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Lorie Brown RN, MN, JD

Posts by Lorie Brown RN, MN, JD

  1. I was surprised when the Nursing Board initially took no action.  This is a serious med error and a violation of the nurse practice act.  I don't think it is right to tell someone they are not filing charges and then to do it later.  The criminal charges are not appropriate.  However, the proper disposition of this matter is with the nursing board and a medical malpractice case if the family chooses to proceed with one.

  2. On 9/9/2019 at 3:51 PM, Crash_Cart said:

    Well they better send officers to physically restrain the patient when the forced blood draw without consent takes place. 

    I think there are just so many things wrong with this from both a legal and ethical practice perspective. It unfairly puts the nurse in the middle of it all.   

    On 9/10/2019 at 2:24 PM, kbrn2002 said:

    Too bad I don't have a lawyer handy that I can ask some of these questions. What about the patient that comes in unconscious or impaired enough to not be able to give consent? I assume for that patients medical care the labs would be ordered anyway regardless of law enforcement.  My question is this, a person's medical record is private so what if the patient isn't able to give consent or refuses to give consent for law enforcement to access the test results through the medical record?  If the patient is aware and able to refuse consent can they even fight a subpoena to access the results?

    When a patient comes in unconscious, then there is an emergency consent doctrine which means patients can be treated in an emergency situation.  That does not mean they can do things which are not medically necessary.

    When a subpoena is issued, the patient can move to quash the subpoena in court but that means they will need to hire an attorney quickly and ask for a temporary restraining order but you have to show the harm of having the blood drawn is great so I think it would be tough to pass that hurdle.

    On 9/10/2019 at 2:24 PM, kbrn2002 said:

    Too bad I don't have a lawyer handy that I can ask some of these questions. What about the patient that comes in unconscious or impaired enough to not be able to give consent? I assume for that patients medical care the labs would be ordered anyway regardless of law enforcement.  My question is this, a person's medical record is private so what if the patient isn't able to give consent or refuses to give consent for law enforcement to access the test results through the medical record?  If the patient is aware and able to refuse consent can they even fight a subpoena to access the results?

    When a patient comes in unconscious, then there is an emergency consent doctrine which means patients can be treated in an emergency situation.  That does not mean they can do things which are not medically necessary.

    When a subpoena is issued, the patient can move to quash the subpoena in court but that means they will need to hire an attorney quickly and ask for a temporary restraining order but you have to show the harm of having the blood drawn is great so I think it would be tough to pass that hurdle.

  3. You may recall the July 2017 case of Alex Wubbels, a Salt Lake City nurse who was arrested for refusing a police officer’s command to draw blood from a comatose auto accident victim without a physician’s order or warrant.  The uproar from the incident not only led to a change in the Salt Lake Police policies regarding blood draws but in a Utah law specifically requiring warrants be obtained before getting such draws in the future.

    Recently in Texas, Jonathan Moore, with 5 prior DWI convictions and off probation for only 5 days, was involved in an accident resulting in the deaths of a former Dallas Councilwoman and her daughter.

    At the scene, police who stopped Mr. Moore were concerned that he had been drinking.  However, despite the breathalyzer test showing an alcohol level of 0.00, Moore proceeded to fail all 6 field sobriety tests administered to him.

    Moore was taken to the hospital where police officers asked the nurse to draw his blood for a drug screen.  She refused stating she could not withdraw blood without patient consent and, because Moore supposedly was intoxicated, he could not give consent.  The nurse suggested that the officer get a warrant.

    The hospital’s policy states that it’s the officer’s job to obtain a warrant and cite the reason for the requested blood draw.  It is not the responsibility of the nurse.

    Nevertheless, the Texas Nurses Association (“TNA”) believes that “if a person is in custody and has been arrested, law enforcement can request taking a blood draw without an individual’s consent.  It is law enforcement’s responsibility to know that the person has been arrested for an offense that does not require … consent.”

    Clearly, we have a conflict in the rules between hospital policy and the TNA.

    Always follow your hospital’s policies which is what the nurse in this case did, she insisted on a warrant to draw the blood.

    This case is a bit different from that of Nurse Wubbels because here the person was not comatose and was the actual perpetrator of the crime.  Whereas in the Wubbels matter, the patient was a victim injured by the perpetrator.

    I recommend that you make sure that your emergency room has clear policies and procedures in place to ensure you know what to do and under what circumstances you can draw blood so that you never to find yourself in one of these situations.

     

  4. Hi Lorie

    I live in South Florida and I am on Team B for hurricane coverage which means I go in post-storm. I am expected to work Tonight 7pm to 7:30 am and Thursday 7pm-7:30 am for "Post Storm". My dilemma is I'm already scheduled for Fri & Sat nights. That means 4 nights in a row. I already worked Sunday night Sept 1st. 
    Do I have any legal way to not work all those shifts?


    Dear Hurricane Dilemma

    Thanks for the great and timely question.  Employment law comes from the ancient master-servant relationship.  Therefore, your employer can ask you to do anything they want.  If they need you for post-disaster relief and then the weekend, it is your responsibility to comply.  If you think that is too much, ask your employer to change your schedule or find someone to trade.  

    If you are scheduled to work, you must show up or face discipline up to and including termination.  Some states have laws preventing mandatory overtime but I do not think Florida is one of them especially in an emergency situation.  

    The only way to get this changed is by changing the law or sometimes through union or an employment contract.  I know this is not what you want to hear but I hope this helps.

    Good luck

    Lorie

  5. Hello Lorie

    I was falsely accused of falsifying documentation at work. My employer conducted an internal investigation and concluded I falsified documents. In the investigation report it states things I supposedly admitted to. They wrote things I never said. They have terminated me, and they were also reporting me to the BON. I have been a nurse for 10 years. I have no previous disciplinary actions. Also no civil or criminal record. Nothing more than a speeding ticket or 2.

    What should I do to refute this, and keep from losing my license?


    Dear Falsely Accused,
    I am sorry this is happening and I hear it all too frequently.  The best advice is to hire an attorney. One that is experienced representing nurses before the Board.  You can find one at TAANA.org.  Your license is too important. 

    Hope this helps.

    Lorie

  6. Hi Atty. Lori, 

    I am a 30 yo Filipino nurse working in Dubai for 7 years as a senior nurse. There was an accusation against me and unfortunately, I was terminated by my employer because of that. A police investigation was made and after a lengthy investigative period, I was cleared of the case and I still have no criminal record (I was just given a warning by the police department but still no criminal record). But unfortunately, the damage is already done and I was already terminated and my Dubai nursing license was already suspended, but my Philippine nursing license is still active. Now I am planning to apply for the NCLEX exam (Northern Mariana Islands Board of Nursing), and I want to know if my application for the exam will be rejected because of my suspended Dubai license? What other options do I have? Would it be a smart idea to just say no (to the question: Any history of revocation, suspension of license from another country?) just so I can take the NCLEX exam? Your response is really appreciated as I am in a desperate situation.

    Thank you, Atty Lorie


    Dear Suspended in Dubai,

    Thanks for reaching out to me.  I am not familiar with obtaining a license based on a foreign license so I cannot respond but I would be truthful.  If the National Council of State Boards of Nursing which runs NCLEX finds out you were not truthful, it will be a problem.  I spoke to nurses in Dubai at a Hospital and I understand their laws are tough. If there is any way to get it reinstated, that is the best course.

    I wish you the best

    Lorie

  7. Hi Lorie

    I work in a small hospital in central Texas and they have recently hired an RN that is on stipulations. We are at a rural facility and the ER is staffed with 2 RN's and one doctor. She is on stipulations for administering a paralytic to a patient while working in the ICU without a doctor’s order. She forfeited her license but it has now been reinstated with restrictions. She is required to only work with another RN as a supervising RN. My question is, What is my responsibility when working with her? Am I responsible for any mistakes that are made?

    Thank you for any clarification.


    Dear Am I Responsible,

    Thanks for reaching out to me.  The purpose of stipulations on a license or probation on a license is to make sure the nurse is safe.  It is considered an encumbered license. Many times they want another nurse there to be a resource if she has any questions.  The Board does not define the role of a supervising RN. Does your facility have a policy that would cover this? If not, have you asked your manager about expectations?  The facility is responsible for any malpractice even if you are supervising her. With that said, that does not mean you will not be named in a lawsuit but in my experience, nurses are usually not named individually. Sometimes facilities think a nurse with stipulations is a liability.  I choose to think of them as wanting to do really well because they are under a microscope and they want to get off probation and have the stipulations removed.

    I wish you the best,

    Lorie

  8. Hi Lorie

    I'm opening a weight loss clinic in Texas and have a supervising physician.  I want to offer telemedicine visits.  What are the liabilities associated with telemedicine?  I'm wondering because the clinic near me offers it.


    Dear Telehealth Weight Loss

    Great question. 

    The liabilities of telemedicine are the same as in an in-person clinic.  Make sure you use HIPAA compliant video conferencing services and follow the telemedicine laws in your state.  I would suggest that you don't prescribe controlled substances. Lastly, check with your medical malpractice carrier’s risk management service for additional information. 

    Good luck with your practice.  Be sure to come back and let us know how things are going.

    Lorie

     

  9. Hello Lorie

    I am currently an LPN and R.N. student I want to start a business where I collaborate directly with nursing homes or patient families to provide residents to participate in offsite activities. For example trips ( museum, library, shopping etc ) I would have CNAs and HHAs and other LPNs to assist me for toilet needs and medication administration etc I was wondering where should I start? Do I need to participate in any legal matters like insurance etc?


    Dear Future Business Owner,

    I love your idea.  It is really important that you start your business on solid legal ground.  You definitely will need insurance and consents. I suggest you hire a small business attorney with health care experience.  In addition, I would like to suggest another resource, the National Nurses in Business Association at NNBAnow.com

    I wish you the best and I love how nurses use their knowledge to create businesses that serve a need.

    Lorie

  10. Congratulations on your sobriety.  I cannot imagine all the obstacles you faced.  I represent nurses in your situation and all too often I hear a similar story but they don't know what is on the other side when you have sobriety under your belt.  Get help before it's to late.  It is confidential.  I lost 2 clients to substance abuse, one with a husband and 2 small children.  I do not want this to happen to any other nurse.  There is help available but the first step is to admit you have a problem and then get help.  There are so many protections in place such as HIPAA and even stricter protection for mental health.  Get help before the Board gets involved.  It's your license, your livelihood and YOUR LIFE.

  11. Here are a few ways in which nurses can be called before the Board and how you can protect yourself.

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    1. The first and obvious the Board feels that you are a nurse 24/7 and anything that you do that could look bad on our profession or be a concern for your judgment, they will take action.  This means any criminal matter where you are arrested, charged or convicted such as a DUI.

    2. Do not use controlled substances, illegal substances, marijuana or alcohol.  If you take a controlled substance and do not have a valid prescription and you have to take a drug test that shows positive, it does not look good for you.  And don’t take medications without a valid, current prescription or borrow medications from someone else as this would be considered practicing medicine without a license by self-prescribing and it is also called diversion.  In addition, do not give a medication to someone else even if they’ve had a valid prescription for that medication in the past. This also is considered practicing medicine without a license and diversion.

    3. Do not cross professional boundaries.  Nurses are required to care of patients during the time that they are assigned to the patient’s care.  Do not come to visit patients after hours and do not continue a relationship with patients after the nurse/patient relationship is concluded.  I’ve seen nurses who subsequently marry patients and then, if they divorce, the ex-spouse then files a complaint against the nurse’s license. I have seen nurses who, trying to be nice, will conduct banking chores for the patient.  Taking the patient’s debit card and PIN, they do the transaction only to find that the patient then alleges the nurse stole money. Don’t become involved with patients after the nurse/patient relationship has ended and only provide activities within the scope of your practice.

    4. Be mindful of HIPAA.  Talking about a patient outside of their room, even without using names, can be a HIPAA violation.  You never know who might be listening. And don’t access patients’ records if you are not providing care for that patient and have no reason to access the patient’s records.  One nurse’s adult son was in the emergency room. She could not leave her position but looked at his chart to get his information. She had no business checking the chart which was a violation of HIPAA.  Don’t talk about patients except for treatment purposes and only in a secure area and do not access any other patients’ charts unless you are providing care or have a legitimate reason to do so.

    5. Make sure you use due care in administering and signing out narcotics.  With the opiate crisis these days, there is software in the Pyxis machine to see who is giving more medications than the others who are on the unit.  Don’t be an outlier. Discuss the medication strategy with your coworkers and make sure that everyone is on the same page. When I went to nursing school, pain was considered the 5th vital signs and we always wanted to stay on top of pain.  However, things are changing. In fact, sometimes they don’t even give narcotic pain medication, even after surgery. If you do give pain medications, make sure you administer them as soon as they are removed from the Pyxis. Do not carry it in your pocket except to go directly to the patient’s room. I have seen it argued before the Board that by waiting too long to administer injectable narcotic medication, the nurse had an opportunity to take some or all of the medication and replace it with saline. Also, make sure you waste medications right away for the same reason and make sure the witness actually sees the waste and cosigns it. Going to a coworker after you wasted the medication and asking a coworker to cosign the waste without witnessing is in violation of your facility’s policies and procedures. So, make sure you follow all the facility’s policies and procedures. If you do get reported to the Board, my experience has been that if there are discrepancies with narcotics given, the Board will think that you are using them and if you aren’t using them for your own use then you are selling them.  They can be very unforgiving. Protect yourself by following your policies and procedures to the letter.

    The above-mentioned tips may seem obvious but you would be surprised how many nurses are called before the Board for these types of issues.  The best protection against a Board Complaint is to be proactive and follow the rules.

  12. 1 hour ago, LC0929 said:

    Thanks Lorie ...and I don’t have any problem with dealing with MA, with the exception of the fact that I am not an addict but I have to dish out thousands of dollars to prove it.... I’m not willing to pay a lawyer to defend me, or psychologist to analyze me when I have not done anything to warrant investigation....what is also disturbing is the fact that the MABORN is essentially saying that they’re better than the NH BON.... I was taught that the Nurse Practice Act, as well as statutes, etc, were the same nationwide...maybe things have changed in thirteen years....yes, I’m frustrated...putting it lightly....but I’m not willing to sell my soul or my integrity to keep a license....and no nurse should be expected to....

    There is a Model Nurse Practice Act but each state has their own Nurse Practice Act and they are all different and may not be based on the Model.  The statutes are different in each state too. Unfortunately, it is guilty until proven innocent before the Board and MA does not have to follow what NH did.

  13. Each state has the authority to regulate nursing practice.  Your license is not reciprocal unless you have an e-compact license.  It is a nurse's responsibility to keep the Board apprised of their current address even if the license is expired!!!!  They can still take action on an expired license.  Even if one state dismisses a case, action can still be brought on a license in a different state.  I know you are upset but I would recommend cleaning up MA or you may have a problem getting a license in another state.  The American Association of Nurse Attorneys has a position statement on what is called retained jurisdiction with expired licenses.  https://member.taana.org/resources/TAANA_Position_Paper_2016-10-13.pdf

  14. Hi Lorie

    I have had severe daily migraines since I was 7 and took my lawfully prescribed migraine medicine Fioricet for 20 years in the middle of the night before work, which lasts about 3-4 hours.  I was taken by security and took a drug test and passed fully minus the Fioricet which I proved my script.

    My director still is accusing me of being impaired. I was not- and occasionally my migraines can make me look impaired. I was probably acting defensive very anxious/shocked I was being accused, but initially, his accusations were based on my eyes-they water and get bloodshot when I have a migraine and I had burned the first time (and last time) tanning artificially the night before.

    I didn’t get to tell my story. I was sent home, drug test passed with MRO follow up for safety concern for a high level of Fioricet, occupational health followed up and my PCP wrote to not take the medication at work (which I don’t anyway) and cleared. I have been out of work for 3 weeks now still.

    Now they are meeting the quality for patient services and safety Dr. RN. And I am still home.

    Is an accusation of being impaired alone reportable to the board of nursing? Even after a drug test is taken and I am legally prescribed a medication?

    Is this something they will fire me over and then report to the BON? What can I expect? What are my rights?

    Thank you


    Dear Wrongly Accused

    I am sorry this is happening.  I too am a migraine sufferer. Anyone can report you to the Board for any reason.  So, yes, you can be reported for appearing impaired at work.

    As far as the Fioricet is concerned, the Board is concerned with nurses taking controlled substances for a prolonged period of time. The reason why they are controlled is because they are habit forming. The Board has no way of knowing if you took your medicine at work or not. You may want to talk to your physician about ways to control and treat your migraines without using controlled substances.

    As far as employment is concerned, most states are employment at will and they can fire you for any reason.   If you are reported to the BON, you should receive a call or a letter. Make sure your address is correct so you will receive the mail because you will only have a certain number of days to respond.

    I hope you were able to keep your job and nothing comes of this.

    Lorie

  15. Hello Lorie

    I have been reported to the NPDB. With that being said, I am wanting to know if I can apply for a compact license?


    Dear Reported to NPDB

    It depends on the reason you were reported to the NPDB.  The NPDB was created to be a clearinghouse. If a physician had several medical malpractice claims in Texas and then moved to Oklahoma, there used to be no way to verify the medical malpractice claims.  With the NPDB, each state has access to any adverse action. If it is a medical malpractice claim, it usually is not that much of an issue for nurses but if it has to do with an action against your license, then it becomes very important.

     I hope this helps.

    Lorie

  16. 28 minutes ago, beekee said:

    It’s patient abandonment if I call out sick?  Really?!?!  I’ve worked sick. I’m slower, less efficient, more prone to errors and may pass my illness to people who cannot physically handle more illness.

    So....isn’t it better than I call out?  It’s absolutely ridiculous that anyone would advocate for a nurse to work while ill. 

    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.

     

  17. 47 minutes ago, llg said:

    I am not totally satisfied with your answer to this question, Lorie.   It's morally wrong to "guilt trip" nurses about taking sick leave when they are truly sick or injured.   And jumping quickly to the "patient abandonment" concept is irresponsible -- simply adding fuel to the fires of those who want to abuse their staff by expecting them to work when sick/injured. 

    If the hospital has not planned alternate staffing for legitimate episodes of illness/injury then SHAME ON THE HOSPITAL, not on the sick/injured nurse.

    If there are staff members using the sick/injury excuse when they are not truely sick/injury -- that's another story.   But discussions and strategies regarding absenteesim should always distiguish between the legitimately ill and the fakers.

       

    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.

  18. 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.

  19. 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

  20. 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

  21. Hello Lorie,

    I received my ADN March 31, 2017. I decided to take my boards on September 13 of that same year, I had 82 questions. NMBON issued me a license, to which I took to the floor precepting, after 4 days on the floor, NMBON sent me a letter saying that I had failed my Boards and I would have to retake them. I was horrified. I then, protested and they told me that it was "human error, and it happens from time to time". I took my boards again the following month, to which I failed (I knew that I failed before the screen went black). I left in tears. Since then, I have been discouraged and I no longer want to take my boards for fear of "human error" to happen once again. My question is, I was told that I should have hired an attorney, was there grounds for me to hire one back then? Also, do you have advice for me now? Should I take my boards in another state? Please advise.


    Dear victim of human error,

    I am sorry this is happening.  The NCLEX is the same in all states so I am not sure if it would make a difference to take it in another state.  I have not heard of the Board rescinding a license after it is issued. I would highly recommend talking to a nurse attorney in NM.  At least you will know if there is anything else you can do.

    Good luck with getting this resolved

    Lorie

  22. Hi Lorie

    What should you do if you get bullied constantly at your job and are even feeling abused?  I was hired in a small hospital, and since the first week, the manager and director of care started bullying me and even abusing me by changing my assignment to make things so difficult for me that can I never go to any breaks. This continued for 5 months, so I resigned from that job.


    Dear bullied and abused:

    I am sorry you had to experience this.  Bullying is such a big problem in nursing.  Let me recommend Renee Thompson at RTConnections.com Renee is the foremost bullying expert in nursing and has developed a system on how to deal with it.  

    You did the right thing by resigning. I say you can always find another job but you cant get another license.  As far as the no breaks, you might want to contact the Department of Labor in your state. In Texas, for example, the nurses there filed a class action lawsuit asking for pay for lunch they never took and were not paid.  I hope you do not experience this in your next position.

    I hope you are able to find a better work environment.

    Lorie

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