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.
Hurricanes, Wildfires and Blackouts, Oh My!
As we in California are in the midst of the wildfire season, hospitals are preparing for power outages. When there is a wildfire in the area of a hospital, the power companies often plan to cut electricity to prevent more damage from the fires.
California law requires hospitals to have backup generators for critical care operations. However, a prolonged blackout can make it difficult. Also, of concern is people in homes who need medical equipment since a power outage could be catastrophic for someone requiring electricity generated equipment.
In fact, after a power outage in Florida during Hurricane Irma in 2017, 12 nursing home patients lost their lives due to the absence of electricity. As temperatures soared, they became overheated. Now the nurses and administrator there are facing criminal charges.
It is sad that the nurses are having to defend themselves in this matter as they work at the facility under adverse conditions while helping people in the middle of a hurricane rather than focusing on keeping themselves safe. They, along with other facility staff, rely on their facility to provide the necessary equipment and services for them to properly care for their patients. It will be interesting to see what happens from this.
Although it is tragic that these patients died, the Florida nursing home itself should have been required to have a backup generator to protect the health and safety of their residents. Laws should be in place to make sure our most vulnerable population is protected.
You may want to check with your facility to learn if you work in an area where a natural disaster could occur to make sure that it has adequate supplies, equipment and backup generators to take care of these patients and hospital staff.
Nursing And Ethical Issues
It is unusual for a matter before the Nursing Board to find its way into the court system primarily because of the cost. Recently, in Pennsylvania, one case did exactly that and wound up in court brought by an LPN.
In this particular case an LPN was charged on July 16, 2014 with 3 counts of drug related offenses and a count of disorderly conduct. To the charge of disorderly conduct, she entered a nolo contendere plea where a guilty plea is entered but the Defendant does not admit to the crime. She pled nolle prossed to the other 3 charges which means they were dismissed.
The LPN denied engaging in these types of behaviors but the Board believed the court documents and suspended her license for a period of 6 months. The National Council State Board of Nursing for the years 1996 through 2006, collected information showing 126,130 (more nurses than tin the entire state of Indiana!) actions were taken against nurses. 13% consisted of suspension and 7% consisted of revocation. Suspension is the second most common taken action. Probation was the most common Board action taken.
But what is interesting about this particular case is that the Board based the suspension on the conviction of a crime of moral turpitude which is an active behavior that gravely violates the sentiment of accepted standard of the community. However, the Court of Appeals stated that it was not a crime of moral turpitude and disagreed with the Board’s interpretation.
In my limited experience with these types of appeals before a court, this is a great result! I would love to see more people question the Board and appeal their actions to a regular court so that the Board can stay in check. Unfortunately, these kinds of matters are very expensive to pursue. The Boards have unbridled authority to do what they wish … and this needs to stop! This was an LPN who appealed the decision and I am so glad that the court agreed with her.
What are your thoughts? Let us know in the comments below.
Does Your Facility Have Your Back?
I’m sure you’ve read in the media or on my blog about Nurse RaDonda Vaught who has been charged with reckless homicide for an inadvertent medication error.
In a news article released by hospitalwatchdog.org, they described what Vanderbilt University Medical Center (VUMC) did not do that could have prevented this tragic incident.
Whenever the Centers for Medicare & Medicaid Services investigates, they prepare a deficiency report. When a deficiency report is received by a facility, they must respond to the deficiencies and offer a plan of correction to remedy the deficiencies.
“The real issue in this case is that there were no effective systems in place to prevent or detect the accidental selection, removal, and administration of a neuromuscular blocker that had been obtained via override.”
As in the past, I am in no way saying that Nurse Vaught’s actions were proper. My position is that this is a medical malpractice rather than a criminal matter! However, VUMC did not have her back and fired her rather than fix the system issues that contributed to this error.
Once CMS investigated, VUMC had to put systems in place to prevent these types of problems. In VUMC’s Plan of Correction, the facility has agreed to:
1. Take vecuronium off override. Had vecuronium been taken off override, Nurse Vaught would never have been able to access this medication.
2. Implement bar coding verification in the radiology department. Like most areas, if one takes a medication out of the Pyxis or the med cart and gives it to a patient, the medication’s barcode is scanned. This ensures that the patient is receiving the correct medication. In this situation, if Nurse Vaught would have been able to scan the patient’s wrist band, it would have alerted her that this was not an ordered medication for this patient.
3. Implement the second nurse verification in the radiology department. Having a second nurse review and verify the accuracy of the order and the medication, this would have prevented the death of Charlene Murphy.
4. Require a nurse to enter “PARA” in the automatic dispensing cabinet (ADC). In order to obtain a paralytic drug from the ADC, a nurse must first type in the letters P-A-R-A. This too would have prevented Ms. Murphy’s death.
5. Implement policies that did not previously exist for monitoring high risk medications such as versed or vecuronium. It is surprising that prior to the incident with Ms. Murphy, VUMC did not have policies and procedures to monitor such dangerous medicines. They now do.
The article goes on to question whether the District Attorney (DA) has a conflict of interest because the DA, Glenn Funk, has multiple, personal and professional relationships with Vanderbilt University. He is an Adjunct Professor at the Vanderbilt School of Law, served on the Vanderbilt Kennedy Center Leadership Council and he and his wife are members of the Next Step Advisory Council at the Special Education Department at Vanderbilt’s Peabody College.
Criminal prosecution will not provide safer medicine. It is a system issue that needs to be addressed.
It should go without saying that Vanderbilt and VUMC attempted to cover up this tragedy and the Murphy family did not even know of the situation for almost a year after the incident. My heart goes out to Ms. Murphy’s family, to RaDonda Vaught and to all of the nurses who everyday put their health, their lives, their well-being on the line in the service of others.
The Pyxis and Your Nursing License
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.