Horse Sense: Twenty Years Later, Tricia’s Gift To Me.

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Tricia introduced me to the world of horses. When I say “world” I mean the amount of it that I would allow my hands to get involved in. She was my best friend in high school, and she both irritated and mesmerized me because she just floated in and out of the real world at will. On her terms. At just 17,  Tricia had already lived an extremely full life, and only now can I understand why she died so early, so suddenly. She established her legacy and had done the work she was supposed to here.

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She was bold, passionate, courageous, vivacious, and unconcerned with worldly things. As long as she could perform and be with animals as much as she wanted, Tricia was happy. By the age of 17 she was both training AND showing world class Arabian Horses in competitions all over the state—and she had no problems taking home awards or ribbons either. She trained beautiful white laborador puppies to be guide dogs for the sick and disabled. She prepared them for their testing and certification…..aaaaaaand if one or two didn’t pass, that was okay with her and her mother Joanne, because they’d keep the ones who flunked.

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My favorite part of going over to their house was being greeted by both their favorites., I can only remember the name of the big black one, Magic. But they loved me. And, I, adored those dogs to no end. One of the memories that always remains with me is watching both of her big dogs take turns diving into the pool during the summer time.

After persistent prodding,  Tricia eventually got me on the back of “Bud,” a stubborn old man of a horse. But once I climbed atop his strong back and felt his energy, it seemed to match mine. I felt like we were both this moody pair….and all of a sudden horses weren’t so scary. Basquadar on the other hand, well, he was a different story. HE KNEW he was an award winning ARABIAN, and he only had eyes for his trainer and master, Tricia. I only rode Bud a few times, back then animals weren’t such an integral part of my life as they are now and I wish I had participated more before Tricia died. Though she was my best friend, we were on different “planes.”

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There were things I couldn’t quite grasp about her, something deeper, something about her was older than me. And I could never quite get what it was. But, I was content just watching her do what she did with animals and what she did on stage. She was glitter when she performed. She sparkled. She was the same way with animals.  I never could quite understand why she never cared what people thought about her…..now, I get it…..

I look back and remember Tricia each time I pass this huge ranch property off of 59th avenue and Thunderbird Road. I think they board race horses there. Each time I pass the property I feel this “pull” toward those horses. So much so, I park across the street and cross the road just to sit and watch them. Ill sit there as the sun rises on the way home from a night at Fuego, watch them run free first thing in the morning….and I will do the same at sunset too. I watch them preen eachother, nip at eachother when they get annoyed, stand up on their hind legs when they get startled by something they don’t like, tend to their babies, and do all sorts of other things horses do. Snort, stomp the ground, eat grass for hours on end…….

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I have a good friend who is in the Army and when his PTSD gets to him he walks….and walks…..and walks…….I do the same thing. Only, my usual destination is to get to the place where the horses are, and the big lush green trees with lots of shade…and my favorite place to be with the horses from a distance.

The horses have gotten used to my presence now. So, this week being an exceptionally weird week, a week in which I had two very life altering things occur, I felt I wanted to get nearer to them. As I walked the few miles it took to get to the big ranch I stopped alongside the gate this time. Six of them were clustered together off in the distance but they immediately sensed me standing there with my fingers curled in the fencing, peering at them….wondering If just this once, theyd give me the chance I had been hoping for. To connect with just one. To pet just one.

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On this day it appeared I was in luck. All six slowly made their way toward me, but stopped suddenly, looking at a caramel colored horse for what appeared to be guidance. It was the caramel colored one who came alone to visit with me first. I held my breath, anxious with anticipation and raw with emotion…..what was this guy going to think of me? Would he hate me? Would he stomp around and snort and show dismay? Would he report back to the others that I was “bad people?” My energy wasn’t exactly the best after all……but I took off my sunglasses for good measure so he could see my eyes.

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I wasn’t prepared for how deeply he looked into me. It was as if this big beautiful animal knew everything about me already. He sniffed my head, then the hand I stretched out to him….Suddenly, without warning, he put his face next to mine and held it there for what seemed like at least ten minutes. He didn’t move….I didn’t move. We were both in one space, inside this one moment in time.

My hand rested on one side of his face as he held his position next to me. I felt his warm energy, his light, his calm, his peace. It was like feeling his vibrations seep into my own spirit. And the tears…they spilled instantly…. they were hot, and they came so fast, but they felt good. I felt a spiritual release. This “its going to be fine really” kind of vibe coming from him and it was one of the most memorable moments Ive ever had with an animal. He felt my spirit….and I felt his. We were strangers to eachother but to him I was no stranger. He just “knew.”

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With a sudden jump he turned and galloped back to the rest of his companions and they appeared to commiserate for a little bit, each one of them looking up at me..their heads together. My curiosity piqued, I stayed in my position so as not to startle them. After a moment or two, all six of them came sauntering over. Each one stood before me, so incredibly big and shiny in the sun, so magnificently sweet and honest. They all took a turn dipping their head next to my cheek and I caressed each one with my hand telling them “thank you” as they looked into my eyes. Three ran back to a patch of grass after coming to meet with me. Three remained. Each one taking turn after turn getting affection from me, until, the caramel colored one nipped at the other two, causing them to run away reluctantly.

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He bent his head down once more so I could reach him, and this time I put my arms around his neck and gave him a hug and told him thank you for giving me a chance……that I needed this so much. He looked up and put his forehead to mine for a moment and at that second it was as if there were no cars racing by the side of the road, in fact there was no city noise at all. It was just me and this horse and his spirit, both our heads touching eachother…..This horse that did more for me in just a small amount of time than he will ever know…

Or maybe… he did.

 

The Arizona Board of Nursing: Posturing Against Gay Nurses?

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     Imagine working a good portion of your life as a nurse practitioner. You’re settled into your own practice, established in life. You have the latest BMW SUV out there, a beautiful home, the best dogs ever….and loving parents who are bursting with pride every time you come up north to visit. You would think that graduation day was just yesterday by the way they beam at you over the dinner table during every Sunday dinner.

     The seasons come and go in a small northern Arizona town. The leaves are boldly beautiful in the fall, the snow sparkles in the winter. As you sit in a cozy living room having coffee and homemade cookies with your parents over a holiday weekend its hard not to breathe it all in…..this is your reality, your life. Everything is preciously simple, predictable…. and yet so peacefully, unbreakably, enduring. You take pride in the fact you can care for them, oversee things to make sure they are well provided for. There is nothing in this world you can’t give back to them after all they have done to help you through school.

Life. Is. Great.

Until it isn’t.

Until it won’t be anymore.

Until all that remains of your life are just fleeting embers floating away in the wind……

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Such is the story of one nurse practitioner I began corresponding with in 2013. He had been following my case for quite some time and was frustrated with his counsel. It seemed to him that his attorney was more interested in placating the Arizona Board of Nursing than representing his interests. A short time later he would take his defense into his own hands by doing all the legal work himself in order to ensure that his own bests interests were being kept front and center.

He stayed up many days and nights at a time doing legal research, studying other nurse’s cases, emailing back and forth with me. The following are highlights of this nurse practitioner’s journey battling the Arizona Board of Nursing.

Valerie Smith: Special Consultant to the executive director

Valerie Smith: Special Consultant to the executive director

Joey Ridenour, Executive Director of the Arizona Board of Nursing

Joey Ridenour, Executive Director of the Arizona Board of Nursing

As most nurses know, it’s  easy for virtually anyone to file a complaint against one’s license. In Nathan’s case this was no different. In August of 2011, a patient who became angered by a question Nathan had asked him during a psychiatric assessment, filed a complaint against his license. The patient would later contact the board to “quash” the complaint, advising the Board of Nursing that he did not want Nathan to be disciplined for no reason. Nathan recalls “The guy filed a rambling similar complaint on a NP co-worker at the same time. Hers disappeared… mine didn’t. The only difference I could see was an ASU connection. She was a grad and a preceptor and had good connections there.”

The complainant’s request fell on deaf ears…the Board of Nursing would continue their hunt into Nathan’s past…and into every private aspect of his life. Instead of dismissing the complaint against Nathan, they came up with 12 “Factual Allegations” UNRELATED TO THE INITIAL COMPLAINT to potentially charge him with.

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For a period of 13 months Nathan’s case sat on a desk and was passed off from investigator to investigator until it landed on the desk of University of Phoenix Assistant Dean of Nursing and 2014 RN.com “Giving Excellence Meaning” Award Nominee—a Nurse Practitioner herself, Janeen Dahn. From the point she picked it up, Nathan recalls, everything went to hell—AND FAST.

As per usual for most nursing board investigations, (depending on who you know) the state uses all its time, technological, and financial resources to delve into the life of a nurse. Nathan’s case was one that required the “special knowledge and tactics” of Valerie Smith—the on again off again retired consultant that me and others believe is “brought out of retirement” for the more “problematic cases” such as Nathan’s and mine. The AZBON’s hired gun, Valerie Smith has a background primarily in psychiatric nursing (no general med surg. just psych.) and is notorious for “diagnosing on the spot.” (She did as much on the stand during my administrative hearing when I cross examined her)

The common denominator among nurses who come to me with their stories is their interaction with Valerie Smith. Nathan and I were similar in the sense that we fought the charges and sought to secure our constitutional and/or Civil Rights during a process that ceremoniously strips them away from a nurse. HIPPA does not apply to ANY NURSE under investigation. The Arizona Board of Nursing has within its grasp the ability to subpoena any and all legal, medical, and psychiatric/pharmacy records. They can, and will, use what they find within those records against a nurse whether it is relevant to a case or not.

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It’s well known by now that a nurse’s personal life, their entire career, their physical and mental health history are all fair game. In many instances, the Board of Nursing pads its investigative reports with defamatory false “statements” from “coworkers” to further their case against a nurse. Sometimes—they go too far in their attempts to inflict harm–Most recently they made the mistake of publishing a nurse’s personal address, her email address, her social security number and date of birth on a public site. There is no maneuver that escapes them when they are in pursuit of a nurse’s livelihood. However, it should be noted once more–they apply the shock and awe approach to specific cases, and not all cases.

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During the course of his investigation Nathan was shocked to learn that his medical records had been subpoenaed by and reviewed by Investigator Dahn. During a meeting with her, Dahn (allegedly) quizzed him about his sexual preference and his sexual practices as per what was written in his primary care physician’s progress notes. The words “high risk behaviors” were (allegedly) used by Dahn. He described to me the “three religious medals she wore” on her clothing as she interrogated him and how he found it ridiculous.

You see, Nathan is gay. “I outed in the 80’s…” he recalls.

Within all the medical records reviewed, Investigator Dahn (allegedly) included in the investigative report a one page progress note from his physician that discussed his gay status and his negative HIV status as well as other personal particulars irrelevant to the initial complaint lodged against his license:

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“She (Investigator Dahn) (allegedly) made a big deal out of a few things: that I graduated from a diploma RN program. That my medical record said ‘high risk behaviors’. The investigative interview was a sham, she wasn’t even listening to me…conclusions were drawn. It’s a kangaroo system with zero objectivity. I was sure I had the justification, the rational data, and expert emails to justify my actions in the complaint. Then she (Investigator Dahn) hits me: “Why did you quit this job without notice? Why were you given a written warning at ___________? (I’m an NP) Why did you write yourself 2 separate anti-biotics in 2011? And a few more totally unrelated to the initial complaint. The board meeting was last Monday. Four days before that, my lawyer called to say the original complaint had not even mentioned that there were 12 items stating unprofessional conduct and failing to maintain minimum standards. I was like WHAT? I didn’t even get to answer to them. I still don’t know what they all are-I have an idea. They are now trying to railroad me into a 12 month probation… I’m not sure I even want to remain in the profession-I’ve been in clinical practice for 15 years.”

Janeen DahnPhD, FNP-BC: 2014 Nurse.Com GEM Award Finalist and Assistant Dean of Nursing at University of Phoenix

Janeen DahnPhD, FNP-BC: 2014 Nurse.Com GEM Award Finalist and Assistant Dean of Nursing at University of Phoenix

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Nathan felt strongly that they were using his sexual orientation as a basis to establish that he wasn’t a safe practitioner, that somehow his sexual orientation would translate to him providing unsafe care to patients. Over the past few years, Nathan has had to go back and forth with the Board. It was his full time work searching for jobs, strategizing and reading up on the law in order to find ways to secure his constitutional rights throughout the process. It hasn’t been easy to do, as there are blocks to Constitutional Rights when you are a nurse under investigation in Arizona:

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“It’s in the 4th amendment to the Constitution, due process, searches of private matters, probable cause , double jeopardy all to protect our liberty=right to practice chosen profession from government action=AZBON. They claim they have to balance with public safety -no member of the public was at risk even if the crap they are claiming against me was true. There are checks in place so government or government agencies can’t make up things against you, to take your protected health information, to delve into personal private areas of your life. I was born and raised in Boston where all these crazy ideas began… it’s in my blood. I think around here people like to feel they can make up their own rules. I beg to differ, we’ll see. Odds are against me but I love a good fight.”

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     When Nathan requested discovery of all evidence the Board of Nursing had against him, they denied his requests. One would think that a nurse can appeal to other government agencies for another set of eyes, an impartial party—to take another look. In Arizona such an agency does not exist. Nurses, patients, and other attorneys have appealed to the State Ombudsmen’s office numerous times (without response or resolution), the Auditor General’s office, the State Attorney General’s office, and state legislators themselves. The media itself—will not investigate the Board of Nursing’s actions against licensed professionals. They will however—investigate the Medical Board and the Dental Board. Go figure.

Former House Representative Steve Gallardo "came out" in 2014.

Former House Representative Steve Gallardo “came out” in 2014.

As the years go on and Joey Ridenour continues her “Command” role over Arizona’s version of “B613″– the Arizona Board of Nursing soldiers on in its effort to impede upon the basic Civil Rights of nurses. In my case—freedom of speech (my social media accounts are still monitored by the state) and in Nathan’s case—his status as a gay man who happens to be a nurse practitioner. Other cases involve nurses who are older in age. Yet, nurses with multiple DUI’s or multiple drug offenses are gently set free from the proverbial investigative web of wonder to resume their careers unscathed. Their records fiercely protected from the public’s eyes like the B613 files in Scandal. At one point, Nathan took note of several cases against ASU nurses that were dismissed by AZBON officials, but he and I were too busy to investigate further. The question still lingers.

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Nathan has experienced other challenges on his road to justice. He lost his home. He lost his vehicle. He was unable to secure a job, but was finally able to get Circle K to hire him. He had to quit after a short while due to his declining health. His health status has taken a significant hit throughout this process. He has also watched his parents’ health decline these past few years as a result of the ordeal that has impacted not just him—but all of his loved ones and friends who have been on this road with him.

…..Just one day prior to his hearing before the Arizona Board of Nursing his father suffered a stroke and Nathan was unable to be with him because he was scheduled to do his own defense the following morning……

During the years we corresponded back and forth, supporting each other in the middle of the night as we struggled to put together our own cases and cope with our losses, he shared with me how he felt on one occasion he had gone out of state to visit his parents: “When I went back to MA for a job interview I saw my parents for the first time in 18 months and I couldn’t believe my eyes… they don’t even look the same. I think this has had an effect on them. They are both in their 80s. The last time I saw them they were vibrant and active, now they appear withdrawn, almost defeated.”

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There is a lifelong guilt, the responsibility one bears upon their shoulders, when they choose to battle against the Board of Nursing’s injustice. It’s no longer about just you, everyone around you becomes a part of things. Everyone around you suffers with every hit you take. Your family, your friends, your significant others. In some way or another,  to some degree….they are affected by the point of impact.

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     I have not yet heard back from Nathan about the outcome of his case. My guess is he is in MA caring for his ailing father and supporting his mother. I hope he triumphed. I hope he is able to recover what is left of his practice… more than that—I hope he is able to get back to living his life, one with peace and the self-realization that he is bigger, bolder and better than the process that has not just engulfed him spiritually, physically, and mentally—but has taken a good portion of his hard earned life from him.

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     I don’t know what I would have done without those emails back and forth in the middle of the night the past few years…..our experiences and feelings mirrored each other’s in so many ways. I consider him my friend, my colleague, and a brother in all this….and I am proud to finally tell his story. Because he was and is so brave where others are not. Because he chose to keep getting up no matter how many times he was knocked down. Because he wanted to set an example and establish a precedent for all gay nurses.

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I believe Nathan has an important message to get out there—BEING GAY DOES NOT EQUATE WITH BEING A DANGEROUS NURSE. BEING GAY DOES NOT MEAN YOU ARE ANY LESS OF A GOOD SOLID PRACTITIONER THAN THE NEXT NURSE. BEING GAY CANNOT BE USED AS A PREDICTOR OF FUTURE BEHAVIORS AS A NURSE PRACTITIONER, OR A NURSE FOR THAT MATTER. BEING GAY SHOULD NOT BE A PRECURSOR FOR LOSING ONES HARD EARNED NURSING LICENSE. BEING GAY DOES NOT GIVE THE STATE OF ARIZONA THE RIGHT TO USE THAT STATUS TO TAKE AWAY THE LIVLIHOOD AND STABILITY OF ANYONE. BEING GAY IS NOT A VIOLATION OF THE NURSE PRACTICE ACT.

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THE DEFINITION OF A NURSE…..should not EXCLUDE people on the basis of race, gender, ethnicity, religion, socioeconomic status, or sexual preference. The question is, just how far will state lawmakers allow ANY STATE to go when it comes to persecuting nurses on the basis of these very factors? More importantly—how low will the profession allow itself to be taken down before making a stand that supports acceptance, tolerance, and the high standards we’re expected to uphold as touted within the Code of Ethics for Nurses?

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Maybe—this case is a sign that our profession has arrived at a point in time that The Code, The Oath, and the very tenets that Nursing was built upon no longer matter…

“The Discovery Process” and One Arizona RN’s Story

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There has been an increased frequency of nurses who have contacted me,  asking about whether or not they are allowed to see the evidence against them in their cases before going in to meet with the AZBON staff. A local attorney here seems to have been botching cases right and left by not ensuring that these nurses are given a proper discovery opportunity so that both client and attorney are aware of the charges brought against a nurse. So, let me set the record straight: YOU SHOULD NEVER, EVER, GO INTO A MEETING WITH ANY BOARD OF NURSING STAFF WITHOUT KNOWING WHAT THE BOARD HAS AGAINST YOU. YOU ARE ENTITLED TO KNOWING WHAT EVIDENCE THE BOARD IS GOING TO USE TO DECIPHER CHARGES AGAINST YOU.  One could deduct that my previous attorney provided ineffective assistance of counsel. I subsequently filed a complaint with the State Bar for that.  This is called the DISCOVERY PROCESS. I didn’t know about it until I got to My SECOND ATTORNEY.

I’ll go further and warn you NOT TO SIGN WHAT YOU DONT AGREE WITH– WITHOUT HAVING HEAVILY WEIGHED ANY AND ALL OPTIONS, OR WITHOUT INTENSIVE TALKS WITH YOUR ATTORNEY IF YOU HAVE ONE.

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If YOU DON’T KNOW what you are going to be answering questions for, YOU DON’T GO INTO THE MEETING UNTIL YOU DO. Ask your attorney to make an appointment to view the file BEFORE going any further. The Board has been encouraged to fast track their cases to decrease their investigation times, as a result many nurses are falling victim to going in “cold” to interviews. Believe me, the Board has time to spare. They have cases that are at least 4 or more years old. THEY can WAIT for YOU to catalogue what’s being used to judge you. NURSES OUT OF ARIZONA—I highly suggest that you do the same and talk to your attorneys about the “Discovery Process” before you go before your own Boards of Nursing. In general, Administrative Law is a very tricky area and nurses do not get the same latitude or rights that murderers, rapists, or other criminals get in civil court. It’s prudent that you preserve what little rights you DO HAVE to ensure an effective defense that protects you and your license the best. ASK QUESTIONS! If your attorney can’t answer them, or appears more interested in pleasing the AZBON and talks more about pleasing THEM than DEFENDING YOU—find another attorney.

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The following is a hand written letter I received from a Registered Nurse in Arizona. She asked that I publish it on my blog so that her story would be heard, which, I am happy to do because it resembles my own case in quite a few places….

“I was a nurse in good standing for 30+ years at Yavapai Regional Medical Center in Prescott, Arizona. I was fired from my job as a staff nurse on a Medical Surgical floor on April 15, 2010. I was reported to the Arizona Board of Nursing for being an unsafe staff nurse. I want you know that I have NEVER, in my career, physically or verbally abused a patient, stole drugs from a patient or hospital, or took drugs myself. I have made some medication errors over the years, as almost all—if not all—nurses do at some point or another, but I never overdosed or caused harm to any patient. In 2011 I was placed “on probation” for two years by the Arizona Board of Nursing. My lawyer advised me to sign the consent agreement, because if I didn’t I’d lose my nursing license. She told me not to tell the AZBON I was harassed and bullied by my boss because the BON would say that I was blaming the hospital instead of taking accountability for my actions. I spoke with Valerie Smith, RN, who (allegedly) explained the terms of the agreement to me in person. I told her I did not feel comfortable signing the agreement for her because there were several false statements in the consent agreement. She (allegedly) told me to initial the ones I thought were false. I asked her what good that would do me. She then (allegedly) told me not to hash over the past and ‘get over it and get on with’ my life. I worked in the same hospital for 34 years as a direct care nurse, and I had never met another nurse who would say such a thing to another nurse….I will not be forgetting that anytime soon.

Valerie Smith: Special Consultant to the executive director

Valerie Smith: Special Consultant to the executive director

The following restrictions were placed on my license:

I cannot work nights.

I cannot work for home health, registry, outpatient hospice, or travel agencies.

I had to undergo a psychiatric evaluation. (Which, I passed)

I had to take a pharmacology course. (Which, I passed)

I had to take an RN refresher course. (A $2,000.00 cost to me)

I must WORK as an RN for 2 YEARS WHILE ON PROBATION before I can get OFF PROBATION.

I have not been able to find a job. Anywhere. The job I had finally found fired me the same day they found out I was put on probation even though I was never late for work or called in sick or had any patient complaints. They told me they did not want a “nurse on probation” working for them and weren’t willing to do the paperwork that the AZBON was asking them to complete for me to work there. The Arizona Board of Nursing says I can work while on probation. The State of Arizona says I cannot work. I spoke with a Director of Nursing in Phoenix who told me her boss will not allow her to hire any nurse on probation or a nurse with any complaints on their nursing license. I also talked to an employment lawyer in Phoenix and he said that nurses on probation in Arizona are BLACKLISTED. In 2013 I wrote a letter to both my Nurse Investigator (Nikki Austin) and the Monitoring Department of the Arizona Board of Nursing.

I requested to be taken off of probation due to the fact I could not find a job in Nursing. I had also sent them a letter of recommendation I received from my instructors in the RN Refresher Program I completed. I was recognized as the first nurse in my group to correctly identify what was wrong with my patient, I was the only nurse in five groups of nurses who communicated with each member of my team. Nikki Austin, whom I never did meet in person or spoke with on the phone through the entire investigation, never answered my letter.

Policy and medication errors are made by 100% of nurses at some point in their careers that do not result in patient harm. This is the human part of our job. Not one of us is perfect, no matter what we show everyone around us. Nurses reported to the Arizona Board of Nursing for these types of errors are placed on probation and can never resume their careers from that point forward—while nurses that physically and verbally abuse patients or make errors that harm or kill people get a “Letter of Concern” from the Board that is never made public and is not considered a form of discipline. Here is an example I found in the AZBON minutes: Recently, a nurse gave a 94 year old patient 2mg. of IV Dilaudid, resulting in the respiratory arrest and death of the patient. This nurse received a “Letter of Concern” by the Arizona Board of Nursing. To me, it is basic common sense not to give an elderly patient that high a dose of a strong narcotic. In Arizona, nurses are told to self-report errors and self-report to the Arizona Board of Nursing, if they violate the Nurse Practice Act. In this day, that is an act of career suicide. What staff nurse will self-report an error if he or she knows that nurses on probation, who haven’t caused any injury to their patients—will always have difficulty finding another job in their chosen profession that they went to school for years to be a part of?

There ARE OTHER WAYS TO DISCIPLINE NURSES. To hold them accountable and re- educate them without causing such damage to not just the nurse, but to their families too. Technically speaking, I should have been able to go back to work after completing the Pharmacology course and the RN Refresher course. Personally, I think the course benefitted the college more than it did me because I had to pay $2,000.00 to the college in order to enroll.

I am writing this letter to you in hopes you will put it on your site and share it so that the Board will be exposed for what they are doing to hundreds of nurses that are doing the best they can in these times when staff has basically been cut in half. I have used up all of my savings and retirement funds, and I have no medical insurance. I can’t pay for it. I am 62 years old now. While I know I do not have much time left to work, even if I could never work again, I want my nursing status returned to a “Nurse in Good Standing.” After all I have done in my career to care for people, I deserve that. I hope you can at least tell my story the way you told yours.

Thank You,

Catherine S.

Another MD Imposter on the AZBON?

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Well, here we are presented with another case of a member of the Arizona Board of Nursing (allegedly) advertising themselves as an MD —–while working as a Nursing Professor—at the same time. Information was passed on to me from some other nurses in Arizona who stay on top of the Board and their activities since my case broke back in 2011. Governor Brewer appointed this individual to the position.  The other individual was working as a Nursing Instructor at Scottsdale Community College and the AZ Medical Board made her take the credential off of her advertisement, however the AZBON never disciplined that person, Im inclined to think the same thing will happen with Ms. McCormies. Again, the Arizona Nurse Practice Act only applies to some nurses in Arizona, depending on who you are. It is not a universal document applicable to everyone.

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American Towns.com

American Towns.com

local.yahoo.com

local.yahoo.com

Potential conflict of interest? You decide:

In 2012 (an election year I think?) former Governor Jan Brewer’s son Michael Brewer was hired into AZBON Executive Director Joey Ridenour’s husband’s law firm—could that have been an exchange for Ridenour to remain at her post as the head of the AZBON? (she’s been there for longer than a decade)

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NBC Primetime Gives CHF and End of Life Center Stage

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On January 29th 2015,  NBC’s Parenthood gave the world a candid, graceful view into some very important issues often overlooked not just by millions of people all over the country, but by the entertainment industry as well: Heart Failure, end of life processing, and end of life choices. As a former Heart Failure/Heart Transplant Nurse I watched each of the last few episodes with bittersweet recollection as I reflected upon so many faces and families… the times we as healthcare providers got it “right,” and the moments we all knew we missed the mark.

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What I loved about the last few episodes of Parenthood: For once, the main character wasn’t dying of Breast or lung Cancer and viewers were introduced to—for the first time on primetime television— the reality of what Heart Failure patients and families live with daily. We were able to get a peek into the deterioration of a loved one’s physical abilities, the struggles of various family members as they tried to cope with anticipatory grief while supporting the choices of a parent and spouse to forego further treatments… and the life review many patients and families embark upon as a means of making things right, tying up loose ends,  and arriving ( ideally) at a peaceful acceptance of an impending life transition.

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Parenthood presented a more than optimal picture of the death and dying process, beginning with the crucial conversation between Mr. and Mrs. Braverman in the hospital as he resolved that they would make the important decision together and then talk to their children individually. The last few episodes were delicate and touching as we all watched the Braverman adult children have their own private moments with their father, each being given the chance to say things they needed to say, to tell their father something he needed to hear, to include him in on important life events before time ran out. We followed the gradual decline of Mr. Braverman as he needed to sit and rest more frequently, struggled with his limited ability to physically and emotionally cope with the family arguments at the dinner table, and lastly—his painfully difficult attempts to take a simple walk with his wife. He had opted not to have heart surgery in favor of living out the remainder of his life the way he felt it was supposed to be…passing away peacefully at home while napping in a chair that faced a window towards the sunlight.

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We should all be so lucky. Our parents and loved ones should all….be so lucky– and blessed– to have this healthy, robust, ideal, end of life experience. There really is health in death and dying, although that is a difficult concept for most people to comprehend.

Obviously these are my  opinions, based on my own experiences as a nurse. But I felt that Parenthood beautifully illustrated the things I always wanted for the families I cared for to have toward the end of life:  a therapeutic life review, support, love, laughter, hope, no conflict or opposition to a loved one’s choices, family members circling around a loved one in a show of warmth and continuance of life while in the setting of a life transition. Time after time, it’s what patients have told me they wanted the most: to see that there will be a continuation of life. That life will be okay for all those left behind. That there will be happiness when they go on to the next place, wherever it is they believed that will be.

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Mr. Braverman was able to quietly let go, having been assured all of these things. He shared in the birth of a great grandchild, walked his eldest daughter down the aisle at her wedding, and was relieved by the reunion of another daughter with her husband after a lengthy separation. He knew that all was as it should be, and that all would be well—but much more importantly—he knew it was okay to go, that he had his family’s permission and blessing.

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Parenthood-finale-3There are a plethora of medical related shows saturating nighttime television, and yet very few really hit the reality of what its like to care for people as a nurse, the things we experience with them and help them process.  Although these last few episodes weren’t medical in nature, they gave a very real, moving depiction of what it’s like to be a Heart Failure and Heart Transplant Nurse—what we see, hear, and feel while walking alongside patients and families in the various stages of Congestive Heart Failure. It goes far beyond giving medications and taking vital signs, and I hope that there is more attention given to Congestive Heart Failure by the entertainment industry in the future.

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Incidentally, Cardiovascular disease gets very little in the way of research dollars when compared to Cancer’s mammoth like  allotment of research funding and yet it is the number one cause of all deaths in the United States. Heart Failure alone affects five million of all adults in the US, 50% of whom will not survive to the fifth year after the diagnosis is initially made. It is projected that by 2030 greater than eight million adult Americans will be living with it. (Heart Rate Matters)

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Heart Failure care is expensive. In 2012, 21 billion dollars was spent on Heart Failure related care and that number is expected to skyrocket to 53 billion by 2030. (The cost of Heart Failure related care also drives up the overall cost of healthcare in the US) Fifty percent of those costs are due to hospitalizations. Congestive Heart Failure is also one of the leading causes of hospital readmissions: “25% of patients are readmitted to the hospital within 30 days of discharge, while 50% of patients are readmitted to the hospital within six months of discharge.” (Heart Rate Matters)

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KUDOS to NBC for taking the road less traveled. For giving Heart Disease a nod. For showing viewers everywhere that death and dying isn’t this dark ugly thing to be feared and avoided at all costs. For reminding us that the end of life process is a natural inevitable experience every single one of us will face at one time or another, and for focusing on the importance of supporting the end of life choices of those we love.

It’s time that the public and the entertainment industry wake up: RED is the new PINK.

Let’s do something about it.

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“Everyday We Are Given The Opportunity…”

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…to sign our names to history.

 

To HONOR our profession doesn’t just mean celebrating its history, its roots, its intentions or its past accomplishments. To TRULY DO JUSTICE TO NURSING as a profession means revisiting  our past, CONTINUING TO BUILD UPON ITS FOUNDATION, analyzing the strides that have been made as well continuing to look ahead toward the work that has yet to be done. We cannot HONOR OUR PROFESSION if we fail to acknowledge, recognize, or make translucent our mistakes, our missed opportunities for excellence, and our potential (both individually and collectively) to make the future of this amazing art and science the very best its ever been…

 

AJN: Stunting Nursing’s Potential and Growth?

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The following is the article written by Susan Hassmiller and published by Maureen Shawn Kennedy, MA, FAAN, Editor in Chief of the American Journal of Nursing on their blog “Off the Charts” (which by the way is up for an award in 2015 as a top nursing blog):

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Calling All Nurses to Address Health Disparities

January 16, 2015

Susan B. Hassmiller, PhD, RN, FAAN, is senior adviser for nursing at the Robert Wood Johnson Foundation and director of the Future of Nursing: Campaign for Action.

The research on health disparities is stark and continues to increase. The Centers for Disease Control and Prevention’s Health Disparities and Inequalities Report–2013 found that mortality rates from chronic illness, premature births, suicide, auto accidents, and drugs were all higher for certain minority populations.

But I believe passionately that nurses and other health professionals can be part of the solution to addressing these disparities. Nurses are privileged to enter into the lives of others in a very intimate way—lives that are often very different than our own.

I understand that it is human nature to be more comfortable with the familiar, but this is not what we are called to in nursing. More than 150 years ago, Florence Nightingale noted a strong link between a population’s health and its economic prosperity, and she called for all people to be treated equally.

My mother told me that when she first entered nurses’ training at New York City’s Bellevue Hospital School of Nursing in 1943, Director Blanche Edwards addressed the students on her conduct expectations for nurse trainees. Part of that lecture—and of the nursing culture absorbed by those being trained at Bellevue—addressed the equality of all human life and how she expected her nurses to treat everyone with equal care and attention.

My mother said that, although she was aware of differences in skin color, socioeconomic status, and country of origin, she believed that Ms. Edwards was right, and she went about caring for people as if they were equal. Everyone deserved the same care. Anything less was simply unethical.

My mother taught me the importance of treating everyone with compassion and equality, and it’s something that I’ve striven to do throughout my career as a nurse.

Workforce diversity is part of the equation. I’m proud that the Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health, calls for a more diverse workforce and for all health care practitioners to be culturally competent. I’m grateful that my passion and my livelihood are directing efforts to implement these recommendations. And I hope that history will view the report as a factor that spurred more nurses to advocate for a more diverse workforce and equal care for all. To act any other way would not be in keeping with the privilege of being a nurse.

 

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My DELETED Response to Ms. Susan Hassmiller PhD, RN, FAAN on the AJN Site at 11:02 PM:

“When nurses are not allowed to practice to the fullest extent of licensure or to protect their patients, and when the role and definition of a nurse varies from corporation to corporation, your call to nurses is reduced to nothing but a pipe dream reality. If you want this call to action to come to fruition—advocate for the protection of our professions art and science, for our ability to practice unencumbered by workplace violence, huge nurse to patient ratios, and disruptive physician behavior that strips patients of their rights and nurses of their ability to practice what they want to school and were licensed to do. Go to Capitol Hill. Tell the stories of thousands of nurses who were not allowed to do what nurses do. THEN, you give us a fighting chance to accomplish this goal. Better than that, go find the busiest unit in this country, take off the heels, put some scrubs on and work in the trenches with the others so you actually “get” where we are coming from. Till then, be prepared for more of the same. This is not a patient driven healthcare system, if it were, we wouldn’t be losing a thousand or so lives per day to medical errors that should have and could have been reported before reaching the patient. We exist within a corporate driven and profit driven healthcare system….until that changes, disparities will persist.”

(Note: I find the suppression of views, the suppression of peoples thoughts and ideas extremely disappointing because this another example of what is wrong with Nursing right now, how we have failed to grow and learn from each other. Avoiding spirited debate does nothing for nurses, it fails to teach us how to learn from each other or how to engage in healthy opposing discussions that don’t seek to change the minds of others, but serve to shed light on new perspectives and ways of doing things.)

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About the Journal

The American Journal of Nursing is the oldest and most honored broad-based nursing journal in the world. Peer reviewed and evidence-based, it is considered the profession’s premier journal. AJN adheres to journalistic standards that require transparency of real and potential conflicts of interests that authors and editors may have.

AJN’s mission is to promote excellence in nursing and health care through the dissemination of evidence-based, peer-reviewed clinical information and original research, discussion of relevant and controversial professional issues, adherence to the standards of journalistic integrity and excellence, and promotion of nursing perspectives to the health care community and the public.

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The deletion of my responses by AJN’s Editor in Chief Maureen Shawn Kennedy sends a clear message that my nursing perspective isn’t worthy of promotion to the healthcare community and the public.

Shawn, do us all a favor and drop the journalistic integrity thing off of your “about section” because you clearly don’t adhere to any standards that resemble it. And quite frankly, that’s poor role modeling for the Future of Nursing.

On Being the “Old School Nurse” in Modern Times

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Being the Old School….

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I have had so many nurses tell me that I should have been a nurse in a whole other era. As a child I dreamt of wearing the white dress and the white tights and the white shoes and the shiny nursing pin on the lapel of my dress. I dreamt of the things I would teach people, the changes I would have the chance to help people make in their lives, and the opportunities I would have to be a part of the best and worst moments of people’s lives. As far as I was concerned, Nursing was it for me. For Life. And I worked for it. The first day I wore the white dress, tights, and shoes I looked at myself in the mirror with such hope for the future. I vowed to myself I was going to use every bit of what I learned at Northern Arizona University. I was going to apply the theory, evaluate my own outcomes, look for new trends and maybe develop new theories and studies…..I wanted to do it all. To me, Nursing was an endless horizon of possibilities and light…and even on the traumatic days of losing a patient there was still some light to be found as a reminder of why I was there, in this profession, doing what I was doing. I was made fun of by my peers for doing 30 minute one to one teachings about heart failure or heart failure medications instead of just leaving the packet or showing the patient the movie. I was teased about my thing for “drawing my teaching material” on a big tablet of paper to help patients to understand their disease and why their medications were important and where they were working at. I was always told “why cant you just do it the way everyone else does.”

Meaningless Master’s…Meaningless Dreams

The real weirdness all started when I began my Master’s program. If I had to go back and do it all over again I probably wouldn’t have done it. Why? Because I truly believe I would still be an RN at the bedside today. You see, as you advance your education within the nursing profession your view gets BIGGER….WIDER. Your beliefs change a little. You want to make changes for your peers, for your patients. You start seeing things you hadn’t noticed before. Problems to be anticipated, processes that need to be fixed to optimize better and safer patient outcomes, nurse recruitment, retention, and resource utilization. You see a larger view than the nurse next to you because you are learning about a different side of nursing and the healthcare system that calls on you EVEN MORE to RELY ON YOUR SENSE OF MORALS, VALUES, AND ETHICS.   If I could go back, I’d want to go back and just be like everyone else. No Masters, no Post Grad work. Just a BSN.

I know it sounds counterproductive or maybe even disheartening, but in the corporate environment there is little to no room for a nurse who is educated above a Bachelor’s Degree level to do much of anything. Whatever corporation you work for has already defined what nursing is and what it is not within their walls. They have already decided how you will function no matter what your education level. An RN is an RN as far as their definition of nursing goes. I will say that my former stomping grounds at the Mayo Clinic were absolutely heaven to work in because nurses were revered by all the providers. We had autonomy. There was a strong sense of trust between the disciplines and the nurse’s hunch, or plan of care, or sense of what was going on with the patient MEANT EVERYTHING to those doctors. We truly were their right hand, and they relied upon our knowledge base and our knowledge of the patient in a critical manner. We were partners. And it was wonderful. There are times I wish I could go back and cut out the part when I got Cushing’s and it all went downhill…….moments I wish I could go back and re live it all again because it was—for lack of a better way of saying it—the time of my life. All my nursing dreams come true.

Career Defining Moments: We All Have Them….and They Forever Change Us

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It wasn’t “just” the Cushing’s though, that forever altered my journey at the Mayo….stuff changed when I got the MSN. Things were never the same. Cushing’s or not, I knew things would never feel or look like they used to. One of the defining moments of my career was when my nurse manager at the Mayo Clinic took a project I had worked SO HARD on to HELP HER implement a work process initiative that wasn’t being readily accepted by the staff— EASIER. I spent hours researching, utilizing my knowledge of the unit, statistics on nurse satisfaction, recruitment, and retention….patient safety data….my knowledge of the organization’s mission and values until I had crafted a multi-pronged project that would help get this project back on track again and get it moving faster. Her facial expression was stoic, her voice monotone, her energy thick with frustration. My manager’s response to me was that my PowerPoint and my white paper “looked like a random stream of consciousness and plagiarized even.” My heart broke that day. My nursing spirit was shattered that day. The light of hope and enthusiasm had dimmed in my heart that day for any prospect Id have for using my education to help on the cardiothoracic surgery stepdown unit. To add insult to injury, my nurse manager told me not to email her ideas any more, that she didn’t want them. There are few days I remember crystal clear from my nursing career as a cardiac surgery/heart transplant nurse—it was the day my manager told me “I was nothing” (she didn’t say it but that’s what I heard) and standing at the head of an OR table to see my first heart transplant. They were the worst and the best moments of my career. To be honest, my spirit as a nurse remained broken after that day.

The Catalyst for Recall…

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You are probably asking why I am bringing these things up now. Well, that’s easy: WE HOLD EACHOTHER BACK. WE LIMIT OUR OWN POTENTIAL. WE ARE THE ONES RESPONSIBLE FOR THE CURRENT STATE OF NURSING BECAUSE OF HOW WE REGARD ONE ANOTHER AND SUPPRESS EACHOTHER’S UNIQUE QUALITIES, TALENTS, AND VOICES.  I recently came across an article that was posted to the American Journal of Nursing’s blog: Off the Charts. As I read the author’s words, I became frustrated with its overall message and tone. The article presented as pretty, shiny, idealistic, and in a nutshell– telling us “all was well and on track” in the nursing world and she was proud to be one of the drivers of that. It’s been quite a few days now since I read Susan Hassmiller’s ODE to Self–the pretty paisley words of encouragement resembled a teacher patting her students on the head letting them know “everything is ok now children you can get back in your seats.” I immediately responded, professionally of course, and I waited to see if the American Journal of Nursing’s Editor in Chief Maureen Shawn Kennedy MA, FAAN would actually “bless me” with a sign of the cross from the Nursing Pulpit and allow the post to be “seen by the masses” within the profession.

I made a plan. If she allowed the post to be seen, read, and responded to Id engage in some good collegial debate with my nursing colleagues and learn a thing or two, ….. If she didn’t allow the post to go through Id BLOG about ALL MY THOUGHTS on what Susan Hassmiller had to say in her “State of the State Address on Nursing” and publish it myself. I’m sure that Editor in Chief Shawn Kennedy was so excited about receiving Susan’s piece she must have nearly peed her pants trying to get it posted before running to the bathroom. After all, Susan Has miller IS the “IT NURSE” the “IT NURSING VIP” you want to be in good favor with. Yours truly, has written Ms. Hassmiller several times over the past few years since my Banner Health Whistleblowing case and I’ve never heard a single response from her—which translates to “YOU aren’t worth MY TIME.” I’m going to be nicer than that, and give HER MY TIME on MY BLOG.

Guess What? I AM The Future of Nursing….Ready or Not

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I could play this in the opposite direction—SHE should be so honored, because whether she likes it or not—I AM CHANGING THE FUTURE OF NURSING. RIGHT NOW. AS WE SPEAK. Just like nursing programs are using her to inspire their students, my blogs are also being utilized in nursing curriculums across the nation. So– Shawn and Susan, you aren’t the ONLY people who GET TO PLAY ON THE “Campaign to Change Nursing” PLAYGROUND. There are OTHERS in the sandbox with you. Can you play a little nicer and pass the pretty red ball around so we can all play too?

The Benefits and Blessings of Blogging

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Blogging has afforded so many of us out here in cyberspace to have our voices, experiences, and perspectives heard, acknowledged, considered, responded to, and maybe even acted upon to improve the profession itself or the future of patient safety. Blogging has given those of us “pesky tell it like it is” professionals the chance to BYPASS the higher echelons of the profession and enter the minds and hearts of multiple generations of nursing. If you think about it, that in and of itself could be considered “Campaigning to change the future of nursing.” I do. And I give thanks to social media every single day that I don’t have to get on hands and knees begging the likes of Shawn Kennedy to bestow upon me the blessing of being published. I can make a change in the future of nursing, I deserve to make a change in the future of nursing, and I deserve to be heard and considered by the masses just like the suits and heels of our profession who probably haven’t worn scrubs and worked a 14-16 hour shift in YEARS.

An Altered Reality….and the REALITY

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Ms. Hassmiller discusses some of the tenets learned by her mother at Bellevue Hospital’s nursing program and how they have influenced her view of nursing and her own personal practice. Though I give kudos to her for trying to follow in her mother’s footsteps by being the Golden Nurse, I have to ask the question of why I wasn’t treated with the same regard when I tried contacting her via emails, twitter, and Facebook. I don’t call that professional regard for another colleague’s concerns or ideas, compassion for another colleague’s disposition, or her efforts at striving to treat all human life with equality “because all human life deserves to be treated with equal care and attention.” Yes, Ms. Hassmiller, its always “more comfortable to stay with what (and who) you know,” but ignoring me as a colleague or anyone else whose views differ from yours or those you are being “influenced to ignore” hardly constitutes the kind of professional behavior nurses were taught at Bellevue so many years ago. You see, in order for change to happen for nursing and for patient care, a certain degree of discomfort must be experienced. (Remember Lewin’s Theory of Change from school?) Sometimes that discomfort may come in the form of interacting with people you just plain don’t like or even want to hear. Consequently, you yourself could be stunting the professions growth and evolution in the same fashion as Shawn Kennedy when SHE DELETES  my posted responses.

Your piece is a “call to arms” (should be a call to COMPASSION) that carries with it unrealistic expectations that cannot be met right now, Ms. Hassmiller. For example, you discussed workplace diversity. Just a couple of weeks ago I was involved in a heavy debate with other colleagues in a chat  entitled “Is it rude to speak a different language in the nursing station?” The responses were shocking, discriminatory, mean spirited, harassing, and presumptuous—andnot in  in any way culturally sensitive. Please recall a recent court case outcome in California in which Filipino nurses won nearly a million dollars in their suit against a hospital that literally terrorized them—their own nurse coworkers did this to them every shift. The way these nurses were treated, and the way other nurses are being treated TODAY, AT THIS MOMENT simply for being from another country of origin and speaking a second language (God Forbid) in the presence of their colleagues is NOT CULTURALLY COMPETENT BEHAVIOR THAT DISPLAYS EQUALITY AND COMPASSION.

“The $975,000 settlement, announced Monday by lawyers from the Equal Employment Opportunity Commission, is believed to be the largest language discrimination settlement in the U.S. healthcare industry, according to the Asian Pacific American Legal Center.

Officials at Delano Regional Medical Center insisted they did nothing wrong and settled the lawsuit only because it made financial sense. Under the terms of the settlement, however, the hospital must conduct anti-discrimination training and hire a monitor to track workplace conduct.

The case, filed in 2010, involved 69 immigrants who said they suffered “constant harassment and humiliation when they opened their mouths, or talked with family members on the phone,” said Anna Park, a Los Angeles-based attorney for the commission. She said nurses were banned from speaking Tagalog and other dialects in break rooms, hallways and the cafeteria.”

Your mother, she hit the nail on the head when she said “anything less is unethical” behavior for nurses—in these cases terrorizing, bullying, making fun of, isolating, or discriminating nurses in the workplace because they do not resemble “everyone else” or “look like everyone else” or “talk like everyone else” is indeed unprofessional and unethical, not to mention terribly abusive and traumatic. And I’m sorry to say, hardly any nurses “were advocating for a more diverse workforce and equal treatment for all” in the nursing forums discussing this topic. This IS (whether you like it or not) the current reality of the profession you speak of.

Behaviors Unbecoming: Becoming A Trend

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Nurses making fun of patients on the internet, taking inappropriate pictures in their workplaces, prejudging patients on their admission diagnosis, disregarding pain levels, treating prison inmates like they are less than human, nursing magazines writing articles telling “civilians what not to do” in the hospital so they aren’t a “nightmare to the nurses” or calling on nurses to submit the funniest or craziest birthing plans they have ever heard of —and nurses ARE responding— none of these things would probably fall under Bellevue’s standards of nursing conduct…..In fact, how many nurses are conducting themselves on social media every moment of the day probably wouldn’t fall under Bellevue’s standards of nursing conduct.

So What’s The Problem?

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Consider the state of Arizona—We are after all the model state for all that is going wrong in nursing: Nurses failed to report conditions at the MCSO jail and a patient died, Nurses failed to report conditions at the State Mental Hospital and a patient died, Nurse and Doctors failed to report conditions at the Carl T Hayden VA Medical Center and hundreds of veterans died. One in particular case—a vet who presented to the ER reporting that he was going to kill himself was turned away and told to sleep it off in a corner of the ER and then go home. He went home alright, and killed himself.

Keeping quiet about medical errors and helping to cover them up, not speaking up for patients to protect one’s self also probably wouldn’t fall under Bellevue’s standards of nursing conduct. Perching in front of computers and perusing through dating websites, internet shopping, tweeting, or Facebooking while call lights are going off and patients are falling would probably fall under downright disgraceful behaviors within Bellevue’s white halls of academia. But this is the reality of your profession today. It is falling apart, the foundational fabric unraveling, and the time honored tenets tossed out in favor of “what everyone else is doing.” It has become about speed and productivity. How fast a patient can be moved in and out, the bed cleaned and a new body put in it.

Passivity and a Fractured Profession = A Profession in Peril

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We have, as a profession, allowed corporations to divide our profession and decide what nursing is and what it is not. We have allowed people who have never been to nursing or medical school, who sit in board rooms every day, decide what skills nurses will perform and what nursing skills can be taught to other personnel so nurses don’t get paid as much. Our profession, collectively, has done NOTHING to change the fact that nursing care is lumped in with the hospital room charge. Our profession, collectively, has done nothing to protect each other from work place violence, whistleblowing retaliation, or disruptive physician behavior, not to mention impossible nurse to patient ratios. The icing on the cake is this ever growing mentality that “the nurse knows more than the patient.”

Forgive me if I cannot envision the shiny hopeful future Susan Hassmiller does. Excuse my pointed view of the profession’s reality, but—as Iyanla Vanzant would say: “Let’s call a thing a thing” already. Our profession is in trouble, has been in trouble, and is continuing to deteriorate without aggressive push back from a profession that has been around for decades upon decades. What this means is—patient safety is in trouble and will continue to be in increased jeopardy because the state of nursing is directly tied to the state of patient care. At a loss of around 1,000 patients per day Ms. Hassmiller, I’d say we as a profession have some explaining to do. The loss of life due to medical/nursing errors is now the third cause of death in this nation and it doesn’t have to be. Forgive me, but I cannot agree with your optimism for the future when you yourself probably haven’t taken off the business suits, heels, stepped off of the podium,  donned scrubs and worked on one of our nation’s busiest nursing units for 12-16 hours—shorthanded, without patient care aides, a telemetry pager going off every five seconds, without the critical supplies you need to get your job done and a team of nurses who function nowhere near the definition of a “team.”

Aside from the need to support a more diverse workforce and the equal treatment of all (colleagues and patients) I will agree with you on one specific point Ms. Hasmiller—to act any other way than in the most ethical, professional, compassionate way towards colleagues and patients “would not be in keeping with the privilege of being a nurse.” But I guess your words didn’t and don’t apply to ME.

I acted in all of those ways on the night of April 12, 2011, at Banner Del E Webb Hospital and I was found to be what you would refer to as “not in keeping” or privileged to be a nurse today. My patient passed away, having had their rights stripped from them with no one taking accountability for it.

So try something a little different. Before writing the next article telling all of us good little girls and boys that the world is as it should be and the world of nursing and its future is all shiny and pretty like the DWTS Mirror Ball Trophy—browse through some nursing discussions online, then get back to us on the “real state of our profession” and what you think we should do about it.

Emphasis on the word “WE.”

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“Doc said if he ‘acts up again’ give em’ all at once!” How Far Is Too Far?

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Before you get into reading this blog about Nursing, Social Media Etiquette, and representing the Nursing profession in an appropriate manner, I want to make it clear that there is a BIG DIFFERENCE in utilizing various media outlets as a means of raising a red flag when a patient has been harmed or had their rights stripped from them and taking to Twitter to spout off after having to insert an IV into “the biggest hypochondriac I’ve ever seen!”

DISCLAIMER—Yes, I know that not ALL NURSES do this.

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Look, I get it. Nursing isn’t always pretty, it’s not always easy, and its certainly not always black and white…in fact I’m sure most of you remember hearing the phrase “It depends” A LOT during nursing school. Seriously– we all have our limits, our boiling points, our triggers as nurses. We like to vent, we NEED. TO. VENT… and while we’re on the job we do it in various ways. Some nurses get together and go down to the cafeteria to have a break and blow off some steam and talk about things frustrating them in the safe company of peers, others go into the break room and take a time out by themselves to deep breathe, ground themselves, rethink a situation or maybe even prepare a response.

Since the dawn of the profession nurses have found ways to share with one another in order to rally, garner much needed peer support, a sympathetic ear, and to hear those soothing, golden words of validation:  “I totally understand….that happened to me too….” There was no such thing as Social Media, and nurses weren’t being showcased as a profession everywhere via television shows, movies (both good and ‘bad’ ones), websites, blogs, and social networking sites such as Twitter, Instagram, and Facebook.

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If we take a moment to revisit Maslow’s Heirarchy of Needs you’ll recall that there exists several basic human needs that we all must have in order to achieve a sense of wellness: good self esteem, a sense of safety, belonging, and acceptance. Patients aside, no truer statement could apply to our profession then that one when it comes to promoting and nurturing the mental well being of the nursing workforce. Y’all know what Im talking about too. So many of you out there strive to fit in, to be part of “that group” or the management team that calls the shots. You know it boosts your self confidence, fosters that sense of security, strokes the ego, establishes a foundation of reassurance that you are who and what everyone expects you to be. You do what everyone else does, because everyone else is “doing it” and because it “must be okay” (even though the Code of Ethics clearly states it is not). If it’s your goal and if that’s how you wish to fulfill those basic needs in your professional life, then go with it.

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Inevitably, there comes a time when doing “what everyone else does” is just not okay. Not even by a mile. A moment when you have to see past what everyone else is doing and really examine the right and wrong of a situation, break away from the pack mentality, and listen to your own inner voice. When it comes to blowing off steam on the job, venting, or whatever it is you want to call it, there is no “It depends” and there is no such thing as a “Gray Area.” It is, indeed,  “black and white” and the intent shines right through what you post on sites such as Twitter, Facebook, or Instagram.

Its a simple concept, really. There is a right way and a wrong way to vent, share your experiences, ‘horror stories’ or ‘funny moments’ in a way that doesn’t misrepresent our profession and everyone who is a part of it or hurts healthcare consumers who may be reading your posts. Whether you realize it or not, when you send off jokes into the Twitterverse about the penis of a patient whom you just put a foley in bragging that you did it “extra rough to teach him a lesson for being a perv” or the “crazy guy who won’t stay off the call light” or the “needy family that wants me in the room every second because the patient is dying” you are representing ALL OF US. You are showcasing NURSING as a PROFESSION:  TO THE WORLD. You are showing PATIENTS that we cannot be trusted, that they can assume the minute we leave their rooms we’re going to go right onto our smartphones to tweet an update about the latest irritating incident with the “Fibromyalgia patient who thinks she knows more than me, the nurse.”  (By the way these were actual tweets taken off of Twitter, posted by nurses during their shifts)

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Here’s a newsflash to all you geniuses out there: Our patients DO KNOW MORE THAN THE NURSE in more ways than you can even think of… and the list is longer than what would fit in one tweet, or two, or three. More than that, they are on to the whole “Social Media venting about patients” phenomenon. Yes, patients are actually pretty tech savvy, especially the Patient Safety and Medical Mal Awareness crowd. I’ll be a nice nurse and “share” the following “intel” for you to consider if you’d like to keep your license and save yourself hell on earth and a trip or two to court.

Healthcare consumers actually create fake Twitter and Facebook accounts so they ca surf different forums, reading through discussions in an effort to better arm themselves against the potential harm that exists within the healthcare system. They pose as nurses, as doctors, and they respond to the snarky posts like the “other nurses do.” Depending on how offensive the discussion is and if they get upset enough, they write down the Facebook name or Twitter handle,  copy and paste the links to your accounts,  the offensive discussion, and they report it as unprofessional conduct to the local Board of Nursing if they are able to find out where you are located. One patient told me that she reported to where the nurse(s) actually worked, complete with screenshots from a smartphone.

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Yes, it’s happened. And if you think for even half a second that a Board of Nursing cannot blaze a trail right to you—you’d be devastatingly naïve. A State Board has, at its beck and call, the ability to utilize experienced IT Technicians and Private Investigators when they want to track down individuals, and it’s a lot easier than you think it is. In fact, I STILL HAVE IT TECHS monitoring all my social media accounts! (Regardless of this I don’t hide or censor anything I have to say, for those of you who don’t know that by now) The postings that these investigators compile are procured at all times of day or night …think on that for a second. If your state wants to spend the money to find you, latch itself onto your social media accounts, they will do so… and because they had to go through all the trouble of doing it—your outcome may not be so good. I will reiterate once more that my case is not applicable here, I made carefully calculated decisions upon which I felt I had to act for not just one patient, but the greater good of a community and I took the consequences.  I wasn’t making fun of patients on Social Media.

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Now before you start saying to yourself that the First Amendment covers you and your Social Media activity, THIS is where “It Depends” and the “Gray Area” comes into play…

First things first. If you are making harmful, untrue, or non factual statements about a “private person” like another nurse, a nurse manager, or a patient of yours—the First Amendment does NOT apply to you. But! If you are opining about, or criticizing President Barack Obama, his policies, your Governor’s psychotic choices or the local Sheriff’s tendency to focus on all people who are brown—well, then, the First Amendment DOES APPLY. Why? Because these are public officials. People who took these positions or were elected into them knowing that their actions and the things they say or policies and regulations they set or implement are subject to criticism by their constituency. The First Amendment was set into place for that reason. To protect the very people that are subject to the rules, policies, regulations and whatever else government officials come up with that affects YOU as a PRIVATE CITIZEN. It was created to protect you from being retaliated against, harmed, or jailed for expressing your views. It was set forth to prevent government from getting too heavy with power. Think of it as a “checks and balances.” Now, is it always implemented or enforced? No. A prime example would be my situation in Arizona. The Arizona Board of Nursing doesn’t like to be criticized, their rules and policies scrutinized or discussed, so I feel like (as do so many others here) the agency retaliates to inflict fear/harm and the Arizona State Government ALLOWS IT. An example of that? The State of Arizona’s Ombudsmen’s office not completing their investigations into serious allegations I, attorneys, and other nurses filed against the AZBON.

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So lets review—want to criticize your Governor, the President, or local law makers on Social Media and flex a little political muscle? Go for it. It’s your right. You can’t be dragged into your Board of Nursing for it (Arizona nurses are exempt from this, of course,  because its moment to moment here and it depends on “who you know”).

Want to whine about the “pain seeking Fibromyalgia patient you’ve had to ‘put up with’ all day,” unload about the “crazy family” you have to contend with on your shift by itemizing their crazy actions on Twitter throughout your shift, or perhaps you’d like to share a chuckle about the “unusual anatomy of the young guy you just put a foley into and can’t get over”—-You ARE NOT COVERED by the First Amendment. In fact, if your colleagues are included in on your Social Media feeds and are particularly horrified (because they KNOW WHO you are talking about) they may just report you to the hospital’s management or your state’s Board of Nursing themselves—anonymously.

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There are just so many opportunities for you to fall into the quicksand on Social Media that it is not worth it to make snarky remarks about patients on Social Media.  It’s also not fair or therapeutic for patients to be frightened of healthcare providers because of discussions they see on Social Media. Healthcare consumers have the right to feel like they are in a safe environment, one  in which they can trust their providers enough to undress, or allow themselves to be examined.

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A word about “Nursing jokes.” It is not even near appropriate or acceptable to post a picture of IV sedative vials lined up on a med room counter and caption it “Doc said if he ‘acts up’ again to give em’ all at once!” on Social Media—AT ALL. EVER. I mean, really? Where in nursing school did any professor say it was okay to be representing the values of the profession this way? At a time when we as a nation are losing 1,000 lives per day due to medical errors, making tasteless “innocent” jokes like this that you think are harmless actually hurt the entire profession by casting a negative light on what we do, and who and what we are about. Not to mention the fact that it could literally scare healthcare consumers to see such a thing—as well as  nurses laughing along with it—showing support of that behavior.

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Once the RN is beside your name, its like a light switch you cannot turn off. What you say and do on Social Media and in real life doesn’t just affect YOU, it doesn’t just reflect on YOU, it reflects and represents the values and beliefs of the thousands of nurses all across the country. The profession of Nursing in its entirety. No single nurse in this profession has the right to undermine the trust people have in Nurses as healthcare providers. No single nurse has the “right by license” or “freedom of speech” to engage in harmful behaviors that make the rest of us look like we are uncaring, all knowing, sarcastic, short tempered, insensitive individuals. No single nurse has the right to set that example to the future of our profession.

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Karma is a crazy thing….and you never know when a “nurse” in a Facebook discussion forum or a Tweet chat in which you all are sharing jokes about various patients or parts of their anatomy or their weight, or their body odor etc. might actually be a “patient” or a member of your local Board of Nursing perusing through your discussion. You never know when the “nurse” you are tweeting back and forth with and sharing “patient stories” with that are harmful, insensitive, and judgmental might be a patient just wanting to test the waters and see HOW NURSES REALLY feel about taking care of people.

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The reality is, all of these scenarios are playing out every day. The patient safety movement has gotten EXPONENTIALLY larger. There are some angry, angry, permanently harmed patients out there (and I don’t blame them one bit) who have been wrongly maimed in hospitals– some of whom, are hungry for some justice regardless of where it comes from. One patient told me “as long as I can get whoever I can in trouble for harming someone else or being unprofessional I’m gonna do it, because ‘they’ hurt me.” You see, some of these patients lump all nurses together. Some of them also lump all doctors together. You may have nothing to do with what happened to a patient, but lets say they stumble on to some of your snarky Tweets about patients (regardless of the fact you didn’t share identifying information) and you happen to live in their home state? They could easily copy and paste tweet after tweet, look around a little to try and find out your “real name” and turn it all in to the State Board of Nursing—maybe even your hospital’s administrative team.

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Is passing judgment on patients, making fun of them, or misrepresenting the profession on Social Media really worth the price you will pay?

You guessed it!

“That depends”….

On what? You ask.

On how “invincible and all knowing” you think you are and how big you think that bubble is that shields you from reality.

AZBON to Nurses: “Play Doctor? No Problem! Advocate for Dying Patients? Lose Your License.”

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A few weeks back….I was threatened by the Arizona Board of Nursing with a Class 6 felony for being an RN imposter by not updating two spots on my Linked In “Past Work History” section. But what started it was a Nursing Professor from Scottsdale Community College who, per her Linked In Profile at the time, listed the Arizona Board of Nursing as one of her current (and longtime) employers. After getting together with an attorney very familiar with the Board, we put our heads together and realized the Professor was NOT on the AZBON’s roster of employees or members. As if that were not enough, I did a little research of my own and found that this particular Nursing Professor was a Nurse Practitioner and Legal Nurse Consultant who was advertising herself as an “MD” on a physician website designed to “Rate your Doctor.” On the site, the “MD” and the “Doctor *****” were in big bold lettering. A patient perusing through this site would have had a difficult time figuring out if this individual was a Nurse Practitioner or indeed a Doctor. Before those of you go into troubleshooting mode—-No, the Professor did not have a Doctorate Degree or otherwise.

Since this NURSING PROFESSOR gifted me with the courtesy of FREE PR and FREE ADVERTISING for my chosen Social Media platform(s)via my name being prominently displayed at the very top of the Nurse Imposter List (Yes, folks, I’ve got VIP front page billing!) as the ONLY Nurse Imposter for 2014, I thought I would share the joy by reporting her to the Arizona Medical Board for posing as a Doctor/MD and misrepresenting herself to the public at large. I even did one better, just to prove a point. I emailed the Arizona Board of Nursing’s Executive Director Joey Ridenour to inform her that the Board’s “Informant” was herself posing as an MD when her credentials were that of a Nurse Practitioner.

I figured since we got all “TECHY” in my case, and we were all about the semantics, the fine print, and all the “legal mumbo jumbo”– the same rules should apply to a Scottsdale Community College NURSING PROFESSOR who is SUPPOSED TO BE setting an example for the future of our profession, rather than using her “knowledge” to try setting up another nurse for a Class 6 Felony. I mean, is it not enough that my nursing license is gone? I suppose it wasn’t enough punishment for her.

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Though the timeline of events (as I previously blogged them) certainly does suggest that the AZBON and the NURSING PROFESSOR have professional/personal ties and had this pretty well thought out…..They didn’t factor in “human error”….because someone made a little boo-boo and emailed me a copy of the State Board of Nursing’s “evidence” against me, which of course, I picked apart with a little bright light and a magnifying glass.

Now! We get to the part that has sadly become all too predictable, though, certainly not surprising. I wondered if Executive Director Joey Ridenour would actually investigate the allegation and evidence I sent her that CLEARLY depicted a Nurse Practitioner advertising herself as a Physician and BREAKING THE STATE NURSE PRACTICE ACT. She did not. I sent her an email with everything she needed to know. No response. No complaint was placed against the NURSING PROFESSOR’S license, no “Pending Investigation” tag was placed on HER License. So, I went to the Arizona Medical Board and gave them my evidence. The website she was advertising herself on was altered shortly after my report and any indication that the Nurse Practitioner was a licensed Physician was taken down. Chalk one up for the Arizona Medical Board, since they failed to discipline Dr. Keng Yu Chuang for stripping all the patient education from a vulnerable patient’s hospital room and intimidating them into further treatment they told me they did not want. I’m working on my THIRD complaint against him, and Frank Fausto of Banner Del E Webb now. (I will keep doing so until he comes clean and admits to the Board his dishonesty in lying during my case or admits it to me and apologizes) But that is for the next blog titled “dying with dignity, without a Doctor’s Order.”

What has me perplexed is why it’s okay for a Nurse Practitioner to advertise themselves as a licensed Physician, but it IS NOT OKAY for me to have failed to update two TINY SPOTS on my work history—an honest oversight. Why is it the NURSING PROFESSOR, gets to break State Statutes and the Nurse Practice Act and receive absolutely NO DISCIPLINE, and I get placed at the TOP of the “Imposter List?” Again, I’m no longer upset about it since I have been getting FREE advertising. My new imposter status has helped me make more connections on social media, politically, and with healthcare consumers throughout the valley than any other stunt the AZBON has pulled so I really should be thanking them…….If I could only swallow down the urge to puke at the thought of it….

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If this were the only situation in which the Arizona Board of Nursing chose to look “over there” for “just a sec” on some things, while having tunnel vision on other things it wouldn’t be so disturbing. As I have highlighted before in previous blogs, nurses can get DUI’s, repeat DUI’s, extreme DUI’s with arrests—and receive nothing more than a mere “Letter of No Concern” in their nursing file, which is not publicized. This means if you looked up the nurse’s name, you would not see any complaints filed against his/her license because the charges were kept “private from the public.” You can also be a party in a sentinel event in which a death resulted and not be ordered to take skills remediation courses….instead, for your convenience, all that will be issued is a “Letter of No Concern.”

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Let me clarify something, unless a gross intentional offense that harms another patient takes place I staunchly oppose heavy handed discipline that takes any decent hearted nurse out of the profession and away from doing what he/she has spent years studying to do and loves to do. There is a quote by Virginia Henderson, Nurse theorist that addresses that very sentiment….I read it every day. I am pro education as a means of preventing further nursing care errors. Skills review, precepting, dialoguing, engaging in activities similar to those in the last few semesters of nursing school….those are the kinds of things that improve a nurse’s awareness and skillset. NOT 8 YEARS OF STACKED PROBATION WITH IMPOSSIBLE TERMS THAT LEAD A NURSE TO DRINK, DO DRUGS, SUCCOMB TO SUBSTANCE TO SELF MEDICATE, AND EVENTUALLY KILLING THEMSELVES AFTER THE LOSS OF THEIR HOMES AND FAMILY STABILITY.

Heavy handed and cruel sentences do nothing to address the actual problem, it just hurts another life. Until the next nurse comes along and falls in the same hole making the same error…..Why not feature the nurse in the Regulatory Journal and have them write up their own case and discuss for nurses what could have been done better next time and a statement of reflection on how the incident has affected them and their practice as a nurse? I find these approaches much more humane, and productive and more likely to preserve a safer more robust nursing workforce. It also encourages health interaction among peers, and more learning takes place than fear. #Campaignforaction #futureofnursing #Toerrishuman #IOM

“If for too long we deprive a person of what he values most—love, approval, fruitful occupation, this condition of deprivation is often worse than the disease we are attempting to cure.”

~Nurse theorist Virginia Henderson

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Recall that the Arizona Board of Nursing as an agency exists solely at the will of the Arizona State legislature via a Sunset Clause. The State Legislature and the State Auditor General have told the Arizona Board of Nursing that they must adhere to specific timeframes for investigations due to their consistently long investigation times, overuse of resources, and the constantly expanding list of resources that the agency is asking for every fiscal year. (I currently have all their financial records from 1981 to present and am in awe that the AZBON has gotten away with no thorough/complete financial audit all these years with the exception of one partial one) Pertaining to lengthy investigations–After doing some research I found one case that had started in 2009 that I blogged about recently and it didn’t resolve until a couple of months ago. I was also emailed about two nurses who worked at a valley hospital (2 years ago) that didn’t check a unit of blood like they were supposed to and a patient didn’t have a very good outcome. Though they were both fired and turned over to the AZBON, they never had their licenses updated on line to reflect that a complaint had been filed or that they were “under investigation.” Until now. In another case, a nurse wrote me to ask me what was so different about the time frame in which my license status was updated and how long it took for his license status to get updated (it still hasn’t been). He was charged and arrested and jailed for domestic violence—twice. Well over a year ago. He did not self-report as he was supposed to, and he is JUST NOW getting a letter from the Arizona Board of Nursing to inform him they found out about it. I recall my license status was updated within 48 hours of the AZBON getting the complaint from Banner Del Webb Hospital. On paper The AZBON makes everything look pretty so the Auditor General, the Ombudsmen’s Office, and the State Legislature can see that they are playing by the rules, Here are just some of the major issues that threaten the well-being of not just the public, but the health of the nursing workforce:

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  1. More nurses than ever are getting DUI’s/impaired driving offenses
  2. There is no remediation for drinking and driving, no community service, or public speaking requirements
  3. No limitations on how long Directors can serve, they are not elected officials— and they should be. For obvious reasons.
  4. The Board Members are not currently practicing at the bedside, are not elected into the position, and are placed there by people in the Governor’s office who know nothing about the practice of nursing or what it takes to get through a 12 hour shift laced with crisis after crisis.
  5. Long investigation times persist, leaving a nurses life in limbo for the duration of an investigation.
  6. Focusing on the wrong nurses while letting the “dangerous ones” slip through the cracks places the public in danger
  7. Little to No oversight by the State Legislature. The Board writes insanely draconian rules that allow it more and more power and the Legislature—focused on gay marriage, immigration, Obamacare, who gets to use public bathrooms, who can or cannot own nun chucks in this state, CPS, and Education—pay no mind when the rules cross their desks, they just sign off on them not realizing what it is doing to the nurse workforce.
  8. Zero Use of the ARS/State Nurse Practice Act
  9. OVERUSE OF PERSONAL OPINION AND JUDGMENT AND NOT ENOUGH APPLICATION OF STATE LAW.
  10. OVERUSE OF STATE RESOURCES. (example: internet stalking nurses whose licenses you have already revoked or trying to get at nurses who post to my pages with negative opinions about the agency)
  11. Using “rubber stamp” Psych doctors like Dr. Phillip Lett who is an addictionologist, and spends less than 5 minutes with a nurse asking irrelevant questions which somehow culminates into a 40 page report that pretty much regurgitates the AZBON investigative report’s opinion of the nurse under investigation.
  12. Resistance to transparency.
  13. Labeling everyone as crazy or mentally disturbed (a classic gaslighting technique) so it takes the attention off of  The Board and their actions or in many cases–lack thereof.

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NEWSFLASH TO ARIZONA LEGISLATORS: Just because the word “Nursing” is in the name of the agency, it doesn’t mean that we are all on the same page. THEY are NOT a nurse’s buddy, advocate, BFF, or a nurse’s supporters. Their job is to take nurses off the streets, to take them out of the profession, which, affects YOUR FINANCIAL BOTTOM LINE AT THE END OF THE FISCAL YEAR! How? We all end up on welfare, AHCCCS, and Foodstamps and YOU SUPPORT US, our families, AND OUR BASIC NEEDS, When we could be out there contributing to the economy and to our families on our own.

My advice to legislators—BEFORE YOU SIGN AWAY OUR LIVES during a particularly long day at the State Capitol, stop and think about the implications for the nursing workforce, and for the financial end of things. Will your signature help the nursing workforce? Are you signing a new “rule” that would potentially violate the rights of Arizona RN’s and unnecessarily yank them out of the profession at a time we need them THE MOST? Just what type of information are they subpoenaing? Are they getting information about nurses that is unnecessary and not pertinent to a case? I mean, I have heard that subpoenas are kind of expensive…and does the State Board of Nursing really have to know whether or not we have an STD or whether we are homosexual, or that we have had multiple partners when sexually active, or that we engage in what “they think” are risky behaviors?

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Please remember nurses do not have any rights in the Administrative Law setting. And that Administrative Law is extremely tricky. CRIMINALS GET MORE RIGHTS AND CONCESSIONS THAN WE DO. Nurses do not get covered by HIPAA like everyone else. We are left wide open and vulnerable for any and all information about our mental health, physical health, and sexual health to become public information because it’s the “Board’s rule” to find it all out and make it public. This is where the INEQUITY CREEPS IN….

Who gets the axe and who doesn’t? These days, nursing in Arizona is like going on one of those television shows where people have to vote for you. Like Dancing With The Stars or American Idol. No one knows who will make the cut. Think about it, because that is the reality of Corporate Nursing. If you have not done so already, please make time to read Brave New World by Aldoux Huxley. You will be shocked at how closely our profession mimics portions of the book. The scary thing about our profession is that one day all can be well and beautiful, and the next day your life is forever changed.

You will never see it coming, believe me. The State Board of Nursing further complicates the current practice environment here in Arizona by being finicky about who it decides to discipline, let go, prosecute, or revoke. In the Outcomes I have published for the past ten years on my blog it is painfully clear that there is absolutely no rhyme or reason to how they discipline, or why they would discipline nurse A for something minor while giving a pat on the back to nurse B who just got her tenth DUI in the past few months with a “Merry Christmas and good luck to you!”

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Truthfully, that is what happens here. That is the reality. I mean, thanks for the FREE PR and all, but honestly—at the end of the day, I wasn’t the one “playing Doctor.” Perhaps ya’ll might want to actually re read the Nurse Practice Act, and actually use it, apply it… I don’t know—-somewhat fairly?

Seriously I know it’s a new concept. But give it a try…your next audit will be here before you know it. And I’ll be at the Auditor General’s Office front and center with every bit of research I can provide as a concerned taxpayer, healthcare consumer, patient advocate as well as a  nursing advocate for my peers.

Someone has to look out for nurse and patient safety in Arizona.

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I have the degrees, the experience and a widened understanding of the healthcare system—its history and current challenges.

Why on earth would I walk away knowing there is so much more I can do to empower patients and nurses during one of the most turbulent times in our profession’s history?

Hey! The Nation is Bleeding! Anyone Got a Band Aid?

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Thank you to Dr. Besser of Good Morning America for taking the time to fly himself out to the hot zone, ask the hard questions, investigate, and find out the real story instead of blaming nurses, I hope physicians follow your lead in the future….its the only way we will ever get to the root cause of medical errors and cut back on the 1,000 deaths a week….

 

There Is something that everyone needs to understand about private healthcare systems, ie: “Corporate.” If you didn’t already know, each healthcare system has developed a mission for its organization and a set of strategic goals to help them achieve that mission. Strategic goals change depending on the healthcare system’s climate, the ratings they receive from patients, the reimbursement rates they are getting from health insurance companies, and the need for more capital to remain competitive within the market, (seriously, how many of you are sick and tired of seeing every other commercial paid for by a healthcare system that claims it is the latest and greatest at whatever specialty and that everyone should go there. ) Here’s the thing. It doesn’t matter what the CDC says, or what the WHO says, what the American Medical Association says, what the American Nurses Association says, or what anyone else says for that matter. A private corporation DOES NOT HAVE TO IMPLEMENT IT. PERIOD. ESPECIALLY IF IT THREATENS THEIR REVENUE POTENTIAL OR CAUSES THEM TO SPEND MORE MONEY. Recall that Registered Nurses are already the single biggest expense that a hospital incurs. Healthcare systems today are NOT ABOUT THE NURSE OR THE PATIENT, they ARE about cost containment, tightly regulating resource utilization, and monitoring an insurance company’s reimbursement rates.

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 Spending all this time developing position papers and a list of demands for hospital administrations to fulfill in order to provide the “ideal work environment for nurses and healthcare providers” is really wasted paper and wasted brain power. You see, Corporate is corporate, and as long as that goes unchallenged or unchanged, there is only one thing that guides, and will continue to guide the captain of the ship—and that’s filling beds, scheduling as many tests and procedures as possible, staying competitive in the healthcare market by offering the latest technologies, and catering to those people who pay them the money–insurance companies. Hospital systems pay no mind to all this other stuff that has the potential to lead them astray  from their real focus, and that’s on the organizations that do pay them.  It’s  the money, the revenue at the end of each fiscal year that keeps the ship afloat and up to par with all the rest. A hospital administration’s main goal IS NOT TO KEEP NURSES SAFE OR HAPPY, IT IS NOT TO DEFEND YOU IN COURT, NOR IS IT TO MAKE SURE THAT YOU ARE TRAINED PROPERLY TO HANDLE A DISEASE LIKE EBOLA. How do I know this? Read the news. Texas Presbyterian took forever to issue their apology for not being prepared and for making mistakes. One of those mistakes was putting their nurses in the direct line of fire by paying no mind to the seriousness of the situation and allowing those same nurses to take care of other patients. THAT IS AS CARING AS THEY WERE ABOUT THEIR STAFF AND THEIR PATIENTS. ….IS ANYONE OUT THERE AWARE THAT NURSING CARE IS “BUNDLED IN WITH THE ROOM CHARGE?” This is directly indicative of how highly we are regarded or respected in the hospital’s these days, and why it is so easy for them to throw out a nurse like dirty Kleenex. We are a dime a dozen, and when one is tossed out there are ten more they have to choose from.

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Bottom line, unless the Feds step in and start coming down on these privatized corporate hospitals and finding a way to impact their bottom line by making them adhere to certain standards that not just protects its staff, but prepares them for deadly scenarios,  incidents such as the ones involving the Ebola virus WILL KEEP HAPPENING.

Something else to consider…..is the potential for nurses to exit the profession en mass. You see, there are two kinds of nurses. There are the nurses who go into this profession because it is an internal calling, one they have known for a long time. Then there are the nurses who went into healthcare because of the huge amount of jobs available. It is a job. Not a career. For those who went into nursing and healthcare for a paycheck, for a job, the Ebola scare may just run them out of the profession early and unexpectedly. I don’t blame them. If my hypothesis proves to be true, We could end up losing a lot of nurses before we see a resolution to the Ebola scare in the United States, prompting another shortage.

The nation is bleeding. The band aid? Nurses. Every single time something goes wrong, or someone gets hurt, or someone dies, or some policy is not carried out, the nearest nurse is the first one to be thrown over the bleed. All I see is nurse after nurse being used as a band-aid for the massive systemic problems that have been plaguing the healthcare system for decades. The sacrificing of nurses has done nothing to stop the death rate of approximately 1,000 people per day from medical errors. The sacrificing of nurses has not fixed the major issues affecting patient safety in the nations hospitals. In fact, I think it took this Ebola outbreak to finally highlight the insanity of finding the nearest nurse and throwing him or her into the blaring lights of the media. I’m sure the Arizona Board of Nursing would disagree with me. After all, I was thrown over the coals for naming the facility who’s practices were placing patients in direct danger when I was fired.

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This time, it didn’t take. Nurses all over the US wouldn’t allow it.

Sanjay Gupta tried to nail a nurse for “allowing Mr. Duncan to leave the hospital, or not communicating to the rest of the healthcare team”(gee ive heard that shit before) the travel history as reported to her by Mr. Duncan. I think many of us nurses rightly pointed out that a physician has the ability and duty to actually “read” the nurses notes. We also pointed out that it is out of the scope of a nurse to decide if a patient should be discharged or not.  A triage nurse cannot be everywhere at once, nor can she discharge a patient, and the irresponsible remarks made by CNN correspondent Gupta were damaging, publicly calling into question the integrity and trustworthiness of the nurse and patient relationship. Texas Presbyterian Hospital joined Dr. Sanjay Gupta by repeating the same sentiments by making statements at their initial press conference that blamed the nurse for “not communicating to the rest of the healthcare team.” They later retracted their initial statements, and then did so once more in recent days by admitting they had fumbled the ball in this situation. Seriously? They get no atta boys from me.. Who knows what that triage nurse had to go through in those initial hours or days, or what he or she is going through now. I don’t buy into forced apologies to save face, and this is what hospital administrations do all the time to make themselves look good so as to preserve their census and consumer base.

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Now, lets talk about the Centers for Disease Control. This is the top of the line. These are the big boys. The top of the food chain in healthcare (as close as you can get) and THEY TOO, BLAMED THE NURSE WHO TRAVELED by making statements that insinuated that the nurse TOOK IT UPON HERSELF to travel back home to Texas, even though she had spoken with officials, reported her low-grade fever, and received clearance to fly back home. They too, had to backtrack and apologize for their initial accounting of events that pinned the nurse as “the problem.” These big boys are the top of the medical food chain, and here they are setting the example of playing the blame game. I can only imagine how this will affect workplaces all over the country. I mean, if the big bad boys at the CDC can blame a nurse what’s to stop any other doctor from doing the same? Will the WHO follow suit?

Google “nurse whistleblower and you will likely pull up article upon article about nurses all over the United States who have PUT IT ALL ON THE LINE TO TRY AND ALERT THE MEDIA AND HEALTHCARE CONSUMERS ABOUT THE DANGERS THAT EXIST IN HOSPITALS EVERY MOMENT OF EVERY DAY. These pleas for help by the nursing profession have gone unheeded by the media and by state legislators. The message sent to nurses and to healthcare consumers is that patient safety and a nurse’s efforts to advocate for safer, better care simply doesn’t matter. We are the freaks, naysayers, the overly concerned, and the abnormal nurses that can’t just “go with the flow” like everyone else.

All us nurses concerned about the current state of the healthcare system have been talking for sometime now, about what it would take for people to wake up and realize that hospitals are not safe, that their confidence in the healthcare system  is sorely misplaced, and that they are their own best advocates. We have spent hours talking on Facebook and Twitter trying to figure out how we can get the media to understand how big the problem is…..but so far the statistic of 1,000 people dying needlessly each day of unreported medical errors, and no answers about why they happen, doesn’t seem to interest investigative journalists or mainstream media.

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But Ebola! Ebola gets the world’s attention…..

If you looked past the Ebola virus for a second and examined everything behind the curtain, you’d see that the problem wasn’t Thomas Eric Duncan, it wasn’t the Triage Nurse, it wasn’t Ebola. It was a lack of preparedness on the part of the CDC and hospital administrations across the country. It was a lack of caring and a blatant disregard on the part of a hospital administration for its frontline healthcare workers. Here are some statements made by nurses from Texas Presbyterian Hospital that provide perfect examples of how pennies and profits come before patient safety (these were taken from the official National Nurses United website ):

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    1. There was no “policy” in place for them to follow. In fact, the “policies kept changing” and the nurses were confused. Nurse management advised them to just pick “whatever worked” for them.
    2. No one knew what the protocols were. Furthermore they were not able to verify what PPE’s to use.
    3. Mr Duncan was actually left in an open area around other patients for “several hours” before isolated.
    4. Nurses assigned to care for Mr. Duncan were told to carry on their usual nursing duties and care for other patients at the same time.
    5. When a nursing supervisor found out Mr. Duncan was not on an isolation unit she demanded he be moved, but hospital officials would not allow it.
    6. Lab specimens from Mr. Duncan were sent through the hospital’s tube system, rather than personally walked down to the lab, which likely contaminated the entire tube system. Again, there was no policy in place to deal with this.
    7. There was no advanced preparedness for how to care for Mr. Duncan prior to his arrival. No protocols, no system to deal with the dirty linens that were piled high to the ceiling on the day of his death.
    8. The infectious disease department advised nurses that they did not have clear policies to provide nurses to guide them.
    9. Nurses reported the most advanced preparation they received pertaining to caring for ebola patients was an email about attending an “optional lecture/seminar” about ebola that was deemed “optional.” To be effective these classes would have had to be mandatory and offered around the clock in order to accommodate the staff in this large hospital. ***Note, a hospital that is focused on resource utilization and cost containment will NOT pay for training like this that requires extra money for training and extra man hours.***
    10. Nurses inside the hospital also report that there was no hands on training on the proper use of PPE when caring for an ebola patient. There was no training on what symptoms to look for, or training on what to ask patients.
    11. There were no policies for cleaning or bleaching the premises in absence of the housekeeping personnel. There was no one to pick up the hazardous linens, so they piled high to the ceiling the entire time Mr. Duncan lay ill an dying.
  • Nurses did not have access to proper supplies and observed the infectious disease personnel and members of the CDC themselves violate basic principles of infection control…including cross contamination between patients.

The bottom line: Nurses felt like they were left holding the ball to figure out how to deal with Ebola, how to care for Mr. Duncan, and how to protect themselves and their patients.

Members of government agencies, medical correspondents like Dr. Sanjay Gupta, hospital management and administrators or the CEO’s sitting up in their penthouse level offices with the cushy view CANNOT CONTINUE TO USE NURSES AS THE BANDAID THAT COVERS A BLEEDING NATION! Blaming nurses, firing nurses, ruining nurses does not solve the problems. The United States is still losing more than  a thousand lives a day due to medical error/harm. It is still the THIRD LEADING CAUSE OF DEATH AMONG ALL PEOPLE IN THE U.S. Don’t believe me? The Senate Healthcare Committee thought is was alarming enough–they  just recently met to figure out what to do about it.

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 I’m going to say it again: “firing does not fix” all the the things going very wrong right now in the healthcare system.

 “Profits before Patient Safety.”

The situation at Texas Presbyterian Hospital highlights all that is wrong right now with “Corporate Nursing.” Nurses are being expected to do more with less, they are not given proper training to perform even the most basic of tasks to protect themselves and patients, the corporate entity is not investing in the safety of its workforce, the corporate entity will go to whatever length to cover its own tracks and reputation while focusing the attention on something or someone else in order to maintain the “status quo,” rather than accepting responsibility and being accountable for the course of events. Every attempt is made to do what needs to be done in order to maintain a good public image===in this case, the tried and true tactic of throwing a nurse out there in the public eye so that everyone publicly flogs him or her was the first line remedy. The proverbial band aid, if you will. Texas Presbyterian Hospital has also shown nurses how much they CANNOT TRUST their corporate employers.

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This time, it backfired. Right up to the level of the CDC, blaming a nurse didn’t work. The real problems were revealed for a nation to see. Now, whether healthcare consumers pay attention to this and demand better, the status quo will continue. As long as mainstream media and investigative journalists continue to ignore the opportunity to make a huge difference in the lives of thousands of people and healthcare providers by shining a light on all that is wrong, and all that is unethical, and dirty, and deadly with the healthcare system…..we will see incidents such as the Ebola scare continue to happen over, and over, and over again.

Journalists—-you have the opportunity to take on the story of a lifetime, the chance to break it all wide open, the secrets that have been kept for decades, all the things weve never been able to talk about or reveal to the public…..you’ve got it in the palm of your hand to dig into and the chance to save thousands of lives by making healthcare consumers more aware of the TRUTH.

How much more do you need? The facts are all right there. Everything that happened surrounding Texas Presbyterian Hospital, the blame game as played by Dr. Sanjay Gupta and the CDC, the lack of regard for the safety of the nursing workforce, the threat to patient safety, a hospitals determination to do the wrong thing until it was FORCED to do the RIGHT thing, throwing nurses on the problems like band aids expecting that the problems endemic to a troubled healthcare system will be held together—these are all just the tip of the iceberg when it comes to some of the ugly things that take place away from the sight of patients and media. What will it take for you all to finally look at what has been the biggest story EVER staring you in the face for so long? Ebola has uncovered what is happening in virtually every hospital across the United States. The Healthcare system needs saving. It needs a Hero. Which one of you media outlets or journalists feels like being a hero and making history?

Think about it. If you don’t take a chance on opening up the Pandora’s box…. the next victim could be you.

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So you think you are covered by HIPAA? Think again.

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Sorry boys and girls. This is yet another little detail left out of the white halls of academia…because, after all, the nurse factory cannot be slowed down by informing students about EVERYTHING that goes with carrying an RN or how the real world of nursing differs from the pretty idealistic one taught to us in school. Consider this another installment of “Defensive Corporate Nursing 101.” If you haven’t seen my previous postings with the same title, you may want to take a look and have a read because they were written to help make nurses more corporate savvy and better informed about their work environments so that they are better able to make career decisions and understand what’s happening within the hospital itself……

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Here’s the down and dirty. I’m working on a blog right now about Nurses and the Ebola Virus but I have been seeing so many frantic postings about why these nurses haven’t been protected by HIPAA I decided to stop and write this quick blog. First, considering the nature of what is happening right now the public—that means THE PUBLIC AT LARGE—is privy to this information because it involves the safety and well being of THE PUBLIC AT LARGE. Journalists would argue that the public has “the right to know.” And, unfortunately, they would be right. This IS the Ebola Virus. A virus that has killed more than 4,000 people so far. A Board of Nursing would also argue the same thing—that the public has the right to be informed and to know what is going on because it has to do with protecting the —yes you guessed it—THE PUBLIC AT LARGE. This is not just a national security issue, this is probably one of the largest threats to the public’s health that the US has seen in quite sometime….and obviously we are not prepared for it.

 

Is it wrong to release names? Me personally, I say yes. I don’t think that the public needs to know or to see the nurse’s beloved pet, or where she lives, or a nurse’s personal vehicle etc. I don’t think there needs to be articles going into the private lives of these nurses either. If I recall, one of the nurse’s families released her name, though I am not sure if it had already been released by Texas Presbyterian Hospital. I think it is enough to say “a healthcare worker exposed to Mr. Duncan…..” rather than provide all this detail…..but again, I think more of protecting their identities and their dignity and their professional image. They deserve that. We protect sensitive information every day we practice, we make sure to watch out for the private information that involves our patients and I think we as healthcare providers deserve that same regard….and respect……because we are putting it all on the line for complete strangers all day every day, all night every night. Where is the line? When is it our turn to be protected? Why cant we be better protected?

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Federal Law says—too bad. All regulated persons are not granted the same privacy protection that everyday lay people get. The HIPAA law left a hole in the law that leaves us falling through it because regulatory bodies require our private information for investigational purposes, like when you are the subject of a board investigation–that’s just one example. If you have good healthcare providers they will find a way to protect you—mine was fiercely protective of me throughout the past few years of my battle against the AZBON. We had a rapport because we used to work together at times early into my career and he remembered me as a nurse, and I already knew his reputation for being one of the best out there. He has more than proven to me how  much he will do to look out for me and my safety and my privacy. I will be forever indebted to him for that. If you don’t have a pretty good rapport with your doc(s) that will likely increase the chances your records will be forwarded along to anyone who sends “legal requests” for them with nothing more than a signature and a stamp. My advice? Make sure you have a really good rapport with your Primary Care Physician or Psychiatrist/Therapist. I have been formally diagnosed with PTSD and no one ever got a hold of my treatment records. There was a good reason for that. I had providers who were determined to protect my dignity, privacy, and stability when I needed it the most. The better your healthcare team knows you and your values the more likely they are to pull up the gauntlet, circle the wagons  around you and do anything necessary to protect you. Unfortunately pharmacy records are far easier to come by. A pharmacy will answer to a subpoena for your information without question.

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Here is just one example of what the AZBON allegedly did with one nurses personal medical records:   The case itself had nothing to do with anything sexual and the nurse had no prior offenses or criminal history for sex crimes or boundary issues and yet the nurse investigator not only allegedly interrogated her about her sexual history and habits  as they were recorded by her personal physician in the progress notes, she was allegedly judged by the investigator who told the nurse that her sexual habits were  an indicator that she engaged in high risk taking behaviors that were concerning to the investigator.  The nurse was horrified and told me she had never felt so exposed and violated and  angry.

 

Consider one more thing if you are a Corporate Nurse. DO NOT….let me repeat that: DO NOT NOT NOT GET YOUR HEALTHCARE WITHIN THE SAME SYSTEM YOU WORK FOR! All your medical information is easily electronically accessible to management and administrative figures as well as OCC MED —who alerts HR  and your management people to potential liabilities.  Yes, your managers can look you up and vet you at the very same moment you are out on the floor charting or passing morning medications!  If you haven’t done so yet, to be on the safe side, go outside of your employer for ALL HEALTHCARE NEEDS! It’s happened to me and its happened to other nurses. One nurse posted on Facebook that there was a sign up in the bathroom informing staff that their medical records were accessible by hospital  management.  Neat right?

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So the take aways: If you want HIPAA protection start writing your congressman right now , preferably. Because you are NOT given the same rights as your patients. FIND A NEW HEALTHCARE HOME if you are currently getting care within your employers’s franchise. Wanna know why some nurses seem to be “bullied out” or “forced out?”  Their liability factor has either gone up via age, a mental or physical health crisis, or they have simply become too expensive to keep on staff.

Why take a chance with your privacy?  You may not have it with HIPPA but there are other ways to control who gets to know what about you.

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“As Infectious In Life As He Was In Death” : Reporters! Please Preserve Dignity In Death

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In the process of watching  this whole Ebola “Infiltration” play out, I was particularly interested in “who” the person was that everyone was referring to, more often than not, as a walking pathogen, a walking Biohazard sign, a danger to society. Call it curiosity or my nature as a nurse—I like to know the human behind the story, the human behind the illness. It took a while, but I did find some information about Mr. Thomas Eric Duncan, and I was delighted to discover that toward the end of his life he performed a heroic act for another human being and sacrificed his life to do it. Now there is something I like to read…..the life behind the illness.

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     Most people in this physical world have an innate desire to have their life witnessed by someone ….someone who can testify about how a person’s  presence has made a footprint in this world, the things they have done that have impacted the lives of other people. I don’t think any of us desire the end of our lives to be witnessed by billions of strangers around the world via disturbing images described by journalists who are also strangers to us. We in the United States have done Mr. Duncan a disservice by overshadowing the life he LIVED,  illustrating over and over again the rapid and horrific process of his departure from this world.

I believe that he accomplished something very big that has impacted millions of people around the world, and in the process, he has probably saved even more lives while waking up the rest of us. Mr. Duncan  showed us that we are not impenetrable. We are not shielded from third world diseases and illnesses here in the United States. He knocked down that false sense of security that many people have….Newsflash to all those that have forgotten: The U.S. is not surrounded by a massive bubble that shields us from everything.

As I browsed  through articles about his unfortunate demise I felt I needed a different image in my mind of Mr. Duncan, I didn’t want these horrific images in my head of him. Even if he was a stranger, I didn’t feel right having that God awful picture of his last moments in my mind. It almost felt like a violation of his dignity somehow, like I wasn’t supposed to see it, or be there to see it, even if I read it in an article or had an image of  it in my head.

While  digging around the net  for details about who Mr. Duncan was as a person, how he lived his life, who he was loved by, and who he loved….I came across several articles….one after the other….that provided the same cold, mental image of a suffering man alone in isolation, struggling to breathe, the explosive diarrhea, the projectile vomiting, the mask of death upon him, his mother’s scream as she saw her son on the video screen for the first time, the moment the nurses watched as his heart beat slowed to nothing and his life slipped away.  I was particularly struck in the chest by one phrase written by an AP journalist who summed up her timeline of Mr. Duncan’s brief existence in the states with this phrase:

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“He was as infectious in death as he was in life…..”

This is the phrase that wraps up the life of the first victim to die of the Ebola Virus on U.S. soil.

     I was disgusted and nauseated by the use of this phrase from an AP Reporter, not just because it was the very last sentence used to sum up a devastating chain of events leading to the demise of a human being that could have easily been anyone we care about…but because it brought to mind the memories I had of zipping up of body bags (I still remember the strong smell of those bags when we first open them up and unfold them for use); I remember the subtle vibration of the zipper against my finger tips, the sound of the zipper as I advanced it upward…from the feet….to the head. I remember being alone in a still and quiet room performing a simple, mechanical, cold, clinical, “final action.”

“He was as Infectious in death as he was in life….”

     It’s a painfully distasteful phrase any mother or father wouldn’t want to read about their child…..A phrase that has the powerful potential to influence the way we as a nation refer to victims of the Ebola Virus (notice I say ‘victims of’ rather than ‘The Ebola patient’) and how we as members of the healthcare community– especially nurses– refer to anyone who is unfortunate enough to become infected with this deadly illness.

“He was as Infectious in death as he was in life….”

     No, he was not.  Thomas Eric Duncan was actually hero, and if by chance you didn’t do much reading about Mr. Duncan beyond the fact that he illegally came into this country already ill with the virus, (by lying to get past airport checkpoints) you may have missed how he was exposed to the Ebola virus.

On September 15, 2014, while in his place of origin, Mr. Duncan assisted in the attempted rescue of a friend who had the virus by trying to rapidly transport her to the proper facility so that she could get treatment. The woman he was attempting to save was one of his landlords and the family was in peril because they had no transportation to get their loved one to the facility quickly enough. Mr. Duncan took this task on without hesitation, and like any good hearted man might do, simply did what was needed to help another human being. Unfortunately when Mr. Duncan, the woman’s father, brother, and their afflicted loved one arrived to seek treatment for her they were turned away because there were no beds available.

Mr. Duncan immediately, instinctively, scooped her up into his arms, carried her weak and sick body back to the taxi and rode back to her home alongside the woman’s father and brother. One more time, it was Mr. Duncan who gently took her out of the taxi, gathered her in his arms, and carried her into the home where she died just a short while later…….

“He was as Infectious in death as he was in life….”

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     I am going to skip over the parts of Mr. Duncan’s journey to the U.S… We all know he lied to get past checkpoints and should have never made it this far…..but the same can be said for God knows how many other people who have done the same thing, and have not presented with signs or symptoms—-YET.

The point is, that Mr. Duncan was more than a body ravaged with a deadly illness. He was more than a walking pathogen. He was more than a body to be placed in isolation. Mr. Duncan was more than “that guy who started all of this Ebola madness.” This perspective is far from a productive one. The arrival of Ebola into the country was inevitable, just as the spread of HIV and AIDS was when we first began seeing the widespread epidemic. We all had similar responses, similar fears, similar ways of referring to or categorizing people inflicted with the virus. Ebola is no different.

I don’t say that what he did was right, but that aside—-Mr. Duncan isn’t the first, and he certainly will not be the last to get past the system—so get over it. There are far more challenges to come and lessons to learn.  This ride is just getting started.

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     Now, If you haven’t had the chance to get a healthy picture of Mr. Duncan in your mind, take a moment to push aside the ugly microscopic picture of the yarn like Ebola virus that is plastered EVERYWHERE and make a little bit of room in your heart to envision a human being who was just like you and me.

At 42 years old Mr. Duncan was a healthy, active, robust father, a brother, an uncle, a son, and he was engaged to a woman who had hoped to build a life with him. While in Liberia, he had a job as a truck driver. He had reportedly quit his job suddenly, without warning, to come to the U.S—allegedly to reunite with his family and be married.

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It’s quite a different picture isn’t it? Far from the vivid, overly descriptive timeline of events leading towards his death that really do nothing to preserve Mr. Duncan’s privacy or dignity, or to encourage the world to view him as human rather than a diseased body ravaged with explosive diarrhea, projectile vomiting and a deathlike mask on his face toward the end of his life.

Personally I find these articles insensitive and inhumane. This man, who risked his life to rescue another one does not deserve to be remembered in such a way nor more than you and I do. Mr. Duncan lived a life. Not only did he live a life, he left one hell of a legacy.  In his last days he showed us an example of innate goodness, he left a foot print in the world that I am quite sure transcended way beyond the illness that ultimately killed him,  the fact he was the first person to die of the virus in the U.S., or that he was the first person to “bring it” into the U.S.

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Before Ebola, Thomas Eric Duncan lived a life. He did not live an “infectious life.” He loved, and he was loved. He got up every day and went to work to make a living like the rest of us and he did so—without being “infectious.” He probably socialized with friends and family all the time without being “infectious.” His essence, what transcended beyond this physical world, did not depart from us “infectious.”

I strongly discourage journalists, doctors, nurses, and any other healthcare personnel from dehumanizing people who are afflicted with this terrible virus and to remember that we are all human beings FIRST. This message is specifically aimed at AP Reporter Kieran Corcoran who summed up Mr. Thomas Eric Duncan as “infectious in life as he was in death.”  You got it so wrong. He gave his life to help someone else and he did it without question, without hesitation. In my book, that’s the definition of an act of honor, of selfless sacrifice, it’s the fearless act of a Hero.

Everyone deserves to be remembered for something good they did in life—let THESE be the LAST WORDS that sum up Thomas Eric Duncan, THE PERSON:

“We should all be so brave and so giving in this life.”

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This Round Is On Us! (In more ways than one)

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Your tax dollars at work Arizona, courtesy of the July 2014 Arizona Board of Nursing Minutes, this is your tax dollars protecting you and the public’s safety. This could have been your grandmother, or aunt, or best friend, or sister or wife……: “VI.L.3. L C P RN1X979X (Hunter) Hunter addressed the Board with additional information. P and attorney Aaron Bradford were present telephonically and addressed the Board. Quinn moved, Snider seconded, to issue a Letter of Concern for a medication error made on or about May 1, 2009, while employed at Northern Cochise Community Hospital in Wilcox, Arizona, Respondent mistakenly administered Dilaudid 2 mg intravenously into patient A.A., a 93-year old female, resulting in respiratory arrest and death. After discussion the motion carried with eight in favor and one opposed.”

*Letter of concern= no discipline. no remediation or supervision or precepting deemed necessary.

LET ME MAKE ONE THING CRYSTAL CLEAR: MY BLOGS ABOUT THE AZBON’S RULINGS ARE NOT—LET ME REPEAT THAT—-ARE NOT—–ABOUT ATTACKING NURSES. I DO NOT BELIEVE IN THAT. WHAT I DO BELIEVE IN IS EQUITY IN DISCIPLINE AND AT THE VERY LEAST SOME KIND OF REMEDIATION FOR OFFENSES SUCH AS DUI, COMING TO WORK IMPAIRED, OR REMEDIATION WHEN THERE IS A LOSS OF LIFE AS A MEANS TO REVIEW CONCEPTS SUCH AS SAFE MEDICATION ADMINISTRATION, TIME MANAGEMENT SKILLS, OR A PERIOD OF PRECEPTING TIME TO ENSURE OR REDUCE THE LIKLIHOOD OF ANOTHER LOSS OF LIFE.

I DO NOT, ABSOLUTELY DO NOT—BELIEVE IN PERSECUTING NURSES FOR YEARS ON END WITH COMPLEX YEARS LONG DISCIPLINE THAT KEEPS THEM OUT OF THE FIELD, NOR DO I BELIEVE IN INFLICTING GUILT ON A NURSE. I AM AGAINST IT. WHAT CONCERNS ME IS THE LACK OF REMEDIATION THAT OCCURS ON CASES THAT INVOLVE THE DEATH OF A FETUS OR ANY OTHER LIFE. THERE ARE WAYS TO MAKE HEALTHCARE PROVIDERS GO THROUGH PROGRAMS TO EDUCATE ABOUT DRUNK DRIVING, OR COMING TO WORK INTOXICATED, AND THERE ARE REFRESHER COURSES OFFERED AT COMMUNITY COLLEGES TO REMEDIATE SKILLS.

TO NOT DO “ANYTHING” AT ALL, AND FOR THE LOSS OF LIFE TO NOT EVEN BE RECORDED ON A NURSES RECORD WHEN MUCH LESSER OFFENSES ARE RECORDED ON OTHER NURSES LICENSES IS WHERE I HAVE A PROBLEM. THAT IS INEQUITY OF PRACTICE. IT IS FUNDAMENTALLY  UNFAIR TO THE NURSES IN THIS STATE TO TREAT ANY NURSE DIFFERENT FROM THE OTHER FOR THE SAME OFFENSES. I AM THE FIRST TO STAND WITH AND FOR ANY NURSE IN TROUBLE AND WILL CONTINUE DOING SO, WITHOUT JUDGEMENT. BUT WHAT I WILL NOT DO, IS STOP SPEAKING OUT ABOUT THE GRAVE INEQUITIES IN THIS STATE WHEN IT COMES TO DISCIPLINING NURSES. TOO MANY CAREERS HAVE BEEN RUINED AND TWO TOO MANY NURSES HAVE TAKEN THEIR LIVES AS A RESULT OF THE BOARDS ACTIONS AGAINST THEM.

I DO—-HAVE A PROBLEM WITH THAT.

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Here is something interesting and informative for all you community activists and leaders and patient advocates. Repeat DUI and Extreme DUI’s are on the rise the past couple of years and there is no remediation or consequences for driving while impaired over at the AZBON.  For a State agency that touts the phrase “unprofessional conduct” as often as possible it seems that healthcare providers getting arrested for a DUI, repeat DUI, or EXTREME DUI certainly constitutes conduct unbecoming as well as unprofessional. During one recent board meeting, one of the members said “when you get a nursing license, it means you keep that in consideration 24 hours a day 7 days a week, not just when you are at work. You are a licensed nurse at all times.”

 

My question still looms in the iCloud somewhere up there: Why is it that some nurses who have CLEARLY broken the Nurse Practice Act in the grossest ways possible are allowed to go without any discipline or remediation whatsoever,  such as the DUI’s,  working while impaired, and those found responsible for the deaths of patients or full term stillbirths, or neglect/abuse of elders and others who have never harmed patients and make much lesser mistakes or speak up to advocate for their patients pounded on to the point of revocation the more they fight the charges against them? Its as simple as this, and why I am so passionate about justice— there are too many nurses hurting here in Arizona…..just today I was advised that a nurse who has supported me for quite some time on my Blog, Twitter, and Facebook was forced to choose between license revocation or a surrender of license for a set amount of years because they posted their opinions about the AZBON on my Facebook page.

 

Yet another question floating around up there in my own personal iCloud: Just what is  RESPONSIBLE AND ETHICAL STEWARDSHIP of state resources when it comes to protecting the public’s safety and well being? Spending HOURS AND DAYS OF STATE TIME monitoring the social media account of a nurse whose license THEY HAVE ALREADY REVOKED FOR NOT SHUTTING UP ABOUT HER AND HER PATIENTS UNFORTUNATE STORY and the nurses that COMMENT ABOUT THE BOARD……or focusing the state’s time and resources on the REAL DANGEROUS PEOPLE they keep letting go, or the DANGEROUS INCIDENTS that go unremediated and DO POSE A THREAT TO THE PUBLIC SAFETY AND WELL BEING???

 

And lastly, when does the monitoring/stalking of a person stop? You’ve taken the license, you’ve made your point. So, now what is the point of continuing to conduct surveillance of all my social media accounts looking for anything that can be used to prosecute me, or to find nurses who say negative things about the Board to discipline in order to keep them scared and quiet? It seems to me that scoping out the social media accounts of a FORMER RN WHOSE LICENSE YOU YANKED FOR ADVOCATING FOR PATIENT SAFETY is outside the scope and mission of a state agency that is charged with protecting the public’s interests—-NOT THEIR OWN PERSONAL ONES.

 

Here is an idea:  IF YOU DONT LIKE WHAT YOU READ THEN YOU DONT HAVE TO VISIT MY BLOG, OR MY OTHER SOCIAL MEDIA ACCOUNTS—ITS THAT SIMPLE. NOW, PUNISHING NURSES WHO COMMENT NEGATIVELY ABOUT A STATE AGENCY OR OFFICIALS THEREIN WHO CHOOSE TO TAKE ON THEIR PUBLIC POSTS KNOWING FULL WELL THEY WILL BE PRIVY TO PUBLIC CRITIQUE IS IN AND OF ITSELF—UNETHICAL. PERHAPS SOME OF YOU NEED TO RETHINK WHO YOU ARE ASSIGNING TO GO SIT IN THOSE COURSES AT THE Lincoln Center for Applied Ethics at Arizona State University. After all, it wasn’t ME who struggled to answer the questions related to the major concepts within the Code of Ethics for Nurses in Administrative Court or who couldn’t identify even two of the core provisions. It seems to me that if you cant recall or even apply those very important provisions to whatever it is you do over there, then its sort of weird that you assign nurses who probably know way more about the application of the Code of ethics to daily practice than you—to take healthcare ethics courses at ASU. Just something to ponder….after all, a State Regulatory Agency charged with “protecting the public” should probably be up to speed on the whole ethics thing.

 

My research continues. Its amazing all the wonderful things one can find in the State Archives.

Arizona Republic: Call for Submissions–Nurses here’s your chance

Pat Flannery, Journalist/Editor

—Dear Arizona Nurses or TRAVEL NURSES, and Healthcare Consumers—-

Here is your chance to impact how government works and how their practices, policies, and “rules” affect you, your civil rights, or how you live your daily life, and most importantly your perception of safety while practicing as a Registered Nurse not just in this state but as a Travel Nurse. If you have had personal experiences with the Arizona Board of Nursing, or the Medical Board and want to contribute to this Editor please do so using the information below.  Speaking up and speaking out is the only way change wlll be made to current practice environments and the ability to practice with confidence, awareness, and with a sense of security that you don’t have to be fearful. In order for that to happen, stories have to be heard and too many of you in Arizona have relied on telling me your experiences “in secret.” While I respect your privacy and will protect that at all costs…..this does nothing to get the issues out there and the problems that plague our profession in Arizona fixed. Ask for anonymity when you share your story……what could it hurt? If you can tell your story and be heard and feel safe doing it under cover what is there to lose? Healthcare consumers, if your complaints and reports have gone ignored= Please consider the following article that was published in the Arizona Republic today Sunday September 21, 2014……..I cannot make change in this state for nursing alone. I cannot get a bill passed to protect you, alone. Please consider stepping forward and telling your story. Thank You.

Michelle Lee, Investigative Journalist

Michelle Lee, Investigative Journalist

Pat Flannery, Journalist/Editor

Pat Flannery, Journalist/Editor

 A look at how government regulates lives

“Like it or not, government has a larger role in our lives than we might imagine — more than levying taxes, building roads and seeing to the mundane day-to-day activities of governance.

Part of The Republic Watchdog Center’s mission is to keep an eye on the broad range of government activities. Michelle Ye Hee Lee, a reporter on the Government Accountability Team, has an especially focused role: writing about issues and places where government activities intersect with the everyday lives of citizens. In effect, she writes for and about “consumers” of services regulated by government.

It is in that capacity that she began some weeks ago to examine the role of regulatory bodies in Arizona. How many are there? How do they operate? What are they supposed to do?

You might be surprised at the number — at least 50 — and a variety of agencies, boards and commissions that regulate economic and professional activities in Arizona.

Some are better known than others. For example, most people know about state boards that license, regulate and handle complaints about contractors, physicians and nurses.

But how many know that there is an Arizona Regulatory Board of Physician Assistants? In fact, there are licensing/regulatory boards for nearly every health profession — behavioral-health examiners, dentists, optometrists, osteopaths, pharmacists, physical therapists, podiatrists, respiratory care examiners and so on.

How ’bout the Arizona Radiation Regulatory Agency? Or the Arizona Board of Athletic Training?The list of professions or activities regulated in Arizona includes accountants, acupuncturists, appraisers, architects, barbers, chiropractors, cosmetologists, dispensing opticians, funeral directors and embalmers, homeopaths, massage therapists, naturopaths, occupational therapists, speech pathologists and veterinarians.

That doesn’t include agencies that regulate entire industries, such as the state Departments of Health Services, Insurance, Agriculture, Environmental Quality, Financial Institutions, Housing, Real Estate, Liquor Licensing and Racing. There’s even an Office of Pest Management that “licenses, educates and regulates the pest management industry.”

Some of these agencies are funded through the state general fund. But many of them are funded largely through licensing fees charged to those they regulate. They have varying degrees of regulatory clout, and that is often determined by how many employees they can afford to hire.

Lee is taking the time to learn about these many creatures of statute. And this is where you, the reader, can help. If you are a professional regulated by one of these boards or agencies, or you are a citizen who has interacted with one of them, we’d like to hear about your experience.

This is your opportunity to contribute to coverage of a complex subject that affects us all.

Tell Lee what type of business you had with regulators, what you liked or disliked about the experience, any thoughts you have on their regulatory policies and if you were satisfied with the outcome. By the same token, let her know if you feel you or your concerns have fallen through the regulatory cracks, the victim of some loophole that left your problem unresolved.”

Lee can be reached by e-mail at ­michelle.lee@arizonarepublic.com, via Twitter at @myhlee or by phone at 602-444-8290.

ABOUT THE WRITER

Pat Flannery,senior editor for government accountability, has been a Phoenix reporter and editor for 33 years. More than two-thirds of that was spent covering government in its various forms.

How to reach him

pat.flannery@arizonarepublic.com

Phone: 602-444-8715

Twitter: @Azcflan

ARIZONA TRAVEL NURSE ALERT

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UPDATE on Alleged Set up:  I have discovered today after some independent investigating that the nursing instructor who allegedly set me up and turned me over for prosecution of a criminal felony charge is advertising themselves as an MD and “Doctor” when they do not have a PhD or a Doctorate of Nursing Science. Nowhere on social media or in my search did I see any further education than NP-C. So not only did I see they have been a member of the board since 1996, that they are teaching nursing students, but now I am finding out they are doing the same thing which they accuse me of—THAT is the CULTURE here.

THIS  IS WHY I SAY NOT TO COME TO ARIZONA TO PRACTICE OR GO TO SCHOOL OR GET LICENSED.

If you read my blog, and like what you read or agree with it and want to comment, PLEASE do so via email at FYRHONEYBSN@yahoo.com ONLY.  Recently a travel nurse who liked my posts was contacted less than 24 hours later by the Arizona Board of Nursing informing them that they had a complaint against them. They hadn’t been on assignment here for a few years and are in another state now.  I think we are number 5 in the nation for revocations, not as bad as Texas, but still significant… its TOO RISKY to come here as we are not a pro nurse or nurse friendly state. There is just not enough protection or checks and balances, OR A UNION,  and Id hate to see any nurse get trapped here away from their home state…. I am advising that you not “like” my postings so that your name or other identifying information is displayed for the AZBON to look up in their database. I will be happy to welcome and respond to you privately for your protection. Please follow the same advisement on Linked In. Thank You.

The Arizona BON: Ilegally Framing Nurses to Prosecute? E-Trail!

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PLEASE NOTE: I AM TAKING EVERY ACTION TO CONFIRM WHAT I KNOW AND CONSULTING THE RIGHT PEOPLE TO CONFIRM THINGS BEFORE I BEGIN TO CONSIDER FILING CHARGES.

 

***RECALL THAT IN THE CEASE AND DESIST LETTER AND THEIR STATEMENT TO THE OMBUDSMENS OFFICE OF ARIZONA, THE AZBON SAID THE PUBLIC WAS COMPLAINING THAT I WAS MISREPRESENTING MYSELF AS AN RN. I DIDNT THINK THAT THE PUBLIC INCLUDED THE MEMBERS OF THEIR OWN STATE AGENCY FABRICATING EVIDENCE TO TRY AND PROSECUTE ME***

On August 15, 2014 I was approached by an individual on Linked In who asked If I was a “former mayo clinic rn” I responded with “Yes.” She said “Great, I have a legal case I need some help with are you interested?” I told her “Absolutely glad to help! Im excited!” She told me she would be getting back to me within 24 hours with the details of what she would need me to help with. The very next day, August 16th, I received an email from her stating “we will no longer be needing your services, I just looked up your nursing license.” Stunned, I emailed her back and responded “you asked for a former Mayo RN, you didn’t ask me if I was currently licensed or that licensure was a requirement for the consulting job to look at this case. Had you asked me I would have told you I was unlicensed from the start.” I never received a response back.

On September 5, 2014–a Saturday I received the Cease and Desist letter from the AZBON threatning me with a Class 6 felony conviction for impersonating a Registered Nurse on Linked In.

On September 7, 2014 I went to the State Ombudsmens office to add this in to the complaints I currently have pending against the AZBON (as others do) and to discuss the letter sent to me. The Assistant Ombudsmen emailed me later in the day with a copy of the desktop screen shot of what the AZBON was saying was my Linked In Profile—only the entire top half of the Linked in profile had been cut off–the part with my picture and current work as a legal assistant and dachshund rescue volunteer and foster mom. In her email to me she told me the AZBON had good cause for concern because I was misrepresenting myself this way . I responded back telling her exactly what she was looking at and why this was a doctored document to make it reflect I was putting Registered Nurse at the TOP of my Linked in Page.

On September 12, 2014 I had some time to print out that document and look closer at it. Upon further inspection with a magnifying glass I found that the user was someone from Scottsdale Community College Faculty, and that the date and timestamp of the screen shot match the date the “rejection message” was sent to me on Linked In. The tab in the background was an Outlook tab and had the first initial of the persons name and the first three letters of the persons name. In addition to this, I continued  scanning with the magnifying glass and discovered that inside the browser box were the big letters ”OUT OF NETWORK” so it seemed to me this was coming from a MCC server.

Today, September 13, 2014 I bought a premium version of Linked In to investigate further and located the user—it was the exact person who sent me the query asking me for help on a case she wanted my help with. NOT ONLY was it the same person, but they were indeed faculty at Scottsdale Community College AND UPON FURTHER SCROLLING DOWN THE PAGE I DISCOVERED THAT THIS PERSON IS CURRENTLY EMPLOYED BY THE ARIZONA STATE BOARD OF NURSING SINCE 1996.

 

09/20/2014 UPDATE: Upon further exploration TODAY I found that the same community college nursing instructor who allegedly framed me in order for the board to have me prosecuted is actually ADVERTISING THEMSELVES AS AN MD/DOCTOR when they are not a Doctorate prepared practitioner, nor do they have a DNSc on a website targeted for patient and physician networking “RateMD.com” the individual refers to themselves as an “NP” in small letters and in all bigger fonts, refers to themselves as “Dr.” or MD.

 

I AM EXTREMELY DISTURBED THAT THE STATE OF ARIZONA WOULD ALLOW THIS KIND OF BEHAVIOR, THE GROSS MISUSE OF AUTHORITY AND POWER, THE UNETHICAL ACTIONS THAT HURT CONSTITUENTS, THE ILLEGAL ACTIONS THAT COULD HAVE RAMIFICATIONS ON ONES LIFE FOREVER—SIMPLY FOR THE CASE OF “GETTING EVEN” OR TO SLANDER ME FURTHER.

 

LAWMAKERS—-WHEN WILL YOU DO SOMETHING ABOUT THIS? WHEN WILL YOU STOP THEM FROM HURTING MORE PEOPLE????

 

IM FACING A CLASS 6 FELONY AS A RESULT OF AN OVERT SET UP BY A STATE AGENCY? HOW IS THIS LEGAL? HOW IS THIS RIGHT?

 

 

 

 

Healthcare Ethics and Responsible Leadership: A Primer on the 1st Amendment

Joey Ridenour, Executive Director of the Arizona Board of Nursing

When one is appointed to a state government office that is charged with the unique and overwhelming task of protecting the public’s health, safety, and well being– that kind of power must be used wisely,  responsibly, and ethically.   In what has been deemed an unprecedented show of unchecked Arizona state government “muscle,” the Board of Nursing has plastered my name on the front page of their official website as a nurse imposter. I’m sure by now most of you who have read my most recent blogs have read the facts I have made public with regards to what has happened at their past board meetings, their inequity in disciplining nurses, allowing some to skate and others to fry without rhyme or reason, and their tendency to stalk nurses on social media in order to set them up for further prosecution. So far, my past postings have been based purely on fact, and my own experiences and opinions of what happened to me. In fact plenty of Supreme Court Judges have opined to the fact that we as United State Citizens have the inalienable right and freedom to openly criticize federal or government officials and/or agencies. I will provide some quotes from the Supreme Court opinions later in this posting.

For now, lets address this imposter situation. For the longest time a gentleman named Mark Fairall had been trying to get an imposter nurse, Claudia Marquez, prosecuted for her illegal activities and for her alleged involvement in the deaths of numerous seniors at Sun Grove Village, located in Phoenix. His pleas were ignored by AZBON Executive Director Joey Ridenour— and Claudia Marquez was never prosecuted by the Arizona Attorney General, nor was she ever investigated or arrested for her activity.

CLAUDIA MARQUEZ: Imposter nurse at Sun Grove Resort Village continues to beak the law by misrepresenting herself as a Nursing Director but Arizona Officials do nothing.   Cheers, Claudia, crime does pay in Arizona.

CLAUDIA MARQUEZ: Imposter nurse at Sun Grove Resort Village
Cheers, Claudia, crime does pay in Arizona.

Now, let us all examine  the actions Joey Ridenour has taken toward me as an “imposter.” Threatening me with a Class 6 Felony conviction? For publicizing the truth? (Because we all know why Joey is doing what she is doing, they hate my blogs. They hate that I am researching them and publishing my findings) This has nothing to do with my failure to update my resume on Linked In. It has everything to do with straight up retaliation against a constituent that they are paid to protect—and not harm. After all, I have said many a time now that I am now a tax paying citizen they have no jurisdiction over any longer. THEY get paid to protect ME now. Combing through my Linked In and stalking my social media accounts WITH STATE MONEY demonstrates their clear intention of retaliating and threatening me for not only filing an official complaint against them that is still under investigation at the State Ombudsmens office, but for publicizing the past ten years of board decisions, and in my opinion–harmful, unethical actions that have hurt countless colleagues of mine all over Arizona.

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So what does the United States Supreme Court have to say about my right (and all nurses rights) to free speech and being protected from harm for publicizing my opinions and not very flattering public information about the Arizona Board of Nursing? (By the way a recent judgement in the 9th Circuit Court of Appeals agrees) Read On:

Barr v. Matteo, 360 U.S. 564:

“Analagous considerations support the privilege for the citizen-critic of government. It is as much his duty to criticize as it is the official’s duty to administer.” “The censorial power is in the people of the government, and not in the government over the people.” It would give public servants an unjustified preference over the public they serve, if critics of official conduct did not have fair equivalent of the immunity granted to the officials themselves. We conclude that such a privilege is required by the 1st and 14th amendments.”

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Craig v. Harney, 331 U.S. 367; Wood v. Georgia 370 U.S. 375:

“If judges are to be treated as ‘men of fortitude able to thrive in a hardy climate, surely the same must be true of other government officials, such as elected city commissioners…Criticism of their official conduct does not lost its constitutional protection merely because it is effective criticism, and hence diminishes their official reputations.”

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NAACP v Button 371 U.S. 415 referenced by Court of Appeals for the District of Columbia Circuit in Sweeney v. Patterson:

“Judge Edgerton spoke for a unanimous court which affirmed the dismissal of a Congressman’ s libel suit based upon a newspaper article charging him with anti Semitism in opposing a judicial appointment. He said: Cases which impose liability for erroneous reports of the political conduct of officials reflect the obsolete doctrine that the governed must not criticize their governors. The interest of the public here outweighs the interest of appellant or any other individual–the protection of the public requires not merely discussion, but information. Political conduct and views which some respectable people approve, and others condemn, are constantly imputed to Congressmen…errors of fact, particularly in regard to a man’s mental states, and processes, are inevitable. Injury to official reputation affords no more warrant for repressing speech that would otherwise be free than does factual error. Where judicial officers are involved this court has held that concern for the dignity and reputation of the courts does not justify the punishment as criminal contempt of criticism of the judge or his decision.” “This is true even though the utterances contain half truths and mis information.” (Pennekamp v. Florida, 328 U.S. 367)

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Cantwell Vs Connnecticut 310 U.S. 415: “But the people of this nation have ordained, in the light of history, that, in spite of the probability of excesses or abuses , these liberties are, in the long view, essential to enlightened opinion and right conduct on the part of the citizens of a democracy…That erroneous statement is inevitable in free debate and that it must be protected if the freedoms of expression are to have the “breathing space” that they “need to survive”

Cf. Speiser v. Randall 357 U.S. 513 “The constitutional protection does not turn upon ‘truth, popularity, or social utility of the ideas and beliefs which are offered”

Chief Justice Hughes concurring Opinion in reference to New York Times v Sullivan:

“Imperative is the need to preserve inviolate the constitutional rights of free speech, free press, and free assembly in order to the maintain the opportunity for free political discussion, to the end that government may be responsive to the will of the people and that the changes, if desired, may be obtained by peaceful means. Therein lies the security of the Republic, the very foundation of constitutional government…”

Mr Justice Goldberg concurring Opinion in reference to New York Times v Sullivan 1964:

“In my view the 1st and 14th Amendments to the Constitution afford the citizen and to the press an ABSOLUTE UNCONDITIONAL PRIVLEGE to criticize official conduct despite the harm which may flow from such excesses and abuses. The prized American right “to speak ones mind” about public officials and affairs needs “breathing space to survive” The right should not depend upon a probing by the jury of the motivation of the citizen or press. The theory of our Constitution is that every citizen may speak his mind and every newspaper express its view on matters of public concern, and MAY NOT BE BARRED FROM SPEAKING OR PUBLISHING because those in control of government think that what is said or written is unwise, unfair, false, or malicious. In a democratic society, one who assumes to act for the citizens in an executive, legislative, or judicial capacity must expect his (or her) official acts will be commented upon and criticized. Such criticism cannot, in my opinion, be muzzled or deterred by the courts at the insistence of public officials under the label of libel.”

Black, J. Concurring Opinion (Justice Black) In reference to New York Times v Sullivan 1964:

” I concur in reversing this half million dollar judgement against the New York Times Company and the four individual defendants. In reversing, the court holds that the Constitution delimits a states power to award damages for libel in actions brought by public officials against critics of their official conduct. I base my vote to reverse on the belief that the 1st and 14th Amendments not merely “delimit” a State’s power to award damages to “public officials against critics of their official conduct,” but completely prohibit a state from exercising such a power. The court goes on to hold that a state can subject such critics to damages if “actual malice” can be proved against them. “Malice,” even as defined by the court is an elusive, abstract concept, hard to prove, and hard to disprove.

The half million dollar verdict does give dramatic proof, however, that state libel laws threaten the very existence of an American Press virile enough to publish unpopular views on public affairs and bold enough to criticize the conduct of public officials. The factual background of this case emphasizes the imminence and enormity of that threat…In my opinion the Federal Constitution has dealt with this deadly danger to the press in the only way possible without leaving the free press open to destruction—by granting the press an absolute immunity for criticism of the way public officials do their public duty….

I agree with the Court that the 14th Amendment made the 1st applicable to the states. This means to me, that, since the adoption of the 14th Amendment, a state has no more power than the Federal Government to use a civil libel law or any other law to impose damages for merely discussing public affairs and criticizing public officials. The Power of the United States to do that is, in my opinion, nil. Such was the general view when the 1st Amendment was adopted and ever since….We would, I think, more faithfully interpret the 1st Amendment by holding that, at the very least, it leaves PEOPLE AND THE PRESS free to criticize officials and discuss public affairs with impunity.

This nation of ours elects many of its important officials; so do the States, the municipalities, the counties, and even many precincts. These officials are responsible to the people for the way they perform their duties. Freedom to discuss public affairs and public officials is unquestionably, as the court today holds, the kind of speech the 1st Amendment was primarily designed to keep within the area of free discussion. To punish the exercise of this right to discuss public affairs or to penalize it through libel judgements is to abridge or shut off discussion of the very kind most needed. This nation, I suspect, can live in peace without libel suits based on public discussions of public officials. But I doubt that a country can live in freedom where its people can BE MADE TO SUFFER PHYSICALLY OR FINANCIALLY for criticizing their government, its actions or ITS OFFICIALS.

For a representative democracy ceases to exist the moment the public functionaries are by any means absolved from their responsibility to their constituents, and this happens whenever the constituent can be RESTRAINED IN ANY MANNER FROM SPEAKING, WRITING, OR PUBLISHING HIS OPINIONS upon any public measure or upon the conduct of those who may advise or execute it.

An unconditional right to say what one pleases about public affairs is what I consider to be the minimum guarantee of the 1st Ammendment…..”

IMPOSTER ALERT

In conclusion, Joey Ridenour and Valerie Smith, it appears as if you don’t have enough to do over there at the BON offices, or really dangerous nurses to prosecute and investigate to be spending all the man power hours and financial resources the state gives you on a nurse whose license you revoked a few months ago. Surely there are more pressing matters to attend to in the “protection of the public”

Hear this: I KNOW this is NOT about Linked In—everyone knows this. In fact, its painfully obvious, so much so that even I am embarrassed for you. You are not only harassing a state citizen and threatening them with harm by threatening their ability to pursue and keep gainful employment, but you are also attempting to prosecute me for using my voice, publishing my opinions of your policies and procedures, your past board decisions, my opinions of my experiences with your agency, and publishing the opinions of nurses you have harmed all across Arizona. The United States Supreme Court says you cannot do that. But then again, you don’t seem to care about the law.

     I do. I have the right to make a successful living, to be off of welfare and food stamps and AHCCCS, to support my family. I have the right to express my views, I have the right to be a contributing member of this society, and I have the right to use my nursing training and my TWO nursing degrees to the best of my ability as a means to continue helping people in other ways. I earned those degrees, and you DO NOT have the right to keep me from using that education for the benefit of the greater good, for those who need my help, for those who wish to be empowered by learning from me.

Let me make this clear: You no longer own me. You no longer have a say in my life. You no longer scare me. Whatever moves you make toward me with the intention of thwarting, harming, or threatening my security and ability to make a living will not go unanswered or unpublished. You are a Board of Nursing, that’s it—YOU ARE NOT GOD.

The AZBON: We’re turning you over to the Attorney General

Joey Ridenour, Executive Director of the Arizona Board of Nursing

Yep. I just received a certified “Cease and Desist” letter in the mail informing me that I am

1. Being accused of misrepresenting myself as a nurse to the public

2. Practicing as a Registered Nurse

3. Am not allowed to refer to myself as a “nurse” (though I hold two nursing degrees)

(Which, by the way, couldn’t come at a worse time since my health has been crappy and Im being ruled out for Pelvic Cancer)  Yeah, thanks for the added fun AZBON.

All this based on a review of my Linked in Professional History profile and Bio of past work history and my blog.

Executive Director Joey Ridenour has officially forwarded this complaint to the Arizona Attorney General for a class 6 felony prosecution.

I think the AZBON has just taken things a bit too far in trying to shut me up.

 

IMPOSTER ALERT

 

Joey Ridenour—would you really dare to put a single mother just getting back on her feet with a new job and a steady roof over her head back down into the hole again just for the sake of retaliation? And for revealing the truth of what is in your board meeting minutes? And for revealing the grave inequities in how you discipline nurses? With a salary from the state in six digits I’m sure destroying my life is of no consequence to you, nor is destroying my daughter or my family of any consequence to you. But what I will say is that you people over there have absolutely no sense of ethics, compassion, fairness, or sense of right and wrong.

This, however, will not scare me. I am not working as a nurse, and I have openly discussed my career move away from nursing and my license revocation on my blog, my facebook, and linked in–as well as several media interviews. What you are doing in threatening me with a Class 6 felony is just evil, and its sick.

 

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State Lawmakers, nursing community, healthcare consumers: This is a classic case of retaliation against a nurse for speaking out, speaking the truth, and revealing what has been in the dark for far too long.

 

A Class 6 Felony, they really do want to disable me in every possible way. They really do want me to go dive off of a cliff somewhere and disappear. They really are—trying to destroy me.

 

Bring it on. I’m not afraid. I’m living an honest life. And for you to threaten to even take that from me you show the world WHO YOU REALLY ARE.

Question for you: Are you ever scared of what you will have to answer to at the end of your life? Of what you will have to own up to?

 

I’m not.   AND I WILL CONTINUE TO SHED LIGHT . I WILL CONTINUE TO PROTECT MY COLLEAGUES. I WILL CONTINUE TO PURSUE LEGISLATION THAT PROTECTS THEM AND PATIENTS!

 

That is not a threat—ITS A PROMISE.

 

Venomous Val Wields Her “Super Subpoena Sword”

Valerie Smith: Special Consultant to the executive director

In a special edition of Nurseinterupted’s reporting on the oh so ethical activities at the Arizona Board of Nursing we will discuss a subject that seems to come up time after time with nurses who email me, meet with me, or call me to ask advice about how to deal with the board process and the board members themselves—chiefly Valerie Smith,  Joey Ridenour, and the concept of “terror.” Here are the three questions I get the most from nurses currently caught up in the web: “How do I go in there and face them? Do I really need to be scared of them? How am I supposed to look/act with Valerie and/or the Executive Director Joey Ridenour?

What’s the inspiration for this posting? Well, it seems that the Consultant to the Executive Director of the AZBON, Valerie Smith, is up to her shady shenanigans once more—-this time, threatening her endless subpoena power and ability to dig deep into a nurse’s past. Tax payers, pay attention===this is your tax dollars at work, equipping the AZBON with the resources and man power to conduct random, lengthy, unnecessary irrelevant witch hunts. Arizona Lawmakers: Here is where a big chunk of your state budget flies out the window. You want a place to trim the budget a little? Try checking out the overuse of resources within your state regulatory boards, more specifically, my favorite one. I mean how do you put people in power who threaten endless subpoena abilities??? What is that?  Two words for you lawmakers: “Sunset Clause”—I highly suggest ya’ll peruse it right about now.

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     Nurses. If you haven’t inadvertently killed, injured, or neglected someone, been caught stealing drugs from your workplace, or come to work drunk or high there is ABSOLUTELY NO REASON to walk through those glass doors at the Board of Nursing feeling less than confident in the nurse that you know that you are and the person you know you are in the world. You are a human being. Human beings make mistakes. Nurses are not above mistakes, they are not preprogrammed robots incapable of screwing up now and then. Hell, look at my past blog postings reflecting some of the most horrendous Board rulings in the past ten years. If that isn’t screwing up, I don’t know what is. In fact for all intents and purposes, they failed to fulfill the Arizona Legislature’s Requirements over and over again!

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      Our practice environments are more stressful and dangerous than ever. That aside—- Always remember there is more to you than just the role of a nurse—-some of you are mothers, fathers, husbands, wives……perhaps you head up ministries at your church, or volunteer helping animals (like me), or volunteer helping other nurses heal from the traumas of the workplace (an unlikely role I fell into as a result of my ordeal). The point is, YOU ARENT A CRIMINAL. You aren’t walking into the Supreme Court wearing Sheriff Joe’s striped attire, pink socks, flip flops, and handcuffs. You are a professional going in there to tell your side of things. To have your say. So act like it. You’ve been the captain of the ship on your twelve hour shifts, managing, coordinating, and supervising countless things, people, activities, etc. You’ve personally kept one or more critical patients alive shift after shift after shift. You actually know MORE about the latest evidence based practices and current barriers to safe patient care than those interrogating you! Here’s an example: During my cross examination of Valerie Smith, she could not tell me even a few of the barriers to safe nursing care or patient safety issues. And the ANA Code of Ethics for Nurses? When asked to provide me some of the major points within that important document, she was unable to do so. And yet, it was me they accused of having no sense of ethics or ability to apply basic ethical principles to my nursing practice.

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      Lets be real, NOTHING is harder than what nurses do these days on patient care units all over the country, so don’t blow up a meeting at the AZBON as something greater than all that in your head until you are literally puking your way there and on the verge of imploding as you sit in the tiny waiting room anticipating your name being called. Yes, this is what they want. Yes, the room is tiny. Yes, its stuffy as hell. But for a reason….. I prefer the small board room myself, there is more room to breathe and I am able to better manage my energy field with space. (but you don’t get a choice, sorry, THAT room is reserved for the real special troublemakers like me)

The Key Word Is: Human. Every single body walking around that stifling monotone place is a human being. Remember that.

Here is a response to one of my blogs and my response—-hopefully it will provide some insight and help empower you through your own experiences with the AZBON

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Dear NURSEINTERUPTED:

I have a relative who is currently under investigation for not following proper protocol on a certain type of hospital procedure. I am afraid to mention the exact procedure as the nursing board may be reading. Val interviewed them starting with immediate intimidation about how they had the power of any subpoena they wished and had unlimited access to their past. I cannot relay the entire conversation but her every comment showed open bias from the start. I applaud your site. Someone needs to balance the scales. “Unlimited power is apt to corrupt the minds of those who possess it.”

Hello,

This isn’t the first time I have heard reports of Val Smith’s intimidation tactics at the AZBON. They are historical events in and of themselves. They literally paralyze nurses. Val’s demeanor inspires panic attacks and irritable bowel symptoms— and that’s just to start. I have some email addresses for you to write to and you can remain anonymous—-if either you or the nurse you know wants to write about their experience with the board tactics. The AZBON is being looked at from several different agencies/journalists who are currently compiling information and first hand accounts from nurses all over the state. In fact, Im compiling my own ten years worth of data to present to the legislature and publish in my book.

My best advice for your relative is to always remember that my old BFF Val is a human being just like the rest of us===she urinates and defecates and showers and puts on her clothes every day like all the rest of us. She has not been at the bedside in nearly twenty years, and her primary background consists only of psych nursing and disciplining/regulating nurses. If she were to be put on a nursing floor tomorrow and was expected to take a load of patients on a general med surg unit or a progressive care unit, shed likely end up hurting someone. She wouldn’t be able to function as a bedside registered nurse…. this should give your relative some confidence.

     Your relative is a true “die hard, in the trenches” nurse. A nurse who probably has more insight and experience with issues facing nurses than our buddies at the AZBON ever will, because they sit in their little offices waving their wands deciding who gets to be a nurse and who does not—reference my previous blogs. If your relative needs support please have them contact me at FYRHONEYBSN@yahoo.com. Ive personally met with many a nurse from all over the state who come to Phoenix sometimes and meet me at coffee houses or Dennys or churches—just to talk and ask me questions.

     Ive been here for support and to provide my experiences with Val in order to help others “endure her MO.” I actually had the opportunity to cross examine her myself in administrative court and it was probably one of the most empowering days of my life. A couple of hints: She hates full on direct eye contact that holds her gaze, she hates a firm confident voice/response from nurses, she hates a nurse that has the facts behind them and who knows the game being played. She hates a nurse who knows the law. She hates a nurse who can hold a debate with her. Lastly, Val hates a nurse she cannot sense fear in.

     Ive spent a great deal of time studying Val the past couple of years. A word to the wise===if Val senses fear she will take advantage of that. Its where a nurse can slip up and come off looking less than credible— Which, is exactly what she wants. There is a way “around” Val, a way to “deal” with Val, and a way to “survive” Val. You gotta know what she thrives on, what her weaknesses are, expose a few of them now and then, and establish a firm hand in any conversation. You will know you have accomplished something when her face turns cherry red every time she is in your presence,  her jaw clenches tightly, and she sneaks intermittent glares at you because she can no longer hold your gaze for long.

 

     As for monitoring this blog? Yes, she most certainly does, as well as my Facebook and Twitter. Regularly. (I’m sure she is no fan of her picture showing up so frequently here either) As does the rest of the board. At one point she had a pile of my postings she wanted to “review with me because I was making them look bad.”  I promptly declined to review posts and blogs I was clearly already familiar with my own words.  I even warned them before they took my license, that taking the RN wasn’t going to keep me from using my voice, advocating for nurses and patients, or telling my story—what happened with me and my patient. I wish your relative luck. Im here if they need me for coaching anytime and to stand by them. Thank you so much for the feedback.

 

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The AZBON Takes A Military Approach

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In the latest installment of Arizona Nursing’s reality TV series, the AZBON decides to join the Army by employing new Special Ops maneuvers designed to “hide” information from its constituents. More specifically, in one of the latest board meetings it was decided to withhold the names of nurses who have their cases dismissed or who receive a “Letter of No Concern” and only publish the names and cases of nurses who are being formally disciplined with anything from a “Decree of Censure” on up to “Revocation.” Ah yes, the perfect camouflage to blend in with the Arizona desert landscaping, don’t you think? Lying in wait for the next nurse to come along……. Some of the citizens in our state who have been following my case and have followed the Board of Nursing’s activities a bit closer are irate that an agency that was set into place by the Arizona Legislature to protect the public and inform the public has made its own decision on what the public gets to read and know about and what “isn’t of their concern.” I can’t say I disagree. It is the public’s right to know who is who out there in the healthcare world, and its why people (aside from me) do actually read those minutes.

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The following letter was sent to me from a healthcare consumer who recently wrote the AZBON asking for information:

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1. The Board says it does not maintain “lists” — and yet it publicizes a regulatory journal quarterly that contains page after page of disciplinary actions and cases dismissed.

2. The Board advises that at the bottom of this letter :   “as for the reasons the nurses were reported to the board, the substance of the complaints received by the board is confidential pursuant to ARS such and such”

Really. OK. If it was truly that way then why do they maintain live streaming video of all board meetings for anyone across the nation to link in to, and why have they “listed” nurse after nurse who has to go before the Board in its Board Meeting Minutes for the past ten years?

If that’s really the case—then why is that very information publicized on individual nurses licenses, keeping them from finding gainful employment, while other nurses don’t get their complaints published?

Again, at least to me, its just another example of the AZBON playing another round of “eenie meanie monnie moe.” The last time I checked, the Arizona Legislature didn’t include that within the “powers and duties of the Board of Nursing.” Ive come to the conclusion that they assumed I didn’t have the ability (brainpower, will, IQ status)  to either read the Arizona Revised Statutes much less understand and apply it to the cases at hand.

It comes down to this: If you do it to one nurse, you do it to all nurses. It’s about justice and equality. If a nurse commits an offense and is disciplined for that offense===so should the next nurse be disciplined the same way for the same offense. If one nurse’s case is publicized to the world, all cases should be publicized to the world….

But…. I think we have  seen that this is all about the “Good ol’ girls club” in Arizona and its about who you know, how submissive or fearful you are and how willing you are to lay down and render yourself silent whether or not you get to be a nurse in this state. That has been the greatest disappointment to me throughout this whole ordeal…the sacrifice of what we are supposed to stand for and who we are supposed to protect and the oath we made to put others before self. A nurse is a nurse, whether working at the Board of Nursing, or as a nurse at the bedside. We are all connected. We are all subject to being moved by the ripple effect……whether it be in a good or bad way. But we all have a responsibility to not just the people, but to eachother, and to holding eachother accountable.

That is what this is about. And what it will always be about. They did wrong by so many of us—nurses, and patients. And now its time to be held accountable in the eyes of the public, the tax payers, the patients, lawmakers, and  peers. And you can bet I’m taking, and will take, every opportunity to do it.

Simply put, withholding the names and cases of any of the nurses who are reported to the Board appears downright shady. It makes the AZBON appear as if it has something to hide, or that they make personal and biased politically based decisions about what is in the public’s interest and what isn’t. As demonstrated in my previous blogs, the public has good cause to want to know more information about who the board is disciplining and who it isn’t. Members of the public (as well as state lawmakers) are right to begin questioning whether the agency is actually following and applying the state’s Nurse Practice Act. And so are nurses. Why? Because as the years go by, dealing with the Arizona Board of Nursing becomes more like engaging in a round of Russian roulette.

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There is a reason why they have a high rate of staff turnover. Seriously, who wants to conscientiously get up every morning, look in the mirror, and know they are about to spend the day contributing to the undoing of hundreds of nurses all over the state who worked hard to go to school and earn a living? Who wants to spend every day trying to live with what has to be done to cover things up so the Board looks pretty and shiny to the state and to the NCSBN? I mean, we can’t have Joey Ridenour looking anything less than stellar, right? Her political reputation precedes her, after all, both politically in Arizona and within the higher echelons of the profession. Quite literally the “Godfather” of Nursing in this state, attorney after attorney agree that she is so well connected  she’s “untouchable.” One staffer quoted to me that Executive Director Ridenour could “literally get away with murder, and avoid suspicion and questioning all together.” According to an attorney who works at the Board daily: “Some of my cases that I thought for sure would receive harsh discipline, because the offense warranted it, only received a slap on the hand, while others who had very minor offenses were given severe punishments.” So its of no surprise that the Arizona Board of Nursing has gotten away with some of the horrible outcomes it has in the past. Just who are they accountable to, anyway? I thought it was us. The people.

Valerie Smith: Special Consultant to the executive director

Valerie Smith: Special Consultant to the executive director

Joey Ridenour, Executive Director of the Arizona Board of Nursing

Joey Ridenour, Executive Director of the Arizona Board of Nursing

OVERVIEW OF ARIZONA’S PUBLIC RECORDS LAW

“Arizona law requires all officers and public bodies to maintain records reasonably necessary to provide an accurate accounting of their official activities and of any government funded activities. …

An officer is any person elected or appointed to hold office of a public body or any chief, administrative officer, head, director, superintendent or chairman of any public body. Public bodies include the state, counties, cities, towns, school districts, political subdivisions, or special taxing districts and any branch, department, board, bureau, commission, council, or committee thereof.

Records are defined as books, papers, maps, photographs, or other documentary materials regardless of physical form or characteristics, made or received by an governmental agency in pursuance of law or in connection with the transaction of public business and preserved by the agency or its legitimate successor as evidence of the organization, functions, policies, decisions, procedures, operations, or other activities of government. Examples of public records and other matters include calendars, reports, legal memoranda, policies and procedures, accident reports, training videos and materials, tape recordings of meetings where there are no written minutes, personnel records, case files, and data bases.

Every citizen in Arizona has the right to access public records upon request. Arizona Public Records Law specifically requires that public records and other matters in the custody of any officer shall be open to inspection by any person at all times during office hours. Public agencies are required to promptly furnish the requested information. Access to a public record is deemed denied if a custodian fails to promptly respond.

It is best to request public records from the agency that owns or created the record. It is also advised to keep the scope of your request as narrow and specific as possible. Doing so will save time and expense for all parties. “

 

Basically, if you are a nurse who gets summoned before “The Board” in Arizona, there really is no predicting what will happen— despite the process that’s explained to you or the rules set forth by the agency, the Nurse practice act, or the powers and duties administered to them by the Arizona Legislature. You’re going in blind, and there is no point in having ANY expectations. I can only surmise that the latest stealth maneuver of attempting to hide portions of their public proceedings is the equivalent of what soldiers have to do in theatre: Strategize. Do it under cover. Employ all your Special Ops personnel (assistant Attorney Generals, Attorney Greg Harris and Valerie Smith) to make sure its carried off looking clean and legal, and go back underground as soon as possible. The only problem with that is…….there’s this  thing called Social Media,  it’s not going away anytime soon, and the Boards of Nursing & NCSBN don’t have jurisdiction over the entire world wide web and everyone who uses it. They need to get over it.  What’s more encouraging—they can’t stall progress. Our world is experiencing a technological boom—and no one can keep history from happening, or technology from advancing. No matter how many tantrums you throw. Life just happens anyway, with or without your approval, participation, or presence—-No one has the power to stop the world from changing,  or nurses and healthcare consumers from catching on to the fact that the use of one’s knowledge and voice has the potential to move mountains.

 

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Regulatory Excellence: Stepping Back Into The Shadows?

Valerie Smith: Special Consultant to the executive director

While working on my research this evening I noted that in the July 2014 Arizona Board of Nursing Meeting Minutes, the Board may have engaged in yet another session of “Eenie Meanie Monnie Moe” by deciding to no longer publish its rulings pertaining to “Letters of Concern” or “Cases Dismissed” for public access within the meeting minutes as it has been done in previous years. You can access the link HERE to decipher for yourself…..This is bad for several reasons. It is not in the public’s best interest to be kept from that information because (Sorry Valerie Smith I know you hate this) they have “the right to know.” If the Arizona Board of Nursing can publish “some” outcomes, they should be publicizing ALL outcomes. Its not just about inequity, its also about allowing the citizens of Arizona and members of the profession in Arizona to keep abreast of what is truly happening in the board room. The public has a right to be able to research things of this nature, just as members of the profession do, to ensure that the state agency is doing what it has been delegated to do by the Arizona State Legislature. Or has it forgotten that its existence is purely dependent on the Sunrise/Sunset Clause as set forth by the aforementioned Legislature?

It seems to me, that this is just another example of the Arizona Board of Nursing stepping back into the shadows, hiding. It’s in their best interest to be promoting ease of access to information, rather than making the public travel down to the board building itself in order to access the “lists” of those nurses issued Letters of Concern or Case Dismissals. (If you are familiar with trying to access ANYTHING at the Board’s offices you already know its like trying to pull a watermelon out of…..well, choose “A” or “B” and lets leave it at that.) If they have the money to install and maintain the technology for live streaming on their website, and to print, publish and distribute their regulatory journals to every legislator, nurse, and their tenth cousin three times a year then they have the ability to fix this little “glitch” in transparency. My most recent blogs have highlighted a grave inequity in disciplinary measures at the Board of Nursing, some of which have allowed potentially harmful practitioners to continue to be out in the public practicing, putting the public in direct danger. If the public and members of the profession do not have the access to the information required to remain in full disclosure of an Agency that is charged with overseeing not just the safety of the public but licensed carrying providers then that indeed is a problem. Not only will the members of the nursing profession in Arizona question the practices of this agency, but it also causes the public to question to what extent, if at all, the Arizona Board of Nursing is functioning in the best interests of its constituency……or perhaps to what degree it is serving its own needs……my guess is the latter of the two……but I could be a little biased.

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Time to Toss the Tiaras and Be Real.

Joey Ridenour, Executive Director of the Arizona Board of Nursing

 

None of us is that shiny ideal prettied up nurse we see in those fluffy commercials on TV that tempt people into our profession….In fact,  I’m kind of tired of seeing the same lame title given to nurses every year: “the most trusted profession in America.” Seriously? We all know why we shouldn’t be named that, or why we don’t deserve that honor.  Florence Nightingale, may she rest in peace, would be scoffing and rolling her eyes in her grave right now. Because she knows better. In fact, Florence was quite the hell raiser herself. Never one to be silenced or disregarded. She had her “things” and we all have ours. It didn’t make her any less of a nurse, and one hell of a pioneer at that—but she made mistakes like the rest of us have, and will. The difference between then and now is fact she could learn from the mistakes made, study them, find ways to prevent them, and continue on with her mission, her calling—caring for people. None of us will ever be perfect, especially now at a time where the practice of nurses and our control over it is rapidly unraveling…and our foundation—growing weak. Not only must we monitor those patients in our charge, keeping them alive another 12 hours, but we also have been forced to split our minds and souls in half because we ourselves have to be wary about the landmines all around us, or the quick sand ready to suck us down into the netherworld, everywhere we practice. It could be a doctor, another colleague, a nurse manager, an administrator, or even a patient who gets angry—that ends your career. Because, after all, everyone else is right “except” for the nurse. I always wondered if this was the reason Florence Nightingale didn’t like the idea of hospitals or sequestering the ill and injured in one place like that. Perhaps she knew it wasn’t good for either the nurses or the ill. Im sure she wouldn’t have liked what Boards of Nursing have evolved into either.

Can anyone tell me why Arizona TV reporters seem more interested in putting a spotlight on just one regulatory board and not the others?

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…..Especially because the very people who are hurting their colleagues and failing to put patients before politics have an RN after their name too. I did a little research into the Arizona Sunset Clause and the most recent Auditor General’s report (2011) on the Arizona Board of Nursing as I watched my favorite show “Criminal Minds” tonight, and I found some pretty interesting stuff that made me want to call up the Auditor General and say “Are we talking about the same board here?” Ever since I caught the quote made by then Board Member Kathy Malloch stating that “40% of all complaints received by the board never being opened” it really bothered me, it stuck with me. From what I read in the Auditor General’s report it seems that the Board has the power to determine which complaints have no merit or do not meet criteria to follow up with an investigation. I disagree. Who makes that determination and what criteria must be met? Because, as per the Auditor general’s report, it states that complaints are opened when there is the presence of a violation of the nurse practice act. I gotta tell ya Mr. Auditor General, they pulled one over on you. Because that certainly isn’t happening here. The following are some of the findings and recommendations of the Arizona Auditor General pertaining to the overall performance of the Arizona Board of Nursing and his recommendations (you may see a link to the recommendations and a rise in the dismissals of cases and letters of concern……makes you think…..) I mean, it made me stop and ponder, why I read in the Board minutes that the investigation times are shrinking and more cases are being processed……Someone’s got some splainin’ to do—to the PUBLIC!

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But first, some history on the Sunrise and Sunset Process in Arizona: “Established by Laws 1978, Chapter 210 Arizona’s sunset review process requires the Legislature to periodically review the purpose and functions of state agencies to determine whether continuation, revision, consolidation or termination is warranted. Sunset reviews are based on audits conducted by either the Office of the Auditor General (OAG) or a Committee of Reference (COR). Following the audit, a public hearing is held by the COR to discuss the audit and receive testimony from agency officials and the public.

Established by Laws 1985, Chapter 352, and expanded by Laws 2008, Chapter 132, Arizona’s sunrise process provides a mechanism for both health professions and nonhealth professions to request regulation and, for health professions, an expansion in scope of practice. The sunrise process begins when an applicant group presents the Joint Legislative Audit Committee (JLAC) with a report defining the need for regulation or scope of practice expansion. JLAC assigns the report to a COR for review and recommendation. The Joint Legislative Audit Committee “JLAC” is a 12-member committee consisting of 6 members from each chamber of the Legislature. Five members each are appointed by the President of the Senate and the Speaker of the House of Representatives based on the members’ understanding and interest in agency audits. JLAC membership includes an Appropriations Committee member from each chamber, and no more than three appointees from each chamber may be members of the same political party. Additionally, the President of the Senate and Speaker of the House of Representatives serve as ex-officio members. JLAC chairmanship alternates each year between the House and Senate. oversees all legislative and agency audit functions. Subject to legislative approval, JLAC appoints the Auditor General and directs all sunset, performance, special and financial audits and special research requests. JLAC is required to ensure that agencies comply with audit findings and recommendations and has legislative subpoena power.  

In order to facilitate the sunrise and sunset process JLAC:

1) assigns agencies subject to sunset review to a COR; 2) assigns sunrise review applicants to a COR; 3) determines whether the OAG or a COR will conduct an agency’s sunset audit; 4) directs the OAG or a COR to conduct audits; 5) oversees the preparation and introduction of legislation to delay a sunset review if the OAG or a COR is unable to complete the review according to schedule; 6) directs the OAG or a COR to conduct performance audit follow-up reviews; 7) assigns COR chairmen (JLAC has the statutory authority to appoint COR chairmen, but traditionally the chairs are selected by standing committee chairmen when appointing the members); and 8) meets quarterly or on the call of the chairman.”

 

The May 2011 Auditor General’s Report Concerning the Arizona State Board of Nursing

“Complaint processing delays allow unsafe nurses to continue practicing—Delays in resolving complaints may permit unsafe nurses to continue to practice without needed oversight or limits on what they are allowed to do. In one substance abuse- related case, where a nurse allegedly used a patient’s medication and removed a patient’s emergency kit containing narcotics, it took the Board more than a year to resolve the case. The delay was attributed to difficulty contacting and getting responses back from the nurse, extending the investigation 2 months for a substance abuse evaluation, and waiting 5 months for the nurse to sign a consent agreement”

   Rapid processing allows unsafe nurses to keep practicing! I can think of half a dozen instances over the past few years where nurses did worse than this and were given “Letters of Concern.” And yep, Mr. Auditor General, it could be your next nurse….

“Addressing three factors could improve investigation timeliness: (1) Substance abuse, psychological, and other board-ordered evaluations can prolong complaint investigations for 2 months or longer. If the Legislature gave the Board authority to allow its Executive Director to order such evaluations, as is the case with the Arizona Medical Board’s executive director, evaluations could be conducted earlier so the results could be considered when the Board first reviews the complaint investigation”

Oh she’s ordering them alright, but somehow all the right people aren’t getting them! Review the past board minutes Mr. Auditor General, and you’ll see what I mean. They get Letters of Concern too…..yup, right again, that could be YOUR next nurse. In fact, board ordered evaluations are actually on the rise and are taking up more investigative time. But somehow, the people who seem to really need them, are walking away back into the nursing world without them. Neat right?

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“The Board investigates and resolves complaints involving violations of board statutes and rules, such as any conduct or practice that is or might be harmful or dangerous to the health of a patient or the public. The Board has an approved policy and guidelines used by board staff to determine whether to open a complaint upon receiving an allegation that a nurse or CNA violated a provision of the board statutes or rules, when a criminal background check or review of discipline history in another state indicates that such a violation occurred, or when an applicant for licensure or renewal self-reports such an act. After board staff determine that the allegations meet criteria to open a complaint, the complaint is sent through the Board’s triage process. Triage includes assessing the risk of the complaint allegation and determining priority based on concern for public safety (see textbox); subpoenaing initial information such as employment records, the involved patient’s medical records, and other documents; sending notification to the subject of the complaint; and assigning an investigator. In fiscal year 2010, the Board opened more than 1,600 complaints.

Following triage, board staff investigate the complaint allegations and prepare an investigative report that is used by the Board to deteremine whether to dismiss the complaint or issue a nondisciplinary letter of concern, or whether there is sufficient evidence of a violation that warrants disciplinary action. Board investigators obtain information regarding the complaint allegations by subpoenaing or requesting additional documents and by interviewing involved parties such as the complainant(s), witnesses, and the licensee/ certificate holder.

The Board’s Executive Director can resolve some complaints. Specifically, A.R.S. §32-1605.01 authorizes the Executive Director or designee to close complaints that meet criteria for dismissing the complaint or issuing a nondisciplinary letter of concern. For example, if the complainant does not wish to address the Board and there is no evidence substantiating the complaint allegations or demonstrating that a statute or rule violation occurred, the Executive Director or designee may dismiss the complaint. Complaints resolved by the Executive Director are collectively presented for the Board’s information on a board meeting consent agenda.”

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I think it would be nice if we as a profession knew what that process was, as well as the public. It goes to the issue of Transparency once more, but then again, the Auditor General has cited them on this issue in the past as well…….and if we are talking actual violations of the nurse practice act then for Gods sake why have the practitioners I have highlighted on my past few blogs walked away without a single flake of ash on them from the Arizona Board of Nursing? Why do we have a nurse practice act? To decide who to use it on and who not to use it on???

Perhaps they should take another read at the Auditor General’s recommendation: “When complaint resolution is delayed, patient safety may be affected. Specifically, licensees and certificate holders alleged to have violated board statutes and rules may continue practicing when they are unfit to do so, or may not quickly receive needed supervision.” (Yes this goes for all those Letters of No Concern issued to people who actually grossly violated the nurse practice act, abandoned their patients, used drugs in the workplace, abused elders, stole drugs, and had multiple DUI’s—not to mention falsifying medical records and forgery)

The Arizona Board of Nursing LOVES TO GO OVERBOARD ON USING SUBPOENAS……

According to the Auditor General: “In addition, the Board should also clarify its guidance for investigative staff that specifies when motor vehicle and law enforcement records should be subpoenaed. Board guidelines state that investigators should subpoena documents pertinent to the complaint and obtain relevant law enforcement and court records as applicable. However, in a review of 26 complaint cases, auditors found 3 cases where staff subpoenaed more information than necessary or relevant to determine whether there was probable cause of a violation to refer a complaint for a formal hearing or to offer the licensee/ certificate holder a consent agreement.1 Specifically, motor vehicle and/or law enforcement records were subpoenaed for complaint allegations related to practicing beyond the appropriate scope, making medication errors, and/or arguing with a patient. For these cases, motor vehicle or law enforcement records would not help determine if the alleged violations occurred. Therefore, the Board should clarify its guidance for investigative staff to specify when motor vehicle and law enforcement records should and should not be subpoenaed, based on the nature of the allegations, to help prevent board staff from obtaining unnecessary or irrelevant information.”

The Board currently subpoenas: Any and all medical records of nurses under investigation from any and all physicians. They also access any psychiatric records you may have out there. They also subpoena pharmacy records. Many of these actions are tactics that go way overboard into violating a nurse’s privacy. These actions should be reserved for prior drug offenders, abuse or neglect allegations, nurses involved with repeated sentinel events, or frequent DUI’s. Not every nurse needs to have his or her privacy violated by a state agency in this manner.

The Auditor General: “The extent to which the level of regulation exercised by the Board is appropriate and whether less or more stringent levels of regulation would be appropriate. This audit found that the current level of regulation exercised by the Board is generally appropriate.”

The Auditor General has obviously not read my blogs….

 

Here are some rough statistics from my research tonight:

Between 2013-2014:

70 nursing licenses revoked

61 nursing licenses surrendered

43 nurses placed on various forms of probation (keep in mind a nurse on probation in Arizona CANNOT get a job to save her life)

So lets add that up: That is 174 nurses taken out of or opting out of the nursing workforce here in Arizona for whatever reason…..How many nursing classes is that? The average nursing class is between 15-20 students? Now, multiply that by 10 years……Its roughly 1,740 nurses practicing at all levels of the profession who have literally disappeared from our midst.

I have yet to read the case files.

While we’re at it, let’s discuss the Auditor General’s recommendation regarding having evaluations done by the time the nurse presents before the Board and his/her case is considered. Well, its usually at the board meeting that the evaluation is ordered and the usual time frame for completion is 45 days. Which sets back the investigation times even further. While we are on the subject, giving Joey Ridenour free reign to personally decide what complaints get past the 10 mile high brick wall of the AZBON and which are bounced back never to be seen again was clearly a mistake (again, reference my past blogs) and allowing more latitude to order evaluations? NOT EVERY SINGLE NURSE NEEDS A DAMN PSYCH EVAL. (however, just about every nurse who has to deal with this Board needs a shot of tequila now and then)

Between 2013-2014: 117 Various Psychiatric Evaluations were ordered.

Now lets talk about all those lucky duckies who managed to float on out to the middle of the lake, far away from the grasp of Val Smith or Kathy Malloch or Joey Ridenour. The same lucky duckies, whom, according to the Auditor General, should have been disciplined……

Between 2013-2014: 234 cases were issued either a “Letter of No Concern” despite gross violations of the state’s nurse practice act, or cases were “Dismissed” for unknown reasons not stated in the board minutes.

Ironically, toward the end of the March 2014 Board of Nursing Minutes, it was decided to no longer publish the dismissed cases in the meeting minutes. Transparency at its best, yet again.

So, lets go back to former Board Member Kathy Malloch’s quote in one of the recent Nursing Regulatory Journals….. “40% of complaints are never opened or don’t meet criteria for investigation.” According to whom? And what is the criteria? I argue that the public, again, has the “right to know.” (I know you’re sick of hearing that Val Smith but its true.) So if we combine all of those Letters of No Concern, with those case Dismissals with the 40% that never get opened…….Just how many is the Board looking at, and what exactly is the criteria for their elusive, secret “eenie meanie monnie moe” method for choosing who gets dragged through “Dante’s Nine Circles of Hell” and who doesn’t?

So, Mr. Auditor General, Mr.. Ombudsman, any questions?

Give the People Light and They Will Find Their Way

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I wanted to say thank you for all the private messages of support today and also the wonderful encouraging posts. I have always always said “not one more nurse, not one more patient” and I meant that. Since Dr Keng Yu Chuang did what he did and the AZBON did what they did, as far as I am concerned they have a new watchdog that will be reviewing every single document I can get my hands on to make sure that horrible things don’t continue happening to nurses and to patients and Ill be using my blog to highlight inequities or any violations of the Arizona Revised Statutes I find. This has become a lifelong quest, one I will stand by as long as I am up and breathing. They earned themselves a watchdog that will always be off in the periphery somewhere……keeping an eye on things. Im doing it because the legislature is not doing it. If I can make changes that will prevent my colleagues from getting hurt the way me and so many others have been, then the work needs to be====has to be====done. No matter how long it takes or what it takes to get the information in the public eye. No one is immune from transparency and accountability when it has to do with the lives of patients and the people who work years to get their nursing licenses so they can make a decent living in this world. Government agencies should never hold that kind of power, that kind of ability to use toward good people.  I also do it in honor of those colleagues who have lost their lives to suicide because it was all too much to handle. I blame the AZBON for the loss of their lives because its where all their trouble started and when their lives went downhill….and these were good nurses who didn’t deserve what happened to them. No state agency has the right to so impact the lives of human beings, and devastate them, to the point people think that suicide is an option….or they get to that point where its their only option. I still pray about this every day and ask God if I am done yet, and the answer is always the same “this is the work I gave you to do, and you have to finish it.” Whenever I go against what God wants me to do in life, things get real bad real quick—-so I continue on. A watchdog of the AZ Board of Nursing…..for life. Ill never stop standing up for my colleagues, or speaking out===when they are too scared to. A scared nurse….cant truly protect his/her patients….and what greater threat to the public safety and well being is that?

Accountability + Transparency= Saving Lives!

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It’s the age of Obamacare, as most of you know it, and everyone from the healthcare consumer on up is running around confused or  clueless like chickens with their heads cut off trying to figure out how to navigate everything, at the right price, with the right people, in the right places……but somewhere in all of this new stuff a very important concept is being forgotten: Safety. It doesn’t just start in the doctor’s office either, just in case some of you thought that was where you were the safest…..It really starts with you. How you perceive the healthcare system right now, your knowledge of it, how you apply it to making sure you are getting the best and safest care for both you and your family. A doctor is not ultimately responsible, nor is a nurse. At the end of the day, patients (unless you are a child, a vulnerable older adult, in a coma, in a persistent vegetative state,  or developmentally impaired in some way) are their best advocates. No one knows your body as well as you, and no one can know what you want more than YOU. Depending on the era you grew up in you have certain preset values and beliefs pertaining to health and healthcare professionals….their “set places” and your role within all of that. For instance, babyboomers were taught that the doctor was always right, no matter what, no questions asked–and that a nurse was simply there to take orders and follow them through. Every generation approaches care differently and thus has a different sense of trust walking through the doors of the healthcare system.

But is the doctor’s office or a hospital or a clinic the only place we put our trust when it comes to making sure we as healthcare consumers are safe? Should we be trusting others to ensure our safety as well? Well, Yes AND No.  There is the Joint Commission, there is the Office for Civil Rights, there are the State Health Departments….and then there are the state boards. To be more specific–your state’s medical board and nursing board. These agencies are put in charge of ensuring that the healthcare providers out there caring for you are up for the job. They exist to protect you from those individuals who present a clearly chronic danger to the public safety via a variety of mechanisms. Surprisingly, healthcare consumers take it for granted that these agencies are doing just that.

Assuming is one of the root causes of why there are so many patient injuries and unnecessary patient deaths each year due to medical error, neglect, or abuse. Not only must healthcare providers be diligent in holding these agencies accountable, but so must state citizens—the healthcare consumers/voters themselves. Big government has proven time and time again that it is not infallible. My home state of Arizona is the perfect example of that. Our state’s medical board was put on blast for its unethical practices a few months ago by the State Ombudsmen’s office, and I am currently in the midst of my own ten year retrospective investigation into the activities of the Arizona State Board of Nursing for that same reason.

This legislative session a lot of focus was placed on increasing medical board oversight, despite my insistence that the Arizona Board of Nursing also be reevaluated and its outcomes studied to ensure that they too were doing what the state legislature expected of it. I also wanted to see patient safety legislation set into place that would allow healthcare workers to come forward if they saw any dangerous practices or unethical practices occurring during which patients were being harmed. In previous blogs I have cited the State Mental Hospital’s severe deficiencies (the nurses who work there know all about them yet failed to report), the MCSO jails, and now most recently the Phoenix VA Hospital has come under fire for some of the most atrocious healthcare ethics violations seen in quite some time.

     The topic of veteran’s healthcare is considered “sexy” in our state, journalists eat it up, report on it in the blink of an eye,  and perhaps its that appealing even in your state. It invokes passionate beliefs and expectations…..there are unspoken rules that should be followed….social mores that should never be broken when it comes to caring for and honoring the lives that have sacrificed so much for us and for our country to be what it is today. People don’t want to discuss patient safety when it has to do with prisoners or with mentally ill patients. BUT! They will get irate, demonstrate, make death threats, flood phonelines and radio talk shows when it’s our veterans who are being sacrificed so shamefully and needlessly. Remember two very important things here: 1.) Veterans don’t just go to VA facilities to get their healthcare. 2.) Don’t ever place all your trust and faith in a government that is inherently failing us to begin with when it comes to keeping us safe in the process of getting healthcare services.

Arizona is the classic example of this. Perhaps one of the worst examples. Because in each of the areas I cited above (county, state, federal healthcare settings) people failed to report out of fear. People knew bad things were happening and lives were being lost and did nothing about it. So when I get questions about why I am focusing so much on the Board of Nursing, its because they ARE INCONSISTENT AND the facts are there to support my belief that the overall safety of the public is not being protected. How many of you out there really hold your state government accountable for issues such as this without it being attached to gay rights or birth control or immigration? Remember two more words: Public Records.

The everyday lay person can attend medical board meetings and nursing board meetings to see what’s being discussed and how their processes work, and what kinds of cases are being presented for consideration of discipline. It’s our duty as not just healthcare consumers, but as tax paying citizens, to do the homework that holds  government agencies accountable for the work they are supposed to be doing, while maintaining consistent transparency all across the healthcare system….from the doctors office, to the hospital, right up to the agencies that oversee the people who give you that care. I am in an interesting position to do just that. I cant think of any other nurses in Arizona willing to do it (or who can without getting their careers slaughtered), so I will.  Too many of my colleagues are hurting right now and too scared, and we have had far too many instances of people getting injured in this state due to poor healthcare and poor oversight of the state boards we pay to protect people. What does Dr. Phil say? “You keep going, you keep trying, you keep talking, you keep writing….you keep ‘doing’…..UNTIL.”

     Nurses. Be proactive. Be Investigators. Be Leaders. Hold your state boards accountable. You don’t have to do it full blown and have your name out there, anonymity is always an option. Point a few journalists in the right direction—the right people to talk to, the right email addresses, the right documents, etc–and let them take it from there. I’ve read so many horror stories from nurses all over the country who tell me about their experiences with their State BoardS of Nursing and some of the terrifying unethical things that are done behind closed doors. But yet, no one stands up to say “Excuse Me? Are you actually ALLOWED to do that?” YOU ALL WENT TO SCHOOL FOR YEARS TO DO WHAT YOU DO. YOU CANT AFFORD NOT TO EQUIP YOURSELF WITH KNOWLEDGE OR TO SPEAK UP WHEN THERE ARE THINGS GOING WRONG THAT WILL JEOPARDIZE YOUR LICENSE (ILLEGAL OR NOT)

Write your legislators with fake email addresses and point them to the information they need and make suggestions for positive changes that can be implemented. Provide examples of legislation from other states….Go a step further. Visit with your state legislators under a fake name so your State Board doesn’t even have to know it was you going to interact with lawmakers. I learned that lesson the hard way—I heard second hand that some of the members of the Board would just stroll on over to the State Capitol or make a few phone calls to legislators to tell them I wasn’t in my right mind and then all of a sudden—BOOM. No more interaction with lawmakers……all communication flatlines, asystole, dead. I find it ironic that in nursing school we’re all required to do these projects that revolve around writing our legislators about healthcare issues when we can actually get in trouble for doing it! And try being aggressive about the legislation you want passed, like other citizens, and watch how quick a Board of Nursing gets “involved.”

     Here is a hint. Listen REALLY GOOD: Every single Board of Nursing has a legislative Liaison that tracks bills being introduced into your states Legislature that could directly or indirectly affect the Board of Nursing and how it functions at whatever level. It’s their job to notify the Board of such Bills and to strategize about how to lobby against it or how to support it better. Some Boards of Nursing can also WRITE THEIR OWN RULES and get them passed through the legislature via that same legislative liaison. It is this person’s job to represent the interests of the State Board of Nursing and protect those interests. This is where holding government agencies accountable and establishing (and maintaining) transparency are crucial.

     Take some time to do some investigating on a day you are at home parked on the couch in your favorite comfy clothes, a glass of wine, a dog on your lap (or cat) with a good Lifetime TV show for background noise and log on to your state board of nursing’s website. Who are your board members? How are they appointed? Are they actively working at the bedside? How long do they serve? Become familiar with everything within the site–especially the minutes for each board meeting. Usually they are uploaded in a .pdf format and can be downloaded….Here, you will see all the cases presented and some of the outcomes. Look for patterns. How many nurses had their licenses revoked in a specific year? What were the biggest reasons for revocation or suspension or probation? Does the discipline appear to be consistent or inconsistent? Are the numbers of revocations rising yearly??? If so—it would behoove you as a professional to find out why so many nurses are being yanked out of the profession in a given year within your homestate. Simply put: Ask the questions, find the answers, share the knowledge with others because knowledge always leads to empowerment…..something both nurses and patients lack a whole lot of these days…..

I also hear the words “its hopeless” from nurses and medical mal victims on Twitter and Facebook….perhaps I have even said them myself a time or two during this difficult battle. But I write because this is the only way I CAN HELP PEOPLE, I also do it to empower you—MY COLLEAGUES— to stand up, open your eyes, your mind, your curiosity, and start asking the questions and never stop trying to find the answers. Its what keeps you ten steps ahead of the game in the corporate nursing environment—-its Defensive Corporate Nursing 101.

Know your practice environment, to the greatest extent and to the greatest depths possible. I also write to empower my state’s healthcare consumers to start asking the important questions. I mean, its your dollars paying for the healthcare, and your life paying for the mistakes that are made or could be made each and every time you trust someone else with your care……would you rather be well informed of the trends in our state or naïve to the dangers? Not only can you access information on the state board websites, you can also log on to various websites to compare hospitals in your state to see who has the best healthcare outcomes. It’s that easy…..Unfortunately, its even easier to allow the status quo to continue and cry to the heavens when the system fails you…..

 

There is an answer for that too…..because we all allowed it to.

Tahiti in 2013: Did the Arizona Board of Nursing Take a Vacay?

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(people. that was a play on words. No one went to Tahiti.)

It appears as if 2013 was the year that the Arizona Board of Nursing had other things on their minds than fulfilling the agency’s “mission” to protect the public’s welfare, or perhaps Executive Director Joey Ridenour and her Special Consultant, Valerie Smith, were in Tahiti somewhere….On the agenda for 2013—- Taking pictures of patients’ body parts and posting them to Facebook, a patient wandering away from a facility, failing to follow physician orders resulting in the patient crashing and having to go to ICU, drug diversion in the workplace, abandoning patient assignments, overdosing patients, forgery, falsification of medical records, taking a gun to a home health visit……It appears they aren’t too concerned about DUI’s either. These were just some of the complaints addressed throughout 2013 at the AZBON. It was ironic to stumble upon the legislative liaison Greg Harris’s statements during the board meeting discussing how the Arizona Board of Nursing shouldn’t be focused so much on the legislature’s current spotlight on medical board oversight….rather, evaluating its own practices…… “Mr. Harris noted that the Legislation has been focusing on Medical Board issues but the focus should be on how AZBN runs and operates. What are our processes and procedures? He emphasized the need to understand the role of the Board member and staff, regulation, and do our jobs well. It is essential to make sure staff are equipped and prepared to do their jobs. It is the Board’s responsibility to converse with the Executive director, and identify issues from the public, and staff. Training is essential.”

     Well, I have to give it to him…..he tried. Erstwhile, the Board continues to put lots of decent nurses out of work by making it impossible for them to find jobs or to remain in the workforce by slamming down nearly impossible terms and conditions within their creatively designed consent agreements. Understand that when any nurse applies for ANY job in ANY industry, all the potential employer has to do is look up their license. So it isn’t just a nursing job nurses have a hard time procuring. If the potential employer looks up the records, that individual is walking into one hell of a stressful interview and interrogation when all they are trying to do is make a living. They will continue to experience this over and over again……after a while, imagine what this does to someone’s mind. Their self-confidence. This is how nurses end up stripped of their identities, out of work, in the unemployment lines, and on long-term DES benefits. Its how some nurses I know have ended up addicted to substances to cope, and have become mentally ill with frequent trips in and out of mental health facilities. The state of Arizona pays up either way. The legislature gives the Board more money for more “things,” the Board puts more nurses out of the workforce, and then the state pays money to support the out of work nurses. Now, that sounds pretty effective to me, don’t you think? And if the nursing board has done a number on a relatively decent nurse who has had minor offenses not involving patient harm—-they have, in essence, impaired –if not destroyed– his/her ability to make a living while allowing other nurses who have been a danger to the public and have harmed people to continue working within the profession. Greg Harris may be on to something…..perhaps he was trying to, in the nicest… most cautious way possible…. tell the Arizona Board of Nursing to WAKE UP!

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Here are the definitions of possible discipline per the Arizona Board of Nursing’s Website:

(Letters of Concern = No Discipline)

  1. REVOCATION: Licensee’s privilege to practice either as a practical (LPN) or professional (RN) is revoked for a period of five years. A nurse whose license has been revoked in the State of Arizona may make application to the Board for reinstatement after a period of five (5) years. The applicant must demonstrate that the reason for the revocation has been remediated to reduce the potential of harm and unsafe practice. (§ R4-19-404)
  2. VOLUNTARY SURRENDER: Accept a voluntary surrender of a license certificate.
  3. SUSPENSION: The period of suspension prevents the licensee from working as a practical (LPN) or professional (RN) nurse for definite or indefinite period of time.
  4. PROBATION: All licensed nurses (LPN or RN) on probation have work conditions and may have other mandated requirements. EMPLOYERS must be presented with a complete copy of the licensee’s Probated Order, including findings of fact, conclusions of law, and terms of the order.
  5. DECREE OF CENSURE: This disciplinary action is a public reprimand by the Board of Nursing for a violation of the Nurse Practice Act. It is in the form of a written document and does not impose any conditions on the practical or professional license.
  6. STAYED DISCIPLINARY ACTION: An action which is stayed will not be in effect unless the licensee violates any conditions of an order. For example, a nurse on probation with a stayed suspension is able to work under the stipulations of the probation order. If the nurse violates any condition of the order, the license is immediately suspended.
  7. LICENSE DENIED: An applicant for licensure in Arizona by either examination or endorsement may have their application denied. They will not be granted a license.
  8. CIVIL PENALTY: A monetary penalty of up to $1000 for each violation of the Nurse Practice Act.
  9. IMPOSTORS: Individuals who have represented themselves as nurses, and lack any valid or current nursing license in Arizona.

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Without further ado….the top 13 “Letters of No Concern” in 2013…and all the rest of the lucky nurses who are still out there having got off easy for gross offenses. You Rock.

  1. THE ARIZONA BOARD OF NURSING HAS THE ABILITY TO IMMEDIATELY SUSPEND A LICENSE IF THERE IS AN IMMEDIATE THREAT TO THE PUBLIC HEALTH, SAFETY OR WELFARE AND REQUIRES EMERGENCY ACTION PURSUANT TO A.R.S. 41-1092.11 (B) —WHY DID THIS NOT HAPPEN HERE???? OTHER NURSES WERE IMMEDIATELY SUSPENDED AND PLACED ON THE “CANDO PROGRAM” OR OTHER DISCIPLINARY MEASURES THAT INCLUDED ADDICTION COUNSELING ETC—– Quinn moved, Dalton seconded, and it was unanimously carried to modify the Conclusions of Law the violations in Paragraphs 1 through 9, and modify #7, to delete the word “not” paragraph 7 line 1 and delete last sentence, lines 5-8. Rationale for modifying ALJ recommended order: The Respondent demonstrated poor nursing practice, judgment and possible narcotic diversion on two separate occasions and at two separate facilities left her patients for long periods of time abandoning them leaving them at risk to not obtain proper nursing care. This absence could have caused patient harm. Respondent also found to have the medications morphine and Benadryl in her purse, enough evidence that the medications were in the purse because respondent placed them there. The medications could have been part of a possible medication diversion. Due to the issues of poor practice decision involving abandoning patients and a strong suspicion of drug diversion, the only way to assure the public safety is to order Respondent be placed on probation.       With probation the monitoring department can evaluate and monitor the Respondent to ensure that she has changed her practice of abandoning her patients and is not diverting medications. Quinn moved, Johnson seconded, and it was unanimously carried, based upon the findings of fact and statute/rule violations identified in the Administrative Law Judge Conclusions of Law and Findings of Fact, and as modified by the Board, issue an Order placing Respondent on probation to include the attached terms and conditions. If the Respondent is found to have a substance abuse disorder, probation will be at minimum 36 months with terms and conditions. If not found to have a substance use disorder, probation will be at minimum 18 months to include the attached terms and conditions

 

    1. BANNER DEL E WEBB HOSPITAL: Aranas was present and available for questions. Dalton moved, Berrigan seconded, and after discussion it was unanimously carried to issue a Letter of Concern for failing to take appropriate action to safeguard a patient’s welfare when or about April 26, 2012, while employed at Banner Del Webb Medical Center, in Surprise, Arizona, Respondent admitted he obtained a signature for a surgical procedure from patient R. R, though he was aware the patient had not received information about the procedure from the surgeon and on or about June 4, 2012, Respondent failed to perform a physical assessment on patient W.B. in a timely manner, resulting in a late finding of decreased oxygen saturation leading to an anoxic event which required the patient to be transferred to a higher level of care and extend his stay in the hospital.
  • Johnson moved, Gutierrez seconded, and it was unanimously carried to issue a Letter of Concern for failing to follow facility policy regarding transcription of physician orders on or about November 9, 2011, while employed as a RN at Connections Arizona in Phoenix, Arizona, resulting in an overdose of antipsychotic medications to patient L. A.

 

    1. ELDER: Gutierrez moved, Dalton seconded, and it was unanimously carried to issue a Letter of Concern for failing to ensure an emergency response team was called after a resident fell twice on October 10, 2012 as is mandated by R9-10-703.B; “A licensee shall ensure that a manager of an assisted living facility…when there is an accident, incident, or injury that effects the resident’s health and safety…Immediately notifies the representative, and if applicable…an emergency response team,” and violated a nursing standard of care which calls for taking appropriate action to safeguard a patient’s welfare.”
  • McCormies moved, Snider seconded, and it was unanimously carried to issue a Letter of Concern for administering a Lactulose enema to patient J.P., which is outside the CNA scope of practice, and in violation of your employer’s policies; and for failing to disclose that you were unfamiliar with the enema equipment, resulting in the enema cap being retained in the patient’s bowel, on or about October 28, 2012, while employed as a CNA at Flagstaff Medical Center in Flagstaff, Arizona.
  • Snider moved, Gutierrez seconded, based upon the findings of fact, statute/rule violations identified in the investigative report, to offer a Consent Agreement for a Decree of Censure to be signed within 30 days or issue a Notice of Charges. After discussion, Snider withdrew motion. Snider moved, McCormies seconded, and it was unanimously carried to issue a Letter of Concern for neglecting to check on the welfare of her assigned resident J.F. during the 2:30 p.m. to 10:30 p.m. shift on September 30, 2012 while employed as a CNA at Estrella Care Center in Avondale, Arizona and so were unaware he had eloped from the facility

 

  1. Kerrigan addressed the Board with additional information. Vagg was present and available for questions. Attorney Susan McLellan was present and addressed the Board. Dalton moved, Berrigan seconded, to issue a Letter of Concern for striking a coworker on or about December 29, 2011, while working as a staff nurse at St. Joseph’s Hospital and Medical Center in Phoenix, Arizona. After discussion the motion carried with eight in favor and one opposed.
  2. Dalton moved, Snider seconded, and it was unanimously carried to issue a Letter of Concern for carrying a concealed handgun in to patient R.H.’s home during his monthly home health infusion visits on or around November 13, 2012 to on or around April 26, 2013 in violation of Preferred Homecare’s Employee Handbook and Preferred Homecare’s Human Resources Policies and Procedures, Policy #TE-05 Terms of Employment
  3. Quinn moved, Berrigan seconded, and it was unanimously carried to issue a Letter of Concern for taking unauthorized pictures of a patient’s body parts without the patient’s consent, on or about August 2011, using her personal cell phone in the operating room and then posting the pictures to her personal social media platform, Facebook, while employed as an RN at
  4. Kish was present and addressed the Board with additional information. Gutierrez moved, Johnson seconded, and after discussion, it was unanimously carried to issue a Letter of Concern for falsifying the medical record for patient B.W. by documenting that she conducted a home health visit at 1430 on January 14, 2012 and 1300 on January 21, 2012, when Respondent had not actually conducted home health visits with B.W. on those dates/times while employed at a LPN at Arrowhead Home Health, Phoenix, Arizona. After further discussion, Gutierrez moved, Johnson seconded, it was unanimously carried to rescind motion and dismiss the case.
  5. Johnson moved, Dalton seconded, and it was unanimously carried, Issue a Letter of Concern for altering M.F.’s general consent for surgery on or around January 31, 2012, by adding the word spinal to the type of anesthesia used after M.F. had already signed the informed consent form for general anesthesia while Respondent was employed as a RN at Mountain Vista Medical Center in Mesa, Arizona.
  6. Quinn moved, Busby seconded, and it was unanimously carried, based upon the findings of fact and statute/rule violations identified in the investigative report, to issue a Letter of Concern for practicing beyond her scope when she entered an order for a telemetry monitored patient to leave the unit, using the name of a physician who had not given the order, on or about November 13, 2012., while employed as an RN at Banner Thunderbird Medical Center in Phoenix, Arizona.
  7. Rappoport addressed the Board and confirmed receipt of additional information. Johnson moved, Harrell seconded, and it was unanimously carried to issue a Letter of Concern for administering a total of 5 Percocet tablets on June 20, 2012, in a 3-hour time period for resident R.L., while employed as a registered nurse at Montecito Acute Pain and Rehabilitation, in Mesa, Arizona.

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Nguyen was present and addressed the Board. Berrigan moved, Johnson seconded, based upon the findings of fact and statute/rule violations identified in the investigative report, offer a Consent Agreement for a Decree of Censure. If not signed within 30 days issue Notice of Charges. The motion failed with four opposed and two in favor. Quinn moved, Gutierrez seconded, and it was unanimously carried to issue a Letter of Concern for signing a 24-hour chart review documenting that you had verified all orders for patient E.S. for the previous 24 hours, when you had not actually done so, on or about December 19, 2011; and for failing to timely carry out an order for a “stat” chest x-ray, resulting in delay of treatment of a resident with pneumonia, on or about June 27, 2011; while employed as a registered nurse at Life Care Centers of Scottsdale in Scottsdale, Arizona.

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Johnson moved, Quinn seconded, based upon the findings of fact and statute/rule violations identified in the investigative report, offer a Consent Agreement for a Decree of Censure if not signed within 30 days, issue Notice of Charges. After discussion, Johnson moved to rescind her motion for Decree of Censure. Snider concurred. Gutierrez moved, Snider seconded to issue a Letter of Concern for: (1) practicing without an APRN certificate from on or about October 15, 2012 through October 23, 2012; (2) for prescribing controlled substance prescriptions using your Colorado DEA license from October 15, 2012 through August 16, 2013; and (3) for prescribing prescription only medications from October 15, 2012 through August 19, 2013 after being notified by Medicare on December 12, 2012 that you were prescribing unlawfully in the state of Arizona

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Snider moved, Johnson seconded, to dismiss the complaint. The motion failed with four in favor and five opposed. Quinn moved, Dalton seconded, to issue a Letter of Concern for working outside the scope of an adult nurse practitioner, by performing psychiatric evaluations and initiating treatment in patients with complex psychiatric conditions from on or about November 2007 through February 2011. The motion failed with three in favor and six opposed. Snider moved, Johnson seconded, to dismiss the complaint. The motion failed with four in favor and five opposed. Quinn moved, Dalton seconded, to issue a Letter of Concern for working outside the scope of an adult nurse practitioner, by performing psychiatric evaluations and initiating treatment in patients with complex psychiatric conditions from on or about November 2007 through February 2011. The motion carried with six in favor and three opposed.

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Quinn moved, Johnosn seconded, and it was unanimously carried, based upon the findings of fact and statute/rule violations identified in the investigative report to issue a Letter of Concern for on or about February 17, 2011 and February 25, 2011, Respondent, who is a Family Nurse Practitioner (FNP), practiced outside the scope of a FNP when she diagnosed patient RB with Adult Attention Deficit (ADD) and provided him with a prescription for Adderall, a schedule 2 stimulant. Additionally, Respondent failed to obtain previous medical records supporting the patient claims of being diagnosed with ADD.

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Attorney Ann Fulton-Cavett was present and addressed the Board. Copeland was available for questions. Guiterrez moved, Post seconded, and it was unanimously carried to issue a Letter of Concern for filling out prescriptions refills for two children, signing the providers name to the refills, and faxing the prescriptions to the pharmacy in Tucson, Arizona.

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Quinn moved, McCormies seconded, and it was unanimously carried to issue a Letter of Concern for failing to document a verbal order in a patient’s medical record which reschedules the patient’s Insulin Glargine Pen 20 units from a morning administration time to an evening administration violation of the standard of care which requires that licensed nurses will maintain accurate patient medical records and on or around May 28, 2013 while Respondent was employed as a RN at Mountain Vista Medical Center in Mesa, AZ, Respondent failed to follow the facility’s Heparin Protocol by sending a patient’s blood for Prothrombin Time testing (“PT”) instead of for Partial Thromboplastin Time (“PTT”) during the 12-hour day shift that Respondent was working.

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Quinn moved, Snider seconded, and it was unanimously carried to issue a Letter of Concern for posting to her personal Facebook page on or around January 31, 2012 that you had a bad day following the death of a patient in the operating room in violation of facility policies including, HIPPA Confidentiality 3174 (II.A), (III.B.6) and Social Media Policy 12324 (III.C) while she was employed as a RN at Banner Thunderbird Medical Center in Glendale, Arizona and for failing to complete a pre-operative checklist on patient H.C. on January 20, 2012, while she was employed as the circulating RN at Banner Thunderbird

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Phillips was present and addressed the Board. Gutierrez moved, Dalton seconded, and it was unanimously carried to issue a Letter of Concern for sleeping on duty on May 29, 2012, while employed as an LPN at Innovative Home Health, Phoenix, Arizona

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After discussion, McCormies moved, Gutierrez seconded, and it was unanimously carried to continue with current probation until terms have been met, and issue a Letter of Concern for testing positive for alcohol in a random urine drug screen on or about September 7, 2012.

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Harrell moved, Snider seconded, and it was unanimously carried to issue a Letter of Concern for administering diphenhydramine (Benadryl) to a patient multiple times without a medical order from January 2012 through March 2012, while employed at Fresenius Medical Care-Bullhead City Dialysis, in Bullhead City

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Jordan was not present and was not represented by legal counsel. Snider moved, Johnson seconded, and it was unanimously carried to issue a Letter of Concern for allegedly sharing confidential patient information with a former roommate.

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Attorney Elizabeth Peterson and Imholz were present and addressed the Board. Hunter addressed the Board and confirmed the receipt of additional information. Post moved, Snider seconded, and it was unanimously carried to issue a Letter of Concern for prior concerning work history, including but not limited to, a pattern of poor communication practices while employed as a RN at various facilities in Arizona in or around 2010 to present.

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DO POTENTIAL SEX OFFENSES STILL GET TO WORK DURING THE INVESTIGATION? Chambers addressed the Board and confirmed receipt of additional information. Attorney Guy Buckley, Lewis, and Pencak were present and addressed the Board. McCormies moved, Quinn seconded, and it was unanimously carried to making a finding of reasonable cause based upon the allegations in the investigative report and at no cost to the Board, issue an Interim Order for a psychosexual misconduct boundary violation evaluation

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DO POTENTIAL SEX OFFENSES STILL GET TO WORK DURING THE INVESTIGATION? Valiente was present and addressed the Board. Harrell moved, Gutierrez seconded, and it was unanimously carried, making a finding of reasonable cause based upon the allegations in the investigative report and at no cost to the Board, issue an Interim Order for a psychosexual misconduct/boundary violation evaluation by a Board approved evaluator, and to include any additional testing deemed necessary by the evaluator, to be completed within 30 days and then return to the Board.

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DUI: Gutierrez moved, Berrigan seconded, and it was unanimously carried, based upon the findings of facts identified in the investigative report, upon meeting all licensure requirements, grant licensure and issue a Letter of Concern for the misdemeanor DUI conviction on March 29, 2012, in the Apache Junction Justice Court, for failure to disclose the misdemeanor domestic violence charge on April 8, 2006 in the Chandler Municipal Court, and for failure to disclose the misdemeanor domestic violence charge on March 14, 2008, in the Apache Junction Justice Court.

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Quinn moved, Dalton seconded, and it was unanimously carried to grant licensure and issue a Letter of Concern for on or about October 16, 2012 Applicant tested positive for Morphine in her pre-employment drug screen with Flagstaff Medical Center.

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DUI: McCormies moved, Quinn seconded, and it was unanimously carried to issue a Letter of Concern for on or about May 2, 2012, in case number TR- 2012001256, in the Scottsdale City Court, in Scottsdale, Arizona, convicted of Extreme DUI 1ST BAC > = .20, a class one misdemeanor.

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McCormies moved, Berrigan seconded, and it was unanimously carried, upon meeting all licensure requirements, grant license, and issue a Letter of Concern for Applicant’s misdemeanor arrests and/or citations for domestic violence and alcohol related incidents on October 19, 2006, April 3, 2007, and July 15, 2007

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Harrell moved, Post seconded, and it was unanimously carried to issue a Letter of Concern for pre-signing that you administered J.S.’s afternoon medications in J.S.’s medication administration record on or around April 21, 2012 even though you had not administered any of the afternoon medications to J.S. while you were employed as a LPN with Hacienda Healthcare in Phoenix, AZ.

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DUI: McCormies moved, Gutierrez seconded, and it was unanimously carried to issue a Letter of Concern for self-administering an Ambien on or around 1/23/2013 and then driving a vehicle and resulting in an arrest in Scottsdale, Arizona; admitting that you either took an expired Ambien from an old prescription that belonged to you or you took one of your mother’s Ambien.

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McCormies moved, Quinn seconded, and it was unanimously carried to issue a Letter of Concern for documenting medications not yet given and assessments not yet done, while employed at John C. Lincoln Hospital, Deer Valley, Arizona, in or about July 2007.

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Orosco was present and available for questions. McCormies moved, Dalton seconded, and it was unanimously carried to grant registered nurse license and issue a Letter of Concern for preparing medications for patient D.M., and handing them to another RN who administered them to patient M. F. in error, resulting in M.F.’s hospitalization for observation on or about June 26, 2012 at Discovery Nursing and Rehab in Vancouver, WA

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Johnson moved, Busby seconded, and it was unanimously carried to grant licensure upon meeting all requirements, and issue a Letter of Concern for the March 24, 2005 conviction for Failure to Provide ID, a misdemeanor, in Apache Junction, Arizona; the August 29, 2004 arrest in Tempe, Arizona, resulting in a TASC Drug Diversion Program for Possession of Dangerous Drugs, a felony, and Drug Paraphernalia, a misdemeanor, which were dismissed after successful completion of the program; the admission of previous drug addiction and current alcohol use; and the diagnosis by Dr. Lett, a Board approved evaluator, of Methamphetamine Dependency in Full Sustained Remission, who also opined that Respondent’s light social use of alcohol and positive family history of chemical dependency are seen as risk factors for activating an active substance use disorder.

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Quinn moved, Dalton seconded, and it was unanimously carried, upon meeting all requirements, grant certification and issue a Letter of Concern for Applicant’s criminal conviction in California on November, 19, 1999 for threaten crime with intent to terrorize, a misdemeanor and in Arizona on December 18, 2010 for the criminal conviction for DUI, a misdemeanor.

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DUI: Quinn moved, Johnson seconded, and it was unanimously carried, based upon the findings of fact and statute/rule violations identified in the investigative report, issue a Letter of Concern for Respondent’s DUI misdemeanor conviction in the City of Phoenix Court on September 12, 2011, in Phoenix, Arizona.

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Dalton moved, Johnson seconded, and it was unanimously carried, based upon the findings of facts identified in the investigative report, upon meeting all licensure requirements, grant licensure and issue a Letter of Concern for Respondent’s conviction for Assault- Domestic Violence, a misdemeanor on June 16, 2012 in the Peoria City Court, Peoria, AZ.

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Quinn moved, Dalton seconded, and it was unanimously carried, based upon the findings of fact and statue and rule violations identified in this investigative report, to issue a Letter of Concern for practicing beyond her scope as a registered nurse on or about December 21, 2012, when she flushed a patient’s Pleurx chest drainage catheter without having a hospital policy and procedure in place, while employed as an emergency room nurse at Banner Gateway Medical Center, in Gilbert, Az

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Berrigan moved, Snider seconded, and after discussion, it was unanimously carried to issue a Letter of Concern for inadvertently squeezing a resident’s arm too tightly during care leaving bruises on her arm on June 30, 2012 while employed as a CNA at Glendale Care Center in Glendale, Arizona. After discussion, the motion carried with six in favor and two opposed.

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Snider moved, Gutierrez seconded, and it was unanimously carried to issue a Letter of Concern for failing to change a resident known to have a leaking catheter, from 4:00 p.m. until 9:30 p.m. while employed as a CNA at Santa Rosa Care Center in Tucson, Arizona on September 15, 2012.

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M Meade was present and available for questions. Quinn moved, Johnson seconded, and it was unanimously carried to issue a Letter of Concern for a patient’s impression that Respondent was unaware of how to care for her and disregarded infection control techniques on November 5 through 7, 2012 and for practicing out of her scope as a CNA when she attended to surgical drains and incisions while employed as a CNA at Villa Home Care in Scottsdale, Arizona.

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Elam was present and available for questions. Snider moved, Johnson seconded, to issue a Letter of Concern for the positive drug screen for Methamphetamines on or about October 9, 2011, in Phoenix, Arizona. After discussion, Snider withdrew the motion and moved to dismiss the complaint. Johnson concurred. The motion carried unanimously.

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Furline was present and addressed the Board. Quinn moved, Gutierrez seconded, and it was unanimously carried, upon meeting all requirements, to grant license, and issue a Letter of Concern for the October 30, 2007, arrest on the charges of Offensive Touching, Unauthorized Use of a Vehicle, and Criminal Mischief in Newcastle County, Delaware, and for the February 9, 2012, arrest for Battery/Domestic Violence in Las Vegas, Nevada.

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Gutierrez moved, Berrigan seconded, and it was unanimously carried to issue a Letter of Concern for three residents’ perception that she was rude and rough on August 5, 2012, while employed as a CNA at C Johnson moved, Busby seconded to issue a Letter of Concern for testing positive for cannabinoids during a pre-employment urine drug screen that was performed on or around July 11, 2012 at Scottsdale Healthcare Osborn in Scottsdale, Arizona. The motion carried with nine in favor and one abstained.

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January 2013

NON COMPLIANCE WITH BOARD ORDERS: Kerrigan was present and available for questions. Attorney Rob Chelle was present and addressed the Board. Johnson moved, McCormies seconded, and it was unanimously carried, based upon the language of the Order and the findings of fact and statute/rule violations identified in the monitoring non-compliance report, to issue a Letter of Concern for the September 13, 2012, no-show random urine drug screen and for initially failing to disclose the real reason to Board staff for the no-show and to allow respondent to continue on the Order.

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DUI: Telles was present and addressed the Board. Dalton moved, Berrigan seconded, and after discussion it was unanimously carried to grant licensure upon meeting all requirements, and issue a Letter of Concern for her August 29, 2012 misdemeanor conviction for Driving Under the Influence in Phoenix, Arizona.

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Gherna was present and addressed the Board. Snider moved, Gutierrez seconded, and it was unanimously carried to grant licensure upon meeting all requirements, and issue a Letter of Concern for arrests or citations occurring on or about October 3, 1995, October 30, 1995, May 2, 1996, May 16, 1996, September 2, 1998, March 26, 1999, September 24, 2001, March 7, 2003, and July 11, 2003 in Tucson, Arizona; and an arrest on March 20, 2004, in Scottsdale, Arizona.

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DUI: Munoz was present and addressed the Board. Johnson moved, Snider seconded, and it was unanimously carried to issue a Letter of Concern for the October 24, 2011, misdemeanor Extreme DUI conviction in Phoenix, Arizona.

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DUI: Donnell was present and addressed the Board. Berrigan moved, Gutierrez seconded, to issue a Letter of Concern for March 14, 2012, misdemeanor Extreme DUI conviction in Prescott, Arizona. After discussion, Berrigan amended the motion to read: for complaint #1, to issue a Letter of Concern for March 14, 2012, misdemeanor Extreme DUI conviction in Prescott, Arizona; and for complaint #2, to dismiss the complaint. Gutierrez concurred. The motion carried unanimously.

Rappoport addressed the Board with additional information. Arrossa was present and addressed the Board. Quinn moved, McCormies seconded, and it was unanimously carried to issue a Letter of Concern for administering a 2 mg Morphine Sulfate liquid sublingually to patient C.E., without a physician order on or about June 4, 2012, while employed as a Hospice Nurse Case Manager by Casa de la Luz Hospice, in Tucson, Arizona.

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Are there alternatives to things like this that will help a nurse continue his/her work instead of disabling them from the workforce? Quinn moved, Berrigan seconded, and it was unanimously carried, based upon the findings of fact and statute/rule violations identified in the investigative report, to offer a Consent Agreement for a 24-month stayed revocation with the license suspended during the first 12 months and on probation the second 12 months, followed by a 24-month probation including the attached stipulations. If not signed within 30 days, issue Notice of Charges.

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But I enter a computer order for a case management consult and provide patient education materials and get my license revoked: Post moved, McCormies seconded, and it was unanimously carried to issue a Letter of Concern for failing to notify the physician prior to writing a telephone order on patient D.A. on or around December 16, 2011, in violation of Policy PCI.034 Accepting Written, Verbal and Telephone Orders while employed as a RN at Mercy Gilbert Medical Center in Gilbert, Arizona.

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DUI: Padilla was present, telephonically, and addressed the Board. Quinn moved, Berrigan seconded, and it was unanimously carried to grant certification upon meeting all requirements, and issue a Letter of Concern for the July 27, 2012, conviction of DUI, a misdemeanor, in Tucson City Court, in Tucson, Arizona.

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DUI: Rhodes was present, telephonically, and available for questions. Snider moved, Dalton seconded, and it was unanimously carried to grant licensure upon meeting all requirements, and issue a Letter of Concern for the June 14, 2012 conviction for DUI-BAC.15, a misdemeanor, in Mesa, Arizona.

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Another cruel example of disabling a nurse from working no one hires a nurse under these conditions: McCormies moved, Dalton seconded, based upon the findings of fact and statute/rule violations identified in the investigative report, to offer a Consent Agreement for a 24-month stayed revocation with the license suspended during the first 12 months and on probation the second 12 months, followed by 24-months probation, including the attached stipulations. If not signed within 30 days, issue Notice of Charges. After discussion, the motion carried with eight in favor and one opposed.

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NON COMPLIANCE WITH BOARD ORDER: An attempt was made to contact Bunton, telephonically and a message was left that the Board would move forward with the case. Johnson moved, Dalton seconded, and it was unanimously carried, based upon the language of the Order and the findings of fact and statute/rule violations indentified in the monitoring non-compliance report, to issue a Letter of Concern for respondent’s positive Urine Drug Screen (UDS) for Amphetamines on November 1, 2012, and allow her to continue with Order

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NON COMPLIANCE WITH BOARD ORDER: Nelson was present and addressed the Board. McCormies moved, Dalton seconded, and it was unanimously carried, based upon the language of the Order and the findings of fact and statute/rule violations identified in the monitoring non-compliance report, to allow respondent to continue on with the Order and excuse the missed urine drug screen (UDS) from September 26, 2012.

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DUI: Snider moved, Gutierrez seconded, and it was unanimously carried to grant certification upon meeting all requirements, and issue a Letter of Concern for the September 30, 2011, conviction of DUI, a misdemeanor, in Pima County Consolidated Justice Court in Pima County, Arizona.City, Arizona.

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DUI: Johnson moved, Quinn seconded, and it was unanimously carried to issue a Letter of Concern for the March 21, 2012, misdemeanor Extreme DUI conviction in Sierra Vista, Arizona

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ELDER: Gutierrez moved, McCormies seconded, and it was unanimously carried to rescind the September 20, 2012 Board decision and issue a Letter of Concern for restraining a resident with a gait belt at the instruction of an LPN on March 16, 2012, while employed as a CNA at Chinle Nursing Home in Chinle, Arizona.

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ELDER: McCormies moved, Berrigan seconded, and it was unanimously carried to issue a Letter of Concern for yelling at one resident and reportedly telling another to “shut up” while employed as a CNA at Desert Highlands in Kingman, Arizona resulting in termination of his employment.

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ELDER: Johnson moved, McCormies seconded, and it was unanimously carried to issue a Letter of Concern for failing to follow-up on Resident J.G’s complaints of pain with the resident’s nurse on November 13, 2011, or document her assessment while employed as an LPN at Westchester Care Center in Tempe, Arizona.

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ELDER: Post moved, Snider seconded, and it was unanimously carried to issue a Letter of Concern for inappropriately addressing a resident using foul language on May 12, 2012, while employed as a CNA at Highland Manor Health and Rehabilitation in Phoenix, Arizona.

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March 2013

Quinn moved, Gutierrez seconded, and it was unanimously carried, based upon the findings of fact and statute/rule violations identified in the investigative report, to issue a Letter of Concern for, while visiting a friend, P.N., on or about December 15, 2001, who was a patient at Banner Thunderbird Medical Center in Phoenix, Arizona, allegedly practicing beyond her scope by removing P.N.’s Foley catheter, and for initially saying she inserted the Foley catheter and later recanting her statement.

 

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DUI: Johnson moved, Gutierrez seconded, and it was unanimously carried, upon meeting all requirements, to grant licensure and issue a Letter of Concern for the December 13, 2011, conviction of extreme DUI (Driving Under the Influence) with a BAC of .20 or more, a misdemeanor, in the Mesa Municipal Court in Mesa, Arizona.

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DUI: Johnson moved, Snider seconded, and it was unanimously carried to issue a Letter of Concern for the conviction of DUI (Driving Under the Influence) .08% or Higher, a Misdemeanor, and DUI .20% or Higher, a Misdemeanor, in the Superior Court of California, San Luis Obispo, California on August 29, 2011

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ELDER: Gutierrez moved, Quinn seconded, and it was unanimously carried, to issue a Letter of Concern for receiving a complaint from St. Luke’s Medical Center in Phoenix, Arizona, on or about October 10, 2011, alleging that she engaged in abusive and threatening behavior toward patient M.R. while working as a RN in the Special Care Unit on or about October 25 & 26, 2011.

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NON COMPLIANCE WITH BOARD ORDERS: Galan addressed the Board and confirmed receipt of additional information. Snider moved, Harrell seconded, and it was unanimously carried to issue a Letter of Concern for the January 11, 2013, no-show random urine drug screen and allow Respondent to continue on with the Order.

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NON COMPLIANCE WITH BOARD ORDERS: and issue a Letter of Concern for the missed urine drug screens on December 26, 2012, January 3, 2013, and January 17, 2013, and allow Respondent to continue on with the Order.

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WHY NOT JUST REVOKE, THIS NURSE WILL NEVER WORK AGAIN: Quinn moved, Snider seconded, and it was unanimously carried, based upon the findings of fact and statute/rule violations identified in the investigative report, to offer a Consent Agreement for a 24-month stayed revocation with the license suspended during the first 12 months and on probation the second 12 months, followed by a 24-month probation, and to include the attached stipulations. If not signed within 15 days, issue Notice of Charges.

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Dalton moved, Berrigan seconded, based upon the findings of fact and statute/rule violations contained in the investigative report, to issue a Letter of Concern for a medication error made on or about August 29, 2012 and for mislabeling lab specimens on or about October 6, 2012 while employed as a registered nurse at Yavapai Regional Medical Center in Prescott, Arizona. After discussion, the motion carried with seven in favor and two opposed

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NON COMPLIANCE WITH BOARD ORDERS: Michael was present and addressed the Board. Busby moved, Johnson seconded, and it was unanimously carried to issue a Letter of Concern for the January 28, 2013, no-show random urine drug screen and allow Respondent to continue on with the Order.

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NON COMPLIANCE WITH BOARD ORDERS: McCormies moved, Gutierrez seconded, and it was unanimously carried to issue a Letter of Concern for the September 11, 2012, no-show random urine drug screen, and excuse the January 24, 2013, no-show random urine drug screen due to illness, and allow Respondent to continue on with the Order.

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May 2013

Attorney Ken Baker was present and addressed the Board. Shepis was present and available for questions. Quinn moved, McCormies seconded, and it was unanimously carried, based upon the findings of fact and statute/rule violations identified in the investigative report, offer a Consent Agreement for a twelve (12) month probation to include the attached stipulations and allow Respondent to continue to work as a Home Health RN with Bright Star Home Health under audited supervision by one supervisor which shall include a minimum of two monthly telephonic evaluations with Respondent’s patients to assess the appropriateness of Respondent’s nursing care and conduct, as well as a minimum of two chart audits per month. If not signed within (30) days, issue Notice of Charges.

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NON COMPLIANCE WITH BOARD ORDERS: Galan addressed the Board and confirmed receipt of additional information. Nelson was present and addressed the Board. Johnson moved, Dalton seconded, and it was unanimously carried to issue a Letter of Concern for your April 10, 2013 no-show for a random urine drug screen, in violation of your Board Order; and lift Respondent’s stayed revocation probation and place Respondent on standard probation pursuant to her Board Order.

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NON COMPLIANCE WITH BOARD ORDERS: Johnson moved, Berrigan seconded, and it was unanimously carried to issue a Letter of Concern for your April 25, 2013 failure to provide a random urine drug screen, as required by your Board Order; and allow Respondent to continue with his stayed revocation/probation.

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NON COMPLIANCE WITH BOARD ORDERS: McGeary was present telephonically, and addressed the Board. Gutierrez moved, Johnson seconded, and it was unanimously carried to issue a Letter of Concern for non-compliance with the terms and conditions of the Order, including: failure to complete the 24 month work requirement; failure to meet supervisory conditions

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ELDER: Gutierrez moved, Dalton seconded, and it was unanimously carried to issue a Letter of Concern for failing to check a resident’s brief during your shift and neglecting to report a change of the resident’s condition to your charge nurse on December 23, 2012 while employed as a CNA at Desert Haven Care Center in Phoenix, AZ.

NON COMPLIANCE WITH BOARD ORDERS: Estavillo was present and available for questions. Quinn moved, McCormies seconded, and it was unanimously carried to issue a Letter of Concern for the April 26, 2013 no-show random urine drug screen, allow Respondent to continue on with the Order and all related Amendments, and revert Respondent to standard probation.

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Kent was present and available for questions. Quinn moved, Dalton seconded, and it was unanimously carried, based on the findings of fact and statute/rule violations identified in the investigative report, offer a Consent Agreement for a 12-month stayed revocation/suspension to be followed by 24 month stayed revocation/probation and 12 months of probation and to include the attached stipulations. Allow Respondent’s stipulated agreement, signed December 28, 2010 and effective January 26, 2011 to remain in effect until the matter is resolved. If not signed within 30 days, issue Complaint/Notice of Hearing.

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Non-Compliance/Compliance with Board Orders V.C.1. Amanda Trujillo RN137552   (Galan) Johnson recused herself from the meeting at 1:15 p.m. An attempt was made to contact Amanda Trujillo, telephonically and a message was left that the Board would move forward with the case. Galan addressed the Board. Quinn moved, Berrigan seconded, and it was unanimously carried, based upon the Consent Agreement and Order (attached hereto), and the information contained in this Monitoring Report, deny Respondent’s request to amend the Order. (Valley Home Care had offered me the chance to work for them because I couldn’t find a job—and the director was going to not only supervise me, but assist me with fulfilling all of the consent agreement requirements so I could complete the probation and still have an income—the board voted NO)

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Johnson moved, Dalton seconded, and it was unanimously carried to issue a Letter of Concern for accessing fellow employee’s personal records in the health care record system in violation of agency policy intermittently since 1995 at Southern Arizona Veteran’s Administration Health Center, Tucson, Arizona.

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July 2013

DUI: Dalton moved, Post seconded, and it was unanimously carried to issue a Letter of Concern for a misdemeanor Extreme DUI conviction on March 14, 2012, in Scottsdale City Court, Scottsdale, Arizona. After discussion, Quinn amended motion to delete Findings of Fact #3 and Rule #23. McCormies concurred. The motion carried unanimously.

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DUI: Post moved, Harrell seconded, and it was unanimously carried to grant licensure upon meeting all requirements, and issue a Letter of Concern for her 2001 misdemeanor conviction for petty theft and 2nd degree burglary, and her 2004 Misdemeanor conviction of DUI

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Dalton moved, Snider seconded, and it was unanimously carried, upon meeting all licensure requirements, grant license and issue a Letter of Concern for being impaired on prescription medication while on duty on or about May 21, 2010, at Johnston Memorial Hospital, Smithfield, North Carolina, which resulted in completion of a Consent Agreement for a twelve month probation from the North Carolina Board of Nursing

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McCormies moved, Post seconded, and it was unanimously carried, based on the findings of fact, statute/rule violations identified in the Investigative Report, issue a Letter of Concern for while employed as a CNA at Grace Hospice in Tempe, AZ December 1, 2012 to March 19, 2013, Respondent falsified times of patient visits, hours worked and mileage on March 18, 2013 and April 8, 2013 and wrote on his Board questionnaire received on May 15, 2013 that he knew this behavior was not in line with what is expected of a CNA or aspiring nurse

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Post moved, McCormies seconded, and it was unanimously carried, upon meeting all licensure requirements, grant licensure and issue a Letter of Concern for failing to carry out an order for cardiac telemetry on or about April 5, 2012 while employed as a RN at Chandler Regional Medical Center, Chandler, AZ.

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Quinn moved, Berrigan seconded, and it was unanimously carried, based upon the Findings of Fact and statute/rule violation identified in the investigative report, offer a Consent Agreement for a suspension not to exceed 24 months pending the completion of a substance abuse and boundary violation evaluation by a Board approved psychiatrist and the successful completion of treatment recommendations resulting from the evaluation and/or confirmation is received from either the evaluator or treatment providers that Respondent is safe to return to practice, to be followed by a minimum 36 month stayed suspension/probation to be followed by a 12 month standard probation to include the attached stipulations. If not signed within 30 days, issue Notice of Charges.

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September 2013

DUI: Dalton moved, Berrigan seconded, and it was unanimously carried to issue a Letter of Concern for a misdemeanor driving under the influence (DUI) conviction on June 20, 2012 in the Tempe Municipal Court in Tempe, Arizona.

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DUI: Snider moved, Dalton seconded, and it was unanimously carried to grant licensure upon meeting all requirements, and issue a Letter of Concern for the March 13, 2013 conviction of misdemeanor extreme DUI in Pima County Consolidated Justice Court, Tucson, Arizona.

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DO POTENTIAL SEX OFFENSES STILL GET TO WORK DURING THE INVESTIGATION? Quinn moved, Johnson seconded, on a determination of reasonable cause based on the facts alleged in the investigative report and material presented at this Board meeting, at no cost to the Board, issue an Interim Order for a psychological evaluation focused on sexual misconduct, boundaries, and ethics

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Busby moved, Berrigan seconded, and it was unanimously carried, grant licensure upon meeting all requirements, and issue a Letter of Concern for her August 6, 2008, arrest by the Ramsey County Sheriff’s Office (Minnesota) for aiding an offender to avoid arrest, which did not lead to charges being filed; and her April 24, 2011, one-year stayed entry of judgment for disorderly conduct, a misdemeanor, which was dismissed on December 18, 2012, in Hennepin County Court, Minnesota

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DUI: Busby moved, Berrigan seconded, and it was unanimously carried, based upon the findings of facts identified in the investigative report, upon meeting all licensure requirements, grant licensure and issue a Letter of Concern for: August 15, 2001 misdemeanor DUI- Methamphetamine, and Unauthorized Possession of a Syringe, in Anaheim, California. September 5, 2002, misdemeanor DUI of a controlled substance in Costa Mesa, California. September 22, 2002, misdemeanor DUI of a controlled substance, in Costa Mesa, California.

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Busby moved, to issue a Letter of Concern for violating the privacy of a patient and Arrowhead Hospital’s Information Security Agreement, while employed as an RN in September 2012, regarding computerized information systems that states: “… To access only computer systems, equipment and functions as required for the performance of my responsibilities …” After discussion, Busby withdrew the motion.   Johnson moved, and Busby seconded, based on the Findings of Fact, statute/rule violations identified in the Investigative Report, it was unanimously carried to offer a Consent Agreement for a Decree of Censure to be signed within 30 days or issue a Notice of Charges.

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Busby moved, Gutierrez seconded, and it was unanimously carried to accept the signed Consent Agreement and Order No. 1106096 for a Stayed Suspension with Probation for a maximum period of 48 month, with terms and conditions, as settlement in complaint no. 1106096.

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Busby moved, Johnson seconded, and it was unanimously carried to grant motion for review. Johnson moved, Busby seconded, to rescind prior Order of Denial. Post moved, Berrigan seconded, to grant licensure and issue a Letter of Concern for the felony conviction in Washington, March 18, 2004, for endangerment with a controlled substance.

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DUI: Busby moved, Snider seconded, and it was unanimously carried, based upon the findings of fact and statute/rule violations identified in the investigative report, issue a Letter of Concern for the October 2011 arrest and conviction of extreme DUI and DUI.

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November 2013

Berrigan moved, Snider seconded, and it was unanimously carried to issue a Letter of Concern for failing to document nursing care and failing to follow physician orders and timely deliver of nursing care on or about April 6, 2012 and May 31, 2012 while employed as a RN at Tucson Medical Center in Tucson, Arizona.

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DUI: Post moved, Dalton seconded, to grant licensure upon meeting all requirements, and issue a Letter of Concern for Applicant’s July 11, 2012 DUI and Extreme DUI with Alcohol Concentration of .15 or Greater convictions in Phoenix Municipal Court (AZ) case number 14005091. The motion carried with six in favor and four opposed.

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Quinn moved, Busby seconded, and it was unanimously carried to issue a Letter of Concern for administering Lantus insulin 30 units in error to a patient on or about July 8, 2012, while employed as a RN at Banner Gateway Medical Center in Mesa, Arizona.

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DUI: Busby moved, Gutierrez seconded, and it was unanimously carried to grant licensure upon meeting all requirements, and issue a Letter of Concern for his January 11, 2006 misdemeanor conviction of DUI in Scottsdale, Arizona; and his April 1, 2009 misdemeanor conviction of DUI in Phoenix, Arizona.

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ELDER: Busby moved, Snider seconded, and it was unanimously carried to issue a Letter of Concern for grasping a resident’s arm so tightly that fingerprints were left on the resident’s arm while employed as a CNA at Apache Junction Care Center in Apache Junction, Arizona, on or about October 7, 2011.

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Post moved, Busby seconded, and it was unanimously carried to grant certification upon meeting all requirements and issue a Letter of Concern for failing to disclose her October 11, 2009, felony charge for Knowingly Possessing or Using Cocaine on her nursing assistant application to the Board.

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Amanda Trujillo (V. Smith) Val Smith confirmed the receipt of additional information. Attorney Teressa Sanzio was present and addressed the Board. Johnson moved, Harrell seconded, and it was unanimously carried, based upon the findings of fact and statute/rule violations identified in the investigative report, issue Complaint and Notice of Hearing. (Because I had violated the consent agreement, though I had emailed the board several times to tell them about lack of employment, inability to secure a job, losing the house, losing the car, ongoing health issues and then asking to work at Valley Home Care when I was invited back by the director)

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McCormies moved, Dalton seconded, and it was unanimously carried to issue a Letter of Concern for providing a patient an enema to self-administer on or about August 2, 2012, without a provider’s order and for failing to document the patient’s complaints of abdominal pain in a sick note or document self- administration of the enema while you were employed as a LPN with Pinal County Correctional Health Services. The motion carried with six in favor and three opposed.

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Johnson moved, Busby seconded, and it was unanimously carried to issue a Letter of Concern for your being charged on or about June 12, 2011, and convicted on or about November 2, 2011 in the Missoula, Montana Municipal Court, of DUI, refusal to submit to a breath or blood test, failure to stop immediately at a property damage accident, and interfering with traffic while backing; and for failure to notify the Board within 10 days of being charged as required by Arizona Revised Statutes §32-3208 and Arizona Administrative Code Rule 4-19- 403(28).

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DUI: Busby moved, Dalton seconded, and it was unanimously carried to issue a Letter of Concern for his January 29, 2010, conviction, pursuant to a guilty plea, of driving while intoxicated, a misdemeanor, in Smith County Court in Smith County, Texas; his July 9, 2010, charge of driving while intoxicated in Smith County Court in Smith County, Texas, which ultimately led to a January 31, 2011, conviction of reckless driving, a misdemeanor, in Smith County Court in Smith County, Texas; his failure to report the charges to the Board within 10 days as required by statute and rule, and his failure to cooperate with the Board’s investigation.

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Kerrigan addressed the Board with additional information. Busby moved, McCormies seconded, and it was unanimously carried, based upon the findings of fact and statute/rule violations identified in the investigative report, offer a Consent Agreement for a minimum 36-month Stayed Revocation with the license suspended during the first 12 months and on Probation the second 24 months, followed by a 12- month Standard Probation, and to include the attached stipulations. If not signed within 15 days, issue Complaint and Notice of Hearing.

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ELDER: Dalton moved, Johnson seconded and after discussion, it was unanimously carried to issue a Letter of Concern for raising her voice and/or yelling at residents and throwing a resident’s shoes on the floor while employed as a CNA at Springdale Village Care Center in Mesa, Arizona, on or about October 2011 through December 20, 2012.

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ELDER: Busby moved, Dalton seconded, and it was unanimously carried to issue a Letter of Concern for abandoning your patient assignment on or about November 2, 2012 while employed as a CNA at North Mountain Medical Rehab in Phoenix, Arizona.

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Arizona Board of Nursing 2004: The Top Twenty…or Thirty “Whatever Events”

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(If you’re not a nurse or patient and just want to read the discipline report, scroll down now)

     If you remember anything about patient related scandals you see on television remember the word “Systemic.” Our healthcare system is not patient centered. Everything is all about strategic goals and bringing in the revenue to keep the ship sailing and keep it the biggest prettiest ship sailing the ocean so everyone will want to be on “that one” and not all the rest……We have state boards that have little to no oversight, conflicts of interest (I was told that board member K. Malloch may have had a financial contract with Banner Health at the time of my case and there was another member from Banner Health on the board at the time my case was first presented) that write their own rules giving them more power, and the ability to pick and choose who to discipline or not discipline regardless of the accusations or charges….and they can pretty much do what they wish, when they wish, to whom they wish. Call it their version of  ” eenie meanie monnie moe. ” I don’t recall any discipline being doled out to AZBON Nurse Investigator Nikki Austin when it was discovered she was working without an active JD license during a good portion of my investigation…….but I digress. This is, after all, Arizona. The saying “It is what it is” applies here.

Anywhoo…..Today I was reading an article in the Arizona Republic in which a sixteen year veteran employee who was working as a physician at the Phoenix Veteran Affairs Hospital testified that the facility had become a “breeding ground for horizontal violence within the workplace…where the employees who stand up to wrongdoing are subjected to bullying, false charges and career destruction.” (sound familiar Frank, Steve, Emem, Sara, and Anjali at Banner Del E Webb Hospital?) Dr. Katherine Mitchell goes on to explain that “no matter how critical the issue is to patient care or safety, senior officials will deliberately avoid the problem by covering up any evidence of a deficiency (Sound familiar nurse managers Venus Gaines, Frank Fausto, Michelle Winters, and Denise Hebert?)

Though Ive not heard a word from any of my nursing professors from Northern Arizona University since the Banner Health debacle occurred and I initiated my social media awareness campaign. (I’m quite sure they are horrified one of their own did what I did) I still abide by their teachings of nursing theory, what nursing is, what ethics means, and that you treat every human being in your charge as you would your own family member—in your decision making and in your actions. My dad, by the way, is a Vietnam Vet caught up in all this business and you can bet I’m mad as hell about it. I wonder how many nurses at this facility kept quiet and didn’t report wrong doing—but then again, the AZBON would probably just issue “Letters of No Concern” to them too……

Unfortunately, abiding by a code of ethics or an oath, possessing a shred of human decency, morals, and values does not fit in with the current profit based and profit driven healthcare system. I will reiterate again, that no one was with me and my patient the night of April 12, 2011. No family, no friends, no nurse manager (though he had every opportunity to go in and verify my concerns by doing his own independent assessment….)My patient didn’t want all the things that were done to them. What they wanted was to go home and make amends and be with family. What they wanted was to cease the poking of needles, the tests and procedures, and the lack of rest they were experiencing at the hospital.

It isn’t just the VA Healthcare System that persecutes its employees for going against the status quo and having a conscience. They aren’t the only healthcare system targeting those employees who do have a sense of right and wrong, the ones who can clearly delineate between inhumane treatment of people and preserving what every living breathing person is entitled to===basic human rights. Banner Health System was no better than the VA in this situation with me and my patient. I reported up the chain of command, no one enacted the patient safety policy in place when a healthcare provider reports potential danger or wrongdoing, and I was promptly placed on administrative leave and fired seven days later for putting the hospital at “increased liability” by arranging for the case manager to come visit with the patient. I was turned over to the Arizona State Board of Nursing to defend my license and clear my name against the charge of going out of my scope of practice. My refusal to admit wrong doing resulted in a thorough review of my entire career history, a bogus psych eval in which I spent no more than 5 minutes with the actual doc and the rest of the day having my brain tested via different tests, and yet he had a huge report filled with things to say…oddly enough it looked like a regurgitation of the nurse investigators report…… and a lot of creative writing on behalf of the nurse investigator Nikki Austin, who took past errors and embellished details to the point I looked like a monster of a nurse. A rogue practitioner. A danger to others. In her words “a nurse who pushes people toward death.” Yeah, those words stuck with me too, over the years, they still make my blood boil. Anyone ever heard the term “Gaslighting?” I think it’s part of the orientation at the AZBON…….

During the time I was employed at Banner Del E Webb I had reported several other patient safety issues to the appropriate department and I suspect the last incident with this patient was the final straw for the risk management people in Human Resources. At one point in time almost my whole unit was on contact precautions because they were inappropriately placed on a lot of IV antibiotics without evidence of any infection and had developed dangerous super infections as a result of that. I had also reported a physician who would not respond to my urgent calls when his patient was having an acute stroke. In addition to these reports, I also brought to their attention the fact physicians were coming in early and charting progress notes on patients they hadn’t even seen yet—mine specifically, that end of life patients were being denied appropriate relief for air hunger and pain relief, and that physicians would yell and hang up on me in the middle of the night when I called with acute patient concerns.

VA Physician whistleblower Dr. Mitchell reiterates what I have been telling state legislators all along since 2011 and why I have been trying to get legislation passed to protect healthcare providers: “Employees today still risk backlash for bringing up patient care problems, identifying misuse of facility resources and questioning the prohibited personal practices…” So, let’s consider a pretty simple question—what is more important these days? The paycheck and career ladder, or the safety and well being of human beings we are trusted with caring for???? Everyone at the VA knew what was going on for years and it probably would have gone on for many more years had a newly retired physician not spoken up—-how many lives might he have changed if he had come forward sooner??? How many vets would still be here among us, alive, healthy, and enjoying their families and retirements? My father could have been one of those who died, and I am thankful that he still is alive and breathing and on a few of those “lists” rather than gone from us.

When you make the choice to become a whistleblower your life is never the same and you can’t find work because the Arizona Board of Nursing publishes everything on its public page for about ten years. A whistleblower in Arizona is a criminal in Arizona—period. When you make the choice to come forward in favor of what is right, and just, you must be prepared for all the consequences that go with it. I will be honest…..I was not prepared for it. I have paid dearly, but I have been asked over and over again to admit I was wrong that night in what I did for my dying patient at their request or that I was wrong to come forward and talk to the media via radio, tv, and social media—to this day I have refused to admit any wrong doing for those actions because they were within my scope and duty and oath. Ill admit to having made mistakes in my career like everyone else, but Ive  never wavered and submitted to a forced admission that what happened with me and my patient was wrong. I take accountability for mistakes I make, not the ones I do not make. That was one of the biggest problems with my case—-in each instance I was asked to just admit I was wrong I refused to do it, or to admit that I shouldn’t have done anything–again, I refused to do it. I truly wish the 70 employee whistleblowers from the VA luck with this, and I hope they come from a strong foundation of inner truth, because its what is required to survive the fallout of coming forward and displaying what the American Nurses Association likes to use as buzz words: “Moral courage.”  Hint: Hospital Institutions bristle when they hear those words–you’re not supposed to really display it or act on it!

In the spirit of the article published today in the Arizona Republic I present to you the last installment of: “Ongoing Regulatory Excellence at the AZBON in 2004. ” You will see some gross inequities in discipline, you will see extensions granted to nurses on consent agreements (I was denied that right though I had asked due to several hardships) and you will see some instances of reported elder abuse…..which raised a question in my mind…..if these individuals are turned over to the Board of Nursing for abusing elderly residents who is liable for making the report to the officials that handle those things? Arent there laws that state there are certain instances that require mandatory reporting? Not that it mattered in my case….(sigh) but I guess it’s just one more thing to put on my list of things to research……

In short. Being a healthcare whistleblower is a bloody mess. (Forgive the pun)

(Letters of Concern=No discipline)

 

January 2004

(AS I RECALL, SHE WAS WORKING WITH INACTIVE CREDENTIALS WHILE ON MY CASE…) Nikki Austin, attorney for Chandler Regional Hospital, was present and addressed the Board. The Board directed staff to refer Chandler Regional Hospital to DHS for hiring a new graduate as an RN when he did not have an RN license, and to open a complaint on Troy Garland RN098923 for allowing an unlicensed individual to perform duties and use the title required by a licensed person.

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Miller was present, telephonically, and addressed the Board. Malloch moved, O’Connor seconded, to continue the investigation to allow Miller to successfully complete a 16 hour DUI Level II Education Class and a MADD Victim Impact Panel, to be completed within 60 days, or deny certification. If the 16 hour DUI Level II Education Class and MADD Victim Impact Panel are completed within 60 days, grant certification with a Letter of Concern for the May 26, 1995 conviction of possession of marijuana in Coconino County Superior Court in Flagstaff, Arizona, and for the March 2, 1999 conviction of driving with a BAC of .10% or more in Mohave County Justice Court in Moccasin, Arizona. After discussion, Malloch amended the motion to include: request Miller to complete a urine drug screen by 5 p.m. this day, January 22, 2004. O’Connor concurred. After discussion, the motion failed with three opposed and three in favor.

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Campbell moved, Johnson seconded, and it was unanimously carried to issue a letter of concern for a misdemeanor domestic violence conviction on or about December 5, 2003.

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Williams was present and available for questions. Campbell moved, Johnson seconded, and it was unanimously carried to issue a letter of concern for a criminal assault charge resulting from a verbal and physical altercation with a coworker at Devon Gables Health Care in Tucson, Arizona on or about November 10, 2003.

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Harris moved, Malloch seconded, and it was unanimously carried to reopen Agenda Item V.H.6. Lopez was present and addressed the Board. Twigg addressed the Board with additional information. Malloch moved, Harris seconded, and it was unanimously carried to issue a letter of concern for failing to document a resident’s blood sugar level and administration of insulin at 9:00 p.m. on or about August 2, 2001 while working at Posada del Sol Health Care Center in Tucson, Arizona through Dependable Nurse Kathleen Lambert, attorney, was present and addressed the Board. Malloch moved, Campbell seconded, and it was unanimously carried to issue a letter of concern for appearing to be sleeping on duty while working at Kino Community Hospital in Tucson, Arizona.s, Inc.

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Malloch moved, Hardy seconded, and it was unanimously carried to issue a letter of concern for destroying orders written by another health care professional from a medical record on or about April 11, 2003 while employed by Yavapai Regional Medical Center.

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Malloch moved, Hardy seconded, and it was unanimously carried to reopen Agenda Item V.I.12. Crawley moved, Hardy seconded, and it was unanimously carried to issue a letter of concern for the unauthorized removal of medications from the workplace on or about 2004, while employed at HealthSouth in Glendale, Arizona.

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Ogden moved, Malloch seconded, to issue a letter of concern for failing to follow the chain of command to ensure that 12 inmates received 15 doses of medications on February 15, 2004, while working at the Arizona Department of Corrections. After discussion, the motion carried with four in favor and three opposed.

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Lang was present and available for questions. Malloch moved, Hardy seconded, to issue a letter of concern for failing to document the notification of the physician about late decelerations on a fetal monitoring strip on October 10, 1996 while working at Arrowhead Community Hospital. The motion carried with eight in favor and one abstained.

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Sage addressed the Board with additional information. Harris moved, Hardy seconded, to issue a letter of concern for reportedly pushing a resident in her wheelchair and causing it to hit the wall and to have struck the resident on her back on July 25, 2004, while employed as a CNA at Good Shepard Villa in Mesa, Arizona. The motion carried with seven in favor and one abstained

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Hardy recused herself to avoid the appearance of impropriety, and left the meeting at 5:49 p.m. Crawley moved, Harris seconded, and it was unanimously carried to issue a letter of concern for taking a non-prescribed controlled medication (Oxycodone) and a June 6, 2003 positive urine drug screen while employed as a professional nurse at Western Arizona Regional Medical Center in Bullhead City, Arizona.

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Mason was present and addressed the Board. Campbell moved, Ogden seconded, and it was unanimously carried to issue a letter of concern for reportedly being rough in the care of two residents, causing them to incur skin tears, and speaking harshly to others at Sunview Care Center on June 21, 2004.

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Ogden moved, Hardy seconded, and it was unanimously carried to issue a letter of concern for applying unordered restraints by placing a resident in a wheelchair with the brakes locked and positioning her behind tables in the dining room in such a way that she could not leave, on August 20, 2004 while employed as a CNA at Westchester Care Center in Tempe, Arizona.

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Moore moved, Harris seconded, and it was unanimously carried to issue a Letter of Concern for the misdemeanor arrest on March 8, 2003 for domestic violence, and July 1, 2003 for criminal damage in Tucson, Arizona.

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Harris moved, Ogden seconded, to issue a Letter of Concern for testing positive for marijuana on a pre- employment drug screen for Beatitudes Campus of Care on January 5, 2001 and for allegedly borrowing money from a resident at Highland Manor on or about June 30, 2002. The motion carried with three in favor and two opposed.

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Curtis was present, telephonically, and addressed the Board. O’Connor moved, Harris seconded, and it was unanimously carried to grant certification with a Letter of Concern for the June 21, 1990 conviction

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for theft over $250, a class 6 open-ended felony which was designated a felony on August 2, 1990, for the September 13, 1990 conviction for 2 counts of burglary in the 2nd degree, a class 3 felony, and 1 count burglary in the 3rd degree, a class 4 felony in Pima County Superior Court in Tucson, Arizona.

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Sage addressed the Board with an amendment to the Investigative Report, to delete (11) under Potential Violations of Rules. Harris moved, Campbell seconded, and it was unanimously carried to issue a Letter of Concern for an arrest for DUI with a BAC of over .08% on February 23, 2002, and subsequent conviction on March 18, 2002, and an arrest April 20, 2002 and subsequent conviction May 13, 2002 for possession of an open container of alcohol in a moving vehicle.

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Torrez addressed the Board with additional information. O’Connor moved, Campbell seconded, and it was unanimously carried to issue a Letter of Concern for asking a staff member to remove valium and document that it had been wasted so she could give it to her husband who had run out of his supply of medication on or about October 14, 2003, while employed at Beverly Healthcare South Mountain in Phoenix, Arizona.

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Campbell moved, Johnson seconded, to issue a letter of concern for administering medication to A.W. that had been discontinued on another resident, and for failing to ensure A.W. received the her own medication for several weeks thereafter, in April 2004, while working at Immanuel Campus of Care in Peoria, Arizona. The motion carried with seven in favor and two opposed.

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Campbell moved, Johnson seconded, to issue a letter of concern for failing to ensure that residents who went on a bus tour on February 25, 2004 had appropriate pass orders, and for failing to document their departure and return, and for omitting an IV antibiotic, failing to notify the appropriate staff that it was not given, and for incomplete documentation regarding a resident who went to the hospital, while working at Infinia Esperanza Manor, in Phoenix, Arizona. After discussion, Campbell withdrew the motion. Ogden moved, Malloch seconded, and it was unanimously carried to issue a letter of concern for omitting an IV antibiotic, failing to notify the appropriate staff that it was not given, and for incomplete documentation regarding a resident who went to the hospital, while working at Infinia Esperanza Manor, in Phoenix, Arizona.

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Lavant was present and addressed the Board. Harris moved, Crawley seconded, and it was unanimously carried to issue a letter of concern for pre-pouring controlled medications and failing to waste controlled medications according to facility policy on February 24 and 25, 2004, and incorrectly withdrawing medications for two patients on February 14 and 16, 2004, while employed by Maricopa Integrated Health System.

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O’Connor knows Robin Marshal, but shows no bias. Torrez addressed the Board and confirmed receipt of additional information. Glenmah Clark, complainant, was present and addressed the Board. Rauch- Adams was present and addressed the Board. Campbell moved, Gagnaire seconded, to issue a Letter of Concern for failing to review the medical record entry on or about July 18, 2002, which stated that Decadron was not to be administered, subsequently administering Decadron 10 mg. to G.C. on or about August 9, 2002, and for lacking consideration of the patient and their wishes at the time of care, while employed at Hematology & Oncology Associates in Scottsdale, Arizona. The motion carried with four in favor and one opposed.

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Jetson was present and addressed the Board. Munger addressed the Board with a technical correction to the Investigative Report. Malloch moved, Ogden seconded, and it was unanimously carried issue a Letter of Concern for failing to contact the physician, obtain a physician orders, make an assessment of the patient with regard to suicide risk, or make an entry in the medical record on August 5, 2003 while working at Scottsdale Behavioral Health in Scottsdale, Arizona.

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Pavlina addressed the Board with technical corrections to the Investigative Report. Malloch moved, Campbell seconded, and it was unanimously carried to issue a Letter of Concern for reportedly being inappropriate verbally and physically with a resident between June 9, 2003 and June 13, 2003 while employed by Evergreen Sun City Health and Rehabilitation Center in Sun City, Arizona.

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Campbell moved, Harris seconded, and it was unanimously carried to issue a Letter of Concern for an allegation of shoving a resident in the back who was in a wheelchair, causing pain that required medication, and for using inappropriate language on January 30, 2003, while employed by Sunbridge Park Villa Care and Rehabilitation in Tucson, Arizona.

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Harris moved, O’Connor seconded, and it was unanimously carried to issue a Letter of Concern for pulling a resident’s hair and “thumping her on the hand” as she was trying to enter the kitchen area on July 11, 2003, at Scottsdale Village Square in Scottsdale, Arizona.

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O’Connor moved, Campbell seconded, to rescind prior Board motion of April 24, 2003 for a Consent Agreement for a $50 Civil Penalty, and issue the attached Letter of Concern for throwing water into the face of a patient on or about August 6, 2002, while employed as a private sitter for the patient in Tempe, Arizona. After discussion, O’Connor amended the motion for the Letter of Concern to read: for failing to insure that patient rights were protected while employed at Westchester Care Center in Tempe, Arizona. Campbell concurred. The motion carried unanimously.

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Harris moved, Ogden seconded, and after discussion, it was unanimously carried to rescind prior Board motion for a Consent Agreement for a $50 Civil Penalty, or proceed to hearing, and issue the attached Letter of Concern for possible failure to respect a client’s rights and dignity as represented by her possible terse, abrupt and demeaning manner in caring for residents on July 30, 2002, while working at Westminster Village in Scottsdale, Arizona.

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Malloch moved, Ogden seconded, to issue a Letter of Concern for an inappropriate interaction with a patient on or about October 2, 2003, which resulted in termination of employment from Freedom Manor in Phoenix, Arizona. The motion carried with five in favor and one opposed.

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Pavlina addressed the Board and confirmed receipt of additional information. Kirk was present and addressed the Board. Campbell moved, O’Connor seconded, to issue a Letter of Concern for speaking rudely to patients in February 2003, while employed by Friendship Village of Tempe in Tempe, Arizona. After discussion, the motion carried with five in favor and one opposed.

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Malloch moved, O’Connor seconded, and it was unanimously carried to issue a Letter of Concern for reportedly being rough in a resident’s care on August 22, 2003 while employed as a CNA at Life Care Center of Yuma.

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Saiz was present and available for questions. Harris moved, Ogden seconded, and it was unanimously carried to rescind the prior Board decision of July 24, 2003, and issue a Letter of Concern for the June 4, 2002 incident of a resident stating she had been struck two times on the shoulder with a hitting or pushing motion while employed at Carondelet Health Network in Nogales, Arizona.

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March 2004

Campbell moved to issue a Letter of Concern for failing to assess and intervene on behalf of a patient complaining of pain on or about May 2, 2003 while employed at the Arizona Department of Corrections in Perryville, Arizona. The motion failed. Harris moved, O’Connor seconded, and it was unanimously carried to offer a Consent Agreement for a Decree of Censure, or proceed to hearing.

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Gagnaire, Malloch, Campbell and O’Connor know Sue Hollabaugh, but show no bias. John Nicgorski, attorney,and Orchard were present and addressed the Board. Ogden moved, Crawley seconded, and after discussion, it was unanimously carried to offer a Letter of Concern for inconsistent pain medication documentation on four patient Medication Administration Records and administering a medication without a physician order, from on or about March 5, 2003 to on or about March 11, 2003 while employed by John C. Lincoln, North Mountain Hospital in Phoenix, Arizona

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Teressa Sanzio, attorney, and Russell were present and addressed the Board. Crawley moved, Ogden seconded, and it was unanimously carried to issue a Letter of Concern for taking Darvocet that was not prescribed for personal use on or about December 27, 2002 and for not declaring the use of Darvocet to the MRO in conjunction with a for cause urine drug screen while employed by Hospice of the Valley.

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Campbell moved, Harris seconded, and after discussion, it was unanimously carried to issue a Letter of Concern for yelling at a resident while employed as a CNA at Desert Life Rehab and Care Center in Tucson, Arizona on July 30, 2003, and failing to cooperate during the Board investigation.

O’Connor moved, Harris seconded, and it was unanimously carried to issue a Letter of Concern for falling asleep while caring for a client resulting in a one hour delay in checking his blood sugar on or about June 20, 2003, while employed by Care Coordinator’s Inc. and providing care to a client in a home setting.

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O’Connor moved, Harris seconded, and it was unanimously carried to issue a Letter of Concern for unprofessional conduct toward residents in or about May 2002, while employed as a CNA at The Gardens Care Center in Kingman, Arizona

 

May 2004

D. Jay Ryan, attorney, was present and addressed the Board. Fuss was present was present and available for questions. Campbell moved, Ogden seconded, to issue a letter of concern for striking a handcuffed patient on the side of the head to get his attention on February 20, 2004, while working at Hu Hu Kam Hospital in Sacaton, Arizona. After discussion, Campbell amended the motion to change the word “striking” to “slapping”. Ogden concurred. The motion carried with six in favor and one opposed.

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Davis was present and addressed the Board. Rebecca Woodbury and Linda Maschner were present and addressed the Board. Ogden moved, Moore seconded, to issue a Letter of Concern for stashing a box of medications in the ceiling in November 2003 and for setting medications for others to pass, as well as passing medication which other nurses have set up, while working at the Arizona Department of Corrections from July of 1996 to the present.

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Twigg addressed the Board with additional information. Moore moved, O’Connor seconded, and it was unanimously carried to issue a Letter of Concern for failing to personally report to the Board a licensed practical nurse who said she was a registered nurse and who gave him a photocopy of a license that appeared to be altered.

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Negroni was present and addressed the Board. Pavlina addressed the Board with additional information. Malloch moved, Moore seconded, and after discussion, it was unanimously carried to issue a Letter of Concern for the alleged use of inappropriate language when speaking to a resident and for slapping the hand of another resident on December 8, 2003 while employed as a CNA by Desert Sky and Rehabilitation in Glendale, Arizona, for complaint #1, and offer a Consent Agreement for a $50 Civil Penalty to be signed within 30 days, or proceed to hearing, for complaint #2.

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Cisneros was present, telephonically, and addressed the Board. Moore moved, Ogden seconded, and after discussion, it was unanimously carried to issue a Letter of Concern for using inappropriate language in dealing with a client while employed at Posada Del Sol in Tucson, Arizona on or about July 29, 2003.

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Ogden moved, Campbell seconded, and it was unanimously carried to issue a Letter of Concern for failing to document a patient’s complaint of discomfort at her intravenous (IV) site, the discontinuation of the IV, and the time a new IV was started, and for incorrectly documenting the time an IV antibiotic was administered on February 24, 2002, while working as a licensed practical nurse at Boswell Hospital.

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Malloch moved, O’Connor seconded, and it was unanimously carried to issue a Letter of Concern for failing to notify supervisory staff immediately about resident TL’s change in condition on October 6, 2002 while employed at The Fountain Retirement Hotel.

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July 2004

Ogden moved, Harris seconded, and it was unanimously carried to issue letter of concern for failing to assure caregivers consistently document medications given to residents while working as an Assistive Living clinical coordinator at The Place at Tanque Verde in Tucson, AZ, and refer complaint to Nursing Home Administration Board.

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Malloch moved, Ogden seconded, and after discussion, it was unanimously carried to rescind the Notice of Charges adopted on May 19, 2004 and issue a letter of concern for speaking to a patient in a manner that made her feel threatened in October of 2003, and on November 19, 2003, while working through Aloha Registry at Phoenix Memorial Hospital.

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Campbell moved, O’Connor seconded, to offer consent agreement for a 12- month practice probation to include the attached stipulations or hearing. After discussion, Campbell amended the motion to include as a stipulation: therapeutic communication course. O’Connor concurred. After further discussion, Campbell amended the stipulations to include: completion of a communication/interpersonal skills course. O’Connor concurred. The motion carried unanimously

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Hembise was present and available for questions. Malloch moved, O’Connor seconded, and after discussion, it was unanimously carried to letter of concern for failing to follow facility policies related to medical record documentation, following physician instructions, and providing patients with incorrect information while employed at Mayo Hospital Clinic in Scottsdale, Arizona from on or about May 2003 to September 2003.

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September 2004

COULD ONE REQUIREMENT AT LEAST BE TAKING A COURSE RELATED TO SAFE DRIVING BEFORE GRANTING A LICENSE???? Greenlee was present and addressed the Board. Malloch moved, Hardy seconded, and it was unanimously carried to grant licensure upon meeting all requirements, with a letter of concern for a misdemeanor conviction for DUI on November 19, 1993 in Volusia County Florida; the felony and misdemeanor conviction May 17, 1989 for aggravated assault on a police officer and DUI Volusia County, Florida; the March 29, 1988, felony conviction for aggravated assault on a police officer and misdemeanor DUI in Volusia County, Florida; and the April 1, 1986 arrest for disorderly intoxication from which adjudication was withheld in Ormond Beach, Florida.

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ANOTHER APPLICATION FOR LICENSURE WITH THE SAME ISSUES……SEE ANY DIFFERENCE???? Tolliver was present and addressed the Board. Campbell moved, Molleo seconded, and it was unanimously carried to grant licensure upon meeting all requirements and signing a consent agreement for a 24 month probation, with stipulations amended to include: drug testing, abstain from alcohol within 12 hours of duty, abstain from unauthorized drug use, proof of prescription, notification of practice setting, quarterly performance evaluations, direct supervision, night shift prohibited, registry/home health prohibited. If not signed within 30 days, deny licensure based upon the information contained in the investigative report. If an informal settlement conference is requested, the authority to settle is limited to the terms of the consent agreement offered at this meeting

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Harris moved, Malloch seconded, to issue a letter of concern for allowing new graduate nurses who did not possess an RN license to administer medications and complete patient assessments and sign the medical records as GN while employed at Chinle Dialysis Services in Chinle,

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Arizona on or about August and September 2003. After discussion Malloch withdrew her second. Ogden seconded the motion. After further discussion the motion carried with eight in favor and one opposed.(Nurse #1)

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Judith Berman, attorney, was present and addressed the Board. Begay was present telephonically and addressed the Board. Campbell moved, Johnson seconded, to issue a letter of concern for allowing new graduate nurses who did not possess an RN license to administer medications and complete patient assessments and sign the medical records as GN while employed at Chinle Dialysis Services in Chinle, Arizona on or about August and September 2003. The motion carried with eight in favor and one opposed.   (nurse #2)

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Andreas was present and addressed the Board. Judith Berman, attorney, was present and available for questions. Malloch moved, Crawley seconded, to issue a letter of concern for allowing new graduate nurses who did not possess an RN license to administer medications and complete patient assessments and sign the medical records as GN while employed at Chinle Dialysis Services in Chinle, Arizona on or about August and September 2003. After discussion, Malloch withdrew the motion. Campbell moved, Crawley seconded, to offer a consent agreement for a decree of censure or hearing. After discussion, the motion carried with seven in favor and two opposed. (nurse #3)

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BUT IN THE MEANTIME….STILL FREE TO WORK? NO IMMEDIATE SUSPENSION OF LICENSE? Pavlina addressed the Board with additional information. Campbell moved, Molleo seconded, and it was unanimously carried to issue an Interim Order for a psychological evaluation, to include sexual misconduct/boundary violations, to be completed by a Board approved evaluator and to include any additional testing deemed necessary by the evaluator, to be scheduled within 15 days and completed within 45 days, and return to the Board.

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Harris moved, Campbell seconded, and it was unanimously carried to issue a letter of concern for inappropriate treatment of residents on or about February 18, 2003 while employed at Springdale West in Mesa, Arizona.

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NO FOLLOW UP RANDOM TESTING THROUGHOUT THE YEAR? NO MANDATED AA MEETINGS? Campbell moved, Ogden seconded, to issue a letter of concern for the 2001 convictions for prostitution in Tucson City Court, Tucson, Arizona and the for admitted past use of crack cocaine for which there was successful completion of a nine month residential treatment program. After discussion Campbell withdrew the motion. Harris moved, Ogden seconded, and it was unanimously carried to dismiss the case.

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Harris moved, Johnson seconded, and it was unanimously carried to issue a letter of concern for reportedly being rough with resident care when employed as a CNA at Immanuel Campus of Care

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Sage addressed the Board with additional information. Johnson moved, Molleo seconded, and it was unanimously carried to issue a letter of concern for reportedly being rough and verbally abusive to a resident while employed as a CNA at Friendship Village on August 5, 2003.

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Hardy moved, Molleo seconded, and it was unanimously carried to issue a letter of concern for reportedly speaking inappropriately to a resident at Evergreen Mesa Christian Care Center on May 20, 2004, while employed as a CNA.

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Campbell moved, Hardy seconded, and it was unanimously carried to issue a letter of concern for leaving his shift at Posada del Sol on May 21, 2004, without notifying a supervisor.

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Meyer was present and addressed the Board. Ogden moved, Crawley seconded, and it was unanimously carried to offer a consent agreement for a 24 month stayed revocation with the license suspended for the first 12 months and on probation the second 12 months with stipulations to include: surrender of license, relapse/recovery evaluation, aftercare, nurse recovery group, AA with sponsor, drug testing 1 time per month, abstain from alcohol and unauthorized drug use, proof of prescription, followed by 24 months probation with stipulations to include: stamping of license, relapse/recovery evaluation after 12 months, nurse recovery group, drug testing, proof of prescription, abstain from alcohol and unauthorized drug use, notification of practice settings, quarterly performance evaluations, direct supervision for 12 months, on site supervision for 24 months, registry/night shift prohibited. If not signed within 30 days, adopt the attached Notice of Charges.

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Williams was present and addressed the Board. Ogden moved, Malloch seconded, to dismiss complaint #1. The motion carried with seven in favor and one abstained. Malloch moved, Hardy seconded, to issue a letter of concern for interacting with a resident in a way, which was perceived to be verbally abusive, on May 31, 2004, while working at Maravilla Care Center in Phoenix, Arizona for complaint #2. The motion carried with seven in favor and one opposed.

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Gagnaire and Malloch know Debra Pendergast but show no bias. Malloch moved, Campbell seconded, to issue a letter of concern for failing to follow hospital policy by refusing to submit to urine drug screen on February 4, 2002 while employed by Mayo Clinic Hospital, for complaint #1 and dismiss the case for complaint #2. The motion carried with seven in favor and one abstained.

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Campbell moved, Ogden seconded, and it was unanimously carried to grant licensure upon meeting all requirements with a letter of concern for a misdemeanor arrest for a DUI on March 20, 2004 in Tucson, Arizona.

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Campbell moved, Malloch seconded, and it was unanimously carried to offer an amended consent agreement to extend the terms of probation entered into on November 24, 2004, six additional months and to include successful completion of an assessment course.

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November 2004

Campbell moved, Crawley seconded, to grant licensure upon meeting all requirements with a letter of concern for the misdemeanor arrests involving alcohol on July 27, 1999 and October 21, 1999, which resulted in charges being dismissed; the domestic violence/fighting arrest on June 27, 1998, which was dismissed; and the January 21, 1986 and June 6, 1986 DUI arrests that resulted in conviction according to Arizona Motor Vehicle records

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Malloch moved, Hardy seconded, and it was unanimously carried to issue a letter of concern for failing to properly dispose of two ampoules of Phenergan and one ampoule of Haldol by placing the medication in her locker on or about January 20, 2004 while working at Kindred Hospital in Tucson, Arizona.

ABC News: I’m Standing With the Duke

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The Firing of Katie Duke, formerly an employee at New York Presbyterian Hospital has me spinning. Why?? Because nurses take pictures at work all day every day, all night every night. She did not violate any federal laws, she did not violate any unspoken expectation of sensitivity that nurses must adhere to. In fact, she copied the damn picture off of a physician’s Instagram and posted it out from her account. But here again, as in my case with Dr. Keng Yu Chuang, the physician does not get any sort of reprimand. The NCSBN quickly took this opportunity to weigh in with its usual cautionary statements about social media use and the nursing profession but this is where nurses must, and I emphasize the word “MUST” be more aggressive. Social media is not going away. It is only advancing, and in my case I used it to shed light on a patient situation where her basic human rights were violated and NO ONE in my chain of command or at the corporate level of Banner Health would listen or do anything about it.  Social media holds within its cyber grasp a way to hold the powerful ACCOUNTABLE. A physician throws a tantrum and has a nurse fired for interrupting his agenda with “his patient.” “Our patient” died exactly the way they told me they didn’t want to die, where they specifically told me they didn’t want to die. My patient expressed to me that everyone wanted to do what they wanted to do and no one asked them what “they wanted for their healthcare or for their ending days.”

     The charges against me included “interfering with the hard work of physicians and undoing all their planning.” According to the Arizona Board of Nursing’s investigative report,  my patient had their hospital approved (and self requested)  education stripped from the room by Dr. Chuang himself —education that included information about their disease, medications, lab results, and tests they had undergone in the hospital. The greatest offense I committed? Adhering to my patient’s request for hospice educational material and to talk to a case manager before making any solid decisions for how they wanted to spend their remaining days or weeks. You see, sometimes social media is the ONLY WAY to shed light on what the healthcare system and corporate entities do to silence nurses.

     The fact is always there, we are the last barrier between patients and harm, or patients and unethical practices that violate their rights as human beings. Social Media is an extremely powerful tool that (when used properly, ethically, and with good intentions) can be used for GOOD because it holds EVERYONE ACCOUNTABLE for their actions, it teaches people what NOT TO DO NEXT TIME, it puts “some” doctors on notice that they cant get away with doing whatever they want to patients and nurses when they don’t get their way or when their ego is bruised. Social Media is also an extremely effective way for healthcare professionals from all disciplines to discuss cases and learn from them, learn what to do better next time, learn from eachother’s experiences and perspectives. Simply put, social media helps healthcare practitioners do things BETTER and contributes to safer and healthier patient care outcomes.

      Valerie Smith, the Consultant to the Executive Director of the Arizona State Board of Nursing told Judge Diane Mihalsky in administrative court while she was on the stand that “nurses cannot discuss anything learned while in the process of caregiving.” So, I guess this means we ignore the fact that four jumbo jets worth of people are dying weekly from medical errors that go unreported because nurses are too afraid to stand up and speak out using the mediums and technology now available? Go about our business? No. Using all available resources to protect and alert our patients is our duty. Read up on your Code of Ethics. We took an oath to do it. To protect people, to go to whoever, whenever, however it must be done—to ensure that the protection and rights of our patients are preserved and that the healthcare environment remains as honest and ethical as possible.

     If you have not figured it out yet, I strongly disagree with the NCSBN’s position, my patient was harmed, I was harmed, and no one at Banner or any other healthcare agency I went to did anything about it. Including the CEO of Banner Health, Peter Fine. Social Media was my last resort. And it worked. My case was a catalyst for change, for much debate, for a lot of learning…..and both patients and nurses are more proactive because of how I went public with my case. Im sick and tired of seeing good nurses like Katie Duke taking the fall for everything, being the scapegoat. We are not dirty Kleenex to be tossed out into the garbage as if our education and contributions to patient care do not matter. We are healers, caregivers, human beings. We are not disposable items that can simply be replaced at a moment’s notice. The Judge here in Arizona made a ruling  supporting the Board’s position that first amendment rights do not apply to nurses. Katie Duke’s case is yet another unfortunate opportunity to open up a dialogue on what rights, if any, we do have. Because, it seems to me, as the healthcare system becomes more profit driven the more nurses are pushed around, asked to do more with less, with gag orders in place to go about business as usual no matter what is seen or heard around them.

     According to the Code of Ethics for Nurses—we are not charged with protecting just one person, but with many persons, such as those in large communities. Social Media communities are no exception. If we are going to punish a nurse for copying a picture off of Instagram why not start punishing firefighters for publishing pictures of fires, or soldiers for publicizing pictures of war? It’s the same principle. The problem is—nurses have yet to stand together and take up a position on whether or not they want to stand up for their constitutional rights to express themselves or speak up for patients or publish a picture that violates NO LAWS WHATSOEVER. We are the only profession that lacks the inherent ability to stand together on issues such as Katie Duke’s. Why? Because we want our paychecks. We don’t want to “make waves,” we don’t want to be “that nurse” at work that everyone doesn’t like or that everyone sees as weird or too outspoken or too different. We want to be “like everyone else.” The sacrifice of a good nurse like Katie Duke is just another example of the many casualties that occur every day to nurses all over the country. I stand with Katie Duke. No questions asked.

Did I lose it all for doing what was morally and ethically right by going to social media to tell the world what happened to my patient? Hell Yes. Do I regret it? Hell No. Would I do it all again?

In a heartbeat.

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Rocket Ships and the Arizona Board of Nursing: 2005 ‘Letters of No Concern’

If everyone is in HERE...who is out THERE taking care of the patients? Whatever.

The 1960’s are calling, and they want their racist, prejudicial, egotistical, and maniacal ideologies back (and the demonstrations too). These days, in Arizona, you place yourself at risk by simply walking down the street of a college campus, being gay and trying to get married or obtain the same rights as everyone else, secure a day that honors not just America’s history—but Black history as well, or trying to teach students about their Mexican heritage without people yelling out that we are educating them to revolt against the United States Government and that Mexican American History should be banned. But wait! We HAVE TO celebrate Cinco De Mayo right?

     Does it surprise you at all that our state’s medical board was in the news and extensively investigated,  or that it is so damned hard to practice in an at will red state like ours??? I implore you to examine some important information with regards to our State Board of Nursing. After all, they do exist to promote the safety of the public (yep, that’s you people)…but from where I stand, and what I read night after night—it looks more like they are making a healthy dent in the nursing workforce rather than a healthy change for the safety of Arizonans. The Arizona Board of Nursing is not a “permanent agency” like the Department of Economic Security or the Arizona Department of Transportation, it’s existence is not guaranteed. Here is a formal definition of the Sunset Clause that they exist under: A statutory provision providing that a particular agency, benefit, or law will expire on a particular date, unless it is reauthorized by the legislature.”

     This is why the reports from the Auditor General are so important, but its also important that the public weighs in, and that nurses weigh in. I know it sounds crazy—but everyone has a say. The harsh truth is that we need new blood within the walls of the Arizona Board of Nursing. New people from all generations of nurses with new ideas and new leadership styles and an eye for the real future of nursing, not officials keeping the “future” the way things have “always been.” If the Arizona Legislature doesn’t feel the Board is fulfilling its mission, they have the ability to discontinue the agency and restructure a new one. I read in the 2005 Meeting Minutes that Arizona was considered “one of the best functioning Boards, ahead of the others.” (sigh) Really? No. It is not. The state is currently paying hundreds of dollars per month to keep a live feed on the AZBON website so anyone from around the world can watch the proceedings. Is that really necessary when that’s money that can be allocated to DES or CPS? Or the hundreds of dollars it takes to send out its Regulatory Journal three times a year to just about the whole state of Arizona—is that totally necessary when it can be sent to a mailing list in pdf format to saved the state legislature some money that could—again—go to DES or CPS? And for God’s sake–what does it take to get an actual complaint filed against a nurse who actually did something bad? I have tried filing a complaint, a valid one, one that has a witness to prove it occurred, and the State Board of Nursing STILL WONT OPEN IT. Why? Because it came from me. Yeah, that’s a well-functioning Board.

     It shouldn’t surprise you that in a state that struggles so much to keep up with the current times, our state agencies seem to happily follow the pied piper as the BON does with “their own ideas” of who and what a nurse should be or how to reinforce and retain  strong and well educated nurses in Arizona’s nursing workforce. Ironically, the Arizona Board of Nursing is (and I use the word participating loosely) participating with the Robert Wood Johnson Foundation and AARP in the nationwide “Campaign for Nursing’s Future.” I predict that by the time our board gets done with its contributions we will have one hell of a shortage, and a nice big spike in patient sentinel events secondary to  consistent short staffing and a very young nursing workforce that doesn’t have the seasoned veterans to mentor them. Practicing nursing in Arizona is much like what that English professor did the other night—taking a stroll down the street on the ASU campus after teaching a course and experiencing a classic MCSO style take down by an ASU Officer. Here, in Arizona, —anything can happen. And for the stupidest of reasons. The Board of Nursing is collaborating with the Arizona Nurses association, The Arizona Hospital and Healthcare Association, and the Arizona Association for Homecare in creating goals and achieving outcomes to improve the working climate for nurses: The Summary of “Arizona Action Coalition” is as follows:

Here are 8 recommendations of The Future of Nursing: Leading Change, Advancing Health

In 2008, The Robert Wood Johnson Foundation (RWJF) and the Institute of Medicine (IOM) launched a two-year initiative to respond to the need to assess and transform the nursing profession. The IOM appointed the Committee on the RWJF Initiative on the Future of Nursing, at the IOM, with the purpose of producing a report that would make recommendations for an action-oriented blueprint for the future of nursing.

Recommendations:

  • Recommendation 1: Remove scope-of-practice barriers.
  • Recommendation 2: Expand opportunities for nurses to lead and diffuse collabora­tive improvement efforts.
  • Recommendation 3: Implement nurse residency programs.
  • Recommendation 4: Increase the proportion of nurses with a baccalaureate degree to 80 percent by 2020.
  • Recommendation 5: Double the number of nurses with a doctorate by 2020.
  • Recommendation 6: Ensure that nurses engage in lifelong learning.
  • Recommendation 7: Prepare and enable nurses to lead change to advance health.
  • Recommendation 8: Build an infrastructure for the collection and analysis of inter­-professional health care workforce data.

For more information visit www.iom.edu/nursing

 

     Call me crazy, —many have— but after reading ten years’ worth of Board minutes I do not see how the Board of Nursing is going to be of any help in removing barriers to scope of practice so that nurses can practice to the fullest extent of their licensure. Why is this? Simple. Their rulings are all over the board. (no pun intended)  There is no rhyme or reason to them, or so it seems. Good nurses are being taken out of the field after years of education. Aside from that, hospitals do not like it when a nurse practices to the fullest extent of their education and licensure. It does not make them money. It costs them money. (Nurses are actually part of the room charge.) Here’s an example: When I tell a case manager and a doctor that I don’t feel my assessment reveals that patient “A” is ready to go home yet and still presents with a lot of safety issues and an unsafe home environment. That yields a cascade of services that costs a hospital money because that bed remains closed off to another patient who could be receiving more services and consults that make the hospital more money. (Tests and surgeries) My little old elderly patient is not making the hospital money, he is taking up a valuable bed. Here is the reality—-it does NOT MATTER WHAT YOU LEARN IN SCHOOL. A nurse is defined differently in every hospital and the scope of practice is different in every hospital, and there is no initiative on God’s green earth (no matter how well intentioned of well publicized that will change that) A hospital’s first priority, its biggest priority, is stable revenue with the potential for increase. Remaining competitive, securing the necessary capital to remain at the top of their game in the healthcare market where every dollar from every consumer counts to achieve those strategic goals……..When you hear “patient centered care” on all those hospital TV or radio commercials, switch the channel. If you aren’t at the Mayo Clinic, you aren’t going to get it. Period.

See, the Arizona Board of Nursing is too busy putting nurses in these cute little rocket ships and lighting such a powerful fuse that produces enough of a blast to send good competent nurses off to the farthest corners of the universe never to be heard from again. Kind of like the movie that Sandra Bullock is in. Poor George Clooney gets one last look at the sunset from space and floats off into some galaxy somewhere and dies. Sandra Bullock has to do everything short of going crazy to stay alive, to stay in the game…because she too has been flung around quite a bit and detached from the mothership. For the purposes of my discussion, the mothership I am referring to here is our profession. Sandra Bullock fighting to get back to earth is what it is like to survive a probation, a suspension, or whatever hundred million combinations of discipline they heap onto a Registered Nurse AND theten million utterly impossible ‘requirements’ they attach to it. In most cases, nurses just give up and leave the profession. Until we find another universe to exist in, you tax payers support us. Sweet huh?

How’s that for a “Campaign for Action AARP and RWJF?

     Now…Here’s a novel idea— Why don’t we spend more time proactively reeducating or counseling, rather than disabling, dehumanizing, and ending the careers of other healthcare providers, our own peers? WHY DONT WE INSTEAD, AIM FOR RETENTION AND POSITIVE OUTCOMES  THAT ENCOURAGE A HEALTHY WORK ENVIRONMENT NURSES DO NOT HAVE TO FEAR BEING IN? Why don’t we take actions that not only fulfill the mission of the AZBON, but guarantees  Arizona a robust nursing workforce, which in essence means a safer healthcare environment! Id like to see Joey Ridenour or Valerie Smith or any member of the Board of Nursing do a 14 hour shift on a complex heart transplant unit WITHOUT a CNA to help, a phone that’s always ringing and a telemetry pager that is constantly going off—and survive it– without a single misstep, or a single sigh of exasperation. Isn’t it strange we don’t persecute doctors…. why is it we take such liberties in doing it to the the very providers that remain at the bedside 24 hours a day seven days a week? Some of the doctors I worked with at Banner Del E Webb Hospital would sneak in at 0530 and log onto computers documenting assessments on my patients when I knew darn well they hadn’t seen any of them, typing in phrases such as “patient is alert and states he is feeling better today.” Oh really? Is this the same one with Congestive Heart Failure that finally passed out and went to sleep after a night of me diuresing him so he could actually breathe better? And yet….our Medical Board seems to think disruptive behavior, falsifying medical records and getting paid for consults you didn’t actually do is….well…..just fine.

I tell you, the VA scandal is just the tip of the iceberg, the problems—they are systemic and are not isolated to just one healthcare system or state agency….failing to acknowledge that and do something to change it is simply being naïve in the facts….or being afraid to stand up and speak the truth.

 

The “Letters of No Concern” for the year 2005 are below for you to consider.

 “Letter of Concern: Paper version of unpublicized slap on the hand. It means no discipline.”

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January 2005

Gagnaire and Johnson know Kathy Scott but show no bias. Gagnaire moved, Johnson seconded, and it was unanimously carried to issue a letter of concern for practicing beyond the LPN’s scope of practice when Lehan regulated an IV infusion of Propofol medication on or about October 20, 2004 at Banner Thunderbird Medical Center.

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Ogden moved, Crawley seconded, and after discussion, it was unanimously carried to issue a letter of concern for delaying the transport of an unresponsive resident to a hospital on August 19, 2004, by calling the physicians and the family members before calling 911, while working at Arizona Eastern Star in Phoenix, Arizona.

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Campbell knows respondent Campbell but shows no bias. Charles Campbell was present and available for questions. Harris moved, Johnson seconded, and it was unanimously carried to issue a letter of concern for sleeping on duty on or about November 4, 2004, while employed by Care Staff Registry and assigned to work at Select Specialty Hospital in Phoenix, Arizona.

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Campbell moved, Hardy seconded, and it was unanimously carried to issue a letter of concern for allegedly failing to administer medications as ordered by physicians on July 29, 20 and 31, 2005, while working at Las Fuentes Care Center in Prescott, Arizona.

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Campbell moved, Harris seconded, to issue a letter of concern for the misdemeanor arrest on March 23, 2005 in Tucson, Arizona and for failure to follow dialysate orders on or about September 8, 2004; for failure to follow the dialysis unit’s policy and procedure for priming a patient’s machine when she connected an incompatible liquid solution (vinegar) to a patient’s dialysis machine on or about August 15, 2000, while employed by Gambro Healthcare in Tucson, Arizona. After discussion the motion carried with five in favor and one opposed.

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Campbell moved, Hardy seconded, and it was unanimously carried to issue a letter of concern for transcribing an incomplete order for Dopamine onto a medical record and administering the medication using this order on November 24, 2004, while working through Absolute Staffing at Mesa General Hospital.

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Hardy moved, Busby seconded, and it was unanimously carried to rescind prior Board decision to offer a Consent Agreement for a Decree of Censure, and issue a letter of concern for failing to have documented the low blood sugar every 30 minutes.

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Mealman was present and addressed the Board. Hardy moved, to offer a Consent Agreement for a Decree of Censure, or hearing. Hardy withdrew the motion. Busby moved, Hardy seconded, to issue a letter of concern for adjusting a Coumadin dose from 2.5mg. to 5mg. for two days for patient S.C. without a physicians order on or about April 23, 2005, while employed at Nightingale Nurses Registry in Phoenix, Arizona. After discussion, the motion carried with four in favor and one opposed.

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Busby moved, Hardy seconded, and it was unanimously carried to grant licensure upon meeting all licensure requirements with a letter of concern for failing to contact a resident’s physician and family member after there was an acute change in their medical status which required transfer to an acute care facility on or about January 10, 2005, while employed by Dedicated Health Professionals and assigned to Life Care Center of Paradise Valley, Phoenix, AZ.

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Ogden moved, Harris seconded, and it was unanimously carried to issue a letter of concern for perceived verbal abuse of a resident on or about March 5, 2004, while employed at Hearthstone Care Center for complaint #1. Johnson moved, Harris seconded, and it was unanimously carried to issue a letter of concern for failing to check for nasogastric tube placement, stop a tube feeding after suspected aspiration for resident J.L., and document corrective interventions on or about May 13, 2004, while employed at Immanuel Campus of Care for complaint #2.

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Harris recused himself to avoid the appearance of impropriety, and left the meeting at 2:30 p.m. Rondot was present and addressed the Board. Campbell moved, Johnson seconded, and it was unanimously carried to issue a letter of concern for failing to notify the physician when S.B.’s blood sugar was over 400 as required by facility policy, and for failing to document the administration of Insulin on or about November 14, 2004, while employed at Banner Behavioral Health in Scottsdale, Arizona.

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Hardy recused herself to avoid the appearance of impropriety, and left the meeting at 12:10. Davis was present and available for questions. Campbell moved, Johnson seconded, and it was unanimously carried to issue a letter of concern for medicating a patient without a physician order, specifically nitroglycerin and TUMS ©, and for failing to contact a patient’s physician with a change of condition, while employed at Arizona Eastern Star in Phoenix, Arizona.

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Campbell moved, Hardy seconded, and it was unanimously carried to grant certification upon meeting all requirements with a letter of concern for the January 21, 2005 conviction, pursuant to a guilty plea, of public sexual indecency, a misdemeanor, in Mesa City Court in Mesa, Arizona, for which she is currently serving probation

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Campbell moved, Hardy seconded, to issue a letter of concern for allowing a patient to leave the facility and failing to notify the nursing supervisor or the physician on or about April 2004, and also for giving a patient Cortisone 120 mg. instead of 60 mg. as ordered on or about July 2004, while employed at Banner Desert Medical Center in Mesa, Arizona. After discussion, the motion carried with five in favor and one abstained

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Johnson moved, Campbell seconded, and after discussion, it was unanimously carried to issue a letter of concern for changing a Xanax from 0.5 to 1.0 mg. without the physicians approval, and giving an additional dose of Morphine 15 mg. and Lorazepam 0.5 mg. on or about September 21, 2003 while employed at Desert Highlands Care Center in Kingman, Arizona.

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Busby moved, Hardy seconded, and it was unanimously carried to rescind prior Board decision to offer Decree of Censure, and issue a letter of concern for a 2000 pre-employment urine drug screen which was positive for amphetamines and methamphetamines

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Campbell moved, Johnson seconded, and after discussion, it was unanimously carried to issue a letter of concern for failing to appropriately assess and document a resident’s fall on or about June 5, 2004, while employed at Sun Grove Village.

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Malloch moved, Hardy seconded, and it was unanimously carried to issue a letter of concern for being rude and rough in the care of a resident while employed as a CNA in June 2004, at Glencroft Care Center in Glendale, Arizona.

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Gagnaire moved, Crawley seconded, and it was unanimously carried to issue a letter of concern for failing to properly exit the Pyxis on April 30, 2004, while working through Alacrity Healthcare Staffing at Chandler Regional Hospital, which may have contributed to the theft of 25 Percocet.

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Ogden moved, Molleo seconded, and it was unanimously carried to grant licensure upon meeting all requirements with a letter of concern for a misdemeanor conviction for public sexual indecency November 25, 1988, in Glendale, Arizona, and for the felony arrest October 28, 1999 in San Diego, California that was subsequently dismissed.

Johnson moved, Harris seconded, and it was unanimously carried to issue a letter of concern for administering to patient S.W. 100 Units of insulin instead of 10 units on October 6, 2004, while employed by Fountain View Village

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Malloch moved, Johnson seconded, and it was unanimously carried to issue a letter of concern for the March 16, 2002 arrest for DUI in Phoenix, Arizona with BAC .215 and subsequent conviction of a misdemeanor DUI on April 16, 2004, in Phoenix Municipal Court in Phoenix, Arizona.

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Grady addressed the Board and confirmed receipt of additional information. Campbell moved, Ogden seconded, to issue a letter of concern for not scheduling an appointment for a patient with suicidal ideation to be seen in a timely manner, on or about May 6, 2004, while employed at ValueOptions in Phoenix, Arizona. The motion carried with seven in favor and one opposed.

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Gambold was present and available for questions. Harris moved, Johnson seconded, and it was unanimously carried to issue a letter of concern for reportedly speaking inappropriately to a resident, and for tying a resident’s leg to the bedrail to keep it straight on May 25, 2001, while employed as a CNA at Heather Glen

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Hardy moved, Ogden seconded, and it was unanimously carried to rescind the Board’s prior decision to issue an Order of Denial and accept the recommendation of the Settlement Conference as follows: Upon meeting all requirements, grant certification upon successful completion of a Board-approved Anger Management Program and a negative drug screen, then issue a letter of concern against the certificate for her November 21, 1994 felony conviction of negligent homicide in Osecolo County Judicial Court in Reed City, Michigan and her one time use of marijuana in 2004 in Arizona.

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Webb was present and available for questions. Cambpell moved, Ogden seconded, and it was unanimously carried to issue a letter of concern for making several medication errors, and using profanity during 2003 and 2004, while employed at Desert Terrace in Sun City, Arizona.

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Martinez was present and available for questions. Malloch moved, Johnson seconded, and it was unanimously carried to issue a letter of concern for reportedly being physically inappropriate to a resident while employed as a CNA at the Lingenfelter Center in Kingman, Arizona on October 1, 2004.

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Sage addressed the Board with additional information. Malloch moved, Ogden seconded, and it was unanimously carried to issue a letter of concern for reportedly speaking inappropriately to one resident and swearing within hearing distance of another while employed as a CNA at Immanuel Campus of Care in Peoria, Arizona, on or about October 27, 2004

 

March 2005

Johnson moved, Hardy seconded, to issue a letter of concern for failing to document vital signs and nursing care in the medical record for patient S.C. on or about April 12, 2004 while employed as a traveler nurse at Phoenix Baptist Hospital. The motion carried with six in favor and two opposed.

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Malloch knows Deb Krmpotic and Loretta Holt, but shows no bias. Robert Gregory, attorney, and Potter were present and addressed the Board. Malloch moved, Johnson seconded, and it was unanimously carried to issue a letter of concern for failing to document more accurately in the medical record, for changing the patients dressing without an order, and for administering an extra dose of Narcan for patient B.S. on or about March 25, 2004, while employed at Banner Baywood Medical Center in Mesa, Arizona

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Guerrero was present and available for questions. Campbell moved, Malloch seconded, and it was unanimously carried to issue a letter of concern for leaving the facility for approximately fifteen (15) minutes to go to the store on or about May 20, 2004, when assigned by Dependable Nurses Staffing to work at Hacienda de los Angeles in Phoenix, Arizona, and for the DUI Misdemeanor conviction on or about June 3, 2004, in Chandler Municipal Court, in Chandler, Arizona.

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Johnson moved, Malloch seconded, and it was unanimously carried to reopen Agenda Item V.G.10. Harris recused himself to avoid the appearance of impropriety, and left the meeting at 3:00 p.m. Deptula was present and addressed the Board. Malloch amended the prior Board motion to allow Deptula to work in a home health setting under direct supervision, and if successful, she may return to the Board in 6 months and request reconsideration; include drug screening, abstain from alcohol within 12 hours of duty, abstain from unauthorized drug use, proof of prescriptions. Campbell seconded, the motion and it was unanimously carried.

May 2005

Campbell moved, Hardy seconded, and it was unanimously carried to issue a letter of concern for failing to transcribe a verbal order for Dopamine onto a medical record on November 14, 2004, while working at Mesa General hospital in Mesa, Arizona

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The earlier statement made by attorney, Melody Emmert, also applies in this case. Bartram was present and available for questions. Campbell moved, Hardy seconded, and after discussion, it was unanimously carried to issue a letter of concern for a misdemeanor DUI conviction on April 21, 2004 in Mesa Municipal Court

Campbell moved, Harris seconded, and it was unanimously carried to issue a letter of concern for reportedly being rough in the care of a resident while employed as a CNA by Maxim Nursing Registry and assigned to a shift at Scottsdale Rehabilitation and Nursing Center on January 24, 2005.

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Johnson moved, Hardy seconded, and it was unanimously carried to issue a letter of concern for failing to document the removal of Demerol 75 mg in the Controlled Substance Record on or about June 9, 2004, while working in the Emergency Department at the Arizona Physicians Hospital at Kino through Spinnaker Healthcare in Tucson, Arizona.

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July 2005

Campbell moved, Hardy seconded, and it was unanimously carried to grant licensure upon meeting all requirements with a letter of concern for a misdemeanor conviction for prostitution on September 13, 2001 in Phoenix, Arizona; for the September 8, 1993 misdemeanor theft conviction in Dayton, Ohio; for the February 10, 1984 felony forgery theft in Montgomery County, Ohio; and the February 10, 1984 misdemeanor theft deferred finding in Centerville, Ohio.

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Jeff and Marlane Williams, complainants, were present and addressed the Board. Crawley moved, Campbell seconded, to issue a letter of concern for failing to notify hospital security immediately about a patient’s visitors who appeared suspicious on or about June 18, 2004, while working at University Medical Center in Tucson, Arizona through American Mobil, an agency. The motion carried with six in favor and one abstained.

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Ybarra was present and addressed the Board. Campbell moved, Crawley seconded, and after discussion, it was unanimously carried to issue a letter of concern for failing to do a thorough assessment of the patient at Hacienda Rehabilitation Center on September 21, 2004.

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Malloch knows Carol Cammarata but shows no bias. Taylor was present and available for questions. Campbell moved, Busby seconded, and it was unanimously carried to issue a letter of concern for failing to contact a patient’s physician with a low blood sugar result on or about January 9, 2005, while employed by Integrated Registry and assigned to Life Care Center of Paradise Valley, Phoenix, AZ.

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Buck was present and available for questions. Campbell moved, Busby seconded, and after discussion, it was unanimously carried to issue a letter of concern for failing to notify the physician about a medication error for resident A.T. on or about April 27, 2004, while employed at Life Care Center of Scottsdale in Scottsdale, Arizona.

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Grady addressed the Board with additional information. Herman and Marilyn Shifter were present and addressed the Board. Johnson moved, Crawley seconded, and it was unanimously carried to issue a letter of concern for administering Ativan to a skilled unit patient from the patient’s personal prescription, without an order from the attending physician and while not assigned to the skilled unit, on or about December 3, 2004 at Classic Residence Care Center in Scottsdale, Arizona.

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Busby moved, Hardy seconded, and it was unanimously carried to grant licensure upon meeting all requirements with a letter of concern for the November 11, 2004 arrest for possession of marijuana by Northern Arizona University Police in Flagstaff, Arizona, as amended.

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Busby moved, Harris seconded, and it was unanimously carried to issue a letter of concern for failing to document according to facility policy when administering and wasting Dilaudid during June 2004, while employed at Arrowhead Community Hospital in Glendale, Arizona.

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September 2005

Busby moved, Campbell seconded, and it was unanimously carried to rescind prior Board decision of September 12, 2002 to offer a Consent Agreement for a Decree of Censure, and issue a letter of concern for a one-time DUI and for making a threatening statement to three police officers on or about February 22, 2002.

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Olson addressed the Board and confirmed receipt of additional information. Campbell moved, Hardy seconded, and after discussion, it was unanimously carried to grant licensure upon meeting all requirements with a letter of concern for the November 19, 2003 arrest for indecent exposure and subsequent conviction, pursuant to a guilty plea, of the amended charge of disorderly conduct, a misdemeanor, in the Birmingham Municipal Court in Birmingham, Alabama.

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Hardy seconded, to issue a letter of concern for failing to properly identify a resident resulting in a medication error on or about May 7, 2005 while working at HCR Manor Care in Tucson, Arizona. After discussion, the motion carried with five in favor and one opposed.

Campbell moved, Busby seconded, to issue a letter of concern for allegedly being rough in the care of a resident at La Colina Care Center on February 12, 2005 while employed as a CNA for complaint #1, and dismiss complaint #2. After discussion, the motion carried with six in favor and one opposed.

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Campbell knows respondent Meeker, but shows no bias. Torrez addressed the Board with additional information. Busby moved, Johnson seconded, and it was unanimously carried to issue a letter of concern for failing to follow facility policies when documenting and wasting narcotics from on or about February 8, 2004 until March 19, 2004, while employed at Maricopa Medical Center in Phoenix, Arizona

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Campbell moved, Busby seconded, and it was unanimously carried to issue a letter of concern for making inappropriate remarks to resident M.G. on or about April 12, 2005, while assigned to work at Sun View Care Center in Youngtown, Arizona.

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Busby moved, Hardy seconded, to issue a letter of concern for failing to supervise LPN staff who administered medications through peripherally inserted central catheters while employed at Manzanita Manor. After discussion, the motion carried with four in favor and three opposed.

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Grady addressed the Board and confirmed receipt of additional information. Lucas was present and addressed the Board. Hardy moved, Rich seconded, and it was unanimously carried to issue a letter of concern for being rude to a patient and her companion on or about September 17, 2004, while employed at NextCare Urgent Care (Pinnacle Medicine), Tucson, Arizona.

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Grady addressed the Board with additional information. Sharon Harrison, complainant, was present and addressed the Board. Latimer and his attorney, Michael Ryan were present and addressed the Board. Rich moved, Hardy seconded, and it was unanimously carried to issue a letter of concern for discussion the surgery of an individual in a health care setting for a purpose unrelated to the health care needs of the individual, on or about October 25, 2004, at Physician’s Surgery Center in Bullhead City, Arizona

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November 2005

Busby moved, Crawley seconded, and it was unanimously carried to rescind prior Board decision of January 2006 to offer a Consent Agreement for a Decree of Censure, and accept issue a letter of concern for accepting an assignment, counting narcotics, and passing medications prior to seeing an unconscious resident, who was being assessed by the charge nurse, but whom was part of your resident assignment

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Campbell moved, Hardy seconded, and it was unanimously carried to adopt a stayed revocation indefinite suspension with terms to include: surrender of license, psychiatric evaluation and treatment and refresher course, followed by a stayed revocation with terms to include: psychological and psychiatric treatment, notification of practice settings, quarterly performance evaluations, direct supervision for 18 months with preceptor for 6 months, registry/traveling nurse/float pool/home health work/on-call prohibited, night shift prohibited, with other requirements to include: if deemed appropriate by evaluator.

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Rappoport addressed the Board with additional information. Campbell moved, Hardy seconded, and it was unanimously carried to issue a letter of concern for failing to document prescribed medications, specifically Percocet tablets, fro two residents on or about March 2, 2003, March 6, 2003 and March 7, 2003, while employed at Palm Valley Rehabilitation Center in Goodyear, Arizona for complaint #1; to dismiss complaint #2; and to issue a letter of concern for failing to document prescribed medications, specifically Vicodin tablets for two residents on or about January 12, 2004 and January 13, 2004 while employed at Good Shepherd Retirement Center in Peoria Arizona for complaint #3

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Campbell moved, Crawley seconded, to grant certification upon meeting all requirements with a letter of concern for a misdemeanor conviction for driving under the influence with a BAC of .255% on July 2, 2004 in Flagstaff City Court in Flagstaff, Arizona. After discussion, the potion carried with four in favor and one opposed.

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Smith addressed the Board with additional information. Stover-Wall was present and addressed the Board. Campbell moved, Johnson seconded, to offer a Consent Agreement for a 36 month stayed revocation with the license suspended during the first 12 months and on probation the last 24 months, followed by a 12 month probation and to include the attached stipulations, or hearing. The motion carried with six in favor and one abstained

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Twigg addressed the Board and confirmed receipt of additional information. Damgar was present and addressed the Board. Campbell moved, Hardy seconded, to offer a Consent Agreement for 24 month probation to include the attached stipulations or hearing. After discussion Campbell amended the motion to include: drug testing 2 times per month for first 6 months then monthly, abstain from alcohol, abstain from unauthorized drug use/proof of prescription/one prescriber, notification of practice settings, quarterly performance evaluations, direct supervision, may work home health at current setting Maxim Health Care, night shift prohibited, on site supervisor evaluations monthly, neuropsych evaluation with a focus on memory. Hardy concurred. The motion carried unanimously.

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Campbell moved, Rich seconded, to issue a letter of concern for reportedly being rough in the care of 2 residents while employed as a CNA at Springdale West on June 8, 2005. After discussion the motion failed with three in favor and three opposed. Johnson moved, Hardy seconded, and it was unanimously carried to dismiss the case.

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Twohig addressed the Board with additional information. Busby moved, Johnson seconded, and it was unanimously carried to issue a letter of concern for speaking inappropriately to a resident and failing to obtain assistance with the care of a resident who was resistive and combative on or about July 10, 2005, while employed at Prescott Valley Samaritan in Prescott Valley, Arizona.

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Derryberry was present, telephonically, and addressed the Board. Campbell moved, Hardy seconded, and it was unanimously carried to grant certification upon meeting all requirements with a letter of concern for a misdemeanor conviction for extreme DUI on December 13, 2002 in Flagstaff Municipal Court in Flagstaff, Arizona.

Ongoing Regulatory ‘Excellence’ in Arizona: 2006

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 “Letter of Concern: Paper version of unpublicized slap on the hand. It means no discipline.”

     There are IT nurses and then there are us Research and Statistics nurses. Nerdy nurses, if you will. I don’t know about IT Nurses but it seems to me they like to look at better ways of doing things, asking the questions other people don’t think to ask, going into corners no one realizes are there….to find unexpected answers or what “X” is equal to. I admit I am one of those. I like to develop practice based nursing theories, I like to ask questions, I like to develop hypotheses and then figure out a way to test them out. I like to change outcomes for the better. I also like to look for trends no one else realizes exist. Fact Checking. Comparing and Contrasting. Then analyzing everything I have in front of me to see what the bigger picture is. Getting at the truth. Lucky for me I took a few classes, and I have plenty of time on my hands. Enough time to not only write a book about my experience with Banner Health and the Arizona Board of Nursing, but to design and publish my first research study about the very agency that reiterated time and again how much of a danger I am to the general public.

Seriously, you gotta understand how much those words really stuck to me. “Danger to the public.”  Someone I know would tell me it’s one of my “stuck points.” Some of you military vets out there probably know very well what a stuck point is and are tired of hearing those two words!  So I decided to do something about that.  Why not compare myself, my investigative report (and its plethora of creative writing thanks to Nikki Austin) to nurses from the past ten years. There’s additional incentive when journalists want your help too. Every few years the Arizona Board of Nursing is subject to an evaluation from the Office of the Auditor General and this “performance report” is given to the Arizona Legislature so that the lawmakers can decide whether or not to continue the Board of Nursing as it is. They are under what is called a “Sunset Clause.” Unfortunately the Auditor General is not a nurse nor does the auditor have experience with healthcare or nursing, nor does he/she think the same way a nurse does when it comes to quality assurance checks. I am interested in comparing and contrasting their past reports with mine.

In some way or another, all of us nurses are mini investigators every day. Whether we are trying to figure out what labs mean, or what the color of that body fluid indicates, or those all too fun to read Arterial Blood Gases—-we are all seeking to put together a puzzle that achieves  a bigger picture that will perhaps yield us some concrete answers. Data. Data that helps us develop a plan. You remember that, right? The Nursing Process: Assessment, Diagnoses, Planning, Intervention, and Evaluation! Nurses are mini investigators in lots of ways, all day every day. Our brains were made for it. The past six months or so I have done a lot of reflecting on the different meanings of justice. Because, you see, I had always pictured it just one way—in a court room. But I have slowly opened my eyes to new ways of accomplishing justice. I now envision  it as ensuring the safety and preserving the empowerment of my colleagues and patients.

Administrative law is tough stuff. If you haven’t noticed, real criminals have more rights than we do because of this area of law. There is no justice in the field, in the hospitals. Banner Del E Webb taught me that. It’s ruthless, some of your coworkers===can be ruthless. But, justice can be achieved by shining a light in places for people to see “truth.” From there, they find their own way. Its my deepest hope that the book I am writing  and the hours I have been spending on research will help  contribute to much needed change and legislation that protects the patients and peers I’m so passionate about while serving to preserve the moral ethical foundation of our profession.

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     It’s 2006 in Phoenix, Arizona. During this time, The Arizona Board of Nursing was actively involved in participating with the Governor’s office via a special task force to increase the nursing workforce and also with the NCSBN via another program called Commitment to Ongoing Regulatory Excellence (C.O.R.E.) I thought this would be a great title for the remaining reports instead of “The Daily.” Like I have emphasized before, these are not all of the cases presented during the year, many of them hadn’t had outcomes just yet and I have to go back and see how many of them I can access and extract data from. This is all for the book I am writing and for some of the local media who have requested my help and perspective as both a nurse and whistleblower.

Truth is, I’m looking at several variables right now, and I am still designing the study and the survey questions/methods. I’m taking a quantitative approach but I can also appreciate the value in approaching my investigative study from a qualitative standpoint as well……because, it is more my nature to come from the human aspect of any situation….especially when my peers or patients have been permanently and irreparably harmed whether it be in a professional, spiritual, emotional or physical way. The trend I continue to see is inconsistencies in disciplinary measures. For instance, “Nurse A” has had several DUI’s in recent years and is applying for an RN license. The Board issues her a letter of concern for the DUI’s and related arrests and grants her a license…..while Nurse B has committed the same offenses, is applying for a new RN license as well, yet she receives sanctions before even having her license granted—she has to go to AA meetings, have a sponsor, have random blood or urine testing, and be evaluated by an addictionologist. Also disturbing are disciplinary measures that read something like this: “Busby moved, Hardy seconded, and it was unanimously carried to rescind prior Board decision to offer a Consent Agreement for a 36 month stayed revocation with the license suspended during the first 12 months and on probation the last 24 months, followed then by a 12 month probation and to include terms and conditions, and accept the signed Consent Agreement for a 24 month stayed revocation probation with terms and conditions, followed by a 12 month standard probation with terms and conditions.”

There are MANY, MANY of these for offenses far less than the ones you will read below….How is a Registered Nurse ever supposed to recover from an impossible set of terms like the one above? How is he/she supposed to ever fulfill all of these requirements if no one will hire him/her? It seems to me, like one step away from revoking a license….or going right to the cliff and putting one foot forward but never taking the actual jump. This is extreme, in many cases, inconsistent====in far too many cases, and damaging to our nursing workforce. I have included some in the listing of disciplinary measures this time. These are the kinds of instances I keep encountering and it’s both frustrating and difficult to “get” why this is a “thing” to begin with.

The list of discipline that follows are, again, what I call “Letters of No Concern” issued by the Arizona Board of Nursing in 2006………

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Malloch knows Selma Kendrick but shows no bias. Busby moved, Perry seconded, and it was unanimously carried to issue a letter of concern for admitting she abused her prescription for Oxycodone in or about April 2006 while working at Banner Good Samaritan Hospital.

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Sandra Rogers, attorney, was present and addressed the Board. Rice was present and available for questions. Busby moved, Johnson seconded, to issue a letter of concern for failing to follow the facility policy on or about January 22, 2005 while working at Palo Verde Behavioral Health Hospital in Tucson, Arizona by failing to notify a patient’s physician that the patient told her therapist she felt like hanging herself from a doorknob. After discussion, the motion carried with four in favor and three opposed.

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Busby moved, Perry seconded, and it was unanimously carried to issue a letter of concern for reportedly physically abusing a resident in or about May 2006, while employed as a CNA at Santa Rosa Care Center in Tucson, Arizona.

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Busby moved, Perry seconded, and it was unanimously carried to issue a letter of concern for falsifying a patient’s vital sign record to reflect within normal limits when the actual findings were not within normal limits, and delegating patient teachings to a CNA on or about July 8, 2004 and leaving the facility for several hours without notifying other staff while working at Paradise Valley Surgical Recovery Center.

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Olson addressed the Board with additional information. Busby moved, Perry seconded, and it was unanimously carried, upon meeting all requirements, grant licensure and issue a letter of concern for the multiple arrests and felony convictions on February 26,1974 for forgery, and on April 15, 1975, for auto theft, felonies, in Orange County Superior Court in Orange County, California, and August 31, 1988, convictions of 4 counts of unarmed bank robbery, and on September 17, 1990, for possession of contraband by an inmate (Narcotic Controlled Substance), felonies, in the U.S. District Court for the Central District of California.

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Link recused herself to avoid the appearance of impropriety and left the meeting at 4:45 p.m. Park was present and available for questions. Busby moved, Hardy seconded, to issue a letter of concern for working in a position as a Behavioral Health Nurse Practitioner without formal educational preparation and/or certification in psychiatric/mental health, while employed by St. Luke’s Behavioral Health Center Child & Adolescent Crisis Services-Urgent Care Unit, Phoenix, Arizona. After discussion, the motion carried with five in favor and one opposed.

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Busby moved, Perry seconded, and it was unanimously carried to issue a letter of concern for an arrest on March 1, 2005, shoplifting offense in Tucson, Arizona

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Polak addressed the Board and confirmed receipt of additional information. Showalter was present and addressed the Board. Busby moved, Perry seconded, and it was unanimously carried, upon meeting all requirements, grant license, and issue a letter of concern for five (5) misdemeanor arrests for driving under the influence of alcohol from April of 1994 to December of 2000, resulting in misdemeanor convictions in the States of California and Virginia.

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Cash was present and addressed the Board. Robertson moved, Johnson seconded, and it was unanimously carried to issue a letter of concern for failing to prevent a patient’s fall which resulted in injury to his eye, on November 4, 2005, while working for Nursing Solutions in Phoenix, Arizona.

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Leslie Paradise, complainant was present and addressed the Board. Johnson moved, Robertson seconded, to dismiss the case. After discussion, Robertson withdrew the second. Busby seconded. The motion failed with five opposed and three in favor. Hardy moved, Robertson seconded, to issue a letter

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of concern for failing to respond to a request for comfort measures while employed at Sun Health Care Center on December 3, 2005. After discussion, the motion carried with five in favor and three opposed.

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Busby moved, Link seconded, and it was unanimously carried to grant certification upon meeting all requirements, and issue a letter of concern for a March 15, 2004 arrest for assault and criminal damage by Phoenix Police, in Phoenix, Arizona.

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Malloch knows Kate Ludwig but shows no bias. Perry moved, Link seconded, and it was unanimously carried to issue a letter of concern for leaving her assignment without notifying proper supervisory personnel while employed as a CNA on December 21, 2005, at Maryvale Hospital, in Phoenix, Arizona, and for attempting to cash a forged check on August 9, 2004.

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Sue Rhodes was present and addressed the Board.   Johnson moved, Robertson seconded, and it was unanimously carried to issue a letter of concern for failing to document the advice received from an RN, related to the titration of morphine for a patient on or about December 20, 2005, while employed at Hospice.

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Busby moved, Link seconded, and it was unanimously carried to grant certification upon meeting all requirements and issue a letter of concern for not putting up the side rail before turning a patient on January 26, 2006, while assigned to Plaza Healthcare and leaving her shift on January 27, 2006, without notifying anyone, while assigned to Kivel Campus of Care, both incidents occurred while employed by Arizona All Medical Staffing in Phoenix, Arizona.

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Roseman Atkins was present and addressed the Board. Dr Alvaradowas present, telephonically, and addressed the Board. Johnson moved, Robertson seconded, and it was unanimously carried to issue a letter of concern for failing to accurately document medication administration and nursing care to patient K.D. on or about May 13, 2005, while employed at Banner Thunderbird Medical Center.

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Goode and Chris Castillo were present and addressed the Board. Campbell moved, Perry seconded, and it was unanimously carried to issue a letter of concern for the convictions on May 5, 2004, for Possession of Drug Paraphernalia in Gila County Justice Court and on August 25, 2004, for DUI in North Mesa Justice Court, both misdemeanors.

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Johnson moved, Busby seconded, and after discussion, it was unanimously carried to issue a letter of concern for leaving the Chinle Nursing Home without another licensed nurse to direct staff and provide nursing direction on or about May 21, 2005

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Busby moved, Crawley seconded, to grant certification upon meeting all requirements with a letter of concern for a misdemeanor conviction of selling liquor to a minor on February 6, 2004 in Phoenix, Arizona. The motion carried with eight in favor and one opposed.

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Busby moved, Perry seconded, and it was unanimously carried to issue a letter of concern for improperly restraining a resident causing him to incur bruising while employed as a CNA at Santa Rosa Care Center on September 21, 2005.

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Busby moved, Perry seconded, and it was unanimously carried to issue a letter of concern for improperly restraining a resident while employed as a CNA on or about September 22, 2005, at Santa Rosa Care Center, in Tucson, Arizona.

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Busby moved, Robertson seconded, to issue a letter of concern for abandoning her assigned client on May 1, 2005 while employed as a CNA at Angels PRN, a Home Health Agency in Yuma, Arizona. After discussion, the motion carried with five in favor and four opposed.

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Busby moved, Perry seconded, to grant certification upon meeting all requirements and issue a letter of concern for a 2005 DUI in Tucson, Arizona. The motion carried with eight in favor and one opposed.

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Levendusky was present and addressed the Board. Rich moved, Busby seconded, and it was unanimously carried to issue a letter of concern for allegedly altering a Medication Administration Record (MAR) on or about September 21, 22, 23, 24, and 25, 2005 indicating that Humalog Insulin had been given, and then changing the entry to indicate the Insulin had not been given to resident M.M. while employed at Grandview Terrace Retirement Center in Sun City West, Arizona.

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Munger addressed the Board with additional information. Johnson moved, Busby seconded, and it was unanimously carried to issue a letter of concern for failing to evaluate, document, and report to a physician bruising on a patient’s foot August 24, 2005, while working at Mountain View Manor. The patient was later diagnosed with a fractured bone in her foot.

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Busby moved, Hardy seconded, and it was unanimously carried to issue a letter of concern for failing to document Narcotic medications from on or about September 28, 2005, until October 25, 2005, while employed at Paradise Valley Hospital in Paradise Valley, Arizona.

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Blank was present and available for questions. Campbell moved, Johnson seconded to issue a letter of concern for failing to supervise the actions of an LPN who responded to a patient M.F.’s hypoglycemic event by giving M.F. peanut butter, which led to M.F.’s hospitalization for possible aspiration pneumonia in August 2005. After discussion, the motion carried with seven in favor and one abstained.

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An attempt was made to contact Wells, telephonically. Julie Fernandez, complainant, was present and addressed the Board. Campbell moved, Hardy seconded, and after discussion, it was unanimously carried to issue a letter of concern for lack of professionalism in obtaining necessary information in caring for an infant.

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Julie Fernandez, complainant, was present and addressed the Board. Johnson moved, Rich seconded, to dismiss the case. After discussion, the motion failed with five opposed and three in favor. Campbell moved, Robertson seconded, to issue a letter of concern for showing lack of sensitivity in communicating and meeting the patient’s needs in October 2004. After further discussion, the motion carried with six in favor and two opposed.

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Johnson moved, Perry seconded, and it was unanimously carried to issue a letter of concern for failing to maintain security of narcotics by placing a dose of narcotics within the reach of a confused resident while working at Desert Life Rehabilitation & Care Center in Tucson, Arizona.

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Busby moved, Hardy seconded, to rescind prior Board decision of November 17, 2004, to offer a Consent Agreement for a Decree of Censure, and issue a letter of concern for failing to ensure that staff at Posada del Sol in Tucson, Arizona, were using appropriate insulin syringes, not tuberculin syringes, to administer insulin to residents. After discussion, the motion carried with seven in favor and two opposed.

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Campbell moved, Hardy seconded, and it was unanimously carried to issue a letter of concern for reportedly being verbally abusive and rough in the care of a resident while employed as a manager at Our Place, 10th St, in Tucson, Arizona in April 2005.

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Busby moved, Rich seconded, and it was unanimously carried to issue a letter of concern for not immediately reporting witnessed abuse of a resident to the appropriate supervisory personnel while employed as a CNA on July 30, 2005 at Posada del Sol, in Tucson, Arizona

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Johnson moved, Busby seconded, and it was unanimously carried to issue a letter of concern for failing to report a resident’s complaint of physical abuse while employed as an LPN at Posada Del Sol, in Tucson, Arizona, on August 1, 2005.

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Becker was present and available for questions. Hardy moved, Becker seconded, and it was unanimously carried to issue a letter of concern for failing to accurately document use of narcotics from on or about March 2005 to October 2005, and also for administering Percocet via the Nasal Gastric tube when the order did not apparently specify that the Percocet by this route, while employed at St. Joseph’s Hospital & Medical Center in Phoenix, Arizona.

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Torrez addressed the Board with additional information. Malloch knows Herb Geary but shows no bias. Johnson moved, Busby seconded, to issue a letter of concern for using a personal website while on duty to make entries that contained information that could have potentially identified confidential patient information on or about 2004 and 2005 while employed at Banner Good Samaritan Hospital in Phoenix, Arizona. After discussion, the motion carried with six in favor and one opposed.

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Campbell moved, Busby seconded, to grant licensure upon meeting all requirements with a letter of concern for the April 28, 2003 arrest and subsequent conviction on May 12, 2003, possession of a controlled substance (marijuana, under 4 ounces), a misdemeanor, in the Connecticut Superior Court in Enfield, Connecticut, and for reportedly verbally abusing a patient at Huntington Hospital in Huntington, New York, in July 2004. After discussion, the motion carried with four in favor and three oppose

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Malloch knows Deb Krmpotic but shows no bias. Midkiff addressed the Board with additional information. Teressa Sanzio, attorney, was present and addressed the Board. Triant was present and available for questions. Rich moved, Busby seconded, to issue a letter of concern for allegedly failing to accurately assess, intervene, and document the care of patient H.T. on or about March 28, 2005 while employed at Banner Baywood Medical Center. After discussion, the motion carried with six in favor and one opposed.

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Busby moved, Johnson seconded, to issue a letter of concern for failing to follow facility policies related to the observation of a suicidal patient on or about January 22, 2005 while working at Palo Verde Behavioral Health Hospital in Tucson, Arizona. After discussion, the motion carried with four in favor and three opposed.

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Rich moved, Hardy seconded, to issue a letter of concern for failing to be aware of the actions taken by a CNA she was supervising, who restrained a patient without an order, on or about March 4, 2004, while employed as the night charge nurse at Palm Valley Rehabilitation and Care Center in Goodyear, Arizona, resulting in the termination of employment of both employees. After discussion, the motion failed with five opposed and two in favor. Hardy moved, Campbell seconded, and it was unanimously carried to dismiss the case.

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January 2006

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Torrez addressed the Board and confirmed receipt of additional information. Teressa Sanzio, attorney, and Michelle Stillenger were present and addressed the Board. Garner was present and available for questions. Campbell moved, Johnson seconded, and after discussion, it was unanimously carried to issue a letter of concern for failing to follow facility policy when accessing and administering controlled substances to patient T.S. on or about February 1, 2005, while assigned by Cross Country Staffing to work at John C. Lincoln Hospital in Phoenix, Arizona.

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S. Smith addressed the Board with additional information. Biegert was present and addressed the Board. Campbell moved, Crawley seconded, and it was unanimously carried to, upon meeting all requirements and signing a Consent Agreement for a 24 month stayed revocation with the license suspended during the first 12 months and on probation the second 12 months, followed by 24 month probation to include the attached stipulations, grant RN license stamped “Refresher Course Only”. Upon successful completion of the refresher course, grant RN license. If not signed within 30 days, deny licensure based upon the information contained in the investigative report. If an informal settlement conference is requested, the authority to settle is limited to the terms of the Consent Agreement offered at this Board meeting.

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S. Smith addressed the Board with additional information. Castelhano was present and available for questions. Hardy moved, Rich seconded, and it was unanimously carried to offer a Consent Agreement for a 24 month stayed revocation with the license suspended during the first 12 months and on probation the last 12 months, followed by a 24 month probation and to include the attached stipulations, or hearing.

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Johnson and Malloch know Kathy Scott but show no bias. Rich moved, Crawley seconded, and it was unanimously carried to offer a Consent Agreement for a 36 month stayed revocation with the license suspended during the first 12 months and on probation the last 24 months, followed by a 12 month probation and to include the attached stipulations, or hearing.

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Busby moved, Rich seconded, and it was unanimously carried to issue a letter of concern for failing to follow facility policy related to documentation of Lortab during the month of October and November 2004 while employed at Scottsdale, Healthcare in Scottsdale, Arizona.

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Malloch and Hardy know Cathy Lucius but show no bias. Nelson addressed the Board and confirmed receipt of additional information. Mitchell was present and addressed the Board. Busby moved, Campbell seconded, to issue a letter of concern for the alleged inappropriate behavior and threatening comments made in the classroom of GateWay Community College while enrolled in the Maricopa Community College District Nursing Program, resulting in dismissal from the nursing program and from the college on or about October 13, 2004. After discussion, the motion failed with four opposed and three in favor. Rich moved, Hardy seconded, and it was unanimously carried to offer a Consent Agreement for a $50 Civil Penalty to be signed within 30 days, or hearing.

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March 2006

Busby moved, Crawley seconded, and after discussion, it was unanimously carried to rescind prior Board decision of July 21, 2005, to offer a Consent Agreement for a stayed revocation/suspension for 12 months followed by a stayed revocation/probation for 12 months followed by a 24 month standard probation or hearing, and accept the signed Consent Agreement for a stayed revocation/indefinite suspension with terms and conditions followed by a 12 month stayed revocation/probation followed by a 24 month standard probation to include terms and conditions.

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Twigg addressed the Board with additional information. Garrett was present and available for questions. Campbell moved, Hardy seconded, and after discussion, it was unanimously carried to issue an Interim Order for a sexual misconduct evaluation by a Board approved psychologist with expertise in sexual and boundary misconduct to be scheduled within 15 days and completed within 45 days, and return to the Board.

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Campbell moved, Johnson seconded, and it was unanimously carried to issue an Interim Order for a sexual misconduct evaluation to be completed by a Board approved evaluator who is at minimum Ph.D. prepared and to include any additional testing deemed necessary by the evaluator, to be scheduled within 15 days and completed with 45 days and return to the Board. If the Interim Order is not completed, adopt the attached Notice of Charges and include the factual allegations and alleged violations for failure to comply with the Interim Order.

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Perry moved, Hardy seconded, and after discussion, it was unanimously carried to issue a letter of concern for failure to follow facility policy and procedures to maintain patient safety during a post-procedure discharge on or about July 23, 2003, while employed at East Valley Endoscopy, Mesa, Arizona; and failure to cooperate with a Board investigation and maintain a current address of record with the Board.

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Perry moved, Busby seconded, and it was unanimously carried to issue a letter of concern for maintaining a social, non-professional relationship with a patient and his family while assigned to his care in 2005 while employed by Hospice Family Care

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Campbell moved, Hardy seconded, and it was unanimously carried to rescind the Board’s prior vote to offer a Consent Agreement for a 12 month stayed revocation suspension, followed by a 12month stayed revocation probation, then followed by a standard 24 month probation all with terms and conditions, or proceed to hearing, and accept the signed Consent Agreement for a 12 month stayed revocation/suspension with terms and conditions, followed by a 24 month stayed revocation/probation with terms and conditions, then followed by a 12 month standard probation with terms and conditions.

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Malloch recused herself to avoid the appearance of impropriety. Crawley presiding. Hansen was present and addressed the Board. Attorney Karen Owens was present and addressed the Board. Rich moved, Johnson seconded, to issue a letter of concern for LPN completing an initial assessment on patient P.C. on July 19, 2005 and performing patient acuities while employed by Flagstaff Medical Center in Flagstaff, Arizona. The motion carried with eight in favor and one abstained.

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Lester addressed the Board with additional information. Hardy moved, Busby seconded, to grant certification upon meeting all requirements, and issue a letter of concern for a misdemeanor conviction for Extreme DUI on July 2, 2003, in Phoenix Municipal Court, Phoenix, Arizona. The motion carried with eight in favor and one abstained.

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Pinto was present and addressed the Board. Busby moved, Hardy seconded, upon meeting all licensure requirements, grant license and issue a letter of concern for failure to adhere to documentation policy and procedures on or about December 26, 2005, and January 17, 2006, while employed by Intelistaf

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Healthcare and assigned as a traveler nurse in the CVICU at Banner Good Samaritan Medical Center, Phoenix, Arizona. The motion carried with seven in favor and one abstained.

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Johnson moved, Hardy seconded, and it was unanimously carried to issue a letter of concern for the July 13, 2005, conviction of DUI, a misdemeanor, in Yavapai County Justice Court, Prescott Precinct, in Yavapai County, Arizona

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July 2006

Perry moved, Hardy seconded, and it was unanimously carried to issue a letter of concern for inappropriate patient referral and follow up from in or about January through April 2006, as a result of personal and professional life stressors, while employed by Cigna HealthCare for complaint #1, and dismiss the case for complaint #2.

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Hardy moved, Johnson seconded, to offer a letter of concern for failure to insure appropriate follow up for a patient presenting with a breast lesion in or about February 2005 while employed at WellCare in Phoenix, Arizona. The motion carried with five in favor and one opposed.

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Johnson moved, Busby seconded, and it was unanimously carried to issue a letter of concern for refusing to undergo a UDS requested by Board staff on or about January 20, 2006 while she was employed at Desert Regional Hospital in Palm Springs, California.

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Hardy moved, Robertson seconded, to issue a letter of concern for failing to provide a for cause urine drug screen on or about November 17, 2005, following a patient complaint to her employer while employed by Centrum Healthcare in Phoenix, Arizona. After discussion, the motion carried with five in favor and two opposed.

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Busby moved, Hardy seconded, and it was unanimously carried to grant certification upon meeting all requireMents and issue a letter of concern for a misdemeanor conviction for DUI on September 26, 2005, in Tempe West Justice Court, Tempe Arizona.

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Bauer addressed the Board with additional information. Busby moved, Link seconded, and it was unanimously carried to issue a letter of concern for a felony DUI conviction on March 31, 2004, that was later reduced to a misdemeanor on March 9, 2005, in Maricopa County Superior Court, in Phoenix, Arizona.

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Melanie Balestra, attorney, was present and addressed the Board. Link knows Balestra but shows no bias. Hapke was present and addressed the Board. Busby moved, Robertson seconded, and it was unanimously carried to issue a letter of concern for failing to assure that the nursing staff had compete information regarding the care of patient D.H. before leaving the facility on or about January 10, 2006 while employed at Cigna in Phoenix, Arizona.

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and it was unanimously carried to issue a letter of concern for failure to obtain an x-ray report and initiate an appropriate follow up referral for a patient on or about December 7, 2004, while employed by Clinica Adelante, Surprise, Arizona.

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McCuin was present and addressed the Board. Johnson moved, Robertson seconded, and it was unanimously carried to issue a letter of concern for failing to follow facility policy related to documentation while assigned to work at Banner Desert Samaritan Hospital and employed by Banner Professional Registry on or about November 2005.

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Perry knows Brenda McCoy but shows no bias. Twigg addressed the Board with additional information. Link moved, Perry seconded, and it was unanimously carried to issue a letter of concern for responding inappropriately to a resident by raising your voice and speaking rudely on or about December 7, 2005 while working at Catalina Care Center in Tucson, Arizona

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Johnson moved, Busby seconded, to grant licensure upon meeting all requirements, and issue a letter of concern for a misdemeanor conviction for misdemeanor reckless driving on November 15, 2005, in Superior Court of California, County of San Luis Obispo. After discussion, the motion failed with four in favor and fOur opposed. Hardy moved, Crawley seconded,

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Perry moved, Busby seconded, and it was unanimously carried to issue a letter of concern for failing to document circulation/motor/sensation checks to patient L.R.’s left leg on or about March 3, 2003 and March 4, 2003 while employed as a registry nurse at Banner Mesa Medical Center.

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A Fresh Idea: “Back To Caring” Would Put Nurses Back to Work…

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     I have three years’ worth of board meeting minutes left to review before I go into phase two of my research and travel back again to start reading each and every case and gathering my data for the research study. As I have journeyed back in time at the BON I see some disturbing trends and some opportunities that would help nurses re enter the workforce instead of ostracize them—especially those nurses, like myself, who have never had sentinel events, accusations of abuse or neglect or drug/alcohol infractions. I believe I have seen not one, but two HIPPPA violations that received “Letters of Concern” and not revocations……..Nurses who have had one or more DUI’s get a simple non publicized letter of concern. But isn’t that DUI placing the public well being at risk? If we go back to the writings and theory of Florence Nightingale , even she would be admonishing such a thing. Driving under the influence is like being at the controls of a powerful missile with the potential to kill, and it hardly seems proper to issue a simple letter of concern without some kind of course that remediates this behavior instead of encouraging it to occur. So far I have read of several nurses who have racked up two, three or more DUI’s, some of them extreme. Throughout my own investigation I was referred to as a potential danger to society, or as Nikki Austin put it, a nurse who pushes patients toward death because I educate about Hospice and Home care alternatives. Is the impaired nurse behind the wheel any less of a nurse who is putting patients at risk for death or dismemberment? What is the difference?

     Another disturbing trend I see is this insatiable need for the Arizona Board of Nursing to publish anything and everything in a person’s past as far back as 30 years —in one instance an individual was responsible for a vehicular homicide many years ago and moved here to Arizona, I wonder===whether it was to start a new life, to try and make some kind of effort at moving forward, to do something good with his life after such a tragedy, to reconcile what had happened by helping others. This was brought up during his application for a nursing license here. Can you imagine how traumatic and humiliating that might have been for this individual. We know nothing about him but can only assume that he made the cross country treck to heal…..to find purpose in life again, to try and find self forgiveness. How far is too far with the Arizona Board of Nursing?? ….Is there is a point at which it does more harm than good in the name of protecting the public?  Yet…still… there are many cases I have identified that could have been handled more aggressively to protect the public….but these were waived off. Im peeved, to say the least.

Nurses and LPN’s and CNA’s seeking licensure in this state are not immune to lengthy investigations that go back thirty or more years either. I feel like there has to be a line, a criteria, a stopping point. We are all human beings who have made mistakes in our past and are seeking new paths of change, new ways of doing better with our lives…..some of these people find that in seeking the role of a healthcare provider. I have seen several cases in which applicants are applying for RN exams or CNA exams slapped with consent agreements/revocations/probations even before having taken the exam. So here is my question—–with things like these on their licenses for people (employers) to see, they continue to pay for their past, unable to move on, unable to do better in life, and give back. Surely there are other ways to allow someone to take a test and grant them certification and request these applicants to submit their employee reviews to the board. Because, really, who is going to hire a new RN or CNA or LPN with a past right out of the gate? The message each rejection sends to that person is ” youre not good enough.” They have just invested years into learning and hoping for a new direction in life and here they are back at square one. There are other ways to monitor these individuals…..I know there is. A way that doesn’t rob them of the ability to make a difference in the world and within themselves to become better people.

 At times I feel as if the Board of Nursing expects absolute perfection and nothing less. For example, you cant even teach with two nursing degrees in this state if you have been disciplined by the board because===and this is what I have been told “we don’t want tainted nurses teaching our students.” Tainted? Do you know me? Did you take the time to read my resume and letters of reference and nursing philosophy and my writing portfolio? “No, we just check your license first.” Imagine for one moment, how many truly talented and big hearted hopeful people are turned away and judged every single day for their past, being told “you aren’t good enough.” Transformational and innovative leaders/thinkers that could help change the future of our profession…… It isn’t just me either, so many nurses in Arizona write and call me with the same words and that palpable  all too familiar pain in their voice: “But Im not a criminal, Im not some animal, Ive never hurt anyone, I just made a mistake and now I cant find a nursing job anywhere.” How does this help the workforce? How does ithelp our profession by yankng seasoned nurses out of the profession and leaving brand new grads on the floors housing the sickest of the sick? Be notified, its happening more and more. Its especially frustrating when hospitals will not hire new grads right now in favor of experienced veterans……well, with as many nurses as I have seen taken out of the profession between 2007-2014, we could have had some pretty good mentors out there providing some very good direction and leadership to the newer generations. But……lets not forget….the Arizona Board of Nursing must protect the public…..even if it means leaving the baby nurses out there alone with less and less veterans to help them grow and develop. Way to protect the public.

Now, envision an aircraft graveyard. Do you remember that movie with Patrick Dempsey in it called “Cant Buy me Love?” The scene where he takes the girl of his dreams to the aircraft graveyard? They are forever parked there, each one with a history all its own….some having flown historical missions, others having delivered scores of American Veterans back to their home soil after war…..they each have a beautiful start, a shining hopeful beginning when they are considered the latest and greatest thing, a commodity, the plane everyone wants to get a turn at flying……a turn in the cockpit….some of those pilots dream of the day they will get to do it…..and then something happens. Maybe the plane gets too old, falls out of the times, the technology, perhaps its too war torn, has logged too many miles….who knows, really. The point is, they remain there. Their journeys and stories hidden in the heart of each hollowed out interior. The same thing happens with nurses who are jerked out of servicing humans too soon. The disappointing and heart breaking thing is that it doesn’t need to be this way. Our Board of Nursing has become well known as the Draconian Era Board of Nursing among all boards across the nation. They haven’t moved forward with the times……..and ironically, they are participating with the “Future of Nursing Initiative.” (I went to Macayos with my family and had a Patron Margarita with my dinner after discovering that little jewel.)

Nurses. My greatest advice to you is to be PROACTIVE. KNOW THE PLAYERS ON THE PLAYING FIELD. Become familiar with, and even memorize your state’s statutes pertaining to healthcare workers, the nurse practice act and how and under what terms your Board of Nursing can “write its own rules.” Ill tell you right now, until enough of you start doing this and picking up on violations things will continue as they are, and they aren’t good from what most of you tell me across the nation. Network with your state’s legislators—-CONSTANTLY. Don’t let go! Don’t just give up! Its easy to say, but the way I see it, giving up means allowing more nurses and patients in this state to get hurt and I don’t want to be part of the problem, rather, I want to be part of the solution.

Research your board members! Investigate them as they do you====I mean, who are they? Do they post a CV or resume? Are they members of special interest groups? How long has it been since they have been a bedside nurse? Have they EVER been a bedside nurse? Are there term limits in your state? Is there a system for checks and balances so that some iota of justice is preserved? How are the board members appointed? By the governors office? Are they elected by peers? Are they simply nurse management or administrative officials??? Here’s a helpful tip–more often than not your State Nurses Association is tightly bonded with your state’s Board of Nursing. And the members of both those organizations are usually college professors or nurse administrators or managers—so be cautious who you go and talk to or who you trust.

     Research their outcomes. Yes, its boring, but, this is your career we are talking about and God willing no situation will arise when you have to go “there” but should you need to, its crucial to know who and what you are up against, their voting records, how many revocations and suspensions there are per year, read the past board minutes and get in touch with nurses who have been before the board before on Facebook, see if you can network that way so you can learn even more. By the time it is your turn, and hopefully it isn’t, you will have some kind of idea in your mind about the process and who is who. Also, do read the portions of the minutes where they discuss legislative updates and other pertinent information to your state’s practice environment====there is a lot of rich and useful data there! Go in smart! And as I have said time and time again ONLY HIRE NURSES ENDORSED BY THE AMERICAN ASSOCIATION OF NURSE ATTORNEYS. If you are in Arizona that is Teressa Sanzio and Lisa Gervase, orrrrrr a new aggressive high profile law group that just moved here.  They have heard of my case and have an excellent record defending clients—the Rose Law Firm. Administrative law is very very tricky and there are some attorneys here in my state who are more afraid of the AZBON than they are of dying that they forget to defend their clients properly. Do not make the same mistake!!!!! No matter what state you are in!

****If you ARE in Arizona, do not bother with an administrative hearing before an Administrative Law Judge to appeal your case, its just my opinion***

So far, my findings between 2007-2014 indicate that roughly 9 out of 10 rulings are in favor of the Arizona Board of Nursing. But—of course, that’s up to you. I did it because I wanted to know that in my own mind I prepared well,  fought until the end, I faced my worst fears in the face and stared them down and walked out holding my head high. Its funny, you think the worst moments of your life will always be these horrible memories, but those two days in administrative court were my proudest moments because in my heart I fought hard not just for me, or for my colleagues, or for my patient====but I “did the thing I didn’t think I could ever do.” And I’m still alive. They were changing days in my own life, a growth process for me.

     Virginia Henderson, Nurse theorist, once said that  “If for too long we deprive a person of what he values most—love, approval, fruitful occupation, this condition of deprivation is often worse than the disease we are attempting to cure.”   Think about this for a moment. In the past three and a half years I have had visit after visit, telephone call after telephone call with nurses in Arizona and other states that are hurting, and they are hurting badly. These are decent nurses, like myself. Nurses who have made their share of mistakes in their careers, or in their lives but have paid for them, taken accountability for them and now continue to pay for them at every job interview, or every time someone accesses their name on their State Board of Nursing Website. In our state, I heard that disciplinary records remain on the website for ten years. So for ten years, Arizona nurses in the same position I am will be subject to judgment each and every time we go on job interviews, interrogations, bias, and ultimately==passed over for gainful employment no matter what industry we choose to enter. How is that fair to ANY HUMAN BEING? OR THEIR FAMILY? I understand if the offenses involve reckless and wrongful death, neglect, and offenses similar to that, during their course of caregiving. But the rest of us. We are forever admonished. Over time that wears away at someone’s self-esteem, who and what they see in the mirror, their self-worth. I mean, come on, do a care plan on someone like this (that is if you even do them) and you can clearly see how their Maslow Pyramid has literally crumbled down to the foundation, their altered role status, their at risk diagnoses. Unfortunately, when it’s happening to you, you fail to perform the nursing assessment on yourself…..you fail to see how you slowly fail to thrive, and your health goes downhill……nurse after nurse……it’s the same story. Here in Arizona so many of them are hurting and so far along into mental anguish, despair, PTSD, they are no longer able to frame themselves, their present, their future, or who they see in the mirror every day in a therapeutic and realistic way. When the Board of Nursing does what they do without regard for ethics or for necessity, they overlook an important factor=====the human factor….and the family that has to suffer with their nurse. Because he or she is more than a nurse, now they are a wounded healer, daughter, son, sister, brother, wife, husband….friend. Many I know have been in and out of mental health units, some have tried committing suicide a few times. When you strip someone of everything they are, their identity, it has powerful consequences……they not only get punishment from the Arizona Board of Nursing, but they are punished at every interview, and they punish themselves every time they go home and see how they have ruined their family or their family’s future. In Arizona, Nursing is no longer a healing profession, its a mine field. And when you step on the landmine….there is nothing left.

     So what is the answer? What can make it better? What can help these nurses get back to work, reintegrate back into society,  get some counseling to improve their self-esteem, get support from their peers, and complete the terms of the punishment set forth from the Board successfully? I mean, the AZBON has a CANDO program for substance abusers, why not the rest of us? The idea is to reduce revocations, reduce surrenders, increase timely probation completion and remediate nurses in the areas the board thinks they need to be reeducated in. For example, for DUI offenders, have them do a few shifts at county hospital, ride along with the phoenix police department, or complete a course involving the consequences of DUI instead of just issuing a letter of concern????   For those with prior offenses that were centered on violence, offer the option to go to a regular anger management groups and have proof of sign ins. For those with boundary issues, send them to a class about maintaining boundaries instead of just issuing the standard letter of concern. When I read “Letter of Concern” I read “No big deal, on to the next one.” While I have been researching for my study I thought of several things. The number one reason most people cannot complete their consent agreements is because nurses on probation are not considered hire able, they are considered a liability, not trustworthy. There are very few to no places that will hire the nurse on probation, and the lucky ones are the nurses who are already employed when placed on probation. Myself, along with other nurses, have been told we are no longer marketable, we are a liability, we aren’t worth the risk. Hear that a few hundred times and get back to me on how you feel.

 

Truth be told, in a majority of cases the State of Arizona is spending hundreds of thousands of dollars supporting out of work or poverty stricken nurses out of work===and their families via cash assistance, food stamps, and AHCCCS. Why not implement a multipronged initiative, or program that helps get these nurses back to doing what they love and for some of them, what they were called to do all their lives???? It’s a simple concept. The Arizona Board of Nursing, working with the Arizona Hospital and Healthcare Association can collaborate on developing a comprehensive program that would find and contract with state funded clinics, DES nursing roles, homeless medical clinics, doctors’ offices or urgent cares that would be willing to host a nurse on probation on either a volunteer/precepting basis, submitting job performance reports as required by the board or the nurses would get paid at a reduced “probation rate” so that they could be earning an income while completing their probation terms.  Plenty of nurses on probation will tell you that its next to impossible to find work and your despair and hopelessness just continues to grow until you succumb to things like alcohol or drugs to cope with the pain and loss, or you succumb to the mental illness with some nurses thinking that the Arizona Board of Nursing staff are following them everywhere. (No, seriously, I have heard that from several nurses) I joke that they have a sniper assigned to me, but this is indeed a joke. My way of blowing off steam. (Or am I not allowed…) I blog enough that it wouldn’t be of any surprise that they haven’t had an IT guy and private investigator assigned to me throughout the duration of my case.

My point is, were losing good nurses, talented nurses, caring nurses, that could be out in the workforce right now this minute if a program called “Back To Caring” was developed and implemented to pull these nurses out of despair and give them their income back, getting them off of DES benefits and welfare, giving them their pride back, their self-esteem, their purpose. Not to mention giving them their role back within their families, restoring it to a point where they can be a better mother or father to their children again, a daughter or son to their parents…..and more importantly, become an active participant in society again. What is happening right now with the Arizona Board of Nursing is called dehumanization. The undoing of nurses little by little, an unraveling. And no one, no nurse, no family of a nurse, deserves to see it happen or experience it. Especially when there is a remedy for it. When there are possibilities.

With a program like “Back to Caring” in place, nurses would begin to heal. The State Board of Nursing could ensure that they are capable of being sound and ethical practitioners through a program like this. Continuing with the status quo, does nothing but continue a harmful cycle. Believe me when I say I know of nurses both here and outside of Arizona that have taken their own lives for something as simple as a patient complaint in which a patient wasn’t harmed and the patient was angry. (Why do you think I keep talking about my case, I do it in honor of my patient and the nurses who couldn’t make it out of the dark) Or a medication error that has hurt a patient. Or even having their sexual orientation held against them.  We are all nurses for God Sake—isn’t it our duty to care for each other and help each other along too?

If the Arizona Board of Nursing can send some of the nurses in my previous reports back out into the streets with nothing more than a slap on the hand….surely they are capable of exploring the meaning of the words “therapeutic, healing, and second chances.” Now whether they want to do the RIGHT THING, THE HUMANE THING…..well, of course, that’s up to them…..after all, they are in charge of

The Future of Nursing in Arizona

Without further ado……..the 2007 Board of Nursing Minutes

 

 

An attempt was made to contact the complainant, Schlomit Gruber telephonically. Turner was present and addressed the Board. Malloch moved, Robertson seconded, to issue a letter of concern for being insensitive and using inappropriate language while providing care for patient P.M. on June 9, 2006 while working at John C. Lincoln Hospital. After discussion, the motion carried with five in favor and one opposed.

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Wiggin addressed the Board with additional information. Grant was present, telephonically, and available for questions. Johnson moved, Robertson seconded, and it was unanimously carried to issue a letter of concern for failing to perform a complete assessment on a patient who had sustained a fractured right femur from a fall, while working at Gila River Indian Care Center, on or about June 1, 2006

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March

Harris was present and available for questions. Malloch moved, Link seconded, and it was unanimously carried to grant licensure and issue a letter of concern for the November 6, 1997, comments to a co-worker at Venice Hospital in Venice, Florida that she believed were “inappropriate, unprofessional, and sexual in nature,” and for his behaviors on December 22, 2004 and March 1, 2006, at Banner Good Samaritan in Phoenix, Arizona, that made other employees feel uncomfortable.

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Based upon the hearing transcripts, the Administrative Law Judge’s Findings of Fact, Conclusions of Law, Recommendation, and the information presented at this meeting, the Board members agreed that disciplinary action should be considered in this matter.

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Busby moved, Link seconded, and it was unanimously carried to accept as Findings of Fact the allegations contained in Paragraphs 1 through 38 and Conclusions of Law the alleged violations in Paragraphs 1 through 12.

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Malloch moved, Busby seconded, and after discussion it was unanimously carried to issue a letter of concern for poor medication administration to include pre-charting documentation of medication administration.

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Busby moved, Link seconded, to rescind the Order of Denial issued on September 12, 2006, grant CNA certification and issue a letter of concern for a 1993 conviction for theft, a 1999 conviction for shoplifting, and a 2004 conviction for threaten/intimidate and use of phone to harass, all misdemeanors. After discussion the motion carried with seven in favor and one opposed.

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Malloch moved, Link seconded, and it was unanimously carried to issue a letter of concern for inappropriate language and comments to co-workers about patients, on or about August 8, 2006, while as a travel nurse by Independent Nurses and assigned to the rehabilitation unit at Banner Good Samaritan Rehab Hospital in Phoenix, Arizona.

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Rix was present and available for questions. Rappoport addressed the Board with additional information. Link moved, Robertson seconded, and it was unanimously carried to issue a letter of concern for the administration of 2 mg Morphine Sulfate intravenously to a patient with a known allergy and failure to follow medication administration standards of care on or about September 28, 2006, while employed as an ICU staff nurse at Paradise Valley Hospital in Phoenix, Arizona.

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Nelson addressed the Board with additional information. Busby moved, Link seconded, and it was unanimously carried to issue a letter of concern for an arrest for disorderly conduct for domestic violence on or about August 5, 2006 in Parker, Arizona.

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Adame was present and addressed the Board. Busby moved, Link seconded, to issue a letter of concern for abusing two residents verbally and emotionally while employed as a CNA at Hospice of Arizona and assigned to the Hospice Unit at Freedom Plaza. The motion carried with seven in favor and one opposed

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Hanson was present and available for questions. Nelson addressed the Board with additional information. Link moved, Busby seconded, and after discussion it was unanimously carried to issue a letter of concern for failing to complete paperwork required for recertification for continued care for five patients in or about July 2006 while working at Firstat Home Health Care Agency.

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Pop was present and available for questions. Torrez addressed the Board with additional information. Malloch moved, Busby seconded, and it was unanimously carried to issue a letter of concern for documenting on the medical record for resident L.S. that Dr. Rajan had been notified about the wound treatments on or about July 20, 2006, and July 22, 2006, when in fact Dr. Rajan had not been notified, while employed at Sun Grove Village Square.

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A VIOLATED, SECOND CHANCE CONSENT AGREEMENT An attempt was made to contact Nickerson telephonically. Barber addressed the Board with additional information. Malloch moved, Crawley seconded, and it was unanimously carried to offer an amended Consent Agreement extending the current probation for an additional 12 months with a relapse prevention evaluation scheduled within 15 days and completed within 30 days, a course in legal ethical nursing, monthly employer performance evaluations for the first 6 months, no further opportunity for the step down component, and no early release, to be signed within 30 days or proceed to noncompliance hearing.

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Busby moved, Crawley seconded, and it was unanimously carried to issue a letter of concern for the July 2004 arrest for assault and domestic violence, during which Yond admits being intoxicated, and for failure to complete court requirements resulting in a warrant being issued for her arrest on or about January 19, 2006, in Phoenix Municipal Court.

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WHO IS GOING TO HIRE THIS PERSON WITH ALL THIS ON THEIR LICENSE??? Dooher was present and available for questions. Attorney Jay Ryan was present and addressed the Board. Nelson addressed the Board with additional information. Malloch moved, Crawley seconded, and it was unanimously carried to grant licensure upon meeting all requirements and signing a Consent Agreement for 18 months probation, to include the attached stipulations. If not signed within 30 days, deny licensure based upon the information contained in the investigative report and adopt the attached Notice of Charges for her practical nurse license and CNA certification. If an informal settlement conference is requested, the authority to settle is limited to the terms of the Consent Agreement offered at the Board meeting.

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Rivera was present and addressed the Board. Malloch moved, Crawley seconded, and it was unanimously carried to issue a letter of concern for inappropriate behavior while caring for a female resident at Sunview Care Center in Youngtown, Arizona on or about October 12, 2006, resulting in the termination of employment.

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SO IN THE MEANTIME THIS PERSON CONTINUES TO TAKE CARE OF PATIENTS:   Scrivano was present and available for questions. Malloch moved, Link seconded, and it was unanimously carried to issue an Interim Order for a sexual misconduct evaluation to be completed by a Board approved evaluator and to include any additional testing deemed necessary by the evaluator, to be scheduled within 15 days and completed within 45 days and then return to the Board. If the Interim Order is not completed, adopt the attached Notice of Charges and include the factual allegations and alleged violations for failure to comply with the Interim Order.

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SO IN THE MEANTIME THIS PERSON CONTINUES TO CARE FOR PEOPLE??? Lester addressed the Board with additional information. Hillyard was present and addressed the Board. Malloch moved, Crawley seconded, and after discussion it was unanimously carried, based on the information contained in the investigative report, issue an Interim Order for a psychological evaluation, to include substance abuse an anger management evaluation, to be completed by a Board approved psychologist, and to include any additional testing deemed necessary by the evaluator, to be scheduled within 15 days and completed within 45 days and then return to the Board. If the Interim Order is not completed, adopt the attached Notice of Charges and include the factual allegations and alleged violations for failure to comply with the Interim Order.

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THEY COULDN’T SEND THIS PERSON TO A BOUNDARIES AND ETHICS CLASS???? Link moved, Hardy seconded, and it was unanimously carried to issue a letter of concern for giving a patient his personal phone number while working at the University Medical Center in Tucson, Arizona.

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May

Attorney Craig Martin was present and available for questions. Keller was present and addressed the Board. Busby moved, Link seconded, and it was unanimously carried to issue a letter of concern for refusing to submit a “for cause” urine drug screen on or about June 7, 2006, while employed at Tempe St. Luke’s Hospital.

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Grady addressed the Board and confirmed receipt of additional information. Langdon and attorney Mary Pryor were present and addressed the Board. Perry moved, Robertson seconded, to dismiss the case. The motion failed with three opposed and three in favor. Crawley moved, Malloch seconded, to issue a letter of concern for writing admission orders after the fact for another nurse practitioner and failing to document an assessment on or about October 20, 2000 at Scottsdale Healthcare Shea while employed by Neonatology Associates, Phoenix, Arizona. The motion carried with four in favor and two opposed.

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Torrez addressed the Board with additional information. Thomas and attorney Judith Abramson were present and addressed the Board. Malloch moved, Judith seconded, and it was unanimously carried to offer Consent Agreement for 24 months probation with the attached stipulations, amended to include: psychological and relapse prevention evaluation at 12 months, relapse prevention therapy, and other requirements to include: may be “on call” for one full weekend and three weekdays in one month only while employed at May Clinic Hospital in the Endoscopy lab; may complete the terms of Consent Agreement in the State of Colorado or New Mexico; psychiatric evaluation to be completed by an evaluator with expertise in substance abuse and psychiatric disorders; psychiatric treatment only if recommended by evaluator; Thomas may arrange for random UDS testing with her present employer Mayo Hospital Mayo Clinic Hospital. The testing must meet the Board’s standards. Thomas may also be tested in the State of New Mexico when she is traveling, or hearing.

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Andrews was present and addressed the Board. Johnson moved, Robertson seconded, and it was unanimously carried to issue a letter of concern for submitting a urine drug screen positive for Morphine on or about October 2006 while working at Westminsister of Scottsdale in Scottsdale, Arizona.

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Malloch knows Susan Ubanks but shows no bias. Warder was present and available for questions. Crawley moved, Robertson seconded, and it was unanimously carried to issue a letter of concern for failing to submit a for cause urine drug screen on or about September 27, 2006 while working at Flagstaff Medical Center.

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Link knows James Guidry but shows no bias. Terry Grainger and Leslie Robinson were present and addressed the Board. Malloch moved, Johnson seconded, and it was unanimously carried to issue a letter of concern for failing to maintain an accurate recording on the narcotic sheet for the amount of Methadone remaining in the container after administering the ordered amount of Methadone to E. O. on or about November 22, 2006, while employed at Evergreen Sun City Health and Rehabilitation Center in Sun City, Arizona. (Nurse 1)

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Link knows James Guidry but shows no bias. Terry Grainger and Leslie Robinson were present and addressed the Board. Johnson moved, Malloch seconded, and it was unanimously carried to issue a letter of concern for failing to maintain an accurate recording on the narcotic sheet for the amount of Methadone remaining in the container after administering the ordered amount of Methadone to E.O on or about November 22, 2006, while employed at Evergreen Sun City health and Rehabilitation Center in Sun City, Arizona. (Nurse 2)

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Link knows James Guidry but shows no bias. Terry Grainger and Leslie Robinson were present and addressed the Board. Johnson moved, Crawley seconded, and it was unanimously carried to issue a letter of concern for failing to maintain an accurate recording on the narcotic sheet for the amount of Methadone remaining in the container after administering the ordered amount of Methadone to E.O. on or about November 22, 2006, while employed at Evergreen Sun City Health and Rehabilitation Center in Sun City, Arizona. (Nurse 3)

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Johnson moved, Link seconded, and after discussion it was unanimously carried to issue a letter of concern for using profanity when speaking to a resident on or about November 8, 2006, while employed at Kivel Campus of Care in Phoenix, Arizona.

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Johnson moved, Hardy seconded, and it was unanimously carried to issue a letter of concern for reportedly verbally and emotionally abusing two residents on January 10, 2007 and January 11, 2007 respectively while employed as a CNA at Santa Rosa Care Center, in Tucson, Arizona, and for reported sleeping on duty twice while employed as a CNA by Interim Health Care, in Tucson, Arizona in 2006

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July 2007

E. Hardy Smith, attorney, was present and addressed the Board. Corporaal was present and available for questions. Twigg addressed the Board and confirmed receipt of additional information. Johnson moved, Malloch seconded, and it was unanimously carried to issue a letter of concern for failing to accurately explain in skilled nursing notes why home visits were not made to a patient on March 6, 2006, March 13, 2006, and March 24, 2006, and what actions were taken to assure the patient received home care as ordered, while working for Centrum/Heritage Home Healthcare.

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Deanna Easton Black, complainant, Grant Perney, attorney, and Brooks were present and addressed the Board. Malloch moved, Crawley seconded, and it was unanimously carried to issue a letter of concern for making unprofessional comments and failing to respond to family requests while caring for patient E.E., while working at John C. Lincoln Hospital in or about December 2005

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Rappoport addressed the Board with additional information. Johnson moved, Crawley seconded, and it was unanimously carried to issue a letter of concern for failing to submit to a for-cause urine drug screen on or about January 26, 2007, while employed as a traveler nurse with HRN Services, Inc. and assigned to Desert Banner Medical Center in Phoenix, Arizona.

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Malloch knows Cindy Linville and Robertson is affiliated with Hospice of the Valley but show no bias. Rappoport addressed the Board with additional information. Johnson moved, Malloch seconded, and it was unanimously carried to offer a Consent Agreement for 12 months stayed suspension probation followed by 24 months probation with the attached stipulations or hearing.

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Sanders was present and addressed the Board. Malloch moved, Busby seconded, to offer a Consent Agreement for a Decree of Censure, or hearing. After discussion, Busby withdrew the second. Motion failed. After further discussion Johnson moved, Robertson seconded, and it was unanimously carried to issue a letter of concern for having a positive drug screen for alcohol in or about October 2006, while employed with Mesa General Hospital in Mesa, Arizona.

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Malloch moved, Woulard seconded, and it was unanimously carried to issue a letter of concern for failing to supervise staff and assuring resident complaints addressed in a timely manner.

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Munnell was present and available for questions. Malloch moved, Robertson seconded, and it was unanimously carried to issue a letter of concern for failing to document care provided to patient H.B., while working at Arizona State Veterans’ Home on or about February 7, 2007

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Rollan was present and addressed the Board. Rappoport addressed the Board with a technical correction to the investigative report. Malloch moved, Crawley seconded, and it was unanimously carried to issue a letter of concern for intimidating residents while working at the Arizona Veteran’s Home in or about February 2007.

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Baloga was present and addressed the Board. Twigg addressed the Board and confirmed receipt of additional information. Malloch moved to dismiss the case for complaint #1 and offer a Consent Agreement for a Decree of Censure or hearing for complaint #2. Motion failed. Busby moved, Johnson seconded, to dismiss complaint #1 and issue a letter of concern for alleged potential violation of patient C.K.’s rights by inappropriate use of seclusion without a valid order and without permitting C.K.’s breaks for bathroom or fluids on November 1, 2006, while working at Tucson Medical Center’s Palo Verde Behavioral Health Center in Tucson, Arizona for complaint #2. After discussion, the motion carried with six in favor and two opposed.

 **********

SO THIS PERSON CONTINUES TO CARE FOR PEOPLE???? Malloch knows Deb Krmpotic but shows no bias. Schafer was present and available for questions. Munger addressed the Board and confirmed receipt of additional information. Johnson moved, Malloch seconded, and it was unanimously carried to issue an Interim Order for a sexual misconduct evaluation to be completed by a Board approved evaluator, to be scheduled within 15 days and completed within 60 days, then return to the Board.

 **********

Torrez addressed the Board with additional information. Johnson moved, Malloch seconded, and it was unanimously carried to offer a Consent Agreement for 24 months probation to include the attached stipulations amended to include: abstain from alcohol 12 hours prior to working, or hearing.

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THERE A REASON THIS PERSON CANT GO TO BOUNDARIES COURSES OR REMEDIAL PATIENT CARE COURSES INSTEAD OF JUST A LETTER OF CONCERN? Malloch moved, Robertson seconded, and after discussion it was unanimously carried to issue a letter of concern for being perceived as being rude to several patient care providers, and for overstepping her professional boundaries by becoming overly involved with the patients and/or families while employed at Gentiva Homecare in Phoenix, Arizona during 2006.

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Johnson moved, Malloch seconded, and it was unanimously carried to issue an Interim Order for a psychological evaluation by a Board approved evaluator to include boundaries and anger management, to be scheduled within 15 days and completed within 45 days and to include any additional testing deemed necessary by the evaluator. If not completed, issue a Notice of Charges based on information in the investigative

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Busby moved, Malloch seconded, and it was unanimously carried to issue a letter of concern for reportedly being rough in the care of resident J.E. on November 3, 2006 while employed as a CNA at Santa Rosa Care Center, and for reportedly reporting for duty with alcohol on his breath on May 10, 2005 while employed as a CNA at Sabino Canyon Rehab and Care Center, in Tucson, Arizona.

 **********

Robertson moved, Link seconded, and it was unanimously carried to issue a letter of concern for a misdemeanor DUI conviction on January 25, 2005, in Mesa Municipal Court, in Mesa, Ariz

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Busby moved, Link seconded, and it was unanimously carried to grant certification upon meeting all requirements, and issue letter of concern for the December 17, 1988, and June 27, 1994, arrests in Tucson, Arizona, for the September 15, 1992, misdemeanor conviction for Drug Paraphernalia Violation, False Report to law Enforcement and Failure to Appear, in Tucson, Arizona, for the July 24, 1997, misdemeanor Shoplifting-Removal of Goods, in Tucson, Arizona, for the January 21, 1999, misdemeanor False Reporting to Law Enforcement, Possession of Drug Paraphernalia, Drive with License Suspended/Revoked/Cancelled, Marijuana-Possess/Use and failure to Appear, in Tucson, Arizona and for the June 28, 1999, conviction for Solicitation to the Unlawful Possession of a Narcotic Drug for Sale, Cocaine Base, a class 4 felony, in Tucson, Arizona.

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September 2007

Malloch moved, Busby seconded, and it was unanimously carried to allow Blumberg and additional thirty days to demonstrate compliance with the following terms: addictionologist/neuropsychological evaluations, enrollment in drug screening, entry into treatment, attendance at AA and Nurse Recovery Group.

 **********

Malloch moved, Crawley seconded, and it was unanimously carried to impose an Order of indefinite suspension pending the successful completion of a refresher and physical assessment course, followed by 24 months probation to include stipulations: notification of practice settings, monthly performance evaluations for the first 12 months, direct supervision, night shift/registry/traveling/float/home health/on call prohibited. If required courses are not enrolled in within 6 months and completed within 12 months, revoke professional nursing license

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Malloch moved, Crawley seconded, and it was unanimously carried to rescind the Board decision of September 12, 2006 to offer a Consent Agreement for 24 months stayed revocation with 12 months suspension and 12 months probation followed by standard 24 months chemical dependency probation, and offer a Consent Agreement for 24 months stayed revocation probation followed by 12 months standard probation with the attached stipulations to include on site supervision, to be signed within 5 days.

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Malloch moved, Crawley seconded, to offer a Consent Agreement for 24 months probation to include the attached stipulations amended to include: evaluation by an addictionologist only if Blanton is unable to be managed without the controlled substance previously described, on site supervision, health dialogue as a telephonic advice nurse under compact license prohibited, or hearing. After discussion, Malloch withdrew the motion. Link moved, Malloch seconded, and it was unanimously carried to offer a Consent Agreement for 12 months probation with stipulations to include: abstain from alcohol, abstain from unauthorized drug use/proof of prescription, one prescriber, one pharmacy, pharmacy profiles, notification of practice settings, quarterly performance evaluations, night shift prohibited, registry/traveling nurse/float pool/home health work/on-call prohibited, neuropsych evaluation if not able to manage migraines through non-narcotic medications.

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Malloch moved, Link seconded, and it was unanimously carried to issue a letter of concern for failing to safely handle a resident’s medications so that another resident took the medications while working at Devon Gables Health Care Center in Tucson, Arizona.

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Crawley moved, Woulard seconded, and it was unanimously carried to issue a letter of concern for the incorrect dosing of Fentanyl and Marcaine and administering the medication by peripheral IV instead of epidural site as ordered, on or about September 7, 2005, while employed as an RN in the cardiac intensive care unit at St. Joseph’s Hospital and Medical Center in Phoenix, Arizona

 **********

Malloch moved, Johnson seconded, and it was unanimously carried to issue a letter of concern for failing to accurately document & maintain patient care records that accurately reflected administering IV medications to patients on or about September 24, 2004, while employed at East Mesa Care Center in Mesa, Arizona.

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Busby moved, Robertson seconded, and it was unanimously carried to issue a letter of concern for an arrest and conviction for DUI in November 2006.

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Crain addressed the Board and confirmed receipt of additional information. Busby moved, Johnson seconded, and it was unanimously carried to issue a letter of concern for a misdemeanor DUI conviction on October 2, 2006, in Prescott Justice Court and for failure to cooperate with the Board’s investigation.

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Nelson addressed the Board with additional information. Busby moved, Link seconded, and it was unanimously carried to issue a letter of concern for leaving her assigned shift without prior approval on our about March 12, 2007, while working at Hopi Healthcare Center in Polacca, Arizona.

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Torrez addressed the Board and confirmed receipt of additional information. Montgomery was present and available for questions. Busby moved, Link seconded, and it was unanimously carried to issue a letter of concern for failing to enter accurate and complete nursing documentation for intake and output volumes, vital signs and medications administered to patients A.G. and G.H. on or about May 19, 2007, while employed at Scottsdale Healthcare in Scottsdale, Arizona.

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Busby moved, Robertson seconded, and it was unanimously carried to issue a letter of concern for failing to undergo a urine drug screen on or about November 13, 2006, while working at La Loma Village Care Center in Sun City, Arizona.

 

 

 

 

 

 

 

 

 

By popular Request: The AZBON

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Jo Elizabeth “Joey” Ridenour, MN, RN, FAAN, executive director, Arizona State Board of Nursing, received the UA Alumni Association’s Public Service Award. She received her bachelor of science degree in nursing from Arizona State University in 1969 and her master’s of nursing in nursing administration from the University of Phoenix in 1993. With a strong foundation in nursing and nursing administration, Ridenour has given more than three decades of service to Arizona and the nation. She is held in high regard throughout the United States for her dedication to uphold high standards for quality nursing and health care. Ridenour has provided exemplary leadership in health care as president of the National Council of State Boards of Nursing, as well as through service as a member of the Arizona Governor’s Nursing Shortage Task Force, the Arizona Hospital and Healthcare Association’s Healthcare Institute and the Arizona Health Sciences Center’s Greater Phoenix Leadership Board.  The awards were presented by Christopher Vlahos, UA Alumni Association president and executive director; Lloyd Fox, UA Alumni Association board chair; and Meredith Hay, PhD, UA executive vice president and provost.

Jo Elizabeth “Joey” Ridenour, MN, RN, FAAN, executive director, Arizona State Board of Nursing

 

FACTUAL ALLEGATIONS:

  1. No set term limits
  2. Appointed by a non healthcare individual in the governor’s office
  3. Write their own rules (gives them a huge amount of power, the more of them that are passed by the legislature)
  4. Special lobbyist to move those rules through legislature quickly
  5. Three or four assistant attorney generals to handle case loads
  6. investigation times up to four years
  7. Disciplinary measures appear on nurse’s license to the public for ten years
  8. Subject to Sunset Clause within the Arizona State Legislature (You can read the audit reports at the office of the auditor general)
  9. Most, if not all board members haven’t been at the bedside in a very long time and have lost touch with current challenges to nurses in the trenches
  10. Not elected into office by their peers
Valerie Smith: Special Consultant to the executive director

Valerie Smith: Special Consultant to the executive director

 

Theresa Berrigan

Theresa Berrigan

 

Shawn Harell

Shawn Harell

Randy Quinn, CRNA, President

Randy Quinn, CRNA, President

Pat Johnson

Pat Johnson

Lori Gutierrez

Lori Gutierrez

Leslie Dalton

Leslie Dalton

Kim Post

Kim Post

Kathy Busby

Kathy Busby

Charleen Snider

Charleen Snider

Carolyn McCormies

Carolyn McCormies

The Daily: AZBON 2014 Outcomes–Inconsistencies

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I think what really gets under my skin is the fact that many of the nurses below were in complicated consent agreements, violated them without explanation, and yet the board voted to allow them to continue on those consent agreements. In my situation, I looked for work, I submitted my monitoring forms on time, and I kept in constant contact with Diva Galan (my babysitter at the board) to keep her apprised of  me and my daughter’s hardships. Yet, despite my communications with the Arizona Board of  Nursing a retired consultant to the Executive Director of the Board of Nursing makes the motion to have my license revokes–and accomplishes just that. She tells the administrative judge that the Arizona Board of Nursing “works with nurses going through hardships when they are on consent agreements. That clearly wasn’t the case with me. But then again, this is Arizona—where injustice is just a way of life.  So just how does the Arizona Board of Nursing decide which nurses to pluck out of the profession for life and which ones to pass on through the process??? And how on earth do some of the practitioners get away with heinous acts by receiving a wave of the hand with the “Letter of Concern” while others with far lesser offenses are dragged through the coals? Seriously, after reading through 2007, 2008, 2009, 2010, 2011, 2012, 2013, and 2014.. I’m confused, perplexed, and downright upset? I still cannot get the Arizona Board of Nursing to acknowledge the complaint I filed against the Banner Del E Webb Hospital nurse manager, Frank Fausto, who blatantly lied to the AZBON during my investigation when there was a witness to prove the facts. He never assessed my patient, much less documented one, nor did he initiate the patient safety policy at the hospital—all direct violations of the Arizona Nurse Practice Act—and because it is me filing the complaint, they will not investigate it. Had he told the truth my case would have had such a different outcome………..

If you’d like to comment/leave feedback you may do so HERE.

These are not all the nurses cases I came across, and am currently reviewing each and every consent agreement/probation/revocation etc and will update this site when that is complete.

January 2014

Taylor was present and available for questions. Johnson moved, Dalton seconded, and it was unanimously carried to issue a Letter of Concern for (1) failing to complete a substance use evaluation by a Board approved evaluator who was at minimum Ph.D. prepared and instead completing an evaluation by a Licensed Professional Counselor in violation of paragraph 2, page 8-9 of the Order; (2) her September 17, 2013 absence from Nurse Recovery Group in violation of paragraph 2, page 12 of the Order and (3) for failing to cause the director of the ethics course to submit a letter to the Board acknowledging receipt of Consent Agreement and Order (“Order”) No. 1108014 in violation of paragraph 6, page 11 of the Order, and allow Board staff to revert Respondent to stayed revocation/probation and reduce the frequency of Respondent’s urine drug testing to a minimum of one time per month for the duration of the Order. Respondent’s Order shall remain in effect until terminated by this Board upon Respondent’s fulfillment of all terms and conditions of the Order.

Parks was present and addressed the Board. McCormies moved, Gutierrez seconded, and it was unanimously carried to allow Respondent to continue on Consent Agreement and Order No. 1209066 (“Order”) and issue a Letter of Concern for missing a Nurse Recovery Group in June 2013 and September 2013 in violation of paragraph 2, page 10 of the Order, and revert Respondent’s license to stayed revocation/probation with terms and conditions effective December 11, 2013. Respondent’s AGENDA ITEM VII.A.1.a. Order shall remain in effect until terminated by the Board upon Respondent’s fulfillment of all terms and conditions of the Order.

McCormies moved, Berrigan seconded, and it was unanimously carried to reopen Agenda Item VI.I.1. Post moved, Berrigan seconded, and it was unanimously carried to issue a Letter of Concern for failing to notify your employer, SEMCO, of your Consent Agreement and Order No. 0803011 effective date May 6, 2009 through August 2, 2011 and allowing a physician with whom you had a personal relationship to provide supervision and monitoring reports to the Board without disclosing the personal relationship to the Board.

 

Dalton moved, Johnson seconded, and it was unanimously carried to issue a Letter of Concern for (1) failing to cause your employer to submit in writing acknowledgement of Consent Agreement and Order No. 0903113 (“Order”) within seventy-two hours of the effective date in violation of paragraph 3, page 8 of the Order, (2) failing to cause two supervisors to submit in writing acknowledgement of the Order in violation of paragraph 5, page 10 of the Order, and (3) failing to cause your employer to submit monthly performance reports in March, 2013, April, 2013, May, 2013, June, 2013, July, 2013, and August 2013 and then again in September, 2013, October, 2013, November, 2013, and December, 2013 in violation of paragraph 4, page 9 of the Order and terminate Consent Agreement and Order No. 903113.

 

Nicholls was present, telephonically, and available for questions. Dalton moved, Snider seconded, and it was unanimously carried to allow Respondent to continue on the Consent Agreement and Order No. 0907071 and allow Respondent to fulfill the terms and conditions of the Order in the state of Texas and issue a Letter of Concern for failing to practice under the direct Supervision of a registered nurse from on or around June 18, 2012 to on or around August 15, 2013 while you were employed as a RN at Virdian Health Management in Phoenix, Az in violation of paragraph 16, page 17 of the Order and for missing one Nurse Recovery Group meeting in July, 2013 and for missing Nurse Recovery Group meeting from on or around October 25, 2013 to the present after you moved to Texas in violation of paragraph 6, page 9 of the Order. Respondent’s Order shall remain in effect until terminated by this Board upon Resident’s fulfilment of all terms and conditions of the Order.

 

Greabell addressed the Board and confirmed receipt of additional information. Dalton moved, Snider seconded, and it was unanimously carried to allow Respondent to continue on Consent Agreement and Order No. 1107108 and issue a Letter of Concern for: (1) Failing to enroll in Nurse Recovery Group within seven days of the effective date of the Order in violation of paragraph 4, page 9, of the Order; (2) Failing to attend Nurse Recovery Group from on or around September 19, 2013 to December 2013 and January 11, 2014 in violation of paragraph 4, page 9 of the Order; and (3) Failing to enroll in relapse prevention therapy within thirty days of the effective date of the Order in violation of paragraph 3, page 8 of the Order

 

Johnson was present and addressed the Board. McCormies moved, Dalton seconded, and it was unanimously carried to allow Respondent to continue on Consent Agreement and Order No. 0904052 (“Order”) and issue a Letter of Concern for failing to attend Nurse Recovery Group on May 29, 2013 in violation of paragraph 1, page 10 of the Order and failing to cause Dr. Peter Mitchell to submit a letter to the Board acknowledging receipt of Consent Agreement and Order NO. 0904052 when he prescribed a controlled substance to you following a surgical procedure on May 4, 2012 in violation of Paragraph 5, Page 12 of the Order. Respondent’s Consent Agreement and Order No. 0904052 shall remain in effect until terminated by this Board upon fulfillment of all terms and conditions, but Respondent may be allowed to step-down the frequency of her random drug testing to on-call and is no longer required to submit reports from Nurse Recovery Group and Alcoholics Anonymous.

 

Gregory was present, telephonically, and addressed the Board. Post moved, McCormies seconded, and it was unanimously carried, based upon the language of the Order and the information contained in this Monitoring Report, issue a Letter of Concern for five unexcused absences from Nurse Recovery Group in months July, 2013; August, 2013; September, 2013; October 2013; and November, 2013 in violation of paragraph 6, page 9 of the Order and for failing to submit to random urine drug testing on October 7, 2013 and November 6, 2013 in violation of paragraph 8, page 9 of the Order, and allow Respondent to continue on Consent Agreement and Order No. 1204064 and to dismiss Investigation Case No. 1310049.

 

 

 

March 2014

 

 

Johnson moved, Snider seconded, and it was unanimously carried to Issue a Letter of Concern for your June 24, 2013 conviction in the Peoria Municipal Court in Peoria, Arizona, for assault (domestic violence) a misdemeanor, his failure to report the charges regarding this incident within timelines set forth by the Nurse Practice Act, and for your June 8, 2011 performance failure, while employed with The Forum at Desert Harbor in Peoria, Arizona, where you failed to properly address toiletry issues of a patient under your care.

 

The proceeding began at 9:37 a.m., with the following Board members present: Quinn, McCormies, Berrigan, Dalton, Harrell, Johnson, Snider, Gutierrez, Post and Busby.

All Board members answered affirmatively that they had received and read the transcript of the hearing and the Administrative Law Judge recommendation.

The Board was represented by Christopher Munns, Assistant Attorney General, Division of Solicitor General. Carri