Lorie Brown, R.N., M.N., J.D. interviews Criminal Defense Attorney, Marc Lopez, J.D. of Marc Lopez Law – www.MarcLopezLaw.com. The discussion includes what happens when the quarantine is lifted, the possibility of having a higher tolerance due to drinking during the stay-at-home orders, DUI/OWI, and protecting your nursing license and professional healthcare license.
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.
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.
- 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.
- 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!”
- 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.
- 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.
- 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.
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.