nurse Archives - Brown Law Office

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.

Malpractice Claims are on the Rise with Electronic Health Records

January 9, 2020 by LORIE A BROWN, R.N., M.N., J.D. 2 Comments

According to The Doctor’s Company, a medical malpractice insurance company, more and more claims are being filed as a result of Electronic Health Records (EHR). Because of drop down menus and lack of alerts, patients are getting harmed.

In one example, a physician intended to order 15mg of Morphine. The drop-down menu gave him the choice of 15mg or 200mg. The physician mistakenly ordered the 200mg. The patient took the 200mg Morphine with Xanax and became somnolent and spent the night in the hospital.

There are numerous problems with copy and paste. In one case, a 38-year-old man presented to his PCP with symptoms of shortness of breath and dizziness. The man died 5 days later of pulmonary embolus, the Plaintiff’s Attorney was able to show that the physician copied and pasted his previous note into the visit just prior to his death. Not only is this information available in the audit trials to show everything which was done to the EHR, but the same exact vital signs were copied, and numerous spelling errors were noted in the previous note and copied with the same errors. The allegation was failure to properly assess this man. Had he been properly assessed; the physician would have been able to identify signs and symptoms of a pulmonary embolus.

Risk management strategies include:

Do not copy and paste anything except patient’s past medical history if you are sure it is accurate.
If your EHR auto populates information, ask that that feature be removed.
Be extra careful in selecting items from a drop-down menu and make sure it is correct.
Make sure you read and review prior medical records, so you have an accurate history.
If you use a scribe, you are responsible for the entry so double check to make sure it is accurate.
It is easy to save your charting for later and even do it at home but how do you remember the information? Remember attorneys can find out what time the patient’s visit was scheduled and what time the entry was made.

What do you do to avoid malpractice with EHR? I would love to hear your comments below.

Privacy Matters To Patients

December 26, 2019 by LORIE A BROWN, R.N., M.N., J.D. Leave a Comment

I often hear of nurses who made HIPAA violations, none of whom intended to breach privacy but either curiosity or carelessness got the best of them.

Here are ten such examples:

EMR – If you forget to log out of a computer terminal, someone else can follow you to access anything under you log in. Computers are smart and everything you do on the device can be tracked. Every keystroke you make, every chart you look at, everything! Even if you accidentally pull up a wrong patient’s chart, that is a HIPAA violation. Should this occur, immediately notify your supervisor.
HANDWRITTEN NOTES – When I was practicing, I had a clipboard with all my patients’ names and what I was to do with each one. Many times, I forgot to throw away my sheets and brought them home where I discarded them in the trash. If these notes are thrown away rather than placed in a secure shred bin, you are violating patient privacy and HIPAA.
PROTECTED INFORMATION – If you have a coworker who has had a procedure and you want to find out how they are, you CANNOT access their records. In that position, you are just like everyone else who is not allowed access to this person’s information. If you want any information on the coworker, you will have to go through the normal way of finding out, just like any family member or friend.
PATIENT FAMILY AND FRIENDS – Be cautious about any information you give to a patient’s family member or well-meaning friend. Make sure the patient has signed a HIPAA release or authorization giving you permission to share information with that particular person.
SHARING INFORMATION – Be careful not to share information outside protected channels. If you text a doctor from your personal cell phone, you have violated HIPAA. Any such text or email must be secured through approved software and channels.
SELFIES – As much as you would love to be friends with your patients, anything you share on your Facebook page or other social media, such as a selfie with the patient, is a HIPAA violation. Frankly you should never take a picture with a patient, but a patient may take a picture with you. I would not even be friends on Facebook with a patient because that too is a HIPAA violation of boundaries. However, if the patient takes the selfie and they post it on their own social media, no violation has occurred. The violation occurs it YOU post it.
REPORTING HIPAA VIOLATIONS – You can self-report any HIPAA violation but that does not necessarily mean you will not get in trouble but to NOT self-report can make the situation worse. However, if you note another’s HIPAA violation and fail to report it, you can make the situation worse as you can be considered an accomplice in the violation.
PUNITIVE MEASURES – HIPAA violations can result in a variety of legal responses that go beyond just being terminated from your job. A UCLA surgeon was sentenced to 4 months in jail and fined $2,000 after he illegally accessed medical records over 300 times of his supervisor, coworkers and celebrities.
ELEVATOR CHATS – In one case, a nurse was trying to reach a physician about a patient but he had not called back when she ran into him in an elevator. She promptly began a discussion with the doctor to get an order. This is a violation of HIPAA because the disclosure of the patient’s situation was not in a secure place
FAXING – If you are extremely busy and need to fax medical information, take the few seconds to confirm it is going to the proper recipient. If you accidentally send medical information to the wrong place, you have violated HIPAA.

A HIPAA violation is an extremely serious offense and can result in huge fines and even imprisonment, as noted in No. 8 above.

In ABC’s reality show, NY MED, they inadvertently filmed two hospital patients without consent. The hospital paid a settlement of $2,200,000 and was instructed to implement a corrective action plan.

HIPAA violations are extreme and saying “it was an accident” is not an acceptable excuse. There is zero tolerance for such and 100% compliance of HIPAA regulations is required at all times.

Please careful to protect your patient’s confidentiality.

You’re Always A Nurse

November 7, 2019 by LORIE A BROWN, R.N., M.N., J.D. Leave a Comment

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.

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.

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