A nurse who had served 6 years in a federal prison for downloading sexually explicit images and videos of minors was rehired by a small Montana hospital.  The nurse’s downloading of the exploitive imageries had been going on for 9 years when federal investigators traced her activities in 2008.  Prior to her conviction, she was a casual status employee who picked up other nurse’s shifts at the facility but, after serving time, the hospital board rehired her as a nurse.  When she was in prison, her license was placed on suspension.  Once the nurse was released from prison, the Montana Board of Nursing felt she was safe to practice and she was able to renew her license. Would you want someone with a conviction of child pornography taking care of you, your child or a family member?

Certainly, her illicit activities did not interfere with her ability to practice nursing but it does bring up a question that is the target of my writing here: should a nurse be allowed to practice after he/she has been convicted of a criminal matter?

What about a person with drinking problems who chose to get behind the wheel of a car, crashed into another vehicle and killed the occupants?  The person was imprisoned for manslaughter and decided after their prison sentence that they wanted to be a nurse after being rehabilitated and serving their time.  Should a person who has committed manslaughter be allowed to be a nurse?

These are the types of ethical issue that boards across the country deal with every day, I certainly do not have any answers.  While I do believe that everyone deserves a second chance, each situation is unique.

The more direct issue here is whether that person is safe to practice as a nurse.  With the growing nursing shortage, hospitals are dealing with difficult questions and issues such as these.  Should the Nursing Board give the nurse a license and let the employer determine if they should be hired?  I would not be surprised to learn that all of my readers have a different opinion on them as well.

Like many areas in nursing, this is just one of those matters in which there may not be uniformity on how to approach such problems.  However, I do believe we need to get a consensus on these kinds of issues to unite as a profession.

I’m hesitant to ask but, nevertheless, I will … what are your thoughts about these difficult ethical issues?  Please leave a comment below.

Lorie Brown discusses the 5 Fatal Mistakes that Nurses make when they appear before the Nursing Board or talk to investigators without legal representation. The Fatal Mistakes include oversharing, not knowing how to object, what evidence you need to present, not knowing or understanding the ramifications of any settlement you agree to, and how to possibly mitigate discipline on your nursing license.

NSO joins up with CNA Insurance Company to publish Claims Analysis for Nurses and Nurse Practitioners.  Here, I want to talk about the analysis for Nurse Practitioners.

It was determined that 29.4% of the closed claims, meaning medical malpractice cases against Nurse Practitioners, were medication related.  The average claim against NPs was in the amount of $240,471, an amount which is interestingly low.  Apparently, this is in line with Physician and Physician Assistant payments.

In addition, the average expense to defend these claims was about $60,000.  I bet you’re grateful that you have insurance!  Can you imagine having to pay that sum to defend yourself against a medical practice claim?

I also found it interesting that most of claims resolved in the $100,000 to $249,999 range.  That range has increased since last 2009.

The highest setting where the actions leading to the claims took place was for Nurse Practitioners working in a Physician Office, followed by a Nurse Practitioner Office.  Third on the list was in aged services Skilled Care Nursing Facilities.  These three make sense since they are the places where most Nurse Practitioners work.

Thirty-Two-point eight percent (32.8%) of the claims were in the area of diagnosis followed by medication at 29.4% and treatment/care management at 22.3%.  Therefore, the majority of claims against Nurse Practitioners are for providing improper medication management.

A further subdivision of the medication prescription claims reveals that the majority of claims were for improper prescribing or managing of controlled drugs.  This is very serious as controlled substances are such an issue these days.

The second highest, which lagged quite a bit behind, was failure to recognize contraindications and/or known adverse interaction between ordered medications.  Nurse practitioners and other health care providers frequently get alert fatigue.  So, when an alert pops on the screen to warn that there may be an interaction, many times they are disregarded because the alert popups are so numerous. It is very important to make sure that your patient is not allergic to medication provided or even medication related to the medication provided such as penicillin and cephalosporins.        The Institute for Safe Medical Practices regards allergy as “never events” meaning that this should never happen.

Also of interest is the claims of illness or injuries related to medication management was headed by medication that resulted in death where the second highest was addiction.

Some risk management tips would include always checking to make sure the patient is not allergic to medications.  Follow the guidelines for safe prescribing of controlled substances including urine testing and contracting, if necessary.  Always review the prescription monitoring drug program reports of your State for patients if you are prescribing controlled substances.

Lastly: good documentation.  Make sure that if you do make a diagnosis, document your rationale and your thought process in making that diagnosis so that even if it is an incorrect diagnosis, someone acting under same or similar circumstances will understand your diagnosis and come to the same conclusion.  The standard of care is what those acting under same or similar circumstances would do.  So by documenting your thought process, even if wrong, and others agree with your thought process, then there can be no liability.

If you would like to review the NSO claims report, you can look up both nurses as well as nurse practitioners at the nso.com website or just click on THIS LINK to be taken directly to the report.

What types of things do you do to protect your most valuable asset, your license?  Feel free to comment below.