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Lorie Brown RN, MN, JD

Content by Lorie Brown RN, MN, JD

  1. Lorie Brown RN, MN, JD

    Trying to Endorse into Texas

    Hello, I am a nurse in Nevada trying to endorse into Texas. Do you have any knowledge on the process with the Texas BON? Each Board of Nursing operates separately, even the compact states. From the tone of your question, I think there may be something in your background that you are concerned about in applying. If so, contact an attorney. But no one can tell you whether you will be given your license. It is determined on a case-by-case basis with each Board. However, an attorney can help you look your best before the Board.
  2. 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.
  3. 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
  4. 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
  5. Lorie Brown RN, MN, JD

    What can I do about bullying?

    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
  6. 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
  7. Hi Lorie I have received a letter from the attorney general that I am being investigated. It says that I am to respond within 20 days of the date of the letter. Can I request more time to respond so that I am able to acquire legal advice and/or representation? Dear Being Being Investigated I'm sorry that you received a letter from the Attorney General. In the letters I am familiar with, it states that you have the right to an attorney at your own expense. Right there in the letter, the Attorney General is telling you that you are entitled to representation. If you need more time to obtain legal assistance, by all means ask for more time. I don't know whether it will be given but you certainly have the right to ask. That's what attorneys do when they're newly involved in a case, they always ask for more time. Good luck with your matters. Lorie
  8. Lorie Brown RN, MN, JD

    I was accused of being impaired at work

    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
  9. Lorie Brown RN, MN, JD

    Should I Carry My Own Malpractice Insurance?

    Many times nurses are not named individually in a lawsuit; it is their employer. The employer has an obligation to defend you and cover you for any of your actions as long as you were acting within the scope of your employment at the time of the alleged malpractice. If you did something outside the scope of your employment such as stealing from a patient or, as an absurd example, having sex with a patient, these clearly would be outside the scope of your responsibilities and would not be covered by your malpractice insurance. A benefit for having your own malpractice insurance gives you the right to have your own attorney. That's an extremely valuable benefit when your interests are at odds with those of your employer. Another benefit for having your own insurance is that certain policies cover you for "disciplinary defense." This means that if you have an action filed against your license, you may be entitled to reimbursement for the attorney fees spent in your defense. Mind you, depending on the attorney, you may need to pay those fees up front but will get some or all of the fees back. Most malpractice insurance policies are called "excess policies" which means that they don't come into effect until coverage with your employer is exhausted but again, you have the right to have your own attorney. There are downsides too for having your own malpractice insurance. If you are in a state that has a cap on damages and your insurance coverage is not covered by the cap, you may have more potential to be named in the lawsuit for the extra coverage. But, let's say that your state does not have a cap, having your own insurance coverage may subject you to being named individually as a defendant in an action because of the additional insurance coverage. So, the choice is yours as to whether you buy malpractice insurance. The cost is relatively low. However, being one who appears with clients before licensing boards, I hear repeatedly from nurses that they never thought they would get in trouble with the Board. Yet every day, I have clients who have complaints filed against them with the Nursing Board. Having malpractice insurance with disciplinary defense coverage would then be invaluable in these cases. 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. Be sure to check out more from the first issue of allnurses Magazine.
  10. Unless you’ve been living under a rock. You know all about RaDonda Vaught, the Tennessee Nurse who made a terrible and tragic fatal medication error. I won’t go over all the details of the case here since there have already been multiple articles in the news and on allnurses.com. I will share more in the video below. As a nurse attorney, I want to give some legal perspectives about this case. The Basics Charlene Murphy (let’s not forget about her) - a patient undergoing a CAT scan RaDonda Vaught - nurse with 2 years of experience working as a help-a-nurse The Doctor (whose name has not been spread all over the news) ordered Versed RaDonda overrode the Pyxis and erroneously retrieved Vecuronium instead of Versed RaDonda failed to perform the 5 Rights of Medication Administration The fatal dose of Vecuronium administered to Charlene Murphy RaDonda still has an active license Vanderbilt Medical Center did not tell the family about the medication error until a year later. Questions Did Vanderbilt Medical Center have policies and procedures for the administration of Versed including monitoring? Why didn’t the family learn the truth of the matter until a year after CMS investigated? Should RaDonda be found guilty of Reckless Homicide and receive a prison sentence? In the State of Tennessee, what is Reckless Homicide? Why did RaDonda plea not guilty? What precedent might the outcome of this case set? The real issue in Radonda’s situation is “did this amount to reckless homicide?” I do not agree that it did. Flat out negligence, no question about it. Medical malpractice, no question about it. I have no idea what a jury will decide should RaDonda’s case go to trial. What would your vote be if you were sitting on the jury? Guilty or Not Guilty? If you find yourself of the opinion that “yes”, RaDonda should be criminally prosecuted, keep in mind that this could be you! Please watch the video below and find out the answers to some of the questions posted above. Then, share your comments below.
  11. I have been thinking about getting a medical marijuana prescription for my chronic pain. But, recently, I've been reading about CBD and know that in some states, CBD oil is legal. Would I be able to use it as a Nurse in my state (if it's legal)? Do I have to worry about my Board of Nursing (BON), or worse ... failing a drug test? Thanks for your question. Marijuana is legal in 9 states for recreational purposes and in 30 states for medical purposes. If you live in a state where marijuana is legal, it is still illegal for nurses! It's illegal no matter where you are, even if you have a prescription. If you use and get drug tested, you will have a problem. Marijuana stays in your system for a long time because it is fat soluble and stored in fat cells. The active ingredient in marijuana is THC. Only the male part of the hemp plant contains THC. The female part of the hemp plant does not contain THC. If you get pure cannabidiol oil, which does not contain CBD, you should be OK and be able to pass a drug test. However, be very careful and be very sure that you are getting the pure oil just to ensure that your urine test won't turn up positive. "I don't know" is not a defense so make sure you are getting the pure oil which does not contain THC. In addition, these oils are not FDA approved so there is no testing to make sure it does not contain THC so be careful. Many think that CBD products containing less than 0.3% THC would be classified as hemp under federal law and that it is legal to possess and distribute. That is not true and, in some states, it is still illegal to possess CBD oil. Again, make sure that the CBD you use contains absolutely no THC (0%) and that it is legal to possess and use in your state.
  12. Lorie Brown RN, MN, JD

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

    Each state has different laws regarding self reporting. Some require to report an arrest and others require it after a conviction.
  13. Lorie Brown RN, MN, JD

    It Can Happen to You

    Here are a few ways in which nurses can be called before the Board and how you can protect yourself. Download allnurses Magazine 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.
  14. Lorie Brown RN, MN, JD

    Help Needed......

    You don't have to go into treatment. Just complete the evaluation to show you do not have a substance abuse problem.
  15. Lorie Brown RN, MN, JD

    Help Needed......

    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.
  16. Lorie Brown RN, MN, JD

    Help Needed......

    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
  17. 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
  18. 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.
  19. 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.
  20. 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.
  21. 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"
  22. 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
  23. 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
  24. 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
  25. Our facility requires a response to all prn medications, charted on the eMAR within one hour of administration. When this is not done, they give us a list of them to go back and do. Sometimes this is a few weeks after the fact. I am uncomfortable doing this because it is basically guessing if it is not mentioned in the nursing notes. Even as a late entry, is this legal if we don’t remember? Hello documenting late meds, Do NOT document anything that you don’t remember. That is false and inaccurate. It also is considered to be fraud. If you do need to go back and document a response to a medication, make sure you do it properly as a late entry. However, if you cannot remember it, it is better not to document than to document something that you cannot testify to under oath. Lorie
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