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

When Nurses Need to Report Criminal Matters to the Board

October 31, 2024 5:19 pm Leave a Comment

In the healthcare profession, nurses hold positions of trust and responsibility. This trust extends not only to patient care but also to upholding the ethical and legal standards that govern their profession. You are a nurse 24/7 and are held to ethical standards whether at work or personal life. One key legal responsibility is self-reporting criminal matters to the appropriate nursing board or regulatory body. Failing to do so can result in severe disciplinary actions, including license suspension or revocation. But when exactly does a nurse need to report criminal offenses, and what are the timelines for doing so?

Understanding the Obligation to Self-Report

Each state has its own regulations for when healthcare providers, including nurses, must self-report criminal matters. The types of reportable offenses can range from misdemeanors to felonies, with timelines that vary from state to state. The requirement to report is typically triggered by charges, convictions, or any legal action against the nurse. Some states require you to report a conviction even if your license is expired.

Below are some general guidelines and a breakdown of specific state requirements:

General Rules for Self-Reporting:

1. Charges or Arrests: In some states, nurses must report arrests, not just convictions, especially if the offense is related to the healthcare profession, such as drug use or theft.

2. Convictions: Most states require nurses to report both felony and misdemeanor convictions. These may include DUIs, assault, fraud, or other crimes that could impact their ability to provide care. All convictions must be reported.

3. No-Contest Pleas: Even if the nurse doesn’t admit guilt but enters a no-contest plea, this still requires self-reporting in most jurisdictions.

4. Disciplinary Actions in Other States: Some states require reporting if the nurse is disciplined in another state for criminal behavior.

State-Specific Timelines for Reporting

· Alabama: Must notify the board within 30 days of any criminal action (Ala. Code § 34-24-59).

· Arizona: Requires reporting within 10 working days if charged with a misdemeanor or felony (A.R.S. § 32-3208).

· California: Requires self-reporting of any indictment or conviction of a felony or misdemeanor within 30 days(Cal Bus & Prof Code § 802.1).

· Florida: Nurses must report any criminal conviction, guilty plea, or no-contest plea within 30 days (Fla. Stat. § 456.072(1)(x)).

· Indiana: Nurses are allowed up to 90 days to report a criminal conviction (Burns Ind. Code Ann. § 25-1-1.1-1).

· Wisconsin: Has one of the shortest timelines, requiring nurses to report any conviction within 48 hours of judgment (Wis. Stat. § 440.03).

What Happens if You Don’t Report?

Failure to report within the designated time can result in severe penalties, including:

· License suspension or revocation

· Fines

· Reprimands or probation

· Permanent mark on your professional record

The penalties depend on the severity of the crime and the board’s discretion. Even if the criminal offense seems minor, it is always better to err on the side of transparency to protect your career and reputation by reporting.

Best Practices for Self-Reporting

1. Know Your State Laws: Keep updated on your state’s nursing board regulations regarding self-reporting. If you’re unsure, contact the board or consult a legal expert.

2. Be Prompt: Reporting within the required timeframe shows professionalism and accountability, which may help during any subsequent board investigation.

3. Keep Records: Document any communication you have with law enforcement or legal representatives related to the offense, as well as your notification to the board. Do not talk to anyone without your attorney present.

4. Consult an Attorney: If you are unsure about how or when to report, seek legal advice to ensure you meet your state’s requirements.

Conclusion

Self-reporting criminal matters is not only a legal obligation but an ethical one. As nurses, maintaining the trust of patients and colleagues is paramount, and being transparent about any legal issues can help safeguard both your career and the reputation of the nursing profession as a whole. Always familiarize yourself with your state’s laws, and when in doubt, report as soon as possible.

Why AI Cannot Replace Legal Nurse Consulting: The Human Touch in Medical-Legal Cases

5:07 pm Leave a Comment

As artificial intelligence (AI) continues to make its way into industries from finance to healthcare, many professionals are questioning whether their roles could be replaced by machines. In the medical-legal world, AI is becoming more prominent, offering tools to analyze data, predict outcomes, and automate tasks. However, when it comes to Legal Nurse Consulting (LNC), AI is no substitute for the critical thinking, clinical expertise, and human intuition that seasoned nurse consultants bring to the table.

Here’s why AI can’t replace Legal Nurse Consultants and why the human element remains indispensable in this specialized field.

1. Clinical Expertise and Intuition

Legal Nurse Consultants possess years—often decades—of hands-on clinical experience that allows them to understand the nuances of patient care, medical records, and treatment protocols. AI may be able to scan and analyze large volumes of data quickly, but it lacks the intuition and deep understanding that comes from actual bedside experience.

For example, an LNC can spot inconsistencies in a patient’s chart that might not stand out to an algorithm. They know what proper nursing care looks like in real-life scenarios, making them better equipped to determine when deviations from the standard of care have occurred. AI can flag potential issues, but it takes a human nurse’s clinical judgment to interpret those findings accurately.

2. Human Understanding of Medical Complexity

AI can process data, but it doesn’t understand the complexity of human health. Every patient is unique, with different responses to treatment, co-morbidities, and personal factors that influence medical decisions. Legal Nurse Consultants are trained to see the bigger picture, integrating these complexities into their case reviews.

Whether it’s understanding how a particular medication interacts with a patient’s underlying condition or the impact of a delayed diagnosis, LNCs provide a level of critical thinking that AI simply cannot replicate. Their ability to understand the emotional, psychological, and physical aspects of patient care is key when reviewing complex medical cases.

3. Interpretation and Communication of Findings

One of the most critical roles of a Legal Nurse Consultant is communicating complex medical information to attorneys, judges, and juries in a clear and understandable way. While AI can generate reports and provide data points, it cannot distill that information into compelling, human terms that resonate in a legal setting.

LNCs bridge the gap between medical jargon and legal proceedings, helping attorneys understand what the medical records are really saying. This interpretation goes beyond facts and figures—it requires empathy, context, and the ability to see how medical issues translate into the legal standards of care.

4. Collaboration with Legal Teams

Successful legal cases rely on collaboration, communication, and trust between the attorney and the LNC. AI can assist with research and analytics, but it cannot build relationships or offer insights in a way that strengthens attorney-client interactions. Legal

Nurse Consultants offer a personal touch, providing advice and insight that is tailored to each specific case, while collaborating in real-time with the legal team.

Attorneys rely on LNCs to give them expert opinions, provide courtroom testimony, and help build the case in ways that AI-generated data cannot. Legal Nurse Consultants can also respond to questions, clarify medical issues, and help attorneys strategize effectively based on real-life clinical knowledge.

5. Ethical Decision-Making and Professional Judgment

Healthcare is about more than just data; it’s about making decisions that affect people’s lives. Legal Nurse Consultants draw on their ethical training as healthcare professionals to evaluate whether standards of care have been met and to determine the impact of medical negligence. AI, while powerful, lacks the ability to weigh ethical concerns, understand the human stakes involved in a case, or make judgment calls based on real-world scenarios.

An LNC brings compassion and professional judgment to every case, understanding the emotional toll on patients and their families, as well as the ethical responsibility of healthcare providers. This aspect of the job requires a depth of experience and human empathy that no algorithm can replicate.

6. Customized Case Analysis

Every legal case is different. AI can process and analyze data in bulk, but Legal Nurse Consultants offer tailored, case-specific analysis. They can adapt their reviews based on the specific needs of the case, the medical conditions involved, and the direction the legal team is taking.

Whether it’s reviewing hundreds of pages of medical records or attending Independent Medical Examinations (IMEs), LNCs know how to adjust their approach to meet the demands of a particular case. This kind of personalized analysis is crucial in litigation, where a one-size-fits-all approach simply doesn’t work.

In addition, AI cannot address contributory negligence and noncompliance. It cannot address judgment calls when it comes to the standard of care. Also, AI cannot evaluate damages and if it is worthwhile to pursue the case.

7. Building Relationships with Attorneys

LNCs play a key role in building long-term, trust-based relationships with attorneys. They’re often called upon for multiple cases over the years, becoming a reliable resource for legal teams. AI, on the other hand, cannot replicate the human connection and collaborative partnership that LNCs foster with their attorney clients. LNCs can help attorneys with the strategy whereas AI cannot.

These relationships go beyond simple case consultation. LNCs help attorneys understand medical issues, craft stronger cases, and provide ongoing support throughout the litigation process—something that requires human interaction, trust, and mutual respect.

Conclusion: The Human Element Cannot Be Replaced

While AI is a powerful tool that can support the work of Legal Nurse Consultants, it cannot replace the critical thinking, clinical expertise, and human connection that make LNCs so valuable in the legal world. AI can assist by automating certain tasks or analyzing data more quickly, but at the end of the day, it’s the human touch that attorneys, clients, and patients rely on.

Legal Nurse Consulting is about more than just understanding the facts of a case—it’s about interpreting those facts through the lens of real-life clinical experience, communicating them in a meaningful way, and providing ethical, judgment-based insights that only a trained professional can offer. AI may assist, but it will never replace the essential role of the Legal Nurse Consultant.

Finding The Joy In Your Nursing Practice

October 24, 2024 4:31 pm Leave a Comment

Like me, many of you went into nursing because it’s something in our DNA. We were born to serve others and provide care to those in need. Those of us who are a bit

older can remember how excited we were to get our “white cap and pin” and ready to hit the floor and do the job of helping all those patients in need.

However, with the stress of nursing today, it’s easy to lose sight on “why” we became a nurse in the first place. Nevertheless, and definitely, it is possible to rediscover your joy in nursing by remembering the feeling and excitement that brought you into the practice.

1. RECONNECT WITH YOUR “WHY.” Write down why was it so important for you to go into nursing? Was it your desire to help others? Did you want to make a difference in the lives of others? What inspired you to provide the best care for your patients?

Sometimes when you read it, when you reflect on your original motivation, it helps to reignite and guide you back to your passion, to what truly matters.

2. CELEBRATE SMALL WINS. Sometimes, we focus on one bad thing that happened during the day rather than on all of the great wins made. Think of the little things like when a patient smiles at you, or you give a medicine which helps ease a patient’s symptoms. These wins are worth celebrating.

Focus on the small victories that happen every day to remind you of the powerful impact and meaningful work that you are doing.

3. PRACTIVE GRATITUDE. Gratitude is the most powerful practice a nurse can have. I suggest keeping a gratitude journal and writing down things that you’re thankful for each day in your nursing practice. This helps you focus on what’s going right rather than what’s going wrong.

4. NURTURE CONNECTIONS WITH PATIENTS. One of the most fulfilling aspects of our job is the connection we make with our patients, whether it’s a brief conversation or a small act of kindness, these moments provide a sense of your purpose and fulfillment that reminds you of the heart of nursing.

5. PRIORITIZE SELF-CARE. It’s difficult to give from an empty cup! Often nurses are exhausted physically and emotionally and are working overtime just to make ends meet.

Take care of yourself first. Exercise, meditate and spend time with loved ones, pursue hobbies outside of nursing so you can feel balanced and joyful in your practice.

6. FIND THE MEANING IN YOUR DAILY ROUTINE. Sometimes it feels that our tasks are just so routine, like taking vital signs, performing assessments, and administering medications.

When you shift your mindset to see how important these activities are to the patients in their healing process, it will help. It helps you derive meaning knowing that these actions are improving your patients’ health and well-being and will remind you of what you’re doing is so important.

7. SEEK GROWTH AND LEARNING OPPORTUNITIES. I consider myself to be a lifelong learner and recognize that pursuing continuing educational education or whatever you can to learn, and grow is so crucially important. Perhaps become a charge nurse or mentor new nurses. Challenge yourself to grow and learn what makes your job feel exciting and increases your sense of accomplishment and purpose.

8. BUILD A SUPPORT NETWORK. You need to change your mental zip code! If you are hanging around with people with negative attitudes, “find a more positive tribe to help you thrive.”

9. ENGAGE IN MINDFULNESS. When you stay present in the moment, this reduces stress, avoids burnout, and you can certainly appreciate the meaningful aspects of nursing practice. Mindfulness techniques like deep breathing or meditation help tremendously … just take a minute during your shift to pause and refocus.

Nursing is a profession of both heart and skill, and while it can be demanding, it also offers incredible rewards. By reconnecting with your purpose, celebrating the small wins, and taking care of yourself, you can rediscover the joy that first inspired you to become a nurse.

Remember, your impact is profound, and the joy of nursing is waiting for you to embrace it again. It is truly possible. It is a choice.

Time Management Strategies for Nurses

October 16, 2024 4:30 pm Leave a Comment

Have you ever had a shift that just seemed to fly by? Where you ask yourself, “where did the time go?” Or maybe a shift where the time goes so slowly that you can hear almost every tick of the clock? Where you wonder if you’re ever going to get out of there?

Time is just how we measure things but actually it’s our experience of time that is very different.

According to the commonplace observation of Parkinson’s Law, “work expands so as to fill the time available for its completion”. So, things take only as much time as we give them. Therefore, the key is to be present in the moment; decide how long something is going to take and then go do it!

When you think about the task, sometimes it gets overwhelming, and you wonder when you’re going to find time to get to it. Rather than thinking about the task, just do it! Thinking about it will not get it done. Just do it.

Time management is not just a skill, it is a necessity. Here are some things that can help you succeed in your fast-paced practice:

1. Be present in the moment. When you are present in the moment, you’re not thinking about all the things that must be done next or everything that happened in the past. When you’re present in the moment, you can truly concentrate and get the task done rather than thinking about the past or the present.

2. Prioritize patient care. Obviously, your patients come first, but you do need to get the charting in as well. Just do the task and then chart. When you are interrupted, is it something that needs your time immediately or can it wait?

3. Create a structured routine. How do you start your day? Do you get your plan to administer medications and tasks? Take vital signs? What is going to be the most productive use of your time to make your routine flow as easily as possible? Don’t take shortcuts like prefilling your meds and don’t take medication out of the Pyxis because even though you think it’s going to save time, that would be against the facility’s policies and procedures.

4. Delegate tasks. My philosophy is do, delegate or delete. We nurses want to do everything ourselves and hesitate to ask others for help. Asking for help is not a sign of weakness! Requesting assistance will help you get your work done in a timely manner and get patients the care they need when they need it.

5. Stay organized. When you are prepared and organized in your work, whether it’s at a desk or a Medcart.

6. Avoid multitasking. When administering meds, performing procedures, or documenting in the chart, multitasking may seem like you’re saving time but, in fact, it increases your likelihood of making mistakes.

7. Take a break to recharge. It seems counterintuitive to take a break when you are so busy, but doing so can help you clear your mind. Stretch, hydrate, or step outside to improve your focus and productivity for the rest of your shift.

8. Reflect and adjust. Take a few minutes to reflect on your day and ask where your time went. Did it go as planned or, if not, what got in the way? How can you adjust and improve your next shift?

9. Take advantage of downtime. Although downtime seems rare in nursing, it does happen occasionally. Use this to catch up on charting, to prepare for upcoming patient care needs, restock supplies, etc. There is always something to do.

Final thoughts: Time management for nurses is a balancing act between patient care, documentation, and self-care. When you take care of yourself, you can take care of others. Prioritizing, delegating, and staying organized can help you work efficiently without compromising patient outcomes.

It’s not just about getting things done, it’s getting the right things done and in a timely manner. This way it supports your patients’ needs as well as your well-being as a nurse.

There are no shortcuts to becoming a successful New Nurse

October 10, 2024 4:56 pm Leave a Comment

You graduated from nursing school and passed the NCLEX and now you have your first job. The excitement is rampant. You want to be successful but how do you know if the unit norms are in compliance with the Nurse Practice Act or even the facilities policies and procedures? For many new nurses, entering the clinical environment can be an overwhelming experience. The need to adapt quickly, coupled with staffing shortages and high patient loads, can make it tempting to adopt unit shortcuts as a way to get your work done. Unfortunately, shortcuts are often a slippery slope that can lead not only to professional disciplinary action but also to compromising patient care and the nurse’s license.

The Appeal of Shortcuts

Imagine being a new nurse, eager to do well, yet faced with a sea of patients, endless tasks, and limited time. When experienced staff or well-meaning peers demonstrate shortcuts—omitting certain documentation, skipping patient checks, or bypassing protocols to save time—it can be incredibly enticing. These shortcuts may appear efficient in the moment, and might even be encouraged by colleagues as “the real way” to manage the demands of the job.

For those who are new to nursing, this “informal training” becomes a quick survival tool. They learn to rely on what appears to be a common practice rather than following the detailed steps taught in nursing school. But what often gets lost in this process is the reason why these steps exist.

The Hidden Costs of Improper Training

Shortcuts have consequences. In the heat of the moment, they might seem beneficial, but over time, they erode the quality of patient care. Without proper assessment, documentation, or critical thinking, vital signs can be missed, patient symptoms can be overlooked, and crucial interventions can be delayed.

For example, imagine a nurse decides to skip double-checking a medication dose, signing for a med that was wasted that you did not witness or documenting a thorough patient assessment. This might save time in the short run, but it could lead to medication errors, missed symptoms, and adverse events. Such omissions can open the door to liability for the nurse, the facility, and most significantly, harm to the patient.

The Legal and Professional Ramifications

When shortcuts replace best practices, it’s only a matter of time before serious issues arise. Inadequate documentation can leave a nurse unable to defend their actions in court, putting their license at risk. If the patient care provided doesn’t reflect the standards of practice due to these “shortcuts,” the nurse may be held accountable for negligence.

Medical record documentation serves as proof of patient care. When a record is incomplete, altered, or improperly done, it raises red flags during audits or legal proceedings. New nurses trained in unit shortcuts might lack the awareness that their documentation habits could lead to severe consequences—termination, investigation by the board of nursing, and potential license revocation.

Breaking the Cycle: Proper Training and Ethical Leadership

As a nurse, it’s crucial to know that being efficient is not the same as cutting corners. When starting out, it’s better to ask questions, seek clarification, and adhere strictly to

protocols—even if it feels slow or cumbersome. Fish do not know what air is because their environment is water. Do not get sucked in to the unit norm. You may not realize you are doing something wrong so ask someone who works outside your institution. Nurses should remember that their primary responsibility is to the patient, and any steps skipped can have a direct impact on the safety and quality of care they provide.

Unit leadership also has a significant role to play in how new nurses are trained. Mentors, preceptors, and unit managers need to be mindful of the messages they are conveying, both explicitly and implicitly. Teaching new nurses proper protocols, highlighting the importance of every aspect of care, and showing them how to use critical thinking can create a safer environment for everyone and making sure the nurse knows the facilities policies and procedures. Leadership must discourage shortcuts and instead foster a culture that values patient safety above all else.

Redefining Efficiency Without Sacrificing Safety

New nurses are at a critical juncture where they’re eager to fit in and succeed. If their unit’s culture prioritizes speed over accuracy, they may adopt poor practices without realizing the potential consequences. It’s the responsibility of both the new nurse and the team to challenge this dynamic.

To new nurses: know that there is no shortcut worth losing your license over. It’s better to take the extra time to ensure things are done correctly than to face a lifetime of regret over a preventable mistake. To seasoned nurses and leadership: remember that your guidance sets the foundation for a new nurse’s career. Teaching shortcuts might feel helpful in the short term, but it endangers your patients and puts your colleagues’ careers on the line.

In nursing, the right way is often the safest way. Take the time, ask the questions, and always put patient care first—because shortcuts may cost far more than they save.

The Irony of Nurse Layoffs During a Nursing Shortage: A Broken System in Crisis

October 3, 2024 4:53 pm Leave a Comment

The healthcare industry is facing a perplexing and unfortunate contradiction: hospitals are laying off nurses even as a nationwide nursing shortage continues to worsen. For those of us who live and breathe nursing, this seems illogical—how can hospitals justify layoffs when they struggle to staff their units adequately? Let’s dive into why this is happening and what it means for the future of nursing care.

The Ever-Deepening Nursing Shortage

The nursing shortage in the United States is not a new phenomenon, but it has reached critical levels in recent years. The pandemic exacerbated the strain on an already overwhelmed system, resulting in widespread burnout, early retirements, and a mass exodus of skilled nurses from the profession. Many nurses have called for legislative action, and many leaders have suggested practical solutions—yet hospitals, ironically, are choosing to lay off staff, including nurses, at this crucial time.

Financial Pressures and Short-Sighted Decisions

One of the primary reasons behind these layoffs lies in the financial pressures hospital systems are under. Rising costs, changes in reimbursement structures, and the increasing expense of providing care have led many institutions to make budget cuts to balance their finances. Unfortunately, labor costs often top the list, and cutting nursing staff can be an easy target for quick savings since nursing is considered a cost center and not a revenue producing center.

Hospitals are also dealing with a decrease in patient volumes for non-emergency procedures, as many individuals delayed elective surgeries during the pandemic. With reduced revenue, some hospital administrators have responded by cutting costs across the board, including eliminating nursing positions—even though these actions may negatively impact patient care in the long run. In addition, many hospitals are putting money into growing or refurbishing the physical buildings.

Replacing Experience with Lower Cost Alternatives

Another troubling trend is the replacement of experienced nurses with less expensive alternatives, like new graduates or unlicensed personnel. Hiring new graduates may seem like a cost-saving measure, but this often results in higher turnover and increased burden on the existing staff who must mentor and train these newcomers. Nurses with years of experience bring a depth of knowledge and experience that is irreplaceable—something hospital systems seem to be ignoring in favor of trimming budgets.

Relying on Temporary Staffing

Many hospitals rely on travel nurses or agency nurses. This temporary staffing solution fails to address the systemic issues causing the nursing shortage in the first place.

The Impact on Patient Care and Morale

The most significant consequence of laying off nurses during a shortage is the effect on patient care. Fewer nurses mean heavier patient loads, longer wait times, and reduced time for individualized care. This “do more with less” mentality leads to burnout, compromised patient safety, and ultimately, a diminished quality of care.

Layoffs also send a demoralizing message to the nursing workforce. Many nurses already feel undervalued and exhausted, and seeing their peers laid off only reinforces the idea that they are replaceable. Nurses enter this field not just as a profession, but because it is a

calling—something deeply embedded in their DNA. Being treated as mere numbers on a balance sheet is not only disheartening but also drives more nurses away from the bedside, deepening the staffing crisis even further.

A Call for Change

Hospitals must rethink their strategies if they truly wish to provide quality care to patients and ensure a sustainable healthcare system. Laying off nurses at a time when they are more needed than ever is a short-sighted solution to a complex issue. Investment in nursing staff should be seen not as an expense, but as an investment in the quality of care, patient outcomes, and the well-being of an entire healthcare system.

We must advocate for policies that support nurses, promote safe staffing ratios, and incentivize retention through appropriate compensation and working conditions. For too long, nurses have been expected to fill in the gaps created by systemic failures—now it’s time for a change.

The nursing shortage isn’t just a numbers problem; it’s a symptom of a broken system that is failing to value its most critical resource: people. To truly solve the nursing crisis, hospitals and healthcare administrators need to put patients and caregivers first—because without nurses, the entire system collapses. Let’s demand better, for the nurses who tirelessly give of themselves, and for the patients who deserve safe, compassionate care.

Call To Action

September 30, 2024 5:00 pm Leave a Comment

Maybe I am dating myself but when you used to look at those ads in the Yellow Pages you likely saw that they all looked alike and said the same thing. This was especially true with ads for attorneys.

“If you’ve been injured in a car accident, call ME!”

At that time, investing in a Yellow Pages ad was very expensive. How was anyone supposed to know whether the ad was working to justify the investment? Therefore, every marketing piece that you create should have a “call to action” and you should track where your leads come from to know if it is effective. A call to action is something that encourages the potential customer to take action and respond. For example, if you are a legal nurse consultant and you’ve sent out a mailing (which I don’t recommend), how can you know if that mailing is effective? A call to action is needed.

A call to action for a mailing would be saying something like “If you call me in the next 30 days of the date of this letter, I would be happy to provide you with a 20% discount on your first case.”

If you are a home health care agency and put an ad in a senior targeted magazine, the call to action could be something as simple as “Mention this ad and get a 10% discount or call us today for a free in-home safety inspection.

Again, a call for action is anything that convinces your potential client to take action towards utilizing your services.

My call to action today is that if you found this newsletter informative and valuable, please share it with other current and future nurse business owners.

Another call to action that I offer is that if you would like to receive a complimentary 15 minute nurse to nurse business owner assessment call. CallwithLorie.com.

Turf Battles in California: Anesthesiologists vs. CRNAs – What’s at Stake?

September 26, 2024 4:59 pm Leave a Comment

The healthcare field is no stranger to professional turf battles, but few are as heated or impactful as the ongoing conflict between anesthesiologists and Certified Registered Nurse Anesthetists (CRNAs). In California, this battle over roles and responsibilities continues to raise questions about autonomy, safety, cost, and access to care, shaping the future of anesthesia services in the state.

At the heart of this turf war lies a central issue: Should CRNAs be allowed to practice independently, without the direct supervision of an anesthesiologist? For years, California has been one of the key battlegrounds, as CRNAs push for expanded scope of practice and anesthesiologists defend their territory, citing concerns about patient safety and quality of care.

What Are CRNAs and Anesthesiologists?

Both CRNAs and anesthesiologists play essential roles in delivering anesthesia care, but their training and paths to practice differ significantly.

CRNAs are advanced practice nurses who specialize in anesthesia. Their path to certification includes obtaining a nursing degree, working as a registered nurse (often in a critical care setting), completing a master’s or doctoral program in nurse anesthesia, and passing a national certification exam.
Anesthesiologists are physicians who complete medical school, followed by a residency in anesthesiology, and in many cases, a fellowship in a subspecialty area. This extensive training equips them to handle complex medical situations.

While both groups are capable of delivering anesthesia services, the battle arises over whether CRNAs can do so without the oversight of a physician.

The California Debate: Autonomy vs. Supervision

California is one of 19 states that have opted out of the federal Medicare requirement that CRNAs must be supervised by a physician to be reimbursed for services. This opt-out allows CRNAs to practice independently in certain settings, particularly in rural areas where access to anesthesiologists is limited. Proponents argue that CRNAs provide high-quality care at a lower cost, helping to fill healthcare gaps in underserved communities.

However, anesthesiologists argue that removing physician oversight jeopardizes patient safety. They contend that anesthesia is inherently risky, and that the more extensive training and experience of anesthesiologists is critical to managing the complexities and potential complications of anesthesia.

The Cost and Access to Care Argument

One of the primary arguments in favor of allowing CRNAs to practice independently is the cost-effectiveness of nurse anesthesia services. Studies show that CRNAs can provide the same level of care at a lower cost, which is particularly important in rural or underserved areas where healthcare budgets are tight and access to care is limited.

Supporters of CRNA independence also point to the growing demand for anesthesia services, especially as the population ages and surgeries increase. With a shortage of anesthesiologists in many areas, CRNAs offer a solution to providing timely and affordable anesthesia care.

Safety Concerns: Is Physician Supervision Necessary?

Anesthesiologists have long argued that their advanced medical training is vital for patient safety. While CRNAs are highly skilled, anesthesiologists emphasize the complexities that can arise during surgery and anesthesia administration, from allergic reactions to heart complications. They argue that physician oversight ensures that someone with the highest level of medical expertise is present to handle emergencies.

However, several studies have shown that CRNAs can deliver safe, high-quality anesthesia care independently. For example, a 2010 study in Health Affairs found no significant difference in patient outcomes between states that require physician supervision and those that do not.

The Future of Anesthesia in California

The battle between anesthesiologists and CRNAs in California is unlikely to resolve any time soon. Both sides have valid points, and the stakes are high for patients, healthcare systems, and professionals. As the state continues to grapple with this issue, several factors will influence the outcome:

Legislation: California’s lawmakers will continue to play a significant role in determining the scope of practice for CRNAs. Bills seeking to either limit or expand CRNA autonomy will shape the future of anesthesia care in the state.
Workforce Shortages: The growing demand for anesthesia services, coupled with shortages of anesthesiologists, may push the state toward granting more independence to CRNAs, especially in rural areas where access to care is a pressing concern.
Collaboration Models: Some hospitals and healthcare systems are exploring collaborative models that allow anesthesiologists and CRNAs to work together, combining their expertise to provide the best possible care. This middle-ground approach could ease tensions and improve outcomes for patients.

Conclusion: Finding Common Ground

At the end of the day, both anesthesiologists and CRNAs have a common goal: delivering safe, effective anesthesia care to patients. While the turf war in California is far from over, it’s clear that collaboration, rather than conflict, may be the key to moving forward. By recognizing the strengths and expertise of both professionals, the state can ensure that all patients—whether in a major city or a remote rural area—receive the high-quality care they deserve.

Getting In Touch With Your Limiting Beliefs

September 19, 2024 5:19 pm Leave a Comment

A limiting belief is a state of mind or belief about yourself that restricts you in some manner.

I had a limiting belief that I was not smart enough to go to medical school, so I became a nurse. Many nurses experienced these limiting beliefs without realizing it. Limiting beliefs are learned from our parents, media, our environment even though we may not recognize it. How so? How can we confront and overcome these obstacles as nurses?

You need to identify the limiting belief which is a deeply ingrained idea about us that holds us back. They might sound like, “I’m not smart enough to become a nurse leader … I’ll never be good at public speaking so I can’t teach or present … I’ve always worked bedside … I can’t trust transition into a new role.”

The first step is to recognize these thoughts when they appear. Pay attention to your inner dialogue, especially when facing challenges. In nursing, we are programmed to believe in lack and limitation such as we don’t have enough equipment, supplies, support or time to adequately take care of our patients.

We become so entrenched in this belief of lack that we don’t realize that the rest of the world is, in reality, very abundant. In fact, if you look at many hospitals, they seem to all have construction underway. These hospitals are nonprofit and must reinvest the profits back into the hospital system. Rather than investing in attracting nurses to maintain and provide quality patient care, they would rather turn these facilities into something like hotels with concierge service. When people are sick they don’t care about the color of the room’s walls; they just want to get the care they need.

Ask yourself if these beliefs are true. Once you identify your limiting belief, the next step is to question their validity. Are these thoughts rooted in fact? Are they assumptions that you’ve made over time? For example, “I’ve never led before” can turn into, “I’ve led patient care teams in difficult situations” or “I don’t have enough experience” can be reframed as “I have years of experience in patient care and my skills are transferable to other roles.” The process of reframing helps us realize that many limiting beliefs are based in fear or lack of self-confidence and are not grounded in reality.

Next you need to develop a growth mindset which is the belief that we can learn new skills or improve the ones we already have. If you say to yourself, “I’m not good at technology” you can shift that to, “I can learn more about technology to improve my practice.”

Adopting a growth mindset helps you turn limiting beliefs into goals for improvement. The shift empowers you to take control of your professional development and push beyond any self-imposed limits.

Seek support and mentorship. No one breaks through limiting beliefs alone. Sometimes we need the help of others because we can’t always see our own limiting beliefs. They can be hidden deep in our subconscious.

Mentorship can provide a mirror, reflecting on strengths that you may not see in yourself. A supportive mentor can help you work through doubt and affirm your abilities, especially when you’re on the verge of a breakthrough.

Set small achievable goals. Overcoming limiting beliefs doesn’t happen overnight. Start by setting small, achievable goals that put you just outside your comfort zone. Growth only occurs outside your comfort zone. If you’ve always believed you can’t

lead a team, try stepping up during your shift and offering to lead in small ways. Gradually build up your confidence by taking on more responsibility or exploring new roles.

Practice self-compassion. Nursing is a demanding profession, and it’s easy to be hard on ourselves when we don’t immediately succeed, or we feel overwhelmed by self-doubt. One of the best ways to get in touch with limiting beliefs and move beyond them is through self-compassion. Instead of beating yourself up for perceived shortcomings, treat yourself with the same kindness you would offer to a colleague or patient. Nurses are hardest on themselves.

Self-compassion creates space for growth and helps you navigate the emotional difficulties of challenging your limiting beliefs.

Visualized success! Visualization is a powerful tool. Take time to imagine yourself breaking free from your limiting beliefs and achieving something that you once thought was out of your reach. Whether it’s landing a leadership position, transitioning to a new specialty, or pursuing higher education, seeing yourself succeed can be a motivating force.

Give yourself permission to dream big and remind yourself that you are capable of growth, change and achievement. If you can conceive it and believe it, you can achieve it.

Lastly, limiting beliefs are not unique to nurses, but they can be particularly challenging in a profession as demanding as ours. By getting in touch with these beliefs and actively working to challenge them, we can unlock our full potential.

Remember, you are more than capable–sometimes the biggest hurdle is simply a matter of believing. Whether you’re at the bedside, in research or exploring legal nurse

consulting, overcoming limiting beliefs opens new pathways for growth and fulfillment. Step-by-step with reflection, support, and a belief in your capacity for change, you can breakthrough these barriers and thrive.

Breaking Free from the Nursing Rut: Finding Your Path Forward

September 12, 2024 11:19 am Leave a Comment

As nurses, we’re used to managing chaos, making quick decisions, and handling life-or-death situations. But what happens when you start feeling stuck in a rut? The excitement and passion that once fueled your every shift begin to fade, and you find yourself going through the motions. It’s a place many of us have been, yet few talk about openly. So, let’s break that silence.

The Reality of Hitting a Rut

Nursing is more than a career; it’s in our DNA. But even when something feels like it’s part of who you are, it’s normal to face times when the weight of the job becomes too much. Long hours, emotional exhaustion, and the sheer pressure of caregiving can drain you. This rut can sneak up slowly, and before you know it, you’re questioning your passion, your career choice, and your future.

If you’re in this place, first, know you’re not alone. This feeling doesn’t make you any less of a nurse, nor does it mean that you’re failing. It simply means you’re human.

Signs You Might Be Stuck in a Rut:

· Burnout disguised as routine: You might think you’re just getting used to the job, but if you’re no longer engaged, that’s a red flag.

· Loss of motivation: If you’ve lost your enthusiasm for learning new things, taking on new challenges, or engaging with patients, it could be a sign you’re in a rut.

· Feeling stuck in your role: You may feel like there’s no room for growth or that your career is stagnating.

· Emotional exhaustion: If you feel emotionally drained before your shift even starts, it might be time for a change.

Why Does This Happen?

Sometimes, the job demands become too much without adequate time for recovery. Other times, it’s a lack of professional growth or feeling unsupported. Maybe it’s a mismatch between your values and the environment you’re working in.

How to Climb Out of the Rut

1. Reflect on Your “Why” Take time to remember why you became a nurse in the first place. Was it the connection with patients? The challenge? Whatever it was, revisit those roots. Sometimes, reconnecting with your original purpose can help you regain clarity.

2. Talk About It Don’t keep these feelings bottled up. Share them with trusted colleagues, mentors, or a professional therapist. Sometimes, just knowing others understand your struggle can lighten the load.

3. Explore New Opportunities If your current role feels limiting, start exploring other areas within nursing. There are so many paths you can take — from clinical specialties to leadership roles, teaching, consulting, or even becoming a legal nurse consultant (LNC). Sometimes, change is exactly what you need to reignite your passion.

4. Prioritize Self-Care Nurses are notorious for putting others first, but it’s essential to prioritize your own mental and physical health. Regular breaks, exercise, and mindfulness practices like yoga or meditation can help you recharge.

5. Set Boundaries Saying no can be one of the hardest things for nurses to do, but protecting your time and energy is critical. Establish boundaries with work and at home to create balance.

6. Consider a Career Reset If the rut runs deeper than burnout, it might be time for a career reset. This doesn’t necessarily mean leaving nursing but could involve moving into a different specialty or shifting into an entirely new role within healthcare.

You Are Not Alone

Ruts are part of any career, even in a profession as fulfilling as nursing. What matters is recognizing it and taking steps to break free. You deserve to feel fulfilled in your career, not stuck.

Remember, nursing is in your DNA. And just like every great nurse, you’re resilient. This phase doesn’t define you. The beauty of this profession is that it offers endless possibilities for growth, learning, and personal fulfillment. Find your path forward — it’s out there waiting for you.

Have you ever found yourself in a rut? What did you do to break free? Share your thoughts and experiences with us!

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