Finding a job with pending accusation

Nurses General Nursing

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Hi guys, I'm looking for words of encouragement or success stories.

I'm an ER nurse with 6 years of experience. The past 3 years I've been having the time of my life doing travel nursing. unfortunately my last contract was cancelled 4 days before my start date because of low census ("we hired too many nurses - sorry"). 2 days after this cancellation I'm notified by the board that I have a accusation against my license.

Early last year (2019) I had a emergency verbal order to restrain a confused patient that came into our department in respiratory distress. The patient was pulling out lines and grabbing at the nursing and RT staff. After the ABG came back the physician ordered BiPAP and the patient was placed on BiPAP while restrained. Long story short the intensivist came down stairs and found this patient restrained while on BiPAP and was not happy.

The ER MD denied any knowledge of the restraints and the intensivist reported me to my agency who then in turn "had to" report me to the board.

Now, a year later, and after 6k in lawyer fees, I'm facing the possibility of probationary measures placed on my license.

As I write this I am unemployed in central California. My agency states they cant work with me until the case is closed. In spite of shining letters of recommendation by every job I've ever worked facilities won't interview me with the pending investigation. My last contract wants to hire me but everything is on a hiring freeze because of CoVID - 19.

Has anyone been through this and can you offer words of encouragement or advice?

I'm stuck here in my lease away from home and ruminating about all the possible negative outcomes. Nights are long and days are slow.

Any advice, please - no negativity.

On 5/1/2020 at 7:57 PM, Davey Do said:

You make a very good point, LovingLife.

However, if a patient is in restraints, they are considered to be a 1:1 and the sitter, who ranges from being a Tech or CNA to an RN, is required to be within an arm's length.

I have no experience with a patient in restraints being on BIPAP, so all I can offer is conjecture.

Depends on the type of restraints and the reason for restraint. Since you work in psych, I'm assuming the primary reason for restraints is for violent/harmful behavior. In the hospital, we also go 1:1 if the patient is being restrained for harmful behavior (in 4 point leathers).

But we often have confused patients we restrain to prevent them from pulling at lines or tubes. A patient in mitts or soft wrist restraints does not require a sitter. The restraint order lasts 24 hours, and requires Q2hr charting when I must check for injury, provide ROM, and offer food/drink and toilet.

We also have enclosure beds (that look like a big pack-n-play) for high fall risk patients, such as people detoxing. Those fall under the same requirements as the soft limb restraints. We've seen an uptick in the use of the enclosure beds on the COVID med-surg unit, as many of the extubated patients are extremely weak but highly impulsive, and we can't get into the rooms fast enough given the PPE donning requirements.

Technically, even having 4 bedrails up is a restraint that requires an order, but we don't have the staffing for those patients to get 1:1 monitoring.

If we had 1:1 staffing, we wouldn't need the behavioral restraints (mitts, soft limb, enclosure beds).

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I would try working for Matrix....or similar company....they represent insurance companies and go into homes....they use nurses for chart reviews. I am so terribly sorry that you are going through this nightmare! Nurses are regularly falsely accused. Prayers help....hang in there and trust...some day you will be glad that you got through! His blessings!

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Specializes in BSN RN CEN.
On 4/30/2020 at 2:10 PM, LovingLife123 said:

It seems you were given a restraint order before bipap was placed.

You absolutely cannot have a patient who is on bipap in restraints. The reason being if they vomit, they cannot take the mask off resulting in that vomit being pushed into the lungs thus aiding aspiration, and possible death.

To anyone questioning this, please do not ever put your patient on bipap in restraints. It’s very dangerous. The restraints should have been removed as soon as the patient was put on bipap.

I know nurses don't like to read the directions but this is not helpful to my post in that I requested words of encouragement or advice on finding a job with the pending accusation. ?

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Specializes in BSN RN CEN.
On 5/2/2020 at 11:39 AM, 42pines said:

That your complaint is about “Verbal orders” may save you, or break you. I prefer the term VORB (Verbal order, read back).

A great read on verbal orders can be found at:

http://dhhs.ne.gov/licensure/Documents/VerbalOrders.pdf

This document is a Nebraska BON advisory, and well worth reading by any nurse.

Notable in Nebraska (remember, different states = different rules) is:

“Facilities are responsible for policies and procedures that identify conditions for the acceptance Verbal Orders page 2 and implementation of verbal orders. The patient medical record must necessarily allow for documentation that provides a retrievable record of the communication between the prescriber and the nurse…”

“Verbal orders must always be transcribed to the patient medical record by the nurse.”

And, very importantly (should your state mimic Nebraska’s rules):

“Verbal orders are subsequently reviewed and authenticated by the prescriber. The prescriber must cosign or authenticate the orders to validate the order.” Read: The doc is in violation if he/she did NOT do this on your order or others.

For you, a few questions:

1) Was it read back?

2) Did you enter it into an electronic record?

Your requirements are to take the order, read it back for confirmation, and enter it into the medical record.

If you did not enter it into an electronic record, you are likely out in left field. But if you did—it is irrevocably locked into that record. Not only that, a time entry notates the time that ER doc called and sometimes that call can be traced. For instance, Doc states: “I deny any knowledge of such an order by me.” OK, please explain to the Court just what the call that you placed at 3:10 to the ED from phone number was for? Uh oh.

Also, why would you enter, contemporaneously, or even later (but not much later) the order, if it was not called in?

Forget the agency. Why? Because even if the agency is found to have maliciously written the complaint, (not the case here) it is likely “privileged.” In short, legal action in this case, by you against the agency will fail. Sad, but true (in most states).

Interestingly here, you may have a positive aspect. Here, it was the intensivist who reported you, not to the BON, which would have been privileged and non-actionable in Court, but rather to your agency, which is likely, not privileged, and is likely actionable.

In short, if the intensivist reported you to BON, you’d be out in left field and could not file an action based upon defamation. But you could (remember, state rules rule) possibly, file for defamation to the interventionist, or to the hospital who may “own” the interventionist.

Let’s assume that you did read it back, and entered that in the medical record. You say that the doc denies any action.

But the rules (if in Nebraska) requires the Doc to “Verbal orders are subsequently reviewed and authenticated by the prescriber.” Did the doc fail the rules? What about other “verbal orders?” Oh, perhaps the doc has NEVER complied—this may be hard to prove, but it is provable.

Now, back to reality. You’ve spent $6,000 and in reality, your lawyer probably hasn’t covered what I’ve covered, and probably has created an extremely costly POC as “answer to BON.” (POC = Piece of garbage). (This may also not be the case.)

From what I’ve seen, lawyers, even ones that do this sort of stuff, who routinely (represent nurses) charge a lot, and give little. I’m sure that there are very competent lawyers and I’m fairly sure that they are likely very rich. To “fight” back by asking the BON to allow you do discovery to pull the medical record showing you 1) entered the order and 2) the doctor called the unit on that day, at that time, is not particularly difficult but such actions cost. Remember most lawyers want cases that return $100k or more.

Most nurses cannot tell a good work product, so there may be little impetus to create one.

Should you obtain by subpoena a copy of the entered order (with identifying information redacted) and a copy of call records, it is possible for you or your lawyer to present this to the BON. Judges (and BON act as “judge,” loathe lies. Catch an opponent (such as the denying doc) in a bold-face lie and you may find the entire case dropped. A copy of the med record (redacted) time/date stamped alone may well get you off the hook and place the doc in a position of your being able to file defamation against that doc. (Practicality will not be discussed here). Your lawyers should have gone over these options.

Now let me back up a bit. Most BON’s have an action “tree.” Often it goes like this: “Was the patient harmed?” If yes, then, “Was there serious harm?” Other aspects may be intentionality. Here is a link to New Hampshire BON “regulatory decision pathway.”

https://www.oplc.nh.gov/nursing/documents/regulatory-decision-pathway.pdf

If you just miffed the interventionist, but there is no record of significant harm to a patient, the BON is not likely to crucify you. See NH for actions that are possible, “supervising, focused remediation, counseling/coaching, is not so harmful.

You say: “my last contract wants to hire me, but everything is on a hiring freeze.” Hopefully you have discussed the complaint to this contract and if so, Covid-19 besides, it’s likely that at some time you’ll be back at bedside.

A few side-notes. BON’s are NOT a nurse’s friend. They are a regulatory machine. It’s not personal—they serve patients, not nurses. A complaint will be dealt with by their pre-determined process. It’s slow, often archaic, and often in violation of Constitutional Rights (both US Constitution and often, more importantly your State Constitution). It's undoubtedly slowed even more by Covid-19, even though most "investigation" can be done by the investigator from home.

For the naysayers on “Constitutional Rights,” see:

https://www.nursingcenter.com/ce_articleprint?an=00000446-201211000-00026

“The Constitution prohibits states from depriving citizens of their property rights without due process. For nurses accused of professional misconduct, this means that they have the right to notice of the charges and the opportunity to be heard in their own defense. Nurses who have had adverse license determinations, therefore, may appeal those decisions.” The reality is most states make it difficult or impossible to do so. Florida is becoming the exception and hopefully nurses will be protected by the Constitution sometime in the future.

Had you taken out a $111 per year insurance policy you’d likely be in a better position. See: https://www.nso.com/Get-a-Quote. Readers: Consider such a policy. Many complaints are not made in good faith, a bit of protection may go a long way.

Interestingly, I have been told by a lawyer who represents nurses, “you don’t have to tell anyone (applying for work) that you are under investigation for complaint.” I disagree and say that ethics do require you to self-identify if the job is in nursing. If you go to work for Home Depot, you don’t. The reality is this: Nurses are presumed guilty until proven innocent by the Board of nurses. Everyone else in America is presumed innocent until proven guilty.

I do wish you luck and hope in time this passes.

This is a lot of helpful information, thank you. I will definitely be obtaining insurance in the future. I know I dont "have" to tell people when applying for jobs but when they look me up in Nursys they can see that one of my licenses is under investigation. Therefore I feel it's easier to say it up front so that they dont think I'm hiding anything - because I am not.

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Specializes in BSN RN CEN.
On 5/2/2020 at 10:55 PM, LovingLife123 said:

You are misunderstanding. I’m not in Psych. I’m in an ICU in a hospital. Restraints are renewed every 24 hours and documented on every hour. I could not imagine renewing every hour.

I’m guessing in a psych facility there are not patients on bipap. I’m talking about a hospital setting. 80% of my pod was in restraints today. No sitters.

This nurse was referring to an acute care, medical setting, not a psych setting. I’m sure the rules are different. But it is standard that every patient who is intubated or trying to remove medical devices are restrained. But you absolutely cannot restrain a patient on bipap.

Policy at this institution says we can place on restraints and get the order within the hour. I got the order but the physician never documented it and I failed to ensure it was documented because I got caught up resuscitating the patient. When the ABG was received RT placed the patient on BiPAP. No harm happened to the patient. Ironically the investigator told me that when the patient went upstairs to ICU an order for restraints was given. Clearly the BON can see from this that they were altered - but I dont have the order while they were downstairs with me. The intensivist reported me because when he came downstairs and started fussing at me I barked back at him... hard lesson learned.

For this day in question we were on Code Black. I had filled out an Assignment Despite Objection form, AND was over ratio. Hopefully the board will show some mercy considering these things... but so far its turned into a MAJOR headache. Learn from my mistake people.

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Specializes in Critical Care.
On ‎4‎/‎28‎/‎2020 at 5:43 PM, chare said:

Reported you for what, exactly?

I'm trying to see how not having a signed order for restraints warrants a report to, and subsequently t investigation by the BON.

Best wishes.

Around my neck of the wood, a facility can be cited for restraining someone on BIPAP due to the high risk for aspiration if they vomit. as someone mentioned before, if patient is noncompliant, 1:1 sitter is placed at bedside.

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I worked ICU and that is my specialty as a NP..... I would email the board and discuss the situation. You should have removed the restraints ...I wrote a great paper for grad school on the dangers of restraints.... and a preventable death. Each state is different... but I suggested reviewing charts...because someone may hire you for that in the interim?

His blessings!

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Pharmaceutical sales may be an interim alternative.

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Specializes in Occupational Health; Adult ICU.
16 hours ago, aspirationpneumonia said:

This is a lot of helpful information, thank you. I will definitely be obtaining insurance in the future. I know I dont "have" to tell people when applying for jobs but when they look me up in Nursys they can see that one of my licenses is under investigation. Therefore I feel it's easier to say it up front so that they dont think I'm hiding anything - because I am not.

Thank you for your response.

Interesting. You say that they can "see" that one of your license is under investigation.

Like you, I too am under investigation. I too am licensed in multiple states. I was unaware than Nursys existed and just registered after reading your response. There is no mention that I am under investigation in my state, at all. I wonder if BON's see more than "unencumbered?"

I am under investigation for not one, but thirty-seven complaints. Interestingly, there are similarities between your case and mine in that the two parties that initiated the complaint did so to a municipality. The municipality, in turn "echoed" the complaint to the BON.

Therefore, like you I can take legal action (when the complaint is (if it is) dismissed) because the allegations first went to a party other than the BON and that party took action based upon the complaint(s) that caused damage. Of course, I must prove that all, or at least most of the complaints were without truth, which I think is the likely outcome.

Interestingly, as in your case, not one complaint is from a patient or a patient's family member. The complaint has been forwarded to my State's Attorney General's office for investigation. Of the complaints, the chief investigator appears to be focusing on one, that being the allegation that I'm cognitively incompetent. (what were we talking about? :)) The only complaint that I believe I could be found guilty of is "inadequate documentation," a complaint that likely could be brought against any, and all nurses here.

As a result, I have lost my job, lost my income, and further, the college where I'm two subjects from completion of a BSN with a cum of 3.95/4.0 (I'm age 70, but the cum does not say cognitively impaired now, does it?) has put my education on hold. The worst part, in my opinion about any complaint is that one's entire life is put on hold, at least from a nursing POV, for well over a year.

I've been told not to discuss the case for fear that to do so would be construed as an attempt to intimidate any persons that are part of the investigation.

In short, as are you, I'm in nursing hell or perhaps Limbo, in essence, largely found guilty, if and only until I'm found innocent.

The most interesting part is that thirty years ago I accidentally found myself in a Superior Court lawsuit and represented myself. My opponent thought it a joke--until about three years, and dozens of days in Court, the case was adjudicated in a two-day trial and I prevailed and was awarded damages. The opposing attorney was a principal in the second largest law firm in my state. My total expenditure for legal representation was $100 which I spent on a consult with a lawyer about technical issues.

The two parties, both of which are other nurses, both of which had worked with me for less than one hour have no clue as to what potentially stands in their future.

I do look forward to writing an article about the outcome here at Allnurses, when the time is ripe.

Do you know if the BON sees other than what I see when I look up my license and only see "unencumbered?" Do you see, in yours state, "under investigation?

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Specializes in Advanced Practice Critical Care and Family Nursing.

A word to the wise, I'd be cautious about posting too much personal data here. This site is not objectively monitored. Frankly I'm shocked this thread wasn't frozen long ago like Bernie, since the admins usually cover up anything legal faster than a COVID cough.

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19 hours ago, aspirationpneumonia said:

I know nurses don't like to read the directions but this is not helpful to my post in that I requested words of encouragement or advice on finding a job with the pending accusation. ?

Well, maybe understanding why you have a pending accusation can help you obtain another job and how to talk to the BON. Just a thought..... ?

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Specializes in Critical Care, ER, L&D.
On 4/29/2020 at 9:06 AM, Emergent said:

I hadn't heard that. Rationale?

I am just thinking over all the things I’ve heard over the years. And I believe it is because of the patients inability to remove the mask if they have an episode of emesis or obstruction of their airway to cough/clear their airway. BiPAP should be used for alert patients who are capable of following commands. If a patient cannot follow commands and/or protect their airway an ETT should be utilized instead of a BiPAP. Basically if you need restraints you probably don’t meet criteria for a BiPAP. As nurses, we should advocate for the least invasive measure possible, but a BiPAP and restrained patient=a patient who doesn’t need to be on a BiPAP but rather have an ETT and sedation. Again, this is my “guess” and conclusion based off things I’ve heard over the years. I vaguely remember being told no restraints with BiPAP and I apologize if this is incorrect.

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