Claim paid out as RN almost an NP

elkpark · Nov 3, 2016

Every professional Liability Insurance application or renewal application I've seen has asked specifically if you've been involved in any kind of claim. I'm no legal expert, but I believe that falsifying information on an insurance application (like withholding information about your history that is requested) is considered insurance fraud. I don't know what kind of penalties might be attached to that if it is discovered, though.

Best wishes!

Trauma Columnist · Nov 3, 2016

Being reported to the NPDB isn't the end of the world. Yes, for credentialing you will forever have to fill out additional paperwork but in the end you can still be credentialed.

The big issue is will you be reported to the BON? This is the real reason you have NSO - you need to contact them and make sure you have legal representation when this settlement goes to the BON. You want to make sure that you say nothing to the BON except via your attorney paid for thru your NSO policy.

I'm terribly terriby sorry you are going thru this. I can assure you can get thru this - you are getting close to the end of this though and yes you will forever remember this incident. It will make you a more cautious provider and one who will never ever ever criticize another provider who goes thru the same thing...take my word for it.

Trauma Columnist · Nov 3, 2016

I thought about this overnight and wanted to come back to this because as anyone can guess I've gone thru a suit that was settled on my behalf that involved a pt injury.

It was devastating to me personally but much less so professionally (surprisingly). I was a brand new APRN and thru a series of errors involving several people there was a mistake made, a pt was injured and lawsuit filed and ultimately settled for what I consider to be a large amt of money but which the attorneys all considered to be fairly low (in the neighborhood of your amt).

It took 7 years for it to make its way thru the court system - all the while it rested right there in my mind day after day. Couldn't discuss it with anyone, yet everyone knew. Oh my other colleagues were all sympathetic but in their own minds thinking..."hmmm..that could never happen to me, I'm too cautious."

Well - that's what I thought too...oh how the mighty will fall.

I do sincerely know what you are going thru - its a horrid experience - one of the worst of my life (not the worst) but definitely the worst in my professional life.

Please do consider counseling - the stress and the time that the stress continues can wear on you.

For me, once the suit was settled, I truly breathed a sigh of relief only to find out that now the settlement info goes to the BON - yikes!

Then...a hearing was scheduled. I had an administrative law attorney write a letter about the steps I had taken in the ensuing 7 years to remediate my deficiencies including additional CME and formal education as well as letters of recommendation and I was very fortunate not to receive disciplinary action.

This all concluded over 3 years ago and even though the initial incident was over 10 years ago, I still remember it clearly.

Please reach out! Take care.

Jules A, MSN · Nov 3, 2016

traumaRUs, thank you for sharing your story. Any of us could be in a similar position and it is good to learn there is life after.

Trauma Columnist · Nov 3, 2016

You are welcome - I always hesitate because even now 10 years later I still feel much guilt over the incident. It is a life-changing event I can tell you that.

The one way it has changed my practice is that it makes me much more compassionate towards other providers that make mistakes. I had been a nurse for 15 years when this happened and always considered myself a very conscientious person. But the right set of circumstances can lead anyone down this road....

gmjohnson6 · Nov 3, 2016

This is the type of thing that makes me VERY nervous about becoming a provider. When I think about the circumstances that could go wrong, or become the "perfect storm"... Does anyone have any advice, in general, to hopefully avoid this type of thing? Or is that too broad of a question as "it could happen to any one".

Trauma Columnist · Nov 3, 2016

I can jump on this one:

1. Avoid call situations where you are answering phone calls and not seeing the pts, depending on someone else's assessment of the situation, especially if it is someone you don't know.

2. Have an orificenal of meds that you know inside and out, know the adult, peds, geriatric, renal, pregnancy precautions for., etc. If you are asked to order something outside your own orificenal, LOOK IT UP!!!!! It doesn't matter if you gave this drug six months ago, INDICATIONS CHANGE - what was okay to give six months ago, might not be an okay indication or dose to give today.

3. When you are new - you are stupid. You do not know everything. If you think you do, you are dangerous.

4. Don't be afraid to look stupid - the only stupid provider is one who doesn't ask questions and makes mistakes.

5. Take near misses seriously - use them as a warning of what could have been and learn from them.

6. Realize that you will make mistakes as a provider. Some have the potential to harm or even kill a patient. This job is a huge responsibility - take it seriously.

7. Ask for and receive a thorough orientation especially. I received a 5 month didactic and clinical orientation provided by MDs and other experienced NPs. This is necessary. A formal residency program would even be better if possible.

8. Keep up to date - medicine changes, drugs change, EBP changes - these are the standards we are held too.

9. Know your resources. Prescribing something or ordering something because NP Sally Nobody said to isn't going to hold up in court.

Being an APRN is not for the faint of heart. However, done right it is a very rewarding career!

Jules A, MSN · Nov 4, 2016

1. Avoid call situations where you are answering phone calls and not seeing the pts, depending on someone else's assessment of the situation, especially if it is someone you don't know.

I agree this is an area of high liability but has anyone who works inpatient found a work around? It is especially concerning when I'm re-starting OP meds on a person based on the med rec done by who knows and with possibly only the patient's recall.

The things I do in an effort to avoid problems:

1. Write every single call down in a notebook including date, time, caller, purpose, outcome even if its something as seemingly benign as ACTM for headache.

2. Remember to clarify allergies and pregnancy.

3. Try to get on the computer offsite so I can actually review labs etc prior to ordering anything, yes even before that cough drop.

4. Ensure staff in ED is licensed if they are consulting me on a discharge.

Anything else? Tips would be most welcome as not prescribing for my colleagues patients who I haven't ever seen and admitting new patients overnight isn't an option.

Trauma Columnist · Nov 5, 2016

I still to this day take call for other providers on an almost daily basis - I always always document in the EMR who called me, at what time, what they told me (I use quotes when possible), I ask what action they would like me to take and then I make a decision.

I am more likely than not to turf to the ER or PCP for eval if:

1. I don't know the nurse.

2. I don't know the pt.

3. If 1 and 2 and are positive, you can bet I'm VERY VERY cautious.

4. I always ask about allergies, and for my pt population: their weight, whether they are on amiodarone, coumadin or dig as these are the biggies for drug interactions for me.

And...in addition to documenting in the EMR, I CC the pts NP and MD. This covers me by providing documentation and ensures f/u. If I am in doubt, we have an encrypted texting system and I can text the MD about the action I have taken.

Buyer beware, BSN · Nov 9, 2016

Too many don't get the gravity of this situation because unless you find yourself in this or any legal morass you're walking on unknown terra not so firma where no one is your friend and your so-called colleagues are few and far between.

The kicker is some are even engaged as expert witnesses there to seal your fate, often for a mere bag of shells.

With the way NPs are being spewed out these days, I fear we will be seeing a lot more of this grief in the future.

As a result, nacent public and political opprobrium is hard to guage but with some primary care physicians stirring the pot of interdisciplinary discord that storm is bound to gain strength.

Of couse, much to the infamy and torment of the majority of otherwise cautious and conscientious practitioners.

But as always, there but for fortune will have greater meaning for all of us more than ever before.

Jules A, MSN · Nov 10, 2016

Buyer Beware makes some good points. In psychiatry you don't even have to be overtly negligent to have a lawsuit filed or to be found liable and as noted above with credentialing for a new job any time you are mentioned in a suit it has to be disclosed and investigated. The nonchalant attitudes of some of the youngsters aspiring to become NPs with no nursing background and only our minimal education never ceases to amaze me. I live in a state of near pucker even with a solid background and fairly confident personality.