STATE OF FLORIDA
DIVISION OF ADMINISTRATIVE HEARINGS
DEPARTMENT OF PROFESSIONAL ) REGULATION, BOARD OF NURSING, )
)
Petitioner, )
)
vs. ) CASE NO. 84-3502
) JENNY LYNNE LYNES CRAWFORD, )
)
Respondent. )
)
RECOMMENDED ORDER
Consistent with the terms of the Order of Continuance of the undersigned dated April 26, 1985, furnished to both parties, a hearing was held in this case before Arnold H. Pollock, a Hearing Officer with the Division of Administrative Hearings in Lynn Haven, Florida, on May 31, 1985. The issue for consideration was whether the Respondent's license as a registered nurse in Florida should be disciplined because of the alleged misconduct outlined in the Administrative Complaint filed herein.
APPEARANCES
For the Petitioner: Edward Hill, Esquire
Department of Professional Regulation
130 North Monroe Street Tallahassee, Florida 32301
For the Respondent: Philip J. Padovano, Esquire
Post Office Box 873 Tallahassee, Florida 32302
BACKGROUND INFORMATION
By Administrative Complaint dated August 31, 1984, Petitioner, Department of Professional Regulation, for Petitioner, Board of Nursing, seeks discipline of Respondent's license as a registered nurse for various alleged acts of misconduct which Petitioner contends constitute various violations of Section 464.018(1)(j), Florida Statutes, and various subparagraphs of Rule 210-10.052,
In short, Petitioner alleges that Respondent administered medication or treatment in a negligent manner, made inaccurate entries on patient records, and negligently failed to file reports or records required by state law, all which individually or together constitute a failure to conform to the minimum standards of acceptable and prevailing nursing practice in Florida.
Thereafter, on September 28, 1954, through counsel, the Respondent filed a request for formal hearing and on October 5, the file was forwarded to the Division of Administrative Hearings for the appointment of a hearing officer.
The case was initially set for hearing by the undersigned on February 21, 1985. However, on February 19, 1985, counsel for Petitioner filed a Motion for Continuance on the basis that she was ill and unable to attend the hearing as scheduled. On March 25, 1955, the undersigned entered an order confirming the oral grant of the continuance referenced above and set the hearing for May 6, 1955, in Panama City. On April 19, 1985, however, Respondent moved for a continuance on the basis of a conflict in her counsel's schedule and thereafter, the undersigned entered the order granting the continuance until May 31, 1985.
At the hearing Petitioner presented the testimony of seven individuals, five of whom were direct employees of Gulf Coast Community Hospital (GCCH), and two who were physicians authorized to practice there. The witnesses were Wanda Skipper, Director of Medical Records; Betty Flemister, Director of Nursing; Vivian Habersham, a registered nurse; Margaret Ann Medlock, also a registered nurse; and Linda Marie Jones, a registered nurse and quality appraiser. The two doctors were Dr. David W. Scott and Dr. Michael X. Rohan, both orthopedic surgeons. Petitioner also introduced Petitioner's Exhibits I through 11.
Respondent testified in her own behalf and introduced Respondent's Exhibit A. The Hearing Officer, at the request of the Petitioner, took official recognition of Board of Nursing Rule 210-10.5e(1) - (13), F.A.C.
The parties have submitted posthearing proposed findings of fact pursuant to Section 120.57(1)(b)(4), Florida Statutes. A ruling on each proposed finding of fact has been made either directly or indirectly in this Recommended Order, except where such proposed findings of fact have been rejected as subordinate, cumulative, immaterial, or unnecessary.
FINDINGS OF FACT
At all times relevant to the issues involved in this hearing, the Respondent was licensed as a registered nurse, having been licensed on September 1, 1967, by examination, with license number 41856-2.
At all times pertinent to the issues involved in this hearing, Respondent was employed as a registered nurse at Gulf Coast Community Hospital (GCCH), Panama City, Florida.
On August 4, 1983, Dr. David W. Scott, an orthopedic surgeon with practice privileges at GCCH, treated Arthur Collins in the emergency room of that hospital. After taking a history from the patient and examining him, he concluded that Mr. Collins was a drug addict who had the ability to manipulate physicians for the purpose of obtaining narcotics.
As a part of his treatment of this individual, Dr. Scott prescribed 100 mg of Demerol four times a day which was obviously insufficient for Mr. Collins who had developed a drug tolerance. As a result, Dr. Scott added an additional drug, Vistoril, to augment the Demerol. Before leaving the hospital that night, and because Mr. Collins was obviously addicted to narcotics, Dr. Scott left an oral order with the nurse on duty at the nurses' station, subsequently identified as Ms. Habersham, not to increase the dosage prescribed for the patient, not to give additional narcotics, and not to call the on-call physician in the event Mr. Collins complained of pain. The reason for this last instruction concerning the physician was to prevent the on call physician, who might not know the patient's history and of his drug addiction, from prescribing additional narcotics.
Ms. Habersham worked as a charge nurse on the day shift during this period and recalls patient Collins. When she was relieved by the Respondent at the end of her shift, she passed Dr. Scott's orders on to her. Consequently, it is clear that Respondent was aware of Dr. Scott's order not to increase Collins' dose and not to contact the on-duty physician in the event Collins asked for more medicine.
Nonetheless, Respondent admits giving Mr. Collins an injection of 125 mg of Demerol even though the doctor's order called for a 100 mg dose. She justifies this on the basis that the patient had said he was in great pain and constantly kept coming to the nurses station begging for more medication. She observed him to be sweating and grabbing at his stomach. Based on her experience in the Army Nurse Corps and the Army Surgeon General's recommendation for a 125 mg dose of Demerol in situations such as this, and because she did not want to wake up Dr. Rohan, the on-call physician, she gave the additional dose on her own authority feeling she could get Dr. Rohan's approval later on.
Dr. Rohan recalls only an incident in August of 1983 where he got a call from a nurse whose name he cannot remember for a "cover order" for a medication. As he recalls it, the nurse in question called to notify him that she had administered more of a drug than was called for in the doctor's order. It was his understanding, however, that the nurse had given too much by accident and was telling him about it after-the-fact, not in advance, to authorize a higher dose. It is clear from the above, therefore, that Respondent called Dr. Rohan after she had administered the higher dosage to Mr. Collins on her own authority.
Respondent indicates, however, that Ms. Habersham had told her that if this particular patient needed more medication he was to get it and that the nurse should secure the authorization by phone. Respondent presented no evidence to support this, however, and though she contended she had a witness to this conversation, the witness was not presented. Respondent contends that she could change the amount of medication prescribed by the physician if it was necessary. She claims that nurse-practitioners can do this within the protocols set down by a physician. Respondent was not then nor is she now a nurse practitioner.
During the month of February, 1984, Linda Marie Jones was unit coordinator for three units at GCCH, including Respondent's. Part of her job involved the monitoring of and investigation of drug discrepancies. During this time, Mr. Jones was conducting an audit of drug accountability in Respondent's unit. This audit, while not based on any suspicion of misconduct by any employee, resulted in a determination that one Nembutal tablet was missing from the unit. A check of the records reflected that this medicine had not been ordered for any patient on the unit that day. She then checked the patients' charts to see if a Demerol 100, a similar drug, had been used, and as a part of this procedure, she found that in the case of some patients, two different records dealing with a specific administration of medication did not agree. Her check of all records on the unit revealed that only the Respondent had any discrepancies. All other nurses' records were satisfactory. Her investigation included a comparison of the medication administration record (MAR) with the nurses notes on which the same administration was to be noted. In the course of her investigation, she checked six patient records, including those of patient Haire, patient Oakley, and patient Crosby.
At the conclusion of her investigation, she prepared a summary of her findings which she presented to Ms. Flemister, the Director of Nursing. Ms.
Flemister met with Respondent and showed her a copy of the report. At that point, Respondent denied having taken any of the medications and said that she could not figure out why the discrepancies existed.
As to the Nembutal, which prompted the investigation initially, Respondent remembered cleaning out the narcotic box the first time, but did not identify a shortage at the time. As a result, the missing Nembutal was attributed to "wastage" and when that happens, the wastage must be recorded on the narcotics sheet. This Nembutal wastage was not recorded by Respondent or any other nurse. Ms. Jones admits, however, that there is no evidence to connect Respondent with the wastage of the Nembutal any more than any other nurse assigned to that floor.
With regard to an administration of Morphine Sulfate to patient Haire at 9:00 P.M., on February 6, 1984, the narcotics control sheet fails to show that morphine sulfate was administered to this patient on that occasion.
With regard to the 8:30 P.M. administration of Morphine Sulfate to patient Haire on February 5, 1984, the narcotics control sheet reflects that Respondent recorded the administration of this medicine but does not reflect the date in question. The entry made reflects the patient's room rather than the date. As a result, it is impossible to tell if the administration was done on February 4 or February 5. However, the Respondent did reflect this administration on the nurses' notes although in the wrong place.
As to the issue of Respondent's signing out Morphine Sulfate for patient Haire at 7:00 A.M. on February 5, the evidence establishes that she did sign out both Morphine Sulfate 100 and Demerol 100 as alleged. The MAR reflects some entry but it is impossible to determine what the entry is or to what drug it refers and Respondent's nurse's notes for that date are silent. The medical records pertaining to patient Oakley for February 5, 1984, reflect that, as to the nurses' notes, the patient was given medication for pain but the notes fail to show what type of medication was administered. It could have been aspirin or tylenol and the note should have said what medicine was administered. This administration was not listed on either the narcotics control sheet or the MAR. If the substance given was not Demerol or Morphine Sulfate, it need not appear on the narcotics control sheet, but whatever it was, it should have been listed on the MAR and it was not.
The records regarding patient Crosby reflect that on February 5, 1984, Respondent signed out 75 mg Demerol for the patient as alleged. The notes do not, however, reflect that she administered Demerol specifically. They reflect only that she administered some medication.
As to the 9:30 P.M. dose of Demerol on February 5, 1984, Respondent did sign out Demerol at that time but the nurses' notes do not reflect what the substance administered was.
Patient Haire's records reflect that on February 4, 1984, Respondent signed out Morphine Sulfate for the patient. The nurses' notes reflect that at 8:00 P.M. on that date, she administered a "pain medication" to the patient without defining what that medication was. The record does not indicate that Morphine Sulfate was administered. The narcotics control sheet for this period is not dated so it is impossible to determine whether Morphine Sulfate was listed on its document or not. However, the MAR reflects that Respondent administered Morphine Sulfate to this patient at 6:00 A.M.
On February 4, 1984, Respondent signed out Demerol for patient Oakley and properly noted this on the narcotics control sheet but the nurses' notes fail to show that the substance was administered as required. Later on, at 8:30
P.M. the same day, Respondent again signed out Demerol for Patient Crosby listing on the narcotics control sheet the patient's room number but not the date. Other dates on the sheet lead to the conclusion that it was February 4, however Respondent thereafter failed to record the drug's administration on the nurses' notes. She also signed Demerol out for Patient Crosby at 7:30 P.M. on February 4 though the narcotics control sheet fails to reflect the date - only the room number. This administration is in the MAR at 8:30 P.M. rather than at 7:30 P.M. but is not in the nurses' notes at all.
On February 3, 1984, Respondent recorded in her nurse's notes that she administered Demerol to patient Crosby at 8:00 P.M. The narcotics disposition record (narcotics control sheet) shows that she signed the medication out between 8:00 and 9:00 P.M., but it is impossible to tell with certainty the exact time.
It is obvious that Respondent's handwriting is poor. This fact adds to the difficulties encountered from the way in which Respondent kept her records. In the opinion of Ms. Jones, who has been doing quality assurance checks for a number of years, Respondent's records are inaccurate, inconsistent, incomplete and totally insufficient for a nurse on the next shift to know what medications have been given and what must be done. In this area alone, Ms. Jones was of the opinion that Respondent's charts are below the minimum standards for nursing practice in the area and even though her own report was erroneous in some respects, there are still enough verified errors by the Respondent to support her opinion that Respondent's performance is less than acceptable.
Respondent admits that some but not all of the charges against her are true. Though she may have mischarted her administration of drugs she never took the drugs herself. The patient always got the drug that he or she was supposed to get and her errors were errors only as to the recordation of time. They were administrative errors, not substantive errors.
She contends that in February, 1984, because the floor on which she had been charge nurse since December, 1981 had been closed, she was forced into a staff nurse position. This was not a good situation and as a result of the closing of that floor, several nurses quit. This loss of nurses resulted in more patients per nurse to the point where Respondent felt that patient safety was in danger. She contends she tried to tell Ms. Jones about this but Ms. Jones would not see her. All of a sudden, she found herself called in front of Ms. Flemister and Ms. Jones and terminated based on the alleged inaccuracies in her records. Respondent contends she received no information about this other than that contained in Ms. Jones' summary and in that regard she says, Ms. Jones assured her that her summary was correct and in no way tried to explain the inaccuracy of the records.
Respondent contends that she had frequently asked her supervisors for extra help but never got any. She contends she had as many as 18 patients to handle by herself and at the time involved in the records discrepancies here, she had 8 patients on the floor. She contends that the errors to which she admits were due to her hectic schedule. As a single parent, she was working, she says, between 60 to 80 hours per week on two jobs and had a sick child at home.
Ms. Flemister, on the other hand, says that Respondent had plenty of help. At the time, Respondent was working the night shift from 7:00 P.M. to 7:00 A.M. The shift was staffed by 4 registered nurses, 2 licensed practical nurses, and a secretary, and in her opinion, this staff was well within the normal range of staff-patient ratio. Ms. Flemister contends that while Respondent was on duty, she had between 5 and 6 patients to take care of. She was the charge nurse for the shift and therefore had less patients than a regular floor nurse. She admits that Respondent did complain about being shorthanded, but these complaints were neither constant nor repeated and were never submitted through proper channels.
Ms. Flemister contends that prior to this time Respondent had been counseled about her writing and documentation, but there has been no evidence of any discrepancies other than those involved in this case.
There are certain procedures followed at GCCH and a part of Ms. Flemister's job is to oversee the standards of the hospital, the Board of Nursing, and the Joint Committee on Hospital Accreditation as they are applicable at this hospital. On the first day of duty, all new nurses are given an orientation which includes records management and how to use a medication cart. A medications test is given and a model cart is used in this training.
On the cart, each patient has his or her own area. Narcotics and barbiturates are kept together. Medication administration records, including a page for every patient, are kept with the cart. Each administration of medication is supposed to be recorded and each use of narcotics is supposed to be listed on the narcotics sheet with the name of the patient, the date, the drug, and the nurse administering it.
Medications are first called for in the doctor's orders and are checked by the secretary and the nurse who checks and signs it initially. The doctor's orders are then used to give medications. When a nurse gives a medication she checks the doctor's order against the medical records and then prepares the medicine, administers it, charts it and signs it off. The entry is recorded on the medical administration record and it and the charting register are both on the cart. The nurse goes back to the nurses' station to record the administration of the medicine in the nurses' notes which are kept in the patient record. This method of documentation is set out in the hospital policy and procedures which are given to all nurses.
Accurate medication records are important so that nurses on subsequent shifts do not administer a drug too soon after the last dose was given and thereby create an overdose. Therefore, medications are logged in several different locations because state law requires it to promote agency oversight by the pharmacy and the Department of Nursing, and because the record is used at shift change to insure an accurate count of narcotics on hand on the medicine cart.
Failure of employees to follow the hospital procedures results in the following sequence of events:
reprimand;
counseling;
a written reprimand; and
discharge; all depending, of course, on the seriousness of the offense.
However, after the discussion with Ms. Flemister and Ms. Jones Respondent was terminated because of the discrepancies between the narcotic record and the poor and illegible documentation in the nurses' records and elsewhere. Respondent, on the other hand, claims that though she has been licensed in the State of Florida since 1967 and has worked at GCCH since 1981, there has never been any prior disciplinary action taken against her nor has she received any prior complaints about her method of charting or administration of drugs and she was doing it as she usually does in February, 1984. Notwithstanding her protestations of no prior disciplinary action, however, the records reveal that Respondent was given a two-day suspension for the incident involving the over administration of Demerol to Mr. Collins and advised that a repeat discrepancy would result in her discharge.
It is important to note that as a part of the investigation into Respondent's alleged misconduct, she was requested to provide a urine sample for urinalysis. This routine drug screen revealed no use of controlled substances within the seven days prior to the test which was accomplished on February 20, 1984.
CONCLUSIONS OF LAW
The Division of Administrative Hearings has jurisdiction over the parties and the subject matter of this proceeding.
In its Administrative Complaint, the Board of Nursing alleged what it considered independent violations of either rule or statute in 16 separate paragraphs. These factual allegations covered the period from August 6, 1983, through February 6, 1984. Each specific paragraph is not identified as a violation of a specific statute or rule. Instead, a paragraph is contained in the Administrative Complaint following the allegations which, in a summary fashion, state that Respondent violated Section 464.018(1)(j), Florida Statutes, by violating other independent sections of the statute or rules of the Board of Nursing.
Section 464.018(1)(j) authorizes the board to take disciplinary action against the licensee for:
(j) willfully or repeatedly violating any provision of this chapter, a rule of the board or the department, or a lawful order of the board or department previously entered in a disciplinary proceeding, or failing to comply with a lawfully issued subpoena of the department.
In this case there is no issue of a violation of a lawful order of the board or department entered in a previous disciplinary proceeding or the failure to comply with a lawfully issued subpoena of the department. Instead, Petitioner alleges that through the various and repeated willful violations of other statutory provisions and board rules, the Respondent has violated this cover provision.
Thereafter, Petitioner sets out the rules and statutes allegedly violated by Respondent. The statutes are Section 464.018(1)(d), which permits discipline of a licensee for:
(d) Making or filing a false report or record, which the licensee knows to be false, intentionally or negligently failing to file a report or record required by state or federal law . . . .
and Section 464.018(1)(f), which permits discipline of a licensee for:
(f) unprofessional conduct, which shall include, but not be limited to, any departure from or the failure to conform to, the minimal standards of acceptable and prevailing nursing practice, in which case, actual injury need not be established.
The rules of the Board of Nursing allegedly violated by Respondent include 210-10.05(2)(d), which authorizes the board to impose disciplinary penalty on a licensee when it determines that the licensee:
(d) has falsely misrepresented the facts on patients' records, including, but not limited to, patient charts, narcotic records, medication administration records, or on applications for employment as a nurse or otherwise misrepresented the facts on records relating directly to the patient.
and, Rule 210-10.05(2)(e), which permits discipline for:
Inaccurate recording, falsifying or altering of patient records, or
Administering medications or treatments in a negligent manner.
The first allegation contained in the Administrative Complaint deals with an alleged administration by the Respondent of Valium intramuscularly to a patient on August 8 and 9, 1983, rather than by mouth as ordered by the patient's physician. No evidence of Respondent's commission of this offense was presented.
In the second allegation, Petitioner alleges that Respondent, on August 6, 1983, administered 125 mg of Demerol to a patient even though the physician's orders called for a maximum dosage of 100 mg. The evidence introduced by Petitioner here that Respondent did this clearly establishes her violation of Rule 210-10.05(2)(e)2. That she felt that the dosage administered was appropriate or that she felt she could secure another doctor's order after the fact to cover her improper administration is immaterial. Her actions constitute negligence and a violation of the rule.
The Petitioner alleges in paragraph 6 that on February 6, 1984, Respondent recorded having administered Morphine Sulfate to patient Haire at 9:00 P.M. on the narcotics control sheet. A review of that document reveals that it does not show that the substance was administered to the patient as alleged. This allegation, therefore, has not been proven.
In the following paragraph, it is alleged that on February 5, 1984, Respondent recorded having administered Morphine Sulfate to the same patient at 8:30 P.M., recording same on the medication administration record but failing to sign the substance out on the narcotics control sheet and failing to record the administration in the nurses notes. In this case, the narcotics control sheet does reflect an administration of the substance but not the date in question and the patient's room number is recorded in the place where the date should be. This makes it impossible to determine on what date the substance was administered to the patient. However, Respondent did, contrary to the allegation, record the administration in the nurses' notes although the entry is made in the wrong place on that document. This evidence establishes without question that Respondent is guilty of inaccurate recording of patient records in violation of the rule.
The next two allegations in the Administrative Complaint both deal with administration of drugs to patients by the Respondent on February 5, 1984. In this case the administration of Morphine Sulfate to patient Haire was not recorded on either the medication administration record or the nurses' notes as required and her administration of "pain medication" to patient Oakley on the same date was not recorded on the patient's medication administration record as required. Therefore, it is clear that the evidence establishes the Respondent is guilty of inaccurate record keeping again, in violation of the rule cited above.
The same can be said regarding the alleged violations on February 5, 1984. Here, three separate instances are alleged regarding patient Crosby. The Administrative Complaint alleges that Demerol was signed out for this patient but the administration of this substances was not shown on the nurses notes and examination of the records in question show that the allegation is accurate. While the records reflect that Respondent administered some type of pain medication, it is impossible to determine from the documents kept by Respondent what medications she in fact administered and when they were given. Consequently, it is clear that this evidence shows her to again have violated the rule in question by keeping inaccurate records.
As regards the failure of the Respondent to record the administration of Morphine Sulfate to patient Haire on February 4, 1984, in the nurses' notes, this allegation has been established in that the nurses' notes fail to show it as required, and this is yet another example of her inaccurate records keeping which, as has been repeatedly stated, is a violation of Rule 210-10.05.
As to the allegation contained in paragraph 14 that Respondent failed to record administration of Morphine Sulfate to patient Haire on February 4, 1984, though the nurses' notes fail to reflect the administration of anything other than "pain medication," the medication administration record does reflect that the Morphine Sulfate was administered some time during this day. The inconsistency in Respondent's records, however, make it impossible to determine at what time medications were given and therefore it is impossible to prove that
she in fact failed to administer the medication as required in this instance. Therefore, though she may escape a finding of improper conduct on the issue of negligent or improper administration of medication, she is clearly guilty of still another instance of keeping inaccurate records.
There is, in addition, evidence to establish without question that Respondent failed to record an administration of Demerol to patient Oakley in her administrative notes on February 4, 1984, just as she failed to record an administration of Demerol to patient Crosby on the same date. These failures to properly record the administration of narcotics on the patients' records constitute violations of both the statute and rule.
The allegation regarding the administration of Demerol to patient Crosby on February 4, 1984, at 7:30 P.M. as opposed to 8:30 P.M. as outlined in paragraph 17 of the Administrative Complaint is only half supported by the evidence. The records clearly show that she did record the administration of the substance in the medications administration record, but failed to record it on her nurse's notes. This is, as has now been so often stated, inaccurate record keeping and a violation of the rule.
On February 3, 1984, Respondent is alleged to have administered Demerol to patient Crosby at 8:00 P.M. but failed to record it on the narcotics control sheet until 50 minutes later. The narcotics control sheet on the other hand in fact reflects that the medication in question here was signed out between 8:00 and 9:00 P.M., and it is impossible to tell from the records exactly what was done. Consequently, it cannot be established whether the record is accurate or not.
In the final allegation, Petitioner alleges that Respondent improperly wasted a controlled substance on February 5, 1984. There was no evidence presented by Petitioner to establish this allegation.
In Respondent's posthearing memorandum, counsel makes three arguments regarding the state of the evidence. The first is that the complaint cannot be sustained under the provisions of Section 464.018(1)(j) because there is no competent and substantial evidence that the Respondent willfully or repeatedly violated the rules of the Board of Nursing. What counsel overlooks, however, is that the same statutory provision provides for discipline of a licensee for willful or repeated violations of any provision of Chapter 464 as well as the rules of the Board of Nursing. The evidence clearly shows that on several occasions, Respondent was guilty of violations of the rule or the statute. For example, on August 6, 1983, she administered an excessive amount of a narcotic in violation of doctor's orders, and she repeatedly failed to accurately and competently keep the proper records on the patients assigned to her care. Both of these examples are violations.
Respondent's second point of argument is that the complaint cannot be sustained under the provisions of Section 464.018(1)(d) because there is no competent and substantial evidence that the records are required to be kept by state or federal law. In this particular instance, Respondent's point is, in part, well taken. Petitioner presented evidence to show that the requirement to keep records was a matter of hospital policy and was called for under the Nursing Practices Act. Nonetheless, it is felt here that this particular statutory allegation as laid by Petitioner is improperly laid, and refers more to the willful failure to complete required reports rather than a negligent or even a willful failure to fully and accurately accomplish nursing charts. Therefore, while the evidence here may not constitute a violation of Section
464.018(1)(d), it does constitute a violation of Rule 210-10.05(2)(e)1 in that Respondent's record keeping is inaccurate, and this rule violation constitutes a violation of Section 464.018(1)(j), since the inaccuracies were repeated again and again throughout the period alleged in the Administrative Complaint.
Finally, in her third point, Respondent contends that the complaint cannot be sustained under the provisions of Section 464.018(1)(f), since there is no competent or substantial evidence that her conduct failed to conform to the minimum nursing standards.
To the contrary, the testimony of Ms. Flemister and Ms. Jones indicates that after at least one warning, Respondent was terminated because of, among other things, the discrepancies in and inaccuracy of her records. Though this is not an explicit statement that Respondent's performance does not meet standards, the inference which may easily and properly be drawn from this testimony is that it does not. There is, without question, ample evidence of Respondent's failure to meet standards in the record and this contention is without merit here.
Therefore, it is clear that Respondent has been guilty of repeated violations of the statute governing the nursing profession and the rules of the Board of Nursing and that her conduct in the particulars, as set forth in the Administrative Complaint and established at the hearing, justify disciplinary action. The statute permits several actions. These include revocation or suspension of the license, imposition of an administrative fine, a reprimand, and probation.
Here the evidence shows that the Respondent has practiced nursing under her Florida license for a number of years without any documented improprieties and this long and creditable history can and should be taken into account in assessing an appropriate penalty here. It should also be noted that there is no indication whatever that Respondent improperly appropriated or abused drugs. It should additionally be noted that notwithstanding the disclaimer of hospital personnel, there is some evidence that Respondent was short of help at the time the incidents involved here took place. Though none of the above factors excuse her substandard performance, they do tend to mitigate it somewhat and as a result, it is clear that neither revocation nor suspension is appropriate.
Nonetheless, it is necessary that adequate action be taken to insure that Respondent is made aware that conduct such as displayed here cannot be tolerated in a profession as critical as that of nursing.
RECOMMENDED ACTION
Based on the foregoing Findings of Fact and Conclusions of Law, it is, therefore:
RECOMMENDED that Respondent be reprimanded and that she be placed on probation for a period of one year under such conditions as the Board of Nursing may specify.
RECOMMENDED this 22nd day of July, 1985, in Tallahassee, Florida.
ARNOLD H. POLLOCK
Hearing Officer
Division of Administrative Hearings The Oakland Building
2009 Apalachee Parkway
Tallahassee, Florida 32301
(904) 488-9675
Filed with the Clerk of the Division of Administrative Hearings this 22nd day of July, 1985.
COPIES FURNISHED:
Julia P. Forrester, Esquire Department of Professional
Regulation
130 N. Monroe Street Tallahassee, Florida 32301
Philip J. Padovano, Esquire
P. O. Box 873
Tallahassee, Florida 32302
Judie Ritter Executive Director Board of Nursing
Room 504, 111 E. Coastline Drive
Jacksonville, Florida 32202
Fred Roche Secretary
Department of Professional Regulation
130 N. Monroe Street Tallahassee, Florida 32301
Salvatore A. Carpino General Counsel
Department of Professional Regulation
130 N. Monroe Street Tallahassee, Florida 32301
| Issue Date | Proceedings |
|---|---|
| Jul. 22, 1985 | Recommended Order (hearing held , 2013). CASE CLOSED. |
| Issue Date | Document | Summary |
|---|---|---|
| Jul. 22, 1985 | Recommended Order | Nurse's giving more medication than ordered and improperly recording doses of controlled drugs repeatedly fails to meet acceptable standards. Misconduct. |
