to deliver the care that the patients deserve. If you are working in a facility that is constantly understaffed and are working a lot of the overtime, you have to admit that, yes, the money’s great but, are you really being giving to yourself?

If a nurse is working so much and not listening to his/her body when he/she needs a break, that is where I see the possibility of trouble. If he/she makes a mistake, it may hurt someone even though the whole reason that he/she is working so much is so there will be enough care and patients will get adequate care. That is contrary though to the result that they wanted to produce.

Also, if you’re working in a place that is constantly understaffed and you have communicated your concerns in a positive manner to your supervisor (not just a complaining manner) then be sure to put your concerns to your supervisor in writing a keep a copy for yourself.

I also suggest that you ask yourself, “Why am I working in a place that is short-staffed?” A lot of times we work and stay somewhere where we know we have concerns about patient safety because it’s our comfort zone and we don’t want to leave our patients. Yet, by allowing the understaffing to continue and you staying in that facility trying to compensate for the understaffing will contribute to the problem as well.

I know my position is unpopular but I say that if you are working in a place that is frequently understaffed…leave! You can always get another job but you can’t get another license.

It is my hope that nurses will come together and communicate their needs in a positive way and that nurses should stick together to accomplish change so that patients can get the best care with adequate staffing.

 

 

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Filed Under: Employment, License Protection, Newsletter

Questioning An Order

July 31, 2014 by LORIE A BROWN, R.N., M.N., J.D. Leave a Comment

What would you do if your supervisor asked you to do something that you think may be questionable? Would you follow the order or would you question it?

Let me give you some examples to consider:

  • You work homecare and you never see your supervisor. She tells you to sign her name on your time card so you can get paid. What would you do?
  • Your supervisor asks you to “fill in the holes” on the turning sheet because State is coming soon to inspect the facility. What would you do?
  • Your supervisor in the ER tells you that “for patients with abdominal pain, when the doctor is busy, we always go ahead and start an IV, draw CBC and BMP as well as get an x-ray. Go ahead and do that.” What would you do?
  • You’re a student nurse and the nurse on your unit asks you to administer medication to a patient even though you are not licensed and do not have authority to do so. What would you do?

Each of these scenarios is an actual situation that I have encountered in my practice. In all four, the nurse responded by doing what their supervisor said.

However, if they had used their GIFTS with the “I” in integrity, the first nurse would not have signed someone else’s name to your timesheet, even if it means that she wouldn’t get paid in a timely manner.

The second nurse would not have “filled in holes” on a turn sheet unless she had personally performed that activity and identified it as a late entry. Nurse number three would not have started an IV, draw labs or have an x-ray done without a physician’s order. And the student nurse would not have administered medications to the patients.

Each of these nurses said that when asked by their supervisor to perform these activities, they had a little twinge in their gut and wondered if what they were being asked to do was proper. Regardless of the hesitation, they performed the tasks anyway because they were directly ordered to do so by their supervisor.

That is where “trusting your gut,” the “T” in GIFTS, comes in. All four of these nurses were disciplined before the Board. Therefore, always trust your gut and be in integrity. And, when in doubt, question! Also make a record of what you questioned so that, if the matter ever comes up, you will have that documentation.

So, the next time when you are in a situation and wondering if something is the right thing to do, use your GIFTS to help you determine the right course of action to take.

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Filed Under: License Protection, Newsletter, Workplace Issues

When Your License Is Put On Probation

May 23, 2014 by LORIE A BROWN, R.N., M.N., J.D. Leave a Comment

Each year 7,000 nurses have some type of discipline placed on their license. My home State of Indiana has the highest number of nurses on probation. Other top contenders for that dubious title are Texas and Ohio. If you would like to see the discipline imposed in your State, check out the National Council of State Board of Nursing website (www.ncsbn.org) which captures all of the statistics on nurse license discipline.

If your license is placed on probation, the Board wants to watch you to ensure that you are safe to practice. There are some requirements such as keeping the Board apprised of your current address and phone number as well as reports from your supervisors. There may be other requirements such as having your employer sign the final order or having you take continuing education courses. There may even be fines. Some Boards restrict the type of environment in which you can practice or the shifts in which you can practice.

Some Board decisions may direct you to participate in counseling or in your State’s peer assistance program which helps those with addiction problems or who use controlled substances.

Remember, if any action is taken against your license, it will be a public record forever, even if the matter should eventually be dismissed.

To get off probation, a nurse must petition the Board to have the probation lifted after the nurse has met all of the requirements set forth in the probation. In a legal proceeding, under oath and recorded by a court reporter, the nurse must present all evidence and witnesses to show that she is safe to practice and that the conditions that led to her probation no longer exist. She also must demonstrate that she has complied with all the terms of the probation.

I suggest that if you are on probation, you keep all the documents that you submitted that show you were in compliance with probation. Send all documents certified and keep copies of everything.

You can still work on probation but must work harder to find a job. Rather than just submitting an application online, network to find out how to reach the decision maker directly. Probation is not the end of the world but, obviously, avoiding trouble is the best action.

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Filed Under: License Protection, Newsletter

BEWARE: The Board Can Suspend Your License As An Emergency

April 24, 2014 by LORIE A BROWN, R.N., M.N., J.D. Leave a Comment

BEWARE
Your license is a privilege and not a right. Just as your driver’s license can be suspended, so can your nursing license. The Board needs only to provide you with reasonable notice which could mean the day before or even, and I have seen it, the morning of a hearing. In the hearing the State must show that you are a clear and immediate danger to the public. If there is a situation with any concern that drugs are missing or you have criminal charges related to your honesty and trustworthiness or even your ability to provide prudent care, the Board can summarily suspend your license for up to 90 days.

Although the State must prove that you are a clear and immediate threat to the public, I recently had an experience where the Board considered the charges alone as ample evidence to suspend the nurse’s license.

With this bad news, you’re probably asking “Now, what do I do about it?”

Most nurses will never find themselves in this situation. Just be proactive and protect your nursing license as you would your driver’s license. Practice nursing safely and avoid situations where there could be any concerns about you ability to practice.

Also, hospitals now have tracking systems in their Pyxis or Omnicell to see if your narcotic administration is the same or similar to your co-workers. If your narcotic administration is higher, the Board may call you in. Your job may have concerns as well as the Board.

If you are a nurse who is really concerned about your patient’s pain and want to stay on top of it, make sure that your colleagues have the same philosophy. Some nurses believe that pain meds should be delivered only when a person asks and other nurses try to help their patients to really stay on top of the pain. Again, just make sure that the philosophy on your unit is the same so that you don’t stand out.

Always remember that your license is a privilege and not a right. Always protect it as you would any other privilege.

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Filed Under: License Protection, Newsletter

Tips To Protect Your Nursing License While Using Technology And Social Media

April 4, 2014 by LORIE A BROWN, R.N., M.N., J.D. Leave a Comment

Brittney Wilson, RN, BSN

Technology and social media have added many new benefits as well as many new challenges to the nursing profession. On the one hand we now can access patient data and chart on patient care more quickly and easily than ever and we have access to a nearly limitless online support system of nurses. However, on the other hand we now could accidently share protected health information (PHI) over social media in just a few clicks of a mouse. Because of this, nurses need to be very aware that with great power come great responsibility and social media and technology should be used fully, wisely, and cautiously.

But don’t start shaking in Dansko’s just yet. There’s no need to fear technology or social media. You just have to be smart about it. Every action you make should be analyzed to consider if it’s in the best interest of the patients you serve and whether it could violate any laws or your state nurse practice acts.

The following are a few tips to help you avoid making mistakes with social media and technology and in the process protect your nursing license.

Make Sure Your Mobile Device Is Encrypted

There are many laws in place to protect patients and their private health data. This means that mobile devices, like laptops, that you use for work and contain PHI must be encrypted. This way if they are lost or stolen the information cannot be accessed by the thieves and you and your organization won’t be facing costly fines and burdensome media attention.

Don’t Share HIPAA Protected Data

I know nurses get tired of hearing about HIPAA but it’s really important to always keep it at the forefront of your mind. Violating HIPAA can be as simple as revealing the date of service and location of patient care. There are 18 patient identifiers that are off limits. Something innocent seeming like a patient’s age can even be an identifier (if they are over 90). If you aren’t careful you can share information that can bring you costly penalties and may even bring you up for review by the nursing board.

Don’t Disparage Your Profession Or Your Boss Via Social Media

.
Nursing needs to be critiqued. There are plenty of issues that need to be highlighted so we can find solutions to the problems. But constantly being negative and disparaging your entire profession, your state nursing board, or your boss are not the best approaches to enacting positive change. On the one hand it could get your fired and if you take it to the extreme and boss-bash, nursing-board-bash, or patent-bash the board of nursing could question your mental health or even worse.

Using These New Tools

Technology and social media should be seen as a tool to better provide nursing care, not as a hindrance. There are many wonderful things that technology can do for nurses and patients but nurses have to make sure they are doing their due diligence when it comes to using these new tools.Brittney-Wilson-200x300
Brittney Wilson, RN, BSN, also known as The Nerdy Nurse, is a Clinical Informatics Nurse practicing in the Atlanta, Georgia area. In her day job she gets to do what she loves every Brittney Wilsonday: Combine technology and healthcare to improve patient outcomes. She can best be described as a patient, nurse and technology advocate, and has a passion for using technology to innovate, improve and simplify lives, especially in healthcare.Brittney is the author of The Nerdy Nurse’s Guide to Technology. She is a social media influencer and blogs about nursing, technology, healthcare, parenting and various lifestyle topics at thenerdynurse.com.

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Filed Under: License Protection, Newsletter

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