Nursing Scope Of Practice

February 13, 2020 by LORIE A BROWN, R.N., M.N., J.D. 2 Comments

Have you ever worked somewhere and your supervisor says, “Just write an order for that. We always do that to help out the physicians.”

In that situation, you feel like you’ve been put between a rock and a hard place. Your supervisor is telling you one thing and your gut is saying, “Hey! Wait a minute! I don’t have an order. I don’t have a policy and procedure and the physician is not available for me to ask.” Your gut tells you that this is something you should not do yet your Supervisor is ordering you to do exactly that.

This is a dilemma in which nurses frequently find themselves.

If you are asked to do something outside of the scope of your practice … trust your gut … don’t do it! The physician just might not cover you for what you did.

In addition, know your facility’s standing orders which are those that you can adjust medications based on labs and things like that. But they must be in the actual order or in the policies and procedures.

Taking it upon yourself to adjust or order medications or order labs is improper without the protection of a standing order or a policy and procedure. This would be called practicing medicine without a license and exceeding your scope of practice.

In addition, as nurses, we know too much. Sometimes when we have a pain, we are inclined to take a pain medication that we had around for a long time that was prescribed for another purpose or a previous episode of the same event. This also is considered practicing medicine without a license and exceeding your scope of practice.

It is really important that as nurses, we set the example. We cannot borrow a pain medication from someone else because we hurt our back. We have to go through the proper procedures as we are held to a higher standard than the general public and need to go through the same channels that the general public goes through. When we are sick, we go to the doctor, emergency room or urgent care to get a prescription.

If you are asked to take a drug test and have a positive urine for a medication for which you don’t have a prescription or a medication that has expired or prescribed for another reason, it is very difficult to protect and defend yourself.

When you take an expired medication or one borrowed from someone else, you are self-prescribing and practicing medicine without a license and exceeding the scope of your practice. It also is considered diversion because the medicine was not prescribed specifically for you or for that reason. Diversion simply means taking something from where it was supposed to go and moving it to another place.

This is such a big issue in healthcare.

Although you may not feel well, go to the doctor who knows the best way to help you. In this way, it is documented that everything was properly prescribed.

When you are faced with these difficult ethical dilemmas and you don’t have policies and procedures to support you, stand in your power and tell your supervisor that you do not feel comfortable doing something which is outside the scope of your practice.

Although you may fear you might lose your job, as I often say, you can always get another job but not another license.

Top 10 Blogs Of 2019

January 2, 2020 by LORIE A BROWN, R.N., M.N., J.D. Leave a Comment

This is one of my favorite things with each New Year. I look at my top 10 blogs to see which ones you really enjoyed. In 2018, the favorite ones were based on license protection so in 2019, I chose to do more articles on that same subject.

Just like with the New Year’s Eve countdown, let’s go down the list starting with number 10 and head to number 1. By the way, you can read the original blog by clicking on the bolded number for each one.

NUMBER 10: PYXIS AND YOUR NURSING LICENSE – Probably among the most important of my videos because day after day I see where nurses are not properly following policy with medication management which is of concern to administration due to our opiate crisis.

NUMBER 9: THE PERILS OF TRAVEL NURSING – This blog discussed the top 8 ways travel nurses can get into trouble and advises how they can protect themselves.

NUMBER 8: WILL NURSES BECOME OBSOLETE – Is new and advancing technology creating a more automated world that is taking the place of nurses?

NUMBER 7: MED ERRORS AND CRIMINAL CHARGES – Tennessee nurse RaDonda Vaught accidentally gave a patient vecuronium instead of Versed resulting in the patient’s death. Vecuronium is used to intubate patients by repressing respiration. While in a PET scan, the patient arrested and died. The issue was not identified until an audit by the Center for Medicaid and Medicare Services (CMS) was done over a year after the incident. After the investigation, nurse Vaught was charged criminally in this matter. While she did commit malpractice, it is my opinion that it should not have risen to the level of a crime albeit for making a horrible mistake.

NUMBER 6: REFUSAL TO DRAW BLOOD – Jonathan Moore was involved in an auto crash killing a former city council woman and her daughter. When Moore was hospitalized, police wanted the nurse to draw blood without an order and without patient consent. The nurse told the officer that a warrant would be needed to make the draw. Crystal clear policies should be in place so nurses know when they can do certain activities.

NUMBER 5: FATAL MEDICATION ERROR UPDATE – This was another article dealing with of nurse RaDonda Vaught who accidentally administered vecuronium to a patient [See NUMBER 7]. Criminal charges were filed against nurse Vaught and the Tennessee Board had initially excused her actions but then decided to take action against her license.

NUMBER 4: NURSES IN TROUBLE WHEN PHYSICIAN OVERPRESCRIBES – A physician was actually practicing “end of life” measures by prescribing 20 times the normal dosages of fentanyl. Nurses who carried out those orders were all fired and reported to the Board. There was one wrongful death lawsuit that settled for $4,500,000.

NUMBER 3: NURSES WITH ADDERALL – This item discusses a Louisiana Board’s concerns about nurses who take the controlled substance Adderall. In fact, it shows a statement by the Board about how Adderall is the most widely abused prescription drug in America and how Boards can take action if a nurse takes any controlled substance.

NUMBER 2: UNUSUAL NURSING BOARD CASE – A nurse received an unfavorable decision by the Delaware Division of Professional Regulations to the Supreme Court which overturned the Delaware agency’s ruling. Two nurses were on duty and required to count medications just as if they were controlled substances. During the count, the supply of hepatitis C medication, costing $1,000.00 per pill, was accidentally spilled to the floor. The nurse put the 12 pills in the sharps container, but the pharmacy ordered them to be retrieved for later distribution to this patient/prisoner. The nurse’s license was placed on probation for 90 days and required her to take continuing education. But she disagreed with the decision and took the matter to the Delaware Supreme Court … and WON! It is unusual for nurses to appeal a case, let alone be successful.

NUMBER 1: PATIENT KILLS NURSE – A nurse accosted by a patient who, before others could restrain him, violently slammed the nurse’s head onto a desk. Lynne Truxillo subsequently succumbed to blood clots in her leg leading to a pulmonary emboli. Though the patient was charged with manslaughter, the obvious truth was that the charge could never bring back nurse Truxillo.

MY PERSONAL FAVORITE: My personal favorite blog was an interview with nurse Yolene Lofton who lost her license simply for recording the wrong date on some documents. It was sad that she lost her license over that error. But it does show just how important your license is and how even a minor error could result in loss of your license and livelihood.

My hope is that you can learn from these blogs and do everything you can to protect your most valuable asset: your license.

What was your favorite blog in 2019? Was it any of the above or perhaps a different one? Let me know in the comments below.

Is The Handwriting On The Wall?

October 10, 2019 by LORIE A BROWN, R.N., M.N., J.D. 2 Comments

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.

Nurses and Drugs Screens at Work

October 3, 2019 by LORIE A BROWN, R.N., M.N., J.D. 3 Comments

Lorie Brown, Nurse Attorney, discusses what happens when you are asked to take a drug screen at work. She discusses what you should do and not do if you are required to take a drug screen at work as well as some of the consequences if you decline or if you believe you will test positive.

He Said, She Said … Who Do You Believe?

May 23, 2019 by LORIE A BROWN, R.N., M.N., J.D. 5 Comments

Shows a nurse and a doctor disagreeing and another nurse watching

One of the hardest things about representing a nurse before the Board is that anyone can make an allegation against the nurse and report it. Many times, these can be a “he said … she said” situation.

“The nurse gave me only 1 type of codone instead of 2!” “The nurse held my arms so tight; I got a bruise!” “The nurse took money from my wallet!” And the list goes on and on.

It is so sad that these allegations are made and the ones in the previous paragraph are just from patients. But coworkers can make allegations too. “I saw her drop a medication on the floor then administer it to a patient.” “My coworker was rude to a patient.” When a hospital hears about allegations from patients and staff about nurses, they are going to be concerned. In my experience, the facility usually takes the patient’s side and even if the complaint is unsubstantiated, frequently the nurse will lose their job.

How can you protect yourself from these allegations? Well, to be honest, I don’t have a magic answer.

I think part of the problem is the culture of nursing. The Board’s job is to protect the public and not the nurse. The hospital thinks the nurse’s job is to promote good customer service.

About the only advice I can give would be that if you have any concerns about taking care of particular patients, voice those concerns and see if you can have your assignment changed. It is not worth it to put yourself in a situation where a complaint can be made against you.

I frequently hear from nurse clients that a particular coworker or manager, “had it out for me.” Should you ever feel like you are in one of situations, it is better to leave the facility and find another job rather than to face an allegation.

I think it would be great if the criminal standard of being “beyond a reasonable doubt” would be applied to a complaint. However, it’s not. The Board can listen to hearsay and if there’s any concern about safety to the public, they will take action. It doesn’t seem quite right but that is what happens.

I think the best way to prevent circumstances is to avoid them. If you feel that you should have a witness while caring for a particular patient or when you are with a coworker, bring someone with you. Then, if you are ever called on the matter, you have some protection. Your license is too important.

How would you protect yourself in these types of situations? Have you ever found yourself at the center of such matter? What did YOU do? Let us hear your comments in the space below.

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