Nursing Board discipline .. when to take the deal

Posted on March 10, 2014 by Beth Collis

Each year, hundreds of nurses face a possible disciplinary action by the Ohio Board of Nursing. Sanctions can include a reprimand, probation, suspension, license limitations, and even license revocation. In many cases, the nurse is offered a Consent Agreement, which is similar to a plea bargain in a criminal case, in which the nurse can agree to the terms of discipline. I am often asked by my clients, “Should I accept the Consent Agreement or should I reject the offer and proceed to a Hearing?”

It is important to first note that whether the nurse enters into a Consent Agreement or proceeds to a Hearing, the Board will issue a final Order against the nurse and that the Order and the sanction imposed against the nurse is a public record which will be on the Board’s website, reported to the National Practitioner Data Bank and www.nursys.com, and published in the Nursing Board’s quarterly magazine, Momentum.

There are pros and cons to accepting a negotiated Consent Agreement. By entering into a Consent Agreement, the nurse often has the ability to negotiate what factual information concerning the disciplinary action will be included in the Consent Agreement. Because a disciplinary action is open and available to the public, being able to negotiate the wording of the Consent Agreement is important. Additionally, the nurse can often negotiate WHEN the sanction will take place or when they will start the conditions for reinstatement of their license (if their license is suspended). Also, the nurse avoids the stress, expense, and uncertainty of a Hearing. If a nurse proceeds to a Hearing, nurse has no ability to negotiate the factual summary that is included in the Order or negotiate the sanction to be imposed. The Board has the sole discretion to issue any sanction as noted above.

However, there can be drawbacks to accepting a Consent Agreement. Consent Agreements are negotiated by only one Board member. In negotiating a Consent Agreement, the nurse waives their right to a Hearing and often regrets not having their “day in court” to tell their “side of the story.”

In determining whether to negotiate a Consent Agreement or proceed to a Hearing, the nurse should consider all options and potential outcomes. These options and potential outcomes, as well as the nurse’s final decision, should be carefully considered, taking into account how the Board has handled similar cases in the past. Whether through a Consent Agreement or a Hearing, the sanction that is imposed in each case depends on the individual facts and circumstances of the matter.

As always, if you have any questions related to this post or the Ohio Board of Nursing in general, please feel free to contact one of the attorneys at Collis, Smiles in Collis, LLC at 614-386-3909 or email me at beth@collislaw.com

It’s That Time Again (RN licensure renewal)

Posted on June 18, 2013 by Beth Collis

Has it really been two years already? Yes! It is time to renew your RN and APRN licenses!

If you renew before July 1st, the renewal fee is $65.00. If you renew between, July 1st-August 31st, the renewal fee is $115.00. After August 31st, your license is deemed lapsed and you must request, complete, and submit a Reinstatement Application from the Board.

Many RNs who submit their renewal application before the final deadline are concerned that their license will not be renewed before August 31st and that they will not be able to work. This is not the case. As long as you renew your license prior to August 31 the Nursing Board will renew your license and will not allow your license to lapse.

Many Nurses are also concerned that their license will not be renewed by the Board in a timely manner if they answer “Yes” to any of the compliance questions on the renewal application. However, a “Yes” response to any of the questions on the renewal application will not prevent the Nursing Board from timely renewing your nursing license. It is imperative that you answer all renewal questions honestly and accurately. Providing the Board with false information my lead to the Board taking a disciplinary action against you.

However, all renewal applications that include YES responses to questions related to your conduct since the last renewal (such as convictions, DUI, etc) will result on your license being sent to the Compliance Unit of the Nursing Board for further review and investigation. Then, even if your license is renewed, this does not mean that the Nursing Board has closed the investigation.

If the Board chooses to open an investigation based on any of your affirmative responses on the renewal application, you may be notified by a Board investigator by phone or mail to provide further information or documentation to the Board.

As always, if you have any questions about this post or the Ohio Board of Nursing in general, feel free to email me at beth@collislaw.com or call me at 614-486-3909.

Yes, you can find a nursing job even if you have been disciplined by the Nursing Board

Posted on January 14, 2013 by Beth Collis

Each year, hundreds of nurses in Ohio face discipline to their nursing license based on a variety of circumstances ranging from violations of the Nurse Practice Act (R.C. 4734) to being found guilty of a criminal offense (such as a DUI) or for being diagnosed with drug or alcohol abuse or addiction. Often nurses face a temporary suspension of their license or are required to submit to random drug screens or other probationary monitoring terms once their nursing license is reinstated during a probationary period.

Under the Ohio public records law, an Order of the Nursing Board or a Consent Agreement that is negotiated between the nurse and the Nursing Board is a matter of public record. The sanction is noted on the Nursing Board website and the actual Order or Consent Agreement is often loaded on the Nursing Board website for anyone to download and read.

Based on the public nature of Nursing Board disciplinary actions, I am often asked “Will I ever find a job as a nurse in Ohio if I have a disciplinary action against my license?” In general, the answer is “Yes!”

Over the past fifteen years, I have represented hundreds of nurses before the Nursing Board. Based on my experience, even nurses who have received treatment for drug or alcohol abuse or who have been found to have violated the Ohio Nurse Practice Act, which has resulted in suspensions of their licenses, eventually can find employment in the field of nursing once their license has been reinstated. However, it is important to note that securing employment can be more difficult for a nurse who has a limited or restricted license.

I typically find that nurses who are honest with employers and clearly and accurately explain the basis for their disciplinary action, as well as the steps that they have taken to remediate the situation have the best chance of finding employment as a nurse. Employers are generally willing to give disciplined nurses a chance at employment if they believe that the nurse has remedied their situation, that they have taken responsibility for their actions, and that they are honest about their conduct.

To prepare to discuss a Board disciplinary matter with an employer, I always advise clients to prepare a “one minute elevator speech” in which the nurse discloses and addresses the disciplinary action taken. I have found that employers do not like to be blindsided about a disciplinary action after they have already employed an individual or to learn of a disciplinary action in a background check. It’s best to head off any questions that an employer might have about your past and tell them yourself up front.

This blog is intended as general guidance and may not fit your particular situation. As always, if you have any questions about this post or about the Ohio Board of Nursing in general, please email me at Beth@collislaw.com or call me at (614) 486-3909.

Three Days in the ICU

Posted on October 15, 2012 by Beth Collis

Last week I was not in my office. I flew to the west coast to be with a relative who had been taken to the hospital. When I arrived, I found the relative had been taken to the ICU at their local small community hospital. For the next three days and nights, I stayed with the relative in the hospital. What I found was really quite amazing.

I was raised in a family of medical professionals and I have spent the better part of twenty years representing medical professionals before their professional licensure boards. I have been to the hospital before, for simple trips to the ER for stitches or a simple fracture. I also spent two nights in the hospital after the births of my children. Nothing in my past prepared me for the time I spent with my relative in the ICU.

I was thoroughly amazed at the level of care that was provided to my relative. I had always known that nurses provided the bulk of the care to patients, but to see it first hand was awe-inspiring. While it was a small hospital, all records were maintained electronically and all medications dispensed were logged into the record. However, since my relative did not have a local physician, they were cared for by the in-house “hospitalists”. Specialists were called in throughout our time at the hospital to evaluate various aspects of the patient’s care, however, it was the nursing staff who provided the constant care to the patient, advocated for the patient, and updated the physicians of the patient’s current medical condition.

Given the fact that the patient did not have an internist who coordinated care, they saw a different hospitalist at each shift. Over the three days that the patient was in the ICU and the other days that they were on a med/surgical floor, they never once saw the same hospitalist. However, the nursing staff provided the continuous care and continuity of treatment to the patient by updating each hospitalist who examined the patient and each specialist as to the patient’s medical history, demeanor and current medical condition. It was a great relief that I did not have to continue to update each physician as to the patient’s condition since they had been prepped daily by the nursing staff.

As a nurse, never under-estimate the superior service and value that you provide to patients and to their families. To the nursing community at large, this blog post is a huge “thank you” to your service to the community.

As always, if you have any questions about this post or the Ohio Board of Nursing in general, please call me at (614) 486-3909, email me at beth@collislaw.com or check out my website for more information at http://www.collislaw.com.

Do you have a prescription for that?

Posted on October 3, 2012 by Beth Collis

In most nursing positions, nurses are subjected to random, unannounced drug screens by their employer. Usually nurses are prepared to provide a drug test as a pre-condition for employment. However, once nurses have been working in a location for a while, they forget that employers may ask them to submit to a drug screen for cause (ie. if there are missing medications), when they are moved to a new unit, or just on a random basis.

If the drug test is positive for an illegal drug, the nurse may face suspension or termination from their job and the positive test result will also be reported to the Ohio Board of Nursing. However, often nurses test positive for prescription medications. If the nurse is able to provide their employer with a copy of a prescription showing that they have been prescribed the medication by their doctor, then it is not a problem. But, in many cases, nurses do not have prescriptions for medications they have taken. On occasion, nurses will take their friends’, spouse’s or kids’ medications, resulting in a positive drug screen.

Testing positive on a drug screen for a medications which has not been prescribed, may result in negative ramifications with your employment and your nursing license. The Ohio Board of Nursing regularly takes disciplinary actions against nurses who test positive for prescription medications, which have not been prescribed to them.

I recently spoke to a nurse who told me that her doctor told her to keep any old narcotic medications in her cabinet in case she or another family member might need the medication. This is improper advise. Medications can only be taken by the person who has been prescribed the medication. You can’t just keep a “stash” of prescription medications in your cabinet to be used by anyone who has access to the cabinet.

If you have left over medications, follow appropriate disposal procedures to discard the medication. Do not store unused narcotic medications in an unsecure location where other family members (including teenagers) may have access to the drugs.

Finally for nurses, if you have not been prescribed a medication, you should not ingest it as it may lead to a positive drug screen that may jeopardize your employment and license to practice as a nurse in Ohio.

As always, if you have any questions about this post or the Ohio Board of Nursing in general, please feel to check out my website www.collislaw.com or email me at beth@collislaw.com or call me at (614) 486-3909.

Who makes decisions at the Ohio Board of Nursing?

Posted on September 19, 2012 by Beth Collis

It’s Board week at the Ohio Board of Nursing. This means that Board members from around the state will meet at the Board offices in Columbus on Thursday, September 20 and Friday, September 21, 2012 to review the official business and make decisions regarding such matters as the implementation or change to a Board rule, granting licenses to nurse applicants, closing or continuing investigations, issuing citation letters to nurses, and ruling on final disciplinary matters against nurses. Ohio Revised Code §4723.06.

The Nursing Board is governed by the Nurse Practice Act, which outlines the powers and duties of the Board members. R.C.§4723. The Board is composed of thirteen Board members: eight are licensed RNs, 4 are licensed LPNs and one is a public member. Board members are not compensated but are reimbursed for their expenses. Board Members are appointed by the Governor and serve four-year terms. O.R.C. §4723.02.

Under the Board’s rules, the Board is only required to meet as often as necessary to carry out its duties. O.A.C. 4723-1-01(D). The Ohio Nursing Board has six regularly scheduled meetings each year. Meetings are typically held the third week in January, March, May, July, September and November.

While the Board members make all final decisions, the daily operations of the Board is managed by an Executive Director, who is also an RN. The Board also has a bevy of attorneys, investigators, licensure specialists, and support personnel that work at the Board office on a daily basis and carry out the daily operations of the Board. In addition, any disciplinary matter that proceeds to an administrative hearing, is prosecuted by an Ohio Assistant Attorney General.

The Board is not governed by a statute of limitations. Therefore, if an investigation is initiated against a nurse or nurse applicant, the Board has no time limit in which it must begin or complete the investigation or license (or deny) the application of an applicant. Investigations and applications for initial licensure can take months before the individual is notified if they will be granted a license or subjected to discipline by the Board.

I am always asked “who makes all the decisions at the Nursing Board?” and “why does it take so long to get through the application or investigation process?” The short answer is that the Board members make all final decisions. However, since the Board only meets six times a year, official Board decisions are only issued at those Board meetings. Therefore, if your case is not presented by the staff to the Board Members to review at a Board meeting, your case will not be acted on until the next board meeting.

The Ohio Nursing Board licenses and monitors thousands of nurses each year. For the vast majority of nurses, they will be issued a license or their license will be renewed quickly and without delay. However, if your license application is subjected to additional scrutiny because of a prior conviction, prior impairment, or action by an other state agency, it can take months to be licensed. Similarly, if you are the subject of a Board investigation, even if your license has been summarily suspended by the Board, it can take months to work through the Board investigative and disciplinary process.

Yes, you must disclose your DUI on your nursing license renewal form

Posted on June 11, 2012 by Beth Collis

This spring, all LPNs will renew their licenses in Ohio. To renew your license, you should have been sent information by mail that will allow you to renew your license on-line. If you have not received renewal information, you can contact the Nursing Board at renewal@nursing.ohio.gov and you will be mailed a paper renewal form. All renewals must be submitted by the deadline (June 30) to avoid a late fee. For renewal instructions go to: http://www.nursing.ohio.gov/PDFS/Licensure/2012_LPN_Renewal_Instructions.pdf

On the renewal form, you will be asked a series of questions. One question that seems to concern many nurses that I am routinely asked about is the following question:

Yes or no. Do you have a “misdemeanor in Ohio, another state, commonwealth, territory, province or country. This does not include traffic violations unless they are DUI/OVI. (Ohio Board of Nursing 2012 Renewal application, emphasis add)

If you have a DUI, even if it was reduced to a reckless operation of a vehicle, you must check YES. Even if your case has been sealed or expunged or is in another state, … you need to check YES. A DUI or reckless operation charge is a misdemeanor and is not a simple traffic violation. Traffic violations that do not typically have to be disclosed are things like “rolling a stop sign” or “going 45 in a 35 mph zone”. However, any DUI/OVI related traffic violation should be disclosed to the Nursing Board at the time of renewal.

If you have been convicted of a misdemeanor DUI or alcohol related reckless operation of a vehicle, the Board has the authority to take a disciplinary action, including suspending your nursing license, placing your license on probation, or placing a restriction on your license.

As always, if you have any questions about this post or about the Ohio Board of Nursing in general, feel free to contact me at 614-486-3909 or email me at beth@collislaw.com.

What part of NO ALCOHOL don’t you understand?

Posted on May 25, 2012 by Beth Collis

Nurses who suffer from substance abuse or substance addiction and who are monitored by the Ohio Board of Nursing in either the confidential Alternative Program for Chemically Dependent Nurses Program or pursuant to a Consent Agreement or other public disciplinary action, are typically required to submit to random (often observed) toxicology drug screens. The screens will detect not only alcohol content in the body but can even detect the metabolites of alcohol (evidence that the body is processing or breaking down alcohol). The tests are very sensitive virtually any consumption or exposure to alcohol in the 3-4 days proceeding such consumption or exposure will be detected.

Prior to initiating the screening process, nurses are advised that they may not consume any alcohol or any substances that may contain alcohol. They are clearly warned to not consume any alcohol, including: beer, wine, liquor, “non-alcoholic” beers and cooking wines. They are also warned to stay away from topical ointments that may contain alcohol and to stay away from cleaning products or aerosols that may contain alcohol. Nurses are usually surprised to learn that many cleaning products contain alcohol and they do not realize that hand sanitizers (the same kinds routinely used in hospitals, nursing homes, schools, etc.), aftershave, air fresheners (Febreze), contain some amount of alcohol.

Despite this requirement, nurses routinely test positive for alcohol or for the metabolites of alcohol in their system (positive ETG test). Ethyl Glucuronide (ETG) is a direct metabolite of alcoholic beverages (ethanol). Its presence in urine may be used to detect recent alcohol consumption, even after ethanol is no longer measurable. The presence of ETG in urine is a definitive indicator that alcohol was ingested.

When questioned, many will initially deny use. Then, they will try to argue that they used a hand sanitizer or over the counter medications, which may have resulted in a positive alcohol or ETG drug screen.

However, while the tests (specifically the ETG test) are very sensitive and can detect consumed alcohol, the cut off for the screening is above the level that would test positive in an “accidental” exposure. Generally, merely cleaning your house with Lysol or spraying your couch pillows with Febreze should not result in a positive screen. However, consuming Nyquil for a cold will result in a positive screen.

As always, if you have any questions about the Ohio Board of Nursing or this post, please feel free to email me at beth@collislaw.com or call me at 614-496-3909.

What the Nursing Board really cares about ..addiction, lies and convictions

Posted on April 30, 2012 by Beth Collis

I had the opportunity to speak to a nursing school last week about the role of Ohio Board of Nursing. In preparing for the talk, I knew I would be asked “What is going to get me in trouble with the Nursing Board?”. I have a pretty good idea of the types of actions that I regularly see investigated by the Board, but I also did a little research and reviewed the last few months’ list of disciplinary actions or proposed actions so I would be ready for this question.

I found, generally, the Nursing Board receives 3000 complaints each year. While the Board investigates all complaints, they only take action against approximately 600 nurses each year.

Half of the nurses disciplined or monitored by the Nursing Board involve cases of nurses who suffer from drug or alcohol abuse or dependency. (see my former post The Alternative Program for Chemically Dependent Nurses) Many nurses voluntarily seek treatment and then are entitled to participation in the Board’s confidential monitoring program.

But, some nurses find themselves the subject of Board discipline after being found guilty of a DUI, or testing positive on a drug screen through their employer. Last month, the Nursing Board cited several nurses who tested positive at work for illegal street drugs or for medications for which they could not produce a valid prescription (ie. they had been given a prescription drug from a friend or family member)

In addition to actions against nurses who suffer from substance abuse, the Board also takes actions against nurses who have felony convictions and misdemeanors involving moral turpitude. The Nursing Board recently cited nurses who had been charged with numerous crimes including: child endangering; Medicaid fraud; transporting or possessing a semi-automatic handgun; stealing narcotics; misdemeanor assault; illegal processing of drug documents; theft by deception, just to name a few.

The Board also takes action against nurses who have been disciplined by other state agencies (other state Nursing Boards) and they take actions against nurses for practicing outside of the scope of their license or for failing to disclose to the Board a disciplinary action or conviction from another agency or district (lies).

Most nurses are surprised to learn that the Nursing Board is genuinely concerned about conduct both at work and also outside of work. In addition to discipline related to practice, nurses can be subjected to disciplinary actions for “bad behavior” outside of the work setting. Nurses are routinely the subject of discipline by the Board for DUIs, assault, child abuse, neglect, passing a bad check and other crimes. As professionals, nurses are held to a high standard by the Board while at work and after work.

As always, if you have any questions about this post or the Ohio Board of Nursing in general, please feel free to email me at beth@collislaw.com or call me at 614-486-3909.

Ohio LPNs – time to renew your license!

Posted on March 8, 2012 by Beth Collis

This month, Ohio LPNs will be mailed instructions by the Ohio Board of Nursing on how to renew their LPN license on-line. The Board will mail the instructions to the address that you previously provided to the Board as your address of record. If you do not timely receive the instructions, you should contact the Board immediately.

If you do not want to renew on-line, you may request to have a paper renewal form mailed to you. To be sent a paper renewal form:

send a written request to: Ohio Board of Nursing, 17 S. High Street, Suite 400, Columbus, Ohio 43215, attn: Renewal; or
fax a request to the Board at 614-466-0388, attn: Renewal;
or, email the Board at renewal@nursing.ohio.gov

Renewal applications received after July 1 will be assessed a $50.00 late fee. If you do not renew by August 31, the license will lapse.http://codes.ohio.gov/oac/4723-7-09

Whether you choose to renew online or to complete the paper renewal form, it is important that you take a few quiet minutes to complete the form on your own! Allowing others to renew your license for you or not taking the time to carefully read and accurately and completely respond to the questions on the renewal can be a costly mistake.

By signing the renewal application you are certifying to the Nursing Board that all information contained in the application is correct and complete. The Nursing Board reviews all original applications for licensure and renewal applications very seriously and will take a disciplinary action against a licensee who fails to provide the Board with correct and complete information.

In addition, any questions in which you have to answer “yes” to will require you to provide a short written explanation. You should take time to provide a clear and careful response. Don’t minimize the incident or fail to take responsibility for your actions, as this could be to used as an aggravating factor if the Board chooses to impose a discipline.

The Nursing Board routinely suspends or revokes licensees who provide a false response to a renewal question. It is always better to provide clear, honest responses to the questions than to provide information that might be misleading or may lead to more questions by the Board. If you do not understand a question, you may call the Nursing Board staff and ask – however, the staff is unable to give legal advice.

As always, if you have any questions about this post or another question involving the Ohio Board of Nursing, feel free to email me at Beth@collislaw.com.

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advocating for nurses and other licensed professionals in Ohio

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