Empowering Nurses at the Bedside and in Business

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Author Archives: Lorie A Brown, R.N., M.N., J.D.

1. A Successful Side Hustle

   March 31, 2023 11:28 am Leave a Comment

   

   I love helping nurses to become successful.

   Have you heard of Stephanee Beggs, R.N.?  Stephanee was in nursing school during the pandemic when the time for her to take the NCLEX neared.  Because she learns a subject better by teaching that subject, she started a TikTok channel.

   That’s right, Stephanee used the social media platform to provide instruction for the NCLEX test.  Her channel was so successful that eventually she had 600,000 followers. 

   Nursing students and other followers kept asking Stephanee to please provide study materials and, as any entrepreneur would do, she saw a need and seized the opportunity to fill it.  She repurposed her information into study guides and materials for nurses which she sold through the global online marketplace Etsy, where people make, sell, buy, and collect unique items..

    Her business, RNExplained, was an immediate success and took off like a rocket to the moon!  To date, her business has brought to her over $2,000,000 in revenue.

   Though I am not one of Stephanee’s magical mentors, I’m sure she has had plenty of mentors to help her achieve this success because I don’t think anyone can do something like this by themselves.

   Forbes.com lists Stephanee as being among this year’s “30 Under 30” successes, an annual presentation of the 30 top entrepreneurs who have not yet enjoyed their 30th birthday.

   What I admire about Stephanee is that she took a personal need, tools to help her study, and used them to teach others as well.  When she realized the number of others she was helping, she created the study guides and sold them on Etsy.  Who knew that would create a $2,000,000 per year business?

   I am proud of the accomplishments that Stephanee has had in her young career, and how they serve so many other nurses while providing her with profitable results. 

   Business ideas are everywhere.  Find a need and fill it.  Stephanee is still working as a nurse in a Los Angeles emergency department, even though she is the CEO of RNExplained, “an educational platform that offers nursing study sheets and tips/tricks for nursing students and nurses around the globe.”

   I love how she took a need that would not only help her but also help thousands of others to pass the NCLEX, showing how even a side hustle can make a considerable amount of money.  She still loves working in the emergency department, using her critical thinking skills in caring for people in need.

   One of the directors of her alma mater at Mount Saint Mary’s offered her a position to teach at the Los Angeles university.  So, she’s able to continue practicing her love of teaching while the sale of her Etsy study materials provides her plenty of passive income.

   Stephanee said her biggest problem at the moment is learning how to grow and scale the business.  I think this is true of most nurse business owners because as they say, “New level, new Devil.”  When things are going well, how can you scale and take your business to the next level?

   Oh, I’m so proud of 28-year-old Stephanee’s selection as 1 of the “30 under 30” by Forbes.com and her $2,000,000 business that is filling such a great need in the nursing community. The learning from this is to create a successful business, you need to find a need and then fill it.

   When it comes time for you to face the new challenges of taking your business to the next level, seek the assistance that will help you be successful.

    

2. A Nurse’s Hero Journey

   March 30, 2023 6:28 pm Leave a Comment

   

   Just like Dorothy in The Wizard of Oz waking up in a new land, imagine one day you wake up wanting to be a registered nurse in a new world of health care.

   As anyone who has read the Frank Baum classic, we know Dorothy sets out to find her way home after a tornado blows the young girl to the land of Oz. And nurses too set out on a hero’s journey after being swept away to the health care world.

   In the first step of a nurse hero’s journey, there is a call to action. In The Wizard of Oz, a tornado blows Dorothy away to Oz. For a registered nurse, the call to adventure may come in the form of a desire to help others or a passion for health care. This calling leads them to nursing, where they can make a real difference in the lives of their patients.

   Next, we have the threshold crossing where the nurse hero leaves their normal world and enters a new, unknown one. For Dorothy, she steps out of the black and white farmhouse into Oz’s colorful world. For registered nurses, when we step onto a floor on the first day of our job, we are met with excitement and overwhelm as we must adapt to a new environment and learn new skills.

   The third step of the nurse hero’s journey is called “the road of trials.” This is where the nurse hero faces challenges and obstacles that test their skill and determination. In The Wizard of Oz, Dorothy faces challenges such as the Wicked Witch of the West and falling asleep in the deadly poppy field.

   Rather than a Wicked Witch, nurses face similar challenges with bullying, lateral violence and enemies who do not want the nurse to succeed. It is also important not to

   “fall asleep in the poppies” where you get complacent with your practice because, as a nurse, lives are on the line. Remember that you are always growing and learning.

   After the road of trials comes meeting the magical mentor. In The Wizard of Oz, the mentor is Glenda, The Good Witch who provides guidance and support to Dorothy during her journey.

   For nurses, the magical mentor is usually our preceptor and other nurses who provide us with support and guidance on our journey as we navigate our careers. This mentorship is invaluable in helping nurses develop their skills in becoming more competent and confident in their work. However, if your magical mentor is really disguised as an enemy, speak up and get a new mentor so that your journey is not derailed.

   The final step in the nurse hero’s journey is the return home. This is when the nurse brings back the knowledge and skills they have gained from their journey to their daily world. For Dorothy, this is when she wakes up in her own bed, realizing that she has been returned home and that she had everything she needed inside her all along.

   For registered nurses, this is when they applied the knowledge and skills they have gained in their work, improving the care they provide to their patients. It is also a nurse’s knowingness that you’ve had it inside you all along and that all the challenges and obstacles you faced on your journey was specifically in your path to lead you where you are now: a hero, a competent and skilled nurse, providing better care to patients and making a real difference in the world.

3. Nurses On Boards

   March 23, 2023 8:33 am Leave a Comment

   

    

   Only 5% of board members for America’s healthcare systems are nurses. This is shocking and terrible, given that nurses are the biggest group of professionals working in hospitals.

   At Palo Pinto General Hospital in Mineral Wells, Texas, near Fort Worth, two of the seven board members are nurses. This is extremely rare. Nurses have so much to offer at the board level that there is even an organization called Nurses on Boards Coalition. It is this organization’s goal to find and encourage as many nurses as possible to be serve not only on hospital boards, but on any other such boards around the nation. The thinking is that nurses can make such a difference in their communities if they are in leadership roles throughout their areas.

   I would love to see more nurses on boards of all kinds of organizations along with those involved with healthcare. It is no small wonder why healthcare is run more like a business by putting profits over patients rather than as a care driven organization designed to provide patients with the best care available. I think this is because there are so few nurses on Boards of Healthcare Corporations. Nurses bring the compassion and humanity.

   There are some wonderful resources on the Nurses on Boards Coalition website at nursesonboardscoalition.org. There you can find a board for which to sign up to participate. The website also provides a board readiness assessment.

   I highly recommend that you be the change you want to see in healthcare by getting involved with boards at the local, state, county or even hospital levels.

   Get involved by participating however you can.

4. Radonda Vaught In The News Again

   March 16, 2023 6:41 pm Leave a Comment

   

   I have noted in past reports about the matter of RaDonda Vaught and once again her situation is making news again.

   You recall that Ms. Vaught was serving as a help a nurse at Vanderbilt University Hospital in Nashville, Tennessee when she was called to give a patient experiencing anxiety about going into an MRI machine a dose of Versed.

   Unfortunately, Ms. Vaught instead pulled and administered to the patient Vecuronium, a paralytic agent, to which the patient succumbed.

   At that time, Vanderbilt was experiencing issues with the Pyxis communications with the electronic medical records and notified its nurses via email to override the Pyxis so that medications could be administered. Therefore, the normal checks and balances were not present.

   As a result, Ms. Vaught was charged criminally and convicted of criminally negligent homicide and abuse of an impaired adult. The judge sentenced her to 3 years probation. At the successful completion of probation, the matter will be expunged from her record.

   Prior to the criminal trial, Ms. Vaught had a hearing before the Tennessee Board of Nursing which decided to revoke her license, an issue which Ms. Vaught is now appealing. The matter is set for oral argument on March 28, 2023.

   In order to have a nursing board matter overturned, a very high standard must be met, and a lot of deference is given to the administrative agency rendering the opinion. Ms. Vaught’s appeal is based on the agency’s decision being arbitrary, and an abuse of discretion. She is asking for a new hearing.

   Since this is a very high standard, the Judge will review the entire transcript of the hearing to determine whether the nursing board abused its discretion or if the decision was arbitrary and capricious. Overturning the ruling would require that the decision must be unsupported by substantial evidence. In Ms. Vaught’s case, Ms. Vaught admitted that she made a medication error resulting in a patient’s death.

   Is revocation of her license an abuse of discretion? Well, I believe that the nursing board’s decision was harsh. The board’s duty is to remedy the situation that caused Ms. Vaught to be before the board to ensure that she is safe to practice. Clearly, this could have been done by continuing education and placing her license on probation while she is being monitored.

   I will be very interested to see what happens in this case. Frankly, I would be terrified to return to nursing knowing that if I make a mistake it could result in criminal charges. It would be like walking on eggshells to do everything perfectly and, as we know, eggs sometimes break.

5. Involuntary Manslaughter: Another Nurse Thrown Under The Bus!

   March 9, 2023 11:28 am Leave a Comment

   

   Another nurse has been “fed to the wolves” by her employer. And now she’s in the cross hairs of the criminal justice system. 

   Aminata Fofana, RN, pled guilty to a charge of involuntary manslaughter in the death of 72-year-old patient Paul Mallory of Columbus, Ohio.  Mr. Mallory was in a nursing home following several strokes and an aneurysm.  He was completely debilitated and required oxygen through a tracheostomy.   

   Ms. Fofana was about to complete her night shift when she found Mr. Mallory’s mask had become soiled.  She removed it for cleaning but, unfortunately, forgot to return the oxygen to the patient who then succumbed to asphyxiation. 

   Initially, the nursing home director told the Ohio Department of Health that the patient must have displaced the tubing. However, according to the family, Mr. Mallory’s only physical movement capability was being able to open and close his eyes. 

   Ms. Fofana pled guilty to the involuntary manslaughter charge and was visibly shaken during her sentencing.  She apologized to Mrs. Mallory and to the court as she expressed heartfelt remorse.  A civil suit for negligence and wrongful death is still pending against the nursing home.   

   This isn’t the first time that a nurse has committed an act of medical malpractice only to wind up being criminally charged in a patient’s injury or death.  How many more nurses are going to be made out as scapegoats where a nurse was doing her job albeit negligently? 

   I’m presuming that maybe the number of on-duty staff wasn’t up to par at the time of the accident.  Given what is going on in healthcare, I would assume it very likely was a busy night and Ms. Fofana was dealing with a lot of responsibilities. 

   Unfortunately, it is chronic understaffing and sheer burnout for those who must deal with these horrible conditions that critically limit nurses’ abilities to provide the best possible care for their patients. 

   Ms. Fofana was forthcoming and honest from the very beginning but not only was she terminated from her position, she is being forced to surrender her license and prohibited from providing nursing assistance to anyone, even as a volunteer position. 

   Fortunately, the judge was lenient and, along with forfeiting her license, Ms. Fofana was ordered to pay a $500 fine, provide 100 hours of supervised community service, have her probation officer approve any future employment and to take classes as might be recommended by the officer.  I did check on Nursys.com to find her license is still active. 

   Despite the apparent indulgence by the judge, Ms. Fofana now has permanent criminal charges on her license record for just doing her job, albeit negligently. 

   I hope that this apparent trend of filing criminal charges against nurses will end or at least become less frequent.  After all, who is going to want to enter the nursing profession if they know they could face criminal charges should they make a mistake? 

   Ms. Fofana’s matter clearly falls under the scope of medical malpractice and should not be elevated to the level of a criminal matter. 

   We have enough issues in nursing that we must deal with on a daily basis. Fear of possibly losing your freedom should not be one of them. 

6. Unable To Find A Nursing Job?

   March 2, 2023 11:43 am Leave a Comment

   

    

   Recently, Katie Duke stated no hospitals have hired her. If you don’t know of Katie, she was on a popular reality TV show called NY Med.

   She was fired from the hospital where she was working because she posted a picture on social media of a room where the life of a trauma patient had been saved following a subway accident. She accompanied the post with a comment describing the scene of the results of man vs. train.

   Afterwards, Katie told a blogger she had to, “[T]ell my truth, own my bad decisions, be transparent and keep pushing through the disapproval and judgment of others.”

   Now a motivational speaker and host of a podcast titled Bad Decisions, Katie tells Becker’s Hospital Review that she cannot get a job in the nursing field. She also is an Instagram influencer and brand ambassador for FIGS designer scrubs while, interesting enough, performs as a stand-up comedian.

   Some question whether her social media posting was a HIPAA violation, but consider that anyone looking at the picture and knowing somebody was hit by a train in New York City, will easily be able identify the victim.

   People get terminated from their positions primarily for three reasons.

   Reason one is because they are a “squeaky wheel.” They keep complaining about working conditions rather than identifying solutions that will help.

   The second reason is that they usually have seniority and are being paid at the highest wage levels. If a hospital wants to cut its budget, they are the first to go.

   And lastly are cultural differences between the nurse and the facility, that is, the job is a bad fit.

   Nurses have come to me and, like Katie Duke, say they can’t get hired. They believe that someone is blackballing them. Or that they had previous discipline on their license. For those nurses, I always ask, “How do you know this?” And seldom do they have a response; it’s just an assumption they make. It is really difficult to prove that someone is blackballing you.

   Unfortunately, an employer has the right to determine who they want to employ and can fire you even without a reason in most states..

   People don’t always know why it is that they can’t get another job. So, we need to keep those three things in mind: don’t be a squeaky wheel, if you can help it, and make sure that you are the right fit for the job. I don’t have a response for if you are the highest paid.

7. Money Is Everywhere

   February 28, 2023 5:57 pm Leave a Comment

   

   When I was growing up, I could always tell what items in the refrigerator were bought “on sale” because there would be tons of it in the refrigerator.  As a kid, it was pretty funny to open the freezer to find boxes of Lean Cuisine alongside cartons of Häagen-Dazs ice cream.  I could always tell what my parents bought that was on sale by simply looking in the fridge and freezer to see what they stocked up.

   Our own relationships with money is very often learned from our parents.  I always thought we could buy things only when they were on sale, because that’s what my parents did.  However, this is called lack thinking.

   Just like nursing, we are conditioned and programmed to believe in lack, lack of equipment, lack of supplies, lack of support, lack of time and most importantly, the lack of money.  It is all these thought processes that are difficult to undo.

   The truth is that money is everywhere!  In fact, 3% of the human population owns 98% of the world’s riches.  The remaining 2% are in the hands of everyone else. If you divide all the money in the world among all the people, each person would have over 1 million dollars.

   This is crazy to me. Money is everywhere . . . all you have to do is just ask.

   If you find yourself struggling with money, here’s an exercise to try.  Write down 50 ways that you can make money right now.  It could be anything like teaching English as a second language to immigrants.  It could be going through your house and determining just what you might sell in the Facebook marketplace.  It could be teaching cooking lessons in your home.  Right here you already are 3 of the 50 suggestions as a starter.

   Come up with 50 ways that you can make money now, don’t stop at 35, keep going to 50.  There’s magic towards the end.  Once you have your list, then pick the 3 ways that you can make the most money in the least amount of time. Of course, make sure that the ways are all legal (*wink*)!

   This will help change your belief system to realize that money is everywhere!

   How many times have you found a coin on the ground?  It happens all the time.  Don’t walk past the pennies, nickels and dimes because you feel it’s not worth the effort to pick them up.

   One of my friends would take any change he found or had left in his pockets at the end of the work day and place it in a large replica of a soda bottle. One time, he found he had garnered over $300 in the bottle. 

   Now, if you’re thinking, “Oh, that’s not it. Amassing coins is not worth the effort,” It is!  It’s worth every single cent.

   Really, money is everywhere.  Just look around.  There are numerous opportunities to make money.  And money is energy; it’s all about circulation. Money is meant to be circulated.

   You pay others to help you with things that you’re not particularly good at.  You pay the doctor.  The doctor pays his attorney.  The attorney pays their staff.  Money circulates and flows everywhere.

   The choice is yours to have money or not.  There are so many things you can do to create a source of money.  If you solve a problem that people have, people will pay for it.  Think about the problems you want to solve for which you are willing to pay. It’s just an energetic circle and the money keeps circulating.

   Money is meant for you to receive and then to give, not hold onto like it is a scarce commodity.  

   Questions: while growing up, what were your beliefs about money?  And what now are your remedies to change those beliefs?  I would love to hear your thoughts in the comments below.

    

8. Do Virtual Nurses Really Exist?

   February 23, 2023 6:35 pm Leave a Comment

   

   Apparently, a number of hospital systems are implementing “virtual nurses” to help the bedside nurses who have been chronically short staffed. 

   Virtual nurses can assist with the admissions paperwork and the discharge education.  They can answer questions, talk to family members and, after the patient is discharged, can be a communication loop between the patient and their primary care physician.  In addition, virtual nurses can do a virtual visit after the patient is discharged to home. 

   I have joked that I was a nurse when “dinosaurs roamed the earth.”  At that time, we still wore whites while some wore their caps and graduation pins.  In those days of giving, nurses on the evening shifts were even required to give patients back rubs. 

   Having said that, and no pun intended, I believe the “hands-on art” of nursing is getting lost in the tasks of nursing.  However, given the challenging times in which we now live, maybe these virtual nurses can be of great help to bedside nurses and lesser experienced nurses.  It sounds like a great job to me, but truly I would miss the patient contact. 

   Becker’s Hospital Review interviewed several chief nursing officers, many of whom believe that virtual nursing is here to stay.  However, one chief nursing officer said that virtual nursing does not create the trust that bedside nursing does. And it’s a challenge to have a real human connection through virtual care. 

   He believes that if this trend continues, we will all lose.  “Nurses put the humanity into care and need to be present at the bedside.”   

   I agree with him. I believe that nursing is a calling that’s in our DNA and by replacing or supplementing nursing staffs with virtual nurses we will not provide the holistic care that patients need.  It makes health care 2D instead of 3D. 

   What are your thoughts?  Please let me know in the comments below. 

9. Will License Discipline Affect My Future Education?

   February 16, 2023 6:53 pm Leave a Comment

   

   Many nurses who think the grass is always greener on the other side will continue their education by becoming nurse practitioners.

   But let me tell you, the problem is that the grass there is not greener because even if you become a nurse practitioner, the problems in health care still exist.  They’re just different problems.

   I have been asked if a nurse has discipline on their license, will they be able to continue their education?  There is no simple answer to this.

   The nursing educational program you plan to attend will have to decide whether you’re a candidate in reflection of any past discipline.  If your license is on probation or other restriction, you will be unable to take part in clinicals because you need an active license to participate.  If you are currently in school for higher education and have a complaint pending against your license, many want to complete the education before you resolve the matter, if possible. However, I believe honesty is the best policy. If you have discipline pending, you should tell the school. It is public record and if they find out and you did not tell them…

   Sometimes attorneys don’t have control over how long a case will last or how soon it can be settled.  However, just know that if you have discipline on your RN license, most likely you will have discipline on your APRN license too and both can be trouble in getting a job.

   Getting an APRN license, especially with a complaint pending or discipline on your license can complicate things.  Just know that each situation is different and unique.  If you have past or present discipline on your license, it may affect your ability to continue your education as well as determining your ability to get an APRN license.

    

10. Non-Competes in Nursing

    February 9, 2023 12:34 pm Leave a Comment

    

    The Federal Trade Commission (“FTC”) has proposed a ban on non-compete employment contracts thinking this will improve wages of health care workers. 

    Covenants not to compete, also known as non-compete agreements, are legally binding contracts between an employee and an employer.  These agreements prohibit employees from working for a competitor or starting their own competing business for a certain period of time after their employment with the original employer has ended. 

    These agreements are used to protect the employer’s interest in the training and development of their employees.  However, due to the high demand for nurses, these agreements can limit a nurse’s ability to find new employment and advance their career. It is a restraint on trade (ability to work). 

    The nurse would either have to move away or provide care in a different type of patient care setting in order to be compliant with the covenant not to compete.  In some states, covenants not to compete for nurses are illegal or unenforceable because it restricts the essential service of health care professionals to provide care in the community. 

    The National Nurses Association, the largest union for registered nurses, agrees with the FTC proposed ban.  Otherwise, non competes hold nurses hostage to working in that facility and they cannot speak out about unsafe conditions and can’t exercise professional judgment required to provide safe and effective nursing care.  When these types of agreements are in place, patients suffer. 

    The FTC is also considering banning “training repayment agreement provisions” (TRAP) where employers pay for training and the nurse is required to stay there for a certain period of time.  These are common with nurse residency programs or sign on agreements.  If a nurse chooses to leave early because they were not given what they were promised or the patient care at the facility is poor or the staffing ratio is unsafe or for any reason, the nurse will have to repay the facility some, if not all, of the money incurred in training. 

    In law, covenants not to compete are illegal.  I have not seen many nurses sign a covenant not to compete agreement, but I have seen them sign the training repayment agreement provisions.  Either way, I think these covenants not to compete should be illegal because nurses should feel free to go where they want to find an environment that best suits them. 

    By giving nurses the freedom to go where they choose, I believe it will improve patient care.  Holding nurses hostage and requiring them to stay for a period of time because the facility paid the money towards their training should also be banned. 

    If a nurse chooses to leave because of unsafe patient care and poor staffing ratios, why should the nurse be punished?  Or if the nurse loses her job for whatever reason. Maybe because the employment was “a bad fit” and the nurse is required to pay it back, that’s a problem as well. 

    Lastly, if you work for an agency and sign an agreement that the facility where you are placed is unable to hire you directly should also be banned.  If you work for the agency for a period of time at the facility, you should be able to work there as a direct hire. 

     Until the FTC ban is an official regulation, if you are asked to sign an agreement with a covenant not to compete or a training repayment agreement provision, I suggest you speak to an attorney who may be able to negotiate these terms for you in your best interest. 

    Have you been asked to sign a contract with a covenant not to compete?  Or a training repayment provision?  I’d love to hear what you have to say in the comments below. 

     

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