The Lowdown on Licensing (Episode 18)

March 8, 2018

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Darcy Grabenstein: Hello from SmartLinx Solutions! In today's podcast, we'll discuss the importance of protecting licensure in healthcare. Our guest is Lorie Brown, a registered nurse who also holds a master's degree in nursing and has practiced in a variety of nursing fields, including medical-surgical nursing, management, and administration. In 1990, Laurie earned her juris doctor degree and became a lawyer. She has represented more than 200 nurses before the licensing board. In 2012, she founded Empowered Nurses, ENO, an organization designed to help nurses protect their licenses. She also has written a book on these issues, Law and Order for Nurses, The Easy Way to Protect Your License and Your Livelihood. Welcome, Lorie.

Lorie Brown: Thank you, Darcy.

DG: Can you tell our listeners why you made the switch from nurse to lawyer?

LB: Sure. I always laugh at this answer because it was not in the divine plan. I actually got a divorce, and I had a good divorce attorney. I said, "I could do this." It was purely by mistake or happenstance. It actually turned out to be the best thing in the world that happened to me. I left my ex in April, studied for the LSATs, took it in May, got accepted in June, and started in August.

DG: Wow, good for you. Lorie, your focus is on helping nurses or healthcare organizations protect their licenses. I'd like you to go into a little detail for us about how you help with some of the following scenarios, such as when a license appears at risk, when someone's worried about renewing their license, or maybe when someone needs professional legal representation, say at a licensing board hearing. What other common licensing issues do you help address?

LB: We help in nine different areas. We help people proactively. People who are concerned that they might get a license matter. We help people in the license renewal process because in that process nurses and other healthcare providers are required to answer certain questions on the application for renewal or even a new licensee. Sometimes those questions can be vague or confusing. It's always important to get the right answer because if you assume you know the answer and you have a problem, it'll be a problem for you. If you don't answer it right, it's called founded material misrepresentation in obtaining a license.

In fact, we get this a lot with criminal law attorneys. They say you don't have to answer it. Your matter was dismissed. The question on the application specifically states "Have you been arrested, charged, or convicted?" If you've been arrested, you have to answer "yes" if your state requires that question, regardless of what your criminal attorney says.

Other areas where we help with is the investigation process. If you are under investigation by the board, if you have an administrative complaint by the board, we help with that process as well. If they want to emergency suspend your license, we help with that. We help with if you are defaulted because you weren't aware there was a matter against your license because you didn't keep your address correct. We help lift a probation or suspension.

DG: Yes, you cover it all, don't you?

LB: Yes. In fact, it's a unique area of practice. There's not a whole lot of attorneys that do it.

DG: Yeah, I was curious about that.

LB: I'm a member of the American Association of Nurse Attorneys. I'm also on the board and the corresponding secretary, currently. In that organization, there's a lot of nurse attorneys who do it, but the organization, I think, may have only have 300 members. Only a small portion of that organization, the members actually do the professional licensing defense.

DG: You're based in Indiana. I assume you're licensed just in Indiana, or are you licensed to practice in other states as well?

LB: I am licensed in Illinois, and I co-counsel cases throughout the country. Regardless of where you're located, I usually can find a co-counsel to work on your matter as well.

DG: Wait, you're based in Illinois, not Indiana?

LB: No, I'm in Indiana, but I'm licensed in Indiana and Illinois.

DG: Okay, I just wanted to make sure. What if someone wanted to find someone similar to you in their state? Where could they go to look?

LB: The American Association of Nurse Attorneys, TAANA.org or, like I said, if you call our office, we will find somebody to work with and co-counsel that case together.

DG: I've got to ask you. Could you share with us a few of your most interesting cases?

LB: Sure, you were asking about my book. In the book, I share some stories. Many nurses were coming to me, and every one of them said, "I never thought I'd be before the board. I'm a good nurse." That's a common feeling among nurses. "I'm a good nurse. I don't have to worry about this." That is the worst place that you can be in because if you think you're a good nurse and you don't have to worry about it, you're going to be surprised if there is a problem. Like I said, none of my other clients ever thought that they'd be before the board. I came up with a five-step system to help nurses protect their license. The system is actually called GIFTS. GIFTS is an acronym, which stands for the word giving. Nurses are naturally, of course, giving to their patients, but they're not necessarily giving to themselves. If you are working 80 hours a week, you're not taking time for yourself. That's a big red flag. That could cause you to get in trouble.

DG: That's funny. It sounds like our last podcast that we recorded recently about self-compassion. It was very important.

LB: It is. You also have to give to your coworkers because if you're just looking for your patients and taking care of your own patients, that's a recipe for disaster as well. Every patient on the floor is your patient, and you work together as a team. If you see another patient's light on and don't get it, you could be responsible even though it's not your patient.

Then the I stands for integrity. Integrity is not just, obviously, you have to be honest in your documentation, but honest in your license renewal and doing what's in line with your core values. If your core values are to be kind to your fellow coworkers and you're not in line with that core value, what's going on? Integrity, being the person you want to be in the world and being honest in your documentation.

I know in my own practice, when I was doing nursing, I was told not to tell the patients about things. I had a hard time with that because that wasn't being integrity with what I believed in. The patients have a right to know about their healthcare or not speaking up about when a doctor is doing something improper, that's in line with my core values of making sure my patients get the best care they're entitled to.

DG: I'm going to interrupt you for a second. If that goes against your beliefs but it also goes against the organization's policies, could you be written up for that and find yourself in front of a board?

LB: If you speak up and the organization is upset about it, is that what you're saying?

DG: Right.

LB: My favorite saying is that you can always get another job. You can't get another license. If your organization is not in line with your beliefs, I would strongly recommend getting another job because that clash is going to be a problem.

DG: Right. That makes sense. Continue your acronym.

LB: Sure. F stands for focus and follow-through. Obviously, that's job number one for a nurse. We are required whenever we give a patient medication to follow up in a half hour and see if it's effective. Whenever we do a treatment, we want to make sure it's effective. Not just focus and follow-through on treatments, but if you're in the middle of something, being very present in the moment. We get distracted, I think, every 5 minutes during the hour and another crisis is occurring, another patient wants something, something's going on. To be focused and follow through with the task at hand, unless a person's not breathing, that is the most important.

DG: In Indiana, where you're based, you were interviewed for a TV news story about nurse impostors. Last year, we blogged about the nurse impostor in Texas. How can nurse and organizations protect themselves from being the victim of a nurse impostor?

LB: The first thing you want to do is check your license and your address. Make sure that your address is correct. If the board wants to get a hold of you, they will contact to by address. If you are not keeping the board apprised of your current address, I've had people call me that are just shocked to learn that their license has been suspended. They just can't believe it. They didn't keep their address correct. I know that in the couple impostor cases in Indiana they had changed the address on the license to be the impostor's address.

The second thing is, depending on your state, when you renew your license online, what is their system like? How do they access the system? In Indiana, you just need your license number, which is public information for everybody, and you just need the last four of your Social Security, which, unfortunately, people can get that as well. If your state has a very easy login system to get access to license information, I would advocate to get that changed.

DG: What are the penalties for a nurse impostor, someone who does that?

LB: It's a criminal offense. Practicing nursing without a license is totally a criminal offense. The same is true if you forget to renew your license. I had a nurse who had criminal offense — criminal charges pending because she practiced on a suspended license.

DG: Wow. Lorie, I get the impression that your focus is mainly on assisting employees as opposed to employers. What types of services to you provide for organizations that want to protect their licenses?

LB: Oh, thanks for reminding me. Never let anybody else renew your license for you. That's another area where nurses have issues. Some nurses are not technically savvy, so they have their husbands do it or their employers do it, which is dangerous because they may not answer the questions properly. You're still responsible.

Your question with how do I help organizations — I speak at various organizations to help the nurses protect their license. By using your GIFTS, you have to use all of them. We didn't get to all of them. We didn't get to the T, which is trusting your gut. Nurses know in a nanosecond if something is wrong with their patient. Yet, they are afraid to call the doctor because the doctor may be upset or may not believe them. The S is for source. You're the source of everything that happens in your life and in your practice. If you're blaming "We don't have enough staff" or "I got a bad assignment," those kinds of things are not going to help you. You're basically giving your power away.

What I do for organizations is I speak to the staff on empowering them by using their GIFTS. Once they use their GIFTS, they're going to be a lot more satisfied in their practice. Patients are going to be happier. Patient satisfaction scores are going to go up. When nurses are happier, patients are happier.

DG: That's so important today with the turnover in the industry. We want our nurses happy, right?

LB: Exactly. I empower nurses through my GIFTS system. I also show them how easy it is to create a culture of empowerment. Where nurses feel like they have a voice, where they have each others' backs, where they support each other, where their actions are trusted. It's just a little exercise they do.

DG: That sounds great. Thank you. I noticed in your media kit you mention a case where a nurse posted something on social media, and she was fired — I think it was a she — was fired because of it. What advice would you give to our listeners so they could avoid something similar happening to them, any kind of guidelines for social media or just in general?

LB: Just be very, very careful of social media. Anything can come back to haunt you. We had nurses at a children's hospital post funeral arrangements for a child who died. They thought they were just sharing information with each other so they could go and support the family and be there for this child that they were very close to. That was a HIPAA violation.

DG: Even though it was internal?

LB: No, it was on Facebook.

DG: Oh, it was on Facebook. Yeah, that would be a no-no. I got it. Even when you think your intentions are good, just think again, right?

LB: Exactly.

DG: Thank you, Lorie, for sharing your expertise with us today. To all our listeners, thank you for tuning in. For more information on empowered nurses, visit EmpoweredNurses.org. For more information on Lorie Brown's law firm, visit YourNurseAttorney.com. If you would like to learn more about SmartLinx Solutions and our fully integrated suite of workforce management solutions, visit us online at SmartLinxSolutions.com. Lorie, thank you so much for your time. Other than the little barks here and there, we're good. We should be good.

LB: Good. OK, well, thank you for the opportunity. It was really fun.

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