nurses Archives - Brown Law Office

Nursing And The Coronavirus

March 12, 2020 by LORIE A BROWN, R.N., M.N., J.D. 2 Comments

A nurse working at Kaiser in California took care of a patient who was positive for the coronavirus. She volunteered to care for this patient because she had training on the recommended protective gear. Her assumption was that should something happen to her, she would be cared for.

Unfortunately, after a few days passed, the nurse became ill. She put herself on a 14-day self-quarantine period. However, she could not get tested to confirm whether she had contracted the coronavirus. At that time, she was put on some type of list.

The United States has the lowest number of tests conducted for the coronavirus as compared to the rest of the world. It goes without saying that if we cannot get tested, how do we know who has it and then how can we limit the spread of the coronavirus?

Fortunately, this nurse had the support of her union, National Nurses United, which hosted a press conference on this matter at 11:00 A.M. PDT on March 12, 2020. You can listen to it here.

What concerns me about this situation is that this nurse took care of a patient with confirmed coronavirus and became ill. My issue with this nurse who became ill after she cared for the patient is that if it is not proven that she contracted the coronavirus during her treatment of the patient, her employer would have grounds to deny any workers compensation claim she might make.

It is very important that nurses who are exposed to the coronavirus get the proper documentation, so they not only get their time off but also for any medical care co-pays and any other sequelae.

I hope nothing like this happens to you, but it possibly could. Approximately 65 employees from the nursing home where many of the deaths from coronavirus are now ill but unable to get confirmatory testing. It’s scary that all these people are getting infected and I am hopeful they can contain the virus.

In the meantime, do whatever you can do to keep yourself healthy including taking vitamin C, exercising, drinking plenty of fluids, get adequate sleep and taking probiotics.

What has your facility done in light of the coronavirus outbreak? Have any specific precautions been put in place there to protect you?

Please share in the comments below.

Nurses As Independent Contractors

February 6, 2020 by LORIE A BROWN, R.N., M.N., J.D. 1 Comment

A new law went into effect in California last month regulating “gig” labor. The legislation was aimed at companies such as Uber and Lyft which inappropriately classify their drivers as independent contractors. The hope was that if they were to be labeled “employees,” they would be entitled to regular employment benefits such as minimum wage, sick pay and insurance benefits. However, the unintended consequence is that this could affect registered nurses, certified registered nurses, anesthetists and nurse practitioners.

This legislation came from an April 2018 California Supreme Court ruling that independent contractors must be free to perform their work as they choose and it must be in a different line of work from the contracting company and the independent contractor must operate their own business.

Here, nurses, CRNAs and NPs are not allowed to work as they wish but must conform to the hospital’s policies and procedures while working in the same line of work as the company contracting their services.

The legislation requires an ABC test which the independent contractor must:

Be free from the hiring entity’s control;
Do work which is “outside the usual course of the hiring entity’s business”; and
Be established in a trade similar to the work being performed.

If nurses work as independent contractors, they’re working within the course of company’s usual business. So, they would fail Part B of the test.

The upsides of the law are that nurses who lack the ability to get benefits can unionize and receive legal protection and health insurance now will be able to have those benefits provided.

Although California’s new law is stronger than many similar laws, 20 states have already implemented the ABC test in one form or another. Therefore, if you take away that this pertains only to the Golden State, you must think again.

There are many pros and cons to being an independent contractor versus an employee. As an independent contractor, you usually can work when you want, make more money and have more write offs than would a traditional employee such as anything that can be considered as a business expense if you are contracting as a business.

The downside to being an independent contractor is that the hospital does not pay their share of taxes which, of course, means you will owe more taxes.

That notwithstanding, having a nicer paycheck upfront certainly is helpful.

Be very careful if you are working as an independent contractor and should have been an employee. This considers your status as misclassified as an independent contractor rather than properly as an employee. There are serious consequences such as owing back taxes to the state and federal governments which could include penalties.

Trusted Nurses

January 23, 2020 by LORIE A BROWN, R.N., M.N., J.D. Leave a Comment

In a Gallup Poll, nursing has again been voted as the most trusted profession for the 18^th year in a row.

One of the reasons it has been so long acclaimed is because of nursing ethics. However, anything that nurses do that may not put our profession in the most favorable light, can be detrimental.

In an MTV reality TV show “Scrubbing In”, they portrayed nurses going to bars in their scrubs. This negatively portrayed the nursing profession. We are held to high standards, just like a physician. Because we are a nurse 24/7, If we go out and drink, we should not wear our hospital attire, nor should we get behind the wheel of a car.

Be careful of any behavior which could be negatively interpreted by the public. As stewards of health, let’s do our part to put our best foot forward in all situations whether or not we are at work.

Having a criminal matter can reflect negatively on the profession. Because we are nurses 24/7, having a positive urine test even with a valid prescription, the Board cannot tell when you took that medication, even if you did take it after work.

Just remember, as a nurse, we are under the public spotlight. Ask yourself if you would have judgement toward a nurse engaging in certain behaviors. If the answer is “Yes,” then don’t do it! For example, if you take controlled substances off work, and the same medication you took comes up missing or a patient says they never received it, it will be difficult to defend yourself.

As nurses, we want to help. But sometimes, helping can mean crossing the line. One nurse went to the ATM for a patient across the street and the patient now claims she never received the money.

I am proud to be a member of the most trusted profession. Hopefully it offsets the reputation of some attorneys! Please join me in continuing to make nursing the most trusted profession and being professional even when you’re not at work.

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.

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.

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