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Old 08-24-2008, 04:32 PM
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Default Nurse Interrupted ~ Disciplinary Action

Nurse, interrupted
A disciplinary action can put a wrinkle in your career ? and tie you up in knots
By Megan Malugani
August 21, 2000

The number of disciplinary actions against RNs has jumped dramatically over the past five years. Some people point out that nursing standards are unusually high in many health care settings.

Anne Adams? life was turned upside down the instant she was summoned to her nursing director?s office and was told she had made a life-threatening medication error. Adams (not her real name), a registered nurse with 20 years? experience in critical care and emergency nursing, had misread a label and administered the wrong medication to a patient. The patient recovered, but Adams? nightmare was just beginning.
After she was informed of the mistake, Adams hired a lawyer and went through her state?s disciplinary process. The state nursing board, which heard her case in 1998, put her on probation for a year rather than suspending or revoking her license, and she considers herself lucky to be working as a nurse. However, she?s struggled with bitterness toward the profession, which she says "cut her adrift" during her time of need, and she?s visited a counselor to help her regain her self-esteem.
"I think all the time: Why did I ever become a nurse?" said Adams, who recalls that colleagues were "stand-offish" and insensitive after the incident. "I feel I wouldn?t have had to go through so much heartache, pain and self-recrimination if I had more support from my peers. Other nurses take the attitude that ?it happened to you, but it would never happen to me.?
"I wish there was a hotline you could call to talk to someone who has been through it before."
Not alone
Adams may have felt alone, but she wasn?t. According to the National Council of State Boards of Nursing, the number of disciplinary actions issued annually to RNs has risen 21 percent in the last five years ? from 4,029 in 1995 to 4,865 in 1999.
Between one-quarter and one-half of all complaints against nurses that are brought to the attention of state nursing boards result in some kind of disciplinary action, said Vickie Sheets, JD, RN, director of practice, regulation and credentialing at the council. Some of the reasons nurses are disciplined include criminal convictions, chemical dependency or substance abuse, and practice issues such as medication errors, documentation errors and failure to assess or intervene, Sheets said.
The notion that only "bad" nurses are disciplined is inaccurate, experts said.
"The vast majority of RNs I?ve represented for professional misconduct are good to excellent nurses," said Donna Moniz, JD, MN, RN, a lawyer at Johnson, Graffe, Keay & Moniz in Seattle. "In my opinion, very few are really poor practitioners."
Because nursing standards are set unreasonably high for many health care settings and the staffing available, technical breaches in standards are common, Moniz said, but only a fraction of apparent breaches are reported.
"If you did a chart audit of a whole group of patients, you would find many examples of nurses not meeting standards," Moniz said. "However, nursing boards do not perform such audits. Particular nurses are reported, sometimes for questionable motives."
According to Moniz, national studies show that medication may be administered improperly between 3 percent and 10 percent of the time. "That?s appallingly high from a patient?s point of view, and yet only a handful of nurses in a given state in a given year are going to be disciplined for that," Moniz said. "The real problem is usually not individual nurses, but the system. As an industry, we need to find ways to reduce medication errors. Being punitive won?t solve the problem."
'Culture of blame?
Although every state nursing board?s primary responsibility is to protect the public, each state approaches this task differently. Many boards revoke a nurse?s license only for the most serious offenses, and put nurses on probation or prescribe education for lesser offenses, Sheets said.
In California, "the board believes that discipline is not intended to be punitive, but a public protection tool. If a nurse could practice safely while being monitored on probation, that would be the course of action the board would take," said Susan Brank, assistant executive officer at the California Board of Registered Nursing. "As a board that represents the public?s interest, we have to walk a fine line and consider both the effects [of disciplinary decisions] on the nurse and the effects on the public," Brank said.
Texas? nursing practice act includes a "minor incident rule" that provides nursing employers with criteria for determining whether an incident should be reported to the state?s Board of Nurse Examiners. "The board rarely receives complaints on minor incidents," said Anthony Diggs, director of enforcement for the Texas board.
The Texas rule is just one of many "alternative, innovative" approaches that states are taking to nurse discipline, Sheets said. Many states have diversion programs for nurses with chemical dependency or substance abuse problems, she said. "It would be wonderful if we could move from thinking of disciplinary action as punishment to thinking of it as remediation," Sheets said.
The power of counsel
Regardless of their state?s approach to professional discipline, nurses should hire a lawyer if they find themselves facing a professional misconduct investigation, said Sharon LaDuke, RN, management information systems nursing coordinator at Hepburn Medical Center in Ogdensburg, N.Y.
"The professional disciplinary system is very much like the criminal justice system. Those with good legal representation have better outcomes than those who don?t have such representation," said LaDuke, who published a study of the professional disciplinary system in the June issue of the American Journal of Nursing.
An accusation of professional misconduct "is a very serious threat to a nurse?s livelihood and mental health," LaDuke said, "so it?s critical that he or she initiates an effective defense by getting immediate, competent advice from an attorney with experience in professional discipline cases. Whether you think you?re guilty or not, you?re entitled to defend yourself."
LaDuke, whose study included survey results from 33 New York nurses who had been professionally disciplined in 1998, said that nurses often misunderstand the adversarial nature of the disciplinary process and speak too freely with state investigators. A lawyer can prepare them for and protect them against such situations, she said.
"Nurses tend to take care of other people and their problems, so they believe they can solve their own problems," said Deborah Phillips, JD, RN, a lawyer at Anthony & Carlson, LLP, in Oakland, Calif. Such naivete works against nurses who are facing the professional discipline gauntlet, Phillips said.
"Just having a nurse tell his or her story is seldom enough to rebut charges. Nurses may not realize how much evidence is stacked against them," Phillips said, adding that lawyers can help nurses prepare evidence in their favor and line up witnesses on their behalf.
In Texas, about 40 percent to 50 percent of nurses whose cases reach the point of a hearing obtain legal representation, Diggs said.
In California, the majority of nurses do not obtain legal counsel in disciplinary proceedings, Brank said, although California RNs are afforded a fair hearing and due process with or without a lawyer. "The burden of proof is legally with the board. We have to have an airtight case to be able to go forward with discipline," she said.
Bouncing back
As Adams? case shows, being professionally disciplined doesn?t have to mean the end of a nursing career. RNs who have been disciplined may find employers more willing to hire them during nursing shortages, Sheets said. Some RNs learn from their experiences and emerge from the disciplinary process as better nurses, she said.
"I think the way a nurse can best move forward is to face it head on and be up front with employers. They should look at the situation objectively and recognize that they may not be the total cause of whatever went wrong, but recognize their piece in it and look at it as an opportunity to improve their practice," Sheets said.
Although Adams? mistake will be on her record forever, she was pleasantly surprised at how accepting her present employer, a major health insurance company, was when she revealed the disciplinary action during the interview process.
"After I told them, I thought, ?Gee, that wasn?t so bad,? " Adams said. "I don?t feel as ashamed anymore, but it took some time."



http://www.nurseweek.com/news/featur...08/discip.html
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Old 08-25-2008, 08:00 PM
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I agree with Ann Adams in that nurses don't support each other enough. I'm envious of the comraderie other occupations enjoy- such as police and paramedics.
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Old 08-26-2008, 07:02 AM
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"Culture of Blame" says it all!

BTW.....

Welcome GiGi!!!


Lot of us here in recovery from something or another, all honest and funny and supportive! Glad you found us!!:th_:
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Old 08-26-2008, 11:07 AM
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Here's link to the MA BON online license verification, it will tell you if the license is active and if not why i.e. probation, surrendered, revoked, etc.

It will not tell you what the person did to get their license altered. Good Luck with your friend. She's lucky to have you. Let us know how it goes?

http://license.reg.state.ma.us/publi...r=red&board=RN
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Old 10-07-2015, 05:34 PM
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Well, it's an ill wind that blows nobody any good. I only saw this thread because it was resurrected by a bot. Since my home state was mentioned, and a number of other things got my attention, I thought I'd say something.

1. I think it's completely likely that nurses are getting reported for practice issues more than "before," whenever that is, even though I do not have current stats in front of me to tell me whether they really are. But if they are, it's understandable. More and more people (especially nurses) are realizing that nurses are not the mindless automatons that just "follow doctor's orders" and as such cannot be held responsible for independent thought, judgment, and action. Professionals are accountable for professional practice. Don't like it? Be a CNA, but even they have a scope and standard of practice.
2. The BoN is not your friend. They do not exist to have your back, but the back of the citizens of their state. Expecting them to be on your side because they are nurses too is not reasonable. It's actually sorta delusional. Never, never, never attend a BoN hearing on your license or practice without legal representation by an attorney with expertise in these matters. Your family lawyer who did your wills and mortgage papers is not the one you want with you in this special arena. TAANA, The American Association of Nurse Attorneys, is a good place to get referrals.
3. Just because we sympathize with you, those of us who are legal nurses may not be on your side either. I get cases from both plaintiff and defense for malpractice in patient care and in other areas that could potentially affect licensure. If I am retained as a possible testifying expert, I am assumed to be (and held to the standard of) an impartial witness for the court, not for either side. I have to call it as I see it. I have been in the position of telling atty clients that the nurses in their suits are negligent in my opinion, that there are extenuating circumstances beyond the nurse's control, that the nurse is blameless, and all stops in between.
4. The vast percentage of medical malpractice suits do not go to trial-- like 96%. Some of those settle. A lot of suits never make it out of the atty conference room. Of the ones that do go to trial, few are found for the plaintiff. This doesn't mean the defense was evil, it means that the plaintiff didn't make a case for the four essential elements, all of which must be met. The defendant had a duty to the plaintiff, the defendant was derelict in that duty, that negligence caused an injury, and that the injury resulted in damages. For example, the surgeon you hired may have made an error in the OR, but if you recover fully, where are the damages?

People should not go crazy worrying about losing licenses. You can go to your state board of nursing website and see the lists of people whose licenses have been revoked or are under restriction, and what the offenses are that caused those. As I am fond of saying, if you aren't felonious, not practicing under the influence of drugs or alcohol, not stealing drugs or valuables, and not deliberately falsifying documentation, you will very likely not be at risk to lose your right to practice. Pissing off the staffing coordinator or coming to work late a lot or being a no-show may lose your job, especially if you keep it up. But the BoN doesn't care about those.
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Old 05-05-2016, 11:22 PM
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I have found that it can depend a great deal on the location and specializations that a nurse works with. For example I live in Florida now, and earn about 15% more than I did when I lived in Kentucky. The need for nurses in certain states like Florida or Pennsylvania helps raise the salary of experienced nurses.This page from the school I attended has some general information including some of what you can expect from the work, and what salary ranges you will be looking at jacksonvilleu.But recently there was scam in nurse's wages and IRS Lawyers resolve the case.
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Old 06-26-2016, 06:31 AM
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Whatever the 'No Blame' culture say it does depend on the institution you are working for. I worked in theatre for a few years and the general attitude there was if you do it right that is what's expected of you. If you make a mistake you are completely incompetent. I left there because of the bullying culture and lack of support when you need it most. People don't function well under this type of scrutiny but it still goes on and good staff are lost because of it.
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