LORIE A BROWN, R.N., M.N., J.D., Author at Brown Law Office

Should It Take 30 Weeks For A License?

April 8, 2021 by LORIE A BROWN, R.N., M.N., J.D. 2 Comments

Imagine having your military serving spouse transferred in the middle of a pandemic and you are an Advanced Practice Nurse then having to wait 30 weeks before you can be licensed in your new state?

Well, that is exactly what happened to Courtney Gramm of California, board-certified and a member of the American Association of Nurse Practitioners.

Mrs. Gramm’s husband, serving with the U.S. Air Force, was ordered to move from Florida to California. But when she applied for her Registered Nurse license in California, she had to be fingerprinted, submit transcripts of her education, and pay a required $350.00 fee as well as $30.00 for a license verification check.

Altogether, she emptied her bank account of more than $900.00 to finally get her nurse practitioner license.

Now, compare these to my home state of Indiana which requires a $50.00 application fee for a Registered Nurse and another $50.00 for an APRN.

However, Mrs. Gramm’s issues did not end there! She submitted everything as required only to have to wait and wait and wait.

She knew she had valuable skills to help during the pandemic in California but couldn’t even work because she was unable to be licensed.

Finally, 6 months later, after contacting her California State Assembly member, Mark Stone, who then contacted the Board of Registered Nursing in California on her behalf, was she able to get her Nurse Practitioner license.

Imagine, a nurse in overall good standing professionally yet not being able to work for more than 30 weeks because she was unable to get licensed.

Something needs to change!

Some states have COVID exceptions where a nurse can get a temporary permit to work right away … but apparently that is not in California.

It is sad that so many people around the nation need the help of nurses but are being denied because of these unreasonable bureaucratic constraints on a nurse’s ability to practice. Unlike nursing where you can get a compact license in 34 states, there are no compact licenses for Nurse Practitioners.

Are there delays in getting a license in your state? I would love to hear your comments below.

What Happened To Nurse Do No Harm?

April 1, 2021 by LORIE A BROWN, R.N., M.N., J.D. 2 Comments

52-year-old Connie Sneed is charged with a Level 5 felony for practicing medicine without a license in Indiana. Ms. Sneed, who had been with the nursing home for 15-years, posted a comment on a Facebook page which caused her to be charged criminally. Her comment was, “I just want y’all to know the hardest thing I’ve ever done in 28 years start a patient on O₂ for 4 days 12 LPM. with a non-rebreather mask … I asked him on day 4 if he’s tired he said yes I said do you want me to take all this off for you and let you go and fly with the angels and he said yes.” She unhooked the oxygen from the resident, and he succumbed a few hours later.

This man did have a diagnosis of COVID and his oxygen saturations were 64%. Ms. Sneed never contacted the doctor to ask for an order.

Nursing is not an independent practice. There must be physician orders or a policy and procedure that protects us for everything that we do.

Ms. Sneed did talk to the daughter who told her, “She could remove it but try to put it back on him later when he calmed down.” Apparently, the daughter did not understand that removing the oxygen mask would cause his demise. The daughter cannot give physician orders.

In an interview with state health inspectors, Ms. Sneed said that it was a terrible week. She had been caring for more than 40 COVID-19 patients at the facility when she forgot to notify the resident’s physician of his decline in condition.

While she may have thought what she was doing was in the best interest of the patient, she did not go through the proper process. She had a duty to pick up the phone to tell the physician about his declining condition and let the physician determine what the best plan of action would be.

Indiana is not a “right to die” state. Physician assisted death or “medical aid in dying” is legal in 10 jurisdictions: California, Colorado, District of Columbia, Hawaii, Maine, Montana, New Jersey, Oregon, Vermont, and Washington state.

Fortunately, Ms. Sneed was not charged with manslaughter as she could have faced a possible death penalty.

So, sometimes caring for patients may not be in alignment with what you believe but we are here to serve the patients and not ourselves

I did have the opportunity to look on the Indiana Professional Licensing Agency website and Ms. Sneed is listed as having an active license as well as a pending compact license application. It appears that she wanted to practice in other states as she lived near the Kentucky border.

While it is unfortunate that Ms. Sneed was so busy with 40 COVID patients, no nurse has the right to take a patient’s life in their hands. [Indianapolis Star article]

Let me hear what you think of this in the space below.

Until next time, happy nursing.

The Tragedy of Substance Abuse and Nursing

March 25, 2021 by LORIE A BROWN, R.N., M.N., J.D. 3 Comments

In 2020, Donna Monticone worked for Yale Reproductive Endocrinology and Infertility Clinic in Orange, Connecticut where she was responsible for ordering and stocking narcotics.

She started to use and steal Fentanyl. Initially she would remove the drug from the secured file, inject herself, and then add saline to compensate for the taken volume of Fentanyl. Eventually, she began taking vials to her home where she not only injected herself with the drug but would, as before, replace the taken Fentanyl with the same volume of saline before returning the corrupted vials to the clinic for use on unsuspecting patients. The sad part is that the patients undergoing surgery who were being administered Fentanyl as an anesthetic actually were receiving a diluted saline/Fentanyl mixture or just saline. Patients were writhing in pain undergoing their fertility procedures because of inadequate pain relief. It is frightening when one realizes that these patients who thought they were being given anesthesia actually were not being sedated. I can’t imagine the pain these unsuspecting victims may have felt.

She was arrested, charged and pled guilty to 1 count of tampering with a consumer product. There were 175 empty vials of Fentanyl drug taken from the clinic and discarded in the clinic’s trash.

Monticone will return to court on May 25, 2021 for sentencing where she faces a prison sentence of up to 10 years. Currently, she is released on a $50,000.00 bond.

She pled guilty only to the charge of tampering with a consumer product which is surprising. She could have pled guilty to theft, possession and numerous other charges. She should have been reported to the Office of the Inspector General (OIG) and placed on its Exclusions List barring her from participation in Medicare, Medicaid, and all other Federal health care programs.

More importantly, this nurse who, in the middle of our pandemic, developed a substance abuse problem and failed to get help. One year into the pandemic, 89% of nurses still experience elevated stress, anxiety, and depression and at risk of substance abuse. It’s easy to see why some nurses turn to substances to numb their feelings.

I truly believe that nurses do not wake up one day thinking, “Oh! I want to steal narcotics.” It is an unconscious craving that they will do anything to satisfy. It is a serious disease.

It is surprising that no one noticed any behavior issues with Monticone who admitted to using at work. In addition, it’s surprising why no one tested the Fentanyl to figure out why patients were not getting the intended pain relief.

There is no shame in having a substance abuse problem, but you need to get help. However, there is shame in withholding necessary pain medication from patients.

Have you reviewed your policy and procedure from your facility of what to do if you suspect somebody is using medications and is impaired?

The worst experience I’ve ever had as a nurse attorney was hearing about 2 of my clients pass away from unintentional overdose of controlled substances. I don’t want this to happen to another nurse. Check out my interview with Paula Davies Scimeca. She has over twenty years’ experience in addiction and psychiatric nursing and she is a recognized expert on the issue of substance use disorders in nurses. Author of “Unbecoming A Nurse” and “From Unbecoming A Nurse to Overcoming Addiction.” You can also access her books here too.

Help is available.

I would like to hear your comments below.

Nursing Boards’ Dirty Little Secrets

March 4, 2021 by LORIE A BROWN, R.N., M.N., J.D. 3 Comments

I would think with the pandemic and with nurses being the number 1 most trusted profession (and in dire need) that nursing boards would have compassion toward nurses who are asked to work harder with more acute patients and with less staff.

These conditions make a recipe for a disciplinary matter before any board. Interestingly, patients’ right to sue for malpractice is curtailed during the pandemic because of the crisis and decreased staff yet nurses can still be reported to the Board with little understanding and compassion for the nurse working under war like conditions.

A board’s mission is to protect the public … not the nurse. If there are any concerns about public safety, specifically if working short-staffed, a board will take action. A recent article on MedPage Today discussed a national trend of boards being more aggressive with discipline and intimidating nurses. Maryann Alexander, Chief Officer of Nursing Regulations with the National Council of State Boards of Nursing states, “To my knowledge, they’re doing an excellent job. I know they are extraordinarily conscientious about their mission and their role.”

However, there are nurses (not attorneys) who consult with others facing board reviews who state otherwise. Among some of the states where these nurses have grievances are California, Arizona, and Missouri.

I caution that it is always best to hire a nurse attorney who is experienced in these matters rather than a nurse consultant who has only gone through such a matter.

A problem with many nursing boards is that they are mainly composed of educators or administrators rather than nurses who actively practice in the trenches like the people who they discipline. Even some consumer board member representatives were former health care executives.

In a malpractice case, one would have to have an expert working under same or similar circumstances to determine whether the nurse met the standard of care. The same should be true for nursing boards.

The National Practitioner Database (NPDB) reports from 2012 to 2016 actions against nurses have steadily increased but actions fell slightly from 2016 to 2019.

Also, actions against Advanced Practice Nurses increased 5-fold during the period of 2001 to 2014.

In my own personal experiences representing more than a thousand nurses, I do believe that the discipline is harsher today than when I first started as an attorney 30 years ago.
Also increasing over that same period are the number of complaints for investigation filed against nurses. An investigatory complaint means an inquiry of the nurse which may result in discipline.

Nurses also can be disciplined for personal issues as well such as neglected child support payments and a failure to pay state taxes.

Unfortunately, even if a nurse believes they have received an extraordinarily harsh decision, most nurses cannot afford to appeal it. The standard for review of an appeal by a court is that the decision must have been arbitrary and capricious. If there’s any basis to discipline a nurse, many courts will uphold the board’s decision because there is an explanation or justification for the board’s decision which can be reasoned from the body of evidence.

Therefore, the standards are vague. There are no bright lines in whether certain actions amount to a violation of the Nurse Practice Act and, if they do, what is the appropriate sanction.

It’s interesting that the same action in one state may get a result that would lead to a different result than in another state.

Unfortunately, it may get to the point where nurses may consider which State’s Nursing Boards are more lenient when they choose to practice in a particular state.

Please give your comments below as to whether you believe there should be discipline uniformity among the states and what can be done about the egregiousness of board actions.

Recipe For Disaster: More Patients Per Nurse

February 17, 2021 by LORIE A BROWN, R.N., M.N., J.D. 1 Comment

California is the only state that has mandatory minimum staffing. However, when the pandemic hit and ICUs were filled to capacity, the state’s Department of Public Health allowed hospitals to apply for a temporary expedited waiver which would allow each nurse to care for more patients.

The law had allowed nurses to take only 1 or 2 patients in ICU during the pandemic but now with the introduction of the waiver, nurses must take even more extremely ill patients into their care. This further burdens nurses who now may have to take care of up to 5 ICU patients at a time.

Although the California Department of Health will no longer accept any expedited staffing waivers as of this past Monday, the hospitals that have the waiver can still flex their staffing and require nurses to take care for more patients. Kaiser Permanente in San Diego is one of those hospitals that their ICUs were filled with the surge of COVID patients in December and January. They were not able to comply with the 2 person staffing ratios.

However, the University of California-San Diego did not apply for a waiver and has been able to provide nurses to keep patients safe and ensure they are properly cared for. Expedited waivers pose a dangerous risk to both patients and nurses. California nurses have fought hard to have mandatory minimum staffing.

Can you imagine taking care of 3, 4 or even 5 ICU patients? The amount of care that these patients require would jeopardize nurses’ licenses as well as patient safety. It is scary that the California Department of Public Health has allowed these ratios to be relaxed, especially during a time when patients are not allowed to sue for any alleged malpractice.

I encourage any who are working in any California facility which has been granted a waiver to talk to their union representatives or, if there is not a union, to communicate with their director of nursing about having those mandatory minimum staffing requirements reinstated so that patients get adequate and proper care.

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