saillady 1,162 Views
Joined Apr 24, '09.
Posts: 11 (64% Liked)
I'm so sorry. I feel like I badgered you. I'll send you my contact info separately and if the need ever arises, I can connect you with my sister. Hopefully, not, however!
I've been a registered nurse for my entire adult life. One thing that astounds me is how we in our profession are so unmerciful with one another. There are about 3 million registered nurses in the U.S. and the only advocacy for nurses seems to come in the form of labor unions. We are an aging profession. In my estimation, few occupations are as productive. Is it realistic to expect a nurse in her late 40s, 50s, and even 60s to produce as she did in her 20s and 30s? With respect to this chronic pain issue - there is no voice or advocacy that I have been able to locate. Hence, the reason for my posts - some other unlucky soul may be able to use it.
At any rate. I hope you are also able to get some pain relief. Perhaps you are already considering another job that is less physically demanding? One really great thing about nursing is the diversity of opportunity. Take care.
Glad to hear that you have a supportive healthcare provider. Just a cautionary note because you say that there are "threatening" noises being made. In this type of situation, there are two entities that are somewhat intertwined and also are not not. First is your employer. You should have some rights under the Americans With Disabilities Act. If you find yourself discriminately terminated, the time limit to do anything about that is 2 years. The Americans With Disabilities Act does not protect your license. The Board only cares about public safety -- not whether you have a license. They can initiate an action based on a complaint made by a private individual, such as a coworker. It does not have to come from the employer.
In my sister's case, two nurses told their supervisor that they could not work with a nurse knowing that she used pain medications. There was a pre-termination hearing where the Chief Nursing Officer tried to force my sister to voluntarily enter an inpatient drug detoxification - with no regard to pain control. The Chief Nursing Officer tried to coerce my sister into revealing the names of other hospital employees using pain medications. She said that they would do a retrospective chart audit and that they would find discrepancies - because every nurse makes them. (They found 3 discrepancies, 2 of which my sister was able to clarify with charting elsewhere in the medical record.). The CNO also insinuated an improper relationship between my sister and her pain doctor. My sister's pain doctor was the head of pain medicine in the hospital and he subsequently dropped her as a patient. During the trial, the prosecution tried to imply the same improper relationship; the the judge did stop that. (Interestingly, my sister's pain doctor encouraged her to educate herself by attending local pain society meetings - because she initially had concerns about using opioid medications and working. The Chief Nursing Officer also attended the pain society meetings. Because she attended the meetings one would think her somewhat educated, on the subject of chronic pain management, so her actions with respect to my sister seemed really strange. Did she attend the meetings simply for the free food?)
Early in the Board investigation, long before the trial, my sister spoke to an Assistant Attorney General (AAG) who's husband had chronic pain - and she seemed very understanding. Based on those conversations, my sister thought she had nothing to worry about. Later, abruptly, that investigator was replaced by another, and there seemed to be no transfer of information. Time went on and on. More people came and went. Things would start and stop and throughout the process, my sister was provided very little information. Then, suddenly, years later, everything seemed to take on a life of it's own.
Those of us who are not legal eagles assume the presumption is that one is innocent until proven guilty. Not so in Administrative Law Court where these cases are tried. My sister's attorney did not even understand that and he saw no need to produce an expert witness for pain management - the judge had very little good medical information, because the expert nurse witness provided by the Board was disqualified as a pain management expert. Additionally, many of the statements that the hospital provided to the Board in their initial written complaint turned out to be obvious untruths, based on the witness testimonies. The judge acknowledged this discrepencies, but did not believe my sister when she said her supervisor knew about the pain medications. During her testimony, the supervisor said she did not know about the pain meds, but, to her credit, she also said she was not concerned about patient safety, impairment, or drug diversion when the nurses made their complaint to her. (The prosecuting AAG was speechless for a few seconds after that statement was made.) At the end of the hearing, my sister's attorney was convinced they won the case.
Six weeks later, the judge issued a written ruling and stated that he was holding my sister to a "higher standard" because she was a nurse. As such, he said, she practiced sub-standard nursing care because she did not tell her supervisor that she was taking mood and mind-altering drugs. He left it to the Board to evaluate my sister for fitness for duty. The Board deferred everything to Peer Assistance Services. Peer Assistance Services recommended the 3-year monitoring program. (I found this very interesting, because Peer Assistance Services is a private organization and they just landed the CO Board of Nursing contract at the end of 2008. Peer Assistance Services focuses on addiction and most of those people have no medical background. There was an Associate Degree RN supervisor who freely admitted she knew nothing about pain management.
Hope this is not information overload. I've left out many details, but you get the picture. Watch your back. Good luck.
I don't know this site very well. Is there a way for us to communicate privately? Don't do anything rash. First do your homework. What does your state Nurse Practice Act say about the matter? What is the policy of your employer? Are you a member of your state nurse's association? ANA? Are you unionized?
Lawyers are a completely separate matter. Does your attorney specialize in licensing issues? This is such a sensitive topic. Few people have much knowledge. We wished we could go to the media with this issue, but can you imagine how that would turn out? Think very carefully before you take action.
For almost 5 years now, my sister has been undergoing an ordeal with her state Board of Nursing because of a complaint lodged by her employer. Long story made short, she had chronic pain, underwent many, many conservative medical therapies, had a 3-level cervical spine fusion, and eventually required use of opioid medications. She was under close supervision of a pain specialist and there were no issues of impairment, drug diversion, or patient safety. She has now spent thousands of dollars on attorney fees (3 attorneys, so far), experienced an unsuccessful mediation, went through a trial that was prosecuted by an Assistant Attorney General (representing the Board), had her license suspended for 9 months (the suspension didn't actually occur until after her pain resolved to a point that she no longer required the pain medication), and is now in a 3-year Peer Assistance Services program for people who have substance abuse and mental issues. In this program she must submit to weekly random urine screens, attend two group therapy sessions per month, and two private counseling sessions per month. Her employer must monitor her and send lengthy reports to Peer Assistance Services. She has received a letter from the federal government stating that because her license was suspended for drug reasons, she is not permitted to work in a facility that receives federal funding (i.e., Medicare or Medicaid) for five years. She is fortunate to have employment, but makes about half the salary she would in other positions for which she is qualified.
That said, it has been very difficult to find information that pertains to the issue of healthcare professionals, management of the healthcare professional's chronic pain, and fitness for work. I just came across the following statement issued by the AANA (American Association of Nurse Anesthetists). I post it below in the event that it can help another "non addicted" nurse who appropriately utilizes prescribed pain medications in her employer/Board dealings. The statement does make a recommendation for a neuropsychological evaluation and written clearance for return to work by the physician. This would mean disclosure to to nurse's employer.
It is my opinion that employers (yes, healthcare providers) and staff/members of the various Board's of Nursing are largely uneducated about this subject. In the interest of protecting the public (an important consideration) they (employers and regulatory agencies) would rather err on the side of conservative, rather than potentially face public outcry in the event that a patient safety situation arise - and then have to explain for their apparent lack of due diligence. Position statements, such as the one cited below, may help to inform and inspire productive conversations and lead to actions that will benefit patients and be fair and supportive to nurses.
AANA Advisory Opinion 5.4
Patient Safety and CRNAs on Drug Therapy Regimens for Pain Management
FYI. NPR "Forum" aired a one hour show about this event yesterday. Here is a link to the audio.
Did you find a course and take it? If yes, can you tell me about it? Would you recommend it? Thanks much!
Don't forget the people who work at the Board who do the bulk of the work, including investigations and managing the disciplinary actions. They are state employees. Some are RNs and some are not. They are the people with whom you would be interacting...
This is my experience. Documentation has changed over the years and is different in various locales. Early on there were Progress Notes for physicians and Nurses Notes for nurses. When I started nursing, we documented our narrative in the Nurses Notes. Physicians used the Progress Notes and used SOAP/IE format. Nurses charted SOAP notes in the Progress Notes when there was a very specific problem. I'm very partial to SOAP/IE notes.
A SOAP note might look something like this.
S: "My left knee hurts today."
O: Left knee, swollen, tender to touch... Walked around the unit for 30 minutes with steady gait this morning.
A: Your assessment
P: Your plan.
Later you would come back and document the evaluation. I'm guessing that SOAP/IE notes would be good for documenting nursing diagnoses, but today institutions may be other ways to do that.
On the other hand, a narrative is a chronological detailing of assessments and patient events, including the mundane ones. Lets say your shift starts at 0700. You may begin by documenting a head to toe assessment. Your narrative charting may resemble something like this.
Neuro: Mental status, neuro check, etc.
Cardiac: EKG rhythm, heart sounds, skin color and warmth, pulses, etc.
Respiratory: Lung sounds, breathing patterns, etc.
You would document the subjective findings in the corresponding system section.
At 0830, you patient may be finished with breakfast. You would document what/how much the patient ate and how well it was tolerated.
Then a family member might visit at 0930 and you would document that and how well the patient tolerated it.
Some hospitals eliminated Nurses Notes and so nurses documented their narrative in the Progress Notes. I remember some physicians were not happy about that. Traditional narrative gives many nurses a sense of security - and I do remember one nurse who swore it was her narrative documentation that saved her during a law suit.
Now nurses also utilize checklists, flowsheets, pathways, charting by exception and electronic medical records. Many nurses still do the narrative in addition to the other required documentation tools. Hope this helps. Others may have a different take on this.
I wrote earlier and referred to my sister's situation.
Re: visiting a Board meeting. I went to my sister's trial and, later, to a board meeting when they decided on the disciplinary action. The trial was prosecuted by two Assistant Attorney Generals (AAGs). My sister was deposed prior to the trial and on the basis of her deposition, the charges were considerably reduced. That said, the AAGs were out for blood at the trial. There was sniping between the prosecuting and defense attorneys - similar to what you might expect in high school. And, believe it or not, the witnesses for the prosecution were permitted to testify over the phone. I'm convinced they were being coached on the other end as they testified.
My sister's attorney was confident that the judge would dismiss the charges altogether and did not produce an expert witness. Although the judge acknowledged the inconsistencies in testimony (outright lies), he did not dismiss the charges. Instead, my take is that he pretty much referred everything back to the Board. And then the Board left the entire matter of evaluation and recommendations up to Peer Assistance Services.
In my sister's instance, the Board meeting was very lackluster. At the beginning of the meeting, the audience was instructed to remain perfectly quiet and not to address the Board, unless first spoken to by the Board. In my sister's case, there was NO discussion about her case- only a rubber stamp of the recommendations made by Peer Assistance Services, which were recorded in documents and handed out to the other Board members when her case came up. For me, not much was gleaned from the Board proceedings.
From a learning standpoint, there is an organization called TAANA (The American Association of Nurse Attorneys - www.taana.org). Their national website has a referral directory. It may be possible to contact someone from a local chapter who would be willing to be a speaker for a school or local group.
Additionally, there is a document titled "Legal Basics for Professional Nursing: Nurse Practice Acts," by Mable H. Smith, RN, JD, PhD. It is available online at the following.
The CEU activity is expired, but the information is very good. I wish we were able to locate TAANA and this document early on.
I have no issue with bona fide offenses related to substance abuse and diversion. If you peruse the BON websites, it is shocking to see the number and magnitude of offenses. If you are guilty, it's best to simply "go with the flow." If you are confident that things will sort themselves out because you have done nothing wrong, think again. These processes take a very long time. BON and AAG personnel turnover, just as they do in any organization. You may have a sense that you are making headway with one person, and then another person, a stranger, suddenly has taken over your case. Once things get to the legal stage, there is nothing you can do to stop that ball. The earlier comments about having liability insurance are also well founded.
Ciao! I love your discussion.
I'm very curious. The BON you describe sounds remarkably like the Colorado BON. Despite your age, your observations were very astute. My sister has an issue that has spanned the last 4, soon to be 5 years. Her nurse attorney told her that the Board does not like it when an attorney is involved and they tend to "come down harder." The attorney also described the Board as "arbitrary and capricious." A question is this, "Is it possible for unjust charges to be brought against a nurse?" If yes, then does the nurse not have a right to defend her/himself? Does s/he not have a right to expect the Board to act with integrity and rational consideration?
I have watched my sister's process unfold from a distance and, for her, it has been life-altering. BONs are comprised of humans who are theoretically guided by the Nurse Practice Act. The substance of the Nurse Practice Act varies from state to state. Some Nurse Practice Acts are 10s of pages long, while others are greater than 100 pages. You can imagine that a less specific Nurse Practice Act would leave more for subjective interpretation - hence, possibly the root of what you observed. I am a RN who is untrained in law and can only speculate.
One nurse put it aptly in an earlier post... you had a great experience before you even started your career. Thankfully, most of us will never have to experience what you saw. It does, however, behoove us to support our state nurses associations and familiarize ourselves with this aspect of our chosen profession. You never know when your number may be the next called!
Hello: I'm on this site looking for information about this very topic. I graduated from nursing school many years ago and my sister is also a nurse. My sister has had chronic pain for a number of years and underwent a 3-level cervical spine surgery. She has had every other treatment, including steroid injections, physical therapy and a trial with a deep nerve stimulator. Eventually, she started using opioids - only after educating herself and under close medical supervision. While taking the medications she worked, obtained her RN to BSN degree, and received an award for nursing excellence. Because she was familiar with the medications, my sister acted as a resource for other nurses when they cared for patients with those special needs on her unit.
This is a long story made short...
A coworker complained to her supervisor that she did not feel comfortable working with my sister knowing that she was using the medications. She was terminated and the hospital reported her to the state Board of Nursing. My sister refused to admit that she was an addict and go into a "program" - initial charges of drug diversion and impairment were dropped at the beginning of her trial. During the trial, her supervisor testified that she had no concerns about impairment, drug diversion, or patient safety. Nothing conclusive came from the trial. The Board has suspended her license (several months now) - even though she has been off all meds since June 2008. She is now in an addiction recovery program (weekly urine tests, bi-monthly counseling, etc.) She has never smoked and never consumed alcohol while taking the meds - nor has she ever craved the meds. Her life is a nightmare.
The moral of this story is to be very careful. Some states (FL for example) have clear guidelines in their Nurse Practice Act. Many do not. Do not expect a Board to be informed or respond to your information. Make sure that you belong to your State Nurses Association and possibly the ANA (maybe you would then have a little support if you find yourself needing it?) . Finding appropriate legal counsel is an entirely separate matter.
Supposedly your medical information is your personal business; it is very hard to keep it that way once something like this starts. When dealing with the Board, you will have not rights and they can do pretty much what they want.
I once worked with an impaired nurse in a unionized facility. I know how destructive such a situation can be to a nursing unit. In that instance, it was very difficult to do anything because of the union. That said, based on what I have observed with my sister - I fail to see any other way to protect the rights of a nurse.
Advertise With Us