My 2 Cents

Practicing Nursing Without a License

Do you think this is common?

Do you think this is more likely to occur in a hospital, nursing home, home care, clinic, out-patient setting, school of nursing, or another setting?

Is practicing nursing without a license a crime in your state? Felony or misdemeanor?

Alleged Theft of Narcotics and Hospice Nurse and Previous Criminal Issues

See http://www.toledoblade.com/apps/pbcs.dll/article?AID=/20080530/NEWS32/805300401

Article published Friday, May 30, 2008 Ex-hospice nurse had felony count Mitchell faced no public discipline by nursing board TALK BACK TALK BACK: Join Forums to talk about this story. By MARK ZABORNEY BLADE STAFF WRITER The registered nurse who resigned from Hospice of Northwest Ohio after she was suspected of stealing liquid pain medication has not faced public discipline from the Ohio Board of Nursing in the 17 years she's been licensed, officials said. Mary Ellen Mitchell, 51, of Maumee, has a valid license through August, 2009, said Lisa Ferguson-Ramos, board of nursing compliance manager. Mitchell has renewed her license every two years since at least 2003, Ms. Ferguson-Ramos said. Information about earlier renewals was not available yesterday. She received her license in March, 1991. Mitchell was convicted in 2001 on a felony charge of theft of drugs, according to Lucas County Common Pleas Court records. A felony drug conviction is a basis for the nursing board to discipline a nurse, Ms. Ferguson-Ramos said. That action would be public. No such action is on Mitchell's record, Ms. Ferguson-Ramos said. But until 2004, a nurse with a felony drug conviction who had a chemical dependency problem could be found eligible for an alternative program. Nurses in the program surrendered their licenses until the nursing board evaluated their recovery and deemed them safe to return to practice. "In 2001, a nurse, in theory, who had a drug problem might have been eligible to participate in the program," Ms. Ferguson-Ramos said. That participation would be confidential, she said. Hospice officials filed a police report Tuesday in which they said they had monitored the nurse and the amount of pain medication she gave to patients from April 1 to May 22 at the hospice facility on South Detroit Avenue. The medication is an injectable liquid, packaged and premeasured in a vial. Patients receive a prescribed dose, and the medication remaining is to be disposed. Hospice officials have alleged the nurse gave patients the prescribed dosage and kept the rest. Mitchell has not been criminally charged. Hospice officials are likely to talk further with Toledo police today, said Judy Lang, hospice's director of communications. Hospice conducts criminal background checks before hiring, but "somehow, for some reason that we honestly cannot explain, [Mitchell's 2001 conviction] slipped through the cracks," Ms. Lang said. "Now procedures are very different and have been enhanced, and this would never happen again." Mitchell was hired about 2 1/2 years ago. "About two years ago, we beefed up our human resources effort," Ms. Lang said, which included hiring a director of human resources with training in the field. In addition, hospice is reviewing the background of current employees, but Ms. Lang would not say how. "That is a personnel matter. I'm not comfortable talking any more about our personnel procedures," Ms. Lang said. Hospice, which has facilities in Perrysburg Township and South Toledo, employs more than 400 people, including about 150 nurses. "This is the first time this has ever happened, and we feel we have had a very professional, well-managed team," Ms. Lang said. After Mitchell's 2001 conviction, she was sentenced to three years' probation and ordered to submit random urine samples and continue treatment with the state nursing program. Courts can order such treatment, but admission to the program would be up to the nursing board, Ms. Ferguson-Ramos said. In 2004, the board decided that those convicted of felony drug offenses are not eligible for the alternative and confidential program. Instead, their licenses are immediately suspended pending final board action. Contact Mark Zaborney at: mzaborney@theblade.com or 419-724-6182.

Ohio Democratic Nurses Caucus Meeting in Cincinnati, Ohio

The Ohio Democratic Nurses Caucus is having a meeting here in Cincinnati, Ohio on Tuesday, August 26, 2008 from 7pm to 8:30pm. For additional information about the Caucus, see its website at  http://www.ohiodemocraticnurses.org/mambo/.

The meeting will take place at our home in Springfield Township. We live in the northern part of Hamilton County near Winton Woods Park and ten minutes from the General Electric facility in Evendale on I-75. If you are familiar with the area, we live in the area between Woodlawn (near Springfield Pike) and Winton Woods Park.

If you are interested in attending, email my legal assistant Jaren, at ldwlegalassistant@msn.com to RSVP and she will email the flyer to you with the address, directions, and the meeting agenda.

If there is interest and depending on the number of nurses who RSVP, we may offer legal or Ohio nursing law and rule continuing education.

Are You Receving Legal Advice from your colleagues at the Water Cooler?

I was contacted by a nurse who is involved in three state Nursing Board investigations. The nurse was told by a colleague that she should just surrender her license in two states and keep her license in one state.

It would be that nice if it were that simple. When you need legal advice, do you go the water cooler at work? The water cooler being the place in an office where folks chat and discuss personal and professional affairs. For nurses it can be the nurses station, lounge, etc.

No one likes to contact attorneys. I feel the same way when I have to contact my  accountant and I really like my accountant. Its a good year for me if I only have to see my accountant around tax time. 

If I had $29.95 for everytime a nurse received legal advice about a licensure or professional practice matter from a person who is not licensed to practice law, I could retire and be a stay at home mom to my five dogs and underemployed/unemployed 18 y/o son.

If you need legal advice consult an attorney. The water cooler is not the place for legal advice and counseling on licensure and professional practice matters for nurses.

Advanced Practice Registered Nurses and Legal Advice & Counseling

APRNs is the term used in the literature to refer to CRNAs, NPs, CNSs, and CNMs. APRNs are advanced practice nurses and have a more expanded scope of practice than RNs.

APRNs are RNs and have some of the same legal issues as RNs.

APRNs as advanced practice nurses may have different legal issues than RNs.

When I started my law practice some seven years ago, I assumed that APRNs would be more likely than RNs and LPNS to seek legal representation, advice, and counseling in a licensure, regulatory, or professional practice matter. I assumed since APRNs receive additional nursing education that would translate into more education (a class or two) pertaining to the law, legalities, and legal issues in nursing. I am not a APRN.

If I would have bet money (and I do like to gamble sometimes) I would have lost.

What is your opinion? Are APRNs more or less likely than a RN or a LPN to seek legal representation, counseling, and advising?

Billing for Skilled Nursing Services

I am a home care nurse. Although I haven't worked in several months (my law practice keeps me extremely busy), I still consider myself a home care nurse and I plan to return to clinical practice at the end of the year.

If you work as home care nurse, only bill for the skilled nursing services you provide. This cannot be overstated. Improper billing may be a crime and may subject you to a Nursing Board investigation. Its not worth it (actually it may be in the short term with the extra income for some) because at some point if you are overbilling, double billing, and engaged in other "under the table" activities while providing skilled nursing care, it will catch up with you.

As a home care nurse, I know it happens. But that does not make it right or appropriate because other nurses are doing it. Take the high road because your license, your liberty, and your career as a professional nurse is "on the line" if your billing for skilled nursing services is questioned for overbilling.

Self-Reporting A Violation to the Nursing Board

I was contacted last week by a nurse who was terminated from his position for falsification of a medical record, i.e. charting ahead.

The employer told the nurse before terminating him that it makes your case look better with the Nursing Board if you self-report. The nurse self-reported the incident to the Nursing Board.

Just a hint. Before you decide to self-report an incident to the Nursing Board, contact your state professional association or speak with a licensure defense attorney.

Self-reporting an incident to the Nursing Board may or not be help your case.

I Didn't Think the Nursing Board Would Revoke My License for THIS!

The Nursing Board has the authority to permanently revoke a license.

This is only the 7th month of the year and I have heard this from 4 nurses. I didn't think the Nursing Board would revoke my license for this!

Don't flame me for this remark but there is a tendency in licensure matters for nurses to downplay and downgrade their situation and the substance of the Nursing Board Complaint.

"I did this, but as least I am not one of those nurses stealing drugs"

"This is nothing compared to the nurse who slapped the patient last year"

"I can't believe the Board is coming after me when the nurses upstairs adminster medications without orders"

"This is silly that I am being investigated when I know nurses who snort cocaine and smoke marijuana on the regular"

Its human to downplay our problems. Its a coping mechanism. Talk to a licensure defense attorney in your state if you are being investigated by the Nursing Board.

Why Didn't I Learn About This in Nursing School?

I met with a nurse last week who was upset about her Nursing Board case. Her license has been permanently revoked. She retained an attorney who told her he understood nursing issues when in fact this was the attorney's first Nursing Board matter.

The nurse remarked that she didn't learn much about legal issues in nursing school.

What about you? Did you receive a well-rounded education in nursing school about the law, legalities, and legal issues in nursing?

I remember a catch all ethics course that included a discussion on the Nurse Practice Act.

Ohio Nurses Association Open Meeting for Members Regarding Dues Structure

Open Meeting for All ONA Members to be held on Saturday, August 9 at 1:00 pm at ONA Headquarters, 4000 East Main Street, Columbus, OH 43213.

Agenda: The first 7 months implementation of new dues structure.

Please RSVP to Nancy Johnson at njohnson@ohnurses.org or 614-462-1034 by 12 noon on Friday August 8.

See ONA's website at www.ohnurses.org.

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