Lorie A Brown, R.N., M.N., J.D., Author at Empowered Nurses

Surprising Findings From Nurse Practitioners’ Professional Liability Exposure Report

November 10, 2022 11:30 am Leave a Comment

Nurses Services Organization (NSO) and CNA recently published their claims data report which tracked malpractice claims against nurse practitioners (NP) as well as claims for violations of the Nurse Practice Act. The data shows that malpractice costs are on the rise!

What this report showed is that the number of claims against nurse practitioners had settled for an amount 10.5% more than 2017, when the last claims report was issued.

Professional liability claims are now settling at an average of $332,137. I’m not sure if this is a result of inflation, or because there are more NPs or because more harm is occurring or any combination of those 3 considerations.

A big surprise is that of all the claims filed, the highest average number is attributed to neonatal nurse practitioners. This is because any injuries to babies are significant. But considering OB is one of the highest areas of malpractice for physicians, it would seem to be true for nurse midwives. But it is not.

Compared to the neonatal statistic, it was no surprise that 23% of claims were in the area of aging services which had gone up 3.1% over the last 5 years.

The top 3 locations where NP claims were made are (1) physician office practices, (2) aging services facilities and (3) nurse practitioner office practices. Considering that the majority of NPs work outside of the inpatient setting, except for aging services facilities, that is not all that surprising.

The highest number of complaints involved diagnosis-related claims. That was a 37.11% increase and those claims settled for an average higher than the professional liability claims, averaging at $385,947.

Death and cancer were the 2 most common injuries representing more than half of the claims. This was due to the failure to diagnose cancer claims since more people go to nurse practitioners for basic wellness issues.

One nice thing is that the number of claims without payments increased by 11.1%. I’m not sure whether more claims without merit were filed since 2017 or if they were winning more claims, but this is good news.

Interestingly, for license protection matters, the highest 3 claims were regarding professional conduct, medication prescribing and scope of practice.

Lastly, about 43% of overall board license matters involved some type of action against the NP’s license. This is good news because it means more than half of the claims are closed with no action taken.

I always find these types of reports interesting, and I like to see the trends they expose to help you protect your license against malpractice or license discipline.

Does One Bad Apple Spoil the Whole Bunch?

November 3, 2022 2:11 pm Leave a Comment

I recently watched a movie on Netflix, THE GOOD NURSE, which is based on a true story. Have you seen it?

If you have not and plan to, please be warned this article contains spoilers.

What I liked about this story is that it focused on the good nurse, Amy Loughan, rather than her fellow nurse, Charles Cullen, who we eventually learn is the serial killer.

Cullen would take Digoxin and Insulin from the Pyxis for a patient, he’d cancel the order and the drawer remained opened, a defect that at the time was fairly rampant in a number of hospitals.

Cullen would take out Insulin and Digoxin and inject those into IV bags in the supply room. He would not know which patients would receive the contaminated bag of fluids. I can see the reason it took so long for him to be caught.

Now, I had a couple of concerns after watching the movie.

First, it is crazy how we can work with a nurse, grow close to them, and then discover a deep dark secret that changes everything you thought about them.

I would be surprised to befriend a serial killer but, unfortunately, we nurses tend to be so kind and giving that many of us only see the good part of individuals and humanity.

I once met a person who claimed she once actually dated a serial killer! She does not believe he was killing at the time of their relationship but began his murderous spree sometime after they parted.

Another thing about the movie was that Cullen had worked at 9 other hospitals before this one. Each hospital suspected something was up but none of them did

anything. No one investigated him so there was no one to stop him. In fact, he commented when asked why he did it and said, “No one stopped me.”

He went on to plead guilty to 29 murders but there may have been as many as 400 victims. He managed to avoid the death penalty but was sentenced to spend the rest of his life in prison. Despite his sentence, there were never any actions taken against the hospitals. That was wrong!

I once personally took a deposition of a nurse who said she was terminated from her job. Based on my knowledge as a professional licensing defense attorney, I asked if she reported her termination to the Board to which she said, “No.”

I asked why she was terminated from the hospital, she replied, “Positive drug screen.”

When I ask why she was terminated from the previous hospital, she repeated, “Positive drug screen.”

And what about the hospital prior to that? Again, “Positive drug screen.”

I was shocked that those hospitals would terminate her but never report her to the Board. She claimed it was just marijuana and, to her, it didn’t matter. However, marijuana is still illegal in Indiana and really for any nurse.

By hospitals not doing their part in reporting suspicious activities or employees with suspected impairments, nurses are being allowed to move on to the next hospital to do the same thing.

I applaud the bravery of the good nurse, Ms. Loughan, who befriended Cullen and eventually got him to confess to his crimes. It was her bravery and commitment to ensure the safety of other patients that is so endearing.

Since these events, nurse Loughan has left nursing to, as she put it, work on herself.

As nurses we tend to jump all into our job and want to help everyone. However, many times we forget that the most important person we can help is our self.

Recently there was a nurse in North Carolina who has been charged with killing 2 people with Insulin. Unfortunately, in those cases, the bad apple succeeded in causing harm to her patients.

Let’s not let a few bad apples spoil our whole profession. It is our duty, responsibility, and privilege to protect our patients and profession. And when we find bad apples in nursing, we need to call them out and put a stop to them.

The Little Engine That Could…Couldn’t

October 31, 2022 5:25 pm Leave a Comment

We all know the story of the little engine that could where the small locomotive was climbing a hill chanting, “I think I can … I think can …I know I can … I can … I know I

We all know the story of the little engine that could where the small locomotive was climbing a hill chanting, “I think I can … I think can …I know I can … I can … I know I can … I can!”

In business, “if you think you can and know you can and can …” is just not going to cut it.

There are four levels of this.

The first is “I think I can.” Often you must think that you can do something in order to say, “Yes” and then actually do it. But knowing only that you can is not enough. Many of you have a business idea and think you can do it.

The second level is, “I will do it.” Similarly, just because you will do it does not mean that anything is happening. Just the thought of willpower alone to have your business be successful will not make it truly successful. Once you think you can do it, then the questions becomes will you do it?

Level number three is “I must do this.” It is so important if you want to have a successful business that you know that you must do it because wishing, hoping, wanting, and trying does not necessarily mean success. But must will not cut it either!

The fourth level is that you are doing it. The only way to have a successful business is to take the actions and just do it. Nike had it right. Just do it!!

Once the little engine that could started climbed to the top of the hill, he was successful and was doing it. The only way to be successful is to take action so you can get the results that you want. Just because you can, you will and you must, without action, you will fall flat.

Nurses Killed in the Line of Duty

October 27, 2022 11:41 am Leave a Comment

I was sickened in learning of the death of psychiatric nurse practitioner June Onkundi who had started her job at the Freedom House Recovery Center in Durham, North Carolina only 3 months ago.

Ms. Onkundi, married with 4 children, was fatally stabbed while doing the work that she loved by the patient, James Gomes, a man who spent half of his life in prison. He has been charged with first-degree murder and is being held without bond.

Elsewhere this past week, a shooting at the Methodist Dallas Medical Center claimed the life of a nurse and a social worker. Jaqueline Pokuaa was a 45-year-old maternity ward nurse. Nestor Hernandez, on parole for aggravated robbery and wearing an active ankle monitor at the time, is being held on capital murder charges.

A study released this past summer showed that two nurses are attacked every hour in the U.S. These events are unacceptable. Nurses should never have to risk their lives just by going to work. Something needs to be done to ensure that events like these never happen again to any healthcare provider.

While I’ve read the public-issued statements from these facilities regarding the loss of life, I would really like to see what the facilities are going to do to protect their employees.

Press statements about the above murders make it seem like these two situations were unavoidable. But that is absolutely not true!

Methodist Hospital in Dallas has had previous incidences of their nurses being attacked by patients but apparently the facility has done nothing to protect them.

I highly endorse supporting Nurses Against Violence Unite, a community about awareness, education, and empowerment with a mission to eliminate violence.

Activist Doctorate nurse Sandra Risoldi formed this organization in 2017 with a strong commitment to promoting mental wellness and supporting all healthcare workers while promoting violence prevention training. I admire Dr. Risoldi for following her passion and her dedication.

If facilities are not willing or able to protect their nursing staffs, we must stand together to have legislation in place to require facilities to do that or at a minimum, hospitals take steps to protect their staff and train ALL nurses in self defense and de-escalation techniques.

Nurses In Dire Need

October 20, 2022 5:40 pm Leave a Comment

You’re a charge nurse on a Saturday night in a short-staffed (5 nurses) Washington state emergency room with 45 patients in the waiting room! What would you do?

One brave nurse finally had enough and decided to call 9-1-1 to ask for help from the fire and rescue team. Two firefighters went to the hospital and for almost 2 hours cleaned rooms, beds and took patient vital signs. Those “extra sets of hands” helped relieve the pressure for the beleaguered nurses.

I do not know whether administration was upset about this incident but, as nurses, we tend to feel like we must do everything ourselves and we cannot ask for assistance, much less venture outside the facility to seek help.

One notable benefit from this situation was the hospital developed a new relationship with the community fire department that provided its help and support at a most crucial time.

Previously, the local fire department had been transporting patients to this hospital and for months had been growing upset about the repeated delays in getting patients accepted for treatment.

However, this was only a temporary “Band-Aid” solution as it did not solve the hospital’s overall staffing problem.

Things in nursing are getting tougher and tougher. The healthcare system cannot keep going like this.

I am curious to see what changes are made to improve our system so no nurse ever needs to feel pressured like this.

The Criminalization Of Nursing Care Keeps Coming.

October 13, 2022 6:27 pm Leave a Comment

DonQuenick Joppy was a good nurse who received three Daisy Awards while working at the Medical Center of Aurora in Colorado where she was the only black nurse on staff. Sadly, she was frequently humiliated and ignored by many of her coworkers and was denied growth opportunities.

At the Center, Ms. Joppy was assigned three patients in the ICU where the nurse-to-patient ratio should have been only one or two patients. She had tried to transfer out of the unit, but all of her requests were denied. She had been chastised for her presentation of improper body language and tone.

A physician had ordered “end-of-life care” for a 97-year-old patient and directed that the man’s ventilator be removed. When nurse Joppy tried to arrange for a respiratory therapist to remove the ventilator, she found the therapist was busy. However, the therapist walked Ms. Joppy through the steps to shut off the ventilator and the therapist then disconnected the ventilator after which the patient passed away, primarily due to septic shock, constant pneumonia, and bowel infarction.

Following an investigation, the hospital fired Ms. Joppy for not waiting until the arrival of the respiratory therapist to proceed. A year after she was terminated, the matter was turned over to a prosecutor and Ms. Joppy was charged with manslaughter, negligent death of an at-risk person and neglect of an at-risk person.

Fortunately, the criminal charges were dismissed “in the interest of justice.” But even though Ms. Joppy still has an active nursing license, she claims now that she is unable to get a job because of the manslaughter charge despite that charge being subsequently dropped. Ms. Joppy followed up by filing a discrimination complaint against the Medical Center.

My heart goes out to Ms. Joppy. Hers is a story that seems to be frequently heard. Currently, she is practically homeless for want of a job. For those sympathetic to Ms. Joppy’s situation, there is a GO FUND ME page to help.

I will be watching what happens with this lawsuit. Often attorneys do not want to take these types of cases because such are difficult to prove. However, I hope she will be vindicated.

Malpractice and License Issues Increase for Nurse Practitioners

October 6, 2022 2:46 pm 2 Comments

The Nursing Service Organization (“NSO”) frequently gathers their claim status, data for nurses and nurse practitioners. Recently they finished the fifth edition of Claims for Nurse Practitioners.

Previously, there have been several studies showing that claims against Nurse Practitioners were fewer than those against physicians. They also show NPs tend to spend more time with patients and have better relationships with those they care for.

However, since 2017, malpractice claims against NPs have risen 10.5% and license discipline claims have gone up 19.5%. This is the largest increase in any 5-year-period. The study adds that neonatal, family practice and adult gerontology primary care NPs had the highest growth in malpractice claims.

It is interesting that these are the high-risk areas for Nurse Practitioners but according to the license defense claims data, it says that the number one area of professional licensing issues arises from professional misconduct and prescribing medications.

It would make sense that Nurse Practitioners who work in family practice and adult gerontology primary care would prescribe the most medications.

It is unfortunate that what is happening in nursing is also happening to Nurse Practitioners who are working an inordinate number of hours and are doing the same job as a physician for less pay, yet their malpractice and disciplinary claims are increasing.

I would love to see Nurse Practitioners being able to see a patient every 15 minutes rather than 10 minutes, thereby giving them time to see the patient and complete their documentation within the allotted period so they are not as stressed and can feel accomplished. If this scheduling occurs, I suspect we will see a decrease in malpractice and license protection claims.

You are the Master of Your Mind

September 30, 2022 6:50 pm Leave a Comment

As a business owner, it is so important that we are masters of our minds.

Dr. Joe Dispenza says that our body is really our mind because we are a system of habits. When we awaken, we unconsciously get out of bed, go to the bathroom, brush our teeth, put the coffee on and do the same habits we do every day. We’re thinking about what’s ahead of us or reflecting on what happened yesterday, whatever, but you’re not thinking about what you’re doing in the present moment.

Our bodies are running the show, not our minds.

As a business owner, it is so important that we master our minds and be conscious of what is happening around us, being present in the moment.

When I started as a business owner, I worked with my laptop from my son’s bedroom during the day and from my own bed at night going through medical records.

My work would be distracted frequently. “Oh, I need to do laundry,” or “I need to go to the grocery.” Something was always getting in the way. “I have to get to the bank!”

Then, every once in a while, I would feel like I just do not want to review medical records, “I’ll do some research, instead.” Or “I’m tired of doing research. I’ll call that attorney.” I was very controlled by my feelings.

It would be unusual if you felt like you wanted to work all the time. When you think about it, we work as a means to an end. Now, as much as I enjoy my work, I love my free time as well.

When I say I want to master my mind and emotions, it means if I am going to do something, I do it! Tony Robbins takes a cold plunge every morning, no matter where in the world he might be. It could be a pool; it could be a river. He doesn’t negotiate with himself but says, “When I say go, I go!”

Your mind will try to talk you out of doing things that you don’t like. But to be a successful business owner, there are always things that you just won’t like but there will be lots of things that you love. At times we have to go past “the yuck” to get to the good.

Therefore, mastering your mind is the most important thing to do to be a successful business owner.

Now, having read this, what are your takeaways? I would love to read your comments below.

When you are triggered

September 29, 2022 4:47 pm Leave a Comment

I don’t know about you but when I was practicing (and even now), certain things would trigger me. So, I thought I would share these steps to help you work through times when you are triggered because being triggered at work can lead to mistakes in your practice, upset, frustration, resentment and makes you appear to your coworkers like you are not a team player.

When you are triggered, it is usually not the situation itself but an unmet need that happened previously. For example, just the other day, a car cut me off in traffic. I got triggered. Was I really mad at the person that cut me off? No, it was deeper. It came from my childhood where I felt unseen, and it followed me today where I felt unseen when the driver cut me off. So, what do we do with these triggers?

I’ve been involved with a leadership program and these techniques came from leadership trainers Lisa Kalmin and Lynne Sheridan who provided these steps to navigate when you are being triggered.

1. Think about your most common triggers ahead of time, it helps.

2. In the moment, name what you are experiencing or feeling. I always joke you have to “name it to claim it.”

3. Allow yourself to experience it. So many times, in nursing we don’t have time to experience our feelings and we have to block them. This is not healthy, and it leads to obesity and all kinds of disease.

I understand that following the 2017 Las Vegas sniper shooting that claimed 60 lives, the organization “Show Me Your Stethoscope” created a meditation room at the responding hospital that treated so many of the victims so that nurses could separate themselves during a difficult shift and have a few minutes to themself.

4. It is said that emotions can last up to 7 minutes if you experience it fully and sometimes for only 90 seconds! But when you allow yourself to experience the emotions, as opposed to just hanging onto them, that’s the important stuff.

5. Usually, if we are triggered, it comes from an experience we had when we were younger. When have you felt this way before?

6. What unmet need is being revisited emotionally? Usually, it’s not even related to the actual current event. Unmet needs can be things such as connection, distraction, security, physical, relief or timing.

7. Rather than relive the past, how can you relate in this present moment? Certainly, you do not wish to relive the past, but should you be able to work through this emotion. How would you like to show up where the person who caused the event to trigger you to experience you now?

I would love to hear how, if you’ve tried these steps and how they have helped you in your practice.

Do you have a paper trail?

September 22, 2022 6:09 pm Leave a Comment

In nursing, documentation is everything! Figuratively speaking, I believe that you will live or die by your documentation. And when it comes to license defense and protecting your license, the same is true.

I am not talking about just documentation in a medical record but I’m talking about protecting your license. You need a paper trail! So many times, I have clients that were reported to the Board for a “he said, she said” situation. Here are some recommendations to create a paper trail.

If you resign, where is your letter or email of resignation? On the latter, make sure you blind copy yourself and keep a copy of the sent mail to show it was actually sent. That way you have proof that you notified the proper person that you have tendered your resignation.

Should you choose to mail the letter, send it certified. If you choose to hand deliver your resignation letter, be sure that you provide an extra copy, request the person receiving it to acknowledge in writing that they received it. Otherwise, they could deny they were ever notified.

Furthermore, they must accept your resignation and you must follow the facility’s policies in terms of providing your number of weeks’ notice because, if you do not give notice, it could be construed as job/patient abandonment.

If you feel you’re not working in a safe situation and if you communicate with your charge nurse, again keep your paper trail, and send an email to your supervisor that you are concerned about your assignment and explain why. Be sure you put it in writing and, again, bcc yourself with your email and keep a copy of the sent mail. This way should any question arise as to whether you properly resigned, you will be able to verify that you reported your resignation to the supervisor.

“He said/she said” circumstances can arise too and trying to get evidence after the fact to confirm your provision of proper notice might be difficult. The Board is going to side with your employer if a “he said/she said” contest pops up.

So, if a “he said, she said” situation occurs and you are not sure you’re going to get reported, keep your paper trail, gather as much evidence as you can and get statements from other people just to make sure that you are protecting yourself.

It is unfortunate that we have to keep a paper trail but just like the medical record, it is your best protection of what happened, therefore create contemporaneous documentation and keep your paper trail.

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