Chavis, duly designated Hearing Officer of the Division of Administrative Hearings. The initial hearing was held on March 23, 1983. After the presentation of the Petitioner's case, the hearing was adjourned and was reconvened on May 27, 1983, in Orlando, Florida, for the presentation of Respondent's case.
This case concerns the issue of whether the Respondent's license as a registered nurse should be suspended, revoked or otherwise disciplined for submitting employment applications which contained false information and for unprofessional conduct in the performance of her duties as a nurse. At the formal hearing the Petitioner called as witnesses Janet Brown, Wilma Green, E. Jean King, Susan Coffin Brennan, Mary Ann Cottrell, and Mary Sheffield. The Respondent testified on her own behalf and was the only witness called by the Respondent. The Petitioner offered and had admitted into evidence, ten exhibits and the Respondent offered and had admitted into evidence, seven exhibits.
Counsel for the Petitioner and counsel for the Respondent submitted proposed findings of fact and conclusions of law for consideration by the Hearing Officer. To the extent that those proposed findings of fact and conclusions of law are consistent with the findings made in this order, the proposed findings were adopted by the Hearing Officer. To the extent that the
proposed findings and conclusions of law are not consistent with this order, they were considered by the Hearing Officer and rejected as being unsupported by the evidence or unnecessary to the resolution of this cause.
The facts set-forth in paragraphs 1 through 4 below were stipulated to by the parties and are found as facts:
At all times pertinent to this proceeding, Respondent was a licensed registered nurse in the State of Florida, having been issued license number 67142-2.
Respondent filled out and filed the applications for licensure as a registered nurse, Petitioner's Exhibit No. 1.
Respondent did fill out and file the applications for employment as a nurse, Petitioner's Exhibit Nos. 2 through 9.
Respondent did falsify her date of birth, age, and date of graduation from nursing school on her applications for employment as a nurse, Petitioner's Exhibit Nos. 2 through 9. This was done by Respondent on the recommendation of an employment agency initially, and was done in order to obtain employment.
On or about April 8, 1982, Respondent filled out and submitted an employment application for work as a nurse to Lakeview Nursing Center. (Petitioner s Exhibit No. 2). The application reflected that Respondent obtained her R.N. degree from Bellevue Hospital in 1948. That information is false. The Respondent received her R.N. degree in 1939.
On or about March 11, 1983, Respondent filled out and submitted an employment application for work as a nurse to Leesburg General Hospital, Leesburg, Florida (Petitioner's Exhibit No. 3). That application reflects a date of birth of December 24, 1932 and the date June, 1948 as the year Respondent received her nursing degree. This information is false in that Respondent's date of birth is September 29, 1918, and the year she received her nursing degree was June, 1939.
On or about January 25, 1982, Respondent filled out and submitted an application for employment as a registered nurse to Sanford Nursing and Convalescent Center, Inc., Sanford, Florida (Petitioner's Exhibit No. 4). That application reflected a date of birth of December 24, 1932 and the year 1948 as the year in which Respondent obtained her R.N. degree. The date of birth and year of graduation are false.
On or about May 28, 1980, Respondent filled out and submitted an application for employment as Director of Nursing at Orlando Memorial Convalescent Center, Orlando, Florida (Petitioner's Exhibit No. 5). That application reflected that Respondent graduated from Bellevue Hospital School of Nursing in 1948. That information is false in that she graduated in 1939.
On or about February 13, 1980, the Respondent filled out and submitted an application for employment as a nurse to Quality Care, a nursing service (Petitioner's Exhibit No. 6). That application contained a false date of birth of December 24, 1932 and a false year of graduation from Bellevue Hospital School of Nursing of 1948.
On or about January 23, 1980, Respondent filled out and submitted to the Physician's Registry an application for employment as a nurse (Petitioner's Exhibit No. 7). That application reflected an age of 47 and date of birth of January 24, 1932. This information is false.
On or about January 8, 1980, the Respondent filled out and submitted an application for employment as a nurse to Medox, Inc. That information reflected a birth date of December 24, 1932 and a year of graduation from Bellevue Hospital as 1948 (Petitioner's Exhibit No. 8). This birthdate and year of graduation are false.
On or about January 19, 1978, Respondent filled out and submitted an application for employment as a nurse to Dr. P. Phillips Memorial Nursing Home, Orlando, Florida (Petitioner's Exhibit No. 9). That application reflected an incorrect birthdate of December 24, 1932 and reflected that Respondent attended Bellevue Hospital School of Nursing from 1945 to 1948. Respondent actually attended Bellevue Hospital from 1936 to 1939.
During March, 1982, Respondent was employed as a registered nurse at Leesburg Regional Medical Center. Janet Gillespie Brown, also a registered nurse, was assigned to act as Respondent's preceptor during Respondent's orientation at Leesburg Regional Medical Center. As her preceptor Ms. Brown trained as well as supervised Respondent's work during her orientation period.
During the time she was employed at Leesburg Regional Medical Center, the Respondent used improper procedures in attempting to insert a foley catheter into a female patient. in cleansing the meatus to remove bacteria the Respondent used a scrubbing technique rather than a wiping technique. This was improper antiseptic technique. The Respondent then attempted to insert the catheter by probing. This also was improper. Upon observing these improper techniques Janet Brown instructed Respondent to make no further attempts to insert the catheter and told her to wait whale she obtained a sterile foley kit which she would insert herself. Respondent did not do as she had been instructed and inserted the catheter after Nurse Brown left the patient's room to obtain the sterile foley kit.
After Nurse Brown returned and discovered the catheter had been inserted against her instructions, she went outside the patient's room with Respondent and explained to her that the catheter she inserted was contaminated as a result of the probing. Respondent agreed and explained that she had not performed this procedure for awhile. The ability to properly insert such catheters is a basic nursing skill. No infection resulted from the improper insertion of the catheter by Respondent.
Also while employed at Leesburg Regional Medical Center the Respondent failed to properly chart food intake of patients in that she charted each item of food consumed rather than charting percentages of food consumed as she had been instructed. Respondent also failed to properly chart the progress of a stroke patient by failing to chart that the patient had been making attempts to verbally communicate. The Respondent failed to properly organize her time, appeared unable to properly assess patient progress by asking appropriate questions and recording the patient's response, and failed to complete daily assignments such as bed baths and picking up food trays.
Respondent did not feel capable of starting an IV (intravenous). Although starting an IV was not considered to be a skill required of Respondent by Leesburg Regional Medical Center, Respondent was unable to change the tubing on an IV and this was a skill expected of her. Respondent was also unable to give accurate counts of the remaining amount of solution in patients' IVs. On one occasion Respondent failed to properly chart the time of the doctor's visit and apparently "switched" the time. Respondent increased the IV flow for a patient as requested by the doctor, but charted the doctor's visit as having occurred later than the time at which she increased the IV.
While working at Leesburg Regional Medical Center the Respondent failed to meet the minimal standards of acceptable and prevailing nursing practice.
During the first part of February, 1982, Respondent was employed as a relief charge nurse at Sanford Nursing and Convalescent Center, Sanford, Florida. Ms. E. Jean King, R.N. was a charge nurse at Sanford Nursing and Convalescent Center and was assigned to assist in Respondent's orientation. While at Sanford Nursing and Convalescent Center, Respondent was observed by Ms. King to be very confused and very disorganized in her work. She could not remember patients' names and in passing out medications failed to medicate some patients. Then asked whether or not a particular patient had been given medication, Respondent became confused and indicated she could not remember whether or not the medication had been given. In taking a phone order from a doctor the Respondent wrote the wrong order on a sheet of paper and could not then remember what medication had in fact been ordered. This necessitated calling the doctor back and having the order repeated. Respondent also administered medications without first taking the pulse and blood pressure of the patient as required. Respondent required much more supervision than the other nurses under Ms. King's supervision.
Respondent's performance and nursing practice at Sanford Nursing and Convalescent Center failed to meet the minimal standards of acceptable and prevailing nursing practice in Florida.
On January 12 and January 27, 1980, Respondent as an employee of Medox, Inc., was assigned to Florida Hospital in Orlando, Florida. At the time she reported for work Respondent was informed by Ms. Ann Cottrell, R.N. (Head Nurse in Special Care at Florida Hospital) about what her responsibilities would be during her shift as team leader in the progressive care unit. The duties outlined to Respondent included responsibility for the administration of IV medications, antiequivalent drugs, insulin and any other specific procedures not within the job description of the licensed practical nurses. Respondent was also instructed that she was responsible for ordering IV medications that were to be administered for the next twenty-four (24) hours, that she was to make rounds with the physicians and observe and report the patients' conditions, and that at the end of the shift she was responsible for making certain that all charts were signed off, the doctor's orders were signed off, and any pertinent information included in the nurse's notes.
During the course of the day Ms. Cottrell checked back with Respondent several times and asked if she understood her responsibilities and whether she was having any problems. Each time Respondent indicated that she knew what she was doing and had done it many times.
During the course of the day the Respondent failed to make a complete report on the patients and as a result, the three to eleven shift was unable to determine what had happened during the day with regard to the patients for which Respondent was responsible. Medications had not been charted properly and many of the notes entered by Respondent were irrelevant to the patient's progress. Respondent also failed to insure that EKG strips for which she was responsible had been read.
Ms. Cottrell, a registered nurse, was qualified to express an opinion as to the prevailing standards of nursing practice in Florida. She testified that in her opinion the Respondent was not qualified to work in an acute care area as a nurse and that her performance of her duties at Florida Hospital failed to meet the minimal standards of acceptable nursing practice in the State of Florida. This opinion is accepted by the Hearing Officer.
CONCLUSIONS OF LAW
The Division of Administrative Hearings has jurisdiction over the parties and subject matter of this action.
Florida Statute 464.018 (1979) empowers the Board of Nursing to discipline licensed nurses who have been found to have committed any act or acts listed as disciplinary grounds in that Section.
Section 464.018(1)(j), Florida Statutes (1979) provides as one ground for discipline:
Willfully or repeatedly violating any pro- vision of this chapter, a rule of the board or department, or a lawful order of the board or department previously entered in a disci- plinary proceeding or failing to comply with a lawfully issued subpoena of the department.
Rule 210-10.05(2)(d), Florida Administrative Code, provides that the Board of Nursing may impose disciplinary penalties upon a determination, that a licensee has falsely misrepresented the facts on applications for employment as a nurse. In the instant case the evidence clearly establishes that the Respondent on eight different occasions between January, 1978 and May, 1982 prepared and submitted applications for employment as a nurse to various hospitals and other health facilities in Florida. These applications contained false information and facts relating to Respondent's date of birth, date of graduation from nursing school and age. The Respondent intentionally entered the false information in order to obtain employment. These acts constitute willful and repeated violations of the above rule and therefore are a violation of Section 464.018 (1)(j), Florida Statutes (1979) as alleged in Count I of the Administrative Complaint.
Respondent was also charged with having violated Section 464.018(1)(f), Florida Statutes (1979) which provides as a ground for discipline:
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 evidence established that the Respondent while working as a nurse at Leesburg Regional Medical Center, Sanford Nursing and Convalescent Center, and Florida Hospital in Orlando, Florida, failed to conform to the minimal standards of acceptable and prevailing nursing practice in Florida. This failure on the part of the Respondent constitutes unprofessional conduct and a violation of Section 464.018(1)(f), Florida Statutes (1979) as alleged in Counts II, III, and IV of the Administrative Complaint.
The evidence failed to establish a violation of Section 464.018(1)(d), Florida Statutes (1979) as alleged in Counts I and IV of the Administrative Complaint.
