Lorie Brown, Nurse Attorney, discusses problems that are the result of a Pyxis audit and how to protect your Nursing License. This includes how it may look like a nurse is diverting medications and making sure you are administering and wasting medication properly so you protect your license.
Nurses always want to be helpful and will share with anyone. However, there are some instances where silence is golden!
1. WORK STATEMENT. If your supervisor calls you in wanting you to write a statement, be very careful. Don’t be pressured into writing a statement. Or, if you want time to think about it first, definitely do so. When you are pressured into writing a statement, read it and read it again to ensure that it is accurate because it could be used against you, for example, at the Nursing Board. Remember, silence is golden!
2. DEA ENCOUNTER. If the DEA shows up telling you it’s best not to be associated with the physician for whom you work because he is in trouble, be very cautious. If they want you to sign a voluntary surrender of your DEA license saying, “You can always get it back later” … realize it is a very bad idea! They will seem like they are doing you a favor and tell you that it’s in your best interests which likely will be followed by their trying to talk you out of getting an attorney. Again, silence is golden!
3. POLICE INVESTIGATORS. If the police ask you to come to the station, note that you are going to be videotaped, a fact they may not tell you. The police will come out looking like 21 Jump Street, all kind, cool and nice to you until you spill your beans. Then they will turn around and file charges against you. Silence is golden!
4. NURSING BOARD INVESTIGATORS. If a Nursing Board investigator comes to your home or your work, they will present themselves nicely and say they just want to get your side of things. Any statements you make against your best interests will be used against you. Silence is golden!
5. OIG/MEDICAID FRAUD CONTROL UNIT INVESTIGATORS. Like the others, these investigators will be courteous and seem all nice. Many are former police officers trained to know exactly what to say to get you to spill your guts.
What most nurses probably don’t know is that talking to these investigators could lead to criminal charges. They all may be friendly and want to talk to you about where you work or where you used to work. Again, anything you say can and will be used against you.
Moral of this writing, silence is golden! Anything you say can and will be used against you. I’ve seen it countless times where nurses, wanting to be helpful, will answer questions which winds up leading them to trouble. It is always best to tell any of these authorities, from your boss to police officers, that you want to think about the situation and will get back to them.
Of course, in situations like noted above, it is best to hold your responses to any questions until you get an attorney to protect your interests.
I receive so many calls from travel nurses who either don’t read their contract or don’t negotiate their contract and wind up having issues. So, I thought I would warn you about some of the perils of travel nursing.
- Keep all Boards apprised of your current address, even if your license is expired in that state. As travel nurses, you probably have licenses in many states. You must keep the Boards apprised of your current address so that if there is a complaint against your license, they can find you and you can respond. Otherwise, the Board may take action without you. If there is an action in one state, the other states may take action too even if your license is expired.
- Know the policies and procedures as well as the Nurse Practice Act in the state where you are working. I get calls from nurses who failed to read these documents and performed a procedure that was not allowed at that particular hospital. These may include drawing blood from or starting IVs in different sites. Also, some things may be standing orders and one facility and not another. It is very important that you know and
followyour facility’s policies and procedures as well as the Nurse Practice Act in the state where you are working.
- I have heard from numerous travel nurses who spent every penny they had to go across the country only to find that their contract had been
cancelled. Make sure that there is some kind of provision in your contract that will pay for your travel to and from your new location in the event your contract is cancelled.
- Hire an attorney to review the contract. You may be required to complete online education and orientation prior to moving without pay. Make sure that this is addressed up front in your contract.
- Make sure that you can only be terminated for objective cause. If a patient complains about you and it is subjective, you should not lose your position. It would be a shame for you would travel across the country only to lose your position over this.
- Recruiters will promise you everything to get you to sign the contract. If it is not in the contract, it will not happen. Where have I heard that before? If it wasn’t documented, it wasn’t done!
- Never contract to work on a type of unit where you are unfamiliar. This is a recipe for disaster. For example, most of your experience is ICU but only a med
surgfloor position is available. The increasedpatient load will be a problem for you.
- With incivility in nursing, as the traveler, it is easy for the staff to make you the scapegoat.
Be very careful and selective in determining which travel company you want to work with. The recruiters all sound nice and inviting while promising you the sky but if it’s not in the contract, it will not happen. Talk to others who have worked for this company to make sure they have had positive experiences. Do your homework and look for online resources such as https://www.thegypsynurse.com/ and Facebook groups for travel nurses. I hope your travel nursing experiences are positive.
On December 26, 2017, Charlene Murphey was a patient at Vanderbilt Medical Center where she was being treated for a subdural hematoma. A PET scan was ordered and she was transported to that department where she stated she suffered from claustrophobia and was afraid to have the PET scan. Versed was ordered. Why Versed was ordered is unknown without monitoring.
Radonda Vaught, a Tennessee Registered Nurse since 2015 went to the medication dispensary machine to find Versed for the patient. Since the order was not put in the system, the Versed did not pop up on the patient’s profile. Ms. Vaught overrode the system and entered the first 2
30 minutes after the medication was administered, they realized the patient, in the PET scan tube, was not breathing. They resuscitated her but by then she had suffered considerable brain damage and shortly thereafter removed from life-saving equipment.
Nurse Vaught was indicted by a grand jury on January 5, 2018, on charges of reckless homicide and impaired adult abuse
Evidently, Vanderbilt Medical Center swept this matter under the rug and claimed the patient’s death was natural. It was not until a year later, when the Center for Medicaid and Medicare Services (CMS) investigated Vanderbilt and issued its report that the truth of this matter was disclosed and the family was informed.
CMS could have suspended Vanderbilt Medicare reimbursement payments if the hospital did not take steps to prevent future accidents. Vanderbilt quickly provided CMS with a corrective plan so that the reimbursements were no longer in jeopardy.
Surprisingly, Vanderbilt told the Davidson County Medical Examiner that the patient succumbed to a medication error was “hearsay!”
This brings up a couple of issues. First, why was versed ordered without monitoring? And, second, why didn’t a warning pop up on the medication dispensing system about the vecuronium?
Usually cases like this are not just one person’s errors.
What bothers me is that Nurse Vaught is being charged in a criminal matter. The event was negligence and flat-out malpractice for which the family has not sued. Ms. Vaught clearly violated the Five Rights of Medication Administration and did not note the medication that she was giving.
What also concerns me is that if every nurse who fails to do something can be subject to criminal charges and loss of their livelihood and freedom, why would anyone want to go into the nursing profession?
Obviously, Ms. Vaught was a relatively new nurse and did not have experience with this medication. There is no forgiving her actions but I believe she should not be charged criminally. There was no intent to hurt the patient. Nurse Vaught was just trying to do her job in the best she could.
There 4 elements needed for malpractice. “Duty” which is what those acting under same or similar circumstances would do, “breach of that duty” meaning they didn’t do something they should have done or did something they should not have done, it must cause harm and there must be resultant damages. This is clearly malpractice.
On the other hand, reckless homicide is the killing of another by a reckless act. Reckless means a person acted recklessly with respect to circumstances surrounding the conduct or the result of the conduct where the person is aware of or consciously disregards a substantial and unjustifiable viable risk that the circumstances exist where the result will occur.
Usually, a reckless homicide is when someone recklessly drives another vehicle and unintentionally kills another.
In this case, was Nurse Vaught aware of the substantial and unjustified risk of giving medication and chose to ignore it? That would be for a jury to decide.
I feel sad for her going through this and I hope this does not set a precedent to criminally charge nurses for what should be classified as malpractice.
What are your thoughts are on Nurse Vaught? I’d love to hear your comments below.
I’ve written often about if a nurse has a second license in another state and there is an action in one state, the other state may take action as well. But, did you know in certain states you must affirmatively report an action in a second state?
Some think that if their license is on probation that they can go to work in another state where their license is “free and clear.” Be careful! If you do not voluntarily tell of a license matter in another state and the situation is found out, that may be a violation of that state’s Nurse Practice Act.
If you have a license matter, you should review your state’s Nurse Practice Act in all states in which you are licensed to determine whether you have to report the action in the other states. In fact, even if you don’t have an active license, another state still can take action against your license. Always make sure that all Nursing Boards where you have a license are kept up-to-date with your mailing address to ensure that you don’t miss any important communications from either state Board.
The American Association of Nurse Attorneys has published a position paper on the statute of limitations and retained jurisdiction. The Association does not feel that it is proper to be able to take action against an expired license after the fact, when sometimes it can be years later.
You also can check the Annual Survey of the National Council of State Boards of Nursing to see how each state is set up and who performs their investigation. It makes for interesting reading.
Another source is nursys.com, a public repository of actions taken on nurses’ licenses. As well as checking on yourself, you can look up records on your coworkers as well to make sure there’s nothing there.
The bottom line is that should you have an action in one state and if you have a license in another, make sure that you do not need to mandatorily report that action. It is better to be safe than sorry and report since it is public record anyway.