At the recent TAANA (The American Association of Nurse Attorneys) Conference here in Minneapolis, one of the speakers told a story of a nurse who wanted to save some money and had her uncle, a real estate attorney, help her with her a letter she received from the State Nursing Board. His advice? Don’t answer it, you don’t work in that state anymore, so why bother? Well let’s just say, tens of thousands of dollars later, this nurse learned a difficult lesson. A lesson that an attorney who specializes in professional license defense would know: an action in one state will likely affect your license(s) in another state. This nurse had multiple state licenses and ended up defending in every state; a very costly lesson.

When choosing an attorney for your Minnesota Board of Nursing matter, be sure it is someone who knows what they are doing and has done this type of representation before. Law, like Nursing, is very specialized. If you work in ICU you would not likely be competent to work in Labor and Delivery. Find an attorney who specializes in the area in which you need representation. There are a handful of attorneys who do this work consistently in the twin cities.

Why choose a Nurse/Attorney?

Just ask your insurer. Hopefully by now you have your own malpractice insurance. Nurses Service Organization (NSO) refers cases to nurse/attorneys who are members of TAANA to represent their clients. A nurse attorney is first of all, a nurse. That means that you will receive the same care, compassion and advocacy as you provide to your patients. Additionally, as a nurse/attorney, I often ‘test’ my clients to ensure critical thinking skills in various practice scenarios. This is often what the nurse is exposed to at the Board hearing where the staff are all RNs. I know how a Pyxis/Omnicell works, I know how safe staffing is often an issue, and I know whether the nurse had a real issue or was thrown ‘under the bus,’ as happens so often in this profession. I also know that nurses often fail to take care of themselves leading to issues where they land in front of the Nursing Board. Trust a nurse, trust a nurse attorney.

While nurses like to believe that the nurses in charge of them have the information necessary to make good decisions, often the decisions are not evidence-based or in the best interest of our patients, or our nursing license. Rather the decisions may be made to save time, thereby saving money (often from a non-medically trained consultant) or upon the request of physicians. Therefore, each nurse MUST know the law and standards of nursing care for your area. Do not blindly follow new mandates. You, and only you, are responsible for your nursing license and the care you provide. What follows is the first of several examples that I have seen in my nursing career.

It was decided that nursing staff would administer Ketamine to treat patients with chronic pain on a medical-surgical floor. The first question should be: What is this drug? Answer: It is classified as an anesthetic. The next question: Am I allowed to administer an anesthetic under my nurse practice act (NPA)? See Minnesota Board of Nursing. Answer: Yes, as long as certain organizational policies and procedures permit this administration.

Prior to this, we had been told that as PACU nurses we could administer Ketamine by this same group of managers/CNS’s. However, I refused until the policy accurately reflected our practice. This, despite management telling us, ‘Don’t worry, the policy is wrong. It will get fixed and in the meantime, you may administer Ketamine in PACU’. I said no. Not until the policy is updated. Never practice outside of your facility’s policies/procedures.

The Board states that there must be guidelines in place to monitor/assess the patient, provide emergency care, educate the patient, and each nurse must personally possess the knowledge of anatomy and physiology, pharmacology, cardiac arrhythmia recognition, etc.

In this circumstance, a lower dose of ketamine was to be given for pain versus a sedation dose. However, each nurse should have a good understanding of the sedation continuum. When the policy was presented to us at the hospital practice committee, it stated that the patient would have their heart rate and rhythm monitored. However, this floor did not have telemetry. I stated that they would either have to change the policy/order-set to remove the word “rhythm” or put the patients on a tele floor. Despite the eye-rolling of some managers, the policy and order-set were both changed to reflect what would be the actual practice and procedure of Ketamine administration on this unit.

As you see, the CNS in charge of this project was not putting her nursing license on the line. Certainly,But my Manager/Supervisor/DON/CNO/CNS said she did not intend to put the staff nurses in jeopardy either. But it would have. That is the reason that each new policy, procedure, and/or medication must be carefully vetted to ensure that nurses are: 1) acting within their scope of practice; 2) acting under a facility policy that accurately reflects the actual procedure/practice; 3) thoroughly educated in each medication as well as any reversal agents, if available; and 4) able to provide emergency care in the event the patient reacts negatively to the administration of the medication.

Receiving a letter from the Minnesota Board of Nursing is every nurse’s worst nightmare. Often nurses who are reported to the Board of Nursing have been terminated from their nursing job or ‘resigned in lieu of termination.’ (Both are reportable by law). As if losing your job isn’t bad enough, now you have to defend your nursing license, your livelihood, who you are!

While being represented by a lawyer is not mandatory, it is highly recommended. You have worked hard to become licensed as a nurse. I know. I am a nurse. Having legal representation will provide a nurse with the best possibility for a fair outcome.

The Nursing Board is represented by an attorney from the Minnesota Attorney General’s Office, shouldn’t you be?

The Minnesota Board of Nursing‘s mission statement reads:

“The mission of the Minnesota Board of Nursing is to protect the public’s health and safety through regulation of nursing education, licensure and practice.”

This may be a surprise to many nurses. The reality is the Nursing Board is charged with protecting the public from nurses who are not safe to provide patient care, not protecting the nurse.

Nurses are held in high public regard and we, as nurses, must do all we can to uphold that public trust. Nurses must help each other when deficiencies in practice are noted or when changes are noticed in a nurse’s practice and physical appearance as that may indicate a substance abuse issue. We should confidentially encourage the nurse to seek help before the consequences become severe.

Nurses are human. We make mistakes, and we too can suffer from substance use disorders (addiction) just like anyone else. We can become overly sensitive to our patients’ needs and end up crossing boundaries, or have a boss who just ‘has it out for us.’

After over 30 years as an RN, I can say I have not ever met a nurse who didn’t put his/her patients first, providing the best care possible even under adverse conditions.