Lorie Brown, Nurse Attorney, discusses problems that are the result of a Pyxis audit and how to protect your Nursing License. This includes how it may look like a nurse is diverting medications and making sure you are administering and wasting medication properly so you protect your license.
Now you’ve got it. The biggest poison in nursing is judgment.
We, as nurses, don’t even realize how judgmental we are. Even though in nursing school we are taught to have a non-judgmental approach toward our patients, we still have that little voice in our head that says things like: “Oh, they are so whiny” or “That patient really needs too much pain medication.”
Sometimes we cover our judgments under the guise of our professional opinion. But this is a trick of the ego. We judge patients and even each other mercilessly. The nurse says, “I took over her care, she’s so lazy, she never does ____.” “My charge nurse is so mean and gives me the worst assignments.” And our judgments go on and on and on.
Judgments cause wars, judgments cause disagreements in relationships and judgments cause heartache and discontent.
And then there’s that sad part, we never know why a person behaves in a certain way. Maybe they are abused at home or have lost a family member or pet.
While judgments are part of the ego, they do not serve us. The first step is to recognize the judgments that you have without judgment of yourself. The second step is to release the judgment by asking yourself is it really the truth or is this just a judgment. The third step is to send the person love. They are a person just like you with hopes, fears, dreams and problems. The last step is to forgive. Don’t just forgive the person that you judged but forgive yourself for judging. After all, we are all human.
This may sound esoteric but give it a try with an open mind. When you are in control of your judgment and replace it with more positive thoughts, you will be much happier and I would not be surprised if your patients, co workers and family notice it.
What are your thoughts about judgment? What techniques do you have to deal with judgment?
As nurses, while we really want to help our patients, we sometimes find that our being helpful can get us into trouble. As you know, we are required to follow tons of rules. We have to watch our professional boundaries to make sure we are not overstepping.
For example, if you work at an assisted living facility where one of your patients needs help getting groceries and you agree to get the items for the patient. This is crossing the line. You are there to provide nursing care and not help the patient with something like that.
I’m aware of what you’re thinking, “You know, I’m just trying to help her out.” But still, that crosses the line and can lead you to trouble.professional boundaries nurses nursing patients
Another scenario is you have a patient who perhaps is constipated and requires Milk of Magnesia. The physician normally prescribes that for all his postop patients but let’s say that, for whatever reason, this order got missed. You go ahead and give the Milk of Magnesia to the patient while fully intending to get an order to cover you.
As much as you wanted to help the patient and relieve their suffering from constipation, this would be practicing medicine without a license.
Don’t fall into the trap; your license is too valuable. It’s a true privilege to be a registered nurse but don’t mess up your career because you felt compassion toward a patient.
Here’s another example: your boyfriend is in pain and you give him one of your own pain medications left over from a surgery you had. As much as you would like to ease his pain, this too is considered practicing medicine without a license.
How about if you were working on a cancer unit and when a patient passes away, the medications are left and not wasted. If you save these for other patients who may not be able to afford these medications, even if ordered, is considered diversion.
If any of these situations cause you concern, I would suggest taking continuing education on ethics and professional boundaries to make sure you are complying with the law. Each one of these nurses thought they were helping people and it turned out to hurt them. Have you run across similar situations? What did you do? I would love to here your thoughts below in the comments.
I have recently seen a number of health care professionals using Gabapentin, which is used to treat epilepsy, postherpetic neuralgia (shingles), but also widely prescribed off-label to treat fibromyalgia, neuropathy, migraines and other chronic pain conditions. In 2016, 64,000,000 prescriptions were written in the U.S. for Gabapentin, the 10th most prescribed medication. This is a 49% increase in just 5 years.
In researching this issue, it appears that Gabapentin can increase or heighten the effects of opiates as well as heroin, marijuana and cocaine. With the opioid epidemic underway, people are looking for another way to relieve their pains and help them to relax, sleep and feel good.
Most drug tests do not check for Gabapentin unless it is specifically included in the panel. In 2017, Kentucky became the first state to make Gabapentin a Schedule 5 controlled substance. It is something that I assume will occur eventually in other states as well.
If you take Gabapentin, just like any controlled substance, I would suggest strongly that if possible, get off it. I believe this substance will be tested more and more even though at present it is not a controlled substance in many states. It will be soon but, for now, the Boards are on alert to look for Gabapentin abuse.
California has had issues with their Board. California has a separate Board of Nursing for Registered Nurses and one for License Vocational Nurses. The RN Board is called the Board of Registered Nursing (“B.R.N.”). In some parts of the country, licensed vocational nurses are called licensed practical nurses, L.P.N.
In 2009, the Los Angeles Times and ProPublica analyzed the records of 2,400 California nurses who faced disciplinary action by the Board between 2002 and September 2009. What they found was that many of these nurses were allowed to continue in their practice while they still had serious allegations against their licenses. The investigation process took so long. They were left free to practice for years while the investigations continued. Many of these nurses simply moved to another state where they continued to practice
The then governor, Arnold Schwarzenegger, replaced most of the B.R.N. due to the extreme length of time it was taking the Board to discipline egregious conduct. It is my opinion that the other Boards learned of this and did not wish to become the subject of criticism and publicity like in California.
However, despite the previous California problems, it appears that the California Board of Registered Nursing is still having issues due to delays in resolving complaints against nurses accused of negligence involving patient injury or death or posed a serious risk of harm to others.
At the closing of 2016, an auditor’s report showed that there still was a delay in resolving these complaints. The audit reviewed 40 cases between June 1, 2013, and June 30, 2016, and found that the Board failed to resolve 31 of those complaints.
There was one complaint against a nurse for a toddler’s death in which there was a delay in referring it to the Consumer Affairs investigators. This complaint took more than 3 years (39 months) to resolve during which time the nurse was allowed to continue to practice!
One of the concerns with the California Board was that its state’s Medical Board has 1 staff member for 900 licensees while the Nursing Board has 1 staff member for 3,000 licensees. I know that funding is a big issue for these Boards. But, when you look at the Medical Board compared to the Nursing Board, the former has more staff and takes much less action against their licensees than does the latter.
I think Nursing Boards are a representative of nurses. In my addresses, I often provide case studies and ask my audience what they would do if they were a member of the Board in those matters. Some interesting responses included taking actions that would be more serious than that which the Board actually took.
Unlike the Nursing Board, the Medical Board protects its licensees. It may not be appropriate for Boards to protect doctors who are not safe to practice but, at the same time, excessive action against nurses is also is inappropriate. When a nurse is accused of the same conduct as a physician and if nothing is done against the physician’s license while sanctioning the nurse for the same conduct, that is not proper.
I am hoping that the Board can find a middle ground when protecting the public as well as rehabilitating the nurse. While I am an advocate for nurses, if a nurse should not be practicing then there is nothing that can be done to help them.
Do you believe Nursing Boards are excessively harsh? If so, what would be your suggestion(s) to resolve this? Let me know your thoughts below.