Speaking Up as a Nurse Without Fear of Reprisal
As nurses, we feel like we have to do everything ourselves. We are conditioned that if we ask for help, somehow, we are weak. We are also conditioned that if we speak up, we will get in trouble and some of us may not be conditioned but have a fear of speaking up.
In the dynamic and challenging world of healthcare, nurses play a crucial role in patient care. While our primary focus is on the well-being of their patients, there are instances where speaking up becomes essential for the betterment of the healthcare environment. However, the fear of retaliation or termination can be a significant barrier. Guidance on how nurses can effectively voice their concerns without jeopardizing their careers.
- Know Your Rights: Before taking any steps, it’s crucial to understand your rights as a nurse. Familiarize yourself with the policies and procedures of your healthcare institution regarding reporting concerns. This knowledge will empower you to navigate the process confidently.
- Choose the Right Time and Place: Timing is crucial when it comes to expressing concerns. Find an appropriate time and place to discuss your issues with the relevant individuals. It’s essential to ensure that the conversation won’t disrupt patient care and can be conducted in a private and confidential setting.
- Pick your Battles: if what you want communicate is not going to serve a purpose, ask yourself is it worthwhile to share.
- Use Constructive Communication: When speaking up, focus on constructive communication. Clearly articulate your concerns, providing specific details and examples. Avoid accusatory language and instead emphasize your commitment to patient safety and the overall well-being of the healthcare team.
- Bring Solutions: don’t complain but give your suggestions for improvement.
- Document Everything: Keep a detailed record of the incidents or concerns you wish to address. Documenting dates, times, and specific details will not only strengthen your case but also serve as a reference in case of any disputes. Make sure to maintain confidentiality while documenting sensitive information.
- Engage in Open Dialogue: Encourage open dialogue by actively listening to the perspectives of others. Engage in a respectful conversation that fosters a collaborative approach to problem-solving. Being receptive to feedback and suggestions can contribute to a more positive resolution.
- Involve the Chain of Command: Follow the established chain of command within your healthcare institution. Start by addressing your concerns with your immediate supervisor or manager. If the issue persists, escalate it to higher levels of management, ensuring that you adhere to the proper reporting channels.
- Seek Support: Speaking up can be emotionally challenging, and it’s essential to seek support from colleagues, mentors, or professional organizations. Having a support system can provide guidance, reassurance, and validation of your concerns.
- Create a win-win: Your solution should create a win-win for you and your healthcare institution.
- Familiarize Yourself with Whistleblower Protection Laws: Be aware of whistleblower protection laws that may apply in your jurisdiction. Understanding these laws can provide you with additional reassurance and protection as you navigate the process of raising concerns.
Speaking up as a nurse is not only your right but also your responsibility to ensure the highest standards of patient care. By approaching the situation with professionalism, using constructive communication, and following established procedures, nurses can voice their concerns without fear of termination. It’s a collective effort to create a healthcare environment that prioritizes patient safety and the well-being of the entire healthcare team.
You Have A Right To Remain Silent
If someone wants to talk to you and calls your cell phone, you can ignore the phone call and send it to voicemail. If they want to talk in person, we don’t need to answer the door. However, when it comes to your employer, the police or an investigator, we feel obligated to talk.
Just know, you have the right to remain silent. It is hard with your employer as they can fire you for not talking but I see it time and time again where nurses think they have not done anything wrong so they spill their guts trying to explain everything which invariably gets them into more trouble. What’s worse is when your employer wants to talk to you, they will not allow you to have an attorney present.
According to the 5th Amendment of the Constitution of the United States, you have the right to remain silent to protect yourself from self-incrimination. You are not required to testify against yourself. But, as nurses, we forget we don’t have to talk or think that if we talk, they will believe us. You should always have an attorney present if you are asked to talk to the police, an investigator, or any governmental agent. Whatever you say can and will be used against you. Even the most innocent thing you say can be twisted against you and unfortunately, most nurses don’t see it coming.
One nurse was accused of diversion and was asked to talk to the police. She went alone, unknowingly. The police officers were dressed like 21 Jump Street cops. They looked young, hip, and cool. The nurse shared everything and by the time she was done, the cops had their entire case against her videotaped and tied up in a neat bow. They did not have to pour through all the medical records to find what was ordered and what was given. I am all for honesty but there is no reason to make the police’s job easier.
Other nurses talk to the Board investigators without counsel. One nurse even had insurance that would have paid an attorney to go with her. Don’t let this be you. Your life, livelihood, and career are too important. Get the counsel you need before you talk to anyone even if it is just to talk to your employer so you can be fully prepared.
RaDonda Vaught Loses License Appeal
As you and other readers probably know, I have frequently brought up issues regarding the case of Former Registered Nurse RaDonda Vaught who not only had her license revoked but was put on trial following a fatal medication error of administering vecuronium to a patient rather than the prescribed Versed.
In the trial she faced a possible eight-year prison term for criminally negligent homicide and abuse of an impaired adult but instead received three years’ probation.
But the Tennessee Board of Nursing also took action by revoking her nursing license in July 2021 to which she appealed. That request was denied.
It is so disappointing that Ms. Vaught lost her license over a medication error. Granted, the medication error should not have occurred, but since it did, one must ask what does stripping away her license do to resolve the problem of inadvertent medication errors?
Boards need to be rehabilitative rather than punitive in such matters. Unfortunately, it seems the Courts don’t wish to face these situations and tend to sweep them under the proverbial rug.
To get a review from a Court, the alleged actions of the Respondent must be arbitrary, capricious and “shock the consciousness of the Court.” Therefore, it’s extremely difficult to appeal against any decisions of this nature.
In fact, in Indiana, the normally non-admissible use of hearsay in Court is admissible in administrative law proceedings with the caveat that it cannot form the sole basis of the decision. The normal protections that we are afforded in regular Court proceedings do not always apply when an issue is instead brought before a Board.
In most states the governor appoints the Board members. I can usually tell what party our governor is based on the actions of the Board. If you are concerned about the unbridled control these Boards have, I would highly recommend talking to your state representative or state senator.
What’s The Verdict?
Last week, the jury returned a verdict in the case of Maya Kowalski. I have previously written about Maya Kowalski, who was a 10-year-old girl at the at Johns Hopkins All Children’s Hospitals in Tampa, Florida.
Maya had suffered from Chronic Regional Pain Syndrome (CRPS) and was receiving Ketamine treatments which reduces the sensation of pain even though they cannot stop it all together. It has been successful for Maya, but she had a very significant flare up which forced her mother, a nurse, Beata Kowalski, to take her to the hospital because severe abdominal pain and vomiting in October of 2016.
Unfortunately, I believe that the hospital had a rush to judgment in considering and reporting Maya’s parents to DCS with a diagnosis of Munchausen’s Syndrome by proxy (meaning the parents were causing Maya’s illness). The hospital clearly did not understand what CRPS is.
Apparently, they had received her pediatrician’s corroboration and recommendations for CRPS treatment, but they still went ahead and reported her to DCS. The hospital district felt that Beata was interfering with Maya’s treatment and disagreed with the dosage of ketamine.
Pediatrician Dr. Sally Smith was also improperly granted access to Maya’s medical record to build a case of child abuse against the family.
Maya was held in the hospital for 90 days during which time she was surveilled by video for 48 hours and photographed. None of this was approved of by the parents. Once custody was given to the hospital, the hospital did what they wanted. Beata became depressed and felt helpless and chose to end her life.
Now there are allegations of sexual misconduct by a male employee who entered her room and stared at her private parts which he forced her to show. Criminal charges will be filed.
The jury deliberated for 16 hours over three days and concluded that the hospital’s actions led to the mother’s suicide.
The jury awarded $211 million for false imprisonment of Maya Kowalski, battery of Maya Kowalski, fraudulent billing of Jack Kowalsk, Maya’s father, inflicting emotional distress on Beata Kowalski, wrongful death claim for the estate of Beata Kowalski and intentionally inflicting emotional distress on Maya Kolwalski. The jury also awarded $50 million in punitive damages.
Prior to trial, the hospital says they are fighting this because they want to make sure that the healthcare providers feel comfortable reporting concerns about Munchausen syndrome by proxy or any other concerns about parental mistreatment of their children. Who but a nurse is in a better position to know what their child’s healthcare needs are.
Unfortunately, Beata’s concerns were not taken seriously, and the nurses thought the mother was harming their child. Fortunately, the jury saw differently and learned the truth.
The sad part about this was at age ten, Maya was isolated in a room, watched on video, and being photographed without the parents’ knowledge or consent. In fact, Maya could not even talk to her mother. Maya’s mother became so depressed, fatigued and suffering from an overwhelming sense of helplessness that she couldn’t continue and chose to take her own life.
Nothing is going to give Maya back the time that she lost in the hospital and how she was treated, and nothing will bring back her mother.
It is so sad when there is a rush to judgment like in this case, which turned out to be not true. I am glad that John Hopkins was held accountable.
Do Peer Assistance Programs Support Nursing?
In a recent article on MedPage Today the question is asked, “Are peer assistance programs defective and harmful to nurses”?
The article specifically discussed recent issues regarding the recovery and monitoring program (“RAMP”) in New Jersey. RAMP discussed how nurses cannot work during the intake process, which can take up to 90 days, after which a decision is made when a nurse can return to work.
It also discussed how costly RAMP is in that those nurses must pay a monitoring fee as well as for the testing which can range from $250 to $2000 depending on the type of evaluation required such as psychological, neurological or substance use.
While the program boasts their high success rates, it is very concerning to me that these programs are designed for nurses to keep their licenses, yet their licenses are promptly suspended for 90 days while the evaluation is being conducted.
In Indiana, nurses are referred to INPRP or ISNAP when there is an irregularity in documentation such as failing to witness waste, sign out or sign the administration of medication. Fortunately, Indiana does not immediately suspend a nurse’s license unless there is a clear and immediate danger to the public, and such is done only after the nurse is afforded an opportunity to be heard on the matter.
With protocols such as RAMP, I’m sure it spreads a chilling effect to nurses who may want or need to enter the program. I don’t believe there is a nurse anywhere who wakes in the morning thinking, “I want to take drugs” or “drink alcohol.”
Unfortunately, such abuse is a disease. Nurses need all the help that they can get. Nursing is stressful and getting even more stressful every day. We need to support our nurses who fall into addiction by providing them with support in a safe haven so they can continue working if they can safely do so or return to the workforce quickly.
In addition, if the nurse cannot work, such as with RAMP in New Jersey, it can be financially devastating to them.
Meanwhile, in Indiana, there is a needs assistance program available to help cover the costs of drug screens and monitoring, but that needs assistance is not guaranteed.
At a time when nurses are so desperately needed, I am hopeful they will be able to get the help they need in a caring compassionate environment so eventually they are again able to re-enter the workforce in a safe and healthy way.
A HUGE NURSING SHORTAGE
Anyone interested in making money in Georgia?
Piedmont Healthcare is offering sign-on bonuses of up to $30,000 to attract nurses to their employ. That hospital system has been relying on expensive travel nurses to treat their patients but instead is now making a concentrated effort to put together their own staff.
Many other health systems are offering sign-on bonuses such as Penn State Health’s offer of $15,000; and Baptist Health Systems which is presently offering a $20,000 enticement.
Nurses are more in demand now than ever throughout the country. The shortage is resulting from many who have left the profession due to being “burned out” with the demands of health care during the pandemic.
Specifically, there is a crucial need for med/surg and ICU nurses and even operating room nurses as health systems try to recoup lost revenue from earlier during the pandemic when elective surgeries were placed on hiatus.
Interestingly, there currently is less of a demand for specialties like pediatric care as well as labor and delivery.
If you decide to apply for a new position that offers a sign-on bonus, be careful because if you are later terminated, or the position does not work out for any reason, you will have to pay back that bonus, usually pro rata.
You will want to negotiate very carefully a contract with a sign-on bonus as there can be many strings attached. Having an attorney review the contract before you sign would be prudent.
While it’s great that “money talks,” I really would like to see the loss of nurses curbed by being treated better so that they will want to stay with their job. Some things to help are assisting nurses decrease burn out, having adequate staffing and showing appreciation to the nurses for their service.
The culture in many of today’s healthcare facilities needs to change if they wish for their nurses to stay.
Though it may sound great to move to Georgia and get a sign-on bonus, do your homework, make sure the unit you are signing onto values and appreciates their nursing staff. And of course, carefully negotiate your sign on agreement so that you can avoid paying back a lot of money if things don’t work out and you choose to leave.
Nurse-Attorneys? Yes. Lawyers Are Donning Scrubs Again to Help Battle COVID-19
“Nursing is in your DNA. We’re called to serve,” said Lorie Brown, the president-elect of the nurse-attorney association. Brown, who works as a nurse-attorney at Brown Law Office in Indianapolis, couldn’t leave her law practice to go back to nursing. But she did devote time preparing a guide about self-care and mental health for nurses, covering such things as mindfulness, meditation and yoga. [Read Full Article]
Free video series offered to nurses fighting pandemic by San Diego nurse, veteran of AIDS crisis
In an article on CBS8.com, Lorie Brown put together the video series called “COVID-19 Video Survival Guide for Nurses and Healthcare Practitioners” to provide tips for nurses on the front line of the coronavirus fight. [Read Full Article]
Leading San Diego RN Creates Free Video Series for Frontline Nurses
“Lorie Brown put together the video series to provide tips for nurses on the front line of the coronavirus fight. It features 18 experts who provide advice such as keeping up immunity, getting better sleep, practicing mindfulness and understanding nurses’ rights.” [Read Full Article]
Nurses stuck on suspension longer than expected
“Lorie Brown is both a nurse and attorney. She’s fighting for nurses who are currently suspended or on probation to return and aid in the fight against the novel coronavirus pandemic.” [Read Full Article]
Starting a nurse-owned business
Nurses are uniquely qualified to start their own businesses in areas such as legal consulting, coaching, and home healthcare. In this article on American Nurse, Lorie Brown gives some tips to keep in mind if you’re thinking about starting your own business. [Read Full Article]
Curiosity Killed the Cat and Got 50 Hospital Employees Fired
Lorie Brown’s article from AllNurses on HIPAA violations following the incident with Jussie Smollett, the actor from the TV series, “Empire”, at Chicago’s Northwestern Hospital. [Read Full Article]
They slip, you fall: Have policy and procedures for hazards to avoid accidents, legal grief
“If I were the risk manager, I’d be putting procedures in place” to prevent foreseeable injuries, says Lorie A. Brown, RN, MN, JD, founder of the Brown Law Office P.C. in Indianapolis. “Policies and procedures set the standard of care. Without that, there’s no standard. It helps everybody to do the same thing. If you follow the rules and follow the policy, and the standards are reasonable, and are followed, no jury will find you guilty of negligence. If you don’t, it’s a breach of your duty of care.” [Read Full Article]
Get to Know Nursing Leader, Lorie Brown
“Lorie Brown is a published author and founder of the Empowered Nurses (ENO) organization, whose career has taken her from practicing nurse to nurse attorney. Learn more about how her legal practice has allowed her to help nurses and other health professionals in need.” [Read Full Article]
Three things you need to do to keep your nursing license safe: An interview with Lorie Brown, RN, MN, JD
“This is episode 10, an interview with Lorie Brown, an attorney and nurse who helps nurses with license protection and empowerment.” [Read Full Article]
Protect Your Nursing License From Board Action, License Disputes, and Revocation!
Undoubtedly, you worked hard to obtain your nursing license. Depending on what type of nurse you are, you may have spent up to 6-8 years, and tens of thousands of dollars, obtaining the necessary education, training, and certifications to become a licensed, practicing nurse. And yet, one split-second mistake, bad decision, or momentary lapse of judgment could cause you to lose your license — and perhaps your career — indefinitely. [Read Full Article]
Wearing Many Hats
“I have a very unique law practice. I am a registered nurse as well as an attorney and am able to combine both professions into one.” She has created a niche market for herself and in doing so, her practice has grown by leaps and bounds… [Read Full Article]
Leadership Is Service
As a registered nurse, Lorie Brown cared for her patients. Now, as an attorney, she cares for her clients, including her attorney clients. As a mother of three children, she cares for her children. Caring is a way of life for Lorie, whether it be in the community, city, state or the world…[Read Full Article]
Five Steps to Avoid Malpractice Claims
No nurse practitioner wants to face a medical malpractice action. According to the National Practitioner Databank, damages were paid by or on behalf of 290 nurse practitioners in medical malpractice cases in the year 2012 alone.…[entire article ]
Protecting Your License
A license to practice nursing in the State of Indiana is a privilege, and not a right. To qualify for and practice as a professional nurse an individual must complete specific educational requirements and successfully pass a national licensing examination. A nursing license is required to practice nursing and must be valued and protected.…[entire article ]
Risky business: Nurses must be aware of social networking pitfalls
“Even listing a patient’s initials can be too much information, said Lorie Brown, RN, MN, JD, a nurse attorney and owner of Brown Law Office in Indiana”…[Read Full Article]
How Nurses Can Advocate for Their Patients
“Advocating for patients is within [nursing’s] mission,” according to Susan Perkins, MSN, a nurse practice consultant who teaches in the nursing program at the University of Phoenix® Main Campus. She stresses that nurses should ask patients open questions to help determine their specific needs, and then go to bat for them when necessary. But sometimes, circumstances can make patient advocacy difficult, says Lorie Brown, JD, a registered nurse and practicing attorney specializing in health … [Read Full Article]
5 Tools to Protect Your Nursing License and Your Livelihood
Over the past 20 years, I’ve represented more than 300healthcare providers before the various licensing boards. I’ve seen nurses accused of practicing medicine without a license for misunderstanding the dosage, nurses accused of neglect for failing to answer another nurse’s patient’s alarm like when the other nurse said she would answer it, and nurses accused of abuse for removing a patient’s hand off a foley catheter as the patient was trying to yank it out.…[entire article ]
MTV’s Scrubbing “Hurts Perception of Nursing”
You play the role of the nurturing caretaker and fearless problem-solver in your everyday life. Whether it’s with your children, your coworkers, or your friends, people often turn to you for both advice and for comfort. You’regret at putting the needs of others above your own…[Read Full Article]
How to Get a Nurse Job After Being Fired
“Absolutely you can get another job,” says Lorie A. Brown, RN, MN, JD, an Indianapolis nurse and attorney who represents nurses before state licensing boards. “It’s all how you present yourself as a conscientious professional and being proactive.”…[Read Full Article]
Nurses-turned-attorneys have unique insight
“Attorney Lorie Brown says nurses may not understand the many rules that affect their licenses. A mistake on the job or failure to disclose a prior disciplinary action – even something as innocuous as a reprimand for being tardy – could lead to suspension or revocation of their licenses.” [Read Full Article]
Doctor Fights for Wages
The Indiana Supreme Court heard oral arguments in a case that, according to attorneys on both sides, could potentially affect every wage earner in Indiana. Debate in St. Vincent Hospital and Health Care Center, Inc. v. Robert J. Steele, 4A02-0005-CV-294 centers around Indiana’s wage payment statutes, as well as a complex series of cases that combine to set a conflicting precedent. [Read Full Article]
Court of Appeals Sides With Kokomo Doctor in Compensation Suit
The Indiana Court of Appeals recently upheld a Howard Circuit Court decision in favor of a Kokomo Oncologist seeking compensation from St. Vincent Hospital in Indianapolis, for nonpayment of wages. Brown Law Office in Indianapolis,which represented Dr. Robert Steele, Kokomo, issued a news release Saturday on the Court of Appeals decision, which was handed down Wednesday…[Read Full Article]
