I actually wanted to cry yesterday (I am being dramatic) as I sat in traffic on I-71 South. It normally take the Nursing Law Bandit 90 minutes to drive from Cincinnati to the KY Nursing Board office in Louisville, Kentucky. I always give myself 2 hours for the drive because of the "cut in the hill" in Northern Kentucky and construction as there is always construction on either I-71 or I-75.

Well guess what? Once you turn on I-71 in Northern Kentucky it is essentially one-lane to the Speedway because of the construction barrels. Okay this slowed me down by 60 minutes.

Then guess what? Outside of Louisville BEFORE and AFTER exit 14 and 3 miles before the Synder Freeway there were two accidents. TWO. I sat in traffic here for 3 hours. The expressway was closed for almost 90 minutes.

I left Cincinnati for a 1pm meeting at the KBN office around 11am and I arrived at 3:30pm. Oh and my meeting was for 1pm.

Okay, so I had my meeting and left Louisville, KY around 4:30pm and guess what? More traffic. I had a 6:30pm meeting back in Cincinnati.

There was an accident on I-71 North which slowed traffic and there are construction barrels on 1-71 North making most of the drive a one lane highway.  

I made it back to Cincinnati for my meeting around 7:30pm.  I met with a nurse from 7:30pm to 9:15pm and then returned a few calls.  

Do you know what I ate yesterday? I had a Pepsi, a Mountain Dew, 4 bottles of spring water, and a hot pickle. This was how I ate at age 13.

I rushed in the door at home to let my dogs out of the utility room (my son put the dogs in the utility room around 3pm) and Luke ran by me so fast I fell (it does not take much for me to fall anyway).

I took two Tylenol, reviewed a case file, and went to bed at 1130pm. I spent most of yesterday in my car. But guess what? I have a new car and I reallllllllllllllly didn't mind!!!!

I purchased a Cadillac Crossover with all the fixins. It is a present to me for me for behaving and being nice during  my divorce (sort of but not really), for my 40th birthday, and the prequel to my mid-life crisis. I also purchased myself a touchscreen computer for my birthday earlier this month. I also purchased 12 (yes 12) summer dresses (can be dressed up or down) at Macy's sale last Saturday. These dresses are popping. I plan to buy a new matching purse and handbag set from V. Wang, an Android tablet (for video conferences; I cannot do a video conference with my I-Pad), and at least 2 pairs of patent leather sandals this month on or before 31st. I also plan to eat at Cheesecake factory at least once a week until the 31st. I am spending a little but certainly not Blowing Money Fast (BMF).

If you are driving I-71 to Louisville, KY, considering taking I-75 to Lexington and then driving to Louisville, Kentucky. I will consider this next time. I really need a magic carpet, broom, or the ability to fold space and time like the navigators in Dune!

NURSE SUPPORT GROUP

 

WHO                   :    FOR ALL NURSES IN RECOVERY

 

WHERE             :     THE CHRIST HOSPITAL CLASSROOM #1

 

WHEN                :    EVERY TUESDAY BEGINNING JULY 19, 2011 6pm-7pm

There currently is not a support group available for nurses in the Greater Cincinnati area (Ohio, Kentucky, and Indiana) which is why this group was created. This meeting will provide nurses the opportunity to meet and greet one another.

For additional information contact Jack @ 513-833-4584.

Download NURSE SUPPORT GROUP[1]  Please feel free to download and share the flyer with nurses in recovery.

I knew it was coming in the good State of Indiana and here it is; the beginning of the end or the end of the beginning (depending on your views) for Initial Applications for Licensure by Examination.

Effective July 1, 2011, the Indiana Board of Nursing requires a national criminal history background check at the cost of the individual. Can you say FBI?

http://www.in.gov/pla/files/Criminal_Background_Checks_PLA.pdf

Maybe this will be a sign for nursing students and NCLEX-Applicants for initial licensure before the Indiana State Nursing Board to really consider their situation, the circumstances, and consult with an attorney before appearing before the Board to respond to affirmative responses for criminal convictions.

The State of Indiana was relying on the self-disclosure of all criminal history by applicants for licensure in healthcare professions which frankly did not work.  http://www.in.gov/pla/3242.htm

The State website also notes that 31 states require a criminal background check for nursing licensure already. Give it another 5 years and it will be close to all 50 states.

Also this may be a money maker for the State of Indiana as $15.00 of the $42.50 goes to the State's general fund. Really? That's nice to tax students who are maxed out with student loans and who may not be able to obtain a license because of the criminal.

This does not apply to renewal applicants in the State of Indiana, yet! I would hope that State Professional Associations representing the various healthcare regulatory boards would "man up" and legally challenge any law requiringbackground checks for licensure renewal with a State Nursing Board as opposed to self-disclosure. Also I don't think healthcare regulatory boards have the manpower to deal with the influx of cases and headaches that would result from mandatory criminal background checks for renewal applicants.

I would probably have to hire an associate attorney (licensed in at least two states) and two paralegals if the Ohio, Kentucky, and/or Indiana Nursing Boards require mandatory criminal background checks for license renewal. Damn maybe I could finally break the sound barrier from the muddy middle class to the murky lower upper but still middle of the middle.

I have always been intrigued with class, income, and education stratifications in the US since high school when my social science teacher named the characteristics of socio-economic depressed neighborhoods and pointed out which neighborhoods were considered economically depressed by definition. Guess what? I lived in what he termed as an economically depressed neighborhood. He described white collar vs. blue collar. He identified poverty level and the characteristics of poverty. He identified the layers between the classes of US society and the definitions and rationales.

I was not offended because I knew we lived good but the concepts, meanings, and implications (I started critically thinking early boo boo) floored me and I wanted to know more.  

This particular lecture by Mr. Brandenburg enlightened and challenged me. Thank you Mr. Brandenburg.  

These were the days when high school teachers could actually offend "you and your mama" and not have to worry about being sued in civil court, workplace complaints, and State DOE complaints. I told my grandmothers and they were very angry and told me about the rich history and sense of family in predominately black neighborhoods. I listened but I knew there was more and I needed to know and to know I needed to read and read and read and I did. I needed to know more about money, business, race, poverty, and economics. Why at age 16? I don't know.

I was interested in astronomy in my preteens and therefore I read up on astronomy. I wanted to be an astronomer and I had at least three telescopes and two microscopes because I went through a biologist phase because I used to fish with my grandfathers. Yes, I can fish!

I mentioned this to my grandmother and she said that's wonderful and purchased more books. I later became interested in Greek mythology and told my grandmother, I wanted to study mythology more. She grinned and purchased more books. I took home ec and started to help more with cooking, cleaning, and ironing and I told my grandmother I wanted to be a housewife. She laughed (I might have to f/u with her about this one now that I think about it!) and she showed me how to cook "soul food" over the years.

Potatoe Salad (from scratch of course) is the key to a long life baby and the movie, Who Made the Potatoe Salad? is real. http://www.imdb.com/title/tt0452706/. I still laugh because regardless of the number of sides, entrees, meats, and desserts we have at one of our many family functions,  someone asks will ask Who Made the Potatoe Salad?

Right before my high school graduation, I told my grandmother, I want to be a lawyer. She frowned, paused (she almost chocked now that I think about it), and then said "There are too many lawyers, you want to be a nurse."

What have I learned since high school and Mr. Brandenburg?

1. Criminal convictions can make a break or person especially one seeking a state license as a healthcare professional today. Got criminal? Talk to a license lawyer like LaTonia before you apply to a technical, trade, vocational, or professional program requiring a state license or certainly before you attempt to "license up."

2. I can be a RN and an attorney; 

3. Knowing how to cook, clean, and iron will never go out of style; 

4. A prenup written cold is better than chocolate served warm; and

5. I will always see myself as the middle of the middle  (like most) regardless of income, class, status, title, or education. 

 

 

Please read this story about a nurse who committed suicide after committing a medical error resulting in a patient death. The nurse admitted to making the mistake and subsequent events reportedly pushed her over the edge: being fired from the hospital and a State Nursing Board investigation. 

Is is really just culture or it just culture the newest "PC" term for the powers that be, be not, and be gone in healthcare?

http://www.msnbc.msn.com/id/43529641/ns/health-health_care?gt1=43001

http://news.gather.com/viewArticle.action?articleId=281474979517624

http://www.allvoices.com/contributed-news/9514641-kimberly-hiatt-the-nurse-who-killed-herself-after-overdosing-a-baby

http://allnurses.com/washington-nurses/suicide-of-rn-555775.html

http://josephineensign.wordpress.com/2011/04/24/to-err-is-human-medical-errors-and-the-consequences-for-nurses/

http://thehealthcareblog.com/blog/tag/nursing/

Healthcare providers who commit errors are being called "second victims." The patient is the first victim as the person injured or killed by a preventable error and the second victim is the person who has to live with the mistake: Kimberly Hiatt, R.N. Medical errors can be eliminated 100%  in a perfect healthcare system , with a perfect work environment, with perfect staffing, staff and processes, and administration by the perfect nurse.

I am not sure what type of debate this will spark however the pendulum has swung toooo far to the left or right (whichever hand you use) in general. I get "public protection" and "patient safety" as a priority of course as a nurse license defense attorney but how do you balance this with the rights of nurses (as the largest group of HCPs) who:

1.  are at a severe & extremely unfair and "unjust" disadvantage in the investigation of these cases by the State Nursing Board (compare the rights and more importantly the discovery process afforded to criminal defendants and civil litigants with the rights and "discovery" afforded to licensees in State Nursing Board disciplinary investigations in your state);

2. are usually terminated by the healthcare organization with little or no recourse but filing a "wrongful discharge lawsuit" (I said filing a lawsuit not prevailing...);

3. the now former employer then challenges the  claim for unemployment benefits; and

4. there may or not be a medical mal case lurking (depending on the error); or

5. a criminal case (depending on the error) and more state and regulatory investigations forthcoming.

We are talking about nurses; most of us with two year or diploma degrees who are trained now to pass the NCLEX (there isn't much time left for anything else) and then pushed out into practice into the Where is Waldo World and regulatory maze of practicing "safely" in a healthcare system. What is just culture? I don't know because I don't see it from end of the table expect in a very limited cases; it is certainly not the norm and what is a just culture is subject to more interpretations than Purple Pain by Prince (I wanted to the say the Bible here but I can't; my grandmother reads my blog now). Also some of the blog posts ask why is a nurse treated so differently than a physician or a dentist in this type of siuation? What do you think?

The cards are stacked against nurses from Day One: before any error is committed or before anything happens, the facility has a plan to deal with the situation and you as an at-willed employed or nurse under a CBA. I see it every day and I cringe because it is just so "unjust." 20+ years with an employer means nothing anymore and you will be discharged the same as someone working at the facility for 2 weeks.

You are essentially at the whim of HR and management who while having visions of sugar plums, dates, raisins, figs, and Fig Newtons are mesmerized and magnetized by the brillance and effectiveness of the organization's strategic planning.

The nurse is thinking what will happen to my career, my license, my livelihood, how will I pay my bills now? and what about my family? The employer is thinking about JCAHO, leveraging the State Nursing Board complaint in the grievance process and arbitration as a long-term "plans within plans within plans" strategy for finally busting up the union, and appealing your award of unemployment benefits to the State Supreme Court and to infinity and beyond: which means filing formal Motions to "Engage You in Mortal Kombat" or  in the alternative "Pimp Slap You" on Judge Judy. Just how many blows can one take to the head wearing a broken helmet when the opponent is wearing cheap gold plated brass knuckles?

It is the nurse (with limited resources) against the employer (with deep pockets, trade association backing, and enough insurance coverage and legal needs to make most attorneys (plaintiff or defense) want to sip its Kool-Aid. I make my own Kool-Aid thank you very much.

It becomes the nurse against the world (like Pac) because for most of us your career, your licensure, your employment and your title is who and what you are. It is not just a title, a role, or a job: it is your essence. Kimberly Hiatt, RN is a nurse. LaTonia Denise Wright, RN is a nurse. You are _______ and you are a nurse. For some if not most of us are you are your license.

When you pull and tug at the essence it is like pulling flesh from the bone for some. This is the rawness exposed when you term a nurse and report to the State Nursing Board for whatever reason for some nurses because the nurse and her license are one and the same. License defense rivals family law with the sheer emotion and criminal law with the potential loss of livelihood (instead of liberty). 

Everything comes into question: finances, licensure, career, marriage, relationships, health, etc. all at once and it can be overwhelming and actually knock the wind out of you.  It is a professional matter but it is personal because you are your license and it is your license being questioned. How can it not be personal some of us may say? The condemnation of the nursing practice is internalized because how do you separate the nurse from the license if you are your license? The same can be said for any licensed individual if your license affords you benefits you would not otherwise have without the license: teachers, doctors, lawyers, RTs, MTs, PTs, OTs....... 

This is a tragedy for the family who lost a child.  I am so sorry for your lost.

 This is also a tragedy for the family of the nurse who took her own life at age 50. I am so sorry for your lost.

I am sure some of you are saying I am more than my license and I am more than a nurse; I am not defined by my license, education, or title. Of course you are but until your license, livelihood, and identify as a nurse is threatened, I don't think one can appreciate the throws of what it means for some of us as nurses if you are your license. How would you know that you are your license until this happens and then what do you do? Is this normal? Is it acceptable?

I would like to think if my law licenses and nursing license was in jeopardy and I was in the mix of a professional crisis affecting my small business and law practice, my career as a nurse license defense attorney, and which would certainly impact everything else in my life (to say the least) that I would be okay but you don't know until are there.

Nurses if you are terminated by your employer and subsequently reported to the Board reach out for help if you are having trouble coping with your circumstances. Don't be ashamed; you are a helper and there is nothing wrong with needing help when you are in a crisis. You worked hard to finish nursing school and get your license and you may have to work even harder to keep it. There is always hope and the road ahead is never as bad as it seems if you have faith in a higher power or if you believe this too shall pass.

1. Seek assistance immediately from colleagues, family members, neighbors, and friends to be there for you. This isn't the time to be super-woman or superman. You are being offered help so please take it and utilize your resources.

2. If you need medical care, get it before your health insurance lapses. Also you can seek medical services on a sliding scale basis.

3. If you need mental health assistance, get it. Counseling can be a positive and provide you with an outlet for your feelings of despair, hopelessness, and help you manage the pain and sort through your feelings and emotions. If you need counseling, there are facilities which offer it on a sliding scale basis if you don't have insurance. Consider attending a support group at a local church for unemployed workers; it may give you a totally different perspective on your situation and plight. If you are considering suicide, call someone, call 911, and reach out for help.

4. Talk to someone at your State Nurses Association for general information on your options. Let them know you are a nurse and you are in a crisis: someone whether it is the Executive Director or the Nurse Practice Consultant will listen and assist you. See http://nursingworld.org/FunctionalMenuCategories/AboutANA/WhoWeAre/CMA.aspx

5. If you are a member of a nursing union, contact your union rep and your local union president to further discuss your situation.

6. Seek legal advice and counseling and consider representation before the State Nursing Board. See www.taana.org.

7.  Review your finances carefully as you may need to tap an emergency fund, retirement fund, etc. Tighten up your finances and start spending less. If you need a room mate to make ends meet, get a room mate.

8. Consider applying for unemployment benefits if you are having trouble securing employment.

9. Eat right and do some type of physical exercise. Crying isn't physical exercise.

10. Remember you are loved and you are wanted and needed by your family, your friends, your colleagues, and the profession. I don't know you but I love you because we are all nurses and just one nurse committing suicide because of what is perceived and objectively and subjectively mirrors professional, licensure, and career suicide to nurse is unacceptable and unjust.

 God bless you, Kimberly Hiatt, RN and may your soul rest in peace. 

Kudos to the Washington Nurses Association for doing what it does best.

See http://www.wsna.org/education/workshops/Culture-of-Safety/

http://www.wsna.org/Topics/Patient-Safety/Survey/