Archive for the ‘legal issues’ Category
June 1, 2012
At 7 AM, when RN Michelle Flacco took over the care of 66-year-old Lester Scanlon, who had dementia and type 1 diabetes, she was notified that his blood glucose level was significantly elevated, at greater than 550 mg/dL. Ms. Flacco performed blood glucose tests three times during her shift, each time after Mr. Scanlon had eaten a meal, and each time his blood glucose level was elevated. However, Ms. Flacco didn’t notify Mr. Scanlon’s physician, nor did she administer insulin to the patient. The next shift, Mr. Scanlon was found unresponsive, with a very elevated blood glucose level. He was diagnosed with diabetic coma. The incident was reported to Ms. Flacco’s state board of nursing, and she was accused of professional incompetence. The board is seeking revocation of her RN license.
That’s the opening of “You’re Being Investigated by Your State Nursing Board” in the June issue of AJN. The case described is a composite, but it illustrates a situation that a nurse can find herself or himself in. The article, currently open access, is by Margaret E. Mangin, who practiced nursing for 12 years before becoming an attorney. For the past 26 years, she has practiced law in San Diego, primarily defending hospitals, nurses, and other health care providers. This is the latest installment of our Legal Clinic column. You might want to check it out. The table below gives the most frequent licensing violations, 1996 to 2006.
Table 1. Most Frequent Licensing Violations, 1996 to 2006 (click image for larger version)
(Please do note: We hope you’ll find the article helpful, and we welcome comments, which we now moderate. But this isn’t the best place for advocacy or extensive outward linking related to recent controversial cases that have been exhaustively treated elsewhere as well as in previous posts on this blog; we reserve in advance the right to not approve them for posting, or to remove similar repetitive linking from our Facebook page, if need be. Thank you in advance!)—Jacob Molyneux, senior editor
Posted in legal issues, nursing perspective | Tagged Blood sugar, boards of nursing, Diabetes mellitus type 1, disciplinary action, licensing violations, Nursing, nursing license | Leave a Comment »
February 17, 2012
By Shawn Kennedy, MA, RN, AJN editor-in-chief
Amanda Trujillo
Our prior post on the Amanda Trujillo case elicited many comments, on a variety of themes. There were also referrals and crosslinks to other sites supporting, analyzing, and weighing in on the situation, including statements from the Arizona Nurses Association and the ANA, and a post on a physician blog, “White Coat’s Call Room,” which has vowed to carry all the details once the case is decided.
One complaint raised by several people in response to our post was that the Arizona Board of Nursing wasn’t supporting Amanda. State nursing or medical boards are regulatory boards that exist to ensure the protection of the public and to regulate professional practice according to the law (in nursing’s case, according to nursing practice acts). They do not aim to protect the individual nurse, but to assure that all those who claim to be nurses are eligible to claim that title and practice within their scope of practice as defined by law.
Some historical context: Regulatory boards were set up back in the early 1900s, after nursing associations successfully lobbied for registration laws to keep out unqualified women who posed as nurses. In 1903, North Carolina was the first state to enact a nurse practice act; by the mid-1920s, all 48 states had laws regulating who could practice and who could use the title “registered nurse.”
Thus, boards of nursing are intended to protect the consumer and the standards of the profession.
While I agree with several comments saying that nurses should be able to practice within the full scope of their education and training, as recommended by the Institute of Medicine Report on the Future of Nursing, what’s also important to keep in mind is that we must do so in accordance with the law—which unfortunately may not always measure up to our ideals or accurately reflect actual professional practice.
Nurses and state associations need to work to change the law where it needs to be changed—and there are many people who devote themselves to making such change happen—but until the law does change, this is how nurses’ actions will be judged, whatever other motives may appear to be in play or not.
(Editor’s note: A few readers have misconstrued the last paragraph as implying a judgment in the Amanda Trujillo case. This is by no means the intended meaning. The focus here is a more general look at the roles of boards of nursing and the importance for all nurses of not leaving themselves vulnerable to accusations of going beyond their scope of practice, as it has been defined in a particular state’s practice acts.)
Posted in ethical issues, legal issues, Shawn Kennedy, AJN editor-in-chief | Tagged Amanda Trujillo, American Nurses Association, ANA, Arizona, boards of nursing, practice acts, scope of practice | 12 Comments »
November 16, 2011
By Shawn Kennedy, AJN editor-in-chief
Last week, we posted here a piece by AJN’s clinical managing editor Karen Roush, decrying the use of the term “physician extender.” It reminded me of a recent article from the New York Times on nurses with doctorates, which reported that if some physicians have their way and their legal strategy succeeds, they will be the only group permitted to use the honorific “doctor.”
Degrees vs. licenses. This borders on the ridiculous, as the title is an academic title that signifies achievement in a field of study; it is not a license. Doctoral degrees are awarded in just about every field of study, from astronomy to zoology. Physicians are awarded a doctor of medicine, dentists are awarded a doctor of dental science, and so it goes. In health care, there are dentists, psychologists, social workers, physical therapists, pharmacists, and yes, nurses too, with doctoral degrees. Nurses have been earning PhDs and EdDs (doctorates in education) and the DNSc (doctorate in nursing science) for years, and now there’s a new nursing doctorate degree—a DNP, doctor of nursing practice—that’s specific to nurses in clinical practice. They are still licensed as nurses, as that’s what they are.
This parochial thinking is held by those physicians (not all, but far too many) who still adhere to the traditional view that they, and they alone, know what’s best for patients and for health care; they’re in favor of teamwork, but only as long as the team recognizes that they are the leaders and decision makers.
Both the media and the health care system bear some responsibility for this. The system itself is physician-centric rather than patient-centric—hospital policies, practitioner admitting privileges, purchasing (especially in the OR), and scheduling have often developed around physician preferences; reimbursements almost always must go through physicians, whether or not they’re actually involved in the delivery of care.
Most media portrayals, both fiction and documentary, focus on physicians as the only important providers in health care, relegating other health professionals to low-level supporting roles (or, as Roush noted,“extensions” of physicians). Read the rest of this entry ?
Posted in advocacy/political action, legal issues, media depictions of nursing, nurse practitioners, professional identity, Shawn Kennedy, AJN editor-in-chief | Tagged Doctorate, Health care, nurse, Physician | 1 Comment »
August 26, 2011
Should you be able to have an online discussion about hospital policies that aren’t working or are unfair? What if the point of your discussion is to improve working conditions or to troubleshoot and not to cast an uncomplimentary light on your employer? Right now, the answer is “good question.”
If you’re a nurse or health care worker of any sort, if you sometimes use one or more of the many available social media options (Facebook, blogging, Twitter, etc.), if you’re worried about what it’s OK for you to do or say online, if you have a job or are thinking of looking for one, we strongly suggest you take a look at this month’s iNurse column in AJN (quoted above).
In it, Megen Duffy, RN, aka blogger Not Nurse Ratched, considers such issues as the following:
- hospital social media policies (always read them; some are surprisingly restrictive)
- HIPAA and potential issues raised by blogging about aspects of work
- the ways your social media history may be mined by HR departments at prospective employers
- the reasons why she strongly believes that social media isn’t going away and has many potential benefits, despite various well-publicized pitfalls—and why nurses need to let their input be known so that social media policies will be sane and balanced
And, since this is social media, we hope you’ll let us know your thoughts, in the form of comments. Maybe Megen will even weigh in, if you really get her attention.—Jacob Molyneux, senior editor
Posted in ethical issues, legal issues, professional identity, social media | Tagged Facebook, Health Insurance Portability and Accountability Act, HIPAA, nurses, social media, Twitter | 6 Comments »
August 22, 2011
Treadmill/Image via Wikipedia
By Margaret Gallagher, BSN, RN. Margaret is a cardiovascular nurse currently working in Georgia. Her last post for this blog was “Return on Investment: A Mother Makes Her Wishes Clear.”
Usually, it’s nice to share stories among friends you haven’t worked with in a while. However, I haven’t been able to let go of one such recent conversation.*
“You want to know what really burns me?” asked Lisa, a long-time nurse, as I sipped my coffee. “The rumors had been going around for a while that the residents get an incentive if the patients’ coag levels stay within therapeutic range. You know that John and I go way back; I decided to just flat out ask him.”
I listened attentively, expecting that Lisa and John’s friendship wouldn’t keep the attending MD from laughing her out of the ICU for this one.
Lisa glowed like an electric oven coil. “John told me it was true, and with a straight face! How dare they! All the residents do is click on ‘heparin protocol’ in the computer when the patient’s admitted. We draw the labs, follow the protocols, and titrate the drip around the clock until the patient is transferred, but they get the bonus. Does that stink or what?”
I couldn’t help but think back to my very first code. It was three states away and nearly three decades ago. For those who’ve never worked in a teaching hospital, July is when the interns, residents, and fellows promote up to their next year’s tasks. In our surgical step-down unit, that meant that the intern paged to the code had been employed as a doctor for all of 36 hours. He appeared, breathless from the stairs, at the code already in progress. Turning to Penny, the charge nurse, he gasped, “I’ve never done this before.”
Penny calmly handed him the chart, open to the orders pages, and her pen. “Write down everything I say as a list,” she replied. Penny ran the code from start to finish, successfully resuscitating the patient. The intern thanked us, signed “his” orders, and left the unit (with her pen). Read the rest of this entry ?
Posted in legal issues, nursing perspective, patient safety, professional identity | Tagged doctors and nurses, nurses, professional identity, respect, what nurses really do | 2 Comments »
June 7, 2011
By Sylvia Foley, AJN senior editor
In 2008, more than 62,000 people who had undergone procedures at one of two southern Nevada endoscopy clinics were notified that “they might have been exposed to bloodborne pathogens, including hepatitis B virus, hepatitis C virus (HCV), and HIV, as a result of unsafe injection practices.” As author Lisa Black reports in this month’s CE–Original Research feature, a subsequent investigation by federal and state agencies found multiple breaches of infection control protocols. Indeed, 115 patients were found to be “either certainly or presumptively infected” with HCV through the reuse of contaminated medication vials.
Especially distressing was strong anecdotal evidence that because of a general fear of workplace retaliation, staff at the two clinics had often failed to report unsafe patient care conditions. At the request of the Nevada legislature, a study was conducted to examine Nevada RNs’ experiences with workplace attitudes toward patient advocacy activities. Black was the principal investigator. Read the rest of this entry ?
Posted in advocacy/political action, audio interviews, continuing education, ethical issues, infection control, legal issues, nurses, nursing perspective, nursing research, patient safety, public health nursing, Shawn Kennedy, AJN editor-in-chief | Tagged hepatitis C outbreak, infection control, Nevada whistleblower protection law, nursing research, patient safety, public health, Texas whistleblowers | 2 Comments »
February 25, 2011
Image via Wikipedia
By Maureen Shawn Kennedy, AJN editor-in-chief
You may not remember February 11, 2010, all that well, but it’s a date nurse Anne Mitchell will never forget. It was the date she was acquitted of all criminal charges in a case that garnered widespread coverage not only in the nursing world (see our October 2009 report) but in the general media (see the New York Times article). Mitchell was the Texas nurse criminally prosecuted for filing a complaint with the Texas Medical Board against a physician for unsafe and substandard practices (that board did agree with her). She and a colleague found themselves embroiled in a nightmare in which they were fired, arrested, and indicted. (Charges were eventually dismissed against Vicki Galle and only Mitchell went to trial.)
The case raised questions about a nurse’s professional and legal duty to safeguard patients—and about the strength of whistleblower protections (Texas has a whistleblower protection law).
In a “what goes around comes around” scenario, this past February those who pressed the charges—the sheriff (who was a patient, friend, and business partner of the physician); the Winkler County attorney; the former hospital administrator; and the physician—were all indicted by a grand jury. Ironically, the indictment was partially for misuse of official information, the same charge they had brought against the nurses.
On February 18, I interviewed Mitchell, Galle, and another colleague, Naomi Warren, who also wrote a letter of complaint accompanying their letter to the Texas Medical Board but wasn’t prosecuted. In the interview (you can listen to the two-part podcast on our Web site, on the podcast collection page called “Conversations.”) Their description of what this experience did to their lives is chilling. Even so, their commitment to their patients is unyielding, and they say they would make their complaint against the physician again without question.
I hope nursing faculty will highlight this case and these courageous nurses to their students.
Posted in audio interviews, ethical issues, legal issues, media depictions of nursing, nursing perspective, patient safety, professional identity, Shawn Kennedy, AJN editor-in-chief | Tagged cleared, Indictment, nurse, patient safety, whistleblower, Winkler County Texas | 1 Comment »
January 17, 2011
Image via Wikipedia
By Maureen ‘Shawn’ Kennedy, AJN editor in chief
On January 13, news from Texas let nurses everywhere take heart that, sometimes, the system works. According to a report by the Odessa American, the Winkler County, Texas, officials, Sheriff Robert Roberts and attorney Scott Tidwell, who had filed charges against whistleblower nurses Anne Mitchell and Vicki Galle, have been indicted on felony charges of misuse of official information. The hospital administrator who fired the two nurses, Stan Wiley, was also indicted. For more on the story, which we’ve kept a close eye on since October 2009 in our news reports and on this blog, see this ABC World News article; the Texas Nurses Association also has an archive of the case.
In a separate civil suit against the county, Mitchell and Galle were awarded $750,000. Very excellent.
Why is this so exciting and significant? The case outcome supports nurses who raise concerns about unsafe patient care and upholds the nurse’s right—duty, really—to advocate for patients. Hopefully, the nurses’ victory and the award from the civil suit will give pause to those who think they can intimidate nurses who are acting on good conscience and within legal and ethical boundaries.
Kudos to the courts for realizing who the real criminals are.
Posted in ethical issues, legal issues, media depictions of nursing, nursing perspective, patient safety, Shawn Kennedy, AJN editor-in-chief | Tagged ethics, nurse, Odessa American, whistleblower, Winkler County Texas | 3 Comments »
January 12, 2011
By Shawn Kennedy, AJN editor in chief
Many of you may be familiar with the recent “nursing-in-the-news” topic involving nursing students and a placenta. (For those who’ve been out of touch, here it is in a nutshell: three students were involved in photographing themselves with a placenta from a recently delivered mother and posting it on, where else, Facebook. The students were expelled. One student sued; the judge ordered all the students reinstated. See this article by the Kansas City Star that sums it up.)
The incident has provoked debate on various Web sites, including our own Facebook page, where the discussion mainly concerns whether the students were treated fairly or too harshly:
“It’s a placenta. I agree that it can seem a bit juvenile to photograph yourself with it, but an offense worthy of expulsion?”
“Juvenile? Perhaps. Punishable by expulsion? Absolutely not, imo. What exactly was wrong with taking a picture of a placenta? It’s not like you can identify who the placenta came from.”
“I think she should be punished but not expelled. in all reality a placenta is medical waste after delivery but it showed no respect for her patient, which needs to be addressed.”
And a really interesting question:
“Would she have been handed the same punishment had it been a picture of a full bed pan?”
Other sites also argue the “no harm, no foul” rationale—since there was no way to link the organ to a patient and so no breach of privacy, what was the harm? Comments on one of several posts about this issue at Those Emergency Blues came out in favor of the students. Nurse and blogger Phil Baumann’s post, “The Placenta Incident and The Shawshank Redemption,” did as well.
The school did seem to react harshly, especially when there seems to be some question as to whether the clinical faculty member might have been aware of the students’ activities.
However, there was a decidedly different tone on a blog called The Stir at CafeMom, a Web site focusing on pregnancy and motherhood, that should give us pause. Author Jean Sager writes the following in a post called “New Pregnancy Fear: Who’s Got Your Placenta Now?”: Read the rest of this entry ?
Posted in ethical issues, legal issues, media depictions of nursing, nurses, nursing perspective, nursing students, patient perspective, professional identity, Shawn Kennedy, AJN editor-in-chief, social media | Tagged American Medical Association, American Nurses Association, expelled student, Facebook, HIPAA, Johnson County Community College, Phil Baumann, placenta, social media policy, Student | 18 Comments »
November 24, 2010
By Christine Moffa, MS, RN, AJN clinical editor
by controltheweb/via Flickr
When I was growing up, my family spent Thanksgiving dinner at my grandmother’s house. She was a star in the kitchen, with cooking and baking skills beyond compare. However, while she made a chocolate cream pie to kill for, her knack for turning every conversation into a newsfeed of various neighbors’ illnesses, symptoms, and near-death experiences, if not actual deaths, stood out more. She did this so much that my brother began referring to her as Grandma Kevorkian.
It turns out that death-and-dying discussions on Thanksgiving might not be such a bad thing, according to Engage with Grace, a nonprofit organization that promotes end-of-life discussions. In 2008 they launched a blog rally timed with Thanksgiving weekend, for bloggers to get the word out about end-of-life discussions. The idea is to have the conversation when most of the family members are together, and the Thanksgiving holiday is a perfect fit. There’s a five-question tool available on the site that can be used as a conversation starter, as well as other resources.
While talking about these topics could potentially clear a room, it’s a lot worse to be sitting at a family member’s bedside in the ICU and not knowing what to choose for them because they didn’t let you know in advance.
For additional information on end-of-life discussions and options, see the AJN articles “Life-Support Interventions at the End of Life: Unintended Consequences,” by Shirley A. Scott, MS, RN, CT, and “Stopping Eating and Drinking,” by Judith K. Schwarz, PhD.
And if you raised this topic at your Thanksgiving meal this year, or at another opportune moment, write in and let us know how it went.
Happy Thanksgiving!
Posted in legal issues, nursing perspective, palliative care, patient perspective | Tagged advance planning, discussing end-of-life options, end of life care, Engage with Grace, living will, talking to your relatives about dying, Thanksgiving conversations | 3 Comments »
That’s the opening of “You’re Being Investigated by Your State Nursing Board” in the June issue of AJN. The case described is a composite, but it illustrates a situation that a nurse can find herself or himself in. The article, currently open access, is by Margaret E. Mangin, who practiced nursing for 12 years before becoming an attorney. For the past 26 years, she has practiced law in San Diego, primarily defending hospitals, nurses, and other health care providers. This is the latest installment of our Legal Clinic column. You might want to check it out. The table below gives the most frequent licensing violations, 1996 to 2006.
