STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

DEPARTMENT OF PROFESSIONAL ) REGULATION, BOARD OF NURSING )

)

Petitioner, )

)

) CASE NO. 88-5570

)

LORI ANN WILLIAMS, L.P.N., )

)

Respondent. )

)

RECOMMENDED ORDER

This matter was heard in Miami, Florida on March 3, 1989, by William R. Dorsey, Jr., the Hearing Officer designated by the Division of Administrative Hearings. The transcript of the proceeding was filed on March 22, 1989. The Board waived the opportunity to file a proposed Recommended Order.

APPEARANCES

For Department of Lisa M. Basset Professional Regulation, Senior Attorney

Board of Nursing: 130 North Monroe Street

Tallahassee, Florida 32399-0750

For Respondent: No Appearance ISSUES

The issue is whether Ms. Williams is subject to discipline for allegedly having abandoned her shift as a nurse at the Palmetto Extended Care Center in Miami, Florida without notifying a responsible person that she was leaving and without securing a replacement.

FINDINGS OF FACT

1. Lori Ann Williams has been licensed as a practical nurse in the State of Florida since December 9, 1985. Her licensure is current. In December of 1987, Ms. Williams was employed by the Palmetto Extended Care Center in Miami, Florida, a nursing home which served an elderly population. The home had an eighty-seven bed capacity and was full. The average age of the patients was 84 years old. The facility had a single floor with two nurses stations, staffed by two licensed practical nurses and at least two nurses aides.

   
   

2. Ms. Williams was employed on the 11:90 p.m. to 7:00 a.m. shift on the night of December 27-28, 1987 along with another licensed practical nurse, and at least two nurses aides.

3. The Administrator of the facility, Ruby Ruth Brown, is a licensed practical nurse. She had received reports from the nurses aides that Ms. Williams was in the habit of leaving the facility during her shift, but returning shortly before the shift ended at 7:00 a.m. During the 11:00 p.m. to 7:00 a.m. shift on the night of December 28-29, 1987, Ms. Brown came into the home at approximately 4:45 a.m. She found the other licensed practical nurse and the nurses aides on duty, but after searching the nurses' stations, all patient rooms, closets and bathrooms, she was unable to locate Ms. Williams. By checking the timecards, Ms. Brown found that Ms. Williams had arrived late for her 11:00 pm. shift (at 11:13 p.m.), but had not clocked out. A nurses aide had last seen her at 2:00 a.m.

   
   

4. In checking the patients, Ms. Brown found that none of the nursing duties Ms. Williams should have performed for her 43 patients since 12:00 midnight had been carried out. Ms. Brown found conditions injurious to the

   well-being of two patients under Ms. Williams' care. One patient's naso-gastric feeding bag was empty, and should have been refilled at 2:00 a.m., but had not been refilled at the time Ms. Brown had arrived at the home. Another patient had pulled a Foley catheter out, which should have been brought to the attention of the attending physician [Some attending physicians direct that the catheter be immediately reinserted, while other physicians are of the view that the catheter should not be reinserted for a period of time due to possible injury sustained when the catheter was pulled out.]

   
   

5. Under the work rules of the Palmetto Extended Care Facility, if Ms. Williams needed to leave during her shift, she should have notified the Director of Nurses, Ms. Virginia Carpenter, or the administrator of the home, Ms. Brown. They would have made arrangements to obtain another nurse to finish the shift. When Ms. Williams left, she did not notify Ms. Carpenter, Ms. Brown, the other licensed practical nurse on duty, or any of the nurses aides.

   
   

6. Ms. Brown confronted Ms. Williams about her disappearance the next day. Ms. Williams said that she had not notified anyone when she was leaving because she had diarrhea and had to leave suddenly. Later Ms. Williams stated that she had told a cleaning lady that she had to leave, but was unsure that the cleaning lady had understood her because the cleaning lady spoke Spanish. The janitorial personnel work from 7:00 a.m. to 7:00 p.m. at the facility, so it would not have been possible for Ms. Williams to have notified janitorial personnel that she was leaving. In any event, it would have been improper for her to have only informed janitorial personnel that she would no longer be on duty.

   
   

7. By leaving her shift without informing other persons responsible for patient care that she would no longer be on the floor, Ms. Williams placed the

   43 patients under her care in danger, especially the patient who did not received the naso- gastric feeding and the patient who had removed the Foley catheter.

   
   

8. Leaving a nursing shift without notifying an appropriate person that the nurse is leaving, and making arrangements for the protection of patients' welfare, is unprofessional conduct. Ms. Williams is guilty of unprofessional conduct.

   
   

   CONCLUSIONS OF LAW

   
   

9. The Division of Administrative Hearings has jurisdiction over this matter. Section 120.57(1), Florida Statutes. A nurse may be disciplined under Section 464.018(1)(f), Florida Statutes for the following:

   Unprofessional conduct, which shall include, but not be limited to, any departure from or the failure to conform to, tee minimal standards of acceptable and prevailing nursing practice, in which case actual injury need not be established.

   
   

10. In Rule 210-10.005(1)(e)4., Florida Administrative Code, unprofessional conduct is defined to include:

    
    

    Leaving a nursing assignment before properly advising appropriate personnel.

    
    

11. The disciplinary guidelines of the Board of Nursing set a range of penalties for instances of unprofessional conduct as defined in Rule 210- 10.005(1)(e), Florida Administrative Code, which run from a reprimand to suspension, probation and a fine. See Rule 210-10.011(2)(j), Florida Administrative Code. During the hearing, the Board of Nursing suggested that a suspension would be an appropriate penalty in this matter, and such penalty is consistent with the guidelines established by rule.

RECOMMENDATION

It is recommended that a Final order be entered finding Lori A. Williams guilty of unprofessional conduct, and suspending her licensure for a period of one year.

DONE and ENTERED this 27 day of March, 1989 in Tallahassee, Leon County, Florida.

WILLIAM DORSEY

Hearing officer

Division of Administrative Hearings The Oakland Building

2009 Apalachee Parkway

Tallahassee, Florida 32399-1550

(904) 488-9675

FILED with the Clerk of the Division of Administrative Hearings this 27 day of March, 1989.

COPIES FURNISHED:

Lisa M. Bassett, Esquire Department of Professional Regulation

130 North Monroe Street Tallahassee, FL 32399-0750

Lori A. Williams 9360 S.W. 185 Street

Miami, FL 331567

Judie Ritter Executive Director Board of Nursing

504 Daniel Building

111 East Coastline Drive Jacksonville, FL 32201

Kenneth E. Easley, Esquire General Counsel

Department of Professional Regulation

130 North Monroe Street Tallahassee, FL 32399-0750

Docket for Case No: 88-005570

Orders for Case No: 88-005570