Blog - Brown Law Office

Devastating Effects of PTSD on Nurses

July 30, 2020 by LORIE A BROWN, R.N., M.N., J.D. 1 Comment

Post Traumatic Stress Disorder (PTSD) occurs in nursing from repeated direct and indirect exposure to traumatic situations. Nurses see every part of humanity: the good, the bad and the ugly.

In a study done prior to the COVID pandemic, 95% of psychiatric nurses in the nation matched the criteria for exposure to PTSD. Another study showed that 24% of ICU and general acute care nurses reported PTSD symptoms as well, while only 17% of emergency room nurses had a probable PTSD diagnosis.

Karen J. Foli, an associate professor at Purdue School of Nursing in Indiana, published an article in April noting that of the 1478 questionnaires, 372 nurses commented about job trauma they had experienced. Responding nurses who work longer shifts and are exposed to unsafe situations that jeopardize patient safety only intensified these findings.

Nurses are required to hurry through tasks, going without food and hydration during their shifts, sometimes without even a restroom break, resulted in unwittingly falsifying patient care documentation. Nurses experienced a range of emotions among which were stress, anxiety, grief, guilt, anger, burnout, and flashback.

According to a February 3^rd press release from the University of California at San Diego (USC-San Diego Health), the suicide rates for the nation’s female nurses was 10 out of 100,000 while for male nurses it was 33 per 100,000! This data was compared to the general public counterparts which were 7 out of 100,000 for females and 27 per 100,000 for males.

According to the World Health Organization, suicide is the 10^th leading cause of death in the global population. It is so sad that nurses are the forerunners in these studies. Most nurses recover naturally from the mental and physical toll that befalls them, however, a small minority will not.

As a nurse, it is important that you get the help that you need, to work in a safe, supportive workplace and to get early intervention if necessary.

Here are some courses available from nurse.com which can help you understand more about PTSD and anxiety disorder.

In the meantime, if you are not working in an environment that is safe and supportive, maybe you need a change because your mental health and wellbeing are too important, and so is your license. You can always get another job but not another license.

Nurses Terminated for Speaking Their Minds

July 16, 2020 by LORIE A BROWN, R.N., M.N., J.D. 2 Comments

Let me preface this article by saying that long term care nurses work so hard. This article is not about the problems in long term care but an after effect of nurses speaking their mind. Reuters published an exposé on June 10, 2020, titled “Special Report: Pandemic Exposes Systemic Staffing Problems at U.S. Nursing Homes.”

In this article, residents complained about how they have called for nurses and not only does no one respond but the call light is shut off.

In one nursing home, a double-amputee hoisted herself into her wheelchair to take herself to the nurses’ station to get the help she needed. In another home, a resident was found sitting in a puddle of urine which was seeping into her coccyx wound.

These are the issues of the longstanding problem with staffing shortages and how they are reflective of chronic turnovers in nursing home.

Of the more than 100,000 COVID deaths in the United States, 40% are connected to long term care facilities.

The article discusses that in one facility, a teenage Certified Nursing Assistant was taking care of 30 residents. The article discusses how management failed to provide protective gear or to communicate how the virus was spreading. One nursing assistant noted that when she brought her own mask to work, management told her not to wear it.

Nurse, Lisa Harmon, who supervises weekend shifts, spoke up about the care and how when health care workers get ill with no one to replace them, the ones on duty have to take care of many more patients. After the article was released, she was barred from the building.

Another nurse who was interviewed about issues at the facility, Colleen Lelievre, was terminated for allegedly making clerical errors involving narcotics for residents. It’s suspicious how this was conveniently discovered just 2 days after the article came out.

It sounds like what was happening at the facilities was improper and endangered patients due to short staffing.

I’m not sure what has since happened with either of these nurses, but it is concerning that nurses who speak up are not being allowed to work or are even terminated afterwards. Nurses should be able to speak their mind about their care.

Nurses should not be afraid of speaking up about bad care. I encourage all nurses to stick together if there is a dangerous situation because that is the only way we can improve patient care.

California BRN Finds Fraud In Investigations

July 9, 2020 by LORIE A BROWN, R.N., M.N., J.D. 1 Comment

The California Board of Registered Nurses was backlogged when Governor Schwarzenegger was in office and it came under extreme scrutiny since the Board was taking no actions against dangerous nurses. The Governor, in 2009, eventually replaced the entire Board.

The tyranny is not over. Joseph Morris, the executive director, resigned this past February after several women working for the Board accused him of sexual harassment.

More so, in 2016 the State Auditor said there was a backlog of cases leading nurses to be more of a risk to patients. These complaints were based on unprofessional conduct, drug use and negligence.

The Board took more than 1½ years to assign the complaint to an investigator regarding an allegation that a nurse caused the death of a toddler by giving the wrong dose of medication. The nurse was allowed still to practice for 3 years while the complaint was under review.

But, if you want to know the real kicker, an auditor recently released a report in that claimed that investigators were allowed to only have 20 cases at a time so they could have time to adequately investigate the score of claims they had.

However, it was discovered in a draft of the auditor’s report issued this week that in the investigators’ haste to distribute cases among staff, the investigators had MORE than 20 cases and falsified their report to make it appear it was properly investigating allegations against the nurses’ licenses.

What concerns me for the nurses, who were the victims of these false reports, what recourse do they have?

If you are a California nurse and have been disciplined, you may wish to go back to the attorney who represented you and make sure that the evidence that the state had was legitimate.

For those who settled their cases on false evidence, I am truly sorry. I hope you can find some recourse.

Indiana Joins The Nurse Licensure Compact

July 2, 2020 by LORIE A BROWN, R.N., M.N., J.D. 3 Comments

On July 1, 2020, Indiana became the next state to join the Nurse Licensure Compact (NLC) which allows nurses who live in Indiana to practice outside of Indiana under the auspices of a Compact License.

To apply for the License, you need to go to in.gov/pla, click pla online services, enter your Indiana license number and the last 4 digits of your social security number. Then, you select new license and click on compact. It only costs $25 to change to an e-nursing license in Indiana.

For example: if an Indiana licensed nurse lives near the border of Kentucky, she will be able to practice in Kentucky as long as she has an eNLC Indiana license. With that she need not have a Kentucky license.

Interestingly, our surrounding states, especially Illinois where the National Council of State Boards of Nurses which administers the NLC is not a compact state nor is Michigan or Ohio.

However, Illinois does have pending legislation under Senate Bill 3067 and Michigan has pending legislation under House Bill 4042.

The eLNC license has been endorsed by several nursing organizations but not without some concerns. The major ones were:

Disciplinary action under eNLC;
Differing standards of care; and
Privacy of patients.

However, the National Council of State Boards of Nursing stresses the benefits of a Compact License which includes:

Practice by telenursing in other eLNC states; and
Responding to national disasters and staffing shortages in other eLNC states.

We have seen this obviously in times of Covid which would have been of benefit to many travel nurses had the states not relaxed the licensure requirements.

Noteworthy is that the medical boards do not have any kind of Compact Licensure, but they have more rules and regulations on telemedicine which we do not have under the Nurse Practice Act.

Many questions are raised by the NLC. If you do not live in a border state area which is a Compact License state and unless you plan to do travel nursing, there’s no need to upgrade and pay the additional fee for an eLNC license.

If you move to a new state of residency, you will have to obtain a single state license valid only for that state and continue to work on your Indiana eNLC license.

A nurse cannot hold a Compact License if he/she lives in a state which is not a Compact state. However, if the nurse moves from a non-Compact state to a Compact state, he/she can be licensed in the Compact state by endorsement under an eNLC license as well.

If a nurse with a Compact license is disciplined, action will be taken both in the state where the action occurred as well as in the state of residence.

The state of residence has the authority to remove all compact privileges. The license then becomes a single state license and will be disciplined.

If the nurse has an adverse action on their license, participation in an alternative to discipline program, a misdemeanor offense relating the practice of nursing for a felony offense, all comprise grounds to disqualify or will create difficulties under the license and may only allow you to have a single state license.

If an APRN with a Compact License does not live in but does practice in Indiana, the APRN will need to comply with the Indiana rules for APRN licensure such as a collaborative practice agreement and controlled substance registration and everything else the comes and goes with becoming an APRN.

I find it interesting in how nursing seems to be progressing in the area of licensure. However, I would love to see nursing be more specific in the Nurse Practice Act in terms of new roles such as coaching and what kind of license is needed for these situations.

I’m curious what you think about the Compact Licensure? Do have one where you live? Does it allow you more freedom in your practice?

I’d love to read your comments below.

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