My Motives. My Purpose. My Dream.

….Having just been released from the hospital for the second time in a week, I came home optimistic and ready to get back to work, scheduling more meetings with state health committee members, cleaning up my draft of the healthcare whistleblower bill I want to see passed, and setting up meetings with patients that wanted to help in the effort.

To my surprise….well, maybe not such a surprise…I was presented with yet another situation in which nurse(s) didn’t want to be affiliated with me because of what a Board of Nursing had to say about me several years ago, and the opinions of SEVERAL nurse bloggers who took it upon themselves to continue their assassination of my character not even knowing the full extent of the details involved in my case with Banner and the AZBON.

Its unfortunate. So here are the true facts— The AZBON LEFT OUT key witnesses that could have exonerated me and testified that I DID FOLLOW HOSPITAL POLICY when educating my patient. The AZBON left out that the Nurse Manager on my case Frank Fausto, lied when asked if I went up the chain of command to report a patient safety concern. The AZBON left out key information from the medical records that indeed shows I initiated a nurse order and has kept the medical record locked. The Arizona Board of Nursing has allowed nurses who have harmed patients, violated HIPPA, ammassed several aggravated DUI’s. diverted drugs, and even killed patients—back out there to practice with only the slap of a hand and a private reprimand.

Here are some more facts: I never hurt a patient in my life. I never under dosed or overdosed a patient. I never stole drugs. I never came to work intoxicated. I never left my posts. I never neglected or failed my patients.

Perfect? That was never a claim on my part. Ever. I was, in fact, just like you. Trying hard to toe the line in a corporatized environment that made me call into question my sense of morals and ethics every day. But social media and a board hell bent on painting a picture can do a whole lot to your life.

But the American Nurses Association wants you to have “moral courage.” They want you to stand up for your patients no matter what. What they don’t tell you about are the consequences to that.

Well, folks, here they are.  The best part?  You’re a criminal —for life. You don’t get to have a life anymore.

Truth be told, this nation never gave its people the option to choose those who have changed our way of being, our way of life, or our way of thinking—aside from a President or local government officials. No one handed out ballots for people like Martin Luther King or Rosa Parks or even Florence Nightingale. And before you start screaming to the masses, I am NOT comparing myself to them, ya dig?

Here’s the thing. People just saw a problem and spoke up. And did something. And didn’t stop doing something until the problem was fixed. I live by what is called a categorical imperative. I learned this in my undergrad years and never forgot it. It was the very heart of my  nursing practice:

“You do for the sake of doing, not for what it will get you or where it will get you or how it will impact your personal circumstances or your comfort or your reputation—you do that which will benefit the greatest amount of people for the better.”

This was the spirit that kept me going up the chain of command to report a patient safety violation on the night of April 12, 2011. Its the same spirit that kept me fighting for my license and the same spirit that kept me fighting for the first amendment rights a board of nursing wanted to take from me.

It is the same spirit that has kept me fighting to protect the interests of nurses and patients today. My license may have been taken, but nurses are continuing to be harmed and patients continue to die TODAY.

Want to know my motive straight from me? There it is. So lets quit with the rumors. If I wanted to profit I would have finished the damn book by now and Lord knows I have enough material for three.

What matters to me is making sure not one more nurse loses their livelihood, their ability to provide for their families, their ability to adhere to a code of ethics they swore to uphold, impacting the rising number of senseless deaths each year  that result from nurses unable to report unsafe situations or medical/surgical errors they know about.

You think you are in a state that is covered? You’d be surprised. I was. And its why I have been trying to fix it. I’m not in this for a license. I’m not in this for revenge. I’m in this because too many nurses and patients are getting hurt, and quite frankly, that IS HOW LAWS GET CHANGED. By people getting hurt. Or by a hole in the justice system.

Thankfully I don’t need permission or approval to get published. I don’t need permission to go see lawmakers or to make changes to current legislation, or to go speak before committee.

I don’t need permission or approval to be ME. And to be authentic and not watered down.

I don’t need permission to be part of a change movement.

I don’t need permission to help right what is so very wrong in our profession right now.

I don’t need to be “liked” to make change that benefits my colleagues and patients or the future of this profession.

I don’t need to be “perfect.”

All I “need” is the desire to do good, to change what is bad, and to help make it better so no one else goes through the same thing.

Want to fault me for that? Hold it against me? Judge me for it? Fine.

But in the same moment, ask yourself what you’ve done to not only walk the harried journey it takes to get there—but to accomplish the goals.

Until then, judge me not for the fact I spoke up and had ALOT of false things said about me and people who continue to HATE me.

Judge me for the fact I am a human being who is seeing other human beings get hurt and I’m just trying to do my part to make it right.

Fault me for that? Cool. Judge me for it? Look at yourself when you do it.

Try and make my voice useless and irrelevant– and my contribution to this profession I earned my right into ( I worked hard for that BSN and MSN just like you did)  and sacrificed to be a part of?

Never.

 

 

 

 

 

 

AZ & National Nurse Rally For Change: Videos

 

 

March 2015: Arizona Board Of Nursing’s Top “Letters of No Concern”

Note: Letters of Concern are the proverbial “slap on the hand” tucked away in a file away from public view form of “discipline” in Arizona. So if an employer or patient were to look up a nurse’s license, these incidents would be hidden from public view.

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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

     

Valerie Smith: Special Consultant to the executive director

Valerie Smith: “Special OPS” Consultant to Exec Director

Quinn moved McCormies seconded and it was unanimously carried to issue a letter of concern for his 08/15/2014 conviction of unlawful discharge of a firearm, a class six undesignated felony in Maricopa County Superior Court in Phoenix, Arizona, which was reduced to a misdemeanor by the same court on 11/06/2014.

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AZBON: “Prostitution, misdemeanor theft, felony possession of narcotic drugs? Sure, well give you a license and a Letter of No Concern!”

Quinn moved Berrigan seconded and it was unanimously carried upon meeting all certification requirements grant certification and issue a Letter Of  Concern for conviction for misdemeanor prostitution in Phoenix, Arizona; conviction for misdemeanor theft in Phoenix, Arizona; conviction for misdemeanor trespassing in Phoenix, Arizona; and arrest and subsequent dismissal after diversion for felony possession of a narcotic drug (cocaine) in Phoenix, Arizona.

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Resisting Arrest? Dangerous Drug Use? Obstructing Police? DUI with drugs???

No problem, the Arizona Board of Nursing will give you a letter of no concern AND AN ANESTHESIA LICENSE!

Because its how they protect the public at large……..

Quinn moved Berrigan seconded and it was unanimously carried to grant CRNA certification upon meeting all requirements and issue a letter of concern for applicants arrest on or about 05/18/2012 for DUI/DUI drugs, dangerous drug use, resisting officer, obstructing police, and operating with a defective headlight for which applicant’s actions cause physical injury to the trooper resulting in applicants guilty plea to resisting arrest, a misdemeanor.

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Hell, you can play doctor in this state and get a Letter of No Concern…….

McCormies moved Preston seconded and it was unanimously carried issue a Letter of  Concern for on or about 05/13/2013 for acting outside of scope of practice when she administered Ativan a benzodiazepine medication intramuscularly and sent the patient to the emergency room without a physician’s order while employed at Con Med Healthcare Services and working at the Pima County adult detention Center in Tucson, Arizona

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NARCOTIC DRUG DIVERSION? No problem! The AZBON has got your back with…yes…..a Letter of No Concern!

McCormies moved Dalton seconded and it was unanimously carried to issue a Letter of  Concern against respondents privilege to practice nursing in Arizona for placing a partially filled vile of injectable versed and a partially filled vile of injectable ketamine—- control medications used to sedate patients during surgical or medical procedures—– into the pocket of flight suit with intention of taking the medications home for his personal emergency backcountry kit while employed as a flight nurse at ******* in Flagstaff, Arizona, on or about 10/26/2012, and for documenting that he wasted a partially filled vile of injectable morphine a controlled analgesic medication, but failed to waste it while employed as a flight nurse at ******* in Flagstaff, Arizona in or about November 2013

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Forget to document a CODE???? No Problem! (Im sure the families appreciated this)

Letter Of Concern:

McCormies moved Berrigan seconded and it was unanimously carried issue a Letter of  Concern for failing to document a patient care assessment, routine or crisis care provided to patient A on or about 12/03/2012 while employed by Banner staffing services and on duty as an RN at Banner Gateway Medical Center in Mesa, Arizona. After discussion, the motion failed with 5 opposed and 3 in favor…. upon re vote it was unanimously carried to dismiss the complaint.

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The Board doesn’t seem to take patient abuse too seriously either, or the non reporting of patient abuse……….

But, they LOVE TO PROTECT THE PUBLIC.

McCormies moved, Dalton seconded and it was unanimously carried to issue a Letter of Concern for her failure to report knowledge of patient abuse, which occurred in the beginning to the middle of January 2015 in a timely manner while working as a certified nursing assistant at reflections hospice in Mesa, Arizona…..

McCormies moved Dalton seconded and it was unanimously carried to issue a Letter of  oncern for her 09/26/2012 allegation of abusing a patient with ALS

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How many of you would like it if YOUR NURSE was doing homework during your conscious sedation procedure—-AND GIVING YOU THE WRONG DOSE OF MEDICATION???? THE ARIZONA BOARD OF NURSING SEEMS TO THINK ITS NO BIGGIE……FOR ALL YOU CONSUMERS, THIS WAS AT TUCSON MEDICAL CENTER.

But the AZBON—does after all—-like to look out for the PROTECTION OF PATIENTS.

McCORMIES moved Dalton seconded and it was unanimously carried to issue a Letter of  oncern for administering the incorrect amount of intravenous droperidol, 1.25 mg to patient a instead of the order dose of 0.625 mg, incorrectly documenting the dosage given his 5 mg, and failing to adhere to the 5 rights of medication administration to ensure patient safety on or about 12/07/2012, and for violating a standard of care by doing online homework while providing care to a patient receiving conscious sedation during a procedure on or about 02/09/2012 while on duty at University of Arizona medical Center in Tucson, Arizona

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Care providers testing positive for marijuana? No problem. There’s a “Letter of No Concern” for that too.

Quinn moved, Dalton seconded, and it was unanimously carried issue a Letter of  Concern for his positive drug test results for marijuana pursuant to a random drug screen by his former employer. Casa Delacruz hospice in Tucson, Arizona, on or about 10/16/2013

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EXTREME DUI’S, REPEAT OFFENSES……HAND IN HAND AT THE AZBON. They all get Letters of No Concern.

So, im assuming that with each person injured or killed the nurse will get a Letter of Concern as well right?

Post moved Preston seconded to issue a Letter of  Concern for 01/18/2013 misdemeanor conviction of extreme DUI with blood alcohol level greater than .15 in Phoenix Municipal Court case number 14421017 in Phoenix, Arizona

“Post moved. Preston seconded, and it was unanimously carried issue a Letter of Concern for 10/18/2013 misdemeanor convictions of DUI, DUI, with a blood alcohol level of .08 or more, extreme DUI with a blood alcohol of .15 – .19 and extreme DUI with a blood alcohol of .20 or greater in Scottsdale Municipal Court in Scottsdale, Arizona”

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“Quinn moved Berrigan seconded and it was unanimously carried issue a Letter of  Concern for 09/30/2014 conviction in Scottsdale city court case number TR201400816 for driving under the influence and extreme DUI with BAC of .15 or more class one misdemeanors in Scottsdale, Arizona.”

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NURSES INVOLVED IN DUI HIT AND RUN??? NO PROBLEM! PROTECTING THE PUBLIC IS PARAMOUNT.

No harm no foul: Letter of Concern from the Arizona Board of Nursing:

Quinn moved Dalton seconded and after discussion, it was unanimously carried to issue a Letter of  Concern for her 09/27/2014 arrest for DUI and hit-and-run from a scene of an accident. Both misdemeanors in Maricopa County, Arizona.

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Dalton moved McCormies seconded and it was unanimously carried to issue a Letter of Concern for misdemeanor conviction for extreme DUI with alcohol concentration of .20 or greater on or about 07/18/2014 in Phoenix Municipal Court Phoenix, Arizona, and for failing to report the charge is for for DUI related offenses and running a red light in April 2014 in Phoenix, Arizona.

Preston moved Post seconded and it was unanimously carried issue a Letter of  oncern for her 12/02/2013 arrest for DUI in Santan Valley, Arizona.
Quinn moved Delton seconded to issue a Letter of Concern for 11/22/2014 arrest for DUI, improper right turn and improper left turn all misdemeanors and conviction of DUI a misdemeanor in the Municipal Court of Tempe, Arizona

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McCormies moved Dalton seconded and it was unanimously carried issue a Letter of  Concern for 02/05/2014 arrest for DUI and extreme DUI for which she was convicted on 09/16/2014 pursuant to a plea of guilty of extreme DUI a misdemeanor in the Scottsdale City Court, Scottsdale, AZ and on her failure to report. Discharge within 10 days as required by the nurse practice act

Quinn moved McCormies seconded and it was unanimously carried to grant licensure upon meeting all requirements and issue a Letter of Concern for her 03/27/2014 misdemeanor convictions of driving under the influence and a DUI subsequent arrest in Las Vegas Municipal Court in Las Vegas, Nevada resulting from 2 separate DUI incidents occurring on 02/13/2012 and 10/17/2012.

Memorial Day: Sales -VS- Sacrifice…Which Is More Important?

Make the sacrifice of NOT SHOPPING today…..

Johnathan Guillory,, age 32, War Veteran. Suffered for years from PTSD and was denied care at the Phoenix VA. He was shot and killed by Phoenix Police on January 20, 2015

Johnathan Guillory,, age 32, War Veteran. Suffered for years from PTSD and was denied care at the Phoenix VA. He was shot and killed by Phoenix Police on January 20, 2015

As we watch them stride confidently toward the big carrier plane, the one that will take them away to a place we can never really get a true understanding of…..tears slide down our faces. We choke down fear filled sobs…. Shove aside any notions that they will not return to us intact. Or that they will not return to us at all.

A year goes by— and its painfully slow. You’ve written letters. Once a week. Twice a week. Sent care packages. Hoped and prayed as hard as you could. Bargained with God…promising to give up anything and everything if it meant your loved one would be one of “the lucky ones” to come back home to you intact…alive…so that life could go on as normal and joyous as it had been before they were called up for duty.

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…..The day finally arrives when you, your family members, and friends stand together in a crowd of other families…cheering together and waving flags as the big jumbo jet lands on the tarmac. The party has been lovingly planned for weeks, every detail has been attended to, and all their favorite foods are prepared.

Relief sets in for everyone as the soldiers begin making their descent down the steps of the plane….each one stopping to look up at the sky in disbelief as they take their first steps back on US soil….some of them kneel down to touch the tarmac with their bare hands for a moment. Now, you know it’s all going to be okay. Everything is good now. The pause button can be released. Life can go on as it was.

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Until it can’t. Until it isn’t OK. Until…as the days and weeks go by, you discover they have changed and something is definitely not right, not the same, and you have no idea what to do…or say….to begin to figure it out.
But that “connection….”   Your way of “being” with each other has changed—

dramatically….

The person who is sitting next to you watching a football game isn’t the same person you sent off to war one year and a handful of days ago. They are distant. Distracted. Easily agitated. They appear deep inside of themselves, far away from you….the realization sets in that this isn’t the same relationship you were in…. This isn’t the person you remember…

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On the eve of Memorial Day weekend 2015 its important that we not just memorialize those who were lost in the line of duty over the decades while defending our flag and our freedom….but the thousands of men and women who are still serving and making the ultimate sacrifice every day: the sacrifice of self in the most personal and devastating way.

PTSD and concussive TBI have emerged to the forefront as more and more of our service men and women have come home forever changed not just physically….but emotionally. We are just now learning how much the veterans from previous wars like Vietnam have suffered for decades without a definitive diagnosis. As a nation we left them flailing out there, without support, without understanding, in a sea of judgment and peril.

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A relative of mine who returned from a 5th deployment described his frustration with people who casually observe he made it back “without a scratch.” “It’s the most frustrating thing, and its irritating, because they have no idea what my life is like, what it feels like, and that just because the marks aren’t there for them to see it doesn’t mean I came back just fine.” Vets often struggle with an acute identity crisis while trying to go through the steps of reintegration in the days and months after returning from a combat setting. Their life roles are different. Their motivations for making every movement throughout the day —have changed.

Our soldiers may make it home from a “place,” but as now deceased Daniel Somer’s put it in his last letter: “I can’t find peace when my mind is still in a war that I can’t even go back to.” Yes, they are HERE, but their minds…their hearts….their identities are still entrenched in the desert terrain overseas. In fact, many vets will endorse a sense of “not feeling normal here.” “I feel more like myself THERE.” They also experience a sense of guilt for being away from their brothers and sisters who remain in theatre. Perhaps they even feel a sense of guilt for surviving an incident one or more of their comrades did not.

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Those of us with Veterans in our lives should be reading up on PTSD, Combat Loss, Combat Bereavement, TBI….learning what they are, what they mean for our soldiers, and what one or more of these afflictions can mean for the day to day self -perception and quality of life of our loved ones.

Its crucial we get reacquainted with our soldiers WHERE THEY ARE TODAY and not where they USED TO BE YESTERDAY. With every deployment….they may come back a little less who they used to be before they left for another tour….reminding them of that does nothing to help them reintegrate back into a family, a home, or into society. You see, no one knows MORE THAN THEY DO, that they are different. NO ONE is more painfully aware that they can never go back to that “normal person” you used to know and love…but who is now forever changed. For many, the guilt and burden of that is just as overwhelming as their efforts to please you and be the person you want them to be.

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If you stop and think about it, all of us go through personal growth and change in our lives….changes that will make us a little bit different as we get older and wiser and as we live and learn our way through challenges.

Veterans are expected to go through these changes and adjust to them at lightening speed. They also have to try and and reintegrate and relearn who they are—at lightening speed….in fact, some vest state that they do it more for you than for themselves. They try hard to be who you remember them to be, who you used to love them for being….and who you hoped would step off that plane.

If you want to honor your soldier….let go of expectations. Love and honor the person that is standing before you in this moment. Stop what you are doing and give them an unconditional message of love by telling them they are perfect as they are right now, today. Reassure them that they will be just as perfect —if not better—each day that lies ahead. It’s what many of our soldiers so desperately need to hear. The gift of knowing that the pressure is off of their shoulders…that they can put down the burden of pretending to be someone they just cant get back to being anymore, that they cant seem to reach any longer.

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Think about it for a second. If you had just emerged through a catastrophic health crisis that left you changed physically, emotionally, or both—would you not want your loved ones to love you just as you are and not hold you to the impossible standard we call “the past?”

I think one of the most precious things we can do for our vets is give them hope and the knowledge that no matter what lies ahead for them, no matter how they may change, there is always that special person or family that will be there to love them, grow with them, remain steadfastly patient with them, celebrate them, and stand by them not just under the best of circumstances….but some of the worst.

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These men and women go overseas to fight for our freedom. For our right to “be” who we are and do as we wish. It just seems fair, and just, that we afford them those same basic rights—to return back into our arms and our hearts just as they are…and where they are on their own journey. Believe it or not, it’s the expectations we impose on them that can do the most harm….and push them farther away into a dangerous, dark, and lonely place.

To me, that is what Memorial Day should be about. Finding ways to reach and hold on tight to a connection with our Veterans. So they always know they aren’t just remembered or honored for their service and sacrifice on a single day…but that we as a nation, alongside their loved ones… will fight just as hard for them as they did for us—every day of the year.

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About the Author: Amanda L. Trujillo BS-MSN is the daughter of an Army VietNam Veteran who has suffered from PTSD and TBI for decades. She also has many friends who are veterans.  A passionate advocate for veteran health and PTSD/TBI Awareness, she is also the Director of Nurse and Patient Advocacy with the Humanitarian Advocate Coalition in Phoenix, Arizona.

 

A Soldier’s Last Mission, A Medic’s Battle For Survival….and Sharon Helman’s Albatross

  Note: Much of this blog posting was taken directly from an article written by Dennis Wagner that was published in the Arizona Republic Sunday August 14, 2014.

The following incidents directly involved former Chief Administrator at the Carl T Hayden VA Medical Center Sharon Helman as she was made aware of the difficulties that veterans were having accessing mental health care they needed to help them with their PTSD and other mental health care concerns.

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Sharon Helman was fired from her post as the VA scandal continued to evolve throughout 2014. She is currently trying to get her job back at the VA Medical Center and her legal team is petitioning the court to be able to do so.

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Brian Mancini served 13 years as a U.S. Army medic and was on a 2nd combat tour when a roadside bomb blew up his military career in 2007.

Mancini says he spent more than 3 ½ years at the Walter Reed National Military Medical Center “Getting my face rebuilt” and undergoing therapy. He returned to Arizona with 2 purple hearts, posttraumatic stress disorder, traumatic brain injury, a missing eye, chronic pain, and a titanium plate in his head.

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As Mancini sees it now, America is afflicted by a delayed casualty syndrome. During the Vietnam War, the ratio of combat fatalities to nonfatal wounds was 1 to 2.6. In Iraq and Afghanistan due to improved armaments and medical technology, just one of 17 casualties is fatal. But many survivors are haunted for life by PTSD and concussive brain injuries from improvised explosive devices.

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In Phoenix, Mancini says he turned to the VA Medical Center and immediately learned that his cocktail of medications, which took years to perfect that the Army hospital, was not on the official formulary, so he would have to start over. He found himself waiting interminably for appointments, unable to get approval of outside acupuncture and chiropractic treatments for agonizing headaches and other pain.

“There was a really dark time in my life when I literally just lay on the floor in my house crying,” Mancini recalls. “I just was really frustrated with the lack of care. I felt betrayed. All they wanted to do was throw a lot of drugs at me, and those drugs were having an adverse effect. They had me on 12 medications. At one point I finally said, you know what I’m done.”

Mancini says he decided to use his medical background to develop an alternative treatment regimen with therapies available in the community: from brain training, to yoga, to fly-fishing. He wrote up a handbook and founded an Arizona nonprofit known as Honor House, then arranged a presentation to Phoenix VA Healthcare Systems Director Sharon Helman 2 years ago. The session did not go well. He recalls. “She was more appeasing me than anything.”

Mancini turned next to Terros, Inc., a community health care organization that focuses on inspirational life changes. Terros adopted the treatment program and lost a pilot effort, then joined in the 2nd attempt to get Phoenix VA involved.

This time, Mancini says, Helman who now faced termination in connection with alleged mismanagement at the Phoenix VA reacted defensively.

“I emphasized the need to go out of network to get veterans the services they so desperately needed regarding PTSD. He wrote in an email, “I specifically commented on the ridiculous wait times and presented a solution with very little interest on her part.”

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Later that same year, Helman would find herself intertwined with the death of another soldier who had been desperately trying to get mental health care. His name: Daniel Somers. He took his own life the summer of June 2013 after losing the battle of his life against PTSD.

Jean and Howard Somers said their son Daniel went to the Phoenix VA Emergency Room seeking hospital admission, where he was told there were no beds available. He lay on the floor weeping and pleading for help. “There was no effort made to see if he could be admitted to another facility,” his father recalled. “But he was told: you can stay here and when you feel better. You can drive yourself home.”

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(I wonder was this possibly an ER nurse who told him he could just lay there and go home when he felt better??? Who had the authority, audacity, and lack of human compassion to watch a soldier curled up on the floor in a tortuous state suffer, weep, and beg for help, and then advise him to go home whenever he felt ok? No one ever identified the staffer who allowed him to go….)

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Daniel Somer’s parents said they had met with Sharon Helman after their son’s death and were informed that wait times for mental health care had dramatically improved. They have since learned that VA patient access records were a fiction. They don’t even know if Daniel’s final act was counted in the Phoenix to be a suicide tally. “It’s like with any statistics out of the VA,” Howard Summers said. “What data are they using? Where did they get the numbers? All we can think is, we were being lied to, like everyone else.” The couple testified before Congress last month and created a reform plan for VA suicide prevention. They also have done the math: if 22 veterans kill themselves daily, and the number has been constant for years, more than 100,000 men and women who served America have taken their own lives since 2001. That’s roughly 15 times the number of US military personnel who died in Iraq and Afghanistan during the same period.”

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Daniel Somers was a veteran of Operation Iraqi Freedom. He was part of Task Force Lightning, an intelligence unit. In 2004-2005, he was mainly assigned to a Tactical Human-Intelligence Team (THT) in Baghdad, Iraq, where he ran more than 400 combat missions as a machine gunner in the turret of a Humvee, interviewed countless Iraqis ranging from concerned citizens to community leaders and government officials, and interrogated dozens of insurgents and terrorist suspects. In 2006-2007, Daniel worked with Joint Special Operations Command (JSOC) through his former unit in Mosul where he ran the Northern Iraq Intelligence Center. His official role was as a senior analyst for the Levant (Lebanon, Syria, Jordan, Israel, and part of Turkey). Daniel suffered greatly from PTSD and had been diagnosed with traumatic brain injury and several other war-related conditions. On June 10, 2013, Daniel wrote the following letter to his family before taking his life. Daniel was 30 years old. His wife and family have given permission to publish it:

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“I am sorry that it has come to this.”

….The fact is, for as long as I can remember my motivation for getting up every day has been so that you would not have to bury me. As things have continued to get worse, it has become clear that this alone is not a sufficient reason to carry on. The fact is, I am not getting better, I am not going to get better, and I will most certainly deteriorate further as time goes on. From a logical standpoint, it is better to simply end things quickly and let any repercussions from that play out in the short term than to drag things out into the long term.

You will perhaps be sad for a time, but over time you will forget and begin to carry on. Far better that than to inflict my growing misery upon you for years and decades to come, dragging you down with me. It is because I love you that I cannot do this to you. You will come to see that it is a far better thing as one day after another passes during which you do not have to worry about me or even give me a second thought. You will find that your world is better without me in it.

I really have been trying to hang on, for more than a decade now. Each day has been a testament to the extent to which I cared, suffering unspeakable horror as quietly as possible so that you could feel as though I was still here for you. In truth, I was nothing more than a prop, filling space so that my absence would not be noted. In truth, I have already been absent for a long, long time.

My body has become nothing but a cage, a source of pain and constant problems. The illness I have has caused me pain that not even the strongest medicines could dull, and there is no cure. All day, every day a screaming agony in every nerve ending in my body. It is nothing short of torture. My mind is a wasteland, filled with visions of incredible horror, unceasing depression, and crippling anxiety, even with all of the medications the doctors dare give. Simple things that everyone else takes for granted are nearly impossible for me. I cannot laugh or cry. I can barely leave the house. I derive no pleasure from any activity. Everything simply comes down to passing time until I can sleep again.

Now, to sleep forever seems to be the most merciful thing.

You must not blame yourself. The simple truth is this: During my first deployment, I was made to participate in things, the enormity of which is hard to describe. War crimes, crimes against humanity. Though I did not participate willingly, and made what I thought was my best effort to stop these events, there are some things that a person simply cannot come back from. I take some pride in that, actually, as to move on in life after being part of such a thing would be the mark of a sociopath in my mind. These things go far beyond what most are even aware of.

To force me to do these things and then participate in the ensuing cover-up is more than any government has the right to demand. Then, the same government has turned around and abandoned me. They offer no help, and actively block the pursuit of gaining outside help via their corrupt agents at the DEA. Any blame rests with them.

Beyond that, there are the host of physical illnesses that have struck me down again and again, for which they also offer no help. There might be some progress by now if they had not spent nearly twenty years denying the illness that I and so many others were exposed to. Further complicating matters is the repeated and severe brain injuries to which I was subjected, which they also seem to be expending no effort into understanding. What is known is that each of these should have been cause enough for immediate medical attention, which was not rendered.

Lastly, the DEA enters the picture again as they have now managed to create such a culture of fear in the medical community that doctors are too scared to even take the necessary steps to control the symptoms. All under the guise of a completely manufactured “overprescribing epidemic,” which stands in stark relief to all of the legitimate research, which shows the opposite to be true. Perhaps, with the right medication at the right doses, I could have bought a couple of decent years, but even that is too much to ask from a regime built upon the idea that suffering is noble and relief is just for the weak.

However, when the challenges facing a person are already so great that all but the weakest would give up, these extra factors are enough to push a person over the edge.

Is it any wonder then that the latest figures show 22 veterans killing themselves each day? That is more veterans than children killed at Sandy Hook, every single day. Where are the huge policy initiatives? Why isn’t the president standing with those families at the state of the union? Perhaps because we were not killed by a single lunatic, but rather by his own system of dehumanization, neglect, and indifference.

It leaves us to where all we have to look forward to is constant pain, misery, poverty, and dishonor. I assure you that, when the numbers do finally drop, it will merely be because those who were pushed the farthest are all already dead.

And for what? Bush’s religious lunacy? Cheney’s ever growing fortune and that of his corporate friends? Is this what we destroy lives for

Since then, I have tried everything to fill the void. I tried to move into a position of greater power and influence to try and right some of the wrongs. I deployed again, where I put a huge emphasis on saving lives. The fact of the matter, though, is that any new lives saved do not replace those who were murdered. It is an exercise in futility.

Then, I pursued replacing destruction with creation. For a time this provided a distraction, but it could not last. The fact is that any kind of ordinary life is an insult to those who died at my hand. How can I possibly go around like everyone else while the widows and orphans I created continue to struggle? If they could see me sitting here in suburbia, in my comfortable home working on some music project they would be outraged, and rightfully so.

I thought perhaps I could make some headway with this film project, maybe even directly appealing to those I had wronged and exposing a greater truth, but that is also now being taken away from me. I fear that, just as with everything else that requires the involvement of people who cannot understand by virtue of never having been there, it is going to fall apart as careers get in the way.

The last thought that has occurred to me is one of some kind of final mission.

It is true that I have found that I am capable of finding some kind of reprieve by doing things that are worthwhile on the scale of life and death. While it is a nice thought to consider doing some good with my skills, experience, and killer instinct, the truth is that it isn’t realistic. First, there are the logistics of financing and equipping my own operation, then there is the near certainty of a grisly death, international incidents, and being branded a terrorist in the media that would follow. What is really stopping me, though, is that I simply am too sick to be effective in the field anymore. That, too, has been taken from me.

Thus, I am left with basically nothing.

Too trapped in a war to be at peace…too damaged to be at war.

Abandoned by those who would take the easy route, and a liability to those who stick it out—and thus deserve better. So you see, not only am I better off dead, but the world is better without me in it.

This is what brought me to my actual final mission.

Not suicide, but a mercy killing. I know how to kill, and I know how to do it so that there is no pain whatsoever. It was quick, and I did not suffer. And above all, now I am free. I feel no more pain. I have no more nightmares or flashbacks or hallucinations. I am no longer constantly depressed or afraid or worried….

I am free.

I ask that you be happy for me for that.

It is perhaps the best break I could have hoped for.

Please accept this and be glad for me.

Daniel Somers

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What troubles me about Arizona are two things: The media and the State Legislature. Change is dictated by what is sexy and profitable at the moment, by what gets ratings or soundbite opportunities for journalists and lawmakers. Journalists get prestigious awards, lawmakers get voters and win elections. But the problem stays a problem. PEOPLE ARE STILL DYING. We don’t work together and pool resources to make change happen in this state. There is no cohesive effort that binds together the talents of “award winning” journalists, experienced intelligent lawmakers, healthcare agencies, and the citizens of Arizona affected by the problems. Everyone does their own thing…..each with a means to an end in their own mind. In all of that—the important stuff gets lost somewhere along the way.

     The journalists love to drop the bomb, they make us aware of the travesties and the injustices occurring, people get mad….….and then they silently walk away like their job is done. Like somehow, because they brought light to the issue, it will magically correct itself and go away. WHY NOT KEEP THE ISSUES FRONT AND CENTER?!!!! Legislators will often posture and pace behind podiums and microphones making strong, passionate declarations and demands in front of the flashing lights and microphones…..but when it comes time to walk the talk on the House Floor…what has actually been done? I reference Veteran Health and Patient Safety as just two examples of major issues that have been brought forward in the past two years on many a newscast…..and still, we are losing Vets. Still, we AS A STATE, are failing to rescue.

See, everyone likes to talk about the problem, and around the problem, and what could potentially be done to attack a problem….but as the media attention fades, the legislators go back to fighting about other issues such as who can use a public toilet and who can’t……and people go back their own lives and forget about Brian Mancini and Daniel Somers…the urgency and impetus for change dissipates.

There is no longer this life or death need to get up and do something to prevent another soldier from dying, to prevent the loss of another wife, mother, daughter, husband, father, son….friend. Lawmakers go back to other things like immigration or education….and the mountain toward change gets harder to climb, dangerously steeper. The terrain becomes that much more complex to overcome. If you are a soldier with PTSD, you know that every day the terrain is difficult and often times unpredictable to navigate. In fact, there are some days you have no desire to even try.

This is not YOUR MISSION.

It is ours….

Or, at least, it should be.

     Without the help of concerned citizens, activists, lawmakers, journalists, and healthcare agencies these Veterans cannot get the job done themselves…AND THE POINT IS—they shouldn’t have to. Because it is our turn now. Whether we like it or not, our draft card has been pulled and it’s our turn to figure out what the battle plan should be. It’s our turn to put on the gear and do the work. It’s our turn to protect and serve THEM.

….And we’re doing a pretty crappy job.

In fact, I’ll be so bold as to say– WE…..are failing THEM.

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 “It Matters.”

Amanda L. Trujillo, BS-MSN

Director of Nurse and Patient Advocacy

Humanitarian Advocate Coalition

Phoenix, Arizona

https://www.azhac.us/

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

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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 When I get stressed out, my usual destination (aside from the gym) 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?

     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

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?

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

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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

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…”

…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?

 

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

 

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?

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.”

 

 

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?

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.

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

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)

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.

 ********

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

—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

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!

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

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.

Quiet1

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

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.

 

AZBON2AZBON01

 

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”

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

 

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?

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.

 

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

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!

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 governme