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Hello:
Wanted to post this, as a way to share my story, and help another practitioner avoid what I've gone through over the past few months. Many of you out there are probably too smart to land where I did, but then again, many out there who are new or who are cruising along just not thinking about it may benefit from my advice.
Earlier this year I was involved in a patient dispute, was terminated from my position, and the company reported me to the Board of Nursing.
There was no harm done to the patient -- more of a charting/billing issue in which I made an incredibly dumb mistake while working in a very pressured position in a retail setting and had zero administrative support to fall back on.
Anyway, a few lessons here I'd like to share:
1. FIRST AND FOREMOST -- get a malpractice policy and keep it current at all times, every minute while you are working. The malpractice policy will come in handy when you have to hire a lawyer to represent you in any dealings with the BON, even if you are innocent. Remember, ANYONE can report you to the BON -- a co-worker, a patient, a "friend," a doctor ....anyone.
2. Don't panic, and get a lawyer. There are lawyers out there who do this for a living and will counsel and advise you on how to present yourself in the best light to the investigators and/or board. Be prepared to fork out at least $2500 to start to retain them. It will go up from there if there are additional needs.
3. If you're in a bad job where you are not supported, or perhaps not really getting along with people you work with, or are unsure of their support, LEAVE as soon as possible and find a better job. Even if you are being paid well with outstanding benefits, etc. There is sometimes so much risk in what we do -- and patients are unpredictable and have the entitlement mentality going in many cases. Don't do patients any favors ...follow the policies of your employer at all times. Do not stay in a job where you feel you are being asked to do more than you can handle -- eventually something can and will happen. Call for help when you need it.
4. If you make an error, do NOT expect the company to come to your aid. They will throw you "under the bus" so to speak very quickly. And rightly so -- they have a company to uphold, and you are just not the priority to them. Thus, the malpractice policy, again -- very important.
5. Take care of yourself -- get counseling, get therapy -- whatever it takes. It's an intensely rough situation to go through -- you may be dealing with the loss of your income, the loss of your colleague support, the loss of your identity -- extremely rough thing. Was for me -- it just about killed me, literally. Luckily I had a wonderful medical provider (an NP who is fantastic) who recommended various steps for me to talk to get my equilibrium back, both mentally and professionally. Luckily I also have a wonderful spouse, family and friends who were there to support me. Luckily, my husband provides an income that we can get by on without my income. If this is not the case for you, you REALLY need to hear this.
6. Be truthful, and tell the story. Tell every detail, and don't try to cover up anything that you did. Yes, it will difficult and mortifying at times to admit what you did ...but this is what I did -- and in the end, the new doctor I will be working with knows the entire details of my story, and has been completely understanding. I had to go on many many interviews after being fired, however, and some of them were not pretty because I was just not ready to present myself properly. I also had to explain to the malpractice company what had happened to be cleared by them. I may receive a "reprimand" to my license soon, and it will follow me forever, unless I get it expunged from my record.
7. Know that you are in an extremely demanding profession and that you are held to an a very high standard -- higher than an RN. Go on the BON site and do a little CME for yourself -- look at the discipline process - look at the various types of discipline that can result from your errors. (for example, Getting a DUI is an instant LOSS of your license, etc.) Know that once you receive a public discipline, it will not only be reported to the state you worked in, but any other state in which you have a license. It will be public, and it will also be sent to a national data bank where anyone will be able to see it as long as you have it. It may make getting certain jobs very difficult.
8. While you may love and admire your colleagues, they are not your friends. They are sort of like that company you work for ....they'll help you to a degree, but when push comes to shove, everyone will have their own best interests in mind. You WILL stand alone to defend yourself. Be good, be friendly, but always keep that professional boundary with them.
9. Do the best job you can and do try to make a few contacts at your job who you may need to use later as references. I am thankful that I had a very good relationship with some of my colleagues and that they were absolutely there to support me through this ordeal. But that's because I always helped them when I could, and I tried to be a decent person at work.
Now that I have somewhat survived this ordeal and looking back, I'm not sure I'd change a thing -- I learned so much -- learned about the reality of the profession, learned about myself and who I am. Got knocked down from my very high horse (and I was on a high one -- I was a top clinician and producer for my organization and thought I could do no wrong). Learned how to handle a tough situation, learned the law, and learned that there are better jobs out there. Most of all, I learned that TRUTH is key ....be truthful in everything you do, even if it means letting a patient yell or get a little mad. Your license and your livelihood is at risk -- and really nothing is worth that, ever.
And lastly, do not affix your identity to this job. For me, I had to re-learn that my worth as a person is not defined by what I do, or how much money I make, etc. This is probably one of the hardest things I had to re-learn and face. Love your job, but love your God, your spouse, your family, your life that make life worth living ... these are the things that will ultimately sustain you in the end.
This sort of thing is terrifying and one of those things so many people assume will never happen to them (and thankfully for most people, won't). Even though I have employer covered insurance and have never been targeted myself, I still have a pretty comprehensive occurrence malpractice insurance policy on the side.
I work extra in nursing and rehab facilities, and even though it's easy enough, families in these facilities seem to be overzealous and love threatening the facility with lawsuits or state notifications. Although the angst is typically directed to the facility itself, I always feel like its just a matter of time before I get dragged down into some BS lawsuit, which is why I protect myself.
I had a physician tell me one time that good malpractice insurance is something that you hope and pray you never have to use, but when you do, you're thankful you got it.
What an excellent well thought out article. I feel for your pain as I had a bad experience as a new grad that nearly killed me too. Although I'm not an advanced practitioner it was my own personal holocaust. I remember a more seasoned RN telling me, " The SBON doesn't exist to protect nurses, it exists to protect patients [in theory]". It was a God-awful experience I could live a hundred life times without ever enduring again.
Best of luck to you in the future, and I would be proud to have you as my own PCP - disciplinary action from the SBON or not! :)
I've used my malpractice insurance services twice. They were great and I highly recommend it to all.
This post is very timely and thank you so much. There are so many things to be concerned about in nursing and advanced practice. Everyone's your friend when the money is being generated, but when an error is made, perceived or real, you stand alone. I am always concerned about the billing. When the physician says "don't worry about that, the billers will take care of coding and billing." Then you never know how it was billed. Your codes could be changed and you don't know. I am also very concerned about new APNs who think they know so much. Even new MDs are worried. Use caution. Finally, considering we can't have health care without nursing, the BON is very harsh and punitive. I don't have malpractice insurance, but the application is on the table and will be completed. Thanks again to the OP and all others who were so honest on this thread.
Thank you for sharing. I have been through a similar storm and I completely understand the emotional toll this takes. I found myself nodding along to everything you said. I too learned a lot through the experience, and while the complaint was ultimately unsubstantiated, it didn't matter because I had been through the torture of waiting and wondering for over a year. Figuring out a new life course if I lost my license, getting my finances together to pay for a lawyer - all things that I never thought I would ever have to consider.
So for anyone out there that still believes this this type of thing only happens to other people, guess what? You are just as vulnerable as the next nurse.
Well, without sharing any personal details, I was notified of the report a full two months after the incident. This was shocking to me as Inthought perhaps they had just tossed it, but the wheels of the boards turn slowly. Once you are contacted by the board they give you a couple of weeks to respond. Hopefully at this point you have a lawyer giving you guidance and sending the documents and communicating to the board for you. The board investigator then takes a look at the response and determines if a violation occurred. In my state, I would have to sign something that basically says I will accept the board's discipline whatever that may be. I personally am hoping for a lesser outcome such as a counseling letter. Every state may be somewhat different. It's my understanding that once I sign the consent order, it could take months to hear from the board as to their final decision. It's truly a nerve wracking process, but in my case, I did find another job with an employer who heard my story and hired me anyway. I'm very grateful for that, but it was pretty mortifying to have to explain myself.
Very rough, isn't it? I can't even explain it .... it's just a total threat and assault on your personal self image, your professional and personal identity ..... a threat to your overall livelihood. If you have actually harmed a patient intentionally that's one thing, but unintentional errors due to poor judgement which result in no harm .... I really do feel the punishment is a bit extreme in the sense that it is public and stays in data banks, etc.
And as far as I know -- record of these errors stay with us forever, unless we pay more fines to have them expunged. In my opinion, this should change if a nurse or provider can prove they've taken steps to remediate and/or have passed a certain period of time without any similar violation ..... but it sticks with you.
As a new NP this is such an eye opener to me and I thank you for this post. I never thought about needing my own malpractice insurance as my company provided a policy. I will now be looking into my own policy. I thank you again.
guest042302019, BSN, RN
4 Articles; 466 Posts
I've had good experiences so far. Can never be too careful I guess. I do my job to the best of my ability. If there's ever anything issue, we just figure it out and move forward.