STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

STATE OF FLORIDA, DEPARTMENT OF ) PROFESSIONAL REGULATION, BOARD ) OF NURSING, )

)

Petitioner, )

)

vs. ) CASE NO. 79-907

) LUANNE J. SIMS ISAACS, R.N. )

)

Respondent. )

)

RECOMMENDED ORDER

Pursuant to notice, the Division of Administrative Hearings, by its duly designated Hearing Officer, James E. Bradwell, held a public hearing in this case on August 14, 1979, in Jacksonville, Florida.

APPEARANCES

For Petitioner: Julius Finegold, Esquire

1107 Blackstone Building

233 East Bay Street Jacksonville, Florida 32202

For Respondent: David R. Wilt, Esquire

209 South Third Street Jacksonville Beach, Florida 32205

ISSUE

The issue posed for decision herein is whether or not the Respondent, Luanne J. Sims Isaacs, R.N.'s license to practice nursing in the state should be placed on probation, suspended ore revoked based on conduct set forth hereinafter in detail as set forth in the Administrative Complaint filed herein on March 30, 1979.

FINDINGS OF FACT

Based upon my observation of the witnesses and their demeanor while testifying, the following relevant facts are found.

1. Luanne J. Sims Isaacs is a licensed Registered Nurse who holds license No. 0980392.

   
   

2. The Administrative Complaint filed herein on March 30, 1979, by the Florida State Board of Nursing (Petitioner) alleges that on various occasions during the periods December 2, 1978; January 24 and 25, 1979; and on February 1, 1979, the Respondent, Luanne J. Sims Isaacs, failed to chart on patients' administration notes or nurses' notes the administration of narcotic drugs

   administered to patients and, as such, violated the prevailing minimal standards of nursing care and is otherwise guilty of unprofessional conduct as set forth and defined in Subsection 464.21(1)(b), Florida Statutes.

   
   

   The Complaint allegations are as follows:

   
   

3. On or about December 2, 1978, at approximately 0800 hours, Respondent, while on duty as a Registered Nurse at Baptist Medical Center, Jacksonville, Florida and signed out on the narcotic control record for Dilaudid I.M. (Hydromophine Hydrochloride) 2 mg., a controlled substance, for a patient, Dorothy Troeger, and failed to chart the administration of same on either the patient's medication administration record or nurses' notes.

   
   

4. On or about January 25, 1979, at approximately 1730 hours and 2100 hours, while employed as above, Respondent signed out on the narcotic control record for Dilaudid 2 mg. I.M. for a patient, Donald R. Wooten, and failed to chart the administration of same on either the patient's medication administration record or nurses' notes. The patient had no doctor's orders for Dilaudid on the date and time in question.

   
   

5. On or about January 25, 1979, at approximately 1900 hours, Respondent signed out on the narcotic control record for Dilaudid 2 mg. I.M. for a patient, Herbert J. Spaulding, and failed to chart the administration of same on either the patient's medication administration record or nurses' notes. The patient had no doctor's orders for Dilaudid for the date and time in question. The nursing notes of said patient as charted by other nurses on duty that day reflect that from 1530 hours through 2330 hours, the patient was resting comfortably without complaints and required no medication.

   
   

6. On or about January 24, 1979, at approximately 1900 hours and again at 2150 hours, Respondent signed out on the narcotic control record for Dilaudid 2 mg. I.M. for a patient, K.B. Forbes, and failed to chart the administration of same on either the patient's medication administration record or nurses' notes. The patient had no doctor's orders for Dilaudid on the date and times in question.

   
   

7. On or about February 1, 1979, at 2100 hours, Respondent signed out on the narcotic control record for Dilaudid 2 mg. I.M. for a patient, William Cordell, and failed to chart the administration of same on either the patient's medication administration or nurses' notes. The patient had no doctor's orders for Dilaudid on the date and time in question. The patient denied getting any "shot," but stated he took "pills" for pain that evening. The nurses' notes which were made by the Respondent reflect that on the date in question at 2200 hours, the Respondent gave to the patient another medication, to-wit: Darvocet N100 by mouth for the patient's complaint of chest pain, which would be consistent with the statement of the patient.

   
   

8. On or about February 1, 1979, at approximately 2110 hours, Respondent signed out on the narcotic control record for Dilaudid 2 mg. I.M. for a patient, Estala Dupont, and failed to chart the administration of same on either the patient's medication administration record or nurses' notes. The patient had no doctor's orders for Dilaudid on the date and time in question. The patient denied receiving any injection for pain and there were not doctor's orders for Dilaudid on the date and time in question for said patient.

   
   

9. On or about February 1, 1979, at 2015 hours and 22300 hours, Respondent signed out on the narcotic control record for Dilaudid 2 mg. I.M. for a patient,

   Rosaline Waters, and failed to chart the administration of same on either the patient's medication administration record or nurses' notes. The patient had no doctor's orders for Dilaudid on the date and times in question. The nurses' notes for February 1, 1979, at 2200 hours recorded by Jay Davis, L.P.N., reflect "a quite p.m."

   
   

10. On or about February 1, 1979, at approximately 2030 hours and 2245 hours, Respondent signed out on the narcotic control record for Dilaudid 2 mg.

    I.M. for a patient, Anita Bessent, and failed to chart the administration of same on either the patient's medication administration record or nurses' notes. The patient had not doctor's orders for Dilaudid on the date and times in question. The nurses' notes for February 1, 1979, at 2100 hours charted by the Respondent reflect that Demerol 75 mg. I.M. was administered to the patient for complaints of abdominal pain by the Respondent. Demerol was order for said patient by the physician and is charted on the medication administration record as well as the nurses' notes, on February 21, 1979, 1/ at 2100 hours by the Respondent, Luanne J. Sims Isaacs, but there is no record of Demerol ever being signed out on the narcotic control record by the Respondent on February 1, 1979, at 2100 hours for the patient, Anita Bessent.

    
    

11. The facts herein are not in dispute. In fact, Respondent testified during the course of the hearing and acknowledged that she had received minimal exposure to hospital nursing techniques at the time of the incidents stated in the Administrative Complaint. She testified that she had experienced difficulty adjusting to the demands placed upon her by this work. She testified, as did her husband, Henry Isaacs, that she (Respondent) often came home "tensed up" about the job, the condition of the patients and the other stressful situations placed upon her from job-related pressures. Mr. Isaacs also testified that Respondent often came home complaining of the lack of help and assistance provided her by the nurses aides and aides' inability to comply with Respondent's requests for assistance.

    
    

12. Dorothy J. Boyle, R.N., who is the nursing director at Baptist Hospital where Respondent was employed, expressed her familiarity with the Respondent's employment at Baptist Hospital. She testified that she familiarized the Respondent with the signing out and charting procedures of the hospital. Mr. Robert W. Beach, Baptist Hospital's Director of Pharmacy and a licenses pharmacist in this state for approximately twenty years, appeared at the hearing and testified respecting the compilation of narcotic control records. Pharmacist Beach, as custodian of the records, introduced the narcotic control records and the patient medical records for the narcotic, Dilaudid. (Petitioner's Composite Exhibits 1 and 2.)

    
    

13. The evidence introduced herein revealed that as alleged on the date specified in the Administrative Complaint filed herein, the Respondent withdrew narcotic drugs as indicated in the Administrative Complaint from the narcotics cabinet and failed to chart the administration of the medications on the medical administration records or in the nursing notes for the respective patients. An examination of the medical records for the patients involved revealed that the drug, Dilaudid, was not a medication ordered by each patient's respective physician for administration to said patients.

    
    

14. Based on the above, including the Respondent's failure to chart the administration of medications to patients and for withdrawing medication for patients without the medication being ordered by the patients' physicians, the Respondent engaged in conduct amounting to a departure from the prevailing

    nursing practices and standards as set forth and defined in Subsection 464.21(1)(b), Florida Statutes.

    
    

15. While it was noted that the Respondent had minimal exposure to hospital nursing techniques at the time of the cited incidents and that she had difficulty in adjusting to job-related pressures and demands, such is no permissible conduct for a Registered Nurse in this state.

    
    

    CONCLUSIONS OF LAW

    
    

16. The Division of Administrative Hearings has jurisdiction over the subject matter and the parties to this action. Subsection 120.57(1), Florida Statutes.

    
    

17. The parties were duly noticed pursuant to the notice provisions of Chapter 120, Florida Statutes.

    
    

18. The authority of the Petitioner, Board of Nursing, is derived from Chapter 464, Florida Statutes.

    
    

19. Competent and substantial evidence was offered to establish that the Respondent engaged in conduct amounting to unprofessional conduct within the meaning of Subsection 464.21(1)9b), Florida Statutes, as alleged in the Administrative Complaint filed herein.

RECOMMENDATION

Based on the foregoing Findings of Fact and Conclusions of Law, it is hereby,

RECOMMENDED:

That the Respondent be placed on probation for a period of two (2) years.

During said probationary period, it is recommended that the Respondent be prohibited from obtaining employment in the area of hospital nursing.

Additionally, it is recommended that the Respondent be required to keep the Board of Nursing advised at all times of her current employment and that the Board require regular reporting from said employers as to Respondent's job performance. Following completion of the probationary period, the Respondent shall show completion of courses for continuing nurses education classes in hospital techniques and charting procedures prior to gaining further employment in hospital nursing.

The above recommendation is based on evidence introduced that the Respondent had minimal exposure in the area of proper hospital techniques and charting procedures.

RECOMMENDED this 9th day of October, 1979, in Tallahassee, Florida.

JAMES E. BRADWELL, Hearing Officer Division of Administrative Hearings Room 101, Collins Building Tallahassee, Florida 32301

(904) 488-9675

ENDNOTE

1/ During the course of the hearing, Petitioner's counsel was granted a motion to correct the date, February 21, 1979, to read February 1, 1979.

COPIES FURNISHED:

Geraldine B. Johnson, R.N.

Department of Professional Regulation Board of Nursing

Suite 504, Richard P. Daniel State Office Building

111 East Coast Line Drive Jacksonville, Florida 32202

Julius Finegold, Esq. 1107 Blackstone Building

233 East Bay Street Jacksonville, Florida 32301

David R. Wilt, Esq.

209 South Third Street Jacksonville Beach, Florida 32250

Docket for Case No: 79-000907

Orders for Case No: 79-000907