Lorie Brown, RN, MN, JD of www.YourNurseAttorney.com and www.EmpoweredNurses.org interviews Carmen Kosicek, MSN, APNP, MPHNP-BC of Alay Health Team, regarding problems Nurse Practitioners and Advance Practice Nurses are encountering both as medical providers and business owners, including collaborative practice agreements, medical malpractice, protecting your license and your assets as well as billing issues for Nurse Practitioners.

Find more information on Lorie Brown at www.YourNurseAttorney.com and www.EmpoweredNurses.org or call (317) 465-1065.

 

A question I receive often is whether a certain task falls within the scope of practice.

Unfortunately, there is no blanket answer. Scope of practice varies state-by-state and institution to institution. Just because you are educated and even trained to perform a certain skill, that does not mean using that skill necessarily falls within your scope of practice. If you do not know or are just not sure, and even if you are sure, double-check!

If you perform an activity that is outside your scope of practice, it might cost you your license because that could be considered practicing medicine without a license.

So, how do you find out whether an activity is within your scope of practice?

Each state has its own Nurse Practice Act and you should make sure that you have reviewed the one for your state. Some Acts are intentionally vague. Here in Indiana, for example, it states: “failure to keep abreast of current theory or practice.”

Well, what does that mean? It does not give specific activities such as removing pacer wires or sutures and whether each is within your scope of practice.

Recently I had a nurse who drew blood from a Quinton catheter when she was a travel nurse in another state. Unfortunately, in that other state, that type of activity is outside of the scope of practice for nurses.

Some State Nursing Boards actually allow you to write in and obtain an advisory opinion. This is a great opportunity for you to ask the question and to receive assistance as to whether the activity is within your scope of practice.

You can check to determine whether the activity is within the scope of practice by looking at your facilities policies and procedures. Is there a policy and procedure on the activity that you plan to undertake? If there is, that’s a good indicator that it is within your scope of practice.

Another issue that comes up is whether you were adequately trained to perform that activity. What education requirements were you to have undertaken to ensure that you are safe to undertake that activity? Check your policy and procedure.

If you have not been certified or checked off on that particular activity and if you don’t feel comfortable performing the task … THEN DON’T DO IT! Your license is too important to risk.

I’d love to hear your comments below about how you familiarize yourself with your scope of practice in your state.

 

One of the questions I am most frequently asked by nurses is whether the Board of Nursing can take away their nursing license.

Unfortunately, the answer to that question is “Yes.”  The license can be taken away temporarily or permanently.

The temporary process is called “emergency suspension”.  Unlike in a civil court where there are rules in place to prevent evidence that may not be accurate or trustworthy from coming in, administrative law allows the admission of hearsay, an out of court statement offered to prove the truth of the matter.  Therefore, a piece of paper that says you did something could be used against you, even if you deny it.

Note that your license is a privilege and not a right.  To take away your license temporarily, you must be shown to be a clear and immediate danger to the public.  Yet, again, if there are letters, employment records, etc. which detail what somebody wrote that may or may not be the truth, it can be introduced and used against you.

Here are some ways to protect yourself from getting an emergency suspension.

1. Follow the hospital’s policies and procedures to the letter. If you need someone to witness the wasting of medication, make sure that person actually witnesses and cosigns your wasting of the medication.
2. Do not use controlled substances – unless you must for a short period of time, such as following surgery or an acute injury. It is preferable not to work during those periods.  If you are asked to take a drug test and your urine comes up positive, the Board will not know whether you used the medications at work or after work.  I know nursing is a difficult and stressful job, but taking medication to try to alleviate some of the stress is not the way to go.  Even if you live where marijuana is legal, its’ use is strictly prohibited for healthcare professionals.
3. Don’t keep old controlled substances. If you have recovered from your medical situation and no longer need the medication, properly destroy them.  Do not leave them around.  It may be tempting to keep them in the possibility of pain on a later date.  However, the Board looks at that as practicing medicine without a license because you did not take the medicine for its intended prescribed purpose.
4. Never borrow controlled substances. If you have a medical issue requiring treatment, go get a valid prescription rather than borrowing medications from another person.  As before, this is considered practicing medicine without a license.

I know this all sounds scary but the adage of “an ounce of prevention is worth a pound of cure” is absolutely correct.  Just do the right thing to protect your license.

 

I am often asked (1) if a Nursing Board matter is a permanent public record and if so, (2) is there any way to get that record expunged?

Unfortunately, there are only a few states that allow expungement of Nursing Board records and only under very limited circumstances.  Kentucky is one of those states but, again, only if certain circumstances are present.

Once you have a formal complaint or discipline taken against your nursing license, it does become public record.  The theory is that the public has the right to know if a health care provider has had any action(s) against their license.  It is even publicly available on www.nursys.com.

Many states now allow expungement of criminal records after a certain period of time.  If your criminal record is contained in the Nursing Board record and your criminal matter is expunged, then why should it still be public record in the Nursing Board files?

Or, what if a nurse was reprimanded early in her career then goes on to have an exemplary career for 15 years? The nurse has a perfect, record but for that one blemish early on that is no longer meaningful. Is it “promoting the integrity of the profession” by stigmatizing that nurse’s record for an error that occurred 15 years before, which no longer represents his or her current practice?

Here is Kentucky’s statute       201 KAR 20:410. Expungement of records.:

Section 1. Definition. “Expungement” means that all affected records shall be sealed and that the proceedings to which they refer shall be deemed never to have occurred.

Section 2. A nurse whose record has been expunged may properly reply that disciplinary records do not exist upon inquiry.

Section 3. Upon a request from a nurse against whom disciplinary action has been taken, the board shall expunge records relating to the following categories of disciplinary action:

(1) Consent decrees that are at least five (5) years old if all the terms of the consent decree have been met.

(2) Agreed orders and decisions that are at least ten (10) years old and which concern one (1) or more of the following categories, if there has not been subsequent disciplinary action and all of the terms of the agreed order or decision have been met:

(a) Failed to timely obtain continuing education or AIDS education hours;

(b) Paid fees that were returned unpaid by the bank; or

(c) Practiced as a nurse or advanced practice registered nurse without a current license, provisional license, or temporary work permit.

(3) Agreed orders and decisions that are at least ten (10) years old and which resulted in a reprimand, if there has not been subsequent disciplinary action and    all of the terms of the agreed order or decision have been met.

(4) Agreed orders and decisions that are at least twenty (20) years old, if there has not been subsequent disciplinary action and all of the terms of the agreed order or decision have been met.

For those who have had a Nursing Board action and want that matter removed from public records, I would strongly suggest that you contact your legislature to get this changed.  It is unfair that a 1-time isolated event is forever on a nurse’s record or if you’ve had a criminal matter expunged and it remains public on the Nursing Board record.

Do you believe that Nursing Board records should be removed after a certain time?  What circumstances would you propose?  I would love to hear your thoughts in the comments below.

 

Lorie Brown, RN, MN, JD interviews Marc Lopez, Esq., a criminal law attorney (www.MarcLopezLaw.com) on nurses and healthcare providers that are arrested for Driving Under the Influence (DUI / OWI), Refusing a Breathalyzer Test, Substance Abuse / Diversion and the Office of the Inspector General’s (OIG) Medicare / Medicaid Exclusion List.