STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

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

)

Petitioner, )

)

vs. ) CASE NO. 83-1429

)

HENRIETTA E. WILLE, )

)

Respondent. )

)

RECOMMENDED ORDER

Pursuant to notice, a hearing was held before Charles C. Adams, a Hearing Officer with the Division of Administrative Hearings. This hearing was conducted on July 19, 1983, in Room 230, St. Johns County Courthouse, King and Cordoba Streets, St. Augustine, Florida. The transcript of the proceedings was filed with the Division of Administrative Hearings on August 4, 1983, and that transcript has been reviewed prior to the entry of this Recommended Order.

Respondent, through counsel, has offered argument and a proposed Recommended Order. That material has been considered prior to the entry of the Recommended Order and has been utilized to the extent that it is not found to be irrelevant, immaterial, contrary to facts found, contrary to conclusions of law reached or contrary to the recommended disposition in this cause. Petitioner's counsel has offered no proposed Recommended Order.

APPEARANCES

For Petitioner: Julia P. Forrester, Esquire

Staff Attorney

Department of Professional Regulation

130 North Monroe Street Tallahassee, Florida 32301

For Respondent: Nicholas A. Caputo, Esquire

233 Second Street

Holly Hill, Florida 32017

ISSUES

The issues presented for consideration on this occasion concern an administrative complaint brought by the State of Florida, Department of Professional Regulation, against the Respondent. In particular, it is alleged that on the named dates, January 7 and 8, 1983, Respondent failed to check vital signs for patients in the intensive care unit who were receiving her care.

Additionally, it is alleged that Respondent abandoned patients in her care by leaving her assigned floor for long periods of time without notifying her supervisor. These actions purportedly are acts of unprofessional conduct which depart from or fail to conform to minimal standards of acceptable nursing

practice per Section 464.018(1)(f), Florida Statutes, and violate Section 464.018(1)(j) , Florida Statutes, by violating Board of Nursing Rule 210- 10.05(2)(d) and (2)(e) 1., Florida Administrative Code, through inaccuracies in record keeping or falsification of patient records or charts.

FINDINGS OF FACT

1. Respondent is a licensed practical nurse, having been issued license No. 0524551 by the Board of Nursing in the State of Florida. At all times relevant to these proceedings, Respondent was employed as a nurse at Ormond Beach Hospital, Ormond Beach, Florida.

   
   

2. Beginning at 11:00 p.m. on January 7, 1983, and continuing until January 8, 1983, at 7:00 a.m., Respondent was working in the intensive care unit of Ormond Beach Hospital. During that time, she was primarily responsible for the care of the Patients Eleanor Prentzel and Evelyn Burkman. On that duty shift, at 12:00 midnight and 6:00 a.m., Respondent checked the vital signs of the two patients. In addition, other assessments were made during that duty cycle related to the patients. The recordation of the vital signs and statement of assessments may be found in the 24 hour nurse's notes pertaining to the two patients. These entries are part of Petitioner's exhibits 2 and 3 admitted into evidence which are patient records related to the patients in question for Burkman and Prentzel respectively. During the duty shift, between 1:30 a.m. and 5:00 a.m., Respondent was gone from her duty station for an unacceptable amount of time. While absent, Ms. Burkman, who was a cardiac patient, complained of chest pains and had to be attended by Margaret S. Vogini, R.N., who was working in the ICU on this shift. Vogini had the patient do deep breathing and listened to her lungs and heart, checked her blood pressure and watched the cardiac monitor. The patient was experiencing pain on deep inspiration, which led Vogini to believe that the problem was with the patient's lungs and not related to cardiac difficulty.

   
   

3. Respondent worked the duty shift beginning 11:00 p.m., January 8, 1983, and concluding 7:00 a.m., January 9, 1983. Again, she attended patients in the intensive care unit. One of those patients was Prentzel. The patient Burkman was assigned to Vogini on this duty shift. Again there were unacceptably longer periods of time when Respondent was out of the intensive care unit. During that duty shift, an unnamed patient became comatose and suffered cardiac arrest; requiring cardiopulmonary resuscitation. At that time, Respondent was not in the intensive care unit and had to be summoned back to the unit to assist other nurses that were working that shift. On this same shift, at 12:00 midnight, Respondent failed to take the temperature of the patient Prentzel. This should have been done in keeping with physician's orders either 30 minutes before or 30 minutes after midnight. Respondent indicated that the reason for not taking the temperature was because she did not want to wake the patient up. This was an inappropriate decision about a patient in the intensive care unit. Respondent also failed to record the blood pressure reading which she took related to the patient Prentzel at 12:00 midnight on this shift. Again, this was an inappropriate judgement about a patient in the intensive care unit.

   
   

4. During the two evenings in question, Respondent was suffering from a bladder infection and reported this problem to Virginia Hilbert, R.N., nurse supervisor of the Respondent. This medical problem required frequent trips to the bathroom on the part of Respondent. On occasion, it was necessary for the Respondent to leave the intensive care unit to accomplish her purposes. At most, those trips would have taken four minutes and did not satisfactorily

   account for the length of time in which the Respondent was not caring for her patients on the two duty shifts at issue.

   
   

5. Because of her conduct on the evenings in question, Respondent was called before the hospital administration for counseling. In the course of this session, Respondent admitted that she did not always take respiration of patients in her charge. She made this comment during the course of a discussion of the events of the two duty shifts in question. Nonetheless, the record does not establish with reasonable certainty that her comments pertained to those patients Burkman and Prentzel who were in her care on January 7-8 and 8-9, 1983.

   
   

6. The circumstances described in discussing the absence of Respondent on the two duty shifts in question, leads to the conclusion that the Respondent was absent from her duty station without properly notifying another nurse or supervisor working in the unit. That absence without proper notification, as established through testimony of Nurse Vogini, was a departure from acceptable nursing practice in that it was below the minimal standards of acceptable and prevailing nursing practice in Florida.

   
   

7. Charlotte Brooks, R.N., Assistant Administrator at Ormond Beach Hospital and Director of Nursing, set forth the importance of taking vital signs as next described. By taking vital signs, the nurse discovers the patient's reaction to illness, stress, and drugs. In the intensive care unit, the results of these checks demonstrate the need to either start or stop medication and measure the patient's response to the disease process. The taking of vital signs can detect shock and various other kinds of problems that the patient may experience. Generally, temperature and respiration checks help to track the patient's progress. Finally, these notations of vital signs made by the nurses assist subsequent shift nurses in treating the patients, to include initiation or institution of doctor's orders based upon reported vital signs.

   
   

   CONCLUSIONS OF LAW

   
   

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

   
   

9. Respondent's inordinate absence from her duty station while treating the patients Burkman and Prentzel on the shift of January 7 and 8, 1983, and further her absence from her duty station while treating the patient Prentzel on the duty shift of January 8 and 9, 1983, was unprofessional conduct by departing from or failing to conform to minimal standards of acceptable and prevailing nursing practice in the nursing community, thereby violating Section 464.018(1)(f), Florida Statutes, thereby subjecting the Respondent to the penalties set forth in Section 464.018(2), Florida Statutes. The failure to take the temperature of the patient Prentzel at 12:00 midnight, January 9, 1983, and the failure to record the blood pressure taken of that patient at that time, constitutes unprofessional conduct within the meaning of Section 464.018(1)(f), Florida Statutes, and subjects the Respondent to penalties set forth in Section 464.018(2), Florida Statutes. No violation of Section 464.018(1)(j) , Florida Statutes, through the medium of a violation of Rule 210-10.05(2)(d) and (e) 1. has been shown. No falsification was proven related to a misrepresentation of facts pertaining to the patients Burkman and Prentzel, nor has there been a showing of inaccurate recording or alteration of patient records, as would be necessary to establish the violation of the latter provisions of statute and rule.

Based upon a consideration of the facts found in the conclusions of law reached it is,

RECOMMENDED:

That a Final Order be entered which suspends Respondent's license to practice nursing in the State of Florida for a period of 30 days.

DONE and ENTERED this 28th day of October, 1983, in Tallahassee, Florida.

CHARLES C. ADAMS, 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 28th day of October, 1983.

COPIES FURNISHED:

Julia P. Forrester, Esquire Staff Attorney

Department of Professional Regulation

130 North Monroe Street Tallahassee, Florida 32301

Nicholas A. Caputo, Esquire

233 Second Street

Holly Hill, Florida 32017

Fred M. Roche, Secretary Department of Professional

Regulation

130 North Monroe Street Tallahassee, Florida 32301

Helen P. Keefe, Executive Director Board of Nursing

111 East Coastline Drive Room 504

Jacksonville, Florida

Docket for Case No: 83-001429

Orders for Case No: 83-001429