Empowering Nurses at the Bedside and in Business

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

  1. Non-Competes in Nursing

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    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. 

     

  2. Fraudulent Nursing Diploma’s and Transcripts

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    The Department of Justice recently arrested 25 people scheming to sell bogus nursing diplomas and transcripts, charging them with wire fraud and wire fraud conspiracy.

    Thousands of people who had hoped to take a shortcut toward becoming a licensed nurse were fooled into obtaining these items that are necessary to sit for the NCLEX.

    The enforcement action spanned 5 states: Delaware, Florida, New Jersey, New York and Texas. In Florida, nurses who were part of this scheme are having their licenses suspended even as you read this.

    This is really scary because more than 7,600 fake nursing diplomas and certificates were issued. However, now that these nurses’ licenses are in jeopardy or being suspended, the phones are ringing off the hook in the offices of many members of The American Association of Nurse Attorneys.

    It is unfortunate that nurses would succumb to these scam tactics and many nursing candidates paid as much as $15,000 for fraudulent diplomas. Do your homework. Make sure your nursing school is approved by your state Board of Nursing which is charged with regulating nursing education.

    There have been nurses who have gone to other programs that have closed. These schools told the nurses that they would accept their credits and they could finish up their education only for them to find later that they paid lots of money to get a fraudulent diploma that was not approved by the Board of Nursing and a fraudulent transcript that allowed them to take the test.

    It’s very unfortunate that so many nurses fell for the scam and will no longer be able to practice which eventually will leave an even greater shortage of nurses for the country.

    If somebody is offering you something too good to be true, BEWARE because shortcuts never work and can get you in trouble.

  3. Stopping Negative Self Talk

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    Do you know that inner critic, the little voice in your head that doesn’t stop? The one that keeps saying, “Who are you to start your own business? Who are you to charge this kind of money? How can you grow a business when you’re having enough trouble finding time with your day job?”

    The inner critic is there to keep you safe. In fact, many of the thoughts that you hear in your head each day are not your own. They are things that you heard from your parents or were indoctrinated in you by society. So, why listen to them?

    The inner critic is from your reptilian brain, which was from our caveman days, when our ancestors would walk out of our cave only to be eaten by a saber tooth tiger or brontosaurus.

    Even though you know now where we live is safe, we still can push that panic button at any time. The reptilian brain is designed to keep you safe and in your comfort zone because if you do start a business, you could get hurt. Or what if you don’t make enough money? What if you don’t get clients?

    You can’t fail because there is no failure. As long as you are solving the problem that keeps people up at night, then you can’t fail.

    Remember that there was a time when we lived in tribes where the men hunted the food and the women cooked the meals? People then acted as a community and worked together to get the job done. Every problem in the tribe could be handled by one of the tribe members.

    However, in society today, money circulates and changes hands to fix problems. When we have a problem, we seek the experts who resolve it. For example, if we have a problem with our teeth, we go to the dentist. If we have a problem with our health, we go to the doctor. If we want to keep our money safe, we keep it in a bank.

    Each of these businesses solves a problem and, as a business owner, you get to solve a problem too. Whether that may be helping attorneys with medical cases, helping people to improve their health by nurse coaching, we ,as business owners, solve problems.

    That negative voice in your head is not real! It is designed to keep you safe and remember that voice is not even yours, so there is no need to listen to it. What I do with my negative self-talk is I can choose the pain or pleasure route. Of course, I chose the pain and I put a rubber band around my wrist so every time I had a negative thought I would snap it just to remind me that those thoughts are not serving me.

    The more gentle way of doing this is to journal the negative thoughts and replace them with thoughts that are empowering. These techniques really work because you can’t just get rid of a thought, you have to replace it.

    I can tell you when I used to do yoga, my negative self-talk would be. “What are you doing here? You’re older, you’re overweight and you can’t bend like a pretzel.” But now my inner critic is more like my inner cheerleader. “Oh, look how much further you can go to touch your toes today,” which, of course, is such a nice feeling.

    So, let’s turn your inner critic into an inner cheerleader.

  4. Murder Charges For Two EMT’s

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    Have you heard the shocking news that 2 EMS workers have been charged with 2nd degree murder after a man died in their care?  An officer’s body cam filmed the entire incident involving an extremely inebriated man.

    During the event, the EMS workers spoke cruelly to the man as he was thrown forcefully facedown onto the cart.  Rather than turning him over, they strapped him face down to the cart.  Tragically, in that position he suffocated!

    It is so sad to hear of an incident like this where healthcare providers’ actions result in criminal charges.  Regardless, the EMS workers were clearly unkind in dealing with the patient, making comments such as, “We hate carrying you” and “I am seriously not in the mood for this dumb” stuff! 

    NO one deserves to be treated this way, especially a patient!

    This is clear malpractice, an unintentional result that resulted in criminal charges being filed.  One news article said the charge was for 1st degree murder while another said it was a 2nd second degree murder. A 2nd degree charge makes more sense because the death was unintentional.  That is, negligent homicide where the death was not deliberate or premeditated.

    If you recall the Radonda Vaught matter that I have mentioned in the past, that Ms. Vaught was doing her job negligently which resulted in a death.  She did not intend to cause harm which makes it negligence and should not rise to the level of a criminal matters.

    But in this matter with the EMTs, I feel a little differently. But that is only because it was clear that this man was in distress and lost his life due to the actions of the EMTs which were aggravated by their comments during that treatment.

    What do you think about this case?  Do you think that this should have resulted in criminal charges?

    I look forward to hearing your comments below.

  5. The Nurses’ Strike Resolved

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    Last week in New York City, 7,100 nurses went on strike to improve patient care and ask for mandatory safe staffing.  A resolution was reached after 72 hours.  Pay was never the issues as an almost 20% raise over the next 3 years.  The nurses negotiated an 

    -increase in over 170 nursing positions, 

    -maintaining fully-funded healthcare for eligible nurses and 

    -lifetime health coverage for eligible retired nurses, 

    -increase in preceptor and charge nurse pay of $5 per hour over standard wages, 

    -an increase for float pool nurses adding more registered nurses and nurse practitioners in the emergency departments, and 

    -continuing to increase nurse education infrastructure in emergency departments.

    Mount Sinai nurses are back to work with safe staffing ratios for all inpatient units “with firm enforcement so that there will always be enough nurses at the bedside to provide safe patient care, not just on paper.” It is also nice that the new staffing ratios will be implemented immediately.  

    At Montefiore nurses received new safe staffing ratios in the Emergency Department, with new staffing language and financial penalties for failing to comply with safe staffing levels in all units. 

    I love that nurses stood their ground for safe staffing.  California has had mandatory safe staffing ratios for years and the nurses love it.  For years, nurses have been fighting for federal legislation for safe staffing but have been unsuccessful.  This result in New York is a great start because change usually occurs on the coasts first.  I hope nurses elsewhere will stand their ground as safe staffing not only improves patient care but also decreases nurse burnout. 

     

  6. The Mess In Healthcare Gets Messier

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    7,000 nurses walked out at 2 hospitals in New York City. I am so proud of these nurses who are saying, “NO,” that they will no longer put up with short staffing. That is the sticking point for the nurses to walk out.

    It seems contrary that nurses would walk out on patients if they’re concerned about having sufficient staff, but this seems to be the only way to emphasize that point.

    The hospital systems offered an almost 20% salary increase but the nurses are more concerned about safe patient care. I believe the nurses did everything they could to reach an agreement.

    According to the New York State Nurses’ Association, there are also over 500+ open positions in 1 health system and 700+ positions that were not being filled at the other health system. There may have been a question as to whether the positions were either frozen or even posted.

    There was a 3rd health system targeted for a walkout as well but in that situation, the parties were able to resolve their differences.

    The question now arises, “Will you cross the picket lines, or will you stand with your fellow nurses?” Many nurses will cross the lines because the pay is very lucrative. However, I would ask that the pay be put toward hiring nurses rather than putting what amounts to a band aid on things if everything falls apart.

    You’re the one who needs to wrestle with your conscience should you choose to cross the picket line. This is not about money. It’s about fighting for safe patient care. You get to decide if you want to put money first and walk past your sister and brother nurses who are trying to make a real difference and improve patient care.

    The hospital claims the strike impacts patients because babies are transferred from NICUs, cancer patients are forced to find alternative locations for treatment, elective surgeries are being postponed and ambulances are being diverted.

    It appears the hospital is trying to shame the nurses for walking out for what they believe. Nurses should not carry 3 times the load. They should not have 20 patients in the ER when the average is 3.

    Nurses should be treated with respect and dignity and given proper staffing. To do this work, day after day, with short staffing is a recipe for disaster.

    No wonder there is a nursing shortage. So many are being burned out and leaving the profession. Many in the nursing population find it getting harder to handle that kind of stress and workload as they get older.

    The decision to strike and leave your patients is undoubtedly a difficult one. You must battle with your feelings about being there for your patients or abandoning them, but I can say that this is one way to make a change. These 7,000 nurses are not just doing this for themselves but for all in the nursing profession.

    According to the National Council of State Boards of Nursing, the average age of a registered nurse is 52 which is 10 years older than the average for the rest of the nursing workforce: 42.

    According to healthaffairs.org, during the year 2021 alone, over 100,000 nurses left the profession, the largest drop in the last 4 decades!

    In addition, the American Association of Colleges of Nursing says that in that same year, 2021, nursing schools turned away almost 92,000 applicants because of a shortage of qualified instructors.

    We are at a crossroads with our profession. We can either be part of the problem or part of the solution. I believe the strike is part of the solution by saying that we are not going to tolerate having too many patients because it is not healthy for the patients or for us. It contributes to increased acts of malpractice and can easily put our licenses in jeopardy.

    Interview with Nancy Hagans, R.N., President of New York State Nurses Association.

  7. Your Work Email Is Not Private

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    When you have an email address, you would think that you have privacy. If your email address is through your employer, nothing you communicate is private, nothing! An employer has access to everything that is sent and received through your employer’s email system.

    Therefore, it is imperative that you do not send or receive anything that you wouldn’t want your employer to see.

    The whole purpose of having a specific email address at work is for business purposes only. You must not use that email address for anything personal or private. Do not even use that email address for the Board or license renewal.

    In addition, everything sent and received through your work email address should never be forwarded to your personal email or to any other person outside of your employer unless directed to do so. Nothing should be forwarded at work unless it is for business purposes with your employer.

    I would strongly recommend that you give the Board of Nursing a personal email address rather than a business email address unless it is your own business. If the Board is trying to reach you and you are no longer with that employer, you have a problem. The Board may consider the email to you as appropriate notice even if you never received it because you left your employment and no longer have access.

    If there is an issue or if the Board is trying to reach you for some reason, do you want your employer to know about it at that time? Or would you rather tell them in your own way?

    Just remember, as I said, nothing you ever send or receive on your employer’s email system is private; your employer has access to everything and be very careful with anything you put in writing because they will be able to see it. They are watching!

  8. Are You An Idea-Generating Nurse?

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    If you’re like me, you probably have all kinds of ideas on how to improve nursing, patient care or on another business venture. This is what makes us great entrepreneurs. We are idea generators!

    However, the downside is that sometimes we get so many ideas in our heads that we start but we don’t finish. Now, is this you?

    For myself, I admit that I am a great starter and maybe a good “middler” but not a good finisher.

    What I do that helps me to overcome “shiny object syndrome,” one where you want to start or chase the next best thing, is to get accountability and create a plan with a timeline for when it must be completed and the steps I must reach along the way.

    When I commit to something, I do not start anything else. This is the number one priority! And I say, “No!” to other opportunities, other ideas.

    I put those ideas in a notebook for storage, so I won’t forget them but keep them easily accessible for when I am ready to move on to what’s next.

    When I’m in a project creation mode, I focus completely on the project and turn off all other distractions. For instance, I unsubscribe from newsletters, podcasts, things of that nature that may derail me and take my interests to the task at hand and in another direction

    Lastly, I stop comparing myself to other entrepreneurs. The comparison monster is always in our face comparing ourselves to others saying, “Look how much further she is than me,” or “She got her book done,” or whatever the comparison thought in my

    head might be. I simply turn it off in my mind so that I can be truly focused on what I have before me at the present.

    I’m curious what you do to deal with “imposter syndrome?” What are some of the strategies that you use? Please let me know in the comments below.

  9. Can A Nurse Use Delta 8?

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    You are probably wondering what is Delta 8?  Delta 8 is known as delta-8 THC tetrahydrocannabinol (THC), is a psychoactive substance found in the Cannabis sativa plant, of which marijuana and hemp are two varieties. It is legal under federal law because it is derived from the hemp plant which does not contain THC (but usually contains 3% or less).  The thinking from the federal government is that there is not enough THC to make you feel “high.”  It is also my understanding that even though it is legal under federal law, certain states consider it illegal. It is also my understanding that there are reported adverse events for Delta 8 and people do experience effects similar to marijuana.

    However, the problem for nurses is that there is no way to know if there are trace elements of THC in Delta 8 which would show up on a urine drug test. The Boards of nursing still frown on the use of marijuana even with a medical card.  Because there is no good testing of THC to see when it was consumed or if the psychoactive components are still active, the Board does not know whether this was consumed over a long weekend or during a stressful shift. Since there is no good testing, the Board does not know if it was Delta 8, CBD or Marijuana consumed.

    The best course of action is to avoid Delta 8, CBD or Marijuana.  It is more important to protect your license.  The Boards have expressed concerns that nurses must know what goes into their bodies.  You are responsible. Saying you took Delta 8 or CBD which is legal, is not a defense.  Just like saying “I just had a glass of wine” which is legal and having a high blood alcohol level.   

  10. More Tik Tok Nurses

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    Can you imagine working in a facility where the ratio is 1 nurse to 53 patients?

    This may be acceptable in long term care but what about at an emergency psychiatric facility? That’s what happened in Buffalo, New York where the institution’s nurses’ demands for safer staffing apparently fell on deaf ears. While the Director of Nursing was on vacation, there was a lack of urgency by those in management and human resources.

    There needs to be safe staffing ratios in all medical facilities. Nurses need to know exactly how many patients they are required to care for that can flex down with higher acuity.

    This TIK TOK video went viral. What is the plan for the weekend with a staffing ratio of 1 nurse to 53 patients? TIK TOK is not the best medium to get results.

    I would recommend resigning but you first must give notice because you cannot abandon the patients. I also recommend reporting to the state Department of Health if you see any blatant unsafe staffing in your facility.

    It is terrible that nurses are being placed in these positions and I am sure the facility will not support you if an allegation is made against your license. Should you challenge any such action, insurance will not cover your defense unless you carry your own malpractice insurance that includes professional licensing defense.

    What steps do you take when short staffing plagues your workplace?

    Have you seen bad staffing numbers in your facility? I’d like to hear your comments below.

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