STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

DEPARTMENT OF PROFESSIONAL ) REGULATION, BOARD OF NURSING, )

)

Petitioner, )

)

vs. ) CASE NO. 81-1795

)

AUDREY E. TUCKER, )

)

Respondent. )

)

RECOMMENDED ORDER

Pursuant to notice, the Division of Administrative Hearings, by its duly designated Hearing Officer, Sharyn L. Smith, held a a1 hearing in this case on November 5, 1981, in Clermont Florida. The following appearances were entered:

APPEARANCES

For Petitioner: William M. Furlow, Esquire

Assistant General Counsel

Department of Professional Regulation

130 North Monroe Street Tallahassee, Florida 32301

For Petitioner: Audrey E. Tucker, pro se

1875 Settle Street

Clermont, Florida 32711

The issue for determination in this case is whether the Respondent's license to practice nursing should be suspended, revoked or other disciplinary action imposed based upon the facts as alleged in the Administrative Complaint filed July 10, 1981. The Administrative Complaint alleges that the Respondent violated Section 464.018(1)(f), Florida Statutes, by departing from or failing to conform to minimal standards of acceptable nursing practice while employed as a registered nurse at South Lake Memorial Hospital in Clermont, Florida.

Specifically, the Administrative Complaint charges that the Respondent was guilty of poor performance, failing to follow physicians' orders, inaccurate charting, failing to administer medication, disregard for authority, poor attitude, allowing I.V.s to run dry and neglecting to complete nursing documentation while employed at South Lake.

The Petitioner presented the testimony of three witnesses, the Director of Nursing at South Lake Memorial Hospital, the Respondent and an investigator with the Department of Professional Regulation. The Petitioner introduced one exhibit. The Respondent testified on her own behalf and introduced two exhibits.

FINDINGS OF FACT

1. The Respondent is a registered nurse who began her employment at South Lake Memorial Hospital on August 29, 1977, and was terminated on April 23, 1980. During her employment, the Respondent received four poor evaluations and/or warnings for her nursing practice. The first warning occurred on August 1, 1979. This warning involved allegations of poor nursing performance by the Respondent. These allegations included the Respondent leaving her unit, failing to properly organize her work, failing to properly restrain a patient, wasting time by running too many EGG strips instead of performing her assigned functions, failing to take vital signs timely when coming onto shift, becoming hostile with the Director of Nursing, and failing to obey the direct order of the Director of Nursing to leave the hospital and go home after an argument on July 12, 1979. Although there was no direct evidence as to most of the allegations, the Respondent admitted to late charting, failing to timely take vital signs, spending time working with ECG strips, and failing to obey a direct order to-go home given by the Director of Nursing.

   
   

2. The next evaluation occurred on November 26, 1979. The deficiencies in Respondent's practice as alleged by the Director of Nursing were that the Respondent gave a patient whole blood instead of packed cells as ordered by the physician, failed to verify an error in transcription by the ward clerk which resulted in a patient's x-rays being delayed for a day, and improperly charting when the Respondent noted on the nursing notes that at 9:00 p.m. there was no significant change in a patient's condition, when in fact the patient had left the hospital at 8:30 p.m. The lack of direct evidence of these allegations was compensated for by the Respondent's admissions as she testified concerning the circumstances surrounding why the incidents occurred.

   
   

3. The third warning occurred on March 19, 1980. The allegations in the warning concerned the Respondent having shouted at a supervisor, abandoning her patients, allowing two I.V.s to run dry, failing to carry out a doctor's orders, and failing to chart. Again, there was no direct evidence of the allegations, however, the Respondent admitted that she left her duty station because of sickness prior to relief arriving in the unit, failed to properly follow doctor's orders, and failed to chart for the time she was present in the unit prior to her reporting to the emergency room.

   
   

4. The fourth and final warning, which resulted in termination, occurred on April 23, 1980. The allegations by the Director of Nursing were that the Respondent hung one-fourth percent normal saline solution rather than the one- half percent normal saline solution ordered by the physician, and that the Respondent failed to administer the 5:00 p.m. medication. Again, the allegations were admitted by the Respondent as she attempted to explain why they occurred.

   
   

5. The Director of Nursing testified that during each of these warnings, the Respondent's attitude was that she had done nothing wrong and, therefore, could not improve on her performance. The testimony of the Department's nurse investigator was to the effect that the Respondent's actions failed to meet the minimal standard of acceptable and prevailing nursing practice. The investigator also testified that, in her opinion, a nurse with Respondent's poor attitude could be extremely dangerous in a hospital setting. After many years of difficult and stressful work, many nurses suffer from what is commonly referred to as "burn out" and are no longer useful, and can be dangerous in a high stress area of nursing.

6. Respondent testified in her own behalf and offered an explanation for each allegation presented by Petitioner. Respondent testified that relative to the first warning, even though she only had two patients, she did not have adequate time to do her charting during her shift and, therefore, had to stay two hours late. Respondent further testified that on one occasion she had not timely taken her vital signs because the Director of Nursing had delayed her with a needless confrontation. Respondent testified that she did not leave the facility as ordered on August 12, 1979, because she was afraid that she would be abandoning her patients, and could lose her vacation and sick leave benefits. With respect to the November 26, 1979 evaluation, the Respondent testified that she gave whole blood instead of packed cells because the whole blood was incorrectly labeled as packed cells. Respondent further testified that she became aware of the error after the solution had infused, and that had she looked at the solution earlier she would have been able to see that it was an incorrect blood product, and would have been able to correct the problem. As to the incorrect transcription resulting in a patient's x-rays being delayed, the Respondent stated that it was the ward clerk's responsibility, not hers, to transcribe the doctor's orders. With respect to the 9:00 p.m. nursing notes when the patient had left the facility at 8:30 p.m., the Respondent's response was that she had been aware that the patient was gone, but was summarizing the patient's condition during the entire shift up to the point the patient left. Respondent acknowledge that the nursing notes may have been misleading.

   
   

7. As to thee warning of termination on March 19, 1980, the Respondent admitted leaving her unit prior to relief arriving. Her explanation gas that she had been attempting for one hour to get assistance, to no avail. Upon questioning, she admitted that she was-only "a little dizzy" and had diarrhea. On that day she did not chart any nursing care given by her while on duty. The Respondent was caring for twelve patients at that time.

   
   

8. With respect to the April 23, 1980 termination, Respondent admitted that she hung the incorrect percentage saline solution, but that she did so because a prior nurse obtained the incorrect solution from a supply room. The Respondent then also admitted failing to give out the 5:00 p.m. medication as ordered, but stated the reason for her failure to administer the medication was her inability to obtain help from her supervisor which was necessary because she was overworked. Respondent also testified that during this time period, she went on rounds with a doctor, and also went to dinner.

   
   

9. The Respondent testified that she felt she was a good and qualified nurse. Respondent also testified that she had been fired previously from Leesburg General Hospital. The Respondent believes her attitude to be good and indicated that the hospital was overreacting to a few isolated incidents.

   
   

   CONCLUSIONS OF LAW

   
   

10. Section 464.018(1), Florida Statutes, provides that the following acts shall be grounds for disciplinary action (against a registered nurse).

    
    

    (f) unprofessional conduct, which shall include, but not be limited to, any de- parture 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."

11. Although most of the allegations in the Administrative Complaint were presented in the form of hearsay testimony, that testimony coupled with the Respondent's admissions are sufficient to support a finding that most of the incidents complained of actually occurred. The only material issue in dispute is whether the incidents complained of were excusable. After due consideration being given to the demeanor and attitude of the witnesses, the greater weight of the evidence supports a finding that the Respondent did in fact on numerous occasions violate the Nurse Practice Act by nursing performance which departed from the minimal standards of acceptable and prevailing nursing practice.

    
    

12. Although there was no evidence presented that the Respondent's poor nursing performance resulted in an injury to any patient, it is apparent from the Respondent's attitude that the Respondent poses a real and substantial danger if she is allowed to continue practicing as she has in the past.

RECOMMENDATION

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

That the Respondent's license to practice nursing in the State of Florida, license number 39108-2, be suspended indefinitely. If the Respondent seeks reinstatement, it will be her responsibility to undergo counseling with a psychologist or psychiatrist, for an in-depth evaluation and treatment, the results of which shall be submitted to the Board of Nursing if and when the Respondent wishes to apply for reinstatement of her nursing license. If the Respondent applies for reinstatement of her license, it shall be her responsibility to demonstrate to the Board that she is able to engage in the practice of nursing in a safe, professional, proficient and legal manner. This demonstration shall include but not be limited to a report by her psychologist or psychiatrist, along with a recommendation from him that she be reinstated to the practice of nursing. 1/

DONE and ORDERED this 8th day of January, 1982, in Tallahassee, Florida.

SHARYN L. SMITH, 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 8th day of January, 1982.

ENDNOTE

1/ This penalty was suggested by the Petitioner in its Proposed Findings of Fact and Conclusions of Law filed in this cause with the Hearing Officer.

COPIES FURNISHED:

William W. Furlow, Esquire Assistant General Counsel

Department of Professional Regulation Old Courthouse Square Building

130 North Monroe Street Tallahassee, Florida 32301

Audrey E. Tucker 1875 Settle Street

Clermont, Florida 32711

Docket for Case No: 81-001795

Orders for Case No: 81-001795