So you’ve decided to search for a new job. Maybe you’re looking for higher pay, more advancement opportunities or a better work environment. There are many reasons why nurses desire to make a job switch.
The job search can often feel like a daunting task. You need to prepare your resume and cover letter, network in the field, and prep for interviews with potential employers.
While it’s important to spend time polishing your resume and practicing your interview skills, don’t skimp on an important part of any job search – company research.
Researching a potential employer means more than just reading their job post and employee benefits summary. Many jobs sound great on paper. But it’s wise to make sure the company is a good fit for your career goals and work style. The job post may sound like your dream job; however, it’s important to make sure the organization you’ll be working for is also your dream employer and an organization where you can grow your nursing career.
Another key benefit for researching a company is that it helps you prepare for job interviews. Many HR managers will ask candidates directly what they know about the organization and why they want to work there. Answering these questions with “I want to impact patient health outcomes” isn’t enough to impress a recruiter. You want to be armed with good company research so you aren’t thrown off by these questions.
Here are a few key areas to consider when researching potential employers.
The culture of an organization includes size, policies, atmosphere, brand, and goals. Start by exploring the company website and social media profiles. Does the company’s online presence feel conservative? Or does it feel innovative and fun? Some organizations have an HR section on their website where they post employee policy handbooks and benefits information. Read through these to get an idea of their attendance policy, time-off allowances, and fringe benefits. It can be difficult to assess the culture online, but it’s a great starting point.
You’ll want to ask questions about the organization’s management style during your interview. Find out who you will report to and ask them how they describe their management style. Does the manager talk in terms of helping nurses succeed and advance? Listen carefully to the manager’s answers, because this person may be your manager if you get the job.
You can find more than product reviews online these days. Employees are reviewing their employers on websites like Glassdoor.com.
Another great resource is LinkedIn. Use it to search for current and past employees and connect with them to get their feedback on what it’s like to work for the company you’re considering. It’s worth it to do some digging and get insight from actual employees. This is inside information you aren’t likely to get from the HR manager during your interview.
Avoid stalling your career growth by using LinkedIn to find out if the company likes to promote employees from within. Ask your contacts about advancement opportunities. Read profiles of current employees to see if they have held a series of advancing positions while working there. If you land an interview, ask for examples of employees who have been promoted from the position you’re interviewing for.
If you’re a new nurse with dreams of advancing your career and education, you’ll want to be in a culture that promotes its talent from within.
Also be sure to research the health of the company. If it’s a hospital, is it growing? Are they keeping up with cutting-edge technology and offering the best patient care in the area? These are signs that you can grow your career right along with the organization’s growth.
By making company research a key part of your job search strategy, you are more likely to land in a job that will be a great fit for years to come.
With 40% of the U.S. population currently consisting of either immigrants or first-generation Americans, and with people of color actually outnumbering Caucasians in some parts of the country, it’s imperative that health care facilities provide cultural competence training for their nurses, to ensure that all patients receive quality care. After all, nurses are on the front lines of patient care and are often the first professionals that patients encounter when they enter the health care system. Fortunately, there are a variety of training options your organization can choose from to help your nursing staff develop these essential cross-cultural skills.
What should a cultural competence training program include? It should discuss overall organizational cultural competence as well as focus on the specific population groups and/or health issues that are relevant to the community your facility serves. It also should address the linguistic access needs of patients with limited English proficiency, as outlined in the National Standards on Culturally and Linguistically Appropriate Services (CLAS) in health care, developed by the Office of Minority Health (OMH) in 2000.
“It’s important to [start with] a broad overview,” says Valera Hascup, MSN, RNC, CTN, CCES, director of the Transcultural Nursing Institute in the Department of Nursing at Kean University in Union, N.J. “If the organization primarily serves a specific population, such as Latinos, then it can target that group or subgroups to discuss more specific care.”
According to Josepha Campinha-Bacote, PhD, MAR, APRN, BC, CNS, CTN, FAAN, president and founder of Transcultural C.A.R.E. Associates in Cincinnati, an effective training program should address the three themes of the CLAS standards: organizational, clinical and linguistic competence. Prior to the development of the CLAS guidelines, most cultural competency training focused on organizational issues of cultural diversity. But a well-rounded program also should help clinicians with diagnostic issues, such as identifying health conditions specific to certain ethnic patient populations or conducting skin assessments for patients with skin of color.
Cultural Competency ResourcesThe Provider’s Guide to Quality & Culture (a joint project of Management Sciences for Health, the U.S. Department of Health and Human Services, the Health Resources and Services Administration, the Bureau of Primary Health Care and the Office of Minority Health), www.msh.org/programs/providers_guide.html#topNational Center for Cultural Competence, Georgetown University Center for Child and Human Development, www11.georgetown.edu/research/gucchd/ncccOffice of Minority Health, www.omhrc.govUniversity of Medicine and Dentistry of New Jersey (UMDNJ) Center for Cultural Competency, http://njms.umdnj.edu/culweb
Cora Muñoz, PhD, RN, professor of nursing at Capital University in Columbus, Ohio, and co-author of the book Transcultural Communication in Nursing, begins her presentations with a frank discussion about organizational racism. “We have to look at ourselves because we have biases,” she says. “Sometimes we aren’t even aware of them, but they impact the way we provide care.”
Muñoz backs up such statements by citing the Institute of Medicine’s 2003 report Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, which found that bias, prejudice and stereotyping on the part of health care providers may contribute to minority patients receiving lower quality care than Caucasians. “A good training program needs to have such knowledge passed on,” she emphasizes.
Options for providing cultural competence training include using an existing training program that can be adapted to your organization, hiring a consultant to develop a program specifically for the institution, creating your own in-house training program, or a combination of all three. Here’s a look at the pros and cons of each approach.
Using an Existing Program
Why reinvent the wheel when there are so many effective cultural competency training programs that have already been developed by experts? Some of the more widely used programs include those offered by the Cross Cultural Health Care Program, Management Sciences for Health, and the Center for Cross-Cultural Health, to name just a few (see “Resources” sidebar). A new and particularly exciting option is the soon-to-be-released Culturally Competent Nursing Modules (CCNMs), which will be launched in February.
Respected cultural competency models that can be found in the nursing literature include those developed by Andrews and Boyle, Campinha-Bacote, Giger and Davidhizar, Leininger, Purnell and Spector.
Train-the-trainer programs, such as the Cultural Competence Leadership Fellowship sponsored by the Health Research & Educational Trust and others, are considered one of the most effective formats for providing cultural competence education. The main reason is that this type of program enables an organization to reach many individuals.
The primary benefit of using an established program is that it has been proven effective. Additionally, many of these programs provide a consultant as part of the package to explain the program and how to implement it.
Campinha-Bacote recommends sticking with existing programs, such as the aforementioned ones, that have a strong track record of effectiveness. It is also important to spend the necessary time needed to research the various programs to determine which one best fits your organization’s needs. For instance, some programs may emphasize cross-cultural communication skills while others may center on building community partnerships or addressing clinical issues.
Muñoz focuses on racial and ethnic health disparities when she gives presentations on cultural competence and transcultural nursing to health professionals. “I train physicians and nurses, so I look at the impact of cultural competence on direct patient care,” she explains. Muñoz also recommends making sure that the program you use contains information that is sound and evidence-based.
The main disadvantage of using an existing program is that it will have to be modified to fit your organization. But as Muñoz points out, many of these programs were designed to be adapted. Plus, the consultant can work with you to help make the necessary adjustments.
Hiring a Consultant
A cultural competence consultant/trainer offers an objective perspective, something that is difficult to obtain from within your organization. An outside consultant can direct your organization in assessing its needs, design a program that incorporates those needs and help guide its implementation, says Hascup. This is a particularly good option for organizations that lack an in-house individual with expertise in cultural competency issues.
While a national consultant can be very knowledgeable, a local consultant knows the community and the populations your facility serves.
In either case, the trainer should have expertise in both clinical and organizational issues, with credentials from a reputable national or international credentialing body. A history of research and/or publications in the area of cultural competency is important. The individual should demonstrate a history of continuing growth in this field, because it continues to evolve, says Campinha-Bacote. Outstanding interpersonal skills, a genuine passion for the subject and an ethics/values and personality fit with your institution round out the qualifications, she adds.
Because of her academic perspective, Muñoz prefers trainers who are doctorally prepared. When seeking a consultant, she advises, find out the number of training sessions the person has conducted on a local, state and national level. Also, ask if he/she has been involved in developing curriculum on a national level. More importantly, ask if the trainer has firsthand experience working with minority communities. The trainer does not necessarily have to be a racial or ethnic minority, Muñoz explains, but should have extensive experience working with minority populations.
Norma Martinez Rogers, PhD, RN, FAAN, associate professor in the School of Nursing at the University of Texas Health Science Center at San Antonio, suggests asking the consultant for client references that you can contact.
Doing It Yourself
The benefit of developing your own cultural competency training program from scratch is that your training department knows your organization’s culture best and therefore has a good grasp of what approaches will be most effective. The disadvantage is that the individual responsible for this task may lack experience and/or expertise in cross-cultural health issues. That’s why the experts we talked to recommend using a cultural competence consultant to guide and direct the process even when creating an in-house program.
Conducting an organizational cultural assessment is a critical first step. As Campinha-Bacote puts it, “Some organizations don’t know what they don’t know.”
Doing an assessment helps determine the strengths and weaknesses of staff in regard to cultural competency, and this information can be used to help design an effective training program, says Hascup. Other experts recommend conducting an assessment both before and after implementing the formal training, to determine how much the nurses have learned. It can also serve as a benchmark down the line.
Additionally, Martinez Rogers, who is president-elect of the National Association of Hispanic Nurses, recommends conducting periodic evaluations and an assessment as part of the orientation process for nursing staff. She also emphasizes the importance of including patients in the assessment process. Several good cultural assessment tools are readily available, including some created for or used by the training programs on our resources list.
Making It Work
Cultural Competency ResourcesWhile this brief list of organizations and programs is by no means exhaustive, it’s a good starting point for learning more about cultural and linguistic competency in health care, including training programs, assessment tools and the latest research.Transcultural C.A.R.E Associates, www.transculturalcare.netThe Center for Cross-Cultural Health, www.crosshealth.comThe Cross Cultural Health Care Program, www.xculture.orgDiversity Rx (sponsored by the National Conference of State Legislatures, Resources for Cross Cultural Health Care and the Henry J. Kaiser Family Foundation), www.diversityrx.org
No matter which training option a health care facility chooses, experts agree that buy-in from administration is essential for the program to be effective. “The top players need to be committed to the concept of cultural competency, because it is their attitude that will filter down to the staff,” says Hascup.
A hospital with committed leaders armed with a cultural assessment and an arsenal of proven-successful training tools is well on its way to being able to provide effective cultural competency training for its nursing staff.
And what is the final word of advice? “If you do not have a program, start one. If you have one, enhance it, because cultural issues are alive and well and constantly changing,” says Campinha-Bacote, who notes that she has tweaked her training model four times in the 15 years since she created it.
She points to new developments that have emerged in recent years, such as a greater emphasis on linguistic issues because of the CLAS standards and changes in the way hospitals use interpreter services. Therefore, a training program developed in the 1990s may be inadequate to address today’s cultural competency issues. “Most importantly,” Campinha-Bacote concludes, “cultural competence is a journey, not a destination.”
With more than two million men and women in custody in American jails and prisons, there’s a great need for nurses to care for the correctional population. Nurses who can cast off their biases and follow strict security rules while helping inmates restore and maintain health could find an ideal career in correctional nursing, says Mary Muse, Director of Nursing for the Wisconsin Department of Corrections. “Correctional nursing allows you to really focus on what nursing is: caring for people,” she says. “If nurses want to be autonomous in their position, there’s probably no better setting than correctional nursing.”
Muse, a nurse for three decades, faced common misconceptions and stereotypes early in her career. Many perceive that correctional nurses aren’t held to the same standards as nurses in other health care settings, such as hospitals and doctors’ offices. “It was a job you took when you didn’t necessarily have something else,” Muse says. “This was a nontraditional health care setting.” Vowing to ignore the stigma, Muse made it her mission to enhance correctional health delivery and help eliminate disparities, while making the fi eld more visible. “Nurses who practice in correctional settings have really been absent from the larger landscape of nursing,” she says.
Of the many ways correctional nursing differs from nursing in a health care setting, the most obvious might be the “challenge of caring versus custody,” says Ginette Ferszt, associate professor of nursing at the University of Rhode Island. While nurses come to their work from a caring science perspective, she says, the primary goal in U.S. prisons is custody and safety.
That disconnect makes the role of a correctional nurse even more important, says Pat Voermans, a correctional nurse consultant and nurse practitioner with the Wisconsin Department of Corrections. “What’s so striking to me is the need of the people in these systems,” she says. Inmates can’t choose their providers, and correctional nurses are the gatekeepers to getting prisoners the health care they need. And, she adds, “We can’t choose who we get. Sometimes we get patients who don’t have the best handle on their decision making and how they interact with others. They’re angry and you have to try to work with them. Trust is a really hard thing to establish with an inmate because they often see us as part of security.”
A day in the life of a correctional nurse
Every day is different for a correctional nurse, but many of the nurse’s duties are the same at jails and prisons across the country. In Connecticut, where the Department of Corrections oversees jails and prisons, intake screening is a major responsibility for nurses, says Dr. Connie Weiskopf, Director of Nursing and Patient Care Services for Correctional Managed Health Care at the University of Connecticut Health Center. Correctional nurses in the state perform about 35,000 intake screenings every year, she says, filling out a four-page document on each inmate’s physical and mental health status.
In addition, correctional nurses in Connecticut administer more than one million doses of medication each year, Weiskopf says. “Many of the inmates in the system are on medication. The nurses administer medication to all the patients.” Inmates who were recently released from the hospital are cared for by nurses in the prison infirmary. Other nursing duties include coordinating outside services for inmates and overseeing care management for HIV-positive patients.
When it’s time for an inmate to leave prison, Weiskopf says nurses coordinate with the correctional department to facilitate the patient’s discharge and arrange for continued care and medications on the outside. Nurses also run hospice units within some correctional facilities, and they can play a role in decisions on early release for ailing inmates. “Sometimes there’s a great deal of effort put into compassionate releases,” she adds.
Voermans, who has spent 25 years working in correctional facilities, deals with programs and policies and provides chronic disease management care to male inmates in minimum security settings. The population, often disproportionately minorities, faces chronic conditions such as obesity, diabetes, and liver disease. Lab work is done on-site, and medications are provided by the state pharmacy. With several inmates sometimes crowded into the same cell, infection control is key, Voermans says. “If you get a transmissible disease like H1N1, you’ve got a crisis on your hands.”
Ferszt says some correctional nurses also try to help patients with mental health issues. “They also do a lot of psychosocial support,” she says. Many of the women prisoners Ferszt works with in Rhode Island put in requests to get medical treatment for reasons other than physical concerns, such as anxiety related to the death of a family member.
Correctional vs. health care nursing
Nurses accustomed to working in hospitals or doctors’ offices might fi nd a correctional setting takes some acclimation. Correctional nurses work closely with security officers, Muse says, in an environment much more regimented than the outside. Sometimes, nurses are prohibited from even bringing a cell phone into the prison clinic. “One of the primary differences is the work environment,” she adds. “It’s not necessarily a warm, bright environment. It tends to be dark.
” Even the equipment available to correctional nurses might be different than in a hospital, Voermans says. While nurses in health care settings can often access state-of-the-art tools and the skills and input of other providers, that’s not always the case in a correctional facility. And, in some ways, the extent of care provided might be different in a prison. “The care you give here is medically necessary care,” she adds. “It’s not elective care.”
Weiskopf says interactions between correctional nurses and patients can take on a new quality within prison walls. While a hospital nurse wouldn’t hesitate to tell a patient with a broken leg about her own similar experience, discussing such details is inappropriate in a correctional facility. “You really do not divulge anything personal to prisoners at all,” she says. And while a hospital nurse might hug a patient with dementia, Weiskopf says, a correctional nurse wouldn’t hug an inmate. “You really need to just focus on the care.”
Correctional nurses need to maintain boundaries because of the potential for an inmate to take advantage of a health care provider, Muse says. “You have to be aware that someone might say, ‘I’m really concerned about my mom. I haven’t heard from my mom in a while,'” she says. While a hospital nurse might help the patient reach out to a relative, correctional nurses would be ill advised to accept a request that could lead to more demands from the inmate. Even when it comes to discussing an inmate’s upcoming surgery, correctional nurses should only give family members vague details, since the inmate could be planning an escape attempt. “You have to clearly present yourself as a professional nurse,” she says.
The differences between correctional nursing and nursing in health care settings can lead to challenges. When nurses can’t hug or touch patients, it might be difficult to show empathy, says Arleen Lewis, a nurse consultant for infection control at the University of Connecticut Health Center Correctional Managed Health Care. Instead, correctional nurses can verbally empathize with patients grieving the loss of a loved one or reeling from a disease diagnosis. “We’ll bring that patient to an area where we can maintain confidentiality,” Lewis says, “and we’ll allow that inmate to verbalize his or her feelings.” Patients are encouraged to discuss their fears while nurses express their support and, if needed, bring in mental health clinicians.
Even routine patient interaction can prove challenging in a correctional setting, Ferszt says. When prison nurses perform tuberculosis or fl u clinics, inmates are lined up for vaccinations. But if a patient wants to speak to the provider, there’s not always time for counseling. While the nurse can request for the inmate to be brought back to the clinic for a later discussion, everything moves more slowly due to facility rules and inmates’ tight schedules. “You just can’t be as spontaneous in your teaching,” Ferszt says, “and in communicating with a woman or man when you’re providing health care.”
Patient privacy and safety
Patient privacy is another potential hurdle for correctional nurses. In private practice, Ferszt says, a quiet, calm setting is the most amenable to counseling a patient. But in a correctional facility, it can be tough to find a private room. Even then, other staff members sometimes walk in and out during a session. “You don’t have the same total privacy you would in another setting,” Ferszt says. The same goes for physical assessments, Voermans adds, which sometimes take place in noisy cells as patients wears chains or shackles.
Because correctional nurses work in a security setting, rather than a health care environment, they follow a different set of rules. “You’re basically in the house of the department of corrections,” Weiskopf says. “That means we need to obey their rules around safety.” For instance, while nurses in health care settings might leave needles on the counter in a patient room, she says, correctional nurses are “constantly counting sharps.”
Muse, who hasn’t experienced any safety issues on the job, says it’s important to be mindful of what nurses leave unattended in exam rooms. Even a seemingly innocuous roll of tape, she says, could be used as a weapon. “It doesn’t mean that weapon is to be used on you. For many people, it’s so they have something to protect themselves should they get in trouble.”
As for Muse, she didn’t consider the potential safety hazards of correctional nursing before she started the job. Walking through the correctional facility during her fi rst week, a supervisor mentioned gang activity there, surprising Muse that such affiliations existed behind bars. The supervisor also noted that nurses should greet passing inmates. “They remember the people who were kind and respectful of them,” Muse says. “If you treat people with respect, generally you get that back.”
Diversity in correctional facilities
Despite the challenges of correctional nursing, the compliance rate, at least anecdotally, is sometimes better among the prison population, says Michael Ajayi, a prison administrator and regional nurse manager, and clinical faculty member at the University of Medicine and Dentistry of New Jersey. “I’m sure many of them know they get good care,” he says. “They respond better to therapy than patients who are on the outside.”
It’s estimated that African American and Hispanic prisoners account for more than 60% of the inmates in jails and prisons, according to the Bureau of Justice Statistics. Although the prison population is quite diverse, that isn’t always the case with the staff of correctional nurses. “You see more minority inmates,” Ajayi says, “but almost all the nurses working with them are Caucasian.”
Correctional nurses should be conscious of this diversity and treat all inmates with respect. “With people from so many different places immigrating to our country,” Ferszt says, “we really need to work on becoming culturally aware.” Patients with certain cultural backgrounds might resist taking medication due to their beliefs, while others turn to herbs for healing. Just as in a traditional health care facility, nurses working in corrections should make an effort to understand those beliefs and find ways to work with patients. “It requires a nurse to be proactive and comfortable seeking out individuals from different backgrounds.”
Health risks and challenges
Because correctional nurses work with a disproportionate number of incarcerated minorities, Voermans says health issues particular to the groups might be more likely inside prisons than on the outside. The correctional population sometimes faces higher rates of HIV/AIDS, hepatitis C, MRSA, and even infectious diseases. Working with minorities means correctional nurses can serve as advocates, shining a light on health issues that afflict certain populations more frequently. One example she mentions is sickle cell disease in black patients. Muse also encourages correctional health care providers to consider the unique needs of female prisoners who are sometimes forgotten in the male-focused field. “For a patient to see a minority nurse they can connect to that might advocate for their health is helpful,” she says.
Since language is sometimes a barrier, Weiskopf says health education materials are often available in English and Spanish. Many correctional nurses have access to a language translation line and chaplains of various religions. Her unit has mandatory diversity training for staff. “We try to be culturally sensitive,” she adds.
Not everyone is cut out for correctional nursing. “It’s important to be someone who wants to serve that population,” Ferszt says. “Nurses need to, like anyone, examine their own potential biases toward that population.” Voermans adds that patients can experience bad medical outcomes when their complaints aren’t taken seriously by medical personnel. And as for the nurses, “If they don’t like the disadvantaged and the poorest, they shouldn’t be there,” Ferszt says.
Correctional nurses should be generalists, Muse says, but also ready to cross over into specialty areas. “In correctional nursing, you never know how your patient is going to present.” Correctional nurses should be poised to leap from oncology to mental health at a moment’s notice, Muse adds. Critical-thinking skills and a strong background in nursing assessment are also key. Ferszt says there are other important traits for correctional nurses, including flexibility and the ability to maintain good working relationships with correctional officers and administrators. “The system can be very frustrating because of its structure. You need someone who can be really flexible.”
It’s sometimes tough to recruit new nurses to corrections. But despite the challenge, Muse says, it’s just as important to recruit the right type of nurse, especially to correctional leadership positions. “There is a need to have minorities in more leadership roles,” she adds. Opportunities within the correctional nursing field include positions for advanced practice providers, nurse practitioners, managers, quality assurance personnel, juvenile nurses, and more. For nurses who feel ready for the challenge of practicing in a correctional facility, Ferszt says there’s an unending opportunity to do good for patients. “By realizing the issues they deal with, we can become better advocates for them in the community and change health care,” she says. “There’s an opportunity to make a real, significant impact.”
What should you do if you find yourself the target of a formal board complaint? Based on my experience handling these types of cases, I’ve addressed a number of common issues, taking you through the beginning stages of the process.*
First things first
You learn that a licensing board has received a complaint against you. The first thing you should do is review your insurance coverage for board complaints, provided you have such coverage. In my experience, most nurses rarely if ever carry this type of insurance. If you fall into the uninsured or underinsured group, I suggest you re-examine this issue and consider carrying such coverage. Most nurses go their entire careers without any type of professional malpractice insurance or insurance to specifically protect against board complaints.
There are a number of reasons nurses forgo malpractice insurance, including costs (too prohibitive) and thinking that they will simply never need it. However, I would highly suggest nurses consider purchasing insurance to protect them in the event of a potential malpractice claim or board complaint affecting their licensure. Insurance rates for this type of coverage are relatively inexpensive, compared to the costs of facing a malpractice claim on your own.
If you do have malpractice coverage, do not assume that it also covers licensing board complaints; this coverage is typically purchased separately. Be sure that you check carefully and contact your carrier if you have any doubts or questions.
Contact legal counsel
Regardless of whether or not you have insurance, you should contact a lawyer immediately—one knowledgeable in administrative law and/or professional license defense. Your attorney should be familiar with licensing boards and the disciplinary process. Just as there are different types of nurses, from perianesthesia to L&D nursing, there are attorneys who specialize in different areas of the law. You will be best served by an attorney familiar with this particular area.
In my experience, your initial response to a complaint is crucial. Address the issue with care. It is completely understandable to be shaken upon learning of a complaint. That highly emotional early period makes consulting with a highly trained and experienced attorney particularly critical. I believe that consulting a lawyer to review the facts almost immediately affords nurses the best chance of having the complaint dismissed without a hearing or resolved on the most positive terms.
The biggest hurdle I see is nurses delaying or altogether failing to contact someone who can help them because they do not want to broadcast that they have received a complaint. This is often complicated by the fact that the charges may include serious or embarrassing allegations. These things should not stop you from reaching out to people who may be able to help you through this difficult time.
Take it seriously
You should always treat a formal complaint as a serious matter, warranting immediate and thoughtful action. Yet, invariably, some nurses will dismiss licensing board complaints or other allegations as frivolous, without basis, or the fabrications of an ill-advised complainant. They may become outraged at being accused of unprofessional and/or inappropriate conduct. Worse, some nurses inexplicably go into denial mode, pretending nothing happened.
Some nurses may assume that once they explain what happened, the licensing board will see the complaint as not worth the paper it is printed on. But even in situations where this is true, nurses must take the complaint seriously.
Regardless of fault, the single biggest mistake a nurse can make is ignoring the complaint or to take the complaint too lightly. Based on the discipline a licensing board may impose, a shower of negative effects may flow from a single complaint. Depending on the alleged offense and the board’s conclusion, a nurse’s reputation and livelihood may be irreparably damaged. Truly, the importance of properly and adequately responding to a licensing board complaint cannot be overstated. In light of the serious nature of board disciplinary matters, many nurses, nonetheless, continue to make crucial mistakes after a board complaint has been filed, which needlessly expose them to additional professional risk.
Beat the deadlines
Nurses must pay close attention to response deadlines. Do not ignore or miss the deadline to reply to the complaint. As a nurse, you know the importance of following orders and the far-reaching consequences of failing to do so. In the disciplinary context, this is no different. When a complaint is filed, the board generally sends a notice of the complaint to the nurse. In that notice, there is almost always a deadline for the nurse to file a written, narrative response to the allegations and a deadline to produce relevant and germane records and/or documentation.
Let’s face it: nurses are busy people. Gathering the relevant information, obtaining the necessary advice, and preparing an appropriate response are time-consuming activities, most of which cannot be delegated to someone else. Compounding these problems is human nature, as we put off dealing with unpleasant activities. As a consequence, the deadline for producing records and filing a response often creeps up on the nurse before he or she has prepared a proper defense. Missing that important deadline can at best harm the nurse’s credibility and at worst result in additional sanctions or disciplinary action. Nurses should never ignore, fail to respond, or miss the response deadline. Usually, additional time is granted if necessary, but you must file a request with the board, usually in writing, prior to the deadline.
Keep it to yourself
Should you speak with the board, investigators, complainant, or witnesses on your own? Short answer, no. Again, the first—and only—person you should contact upon receiving a board complaint is an attorney experienced in handling these types of matters. You need proper advice and an outline of your options. You also should never assume that you can simply explain the complaint away, even if you’re working with a seemingly friendly investigator. If asked, politely decline discussing the matter with anyone without your attorney present.
Although some complaints can be resolved quickly without adverse action, don’t allow yourself to be lulled into a false sense of security. I often encounter nurses who believe licensing boards exist to serve their interests, to protect them and their licenses. This isn’t the case. Licensing boards exist to protect the public. Statements you make at the beginning of an investigation, without adequate reflection or thought, can come back to haunt you.
Furthermore, you should also avoid having conversations with third parties, including potential witnesses. These interactions could damage your defense, and they are not protected from disclosure by the attorney-client privilege. Put another way, saying the wrong thing in the wrong way to anyone (except your attorney) can significantly inhibit your defense and lead to unfavorable consequences.
Finally, do not discuss the issue with the complainant unless your attorney agrees you should. The complainant represents great risk to you, and you generally should not discuss the case with him or her. You may think that if you could just talk to the complainant, you would have a productive, levelheaded discussion that would help the complainant understand your point of view and convince the complainant to dismiss the charge. In my experience, this almost never works; in fact, it can lead to damaging evidence against you. Worse, it may be portrayed as your having tried to intimidate the complaining party. It bears repeating that under no circumstance should you attempt to discuss the complaint with the person who filed it without first consulting the proper legal advice.
Overcoming a bad situation
The complaint and disciplinary processes can be daunting, especially for those unfamiliar with them. Defending and protecting your reputation and livelihood can generate anxiety and angst, and dealing with a complaint can exact a high emotional as well as economic toll. Familiarity with the process itself with timely and proper handling is crucial to obtain the best possible outcome.
With any luck, you will never have a complaint filed against you or go through a disciplinary hearing, but should that come to pass, I hope this article equips you with information that will enable you to make thoughtful and informed decisions.
*Please note that this article is not intended as formal legal advice and should not be used as such. Every case is different, and should you have questions specific to your own situation, I urge that you contact an attorney for further discussion.
Crowded, busy emergency rooms may find their patient loads alleviated by the addition of just one nurse practitioner to general hospital staff, according to a new study by the Loyola University Health System. The NP can curb unnecessary ER visits by serving as a first line of defense, providing preventative treatments, “improving the continuity in care, and troubleshooting problems for patients,” says a Loyola University Health System release.
Published in a recent issue of Surgery, the journal of the Society of University Surgeons, the Central Surgical Association, and the American Association of Endocrine Surgeons, the research analyzed the results of adding an NP to a department with three surgeons. The study recounted an individual experience in one hospital, following nurse practitioner Mary Kay Larson, B.S., M.S.N., C.N.N., A.P.R.N.-B.C.
Researchers examined patient records from one year before and one year after Larson joined the hospital’s staff. Both sets of patients (415 before Larson, 411 after) were statistically similar, including length of stay and readmissions. From these groups of patients, researchers monitored which ones returned unnecessarily to the ER, i.e., those visits that did not lead to an inpatient admission.
Larson credits the decrease in ER visits to her communication with patients, saying she “routinely checked on their progress and responded to their concerns by ordering lab tests, calling in prescriptions, and arranging to care for them in the outpatient setting to maintain continuity in treatment.” She was also responsible for their discharge plans. Patient phone calls increased by 64% after Larson joined the hospital team, as did other outpatient services (visiting nurse, physical therapy, or occupational therapy). Researchers say this combination contributed to unnecessary ER visits dropping from 25% to 13%.
Though further research is necessary to corroborate these results, the addition of RNs to hospital staff may be the key to measurable improvements in patient care and operations.