Information for Nurses

2009-10-20T17:18:00.001-05:00

My blogs have moved to www.nursingattorney/b. I have not posted in a while because we were busy setting up the new blog site. I hope that putting the blogs on my website will help readers navigate the blogs and the articles. Let me know what you think.

Nurse of the Year???

2009-08-11T17:03:00.003-05:00

This is from David Owens for the Hartford Courant on 8/6/09

" A Norwalk woman once recognized as "nurse of the year" was arrested today after an investigation found she's not really a nurse.

Betty A. Lichtenstein, who is also known as Betty A. Trudel, 56, of Norwalk, was arrested Thursday by inspectors from the Chief's State's Attorney's Medicaid fraud control unit on a single count of illegal use of the title "registered nurse," six counts of second-degree reckless endangerment and one count of criminal impersonation.

According to the warrant for Lichtenstein's arrest, the investigation began after a patient at the Norwalk doctor's office for which Lichtenstein worked complained she had acted unprofessionally.

An investigation then determined that Lichtenstein never had a license, yet had administered injections and given medical advice to the doctor's patients, according to the warrant.

The doctor and his employees' belief that Lichtenstein was a nurse was reinforced when in November 2008 she was honored as "2008 nurse of the year" by the Connecticut Nursing Association.

The investigation determined, however, that the Connecticut Nursing Association does not exist and that Lichtenstein used $2,000 of her own money to stage the dinner, according to the warrant.

"The doctor, his staff and a number of his patients received a letter with the letterhead of the "Connecticut Nursing Association," according to the warrant. "The letter stated there would be a special dinner to honor Betty Lichtenstein [and that she] was to received a $10,000 personal award and an additional $10,000 was to go to the charity of her choice."

On Nov. 30 the award dinner took place at the Norwalk Inn, and the doctor for whom Lichtenstein worked was a guest speaker, according to the warrant. Forty one dinners were served and the inn sent a bill for $3,211.11 to the Connecticut Nursing Association in care of Lichtenstein's employer's office. She then wrote a check for $2,168.02, according to the warrant.

Lichtenstein was arrested by Norwalk police in May in an unrelated charge of trying to illegally obtaining prescription drugs and forgery. According to the warrant, she tried to obtain 96 Oxycodone pills with a forged prescription. She used a prescription slip from her employer. That case is pending in Superior Court in Norwalk.

The illegal use of the title "registered nurse" charge is a felony that is punishable by up to five years in prison.

She was released from custody without having to post bail and is due in court Aug. 26 in Norwalk.

Copyright © 2009, The Hartford Courant"

It is amazing the amount of energy and money spent by this woman to fake being a nurse. Just bizarre.

Pondering

2009-08-04T20:19:00.002-05:00

In the 60s, people took acid to make the world weird. Now the world is weird and people take Prozac to make it normal.

Hmm, think about it. Too true. Reuters reports that antidepressant use has doubled in the US.

Pandemic Information

2009-07-22T18:15:00.003-05:00

I found a great blog with a lot of information about preparing for a pandemic: Pandemic Information News

On the right hand side is a list of links for preparation and even some of those links have more and more information. I continue to urge health care providers to get prepared now for any emergency or disaster since they are front line responders. We continue to hear about the flu gaining ground and that we are about to enter the prime time for flu, so preparation needs to happen now. Take the time to consider what you would do if a major outbreak occurred and make sure that you have all the items you need now.

Governor fires Nursing Board members

2009-07-21T15:09:00.003-05:00

On July 14, 20009, the Los Angeles Times reported that "Gov. Arnold Schwarzenegger replaced most members of the state Board of Registered Nursing on Monday, citing the unacceptable time it takes to discipline nurses accused of egregious misconduct.

He fired three of six sitting board members -- including President Susanne Phillips -- in two-paragraph letters curtly thanking them for their service. Another member resigned Sunday. Late Monday, the governor's administration released a list of replacements.

The shake-up came a day after The Times and the nonprofit news organization ProPublica published an investigation finding that it takes the board, which oversees 350,000 licensees, an average of three years and five months to investigate and close complaints against nurses..."

We will have to watch for what the fallout/impact/repercussions will be at other nursing boards. I hope the other states do not overreact to the problems in California because there must be balance for regulation to be effective.

Camp Nurses

2009-07-19T14:32:00.002-05:00

Sorry there have not been many postings, but summer is here and my husband (and I of course) volunteers to run the local Cub Scout camp. It takes up quite a bit of time which is why my blogging is scare this time of the year. Every year we are so grateful for all of the volunteers that take time off from work to sweat in over 100 degree weather and spend time with the kids. We are always grateful for the nurses that volunteer their time to staff the first aid office. This year kept them quite busy with several kids having heat exhaustion. It brings peace of mind to have trained and knowledgeable nurses available on site. So, to all of you nurses (and others as well) that take time to volunteer your time for Scouts, rescue groups, community services, etc. THANK YOU!!!

Tylenol and Soma

2009-07-01T11:51:00.002-05:00

Just a little info in case you missed it: The FDA is proposing restrictions on acetaminophen (Tylenol) because it is the leading cause of liver failure in the US. Soma has also been made a scheduled medication instead of a dangerous drug.

BON License Applications

2009-05-28T17:24:00.002-05:00

As new graduates are completing their applications for licensure, it is time to remind all applicants (and those nurses renewing as well) to be honest with the Board. I have found repeatedly that the Board's reaction is better when the nurse does not try to hide an incident.

Also, be very careful when answering the questions asked. If you are not sure if you should answer yes or no, please take the time to get competent advice. I have seen nurses end up with disciplinary actions because they answered no based on the advice of an instructor, an administrator and an inexperienced attorney. The deception to the Board was unintentional but it is still deception in the eyes of the Board and a disciplinary action is warranted--not how a new nurse wants to start their nursing career.

If your license application is still in the future and you have a criminal conviction (deferred adjudication etc.), it could be helpful to check with a criminal attorney to see if the criminal action could be expunged or sealed. Since the Board does not require a nurse to disclose an expunged or sealed incident, a nurse might be able to avoid a disciplinary action. Worth looking into.

New Continuing Education rules proposed

2009-05-28T09:48:00.002-05:00

The Texas BON has proposed new continuing education rules. These rules make some significant changes to continuing education requirements. According to the Board:

"Under the proposed new chapter, a nurse is authorized to demonstrate continuing competency through the achievement, maintenance, or renewal of an approved national nursing certification in the nurse's area of practice, as well as through the completion of continuing education courses. Recognizing this additional method of compliance provides nurses with the option of pursuing and maintaining a certification in a specific area of practice."

"The proposed new chapter also requires a nurse to demonstrate continuing competency in the nurse's specific area of practice. A continuing competency activity should incorporate and relate to the knowledge, skills, or activities performed or required by the nurse in his or her area of practice. In the case of a nurse educator, the Board anticipates that continuing competency activities related to nursing education should meet the requirements of the proposed new chapter." It is not clear how the Board is going to apply this to a nurse who does not have a specific area of practice. The time period to comment on the rules is until June 14th.

HB 3961/SB 1880 and TPAPN

2009-05-04T09:01:00.003-05:00

I have been telling all nurses to contact their Legislators to discuss HB 3961/SB 1880. HB 3961 passed the house and should be going before the Senate tomorrow!! You need to contact the members of the Health and Human Services Committee to let them know your concerns or even better come to the Senate Chamber and testify regarding the bills. The main issues that I have identified are:

1. Section 10(b): change the "shall" to "may" to give the Board an opportunity to consider mitigating factors that may not warrant a denial or revocation and make this applicable to current cases.

2. HB 3961 is missing Section 12 of SB 1880 which involves formal charges. If Section 12 from SB1880 is added, then to avoid current problems the following should be added:

Formal charges shall be filed at SOAH. (Sec. 301.458. Initiation of Formal Charges; Discovery)

3. Section 11: Does not allow for the times when the ingestion of a substance in inadvertent nor does it allow for false positives or for unusual situations where it is appropriate that a nurse not continue with TPAPN.

4. Section 8(g)(3): this requires the release of attorney work product and should be deleted.

I also see problems with Section 8, but I am not sure that anything can be done about it because of the push to put more restrictions in place regarding potential substance abuse.

Every Nurse Should Know About IBC

2009-04-21T09:40:00.004-05:00

As many of you know, my very close friend Victoria Berry,MSN,RN,CNS,CWCN passed away on April 7, 2009 from IBC/Inflammatory Breast Cancer. When she initially told me her diagnosis, I did not know that there were types of breast cancer nor did I know that this particular type does not show up with a lump. All the steps we have been told to watch for did not apply: self exams, mammograms

This cancer shows up with some, but not all of these symptoms: enlarged breast, redness, hot to the touch, rippled skin, inverted nipple. The symptoms can be so non-specific that it can be misdiagnosed as an infection, bug bite, irritation etc. Victoria had a negative mammogram 5 months prior to her diagnosis. Her IBC showed up looking like mastitis, but she had a very astute physician, Patricia Gunter, MD, who immediately recognized that the symptoms were more than they appeared and it was 2 weeks from the time the symptoms showed up and she was diagnosed with IBC. But, IBC is very aggressive and Victoria lost her battle a little over a year after being diagnosed. Nurses may the first one to see this disease so it is important that nurses know the symptoms in order to urge patients to see a doctor immediately. IBC is not a disease that can wait, it is considered an emergency because it is so aggressive. Also, urge patients to seek specialized care with health care providers that have experience treating IBC.

Below is a video from Komo News 4 in Washington. They have done multiple stories about IBC. They include a report about a 16 year old that died from IBC!

Nursing Jurisprudence Educational Seminar

2009-03-25T14:52:00.001-06:00

I am speaking at a seminar, "Avoiding Litigation", on April 4, 2009 at the Thompson Conference Center, Austin Texas. The one day event is sponsored by the Texas Nurses Association District 5 and is incredibly CHEAP to attend ($15 for TNA members and $30 for non-members)!!!!

Time is Almost UP!!!

2009-03-23T14:06:00.002-06:00

Have you contacted your Texas State Senator and Representative to encourage them to support HB 998? This bill helps nurses when they have an issue before the Texas Board of Nursing by making the administrative process much more fair. So please take the time to call/fax/write/email your Legislator and urge him/her to support HB 998.

Prevention of Medical Errors

2009-03-16T08:52:00.002-06:00

On last Thursday's ER, Dr.Carter was about to receive a kidney transplant and the whole surgery suite was rush-rush. Dr. Benton stopped the surgical team in order to go over a safe surgery checklist. He was berated by the surgeon for slowing things down and was told that it was not needed. Dr. Benton insisted and during the checklist, it was brought out that a fluid was missing. The surgeon said that they would not need the fluid, but nursing said that they would get it anyway. As the surgery progressed, there was a complication and the fluid was necessary to preserve the kidney and thus, make the surgery a success. Dr. Benton drove home the point that safety checklists are there for a reason and the reasons are good and valid.

I immediately thought of the five rights of medication administration. Too frequently, nurses bypass this crucial checks and balance safety checklist and the result is a medication error. Thank goodness, most of the time the error has no long term effect on the patient, but occasionally the result is death or serious harm. Nurses care for their patients and to cause harm is horrible and not something any nurse wants to go through.

So, even if it seems like a waste of time, you must take the time to do the safety checklists. Bypassing even one step could result in something tragic that you will have to live with for the rest of your life.

TPAPN - When Not to Go

2009-03-09T18:18:00.002-06:00

I have written many times on all of my blogs regarding the Texas Peer Assistance Program for Nurses. However, I have been receiving questions from nurses regarding whether they should go to TPAPN because they have been accused of diverting medication or because they have had a positive drug screen or because they are a recovering addict. Each case is different and there is no set answer, so a nurse should contact an attorney with experience before the Board and find out what option is the best for their situation. But, please do not agree to TPAPN if you do not have chemical dependency problems or if you are not an addict. And, do not agree to TPAPN if you do not understand what you will be required to do and not do while in TPAPN.

Do not believe a blanket statement such as "If you do not enter TPAPN, the Board will take away your license." Do not enter TPAPN just to avoid the Board - once again, TPAPN is for nurses with addiction issues or substance abuse/dependency problems and for nurses that are new to recovery or that have relapsed. TPAPN is not for nurses with a past history of addiction, but that have years of recovery.

In summary, do your research, understand your options and then take action, but make sure it is action based on knowledge, not fear.

HB 998 Needs All Nurses to Support It

2009-02-13T10:27:00.000-06:00

Go to Texas Jurisprudence and read about HB 998 filed by Fred Brown. It is a helpful bill and it needs to pass. Please take the time to contact your Legislators.

Nurses win in whistleblower suit

2009-02-04T12:03:00.002-06:00

Thanks to Ohio nurse attorney LaTonia Denise Wright for posting info about this news article, "Two RNs will be awarded 4.9 million dollars [out of a 24.7 million dollar settlement] in a whistleblower lawsuit" It is nice to see nurses receive justice.

Medical Hints

2009-01-16T10:01:00.003-06:00

Okay, maybe you already know about this, but since I just found it and thought it was cool, here goes: Medical Mnemonics is a website that gives you those helpful hints to remember medical tasks. Go have a look, very cool.

Malpractice Insurance - Get It NOW!!

2009-01-07T21:15:00.002-06:00

I know I have commented on this so many times, but there are still too many nurses still not get insurance on their careers. Please take the time to protect your livelihood. It is not that expensive and the benefits FAR outweigh the few problems.
Remember that the main reason to get malpractice insurance is to provide legal representation and expense reimbursement in case a complaint is filed with the Board of Nursing (it is appears much more likely that a nurse will be reported than ever before).

Another reason to buy malpractice insurance

2008-12-10T08:16:00.003-06:00

A nurse was recently sued by a patient's family (all the doctors and nurses involved were named in the lawsuit). Typically the hospital will provide legal defense for the nurses (but not always, be sure to read my other posts on malpractice insurance). In this case, the hospital had gone bankrupt and was no longer in business, which means---NO Paid Legal Defense for the nurses.

There are so many scary traps out there for the uninsured and here is another one to add to the list. This economy is tough and so you can expect more legal actions taking place and ALL health care practitioners should insure their licenses and their careers. Malpractice insurance is for more that defense in a lawsuit, it can also pay for your legal defense for a complaint with the Board of Nurses. Defense Attorneys recommend malpractice insurance in order to protect your interests and shouldn't you listen to those people who work to help you out.

In case you are wondering, I have no financial relationship with malpractice insurance carriers; I just see the financial problems caused by nurses having to defend themselves out of their own pocket and I hope to prevent the same problems for others.

Job Evaluations are not just for your job

2008-11-19T09:21:00.003-06:00

Do you realize that your job performance evaluations are reviewed by the Board? Whenever a complaint is filed, the Board requests copies of your personnel file including your last 2 evaluations. The Board reviews the personnel file because they are looking for a pattern of problems.

Your job evaluations can help or hurt you. It is hard to argue that you were attentive to patients and focused on their care when your evaluation states that there were complaints about you spending your time talking to co-workers or surfing the Internet. It is also hard for your employer to complain that you were a problem nurse when your evaluations show otherwise. So, watch those evaluations and if anything is incorrect in your file, be sure to correct it because you never know when someone may be looking.

Nurses and Addiction

2008-10-30T07:40:00.003-06:00

I still continue to find bias against nurses battling addiction. There continues to be a misconception that addiction is a personality defect or a choice. A recent article on Addiction Nursing was published in Advance for Nurses. This article discusses the specialty field of addiction nursing. I thought the article also contained a good description of addiction.

Berthilde Dufrene, MSN, RN, CARN, PRI-C writes, "Addiction is a chronic, incurable, but treatable brain disease. Patients with this disease undergo recurrent cycles of relapse and recovery. Much like other chronic diseases, such as diabetes, hypertension and heart disease, patients usually receive care during an acute phase of the illness and are stabilized with the aid of medication. Pharmacotherapy during the acute care stage aims at interrupting the addictive process through medically supervised detoxification and relieving withdrawal symptoms and discomfort.

Continuing care involves counseling and behavior modification with hope of guiding the patient toward a recovery lifestyle."

So, since addiction is a disease, why does it continue to be treated as a crime or a choice. Why are we so supportive of co-workers that are diabetic or have cancer, but we turn on nurses with drug or alcohol issues. Why are we not fighting to get a non-public rehabilitation order to help nurses with addiction (it also applies to mental illness). In Texas, physicians, physician assistants and acupuncturists all have the ability to be put under a rehabilitation order, which is a non-public, non-disciplinary monitoring of a practitioner's practice. Why is there such a push to punish addiction rather than support people on their recovery road? Some of this push comes from public advocacy groups, so why are we not educating them so that they see that the steps they have instilled have only resulted in health care providers not seeking help for fear of retaliation.

Horrible Medication Error!!

2008-10-14T09:30:00.002-05:00

A patient in error has an IV medication injected into his spinal canal and then learns that there is no cure for the error and that he will die a painful death usually within days. What a horrible medication error for a nurse or physician to have to live with. every day.

The ISMP error newsletter has a very good article on the erroneous intrathecal (via the spinal route) administration of IV vinca alkaloids, primarily vinCRIStine. The article has helpful hints regarding this error and other medication errors. Nurses should be reading every issue of this newsletter to help protect patients.

Buy Malpractice Insurance Now!

2008-10-01T17:35:00.003-05:00

All nurses that provide patient care should have a malpractice insurance policy. It is not enough that your employer covers you under their policy, every nurse should have their own policy. I think with the financial situation, it is even more important to protect one's career and how horrible to have to go without legal representation or reimbursement for expenses because of financial constraints.

You most likely have health insurance, car insurance and home insurance. Isn't your job worth protecting? Isn't your career more important than your car? You may never get sued, but the number of nurses being reported to the BON is increasing. Insure yourself and be protected.

What Did You Do?

2008-09-15T08:54:00.003-05:00

Since we are dealing the after effects of Hurricane Ike and I have posted about the need to be prepared for any disaster, I wanted to hear from any nurses affected by the Hurricane. What did you do in regards to work? Were you able to work? Did you refuse to work (if so, why)? What were the problems at work? What steps did you have to take to provide for your family while you worked? These comments may help others to see the issues that can occur and thus, help them prepare for future disasters.

So, leave a comment (no need to identify yourself). There is also a poll.

NOTE: The power is still not on in most of Houston and the remaining Gulf Coast, so it is of no surprise that there have been no comments from those impacted. Just another reminder for all reading that preparation needs to happen now. Perhaps once the power is back on and once lives are back to normal, I can get some comments in order to let others know what it was like for your fellow nurses.

Legislature, Are You Listening?

2008-09-02T23:10:00.000-05:00

The next session of the Texas Legislature is quickly approaching and movements are underway to decide what issues should be addressed by new statutes/laws. I have been asked what issues for nurses and the Nursing Board need to be addressed and changed:

1. The State Office of Administrative Hearings [SOAH] should make the final decision in a contested case hearing. Currently if a nurse chooses to go to a hearing before a SOAH Judge to resolve pending allegations the Judge is only allowed to issue a Proposal for a Decision and not a final decision. This means that the Judge’s decision is presented to the Nursing Board and the Board can decide whether to accept all or part or none of the Judge’s recommendations. Thus, after spending a great deal of time and money litigating the case, a nurse could receive a dismissal form the Judge only to have the Board reject that recommendation. The better resolution, and the more fair, would be to have the SOAH Judge be the final decision maker and if either side disagreed with the ruling, they can appeal to the District Court.

2. Deferred Adjudications should not be considered convictions. Frequently, individuals agree to deferred adjudications because they do not have the resources to fight the criminal charge or they are advised that due to external factors a jury/judge may convict them even though they are innocent or harsher sentences might be imposed then what was necessarily warranted. Some nurses are even told that the deferred adjudication will be removed from their record once probation is completed (NOT TRUE!!) or that the Board will not take action on a Deferred Adjudication (once again, NOT TRUE!!!)

Under the Board’s current rules a deferred adjudication subjects a nurse to the same punishment as a conviction. The nurse can attempt to explain the factors surrounding the decision to accept deferred adjudication, but if the Board decides against them, there is little recourse because of the statute. The Legislature should look at this part of the Nurse Practice Act again and consider the unfair impact it has and that it goes against the initial rationale for development of deferred adjudication provisions.

Inflammatory Breast Cancer

2008-08-14T12:07:00.002-05:00

My closest, dearest friend continues her fight against inflammatory breast cancer (IBC). If you have not heard about this disease, it is crucial that, as nurses, you know about this disease. It is very aggressive and often it is first diagnosed as a breast infection and precious time is lost searching for the right diagnosis. Since nurses may be the first health care provider to see a patient, it is very important that you are aware of the signs/symptoms of IBC in order to alert the patient's physician for further diagnostic tests. For more information:

The IBC Research Foundation has some helpful info, such as

There is more than one kind of breast cancer.

We have been taught and are reminded frequently by public service announcements and by the medical community that when a woman discovers a lump on her breast she should go to the doctor immediately. Inflammatory breast cancer usually grows in nests or sheets, rather than as a confined, solid tumor and therefore can be diffuse throughout the breast with no palpable mass. The cancer cells clog the lymphatic system just below the skin. Lymph node involvement is assumed. Increased breast density compared to prior mammograms should be considered suspicious.

Houston Chronicle - FORT WORTH, Texas - American Airlines will unveil two planes Monday featuring a pink ribbon running the length of the fuselage in
honor of its partnership with Susan G. Komen for the Cure, which includes a
$7.5 million pledge from the airline to research a rare form of breast cancer.

The two planes will be the first of eight featuring the pink
ribbon. In press releases Friday, both groups announced American's pledge
will fund research of inflammatory breast cancer, an aggressive and
frequently fatal form of the disease, at the University of Texas M.D. Anderson Cancer Center in Houston. Komen said that kind of breast cancer represents 2
to 5 percent of all breast cancer cases.

Dallas-based Komen said the grant will fund a team of patient
advocates,oncologists, pathologists and scientists working to
improve the ability to diagnose and treat the disease.

Fort Worth-based American, the world's largest airline, has
pledged to raise $1 million annually for eight years to fund the grant. The rest
of the money raised will fund health and community programs.

American said most of the funds will be raised at its annual American
Airlines Celebrity Golf and Tennis Weekend. (press release found in the Houston Chronicle. http://www.chron.com/disp/story.mpl/ap/tx/5932483.html

Also, there is a youtube video taken during the unveiling of the plane that features a survivor of IBC.

A change in name for APNs

2008-08-11T10:19:00.003-05:00

The Texas Board of Nursing posted proposed rules for advanced practice nursing. One of the proposed rules is to change the name of an Advanced Practice Nurse (APN) to Advanced Practice Registered Nurse (APRN) because it reflects that the nurse is both a registered nurse and an advanced practice nurse. There has also been some clean up to the advanced practice rules. The rules are available for comment at this time. [There are also other rules being proposed dealing with the Jurisprudence exam, fees, and vocational nursing education]

Extended Evaluation Program - EEP

2008-07-24T12:25:00.003-05:00

The Board has more information about the Extended Evaluation Program in their current newsletter. The article explains the basis for the program:

The EEP is primarily intended for nurses who have a one-time positive drug test without any other practice issues and who fail to receive a substance abuse or substance dependency diagnosis. Previously, when RNs and LVNs were reported to TPAPN by third-parties and failed to receive an abuse or dependency diagnosis they were ineligible for TPAPN participation and were subject to possible licensure investigation and action by the BON.

Please do not rely upon the availability of this program and take the risk of taking unprescribed medications or drinking prior, even the night before, a drug screen. The Board extends its concern to many areas that you may not initially consider to be within the scope of nursing practice. For example, a pre-employment screen where you are not working as a nurse when giving the screen, but if the screen comes back positive, you will be under the Board's scrutiny. Many nurses wish that they could go back in time and make a different decision when they borrowed their friend's medication and took it or went out to a party the night before they had to give a screen. Caution will help to avoid future headaches.

TPAPN, the BON and the future

2008-07-11T14:28:00.007-05:00

The BON is meeting July 17-18, 2008. One of the agenda items involves the Board's Legislative Appropriations Request. This is how the Board asks for money from the state to fund their activities. There were several issues brought up by the Board that I found interesting (and that also confirm what I have been telling nurses):

1. More nurses are finding themselves before the Board. The number of complaints is increasing and the Board expects 9200 complaints this year. Just two years ago in 2006 there were approximately 5185 complaints and two years before that in 2004, there were approximately 3690 complaints.

2. More nurses are choosing to fight the Board in front of a judge.

3. The cases that are going before a Judge are more complex. This means that there are more nurses challenging the Board rather than choosing not to show up at a hearing and losing by default.

4. More nurses are hiring attorneys to represent them before the Board. After hearing from prior employees of the Board that nurses should never represent themselves before the Board, I am glad to see that more nurses are seeking help when dealing with the Board.

5. The Board is getting tougher on nurses and nursing licensure applicants.

As part of the request, the Board is asking for funding for 3 attorneys, 2 legal assistants and 4 investigators. Below is part of this draft document involving the need for more money to hire more staff:

New Personnel Needed for Enforcement, Legal and Operation Processes -
The agency’s enforcement workload and expenses for its contested cases have steadily and rapidly increased and must be addressed in order for the Board to maintain its mission to protect the public and timely resolve its complaints. The Board needs appropriations to cover the increase in litigation related costs for its expert fees and witness fees. Additionally, the Board will need approximately eleven (11) additional FTEs for FY 2010 and FY 2011 for its Enforcement, Legal and Operation Departments in order to meet the growing demands. Six (6) FTEs are needed for an increased workload due to growing complaints and litigation. This number would include two (2) investigators; two (2) litigation attorneys; one (1)legal assistant; and one (1) administrative assistant. The agency will begin to process criminal background checks for students. The Board will need an additional five (5) FTEs, including one (1) administrative assistant, two (2) investigators, one (1) Attorney and one (1) legal assistant. Although this number appears to be significant, the rise in the number of investigations, plus the complexity of the Board’s disciplinary cases, supports the need to add enforcement, legal and operation staff in order to meet the agency’s mission and timely resolve cases. The Board in FY 2008 will likely receive 9,200 complaints leading to 2,400 disciplinary actions. By comparison, the Texas Department of Licensing and Regulation (TDLR) will have approximately 8,000 complaints in FY 2008 and will likely take approximately 1,240 disciplinary actions (TDLR Statistical Questionnaire, May 2008). TDLR employs thirty-five (35)investigators and ten (10) prosecuting attorneys. Other than the increase in volume of complaints, there are several other reasons why the Board’s enforcement cases will require more resources for the agency to meet its mission effectively and timely:

1. Complaints are increasing by approximately 15% annually;
2. Formal charges statistics and unresolved complaints statistics are increasing;
3. The Board’s policies have tightened with regard to enforcement and
eligibility;
4. Attorney representation has increased significantly; and
5. Proceedings before the State Office of Administrative Hearings (SOAH)
have become more complex.

We project that cost of adding eleven FTEs as follows: four (4) Investigator
IIIs - $167,576; three (3) attorney IIIs - $189,291; two (2) legal assistants -
$88,962; and two (2) administrative assistants - $62,156. Costs of computer
hardware (one time only) - $11,000. Costs of telephones (one time only) $2,750. Costs of Remodeling (one time only) - $11,000. Costs of Furniture (one-time only) $5,500. Costs of annual phone and internet connections - $1,100. Litigation and expert witness fees - $25,000. This will impact the Enforcement and Licensing Strategies.

Looking for a Nursing Job - Part II

2008-06-30T09:26:00.004-05:00

Dear Abby's column today (I read it in the Austin American-Statesman) has some additional hints for job seekers. These hints can also be applied to interactions with the Board as well, just substitute "the BON" for "employer". In case you don't have access to Dear Abby's column, I will summarize the column and also expand somewhat below.

A 26 year old small business owner lists some hints in response to issues he sees with potential job seekers, such as:

-Always present yourself professionally. Every contact with a potential employer is a potential evaluation of you, including emails (and phone messages).

-Read all the information about a position and the company before asking questions that may have already been answered.

-Use professional writing when corresponding. Using "text-messaging" slang is inappropriate. i.e. "Thnx 4 ur help."

-Proofread everything.

-Use an email address using your name or initials, because using addresses such as "badass" or "hotnurse" may send messages you do not intend to send to a potential employer.

-Take phone calls in a quiet place because background noise can cause problems. For example, someone yelling, cursing, crying in the background can have a negative impact on you.

-If you are evaluating multiple positions, do not tell a potential employer that you are waiting to hear from a "better" employer or waiting on a "better position". (Obviously, this one does not apply to the Board).

A very helpful column and don't forget the hints when dealing with the Board. People make first impressions and it is hard to shake those impressions once made. So, it is in your best interest to make sure that impression is one of a professional.

Now is the time to be politically active

2008-06-26T11:29:00.003-05:00

The Texas Legislature is currently looking at regulatory Boards and determining whether they need changes to their statutes and direction. For example, the Texas Medical Board has been holding town hall meetings across the state. Jeff McDonald over at Information for Physicians notes that these meetings are being held in the home cities of major Legislators, which makes it obvious that the meetings are not being held for the benefit of the public or the regulated physicians, but for the Legislature. Jon Porter at Health License Defense posts his thoughts about the meeting.

The Legislature is also looking at the other health profession boards as they prepare for next year's legislative session. Typically the only parties that let the Legislature know what they want in regards to health professions are professional organizations and consumer groups (see my blog on the town hall meetings and regulation in Texas).

TNA is in the process of gearing up for the 2009 legislative session and the National Nurses Organizing Committee has started working for next year's legislative session regarding mandatory RN staffing ratios, the right to advocate, and whistle-blower protections.

Are you a member of a professional organization? Are you letting that organization know the problems you are having with your practice? If you have interacted with the Board or if you have been following the BON's actions, are you letting your organization or your Legislator know what you like and don't like or what your concerns are?

If you don't participate, how can they know what is important to you?!!!!!!! Other professions have more say because they are more politically active. Nurses, routinely, sit by and let others make the decisions about nursing. Nurses are the largest health care profession, but we have very little power and our failure to step up and get involved and get vocal is a direct reason.

Looking for a Job

2008-06-25T08:30:00.003-05:00

I was at the Texas Board of Nursing yesterday and saw the new nursing licenses being prepared for mailing. While there a discussion was ongoing regarding new nurses and it then led to first impressions and job hunting. A lady stated that she was contacting a potential new hire to gather information and she encountered the new nurse's phone message. There was music in the background containing very inappropriate language, so the lady just hung up and never called the nurse again. Be careful how your "personal" life impacts your career. In this situation, a nurse was deemed inappropriate for a position based on a vulgar phone message.

Gotta Read This: Why you don't want a stupid nurse

2008-06-18T18:27:00.002-05:00

So, I was looking up some info on diabetic care and came across this posting, ponies from betelgeuse regarding "Why you don't want a stupid nurse" from 2006. I was so impressed with the frank discussion and explanation that I am putting it here, but I am also giving you this nurse's other blog site, Sinus arrhythmia, because she has some interesting stuff there.

Tuesday, October 24, 2006
Why you don't want a stupid nurse.
There's a blogwar going on this week between MDs and RNs. I'm not going to link to it, because the entire thing is infantile. The argument, in the few paragraphs that aren't raw insults and pissing contests, essentially highlights the deplorable state of communication between doctors and nurses.

Why do you care about this?

I'll tell you why you care that MDs and RNs do NOT communicate well. You have a body (presumably). The body will debilitate, sicken, fall apart and ultimately die. It is the way of bodies. It's what they do. When you come into the ER with chest pain, you bloody well want your nurses and doctors to be a flawless team, communicating well and quickly to save your life.

When your mother falls and breaks her hip, you bloody well want her nurse and her doctor to be on the same page on how to handle her pain and prevent infections. If something bad happens to your mom, you do not want a pissing contest between your nurse and your doctor. You do NOT want your mom's doctor to refuse to return pages at 0300 because he believes that the nurses "aren't calling for anything important". (True story.) The difference between 0300 and 0315 CAN be a big difference in your mom's condition. You do not want a doctor to prescribe some needed intervention for your mom, and have her night shift nurse just blow him off because she says, "Oh, that's just Dr. SonSo, he's not payin attention".

Complications will keep your mom in the hospital another week, exposing her to the most virulent germs you'll find anywhere, continuing her convalescence and worsening her overall health every single day. Fifteen minutes can mean a life-threatening drop of 10 to 20 points of systolic blood pressure (as it was in the case of the unreturned page.) (I got a specialty doc to get the fluids order. Patient went to the ICU, but lived.)

You care that doctors and nurses treat each other with mutual respect. You get sick, your spouse will get sick, your kid will get sick. It is what bodies do. You do not have to subscribe to the buddha's ideas to know that pain and suffering are unavoidable.

Okay, so say you're with me on this idea that nurses and doctors should treat each other with respect. You're a reasonable person. You're probably even a good person, and you think respect is a good idea. But you may not be a doctor or a nurse.

You're probably just Joe Person. What you can do to help fix any problem in health care?

So glad you asked.
1) Never say to a nurse "You're so smart, you should be a doctor." If I had a quarter for every time I heard that...

Here's what is wrong with that comment:
a) The implication that all nurses are dumb. Do you know how what it means when one pupil grows larger than the other? Think that a nurse, any nurse, needs to call the doctor at 0300 and what....ask them? By the time you're done dialing, patient's dead at worst, brain damaged at least. Some nurses are dumb. Some bankers are dumb. Some lawyers are dumb.

b) The implication that all doctors are smart. I guarrantee you that this is not true. Some doctors are most assuredly dumb. I work with one day in and day out, and I am leaving my unit because I can't stand how I keep preventing him from killing people. When the actionable event happens, I'm not going to be anywhere near it.

c) That nurses want to be doctors. I don't want to be a doctor. I chose to be a nurse. I gave up a fat salary being one of those scary-smart nerds who fix large computer systems to be a nurse. Money, above and beyond meeting my needs and wants-to-travel-and-buy-more-books, is not a motivator for me. Not being on call and working 80 hours a week is a motivator for me. Doctors spend five minutes a day with a patient, I spend 12 hours with them. Nursing and "medicine" (as if nursing isn't also medicine) are complementary pieces to providing good health care. One is not the flunked version of the other. Because doctors? The ones I know would not make good nurses.

2) Learn about what nursing is
The public doesn't know. They really don't. Do you know how I know this? Because since I've become a nurse, many of my dear friends find my stories apalling. Perhaps they think I'm painting myself a hero because of the times I say, "I stopped another person from dying yesterday." But every nurse does this every day to varying degrees of urgency.

TV has no idea what nursing is. I want you to understand that. When you watch tv, enjoy tv shows, think to yourself "This is fiction just like the Simpsons is fiction." Please. ER is a great show that shows doctors being heros, and Nurse Whatsername, Julianna Marguilies, going to medical school because she's Such A Smart Nurse. Don't even get me started on Grey's Anatomy. I hate that show.

Here's a fact to know: Doctors are not employees of hospitals. This is a fact in American hospitals. Doctors DO NOT WORK FOR THE HOSPITAL. The nurses do. Hospitals are run by nurses (or should be, they're actually run by MBAs, which is why health care is the state in which it is). Does it matter? No. But it should underscore that the doctors go home. Your doctor isn't available at many times of day/week. Who's there for you? Your nurse.

Nursing is about health promotion, and preventing disasters and complications. Pain and symptom management are things we do well, and work with the MDs to do well. I actually had a urology physician assistant once re-place a foley catheter into a man with prostate cancer and huge complications with his bladder function. The patient had been given dilaudid (high octane narc) for pain for the procedure. Good. The PA sat there, writing orders for the night, and I perched on the desk. PA says to me: "He shouldn't have any problems tonight." "Good," I said, "What are you writing for me for pain?" "He won't have any pain." I laughed. "Then you're writing your phone number down so I can call you at 2:30 in the morning when he complains of pain, right?" He looked at me, and I gave him dead-serious face. "Okay, here's an order for Vicodin." "Great. Thanks. Have a good, restful night." (Do you need to ask whether the patient needed the pain pill?)

You want that nurse who is good at predicting when you're gonna feel like shit. One who knows which med is gonna make you nauseated. One who knows you'll be in pain, and helps you avoid it.

Should you be in a hospital or your loved on is, ask your nurse questions. Lots of them. Most of us love to talk to patients, because hey, it's why we're nurses. I spent an hour with a patient and his wife two nights ago talking about "foot care and diabetes." Sound dumb? I mean, 'foot care'? Ask a diabetic who's had his foot amputated. There are a lot of them. It is one of the most common adverse conditions secondary to diabetes. Three nights ago, I noticed this patient has unequal pulses in his feet. The patient probably thought I was just being a sweet nurse and rubbing his feet to tuck him into bed. That's how people get the idea that we're dumb and sweet. We don't tell them the hundred little tiny things we watch for. I do. Not to show off, but because people usually really like to understand their bodies, particularly when they're sick. It gives them control over their lives, when almost everything about hospitalization and illness rips control away.

His right dorsalis pedis was weaker than on the left. Which meant either deep vein thrombosis, peripheral vascular disease, or some type of arterial insufficiency from the diabetes. A DVT could kill him, but I didn't think it was that. (Why? No "hot spots" on his calves, 0 pain, - Homan's sign.) So I go back to the desk and call Dr. Boob to ask for a NIVA, an ultrasound of his leg veins. After struggling with Dr. Boob not returning my page, and boring me with his self-importance, I got my NIVA order. Patient gets a NIVA in the morning, and it's negative for DVT. Had it been positive, I would have stopped the patient from dying by having that test done....based on my sweet "foot rubbing". It was pretty critical to rule out that as the problem. Don't you think?

So he's got arterial insufficiency, which is typical for diabetics. I talk with the patient and his wife talking about what this means, why they need to care, and what they can do to prevent becoming like my patient from last month with PVD...who had Boxing-Helena-esque gradual amputations. (I didn't mention that last bit.) You think the MD spent ANY time whatsoever discussing diabetes (a complex, lifelong disease process with huge implications for diet, lifestyle, constant medication administration and self-blood testing 4x/day, disease and medication side effects, not to mention family teaching on what to do when the patient conks out unconscious because of an adverse event), ....much less what to do differently to make sure the patient doesn't have his feet chopped off in 2 years?

Don't make me laugh.

Dr. Boob went in, asked "how physical therapy is going", said "we'll talk about discharge next week" and went home for the day. Of course, this is why I call him Dr. Boob. However, Dr. K, the consult doc who I do respect quite a bit...went in, discussed medication changes he'd made for the patient's discharge. (Again, this was Michelle, the night RN, leaving a note for the physiatrist about patient needs for insulin scrip before discharge because I'd spent an hour and a half the day before working with the patient on how to give himself insulin, what it does, how it works, etc.) So K made the decisions about what insulin he thought was needed for discharge. Cool. This is what I want docs to do. This is why "Dr. K" is "Dr. K" and not "Dr. Boob".

You want a smart nurse. You really, really do. Again I say, I'm not special. A lot of nurses can show you how much they know about your body and the medications your doc prescribes. A huge number of people don't hear the doc's explanation (if he or she does explain) about meds or diagnoses. They're in shock a lot. They're sick and feel shitty a lot. They need to hear things again (or for the first time). A lot of patients feel more comfortable asking someone they perceive as being sweet and foot-rubbing. They want to know about side effects. They want explanations in English, and forgive me, but that is one things doctors do NOT do well. It's okay. That's part of what nurses do.

The trouble with nurses is that we're bad at explaining what we do. Most second-career nurses who were in other fields before are exceptions to this. Nursing socializes itself to act meek or deferential. A century of the medical establishment running things is part of the historical reason, another other part we can blame on the very religious Florence Nightingale, who dictated that nursing have her interpretation of Christian values of self-sacrifice and poverty. Those of us who've been in other fields are used to talking about our work and many of us have been in fields where we're on even footing with other men, and are used to being regarded as professionals. Most nurses do not have this sensibility.

So I try to tell people that nurses are smart, and WOW, people believe me. When I was a programmer, I never had to insist "but programmers ARE smart". People know generally what geeks do. So I'm telling you stories about what nurses do. Pass it on. Please.

3) (And this is directed at Americans) Support legislation that nurses support.
Nurses get into the profession because we actually want to take care of sick people. We want the system fixed. We hate accepting an assignment of 8 patients and not taking care of any of them well because we're putting out fires all night. We know you hate it. We hate it more. Unionization has HELPED patient care in California, the studies show that. Yes, there is such a thing as nursing research and nursing journals. (There's New England Journal of Medicine and there's American Journal of Nursing.) Requiring a BSN degree as professional-entry nursing (as opposed to LPNs, Licensed Practical Nursing) has HELPED patient care in North Dakota.

So if you believe me about those things, it will actually indirectly help the cause. Your cause of wanting good health care when you need it.

I will rant later on the evils of Medicare, the abuses of the pharmaceutical companies. And what I think nurses need to do to fix nursing. As well as why you should care.

For now, that's my story and I'm sticking to it.
/jo, RN, BSN

Nursing Malpractice Insurance

2008-06-09T14:12:00.004-05:00

I have actually had several clients lately that have insurance and I am hoping that this is a new trend. Having financial resources available to fund your defense before the Board of Nursing is so helpful, not only does it take some stress off, but it also gives the nurse the resources to fight the BON if the nurse does not agree with the Board's punishment. So go read some of my older posts on insurance and don't delay, get insured today.

Protect Yourself Now

Malpractice Insurance Will Get You Sued

But My Employer Has Insurance

My Employer Will Pay for My Legal Representation

Suing Nurses

Renewing a License While Under Investigation

2008-05-09T09:56:00.003-05:00

You are under investigation and it is time to renew. Here are some answers to common questions:

1. Go ahead and renew. Do not put your life and job on hold while you wait for the Board to complete their investigation. If you have any difficulty getting your license renewed, contact an experienced attorney. For example, if the Board tells you that you cannot renew due to the investigation or due to formal charges being filed.

2. Start the renewal process as soon as you are able to. The Board allows you to renew 60 days prior to the end of your renewal period. For example, if your renewal month is June, you could start the process on May 1. You want to start early because you will most likely have to submit the renewal by mail and not do it online.

3. The Board has stated that the answer is "no" to the question "Are you currently the target or subject of a grand jury or governmental agency investigation" if you are under a current Board investigation because obviously the Board knows if they are investigating you. This question is asking about any other Board/agency or grand jury investigation.

4. Take your time and answer each question truthfully. Keep a copy of your renewal (actually every nurse should do this for every renewal, not just when under investigation and fyi you are able to make a copy of each renewal page when online)

Looking for nursing websites?

2008-05-05T04:12:00.001-05:00

If you are looking for some old favorites or maybe want to explore some new, have a look at RNCentral.com's listing of 100 useful websites.

It Is Nice For A Change

2008-04-10T10:36:00.003-05:00

At the next Texas Board of Nursing meeting, the Board staff is requesting the following according to the agenda for that meeting:

That the Board reduce the renewal fees for Registered Nurses from $67 to $65 and and for Vocational Nurses from $58 to $55 due to a $4.75 reduction in the fee for an FBI
fingerprint-based criminal background check and the increased income from a higher number of RNs and LVNs renewing their licenses. Any excess funds collected from licensees go into the general revenue fund (which means that the excess money goes to the general fund for Texas for all agencies to use and that the excess money cannot be used by the Board of Nursing although they would raise it).

It is nice for a change for the government to try to save us money rather than always taking money from us. Hopefully this rule change will be approved.

The BON may just be the beginning

2008-03-27T07:23:00.003-06:00

A nurse is offered a voluntary surrender to settle the allegations against the nurse at the BON (or maybe the nurse is suspended or revoked, losing his/her license). The nurse agrees to the surrender because the BON tells the nurse that he/she can request the license back after one year and that the nurse either give up the license or have it taken away (more about this later). The nurse is able to work as a nurse aid or even a secretary for a hospital in order to bring in some money to his/her family, right? that type of work does not require a nursing license, so it is acceptable for the nurse to use his/her knowledge as long as the nurse does not overstep professional boundaries, correct?

Not so fast--there is another governmental agency ready to have a go at the nurse. Years ago, Congress gave power to the Office of Inspector General (OIG) to punish physicians who committed fraud in the Medicare program by excluding the physicians from the ability to get reimbursement. The power given to the OIG has increased so that it is no longer limited to only Medicare fraud. The OIG can exclude anyone, not just physicians, but also nurses, aides, administrative personnel, therapists etc. An exclusion means that the person cannot get Medicare reimbursement or work for any entity that receives Medicare reimbursement.

The OIG has two types of exclusions: 1) mandatory, meaning that there is no recourse to argue mitigating factors in order to decrease the amount of time excluded, and 2) permissive, which does allow the presentation of mitigating factors.

The type of actions leading to a Mandatory Exclusion according to the OIG's website are:
1. Conviction of program-related crimes Minimum exclusion period-5 years

2. Conviction relating to patient abuse or neglect Minimum exclusion period-5 years

3. Felony conviction relating to health care fraud Minimum exclusion period-5 years

4. Felony conviction relating to controlled substance Minimum exclusion period-5 years

5. Conviction of two mandatory exclusion offenses Minimum exclusion period-10 years

6. Conviction on 3 or more occasions of mandatory exclusion offences Permanent exclusion

7. Failure to enter an agreement to repay Health Education Assistance LoansMinimum period-until past due loan obligation is repaid

You are not protected by having pled nolo contendere or received deferred adjudication because the OIG's definition of conviction is as broad as most of the BON's.

There are many more permissive exclusions and here are some of those that may impact nurses:

1. Misdemeanor conviction relating to health care fraud. Minimum exclusion period -3 years.

2. Misdemeanor conviction relating to controlled substance Minimum exclusion period -3 years.

3. License revocation or suspension.Minimum exclusion period - the same or greater than the time period imposed by the state licensing authority

4. Default on health education loan or scholarship obligations Minimum exclusion period -until default has been cured or obligations have been resolved to Public Health Service's satisfaction

So, with the example above, the nurse voluntarily surrendering the nursing license would soon receive a letter from the OIG informing the nurse that he/she is being considered for exclusion from Medicare reimbursement. Since this is a permissive exclusion, the nurse can hire an attorney and attend a hearing to argue why the exclusion should not apply. So much for surrendering in order to reach a quick resolution.

It is an election year, which is the perfect time to advocate through your professional organizations that the broad exclusions need to be scaled back down to those actions that affect the Medicare program and not as another level of punishment for licensure actions or criminal incidents.

Now to revisit the other problem with voluntary surrender: Another problem with voluntary surrender is that in Texas(I do not know what other states do, but I do know that there are many states that do not accept the surrender of a license), nurses are told that they can reapply for their license in one year. So, the nurse submits a reinstatement packet and appears before the Board only to be told that not enough time has passed or that the nurse needs to meet certain requirements and then apply again in a year (requirements the nurse did not know he/she would need). I hear from many nurses that are distraught because they thought it would be an automatic reinstatement when they gave up their license a year previously.

Office of the National Nurse

2008-03-06T17:35:00.003-06:00

There is a movement to establish an Office of the National Nurse. I think this would help to elevate nursing in the public's eyes. According to the organization promoting this position:

An Office of the National Nurse would:
Establish symbolic national leadership by elevating and strengthening the Chief Nurse Officer of the USPHS to make this position visible to the nursing profession and the public.
Compliment the work of the US Surgeon General.
Promote involvement in the Medical Reserve Corps to improve the health and safety of the community.
Incorporate proven evidence-based public health education when promoting prevention.

There is much more information available at the blog www.nationalnurse.blogspot.com

Helpful Clinical Information for Nurses

2008-02-19T11:08:00.001-06:00

I found a new blog packed with helpful information on clinical issues: Dear Nurses. Go check it out.

Nurses Rock!!

2008-02-18T15:02:00.002-06:00

The results of the Gallup poll for which occupations rate the highest when it comes to honesty and ethics. Once again nurses rule!!

The article states "Eighty-three percent of Americans rate nurses' honesty and ethical standards as very high or high, easily the most positively rated profession. Nurses were first included in 1999 and have averaged an 81% very high/high rating since then. That has been good for first place each year except 2001, when firefighters were included after the 9/11 terrorist attacks and received a 90% rating."

Funny patients and how to fix health care

2008-01-30T17:25:00.000-06:00

I just read a fun blog that has a funny post about terrible patients and a list of ways to fix health care; both are an interesting read. Go have some fun.

Texas Medical Board Attorney

2008-01-20T22:12:00.000-06:00

I have received calls from physicians that find my blogs asking me to represent them before the Texas Medical Board. I refer physicians to one of my law partners, Jeff McDonald, Jon Porter or Tim Weitz. Please go to our website at www.healthlicensedefense.com to read the bios of each of my partners.

Board stipulations

2008-01-15T13:12:00.001-06:00

If you are under stipulations by your Board of Nursing, here are some helpful hints for a Board Order/Stipulations/Restrictions:

-Make sure you understand what is being required of you. Read the Board's Order completely and ask questions as needed.

-Be sure that you comply in all aspects with the Order/Stipulations/Restrictions because the Board gets very angry with nurses that agree to certain stipulations or restrictions and then fails to adhere to those stipulations or restrictions.

-Keep a record of all conversations you have with the Board staff (name, date, time and exactly what was said). If the conversation was important, follow it up with a letter detailing your recollection and understanding of the conversation.

-When sending in any information or documents, send them by certified mail, return receipt requested so that you know when the Board receives it.

-If documents have to be filed with the Board by employers or supervisors, set up a way for your employer/supervisor to notify you when the report/document has been sent to the Board so that you can ensure that the report/documents are sent in timely.

-Set up a calendar system so that you can keep track of deadlines and submission requirements.

-If you are subject to drug screens, have a system (calendar, another person) to check that you called in as required each day. Also, be VERY CAREFUL with EVERYTHING that you put in your mouth because you could hurt your sobriety record.

-Do not wait until the last month to obtain any required courses. Many approved providers give a limited number of courses per year and so it is better to take any required courses immediately so that you do not miss out.

-Keep the Board informed of any changes in your address or phone numbers.

-Keep copies of all documents in an easily retrievable, organized manner.

A Fun Look at Nurses

2008-01-07T16:24:00.000-06:00

Be sure and read the current article "What Makes Nurses Tick" in the December issue of Advance For Nurses. It is information about what nurses have stated that they like and think. I thought the answer to "What medical TV show do you most enjoy" was interesting. The number one answer was "House", followed by "Grey's Anatomy" and closely by "ER". So the top two answers are shows that rarely show nurses and that are full of inaccurate representations of the medical field (not to say that I don't watch these shows as well). My personal peeves are when it is always the physicians who are first at the bedside in a CODE, surgeons scrubbing without having their masks already on, and people stripping their dirty gloves off and throwing them all over the place (not to mention how they remove their gloves). Go read and have fun.

Stop Nursing Violence

2007-12-12T09:28:00.000-06:00

This is such an important issue that I am posting it on each of my blogs. Go to my "A Nurse Attorney's Thoughts" to read my post on horizontal violence where I discuss "nurses eat their young."

Changes for the Texas BON

2007-12-06T18:15:00.001-06:00

This was sent by the Board to the Workforce Commission:

BOARD OF NURSE EXAMINERS
Fiscal Year 2007-2011 Workforce Plan

D. Anticipated Changes to the Mission, Strategies and Goals over the
next Five Years
The BNE is currently under Sunset Review in this biennium. We anticipate
changes in our mission to include regulating Certified Nurse Aides. We also
anticipate moving towards a “semi-independent” agency status. We see
changes in how we approve nursing schools by increased reliance on outside
accrediting entities. We have implemented some strategies to go “paperless” by
using available technology and plan to implement additional strategies in the
future. We anticipate the continuing education process to evolve into a
continued competency model to include portfolios and practice targeted
requirements.

I do not know what "semi-independent" agency status means, but I thought it was interesting that there is a plan to regulate CNAs. I am worried about the continuing education plans because I have heard complaints from nurses in other states that have practice requirements. I do not know what "portfolios" means.

What do you think?

Emails and employers

2007-11-26T11:51:00.001-06:00

Be very careful what you put in an email (or an online posting for that matter). Remember that anything you put in writing can have the potential to harm you. Here is a recent case that should even drive that home more:

In Scott v. Beth Israel Medical Center, Inc., 2007 WL 3053351 (N.Y. Sup. Ct.
October 17, 2007), the court held that e-mail messages between the plaintiff
and his personal counsel were not privileged because the client's e-mails
were all sent thru his employer's server and the employer's e-mail policy
stated clearly: (i) its e-mail system should be used for business purposes
only; (ii) all communications over the hospital's system were the hospital's
property; (iii) no employee had a right of privacy w/ respect to messages
sent or received over the hospital's systems; and (iv) the hospital reserved
the right to access and disclose such communications at any time w/o prior
notice. The court cited In re Asia Global Crossing Ltd., 322 B.R. 247
(S.D.NY 2005) and Long v. Marubeni America Corp., 2006 WL 2998671 (S.D. NY
October 29, 2006). The court in Long reached the same result on similar
facts. The court in Asia Global Crossing did not find a waiver of privilege
because the substance of the employer's policies and the extent that the
employer's policies had been made known to employees were disputed.

Do patients really know about themselves?

2007-11-15T14:20:00.002-06:00

I was sitting in a patient waiting room today and overheard one patient ask the person with them, "What is that medicine I am allergic to?" The two then proceeded to try to remember which medication it was and listening to them was frightening. The lack of knowledge about something so important serves as a reminder to caregivers:

Be sure to stress the importance to patients that they keep a list of allergies in their wallet and that it applies to any allergy, not just medication.

Question patients carefully regarding allergies and the reactions experienced to the allergic incidents. And document everything.

Peer Review Rules - Pay Attention

2007-11-06T11:19:00.000-06:00

The Board of Nursing has proposed new rules concerning Peer Review in Texas. Be sure to read these today and if you disagree or agree with any of the proposed rules, send a comment immediately to the Board and contact your nursing organization and let them know your thoughts. These rules have the potential to affect your license, so do not sit by and be uninformed.

Stay Informed

2007-10-30T12:02:00.002-06:00

Be sure to read my post about what is happening at the Medical Board because it might affect the Texas Nursing Board.

The Questions the BON Asks

2007-10-19T10:28:00.001-05:00

The Texas Board of Nursing has changed their questions on licensure renewals and applications for licensure. For renewals, they stopped asking if a nurse has "ever" been convicted...and now ask if a criminal action has taken place within the past 24 months or since the last renewal. For both renewals and applications, the Board has phrased the question in bullet point format. They included military actions and a broad question about being "cited or charged with any violation of the law."

The Board finally quit asking nurses to disclose expunged and sealed offenses, but they are putting the burden on nurses to ensure that the criminal activity has truly been expunged. This is a big problem in that people are frequently told their criminal history has been expunged when in fact, it has not. So, be sure that you have proof of the expungement in the form of a copy of the Court Order expunging and/or sealing the offense(s). The Board recommends that a nurse provide a copy of this Court Order along with your renewal or application. However, they do not require it. So, before providing expunged or sealed information to the Board, it would be prudent to discuss the matter with an attorney to determine whether just having a copy of the Court Order is enough and that you do not need to provide that copy to the Board.

The Board has also added a question about whether the nurse is "currently the target or subject of a grand jury or governmental agency investigation." Remember to read the questions very carefully and seek legal advice when there are any questions. The Board considers non-disclosure, even when done in error, to be potential deception and subject to action.

Think For Yourself and Question All

2007-10-05T16:34:00.001-05:00

I was driving home last night listening to a talk radio show. On the show the host was discussing whether a woman that had a mastectomy due to a misdiagnoses should be allowed to sue the doctor for a simple error. The host continued his discussion stating that simple errors should not be cause for litigation and that since the doctor did not intend to misdiagnose the woman, the doctor should not be sued. The host was getting very animated with each caller, discussing how he never sues anyone and that we are all litigation happy. The various callers were discussing how they would either only give the woman the cost of a "boob job" or give her nothing. The host was using all of this to continue to project how we need reforms and that lawsuits cost us all. He would spend a great deal of time with the callers that were agreeing with his premise of too many lawsuits, continuing to ask them questions to draw out more discussion about how this woman deserved no or little money.

I had heard the woman earlier that day describing what had happened and knew that the talk show host had key facts wrong. I called in and waited to talk to the host.
Since there had been discussion about the most this woman should expect to compensated was for the cost of a simple "boob job," I felt compelled when I FINALLY got on the air to discuss this misconception. I explained that the woman was facing extensive reconstructive surgery , not a simple breast enlargement and that her breasts would never be the same as they were before. I explained that women can have significant complications after reconstructive surgery so there was nothing simple about it.

I then proceeded to tell the host that this was not a simple error involving a doctor, instead it was a lab cutting corners and performing multiple tests at once to save money. And that due to the cutting corners, two women have been injured - the one who had the mastectomy and did not have cancer and the woman who did have cancer and has gone untreated for many months. The host then made a statement that surely I was in favor of cutting costs. When I replied, No, not when it ends up inflicting damage on people and I also added that there are continued cost cutting even when the corporate revenues are up and that patients are the ones being harmed and they have no recourse in many situations, but I was hung up on so that it seemed that my last statement was No, not when it ends up inflicting damage on people.

So, the radio station/host was editing people's comments to promote their agenda of too many lawsuits. Instead of allowing me to discuss the issue completely, they hung up on my call. I continued to listen and noticed that I could often pick out exactly when they hung up on other callers that disagreed with the host.

I thought here is another example of how the media is crafting what we hear and see to lead us to their ideas. They are not interested in the truth, but rather what makes better entertainment. I have been present when a person was interviewed for a story, yet when I watch the interview on TV the context is vastly different than what the reality was.

Once again, as nurses you have a scientific mind and you should utilize that mind to question what you are told and shown. Be an individual and investigate the truth. Make up your own minds and take action based on what you know to be right. Others are looking to you to be a leader or at least completely informed. Just because a co-worker, or administrator, or physician or a talk show host tells you something, you must decide for yourself what is correct. If you do not have enough information to determine what is the truth, investigate it until you are an informed nurse.

Just my thoughts, you can disagree, but then again that is the point--question and think for yourself!

Diaster Planning

2007-10-01T09:28:00.000-05:00

I just saw an ad on TV for people to learn about disaster planning for an pandemic. So, my question of the day for nurses - Are you prepared in case of a disaster? I don't mean if your employer has a disaster plan (let's hope they do). I am asking if you have a disaster plan for you and your family. Nurses are going to be heavily relied upon if a disaster strikes and you must be prepared on the home front. If you are tied up assisting, what is your family going to do? Do you have enough food, water? Do you have a communication plan? Will you have to go in to work or report to a regional site? Who will watch your kids? Is your spouse/significant other aware of the plan? What if you have to evacuate your family? your pets?

There are multiple sites with checklists that help to address these issues and help with planning. Be sure to do this today. And while you are at it, don't forget to draft a will.

Can TPAPN Help?

2007-09-24T08:52:00.001-05:00

Frequently, I get inquires from nurses that have been referred to TPAPN (Texas Peer Assistance Program for Nurses) and the nurse was wondering if they should go to TPAPN. If a nurse has substance abuse/addiction issue or mental health issues, TPAPN can be a beneficial rung on the ladder to recovery or health and the nurse should definitely consider entering the program. TPAPN offers not only recovery support, but also the ability to avoid a disciplinary action by the Board.

But, if a nurse is thinking of going to TPAPN solely to avoid being reported to the Board, the nurse should know this is risky and frequently backfires. Several steps in the TPAPN process require a nurse to admit to being an addict or alcoholic and to continue to do this when a nurse is not; it begins to wear on the nurse (especially with the emphasis on truth and accountability in the recovery process). Also, once a nurse admits to a problem it is very difficult to back track and declare there is now no problem. I have heard from nurses that have come close to completion of the TPAPN contract and then decided they can’t “live the lie” anymore and they announce they are not an addict and don’t belong in TPAPN. If this nurse was a third-party referral, TPAPN must report the nurse to the Board, which puts the nurse right back where they started.

How to Find a Nurse Attorney

2007-09-10T10:16:00.001-05:00

I often get inquires from nurses in other states looking for an attorney to represent them before their state’s nursing board. Since I can only represent nurses before the Texas Board of Nursing I wanted to give some hints for nurses to find an attorney in their state. The area of law involved is Administrative Law, so you want to look for an administrative lawyer, not a family law lawyer, not a criminal defense attorney, not a medical malpractice attorney, and on and on. Look for recommendations from –

· State nursing association
· The American Association of Nurse Attorneys referral line (1-866-807-7133)
· State Bar
· co-workers, supervisors (if appropriate)
· sometimes even the Nursing Board will provide names of attorneys that frequently practice before them

Search
· online
· yellow pages (although most attorneys seem to be placing their advertising money into internet advertising)
· professional journals
· articles

Jurisprudence (Nursing Law ) Seminars

2007-08-29T09:24:00.000-05:00

I am going to be speaking at the San Antonio Advance for Nurses Job Fair. I am thrilled to be able to speak before the nurses attending the job fair, but I find these frustrating because I only have an hour and there is SO MUCH I want to tell nurses. When I give seminars, I spend 6-8 hours cramming in all the information nurses need to know (not dry, I include lots of humor and interesting facts to keep you interested).

I have been asked when are my next seminars. The problem is that too many of you are getting your CUEs online or by mail and the demand for speakers to give in person seminars has diminished. I am looking for a seminar company that is still providing in person seminars and occasionally, hospitals hire me to come speak to their nurses, but so far no seminars are scheduled. I am finishing up my book and looking for a publisher, so that may be the only way to get all the information out to nurses. Thanks for all your inquiries.

Careful Advance Practice Nurses

2007-08-07T18:44:00.001-05:00

I just heard from another APN that was about to accept a position and was relying upon the assurances of the agency/employer that was offering the position and the assurances were incorrect. It is your license, so you have to know the laws and requirements for practice. Do not rely upon someone else's assurances. Also, be sure that you check all paperwork because if there is an error, you are the one in trouble.

APNs tend to get in trouble over paperwork issues, not patient care issues. It is extremely heartbreaking to have a nurse in trouble for signing a paper they did not review closely or for following the recommendations of an administrator at an agency.

Watch out when renewing your license

2007-07-20T22:40:00.001-05:00

Be sure to watch for when it is getting close to your renewal period for renewing your license. The Board is getting fingerprints on every licensed nurse that has not already submitted fingerprints and they are also conducting CEU audits. So, if you wait until a couple of weeks prior to the end of your renewal period, you might find yourself without an active license to practice with. And do not be fooled by the Board's wording about "delinquent" licenses, if you do not have an active license, you can not work as a nurse. There is no grace period while your license is delinquent.

So, play it safe and renew 2 months prior to the end of your renewal period.

Laugh a Little

2007-07-07T12:57:00.002-05:00

Here is a little humor for the day:

Hospital regulations require a wheel chair for patients being discharged. However, while working as a student nurse, I found one elderly gentleman already dressed and sitting on the bed with a suitcase at his feet, who insisted he! didn't need my help to leave the hospital.
After a chat about rules being rules, he reluctantly let me wheel him to the elevator.
On the way down I asked him if his wife was meeting him.
"I don't know," he said. "She's still upstairs in the bathroom changing out of her hospital gown."

Sicko

2007-06-30T14:19:00.001-05:00

Don't forget that Sicko, Michael Moore's look into healthcare in America hits the screens this weekend. So far the ratings have been good by film reviewers, but there is another take on NursingLink.com. So, it seems the answer will be to see for yourself.

The Nurse's Chapel

2007-06-26T18:28:00.002-05:00

Go have a look at the blog "Running with Scissors". There are some incredible pictures shown on the blog that were taken inside the Nurse's Chapel in Westminster Abbey.

Continuing Education Changes

2007-06-18T15:06:00.001-05:00

The Board has posted new proposed rule changes to section 216 "Continuing Education". The Board used to audit the CEUs for randomly selected nurses and if they were found to be lacking the required number of hours, an investigation was opened and disciplinary action taken, which might eventually result in suspension of the nurse's license. The new rules will have the Board doing random audits, but if the nurse is non compliant the nurse's license will not be renewed. This makes the process of stopping the nurse from practice much quicker. The nurse can still be investigated and additional disciplinary action taken. Then, if a nurse is found non-compliant and does not get renewed the very next renewal period the same nurse will also be subject to an audit.

I really dislike this rule because it takes nurses out of practice for something as simple as not enough CEUs or not responding to the Board (another reason to be sure that your address is kept current with the Board) when audited. CEUs are not a way to maintain competency, as anyone who has done a home study or online study knows and to use CEUs like this does not appear to be a good use of regulatory power.

Texas nurses need to join nursing associations and fight rules like this!

No more Texas Board of Nurse Examiners

2007-06-18T09:13:00.002-05:00

Okay, I know that title got you riled up or maybe excited or maybe worried, but it is true. This legislative session produced legislation that will change the name of the Texas Board of Nurse Examiners to the Texas Board of Nursing. This is one of the changes requested by the Board during the Sunset Advisory Commission's review of the agency last year. Continue to watch here for updates on the changes to nursing from the new laws.

Changes Coming

2007-06-15T08:22:00.001-05:00

The Star-Telegram published an article about the Board of Nursing in Texas. The article details the Board's reputation for being the most aggressive Board in Texas and at the forefront of nursing regulation in the country.

Nurses in other states should watch Texas because Texas seems to be the pioneer for nursing regulatory agencies in that they are usually one of the first states to initiate various regulatory actions. For example, nurses in other states should watch for criminal background checks for ALL licensed nurses to come to their state. Texas has been doing this for a few years; all nurses that are actively licensed are requested to provide fingerprints and if a background check shows an undisclosed criminal action, the nurse is subject to investigation and possible discipline.

For a long time I have cautioned Texas nurses that the Board of Nursing may follow what the Medical Board has been doing and this article confirms that the changes are coming: The board lists the names of nurses that have been disciplined along with which sections of the law the nurse violated. The article interviewed Board Staff and reported that "in the next few months, it will beef up that portion of the site to give detailed information about specific violations."

Clarification on Process at BNE

2007-06-12T11:23:00.001-05:00

I just got back to my office after representing a individual applying for a license in Texas at the BNE. While there, some of the nurses were discussing what they thought the process would be like when they spoke to the Board. They all thought that it would be in a court-like setting and that they would testify "on the stand" or behind a podium. Wanting to alleviate any stress caused by these perceptions, I explained that the Texas Board of Nurses holds their disciplinary proceedings (Informal Conferences)or Eligibility and Disciplinary Committee meetings in a conference room within the Board. The room is also a library so there are books lining the walls. There are two tables arranged in a "T" fashion in the middle of the room. The larger table is where the Board members/staff sit and the smaller conference table is where the applicant/licensee and his/her attorney sit. No one stands to speak and there are no courtroom type procedures. The Texas Board of Nurse Examiners have gone paperless, so they will utilize laptop computers during the proceedings.

Not even one drink...

2007-06-08T01:42:00.001-05:00

I had posted this earlier on A Nurse Attorney's Thoughts, but because I am hearing from more nurses that have gotten themselves into trouble due to bad decisions while under the influence of alcohol, I am going to post the information here:

Do not take even one drink and drive because it is too costly: not only could you kill or harm yourself and others, but if you are arrested, you start down a course that can have extreme adverse results. DWIs/DUIs are expensive. A recent article in the Austin American-Statesman listed the various costs associated with a DWI. When I added up the high ranges for these costs it came to approximately $50,000 and that did not include recurrent costs such as drug screens. Then you are faced with the criminal repercussions. In addition, if you are licensed by a regulatory board, you will most likely be investigated for possible intemperate use.

For example, a nurse accused of intemperate use must prove his or her sobriety (the DWI or positive urine screen is used by the Board as evidence of the substance abuse). It takes a lot of time and money and produces quite a bit of stress to prove one's sobriety.

It is so much easier and cheaper to just pay for a taxi or have a true designated driver. Also, these decisions must be made prior to engaging in drinking because once a person drinks, their decision-making can be impaired and they will think that they are fine to drive. I represent many health care providers that are accused of substance abuse/addiction and they will agree - Not even one drink if you are going to drive!

Documentation Again

2007-06-04T14:19:00.001-05:00

Documentation is so important for nurses that I think it is important to share this post from Texas Nursing Documentation:

Who Cares About Documentation

Who Cares About Documentation? Nurses had better care and take action. Documentation is required as part of the nursing process. Documentation is not just some tedious task that can wait till the end of the day. A lack of documentation or inadequate documentation lends creditability to the premise that the nursing care was not provided. Inadequate documentation is a violation of the Board's rules and regulations and it can seriously harm a nurse in lawsuits as well. I hear over and over from clients that they wished they had documented "such and such" and "If only I had documented, I would not be before the Board." Nurses must change their way of thinking and organize their workdays so that they can timely and adequately document.

Nurse Practitioners

2007-05-31T14:58:00.001-05:00

Most of my clients that are nurse practitioners are in trouble before the Board of Nurses not because of patient care issues, but rather because of a failure to follow (and usually understand) the rules and regulations governing their nursing practice. It is crucial that nurse practitioners take a copy of the rules and regulations and use them as a check sheet. These rules apply even if a NP is only covering for a colleague.

The American Association of Nurse Attorneys has a book available regarding the law and nurse practitioners (click on marketplace, then on online store:TAANA products). I have not personally seen the book, but it may be worth looking into. It is also very important for NPs to be a member of nurse practitioner associations so that the NP will be informed of any new laws.

Nurses on TV

2007-05-28T17:37:00.001-05:00

Just a quick note: I found a great discussion on the history of nurses on TV at Nurse Ratched's Place. It brought back great memories and I thought some of you might like to see it.

The Best Attorney for the Job

2007-05-28T15:45:00.000-05:00

A previous post explained why nurses should never represent themselves before the Board of Nurses and that they should hire the best attorney available. Now, what is meant by "the best attorney?" Whenever hiring an attorney for any legal work (Board, malpractice defense, real estate, family law etc.), a person should look for an attorney that is knowledgeable and experienced in the particular area of law involved.

Board Certification in the particular area is a good indicator of experience and knowledge. However, when it comes to representation before regulatory boards, it is important to inquire as to whether the lawyer has experience before that particular board and how much experience (how many years have they been practicing before the Board, how many of their clients are nurses). Success with administrative boards often depends on knowing the staff, the policies, and their usual methods.

Be sure to talk to the attorney you are thinking of hiring. Do they return your calls or emails? Do you only get to speak to their secretary or assistant? Do they seem to know the law involved or do they always tell you that they will have to "research" a particular issue? Do they seem to know the people that work at a Board and the ways in which the Board functions? You may want to speak to 2-3 different attorneys because everybody has a different personality and approach to practice. The key is that you want to be able to trust your attorney and have confidence in their representation of you. Because you will be working together for a while, you should also like your attorney and feel comfortable with them.

Hint: Cost is no indication of quality. Attorneys charge different fees based on their experience, education, certifications, overhead and caseload. A good lawyer could be expensive, moderate or inexpensive. The key is to find someone that meets your needs, that is experienced, and knowledgeable. But above all -- DO NOT REPRESENT YOURSELF!

There are some areas of caution to be aware of:
I received several phone calls last year from an attorney Board Certified in Administrative Law (the type of law involving regulatory boards) asking questions about the Board of Nurses and how they functioned. Although this attorney was Board Certified in the particular area of law, he stated that he dealt with real estate and did not have any experience before the Board of Nurses. He was calling for a friend that needed representation before the Board and he was going to refer him to me once he convinced the friend to hire an attorney. The friend never contacted me and now this same attorney is advertising that he is a specialist in occupational licensing defense.

With tort reform changes, there have been many attorneys leaving or branching out from malpractice defense work. Several of these attorneys are looking to administrative law as a new practice area. These may not the best attorneys to choose because of their perceived lack of knowledge and experience before the Board. The only way to determine, is to talk to whomever you are thinking of hiring and decide if this is the attorney you want to hire.

Representing Yourself Before the Board of Nurses

2007-05-28T14:45:00.000-05:00

I heard from a nurse who is facing possible action before the Board. She had asked a nurse friend about hiring an attorney and was told that the Board of Nurses is nothing to worry about, that they will understand what happened and because she is a good nurse nothing will result from the complaint. A quick look at the newsletter shows that this is not true. Many "good" nurses receive disciplinary action by the Board. Some of those actions were not deserved and some may have received harsher restrictions than what was warranted. How can this happen?

The Board's mission is to protect the public, not the nurse. For more on this read "The Nurse Police." Since the Board is not responsible for protecting the nurse, they are interested in resolving complaints against nurses in the fastest way that also protects the public. The Board is not in a position to tell nurses the best ways to defend themselves. The Board is not the nurse's friend, that is not their role. So, who is available to advocate for and protect the nurse? Administrative Law Attorneys with experience before the Board of Nurses.

Nurses that would never think of representing themselves in a malpractice lawsuit will think nothing of going on their own before the Board of Nurses. While a lawsuit can cost you money, losing with the Board can cost your career. There is also the issue of time and knowledge. Nurses are busy working, taking care of their families, and living their lives, they do not have the time to learn administrative law (the type of law involved with regulatory agencies) and to deal with the Board. I attend many hours of continuing education a year in order to remain current with Administrative Law issues and there are even attorneys that cannot keep up with the changes in all the areas of law, so how can a nurse be expected to have the time? A survey was conducted with nurses that had been through disciplinary actions and they highly recommended that nurses not represent themselves and that they spare no expense in hiring the best attorney. Many of my clients are nurses that are under their second investigation and because of the problems they encountered with the first investigation, they decided that they learned from the first time and that it was in their best interest to hire an attorney this time.

Coming next: What is the "best attorney"?

Documentation Issues

2007-05-23T08:04:00.001-05:00

I received a phone call from a nurse that had been told that it was against the law to use other staff members' names in nursing notes. This is not true. It is preferable to use other staff members' names in addition to their title so that it is clear which staff member was involved. For example: instead of "I reported the low BP to the charge nurse" document "I reported the low BP to charge nurse Ned Nurse."

Remember that staffing records and other administrative records can disappear and the documentation may be the only record of which supervisor, co-worker, doctor the nurse spoke with. Good documentation is a Good Defense. For more information about the law and documentation see Who Cares About Documentation?

Bad checks and nursing

2007-05-18T06:27:00.001-05:00

Did you realize that writing bad checks can be used against your nursing career? Many people that write bad checks never make the connection that "hot" checks are theft. Theft is a concern for the Board of Nurses because of the trust position nurses are put in and their frequent access to patient's belongings. This is not to state that just one bad check will result in Board action, but theft by check can come under Board scrutiny.

There are no "innocent" crimes. Any crime can invite Board review. When I was working for the Physician Assistant Board (while at the Texas Medical Board), there was an applicant for licensure that had been convicted of shoplifting. He had changed the price on a pair of jeans and was caught, arrested and convicted. He had to appear before the PA Board to explain why he had attempted to steal from that business and then to justify why he still should be allowed to become a PA in Texas.

Online Newsletter Better?

2007-05-15T14:41:00.001-05:00

All Texas Nurses should review the Board's newsletter both online and the copy they get in the mail. Many times, the newsletter online contains more information in that articles are promptly made available online but are delayed in being published in the hard copy. For example, the article regarding prescription medications that was discussed in a earlier blog is currently available in the April 2007 newsletter, but it will not come out in print form until the July 2007 newsletter.

What? you say you don't read the newsletter except to see who got in trouble!!! (look for a post on this located at a Nurse Attorney's Thoughts) All nurses as professionals are required to be informed about their profession. The newsletter is the method that the Nursing Board chooses to inform nurses about changes in the laws governing their practice. But,if you don't read it, you are ignorant and Ignorance of the Law is NO Defense. So, take the time and become informed - read your newsletter.

When Moving Causes Problems

2007-05-14T18:58:00.001-05:00

Several nurses have found themselves at the receiving end of an investigation because they did not notify the Board of Nurses when they changed their address. As a licensed professional, a nurse must keep the Board informed of where the nurse is located. In Texas, a nurse has 10 days to notify the Board of Nursing of an address change. The Board might contact a licensee for random audits of continuing education or for criminal background checks or even for an investigation into a complaint. If the Board cannot notify the licensee, the proceedings continue without the nurse. In other words, the game continues even if the nurse is not there to play defense.

So, when moving be sure to notify the Board of your new address at the same time you set up your utilities. It is a small thing that is often overlooked, but the consequences can be huge.

Are you a Nurse or Dr?

2007-05-11T09:45:00.001-05:00

Nurses can perform tasks that are within their scope of practice. If the tasks involves a medical act, then there must be an order for that task. Nurses sometimes do not realize these boundaries and can find themselves accused of practicing medicine by stepping beyond their scope.

A common example of this is when a nurse is working a night shift and a patient needs Tylenol or an antiemetic. The nurse decides not to wake the physician and goes ahead and writes a telephone order for the medication and administers the medication. The nurse justifies the action by deciding that the physician will cover the nurse with an order in the morning or will sign the telephone order in the morning. By doing these actions the nurse has practiced medicine and committed fraud by documenting a telephone order that never took place. Harm has resulted to patients by the administration of "simple" medications by nurses who were not aware of the treatment plan or that did not understand the patient's disease process or all aspects of the medication. Physicians are understandably upset at being held responsible for an order they did not give and they are speaking up and reporting nurses.

There must always be an order for a medical task. Orders are not required for nursing tasks because those are within a nurse's scope of practice as determined by licensure. If a nurse cannot get assistance for a patient from a physician, the nurse should not assume the role of the physician, but should take the issue up the chain of command until the proper result is obtained for the patient.

Sepsis

2007-05-10T12:15:00.001-05:00

There is a surge of lawsuits involving infections, particularly the failure to recognize signs and symptoms of sepsis. Patients are dying and when the records are reviewed classic signs and symptoms of sepsis are shown in the records. Also remember that the elderly can present special problems when doing assessments and trying to determine the cause of their presentation.

Some of the signs and symptoms: Fever may be present or the patient may have a low body temperature; increased ventilation, confusion or altered mental status (this is causing a problem with the elderly because instead of recognizing sepsis, the health care provider assumes the confusion is due to old age or other mental illnesses), increased heart rate, decreased urine output, may have chills, shaking, rash. When these symptoms present, laboratory tests need to be conducted to protect the patient.

Remember that any changes in a patient's presentation requires a re-assessment and intervention and then documentation of those actions.

Working while taking pain medication

2007-05-09T11:29:00.001-05:00

In the April 2007 Board of Nurses' newsletter (www.bne.state.tx.us), there is an article that every nurse should read, "Prescription Pain Medication Usage by the Practicing Nurse". A nurse never knows when this issue may come up in his or her personal life and practice and it is a benefit to know the Board's stance on this issue. If a nurse is in management, the article is must read right now. The key is that the medication is prescribed for the ailment that the nurse is taking it for (so, no borrowing of medications from friends or family and no taking a pain medication prescribed for a root canal to treat a hurt back and NO illegal drugs). The nurse also has to stay within the prescribed dosage levels. The newsletter can be found on the Board's website under Publications.

Nurses Beware

2007-05-08T16:50:00.001-05:00

As the Legislative Session winds down, Texas Nurses need to watch for new laws impacting nursing practice. Because of the often rapidly changing legal environment, nurses should be a member of a state nursing association (either general such as TNA or practice specific) so that nurses can be kept abreast of new law, rules or regulations or of attempts to alter nursing practice.

This Legislative Session contained many laws impacting nursing practice and many look like they will pass and become law.

Board withdraws position statement

2007-05-08T16:43:00.001-05:00

The Texas Nursing Board met on April 18, 2007 and due to overwhelming comments received, decided to withdraw the proposed position statement on working hours and send it back to the Nursing Practice Advisory Committee for review and revision. There is more detailed information available in the April 2007 newsletter and on the Board's website www.bne.state.tx.us under "Nursing Practice".

Texas BON's Position Statement on Work Hours

2007-02-28T11:45:00.001-06:00

The Texas Board of Nurses has drafted a new position statement on the hours nurses should work. This statement was drafted to address the problem of nurses working excessive hours and the impact that has on patient safety. Go to the board's website at www.bne.state.tx.us or look in the January newsletter to access further information on the proposed statement. I hear frequently from nurses that are being forced to work more hours that they believe are safe and they fear termination if they refuse to work. This proposed statement will help to address those problems by giving support to the nurses.

Whenever I hear about excessive work hours for nurses, I am reminded of a student nurse that told me at a seminar that when he graduated, he planned to work 12 hours at one facility and then go across the street and work an additional shift of 8-10 hours!!! at another facility in order to make lots of money. He said that he was able to function quite well without much sleep and since there was no restriction on the amount of hours, he could work as long as he wanted to. He ignored the requirement that a nurse must be fit to accept an assignment because he said that whether he was fit or not did not depend on the number of hours he had been awake. He would not give me his name and he ignored any attempts to convince him of the potential danger. As I think about him, I hope that the reality of nursing kept him from fulfilling his plan.

On their website, the Texas BON has other position statements and guidelines to assist nurses and employers with understanding the practice requirements placed on GNs, LVNs, and RNs. Also, check my website for additional helpful articles at www.healthlicensedefense.com