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…

Arizona Board of Nursing: Letters of No Concern

The following are from the September and November 2014 AZBON Minutes

McCormies moved Busby seconded to issue a letter of concern for refusing to place a patient on the bedpan, instructing the same patient void in her brief, and for forcibly moving the patient up in bed on or about July 25, 2013 while working a shift through dependable nursing at Avalon Southwest in Tucson, Arizona, and for sleeping on duty while working a shift for Catalina in-home health services Inc. in Tucson, Arizona in or around July 2011. After further discussion the motion failed. Busby moved Quinn seconded to retry board option number two, to issue a letter of concern for refusing to place the patient on the bedpan, instructing the same patient void in her brief, and for forcibly moving the patient up in bed on or about July 25, 2013 while working a shift through dependable nursing at Avalon Southwest in Tucson, Arizona, and for sleeping on duty while working a shift for Catalina in-home health services Inc. in Tucson, Arizona in or around July 2011.

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Busby moved Dalton seconded and it was unanimously carried to issue a letter of concern for working outside the scope of practice for registered nurse while employed at back in line spine health and wellness from in and around September 9, 2014 through September 17, 2014, and for continuing to work in an advanced practice role on or about September 17, 2014 after he had been advised by the board staff that he was not authorized to work as a nurse practitioner. After discussion, the motion was amended to include upon meeting all license requirements grant licensure.

 

Busby moved and it was unanimously carried issue a letter of concern for on or about April 4, 2012 instructing a CNA to place a hot pack on patient without a current physician order and not documenting the action or doing a pain assessment and for sleeping while on duty on or about August 7, 2012 which resulted in a confused patient wandering who was not supposed to be bearing weight after surgery

 

McCormick moved Dalton seconded and it was unanimously carried to issue a letter of concern for testing positive for marijuana in a January 3, 2014 preemployment screening at Flagstaff medical Center in Flagstaff, Arizona

 

McCormies moved Dalton seconded and it was unanimously carried to issue a letter of concern for her November 16, 2012 conviction pursuant to a guilty plea of extreme driving under the influence, a misdemeanor, in Phoenix Municipal Court in Phoenix, Arizona and the December 17, 2012 violation of St. Joseph’s Hospital medical administration policy when she failed to waste a controlled substance that was removed for patient from the Omni cell until three days later when she returned to work and her June 24, 2013 violation of St. Joseph’s Hospital medication administration policy when she failed to return controlled substances to the Omni cell after the medication was not used for patient during the procedure

 

Busby moved and after discussion for complaint number one, it was unanimously carried to issue a letter of concern for receiving a DUI on March 4, 2013 in Phoenix, Arizona, and for bringing a family member to Tuscany McCormick Ranch in Scottsdale, Arizona, on or about March 16, 2013. Busby moved Machesney seconded and it was unanimously carried to dismiss complaint number two

 

Busby moved and it was unanimously carried to grant licensure upon meeting all requirements to issue a letter of concern for her February 13, 2013 misdemeanor conviction of driving under the influence a misdemeanor. Both occurring in Prescott city court in Prescott Arizona

 

Busby moved and it was unanimously carried to issue a letter of concern for his misdemeanor conviction on or about April 15, 2013 for attempted stalking/ domestic violence in Gilbert, Arizona

 

After discussion, it was unanimously carried issue a letter of concern to respondent for documenting she performed a sharp debridement where patient A’s wound bled more than normal, but failed to document the debridement in the nurse’s notes, causing a delay in treatment while employed at Cornerstone Hospital in Tucson, Arizona

 

Busby moved Berrigan seconded and it was unanimously carried, based on the information in the investigative report to issue a letter of concern for testing positive for cannabinoids on a preemployment urine drug test on or about November 22, 2013 at Scottsdale healthcare in Scottsdale, Arizona

 

Quinn moved and it was unanimously carried to grant licensure upon meeting all requirements and issue a letter concern for his June 7, 2002 DUI conviction Mesa, Arizona and January 5, 2013 DUI conviction Phoenix, Arizona

 

Busby moved and after discussion was unanimously carried to issue a letter of concern for her May 25, 2013 conviction for DUI misdemeanor in the city court of Phoenix in Phoenix, Arizona and respondent’s admission of marijuana use without a medical marijuana card

 

Busby moved McCorvey seconded and it was unanimously carried to issue a letter of concern for abandoning her patient assignment in Prescott, Arizona, on or about August 27, 2013

 

Busby moved and after discussion, it was unanimously carried to issue a letter of concern for failing to submit to random urine drug testing on July 31, 2014 and August 22, 2014

 

McCormies moved Dalton seconded and it was unanimously carried issue a letter of concern for initiating a propofol infusion on a patient in the intensive care unit on or about March 15, 2014, who was not mechanically ventilated and for failing to follow facility policy on bypassing the barcode medication administration system prior to hanging propofol while employed in the ICU at the Southern Arizona Veterans Administration hospital in Tucson, Arizona

 

Busby moved McCormies seconded and after discussion, it was unanimously carried to issue a letter concern for failing to remove nitroglycerin patches from patient A on or about December 2, 2012; December 3, 2012; December 4, 2012; and December 5, 2012 while on duty at the Hacienda at La Posada in Green Valley, Arizona and incorrectly documenting removal of the patches in the medical record

 

Quinn moved Dalton seconded and it was unanimously carried to grant certification upon meeting all requirements and issue a letter of concern for July 7, 2012 attempt to smuggle Crystal methamphetamines into the United States, which was never charged on September 20, 2012

 

Quinn moved. Busby seconded and it was unanimously carried to grant certification upon meeting all requirements and issue a letter of concern for the October 6, 2011 conviction of domestic violence. A misdemeanor in the Municipal Court of Phoenix, Arizona, and on November 27, 2013 conviction for DUI and misdemeanor in the Municipal Court city of Phoenix in Phoenix, Arizona

 

Mcormies moved Dalton seconded and it was unanimously carried to issue a letter of concern for testing positive for marijuana in a return to work drug test on or about December 20, 2012 while employed as a RN at Scottsdale Healthcare

 

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Snyder moved it was unanimously carried issue a letter of concern for medication errors made on or about November 8, 2009 and July 31, 2013 while working as an RN at hospice of Arizona in Phoenix, Arizona

 

Johnson move Snyder seconded to issue a letter of concern for tampering with the prescription label and submitting the label as false evidence. In response to a positive urine drug test for oxycodone a drug for which she did not have a prescription after discussion motion filled with five opposed into in favor Dalton moved Berrigan seconded based upon the findings of fact and statute, rule violations identified in investing date of report offered a consent agreement for decree of censure

 

Johnson move Snyder seconded and it was unanimously carried to grant registered nurse anesthetist certification upon meeting all requirements and issue a letter of concern for applicants April 4, 2013 conviction of driving under the influence of alcohol with a blood alcohol content of .144 at 20 to 50 hours

 

Quinn moved Terrell seconded and it was unanimously carried to allow responded to continue on consent agreement and order, issue a letter of concern, while under consent agreement and order number for failing to complete a psychiatric substance abuse and anger management evaluation of the PhD level board approved evaluator within 30 days of the effective date for the order and for failing to make an appointment to undergo a complete the nursing ethics counseling or submit a syllabus of proposed ethics course work to board staff within 30 days of the effective date of the order

 

Snyder moved, Johnson seconded and it was unanimously carried to issue a letter of concern for failing to obtain relapse prevention evaluation in a timely manner

 

Busby moved Dalton seconded and it was unanimously carried upon meeting all requirements grant licensure and issue a letter of concern for the May 2, 2002 arrest by Phoenix, Arizona Police Department for assault, but did not result in prosecution; for the June 5, 2009 misdemeanor theft conviction, for the December 22, 2003 conviction of disorderly conduct a misdemeanor in the Lake Havasu Municipal Court in Lake Havasu, Arizona for the January 4, 2004 conviction of possession of drug paraphernalia, a class one misdemeanor, for the November 22 2005 conviction of possession of drug paraphernalia, a class I misdemeanor, and for the December 19, 2008 conviction of possession of drug paraphernalia, undesignated felony for which was later designated as a misdemeanor in the Yavapai County Superior Court in Prescott, Arizona

 

Busby moved Berrigan seconded, upon completing of retraining/ retesting within six months of today’s date and meeting all certification requirements grant certification and issue a letter of concern for the October 1, 2009 misdemeanor conviction of driving under the influence of an alcoholic beverage with a blood alcohol concentration of .132 in the Gilbert Municipal Court in Gilbert, Arizona, and for the April 19, 2011 misdemeanor conviction of possession or use of marijuana in the Superior Court of the state of Arizona

 

Busby moved Dalton seconded and it was unanimously carried issue letter of concern for mistakenly administering amphetamine salts to the student, MO, when it had been prescribed to another student on or about April 22, 2014 working as a school nurse

 

 

Busby moved. Johnson seconded to issue a letter of concern for being rough and rude taking care of patients while on duty at the caring house in Sacaton, Arizona, on or about February 9, 2013.

 

Gutierrez moved Dalton seconded and after discussion, it was unanimously carried issue a letter of concern for being verbally abusive to patient, causing the patient emotional distress, as reported by staff and the patient regarding his request for as needed medication during overnight shift on or about January 5, 2014 at foothills rehabilitation Center in Tucson, Arizona

 

Johnson moved Snyder seconded to issue a letter of concern for respondents arrest on or about October 4, 2013 for possession of marijuana and possession of paraphernalia in Tucson, Arizona later dismissed; and for her admission to board staff of her periodic use of marijuana and for failing to report the charge to the board within 10 days as required by statute, enrolled after discussion motion filled with five opposed into in favor Quinn moved Dalton seconded based upon the findings of fact and statute, rule violations identified in the investigative report offer a consent agreement for decree of censure, if not sign within 30 days issue notice of charges

 

Johnson moved Dalton seconded and it was unanimously carried upon meeting all licensure requirements grant licensure and issue a letter concern for the June 30, 1998 conviction in Maricopa County Superior Court for possession of marijuana, a misdemeanor. The November 2, 2011 conviction in Phoenix Municipal Court for driving or being an actual physical control under the influence of intoxicating liquor any drug vapor releasing substance or any combination thereof, a misdemeanor, and for failure to report July 22, 2011 DUI charge to the board within 10 days as required

 

Busby moved Dalton seconded and it was unanimously carried to issue a letter of concern for submitting a dilute random urine drug test specimen on October 25, 2013 consent agreement and order will remain in effect

 

Gutierrez moved Berrigan seconded and it was unanimously carried issue a letter of concern for failing to assure that all surgical materials were accounted for prior to moving patient A to the post anesthesia care unit while working as a circulating nurse at Banner Good Samaritan on March 1, 2013

 

Dalton moved, Busby seconded and it was unanimously carried to issue a letter of concern for failing to check patient’s blood sugar, prior to administration of Lispro insulin 10 unit subcutaneous and failing to notify the physician of a significant delay in patient’s discharge on or about September 21, 2012 at Banner Baywood

 

Johnson moved, Dalton seconded, and it was unanimously carried to issue a letter of concern for failing to notify the physician patient A’s blood glucose result greater than 500 and for discharging patient A with unstable blood sugar on or about September 21, 2012 while employed and on duty as an RN at Banner Baywood

 

Dalton moved Busby seconded and it was unanimously carried issue a letter of concern for failing to cause appropriate follow-up for patient A’s blood sugar of 500 and directing RN to continue discharge order for patient A on or about September 1, 2012 while employed and on duty as a charge RN nurse at Banner Baywood

 

Quinn moved Busby seconded and it was unanimously carried to issue a letter concern for participating in the practice of using a hot pack on or about April 11 and 12, 2012. Without a providers order which caused second-degree burns of the abdomen of the postsurgical patient while on duty as RN

 

Snyder moved Delton seconded and it was unanimously carried to grant certification upon meeting all requirements and issue a letter of concern for the April 30, 2012 citation by the Peoria Police Department for shoplifting, a misdemeanor, from Target for which applicant was convicted on August 7, 2012

 

Busby moved, Snyder seconded, and it was unanimously carried to grant licensure upon meeting all requirements and issue a letter of concern for the January 1, 2014 incident involving her public intoxication and failure to cooperate with police for which she was convicted on March 26, 2014 for obstruction in Scottsdale, AZ.

 

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