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Lorie Brown RN, MN, JD

Content by Lorie Brown RN, MN, JD

  1. Lorie Brown RN, MN, JD

    Best strategies for handling absenteeism

    Hi Lorie What would be the best strategies for handling absenteeism? Hello, Dealing with Absenteeism: I am not sure if you are asking how to handle your absenteeism or as a manager. I just had this conversation with my staff too. Absenteeism affects everyone. It can be considered patient abandonment. Also, the rest of the staff needs to take on more too. It affects the cohesiveness of the team. If you are absent a lot or have team members that are, I would have an open honest conversation about stress management and healthy habits and how it affects everyone else. If your facility has a policy on absenteeism, it must be followed. I suggest getting a coach to help you with why you or your staff keep getting sick and how that can be improved. I hope this helps. Lorie
  2. Lorie Brown RN, MN, JD

    Best strategies for handling absenteeism

    I agree that a nurse should not work when she is contagious and I think a lot of us do because of the strict attendance rules of facilities.
  3. Lorie Brown RN, MN, JD

    Best strategies for handling absenteeism

    I am sorry you feel that way. All I can say is that the Indiana state Board of Nursing on numerous ocassions expressed their concern for nurses who have been written up or terminated for attendance, that they considered it patient abandonment. I personally do not agree with this. I think that working at a hospital, the stress that nurses are under and being exposed to everything is conducive to illness. Also, it would be nice if facilities have "planned alternative staffing" but the sad reality is that many don't.
  4. Lorie Brown RN, MN, JD

    Is my license suspended immediately after I self-report an arrest?

    I am a nurse attorney although not licensed in LA. The state cannot deprive you of a property interest, your license, without what is called due process and an opportunity to be heard. They can call you the morning of the hearing or send a letter but they must give "reasonable" notice which could be the day of. The concern is with the opportunity to be heard, you have a constitutional 5th amendment right to remain silent so your criminal attorney may not want you to talk. Be careful posting this stuff on public sites because it can be used against you. Make sure your address is current with the Board or they can take action without you knowing it.
  5. Hi, Lorie I have a question. I had to cancel my travel nurse assignment due to myself not being able to find housing. I am also pregnant. Because I just started and only received one paycheck, I didn't have any money to stay in a hotel or anything of that sort. My company tried to help me find housing but it was just too expensive. So, my question is because I had no place to live and needed to cancel my contract, the facility charged my agency a penalty fee and now my agency is trying to keep my last worked paycheck. Can they garnish my wages? Is this legal? Dear Travel Nurse I would love to be able to answer your question, but without the contract, I cannot respond. Also, you may want to check with the Department of Labor to see if they can hold your last check. If you signed the contract and started, you may have an obligation, but you would need to review the contract or hire an attorney to assist you. Wishing you the best. Lorie
  6. Yesterday I was terminated from my job for a HIPAA violation. Basically I looked in the chart of a patient that a CPR was called overhead for as I worked in ICU and was up for admission so it was likely this patient would come to me. This is something I have seen many others do as well. After the pt did not come to my unit I re-opened the chart just to see what the outcome had been (stupid move on my part I know, and I guess in my mind I figured I had already been in the chart once so what did it matter?) Anyways the patient did not survive and it ended up becoming a sentinel event due to circumstances I was not initially aware of). The hospital of course audited this patient’s chart and began investigating anyone who accessed the chart (myself included). I knew they were meeting yesterday and was a wreck at work all day. After my shift, I was called to go to HR where they terminated my employment for violation of HIPAA regulations. My previous employer said they would not disclose that information to potential future employers, but that they were required to report it to the State Board. What can I expect to happen? This is my first offense, and I have a spotless license up until now. Will I lose my license over this? Is it even worth it to start looking for jobs right away? or should I be waiting to hear from the BON? Dear Terminated, I am sorry this is happening to you. Unfortunately, hospitals have a zero tolerance for HIPAA violations because the stakes are so high with fines and sanctions against the hospital. Is your address correct before the Board? If so, you can expect to receive a letter in the mail. If not, correct it. I would suggest you hire an attorney to help you respond. You can find one on TAANA.org if you would like a nurse attorney. Just make sure your attorney has extensive experience with these types of matters. I wish you the best, Lorie
  7. Lorie Brown RN, MN, JD

    Nurse Charged With Homicide

    No insurance covers criminal matters.
  8. Lorie Brown RN, MN, JD

    Nurse Charged With Homicide

    I am not aware of any insurance policy that covers criminal activity. It is against public policy. That is what makes these cases so difficult for nurses. Many nurses feel like they have to settle and admit something they did not do because they cannot afford the legal fees.
  9. Lorie Brown RN, MN, JD

    What You Don't Know About Nursing Boards

    Most nursing schools teach to the test. They want nurses to pass the test because the school can find itself in trouble if the examination results show low pass rates. The same Board that regulates nursing licenses also regulates nursing education. The way a nursing board works is all prescribed by statute and regulations. The nursing board is charged with the task of keeping the public safe. So, any concerns about a nurse's action could be subject to discipline. There are 4 types of laws. Criminal law is where your freedom is at stake. Civil law is where there is a civil wrong like a breach of contract and malpractice. Military law is for our armed forces. Administrative law is the body of law that covers the nursing board. The protections that one has in a criminal matter such as innocent until proven guilty beyond a reasonable doubt do not apply in administrative law and the protections on what evidence can be used against you is not available in administrative law. Let's see how this process works. CONSUMER COMPLAINT/ INVESTIGATION PROCESS Anyone can file a complaint against his/her nursing license. Believe it or not, I've seen complaints filed by ex-spouses, neighbors, coworkers and patients. At this point, the complaint is confidential. In some states, the complaint is reviewed by board investigators, and in other states, the investigation is performed by staff at the state's attorney general's office. If you are subject to an investigation, you will receive either a letter or a phone call. Therefore, it is very important to keep your information up-to-date so an investigator can contact you. I advise that you keep a list of places to notify when you move with the nursing board be on top of the list. The investigation process can take quite some time. We are talking in some cases about years. The investigators perform a thorough investigation. If there are concerns about impairment or diversion, they may subpoena pharmacy records and medical records for any controlled substances that you been have prescribed. They can also go back and obtain employment records of all your past jobs. They are able to locate all the places that you have worked through employers which paid state taxes on your behalf. Since the investigator can obtain employment records, a word of caution. When you fill out a job application, make sure that you include all of your jobs and are accurate in why you left. Were you terminated or did you resign? If you were terminated, it is ok to state that you will discuss the reason in an interview. Nursing boards are very concerned about a nurse's ethics and honesty. If you were terminated from one position and put on a job application that you resigned, that is going to be a red flag. If you worked at one place for a short period of time and did not include that in your job application, that's another red flag. Some states also require that you answer questions on your license renewal application, such as "have you ever been disciplined, reprimanded or terminated in your capacity as a healthcare professional. If you answer no to that question and they later find discipline and reprimands in your employment records, that will be of concern. The Board even considers any reprimands for attendance to be reported as that can be considered patient abandonment. Once the investigation is concluded, the investigator will decide whether your matter should be closed or if an administrative complaint/accusation should be filed against your license. ADMINISTRATIVE COMPLAINT OR ACCUSATION Once an administrative complaint or accusation is filed against your license, this matter becomes public. Anybody can find out about it and in some states, it is prominently displayed online or easily searchable. If you have a complaint filed, you could settle your case or go to a hearing. Either way, the Board can give you a reprimand, which is a like a "slap on the wrist and don't do it again." They can put your license on probation meaning they just want to watch you. Your license under probation is considered an encumbered license. They can suspend or even revoke your license. In either of the two latter cases, you would not be able to work as a nurse. You would not be able to practice or even sign your name as "R.N." If action is taken against your license, it will become public record on nursys.com and on the state's license verification systems. In most states, there is no way to get the administrative action removed from your records. It will stay with you for your entire career. ALTERNATIVE TO DISCIPLINE Some states do have an alternative to discipline process where any action or recommendations that they take would be deemed confidential but it is available only in certain limited circumstances. DEFAULT If you do not keep the board apprised of your current address, they can take action on your license and you just might not even know it. That is considered a "default" and the board will do whatever they deem necessary. EMERGENCY SUSPENSION Also, your license can be emergency suspended. If the board thinks that you are a clear and present danger to the public, they can take steps to emergency suspend your license until the investigation can be completed. CONCLUSION Make sure you know your state's Nurse Practice Act and if you get a chance to go to a Board meeting, it is an eye-opening experience. All of these measures that the board can do seem to be quite draconian and I believe being proactive is the best way to protect your license. To learn how to be proactive in protecting your license, be sure to join me in the article in next month's issue. By Lorie A. Brown, RN, MN, JD, Nurse Attorney representing nurses before the licensing board and founder of Empowered Nurses. Empowering Nurses at the bedside and in business. Are you an Empowered Nurse? Take the quiz at www.areyouanempowerednurse.com Be sure to check out more from the first issue of allnurses Magazine.
  10. You're Fired! Out of curiosity, over 50 hospital employees, including nurses, decided to check the celebrity’s medical records. Many said they didn’t go past the name screen but that was enough to be a HIPAA violation. Those individuals lost their jobs. Anything that you do online in the hospital is trackable. You cannot access the medical records of anyone unless you are involved in that patient’s care. Even being only on the face page for any amount of time as little as 17 seconds is a HIPAA violation if you are not involved in the care for that patient. Audit Trails Authorities can find your path if you wrongfully access a record because of what’s called “audit trails.” The same rules apply if you are changing a medical record such as making a late entry and you will need to properly identify the late entry. Although you may be able to simply replace or add to your prior charting, this can be discovered. Your employer or an attorney can go through the audit trails to see exactly how the records may have been changed. Cases which might pique an attorney’s curiosity, such as a heel ulcer developed overnight and yet all the proper preventative records were checked that they were done in the medical record and sudden changes in condition. In these situations, an attorney may get the audit trail to show that the entries placed in the record were entered late after they knew of the heel ulcer or the change in condition. Also, be careful when copying and pasting previous notes. Again, those actions can be tracked and the attorney may question whether you actually performed a new assessment. What is HIPAA? HIPAA established national standards to protect an individual’s medical record as well as other personal health information. Patients’ have the right to privacy for their medical records. Any intrusion into the medical records can result in a significant fine to the hospital. Therefore, most facilities have a zero tolerance policy if the privacy rights of any patient are violated. Improperly accessing records could result in termination as this is what happened to more the 50 health care workers at Northwestern. With medical records and portability information, it is even more important nowadays to be aware of the rules to protect patients’ privacy as well as protecting your license. Privacy and confidentiality also are important when you are conversing with another health care professional outside of the medical area such as in elevators or while having lunch. You never know who may be listening. Even if you avoid using the patient’s name, there may enough information revealed to identify the patient. This is not the first time that a celebrity’s medical information has been improperly accessed. Brittany Spears was hospitalized in a psychiatric unit when several employees improperly accessed her records. They were all terminated. Social media is another big issue. All attorneys advise not to post anything, zilch, about work on any of the social media. Again, you can never know all who may be reading your posts or who may even forward that information to other pages. Violation of HIPAA may result in fines of from $100 to $50,000 per violations and up to $1,500,000.00 a year. Hospitals must designate a HIPAA officer to make sure that the hospital is in compliance. According to the HIPAA Journal, the average HIPAA data breach costs an organization $5,900,000.00. This is astronomical! No wonder hospitals take this so seriously. Do your part by never accessing patient information for which you are not authorized to do.
  11. Lorie Brown RN, MN, JD

    Curiosity Killed the Cat and Got 50 Hospital Employees Fired

    As long as you access the chart for a legitimate reason pertaining to the patient's healthcare, that is fine. Check with your risk manager about putting in an entry "accessed chart to find dietary order for dietary aid" or " accessed chart to notify physician of patient's whereabouts"
  12. As the only RN on a mixed Med-Surg/Peds unit, taking 5 to 6 of my own patients (with no tech on most days), am I responsible for the actions of the LPN? We are not completing team nursing, just each of us individually takes our own patients. With this being said, I am unable to "follow" the LPN to ensure that she is completing her job duties. We have had several incidents, including late medications (10 plus hours), not placing physicians orders into the computer, not calling critical labs to the physician, etc. Management is aware and only states that it all comes back to the RN on duty, as it is ultimately the RN's responsibility and the RN's license on the line. Also, this nurse is not open/honest about the items not being completed; always stating that she is "fine" when asked if she needs assistance with anything. Any advice would be greatly appreciated. I have been nursing 24 years on this unit and would like to keep my license in good standing. Dear Am I Responsible, An RN is responsible for the actions of an LPN. An LPN cannot work independently although an LPN can take their own patient assignments. LPNs rely on the expertise of RNs for patient assessment or changes in condition. It is your license. If you don’t feel comfortable being responsible for an LPN, you should talk to your supervisor. As the RN on duty, you are ultimately responsible. I know you like your job but you can always find another one. However, you can’t always get another license. Hopefully, you’ll be able to work out matters with your employer so that you can feel comfortable supervising this LPN. Good luck with getting this resolved Lorie
  13. I'm a pre-nursing student. My school offers an associate degree and I do have the option to gain it. Is gaining an associate degree in nursing a good decision since I will probably get a job with it while working on my bachelor's? or should I only focus on a bachelor's so I don't confuse myself? Dear ADN or BSN There have been many attempts to have a Bachelor’s as an entry degree into nursing. In fact, in December 2017, New York’s governor signed into law a requirement that nurses need a BSN within 10 years of initial licensure. The push for BSN licensure has been batted around for a long time but New York is the first state that has implemented this requirement. Not knowing in what state you reside, one thing to look into is “Do Associate degree nurses get paid the same as Bachelor’s prepared nurses? Does your potential employer have a tuition reimbursement program for you to continue your education to obtain your Bachelor’s degree? Lastly, look at yourself and ask yourself whether you will be able to finish your BSN while working. Some people need to just concentrate on school rather than trying to combine school with work. It’s an individual decision where you need to look at the pros and cons thoroughly. Good luck with your decision. Lorie
  14. I work in corrections. Quite honestly, we are always understaffed, making quality care delivery impossible. However, as stressful as it is, I do enjoy it. I have been wondering whether I should invest in my own liability insurance. I have never done so before. I don't know how to distinguish which companies are reputable and which companies offer the best value. Of course, I also wonder if I'm just being overly anxious and perhaps I don't even need liability insurance. I just wanted to know your thoughts on the matter. Thanks in advance. Dear wondering corrections nurse, I recently wrote an article for ALLNURSES on whether a nurse should obtain malpractice insurance. You can check out the article here or, if you would like to research the different malpractice insurance available to nurses, you can contact your State Department of Insurance. All insurance policies must be approved by the state in order to be sold. Therefore, the Department of Insurance would have a list of all the insurance carriers in your state that have approved plans in your state. I suggest you know what to look for. Don’t simply look for the amount of coverage. You may get the most coverage for the least cost but be aware that some insurance policies are considered “excess policies” meaning that they don’t even kick in under your hospital has paid the full amount. The best thing about having your own insurance is that you have the right to your own attorney. Therefore, if your position is adverse to your hospital, you’ll have your own attorney who can advocate on your behalf. Another thing to look for in insurance is whether the program has a disciplinary defense. Employers are required to cover you for medical malpractice if you’re acting within the scope of your responsibility. However, the employer is not responsible to cover you if you get reported to the State Board of Nursing. If your insurance has disciplinary defense coverage, then you will be able to be reimbursed for attorney fees should you have a matter before the Board. Good luck! Lorie
  15. Lorie Brown RN, MN, JD

    Nurse Charged With Homicide

    Every day nurses are put in difficult situations. If criminal charges are looming over our head, who would want to be a nurse? This case is clearly malpractice but I don't think it is arises to the level of a criminal matter. Vanderbilt should never have vecuronium in the radiology dept. In addition, there should be a warning that pops up on the Pyxis. Radonda was a new nurse having graduated in 2015. Her license is still active today. Vanderbilt swept this matter under the rug and it was not until CMS got involved, that this matter came to light. This was not just a nurse error but a system error. There were cases in Indiana where the adult heparin was stocked in the Pyxis instead of the pediatric heparin. 3 babies died as a result of an overdose of heparin. No criminal charges were filed.
  16. Hello! I have been moving towards starting my own staffing agency (employing myself), and was wondering what the legal requirements are in general. Should I seek professional help writing up a contract for potential clients? Any help or resources would be greatly appreciated! Dear Starting Your Own Business Look into the National Nurses and Business Association at nnbanow.com. They are great. They have tons of resources to aid you in starting your own business. Seek a competent attorney with expertise in nurse-owned businesses to help you with your contracts and other legal matters. I also suggest that you hired an accountant as well. Wishing the best in your new venture Lori
  17. Lorie Brown RN, MN, JD

    The Dilemma of Multiple Licenses

    Download allnurses Magazine Dear License Dilemma, If you have multiple licenses, you are subject to multiple actions against it for the same thing. It’s as if you have a suspended driver’s license in Indiana for driving under the influence. Ohio would not want you driving in their state so Ohio has a right to know about the status of your driver’s license. The same is true with your nursing license as Ohio has a right to know about your Indiana nursing license status and possibly could take action on your Buckeye State license in response to issues attached to your Hoosier license. Some think that by refusing to renew their license in another state, no action will be taken. This is incorrect. Actions even can be taken against an expired license because the public has a right to know that action was taken against you in another state. Should you choose to reactivate that license, that state for that license wants to have a record of actions in any other state. Once an action is taken against your license, no matter where, it is on your record forever and available to the public for all to see at http://www.nursys.com. It can also take many years for action to be taken against a nurse’s license. The American Association of Nurse Attorneys has published a position paper on the statute of limitations and retained jurisdiction. The paper’s purpose is to create awareness and, hopefully, states will do something about how long it takes for charges to be filed against your license. When it takes so long for actions to be filed, it can be difficult to remember what happened years ago, memory fades and witnesses become unavailable. The paper also discusses retained jurisdiction, the state’s ability to file charges against your license when you no longer have a license. The paper is a valuable reference but, unfortunately, should you have multiple licenses, I call it the “domino effect” because action can be taken against all of those licenses. Lorie
  18. Hello Lorie A 17 year old male went from agitated to obtunded after 40 mg. Geodon within a three-hour period. When the nurse approached the supine patient - who was now at risk for aspiration - in order to raise the head of the bed to 30 degrees and to assess him, the prescribing physician would not allow it, and the charge nurse agreed with the physician. The physician wrote an order: hold vital signs for ten minutes, then resume. The nurse manager insisted that the nurse should not go against the wishes of either the physician or the charge nurse. Is there not a duty imposed on the nurse, under the terms of the state-issued licensure, to act for the benefit of the patient and to intervene to remove the risk? Dear Disagreeing with Physician and Charge Nurse, When you have a disagreement with a physician or charge nurse, your facility should have policies and procedures in place to go up the chain of command. There can be liability if you fail to question an inappropriate order. Your first responsibility is to your patient and should you believe an order is inappropriate or endangers the patient, you have a responsibility to go up the chain of command. If your facility does not have a policy and procedure to address this, ask your nurse manager for direction. Using the chain of command to advocate for your patient can protect you from liability. Lorie
  19. Lorie Brown RN, MN, JD

    Nurse Gives Lethal Dose of Vecuronium Instead of Versed

    Great post. I represented a nurse who was floated to the ER. She never worked there and had no experience. She expressed her concern but management insisted she go. A similar mistake happened but fortunately, the patient did not die. No wonder why there are over 100,000 unnecessary deaths in hospitals each year. Nurses are overworked and are bombarded with new information every few minutes.
  20. Dear Lorie I suspect a co-worker is impersonating a nurse. He was hired as a medical assistant, but recently states he has obtained RN licensure, although this is not supported by the state BON verification link. His job duties have not changed from that of medical assistant; however, he now identifies himself as an RN to patients, staff, other offices, etc. I have been wanting to give him the benefit of the doubt as I hate to be wrong about something like this, but it seems increasingly evident his story does not check out. When confronted about it, he becomes defensive and deflects. Am I obligated to report this to the BON? Dear Obligated, If it were me, I would check the state's Nurse Practice Act to see under which circumstances I would have an affirmative duty to report a nurse to the Board for practicing without a license. You can also check Nursys® to see if that person is licensed. Good luck with this, Lorie
  21. Hi Lorie, I am a newly licensed acute care nurse practitioner in Las Vegas Nevada. I am considering accepting a job where I would be an independent contractor with a 1099. It was suggested that I registered myself as an LLC, but I'm not sure what the benefit of this might be. Can you explain this to me? Dear Independent Contractor vs. LLC One of the benefits of being an independent contractor is that you can deduct or write off any business expense for tax purposes. So, any equipment or supplies that you purchase, that are only used for work, you can write off. However, it does mean that you will to pay your own malpractice insurance and your own benefits. The advantage of becoming an L.L.C. is further protection from liability. Before you decide to work as an independent contractor, speak to an accountant who can do the numbers for you and make sure that it's more advantageous for you to be an independent contractor versus an employee. Some states have made it harder for NPs to be independent contractors such as CA. Please check with your state department of labor and make sure it is legal. Nurses definitely cannot be independent contractors. Good luck with your decision. Lorie
  22. Lorie Brown RN, MN, JD

    Voluntarily Surrendering My License

    Hi Lorie Can I voluntarily surrender my California Nursing RN license - will that affect my other licenses with other states,? like Florida (where I currently practice), and the Compact - I am being audited and I realize that I do not have the 30 full credits for the Calif Nursing license requirement - I only have 29.8 - am short by 0.8 credits. Dear Voluntarily Surrendering Voluntarily surrendering a nursing license can cause problems in any other state in which you have or had a license. You may choose not to renew your license but, by voluntarily surrendering your license, it can have what I call a "domino effect." Any other state can act against your license. It may seem like the easy way out at the time but it really isn't. Good luck Lorie
  23. Hello Lorie, I have a littering ticket from 7 years ago that I have a warrant for. I am about to graduate and i am afraid that this will stop me from taking the the NcLex and getting my license. I would like to know what I should do. Dear Littering, You will need to review the question on your license application. In my state, it asks except for minor traffic violations. If you were not arrested, charged or convicted and it's not considered a misdemeanor, you may not have to respond. Regardless, you have to read the question very carefully. Do not ask the Board how to interpret the question because they are not attorneys. Should your state allow expungement, that may be the best way to resolve this issue. Best of luck to you, Lorie
  24. Lorie Brown RN, MN, JD

    Nurse's Legal Responsibilities for Patient Care

    Hi Lorie Could you refer me to where I can find references for teaching staff nurses about their legal responsibilities for patient care. I hear on a regular basis from nurses, "I'm not losing my license over this or that" or "I'm not licensed to do this or that". I feel like nurses who make these blanket statements really don't know what they are legally liable for. I have our state nurse practice act, but I am looking for detailed information regarding charting. Thank you in advance for your time. Dear Nurse's Legal Responsibilities The standard of care is what those acting under same or similar circumstances would do. Your hospital's policies and procedures are the best guide to what the standard of care is at your facility. The standard of care varies from institution to institution. For a couple of examples, some facilities will allow nurses to remove PICC lines and in others they are not. In some hospitals, nurses are allowed to draw blood from a Quinton catheter and in others they are forbidden to do so. With regard to more detailed information about charting, I would suggest looking at the continuing education programs out there. There are many good ones that are very comprehensive. Hope this helps. Lorie
  25. Hello Lorie I am a pediatric triage nurse for a pediatric hospital. I have identified a need for education for parents and caretakers of young children. I would like to create passive income by writing an ebook or online masterclass. How do I protect myself as a nurse writing educational material? I know there would be some sort of disclaimer. Also, would this be a conflict of interest with my children's hospital, as a lot of the information I would be using is through my training/resources in my position. Dear Educational Nurse Writer It always is a difficult situation when a nurse wants to become a business owner and is still employed. This happens particularly with legal nurse consultants. The hospital does not own you and your free time is yours but if you are doing something adverse to the hospital's interests, obviously they would have a concern. You should talk to the hospital about writing educational materials and make sure that they are supportive. As far as liability, of course, you would need some sort of disclaimer. I hope this helps. Lorie
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