Recently I attended the Nursing Service Organization Annual Summit where they discussed the results of their annual statistical analysis of claims against nurse practitioners.  They look at things such as area of practice, resultant injuries, alleged breaches in the standard of care and on their license protection claims.

Here are some of the risk management strategies that they recommended.

1. Professionalism is the key. Nurse practitioners have an amazing way of developing a great rapport with their patients.  Establishing the rapport and complying with your employer’s standards, policies and procedures is a great step in reducing your risk as a nurse practitioner.
2. You will “live and die” by your documentation. Therefore, document, document, document!  It is important to note in your chart your reasons for your clinical decision making process and rationale.  If your reasoning is supported in the chart, that goes a long way to protect you.  There has never an attorney who has said, “I wish they didn’t document so much.”  It has always been: “I wish they would have documented more!”
3. Additionally, it is important to document all discussions, consultations, clinical information along with the risk benefits and alternatives to treatment options. If you hand out any educational materials, that also should be noted.
4. If the patient it is not compliant, it is important to note that fact in the medical record. You should also document any efforts you have made to encourage compliance.  Simply stating that the patient was noncompliant is not enough.  As a health care professional, you have a duty to warn the patient of the risks of their noncompliance and the benefits of their being compliant.
5. You do not have to provide care to patients who are not compliant. If you have concerns about continuing to provide care to a noncompliant patient, bring that concern to your employer’s attention and consider terminating the care for that patient.  Unlike nursing, as a nurse practitioner, we can somewhat choose our patients.  If you have a concern that a patient may sue you or is not compliant, you can discontinue services by giving them 30 days notice and send the letter by certified mail.  You are required to provide emergency care for the 30 days, and it is helpful to refer them for other care.

Do you have any suggestions for other risk management strategies?  I’d like to read them in the comments below.

Year after year, nursing is voted as the most trusted profession.

And there’s good reason for that because we help people at their most vulnerable times.  We are entrusted with their health, their healing and their mental, physical and psychosocial well-being.

Historically, nurses were nuns which adds to our trustworthiness and credibility.

Anything that you do that could be unbecoming as a nurse, the Board can take action.  If you have a criminal matter against you, you must notify the Board.  Each state varies so I strongly recommended that if you are arrested, know your Nurse Practice Act and reporting requirements so you can report an arrest or conviction in a timely manner.

Remember, anyone can report you to the Board.  I’ve had ex-spouses report nurses to the Board.  Given this, it is important that you remember that you are a nurse 24/7 so no one will report you.

One of my biggest complaints about TV shows with nurses is when they are portrayed going to a bar in their scrubs and drink alcohol.  This is conduct unbecoming of nurse and is unprofessional.  I have no problem with anyone drinking responsibly but I would recommend changing out of your scrubs first!

Remember, it is your license and your livelihood and so protect it.

The nurse from Tennessee who made a horrific medication error, RaDonda Vaught, was originally told there would be no charges against her nursing license.  Regardless, the Tennessee Board of Nursing since has proceeded to file charges.

I reported RaDonda’s story to you here wherein she accidently gave a patient vecuronium instead Versed which resulted in death.  Criminal charges against her are pending.  And on September 27, 2019, the Board filed charges against RaDonda Vaught’s nursing license.  The Board matter will likely be continued because when a nurse has a criminal charge pending, most attorneys advise the nurse to take the Fifth Amendment to protect her Constitutional right against self-incrimination.

I find the excessive delay in the Board filing actions against her license to be very concerning.  The Board can file charges when a violation of the Nurse Practice Act has allegedly been committed.  Clearly, RaDonda Vaught did violate the Nurse Practice Act by her fatal medication error.

As I stated previously, I don’t think a nurse should have criminal charges filed against her license for negligence, an unintentional act.  Clearly, RaDonda breached the standard of care resulting in death.

However, this matter is properly before the Board of Nursing and if the patient’s family chose to file a medical malpractice action.  It is sad when a nurse is doing her job, albeit incompetently, can end up with a criminal charge.

If you would like to review the charges against RaDonda’s license, click here.

What are your thoughts about the Tennessee Board of Nursing filing charges against RaDonda Vaught’s license?  Should the Board be able to file charges after telling her that no charges would be filed?  I would love to hear your comments below.

I frequently have nurses come to me because they have been fired from their jobs and are afraid that they will be reported to the Board.  What’s interesting about these nurses is that almost all have said, “I knew I should have been looking for another job.”  If you feel the handwriting is on the wall, it is better to resign than get terminated.  On every job application, you will have to include that job on the application and include that you were terminated. You cannot simply omit a job because you were terminated.  And you must tell the truth.  If you do not put these jobs on an application or do not tell the truth about being terminated, its considered fraud and material misrepresentation in obtaining a position.

I always say you can get another job, but you can’t get another license.  Many nurses stay in the job because they feel a loyalty to their patients.  I can assure you, when there is a problem or complaint, your employer will have not have loyalty to you.

Many nurses stay in a position rather than leave because it is comfortable for them.  It is so much more difficult to go out and find another job.

I’ve represented 2 nurses around the same proximity in time.  One nurse worked at Hospital A and got terminated and went to Hospital B and said, “If I knew Hospital B was so much better, I would have left a long time ago.”  The other nurse said, who worked at Hospital B, got terminated from Hospital B and went to Hospital A, said the exact same thing.  “If I had known Hospital A was better, I would have left a long time ago.” It’s so interesting that 2 nurses each had very different experiences at the hospitals.

There is a place out that there which you love, you will fit, you will say “I wish I had come here a long time ago.”  If you’re struggling and see the handwriting on the wall, I am not telling you to quit your job but just think about it and make a decision.  Are you staying out of loyalty or comfort?  Could there be a better fit out there?  You won’t know until you try.

I would love to hear your comments below about how you handle difficult situations at work and what you would do if the handwriting is one the wall.