Findings Of Fact The Respondent, Joann Jensen, graduated from the University of Nebraska with the degree of Bachelor of Science in Nursing in 1972. She became licensed as a Registered Nurse in Florida, but upon moving back to the North she let the license lapse. When she returned to Florida in 1976 she was reinstated as a Registered Nurse, and she now holds license number 70429-2 issued by the Board of Nursing. Thereafter the Respondent became employed at Holy Cross Hospital in Fort Lauderdale on the 3:00 p.m. to 11:00 p.m. shift, and was assigned to the nursery where she became charge nurse in August of 1977. She held this position during the March-October, 1979, period which is involved in this proceeding. In October of 1979 the Respondent was transferred out of the nursery into a medical/surgical adult unit at Holy Cross Hospital, where she remained for about six months, when she left the hospital to work for a private nursing agency. Between March and October of 1979 the Respondent was observed by six nurses on several occasions when she continued to feed infants after they had begun to choke, gag and struggle for air. Specific occurrences were described with reference to infant's named Baby Mandell, Baby Saul, Baby Riccobono, Baby McDaniel, Baby Fast, Baby Davis, Baby Pierce, and Baby Fletch, although precise time frames were not uniformly established. Other instances were described generally without reference to any particular infant. The Respondent was further observed to have tube-fed an infant to the point where its abdomen became distended, to have forced liquid into an infant after it had been breast fed by the mother, and to have manipulated the nipple of a bottle in the mouth of an infant in a rough manner so as to increase the flow of fluid into the mouth. On at least one occasion an infant turned blue and required suction to clear its passages. This form of handling of infants by the Respondent continued from March of 1979 until October when she was transferred to an adult-care unit. The testimony of the six nurses presented by the Petitioner also establishes that the Respondent used what is known as the Crede Maneuver to induce newly circumcised infants to urinate. This is a procedure used by some nurses in which the bladder is massaged gently until urination occurs. However, the manner in which the Respondent performed this procedure was forceful and rough, resulting in painful screams from infants. On one occasion there was no stated medical reason for use of the Crede Maneuver on the infant except that the Respondent wanted to have the chart show that urination had occurred during her shift. The evidence further establishes that the Respondent cursed and used foul language in the nursery, and that in one instance this was directed at an infant when the mask used to protect its eyes under the bilirubin lights kept slipping off its face. Placing an infant under bilirubin lights with its eyes masked for protection is a procedure designed to break-down excessive bilirubin in the blood when this is a problem. Although the Complaint did not specifically allege that the Respondent's language in the nursery would be an issue, this evidence was received without objection, but has been accorded no weight by the Hearing Officer. The evidence presented by the Petitioner's expert witness establishes the fact that conduct such as described above, if true, is not acceptable nursing practice, and deviates from the minimum standards established for and prevailing in the nursing profession. Based upon the observed candor and demeanor of all the witnesses, the evidence presented by the Petitioner has been accorded sufficient weight to support the findings of fact set forth herein. No evidence was presented to show that these facts were in accordance with good nursing practice; thus, the evidence warrants a finding that the Respondent's conduct failed to conform to and departed from the standards of acceptable nursing practice. The testimony of the Respondent and her witnesses, and other evidence, amounted to a denial that the occurrences took place, that the Respondent was not working on at least one date when the conduct described was observed, that the charts and records do not corroborate the facts charged, and that the Petitioner's witnesses were engaged in a conspiracy against the Respondent. However, the testimony of the three nurses on behalf of the Respondent establishes no more than that they have not observed the conduct described by the other nurses. There was no corroborative testimony relative to a conspiracy among the Petitioner's witnesses. Further, the occurrences described took place over a prolonged time period, and involved numerous infants. There is no particular significance to the failure of the charts to contain notations confirming the observations of the nurses, or that the Respondent was not shown by the records to have been on duty the particular date of only one incident. The Respondent's former supervisor related one instance when a mother complained that the Respondent had been rough with her infant. An investigation resulted, from which she concluded that the Respondent might have been rough with the baby. This witness also thought there was some merit to the complaints that nurses made of the Respondent's treatment of infants, although she continued to give the Respondent good performance evaluations. In summary, there was not sufficient evidence presented by the Respondent to support her own self-serving denial and assertion of a conspiracy against her, or to effectively rebut the clear and convincing testimony presented in support of the allegations set forth in the Administrative Complaint.
Recommendation Based upon the foregoing findings of fact and conclusions of law, it is RECOMMENDED that license number 70429-2 authorizing the Respondent, Joann Jensen, to practice as a registered nurse, be revoked. THIS RECOMMENDED ORDER entered on this 25 day of September, 1981. WILLIAM B. THOMAS, 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 25 day of September, 1981. COPIES FURNISHED: William M. Furlow, Esquire 130 North Monroe Street Tallahassee, Florida 32301 Marie S. Hotaling, Esquire 1523 North East 4th Avenue Fort Lauderdale, Florida 33304
The Issue Whether the license of Respondent should be suspended or revoked, or whether the licensee should be put on probation or otherwise disciplined.
Findings Of Fact The Respondent, Nancy L. Hunter, is a registered nurse who holds license #87366-2. On March 30, 1979, the Petitioner Board filed an administrative complaint against Respondent, seeking to place on probation, suspend or revoke Respondent's license. Respondent requested an administrative hearing. Prior to the hearing, Petitioner Board withdrew the allegations of Paragraph 3 of the Administrative Complaint, and the hearing proceeded on the remaining allegations, numbered 1 and 2 in the complaint. On or about February 7, 1979, Respondent attempted to have filled a prescription for Ionamin, a Class IV controlled drug generally used as a weight control measure, at the pharmacy in the Women's Hospital in Tampa, Florida. The prescription had been written by Respondent in the name of Eli Rose, M. D. Dr. Rose did not authorize the writing of this prescription, although he had previously written prescriptions for the same drug for the Respondent who had had these prescriptions filled at the hospital pharmacy. Respondent had been a patient of Dr. Rose and had used the drug previously, legitimately obtained, for her personal use as a weight control measure. Respondent Hunter acknowledged the forgery of the prescription for Ionamin, which she uttered to Mr. Eladio Quinomes, registered pharmacist at the Women's Hospital. Almost immediately after the uttering of this prescription, Respondent was confronted with the fact of the forgery and admitted the same. Respondent was suspended from her position and has not practiced her profession since that date. Petitioner submitted no memorandum of law. Respondent submitted proposed findings of fact, and this instrument was considered in the writing of this Order. To the extent the proposed findings of fact have not been adopted in, or are inconsistent with, factual findings in this Order they have been specifically rejected as being irrelevant or not having been supported by the evidence.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, the Hearing Officer recommends that the license of the Respondent, Nancy L. Hunter, be suspended for a period of three (3) months from the date hereof. DONE and ORDERED this 30th day of August, 1979, in Tallahassee, Leon County, Florida. DELPHENE C. STRICKLAND Hearing Officer Division of Administrative Hearings Room 101, Collins Building Tallahassee, Florida 32301 (904) 488-9675 COPIES FURNISHED: Julius Finegold, Esquire 1107 Blackstone Building 233 East Bay Street Jacksonville, Florida 32202 R. Kimber Martin, Esquire Suite 500 Flagship Bank Building 315 East Madison Street Tampa, Florida 33602 Geraldine B. Johnson, R. N. Florida State Board of Nursing 111 Coastline Drive, East; Suite 504 Jacksonville, Florida 32202
The Issue Whether Respondent engaged in unprofessional conduct and, if so, what penalty should be imposed on his nursing license.
Findings Of Fact The Department of Health is the state agency charged with regulating the practice of nursing pursuant to Chapter 464, Florida Statutes. Respondent, Cecil Harold Floyd, was at all times material hereto a licensed practical nurse in the State of Florida, having been issued a license numbered PN 0960631. At all times material hereto, Respondent was employed as a licensed practical nurse by the North Shore Senior Adult Community in St. Petersburg, Florida. At all times material hereto, Respondent was assigned to care for Patient M.F., a patient in the skilled nursing section of the North Shore Senior Adult Community. On February 26-27, 1996, Respondent worked as the charge nurse on the 11:00 p.m. to 7:00 a.m. shift. On February 27, 1996, at approximately 6:00 a.m., Respondent wrote in the nurse's notes that Patient M.F. was lethargic and having difficulty swallowing; that the patient's bottom dentures were out; and that the patient's tongue was over to the right side. In this entry, Respondent also noted "will continue to monitor." After Respondent completed his shift on February 27, 1996, Conchita McClory, LPN, was the charge nurse in the skilled nursing facility at North Shore Senior Adult Community. At about 8:10 a.m., Nurse McClory was called by the CNA who was attempting to wake up Patient M.F. Upon Nurse McClory's entering Patient M.F.'s room, she observed that the patient was sleeping, incontinent, and restless and that the right side of the patient's face was dropping. Based on these observations, Nurse McClory believed that Patient M.F. may have suffered a stroke and she immediately called 911. Following the 911 call, Patent M.F. was taken to Saint Anthony's Hospital in Saint Petersburg, Florida. Prior to coming to this country, Conchita McClory had been trained and worked as a registered nurse in the Philippines. However, Ms. McClory is not licensed as a registered nurse in the State of Florida. Saint Anthony's Hospital's records regarding Patient M.F. indicate that the patient had a history of multiple strokes beginning in 1986. The Department’s Administrative Complaint against Respondent included the following factual allegations, all of which were alleged to have occurred on February 27, 1996: At approximately 6:00 a.m., Respondent recorded in the nurse’s notes that Patient M.F. was lethargic and having difficulty swallowing; the patient's bottom dentures were out; and the patient's tongue was over to the right side. Respondent also noted in the nurses' notes that Patient M.F. should continue to be monitored. Patient M.F.'s roommate told Respondent that she believed that M.F. had suffered a stroke because she could not swallow and her speech was slurred. At about 8:00 a.m., Patient M.F.'s roommate went to the nurses' station and requested that a certified nurse's assistant check on M.F. Patient M.F. was found paralyzed on her left side, soaked in urine and unable to speak. There was no evidence presented to support the factual allegations referenced in paragraph 9b and 9c above and included in the Administrative Complaint.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Department of Health, Board of Nursing, enter a final order dismissing the Administrative Complaint against Respondent. DONE AND ENTERED this 6th day of October, 1999, in Tallahassee, Leon County, Florida. CAROLYN S. HOLIFIELD Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 SUNCOM 278-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this 6th day of October, 1999. COPIES FURNISHED: Howard M. Bernstein, Esquire Agency for Health Care Administration Allied Health - Medical Quality Assistance 2727 Mahan Drive, Building 3 Tallahassee, Florida 32308-5403 Cecil Harold Floyd 1680 25th Avenue, North St. Petersburg, Florida 33713-4444 Ruth Stiehl, Executive Director Board of Nursing Department of Health 4080 Woodcock Drive, Suite 202 Jacksonville, Florida 32207 Angela T. Hall, Agency Clerk Department of Health 2020 Capital Circle, Southeast, Bin A02 Tallahassee, Florida 32399-1701 Pete Peterson, General Counsel Department of Health 2020 Capital Circle, Southeast, Bin A02 Tallahassee, Florida 32399-1701
The Issue The issue in this case is whether Respondent is guilty of violating Rule 59S-8.005(1)(e)2, Florida Administrative Code, for administering medications or treatments in a negligent manner and subject to discipline for unprofessional conduct under Section 464.018(1)(h), Florida Statutes. If so, another issue is what penalty should be imposed.
Findings Of Fact In June 1994 Respondent was licensed as a registered nurse, holding license number RN 2740932. Respondent had been licensed as a registered nurse since 1993 and as a licensed practical nurse since 1987. Respondent's license as a registered nurse became inactive June 21, 1995 after she failed to renew it. In the fall of 1993 East Pointe Hospital hired Respondent as a charge nurse in the transitional care unit, which had recently been started. Although Respondent had only recently become licensed as a registered nurse, the hospital hired her based partly on her current licensing and partly on her previous experience as a licensed practical nurse and respiratory therapist. During the weekend of June 24-26, 1994 Respondent worked the 7:00 pm to 7:00 am shift. As a charge nurse Respondent supervised several other nurses, typically licensed practical nurses. The charge nurse and nurses whom the charge nurse supervised sometimes divided up the patients in the unit, but the charge nurse retained supervisory authority over the other nurses and always remained directly responsible for patients with more complex problems. Patient C. P. had recently been transferred to the transitional care unit from the acute care unit. On the evenings in question, C.P. was among the patients for whom Respondent was directly responsible. Several IVs were being administered the evening of June 24 and early morning of June 25. One patient was having problems with an IV pump and his veins. Respondent asked another nurse, who was under Respondent's supervision, to do the accuchecks on the other patients, including C. P. Accuchecks are finger stick glucose monitors. As was the case with C. P., physicians typically order accuchecks every six hours for patients receiving their total nutrition intravenously. The purpose of the accucheck is to ensure that the patient receiving all his nutrition intravenously does not develop low or high blood sugar, which could have very serious implications. The other nurse failed to perform the accuchecks for midnight at the start of June 25 and 6:00 am on June 25. Respondent failed to follow up to ensure that they were done. Respondent's failure to perform the required accuchecks or to check to make sure that the other nurse performed them constitutes the negligent treatment of a patient. A physician had also ordered that C. P. receive antibiotics intravenously every eight hours, at about 6:00 am, 2:00 pm, and 10:00 pm. Petitioner alleges that Respondent failed to administer two consecutive doses. However, nothing in the nurses' notes documents what would have been a material omission, and no one on the nursing staff bothered to contact the physician who had ordered the antibiotics. There is also a reasonable possibility that IV bags bearing dates and times were mixed up so as to preclude a determination of which registered nurse failed to administer IV medication, if in fact two doses of antibiotics were missed. Respondent later admitted not performing the accuchecks, but never admitted failing to administer the IV antibiotics. Petitioner has failed to prove that Respondent failed to administer the IV medications as ordered. The hospital terminated Respondent's employment shortly after the incidents involving C. P. Respondent has since held two temporary nursing jobs and has applied unsuccessfully for 12 other nursing jobs. She now lives with her mother in Virginia where she earns $100-$200 weekly in employment unrelated to nursing. C. P. suffered no injury as a result of the failure to conduct ordered accuchecks and the failure, if any, to administer the prescribed IV. Respondent has not previously been disciplined as a licensed practical nurse or registered nurse.
Recommendation It is RECOMMENDED that the Board of Nursing enter a final order finding Respondent guilty of violating Rule 59S-8.005(1)(e), Florida Administrative Code, and Section 464.018(1)(h), Florida Statutes, for her failure to perform two accuchecks or make sure that another nurse had performed them and issuing a reprimand to Respondent. ENTERED on December 21, 1995, in Tallahassee, Florida. ROBERT E. MEALE Hearing Officer Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 21st day of December, 1995. APPENDIX Rulings on Petitioner's Proposed Findings 1-4: adopted or adopted in substance. 5: rejected as irrelevant. 6-12 (first sentence): adopted or adopted in substance. 12 (second sentence): rejected as subordinate and irrelevant. 13-15: rejected as subordinate. 16: rejected as subordinate and irrelevant. 17-18: adopted or adopted in substance. 19-21: rejected as subordinate and recitation of testimony. 22-23: rejected as irrelevant and subordinate. 24: rejected as subordinate. 25: rejected as subordinate and irrelevant. 26-28: adopted or adopted in substance. 29: rejected as irrelevant. Rulings on Respondent's Proposed Findings 1-3 (first sentence): adopted or adopted in substance. 3 (first sentence)-4: rejected as subordinate and irrelevant. 5-6: adopted or adopted in substance, although not as to the identify of the other nurse. 7: adopted or adopted in substance, except that the failure either to perform the accuchecks or ensure that the other nurse did is negligence. 8-14: rejected as subordinate. 15-18: adopted or adopted in substance. COPIES FURNISHED: Laura P. Gaffney, Senior Attorney Agency for Health Care Administration General Counsel's Office Department of Business and Professional Regulation 1940 North Monroe Street, Suite 60 Tallahassee, FL 32399-0792 Robert E. Tardif, Jr. Duncan & Tardif, P.A. P.O. Drawer 249 Ft. Myers, FL 33902 Linda Goodgame, General Counsel Department of Business and Professional Regulation 1940 North Monroe Street Tallahassee, FL 32399-0792 Judie Ritter, Executive Director Board of Nursing Daniel Building, Room 50 111 East Coastline Drive Jacksonville, FL 32202
The Issue The issues are whether Respondent violated Section 464.018(1)(h), Florida Statutes, and Rules 64B9-8.005(2) and 64B9-8.005(12), Florida Administrative Code, and if so, what penalty should be imposed.
Findings Of Fact Petitioner is the agency charged with the regulatory and prosecutorial duties related to nursing practice in Florida. Respondent is a licensed practical nurse in Florida, holding license no. PN 0481631. From May 13, 1992, to April 11, 1997, she was employed by Southlake Nursing and Rehabilitation Center (Southlake). On April 9, 1997, Respondent worked as a nurse on the 3:00 p.m. to 11:00 p.m. shift on Southlake's A wing. T.C. was a patient of another nurse on that wing. Around 7:00 p.m., Respondent began administering medications to her patients. Melody Perez, the ward clerk, informed Respondent that T.C. needed assistance because he was in respiratory distress. T.C. was sitting in the hall, six to eight feet from Respondent. Respondent went over to T.C., checked to make sure that there was oxygen in his tank and that his nasal cannula was in place. Respondent saw no outward symptoms of T.C. being in acute respiratory distress such as rapid breathing or anxiety. Respondent told Ms. Perez that she could not help T.C. because he was not her patient. She told T.C. that his nurse, who was on break and had the keys to the other medication cart, would be back in a few minutes. Respondent thought that T.C. just wanted his medications. She did not perform a nursing assessment, as that term is commonly understood in the practice of nursing. She did not take T.C.'s vital signs, count his respirations, or listen to his chest. After telling him to wait for his nurse, she just walked away. On April 10, 1997, T.C. and another resident complained to Southlake's administrative staff about Respondent's failure to help T.C. Southlake initiated an investigation based on these complaints. Conchita Griffin, Southlake's Assistant Director of Nursing, conducted the investigation. As was the custom and procedure at Southlake, Ms. Griffin interviewed T.C., the second complaining resident, Ms. Perez, and two certified nursing assistants (CNAs) who were on duty during the incident. Ms. Griffin then compiled a written report of the incident and submitted it to Southlake's administration. Based on her investigation, and after considering Respondent's disciplinary history at Southlake, Ms. Griffin recommended that Southlake terminate Respondent. Southlake had written policies requiring a nurse to attend to any resident who needed help. The policies require a nurse to assess a patient complaining of respiratory distress by taking the patient's vital signs, listening to respirations and to the chest for congestion. According to the policies, a nurse should attend to any patient in distress, calling the patient's assigned nurse, facility management, or 911 if needed. There are no circumstances where the nurse should do nothing. On April 11, 1997, Respondent was called in and asked about her side of the incident. She admitted that she looked at T.C. and that he did not appear to be in distress. She acknowledged that she did nothing except tell T.C. that his nurse would be back soon. When informed that she was being terminated, Respondent refused to sign the disciplinary form. She was asked to leave the premises immediately. Sharon Wards-Brown, Southlake's nursing supervisor for the evening shift in question, accompanied Respondent to A wing to retrieve her belongings. When Respondent arrived on the A wing, she went into the medication room, picked up T.C.'s chart, removed some pages from the chart, and went to the fax machine just outside the medication room. Ms. Wards-Brown and Beverly Burstell, the nurse manager who was on the floor checking some charts, saw Respondent remove the pages from T.C.'s chart and go to the fax machine. Both of them told Respondent that she could not remove or copy anything from the resident's chart. Respondent told Ms. Wards-Brown and Ms. Burstell not to touch her. Each page of nurses' notes in the patients' charts have a front and back side. Respondent stood at the fax machine for only a couple of seconds, not long enough to copy both sides of one page of nurses' notes. She certainly did not have time to copy both sides of all of the pages that she had removed from T.C.'s chart. Respondent's testimony that she had time to copy some of the nurses' notes from T.C.'s chart is not persuasive. Her testimony that she left all of the original pages in the fax machine is not credible. After being prevented from copying all of the pages that she had removed from T.C.'s chart, Respondent ran into the bathroom. A few seconds later she came out of the bathroom with papers and her purse in her hand. Ms. Wards-Brown called Clara Corcoran, Southlake's administrator, and Ms. Griffen for assistance. All three of them followed Respondent out of the building, demanding that she return the documents that she had removed from T.C.'s chart. Respondent repeatedly told them not to touch her. Ms. Corcoran and Ms. Griffen followed Respondent into the parking lot. Respondent got in her car but Ms. Corcoran and Ms. Griffen blocked Respondent from closing the car door and continued to demand the return of the papers. Respondent finally drove forward over the cement bumper and the grass in order to leave with the papers. Meanwhile, Ms. Wards-Brown returned to the A wing to examine T.C.'s chart. Ms. Griffen also examined the chart within two to three minutes after Respondent left the floor. The chart was still open on the desk. Ms. Wards-Brown and Ms. Griffen discovered that T.C.'s nurses' notes for April 9, 1997, were missing. They knew the notes were missing because both of them had seen the notes in the chart the day before when they reviewed the chart as part of the investigation. Respondent's Exhibit 2 is a copy of the front and back of one page of T.C.'s nurses' notes. The last note is dated March 27, 1997. It is not plausible that T.C.'s chart had no nurses' notes from that time until after April 10, 1997. Even if Respondent did not remove any of T.C.'s original nurses' notes from the premises, she violated the acceptable standards of nursing care by copying the front and back of one page and removing the copies from the facility.
Recommendation Based on the foregoing Findings of Facts and Conclusions of Law, it is RECOMMENDED: That Petitioner enter a final order fining Respondent $1,000 and suspending her license for one year, followed by two years of probation with appropriate conditions. DONE AND ENTERED this 10th day of October, 2000, in Tallahassee, Leon County, Florida. SUZANNE F. HOOD Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 SUNCOM 278-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this 10th day of October, 2000. COPIES FURNISHED: Diane K. Kiesling, Esquire Agency for Health Care Administration 2727 Mahan Drive Building 3, Room 3231A Tallahassee, Florida 32308 Thomas A. Delegal, III, Esquire Randy Rogers, Esquire Delegal & Merritt, P.A. 424 East Monroe Street Jacksonville, Florida 32202-2837 Ruth R. Stiehl, Ph.D., R.N. Executive Director Board of Nursing Department of Health 4080 Woodcock Drive, Suite 202 Jacksonville, Florida 32207-2714 Theodore M. Henderson, Agency Clerk Department of Health 4052 Bald Cypress Way, Bin A00 Tallahassee, Florida 32399-1701 William W. Large, General Counsel Department of Health 4042 Bald Cypress Way, Bin A02 Tallahassee, Florida 32399-1701
Findings Of Fact During early 1982, Petitioner submitted an application for licensure as an Advanced Registered Nurse Practitioner in the category of Midwifery. Petitioner's application was reviewed by the Respondent, Board of Nursing, on July 21, 1982. By letter of that date, Petitioner was advised that her application for certification as an Advanced Registered Nurse Practitioner did not meet the criteria for certification as set forth and defined in Section 464.012(1), Florida Statutes. Specifically, Petitioner was advised that: The midwifery training that she completed in 1962 in England was note post-basic. Enrollment as a midwife on the Central Midwife's Board has not been recognized as an "an appropriate" specialty board for certifi- cation as an Advanced Registered Nurse Practitioner, and The master's degree preparation that Petitioner acquired is not from a program leading to a master's degree in a nursing clinical specialty area. (Petitioner holds a master's degree in Education) Petitioner was further advised that she had one other means of being certified. I.e., that "registered nurses who have received their midwifery training outside the United States may be certified if they have completed an American college of nurse midwifery approved refresher program and the registered nurse is deemed eligible to take the ACNM examination. [Rule 210-11.23(2)(c), Florida Administrative Code] (Petitioner's Exhibits 2 and 3) Petitioner is a currently licensed registered nurse in the State of Florida, having been issued license number 30882-2, on January 1, 1964, by examination. Further, Petitioner was admitted to the Central Midwives' Board (London, England) after successfully completing a one year course of training undertaken by pupils who had previously qualified as state- registered general trained nurses. Petitioner took a three years' course of general nurse training at Bedford General Hospital from 1957 through 1960 and commenced midwifery training on August 1, 1961, as confirmed in the verification of her training and enrollment as a midwife. Debra Fitzgerald, a resident of Atlanta, Georgia, on May 26, 1983, was previously employed by the Respondent, Board of Nursing, from July, 1980 to February, 1983, as a nursing consultant in the educational section dealing primarily with the certification of applicants in the field of ARNP. As part of her duties as an employee of the Respondent, Ms. Fitzgerald reviewed the application of the Petitioner for certification as an ARNP. Upon review of the Petitioner's application, it is determined that the program that the Petitioner attended in midwifery during 1961-1962 in England was not a formal post-basic program equivalent to the standards required of formal post-basic programs in this country. Rule 21D-11.24, Florida Administrative Code. Petitioner was given credit for a total of one hundred four (104) didactic hours and the Board requires a minimum of one hundred twenty (120) didactic hours for proof of the equivalent of a post-basic course requirement in obstetrical nursing. (Testimony of Fitzgerald [by deposition]) Petitioner has not otherwise satisfied the criteria to be certified in keening with Rule 21D-11.23(2)(c)1 or 2, Florida Administrative Code.
The Issue The issue is whether Respondent's license as a practical nurse should be disciplined for the reasons given in the Administrative Complaint.
Findings Of Fact Based upon all of the evidence, the following findings of fact are determined: In this disciplinary proceeding, Petitioner, Department of Health, Board of Nursing (Board), has alleged that Respondent, Sheila Key, a licensed practical nurse, failed to conform to minimal standards of acceptable nursing practice while employed as a practical nurse at Florida Christian Health Center (FCHC), in Jacksonville, Florida, in the Fall of 1999. Respondent holds license number PN 0792331 issued by the Board. The allegations against Respondent arose as a result of a routine Agency for Health Care Administration (AHCA) licensure survey of the facility on October 1, 1999. On that date, an AHCA survey team found an elderly resident with a head injury whose nursing notes had not been properly charted; a resident in the recreation area with blood on her gown and requiring medical attention; and a third resident with unattended sores on his ankles. All were under the direct care of Respondent. As to the first resident, the Board charged Respondent with failing to document the resident's head injury or condition in her nursing notes. In the second case, she was charged with failing to notify a physician or other responsible party in a timely manner about the injury and applying "steri-strips without a physician's order." Finally, Respondent was charged with failing and refusing "to comply with the surveyors' request" that she "remove [the patient's] socks so the ankle area on his feet could be observed." Each of these charges will be discussed separately below. Around 5:15 p.m. on September 30, 1999, A. B., an eighty-seven-year-old male resident at FCHC, acidentally fell and sustained an injury to his head that required emergency room treatment. A. B. returned to FCHC from the emergency room sometime after 9:00 p.m. Respondent reported for duty at 7:00 p.m. that same evening. Although good nursing practice dictated that Respondent promptly perform a neurological check on A. B. after he returned from the hospital, she failed to do so and did not perform one until 7:00 a.m. the next day (October 1). Even then, she failed to document any of her findings in the resident's nursing notes. By failing to document "the fall or his condition" in the nursing notes until the morning following the injury, Respondent failed to conform to the minimal standards of acceptable prevailing nursing practice. Around 7:40 a.m. on October 1, 1999, M. C. suffered a laceration on her neck while being transferred from her bed to a wheelchair. Respondent applied steri-strips to the wound, but she did not have a physician's order to do so. Also, she failed to document the neck wound or her treatment of the wound until 10:45 a.m., or more than three hours later. Finally, M. C.'s physician was not notified about the injury until around 12:15 p.m. FCHC has a written policy entitled "Changes in a Resident's Condition Status," which requires that the nurse promptly notify the resident, the resident's physician, and the resident's family of changes in the resident's condition. Thus, a nurse must notify the resident's attending physician and family whenever the resident is involved in any accident or incident that results in an injury. If the injury is of an emergency nature, such notification is required within thirty minutes to an hour. The evidence establishes that M. C.'s injury was of a type that required notification within this short time period. By waiting for almost five hours to notify M. C.'s physician about the injury, Respondent failed to conform with minimally acceptable nursing practices. She also violated the same standard by applying steri-strips to the injury without a doctor's order. Finally, she failed to conform to minimally acceptable nursing practices by not charting the injury in the nursing notes until more than three hours had elapsed. During the October 1, 1999, inspection, a member of the survey team asked Respondent to remove the socks and dressings on J. R., a resident. The request was made since the team could see a brown discharge on the inner aspects of his socks. Respondent would not do so, and eventually an assistant director of nursing performed that task. After the socks were removed, the survey team found old dressings through which drainage had soaked. They also observed sores that had thick yellow or serosanguinous drainage. Even though the sores had been there for at least a week or so, dressings had been previously applied, and the soaked socks were clearly visible, Respondent had failed to check the resident and was therefore unaware of his condition. Despite this omission, however, Respondent was only charged with failing and refusing "to comply with the surveyors' request," and not with inappropriate conduct with respect to the care of the resident. By failing to respond to a reasonable and legitimate request to remove the resident's socks so that a suspicious area could be observed, Respondent failed to conform to minimally acceptable standards of prevailing nursing practice. Respondent failed to admit responsibility for any of the foregoing violations. As to the resident with the neck wound, Respondent contended that the wound was not serious. However, it was serious enough that the resident's physician believed emergency room treatment was necessary. Respondent also contended that the assistant director of nursing (Widhalm) advised her that she (Widhalm) would call M. C.'s physician, an assertion which Widhalm credibly denied. Respondent further contended that she failed to chart A. B.'s nursing notes because the chart was in the hands of the surveyors. Under those circumstances, however, acceptable protocol requires that the nurse request the return of the notes so that essential information can be timely recorded. Finally, Respondent contended that the surveyor had told her that she could finish her "medication pass" before removing the socks and could do so whenever she had time. This assertion is not deemed to be credible.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Board of Nursing enter a final order finding that Respondent is guilty of the violations described in the Administrative Complaint. It is further recommended that Respondent be fined $1,000.00, given a reprimand, and placed on probation for two years subject to such conditions as the Board deems appropriate. DONE AND ENTERED this 7th day of November, 2000, in Tallahassee, Leon County, Florida. DONALD R. ALEXANDER Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 SUNCOM 278-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this 7th day of November, 2000. COPIES FURNISHED: Ruth R. Stiehl, PhD., R.N., Executive Director Board of Nursing Department of Health 4080 Woodcock Drive, Suite 202 Jacksonville, Florida 32207-2714 Diane K. Kiesling, Esquire Agency for Health Care Administration Building 3, Room 3231A 2727 Mahan Drive Tallahassee, Florida 32308 Sheila Key 3651 Dignan Street Jacksonville, Florida 32254 William W. Large, General Counsel Department of Health 4052 Bald Cypress Way Bin A02 Tallahassee, Florida 32399-1701
The Issue The issues under consideration here are based upon an Administrative Complaint in Department of Professional Regulation Case No. 0104255. Through this complaint, the Petitioner has accused the Respondent of violation of Section 464.018(1)(f), Florida statutes related to a claim that she has acted unprofessionally in her nursing practice. The Operative paragraphs of that complaint are as follows: At all times material hereto, Respondent was employed at Methodist Hospital, Jacksonville, Florida. On or about August 15, 1988, while working the 3-11 shift, the Respondent felt ill due to her pregnancy and telephoned the nurse manager from the previous shift to obtain permission to leave. The Respondent was granted permission to leave, but she neglected to inform the nurse manager that an agency nurse had failed to report in and that another nurse had threatened to leave if the Respondent was allowed to do so. The despondent's absence left only one nurse to care for twenty patients, and she failed to convey this information to the nurse manager prior to departing.
Findings Of Fact In those times pertinent to the dispute, Respondent was licensed as a registered nurse by the State of Florida, under license number RN-1271152. On August 15, 1988, Respondent was working as a staff nurse at Methodist Hospital, Jacksonville, Florida. Her shift on that day was from 3:00 p.m. to 11:00 p.m. in a medical/surgical floor, which is referred to as "3 Plaza II". On that shift, she was the Charge Nurse among the four nurses who were to work that shift. The other nurses scheduled to work on that shift were Rachel Calhoun, Rizalina Chu, and a nurse to be assigned from an agency other than Methodist Hospital. The person that the referring agency intended to send to work the 3:00 p.m. - 11:00 p.m. shift was Helen Lesters. In addition, Theresa Harrison was a nursing assistant assigned to that shift. The nurses were responsible for the care of 19 patients, with the expectation that an additional patient would be admitted to that floor during the 3:00 p.m. - 11:00 p.m. shift. The shift responsibilities for the Respondent and the other nurses had been established by Juliete Williams, R.N. who had worked the 7:00 a.m. - 3:00 p.m. shift at "3 Plaza II", and whose position at that time was one of Head Nurse or Nurse Manager. The schedule that Williams had prepared anticipated that each nurse on the 3:00 p.m. - 11:00 p.m. shift would be responsible for five patients. The Nurse Assistant, Theresa Harrison, was not contemplated as having responsibility in this connection because she was not capable of performing nursing duties. Helen Lesters had been hired through Nurse Finders of Jacksonville through the efforts and coordination on the part of Methodist Hospital and its Staffing Coordinator Helen McGrath. When Respondent arrived at work at 3:13 p.m. on August 15, 1987, she was not feeling well, suffering moderate discomfort associated with a condition known as round ligament pain. That ailment is a sporadic condition common to pregnancy. On August 15, 1989, Respondent was five months pregnant. The round ligament pain had also been prevalent on August 5, 1987. Again, on August 14, 1988, when Respondent went to work, she was not feeling well because of that problem. When she went home that evening after her shift, she was tossing and turning and didn't feel well because of round ligament pain. The scheduling that had been arranged by Ms. Williams was to meet an acuity level related to the patients in a setting which three nurses and an aide was allowed as a staff component. An extra nurse had been placed on that shift. The beginning of the 3:00 pm. - 11:00 pm. shift was somewhat hectic. Somewhere along the way, it was noted that Ms. Lesters had not shown up for her shift. Under those circumstances, there was a discussion between the Respondent and Ms. Calhoun about going home in view of the fact that Ms. Lesters had not come in. 9 The situation of a missing nurse was not uncommon in the hospital and Respondent and Ms. Calhoun had commented on the problems of working with a shortage in nursing staff on other occasions. Throughout the time that Respondent remained at the hospital on August 15, 1988, she was experiencing discomfort in her pregnancy associated with round ligament pain. That condition intensified while she was there. Theresa Harrison called Frona Montgomery to advise Ms. Montgomery that the agency nurse, Ms. Lesters, had not arrived. That call took place sometime before 3:30 p.m. Ms. Montgomery was the Clinical Coordinator at Methodist Hospital on the 3:00 p.m. - 11:00 p.m. shift and as such was responsible for nurses on five floors to include "3 Plaza II". This made her Respondent's immediate supervisor on that date. Under these circumstances, Ms. Montgomery called Helen McGrath, Staffing Coordinator for Methodist Hospital who attempted to find out from Nurse Finders, the agency, why Ms. Lesters had not come in for her shift. She was told that Ms.. Lesters was having babysitting problems and that no substitute nurses were available from that agency. Ms. McGrath's attempts to find replacement nurses from other referral agencies was unsuccessful. The call from Ms. Montgomery to Ms. McGrath to explain the problem took place around 3:15 p.m. Ms. McGrath also tried to call in 8 or 10 nurses on the Methodist Hospital staff, but without success. McGrath became aware of a message from Respondent which had been left around 3:00 p.m. McGrath returned that call around 4:00 p.m. and spoke to Ms. Calhoun and told Ms. Calhoun that the agency nurse was not going to show but an attempt was being made to replace her. Ms. Calhoun told Mrs. McGrath that Respondent was going home and if she went home, Ms. Calhoun would also go home. Around 3:30 p.m., Respondent called Ms. Montgomery and told Ms. Montgomery that if the hospital did not get an agency nurse, a replacement, that Respondent was going home because she was sick. Ms. Montgomery responded that that floor was allocated another nurse and that Ms. Montgomery was working to get one and that she thought they should be able to get one. Ms. Montgomery had in mind calling persons such as Sylvia Brooks and Helen Brown, nurses from the 11:00 p.m. - 7:00 a.m. shift and others as well. Ms. Montgomery had had success in the past with getting Sylvia Brooks to come in. Ms. Montgomery did not give the Respondent permission to leave her floor. Respondent's circumstance was not such a dire emergency that she would have been justified in leaving without being relieved. Not long after Respondent called Ms. Montgomery, Ms. Montgomery received a call from Ms. Calhoun who stated that, "if Respondent goes home, I'm going home too." Although Respondent had heard Ms. Calhoun express her intention to leave if Respondent left, she did not communicate this information to Ms. Montgomery nor did the Respondent describe to Ms. Montgomery the fact of the non- appearance of Ms. Lester or a replacement for her. Nonetheless, Ms. Montgomery was aware of the missing agency nurse and stated intentions of Ms. Calhoun to leave if Respondent did. Around 4:00 p.m., Respondent telephoned Ms. Williams and told Ms. Williams that she was ill and had to leave. Ms. Williams asked Respondent if she had spoken to Ms. Montgomery and Respondent stated that she had. Ms. Williams then replied "O.K.". The impression that Ms. Williams was given out of this conversation was that Ms. Montgomery had allowed the Respondent to leave. Moreover at that time, Ms. Williams did not realize that the situation on the floor would be something other than three nurses remaining and a Nursing Assistant. Respondent without revealing the true nature of the circumstance to Ms. Williams, understood Ms. Williams' statement of "O.K" to mean that Respondent had permission to leave. In not telling Ms. Williams of the fact of the missing agency nurse and Ms. Calhoun's protestations about staying if Respondent left, she mislead Ms. Williams and any implicit permission to leave given by Ms. Williams was without value. Sometime past 4:00 p.m., nurse Chu called Ms. Montgomery because Respondent said she had called Ms. Williams and that she, Respondent, was going home. In addition, Ms. Calhoun was carrying her pocketbook as if to leave. In the conversation with Ms. Montgomery, Ms. Chu asked Ms. Montgomery if she was aware that Ms. Brown and Ms. Calhoun were going home and that Ms. Chu would be by herself. Ms. Montgomery replied that she wasn't aware and that Ms. Chu should not let Respondent and Ms. Calhoun leave because Ms. Montgomery was trying to get help. Ms. Chu then told the Respondent and Ms. Calhoun not to go home. In the conversation between Ms. Chu and Ms. Montgomery, Ms. Montgomery told Ms. Chu to explain to the Respondent and Ms. Calhoun not to leave because Ms. Montgomery believed that Lisa would come in. This refers to Lisa Jenkins who works as a nurse and who is normally on the 3:00 p.m. - 11:00 p.m. shift with the Respondent and Ms. Calhoun. When Ms. Chu told the Respondent that Ms. Montgomery was calling Lisa Jenkins, Respondent said that she did not believe that. When it was apparent to Ms. Chu that the Respondent and Ms. Calhoun were leaving, she attempted to call Ms. Montgomery again and the line was busy. As a consequence, she called Ms. Williams and in that conversation she stated to Ms. Williams that she wanted Ms. Williams to be aware that Ms. Chu was by herself and that the Respondent and Ms. Calhoun were going. Respondent and Ms. Calhoun were at the elevator door at that moment. During this conversation, Ms. Calhoun and Respondent left the floor. Ms. Williams told Ms. Chu to tell them that they could not do that. Ms. Chu replied, "Well, they're gone". Ms. Williams said that she would then come in. Respondent and Ms. Calhoun left the floor around 4:35 p.m. Ms. Montgomery came to help Ms. Chu around 4:45 p.m. In the interim, Ms. Chu was left alone to serve the needs of the 19 patients. Ms. Montgomery is a nurse and could offer assistance as a nurse. Fortunately, no problems occurred with the patients in the absence of an adequate nursing staff. Ms. Williams arrived on the floor around 5:20 p.m. and Ms. Brooks thereafter. According to Ms. Williams whose opinion is accepted, it was necessary to have at least two nurses on duty on "3 Plaza II" on the date in question. The patients who were on the floor were regular medical patients with one or two recovering from surgery. The person responsible for the Respondent in a supervisory capacity on a shift 3:00 p.m. - 11:00 p.m. on August 15, 1988 was Ms. Montgomery. Respondent did not receive her permission to leave and should have not have left with Ms. Calhoun before relief help arrived. In doing so, Respondent left Ms. Chu to contend with a situation in which the patient acuity demanded more of a response in nursing staff. While it is recognized that the Respondent was experiencing some discomfort due to her pregnancy, the more prudent course of conduct would have been to advise the hospital of her illness before coming to work so that some attempt might be made to gain a replacement. Having determined to attend her duties, it was incumbent upon her to remain in her place of employment until a replacement nurse could be found.
Recommendation RECOMMENDED: that a Final Order be entered which finds the Respondent in violation of Section 464.018(1) (f), Florida Statutes for reasons described and places the Respondent on probationary for a period of one year commensurate with terms which the Board feels would be advantageous to the rehabilitation of despondent. DONE and ENTERED this 19th day of October, 1989, at Tallahassee, Florida. Hearings 1550 CHARLES C. ADAMS Hearing Officer Division of Administrative The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399- (904) 488-9675 Hearings 1989. Filed with the Clerk of the Division of Administrative this 19th day of October, APPENDIX TO RECOMMENDED ORDER The following discussion is made of the proposed facts of the parties: PETITIONER'S FACTS 1.-18. subordinate to facts found. 19.-20. The facts in which it is suggested that Respondent had not informed Ms. Montgomery that Ms. Calhoun might also appear are Ms. leave or the failure of the agency nurse to not significant under the circumstance in which Montgomery knew those facts. 21.-22. Subordinate to facts found. 23. Contrary to the facts found. 24.-27. Subordinate to facts found. The initial sentence within paragraph 28 is contrary to facts found. The latter sentence in that paragraph is a correct statement but not necessary. Subordinate to facts found. Not proven. 31.-32. Subordinate to facts found. 33.-34. Not significant in that Ms. Montgomery knew of the from proposed the Ms. circumstances without reference to information Respondent. Additionally, these references in fact finding as well as previous references in proposed fact findings as to the duty to disclose Montgomery do not track the Administrative Complaint in which the allegation is the failure to disclose to Ms. means Williams and may not be properly considered as a of discipline against Respondent. 35.-36. Subordinate to facts found. 37. Is relevant. RESPONDENT'S FACTS 1. Is a reiteration of the statement of the Issues. Subordinate to the facts found. 7. Correct as far as it is stated. What it neglects to receive shift. do, is to indicate that the Respondent did not permission from Ms. Montgomery to leave her COPIES FURNISHED: Judie Ritter, Executive Director Board of Nursing Department of Professional Regulation 504 Daniel Building 111 East Coastline Drive Jacksonville, FL 32202 Kenneth E. Easley Department of Professional Regulation General Counsel 1940 North Monroe Street Tallahassee, FL 32399-0792 Lisa M. Bassett, Esquire Department of Professional Regulation 1940 North Monroe Street Suite 60 Tallahassee, FL 32399-0792 Courtney Johnson, Esquire The Law Exchange Building 24 North Market Street Suite 400 Jacksonville, FL 32302
Findings Of Fact Respondent, Barbara Jiminez, is a licensed practical nurse (LPN) in the State of Florida, having been issued license number PN 0812181. At the time of the incident involved in this case, Respondent was a LPN. In 1987, Respondent was employed as a licensed practical nurse by Holly Point Manor, a nursing home located in Orange Park, Florida. Respondent was also employed as a LPN by another nursing home in the area. She was scheduled to work the 3:00 p.m. to 11:00 p.m. shift at Holly Point Manor. Holly Point Manor was a new facility and had opened in November, 1987. Only one wing of the facility was open and in December, 1987, Holly Point Manor serviced approximately 50 patients. On December 21, 1987, Respondent presented a letter of resignation to Tom Burrell, Director of Nursing at Holly Point Manor. The resignation was effective December 20, 1987. The resignation was precipitated by a verbal altercation with Liz McClain, a certified nursing assistant (CNA) at Holly Point Manor. The verbal exchange occurred on December 20, 1987. However, difficulties between Respondent and Ms. McClain had been brewing for a period of time prior to the verbal exchange of the 20th. After discussing the letter with Burrell, Respondent agreed to work on an as-needed basis at the facility. Burrell indicated that he needed Respondent to work until the beginning of the year, and therefore scheduled the Respondent for the remainder of December. Respondent was scheduled to work her usual shift on December 23, 24, and 25, 1987. She was scheduled to work with Virginia Anderson. Ms. Anderson is also a LPN. On December 23, 1987, Respondent clocked in for work at approximately 2:40 p.m. EST and clocked out the same day at 3:40 p.m. EST. On December 23, 1987, the Respondent and Virginia Anderson began work before the 3:00 p.m. change-of-shift. At shift change, both nurses went into the medication room to "take report" from Nurse Jan Sturgeon, the LPN who had worked the previous shift. A "report" at the change of shift consists of the previous shift's nurse going down the list of each resident/patient and reporting each patient's respective condition to the on-coming nurse. Part of the report includes counting the medications on the medication cart to ensure a correct count in the narcotic drawer of each cart. In this case, there were two medication carts, one for each of the on-coming nurses. These carts are locked and the nurse responsible for the cart maintains possession of the keys to that cart. Ms. Sturgeon "reported off" first to Ms. Anderson, and then to Respondent. Ms. Anderson began her rounds after receiving a report and keys to her cart from Ms. Sturgeon. Subsequently, Respondent received a report and keys to her cart from Ms. Sturgeon. At some time during Respondent's clocking in and taking report, a problem arose over the staffing assignments of the C.N.A.'s. Respondent was the nurse responsible for making the CNA assignments. However, Nurse Anderson had already created patient-care assignments for the CNAs after one C.N.A. had failed to report for work.1/ The Respondent was not satisfied with the assignments created by Anderson and either requested that they be changed or changed them herself. The request or change immediately caused a bad atmosphere between the employees on the wing. Around 3:30 p.m., Respondent telephoned Tom Burrell. Respondent told Burre11 that she couldn't take it anymore and that she was leaving. Burrell told Respondent that she was scheduled to work and if she left she would be reported for what was, in his opinion, a violation of the Nurse Practice Act. Burrell did not give Respondent permission to leave. Either before or after the call to Burrell, Nurse Eppert, the Assistant Director of Nursing, told the Respondent that in her opinion there was nothing wrong with the C.N.A. assignments. Respondent stated, "Here's my keys - - I'm leaving." Eppert informed Respondent that she had no replacement nurse and did not want her to leave. Respondent pointed out that Ms. Sturgeon was still present. Eppert reminded Respondent that Sturgeon was off duty. Eppert then told Respondent to give a report to Nurse Anderson. She refused and told Ms. Anderson to get the report from Ms. Sturgeon who had just given the report to Respondent. Since Respondent had not begun her rounds, Ms. Sturgeon's report was still valid and the narcotic count had not changed. Respondent left Holly Point Manor. The Respondent did not positively know at the time she left whether Nurse Sturgeon would remain to assist. The Respondent did not stay to determine whether Sturgeon would, in fact, cover the shift. However, the evidence did show that Ms. Sturgeon tacitly agreed to stay before Respondent left the facility. Nurse Sturgeon was not the type of person to decline to help when the need arose. After the Respondent left, Jan Sturgeon formally agreed to stay to assist with the 5 p.m. medication pass. She agreed because Ms. Eppert could not find anyone to work due to the closeness of the holidays. After the medication pass, Ms. Sturgeon left for the evening and Ms. Anderson handled the shift by herself. One nurse working the night shift alone was not an unusual event at Holly Point and occurred frequently. In fact, Ms. Anderson had worked the previous evening's shift by herself. One nurse to 50 patients meets HRS staffing requirements for nursing home facilities. However, the hardest part of the evening shift for a solo nurse was the 5:00 p.m. medication pass. Later, the facility was able to retain a replacement nurse for the 24th and 25th. It is not an acceptable nursing practice for a nurse to leave his or her employment until that nurse is sure that somebody else is going to take care of the patients the nurse is responsible for. In this case, Respondent failed to positively ensure someone would replace her. Reliance on tacit agreement by either of the other two nurses is not enough. Likewise, past practice of the facility is not enough. Reliance on tacit agreement or past practice is too amorphous to insure protection and the safety of the patients the nurse is responsible for. However, tacit agreement and past practice do go towards mitigation of any disciplinary penalty in this case. Respondent's actions by not ensuring her replacement or at least the need for such a replacement constitutes unprofessional conduct in the practice of nursing Likewise, it is not an acceptable nursing practice for an LPN to leave without giving another nurse a report on patients that that nurse would be assuming and before counting the medications on the medication cart. However, in this case, the evidence demonstrated that a replacement was there whose earlier report was still accurate and valid. Therefore, formal patient reporting and narcotics counting was not necessary or required. 2/ Respondent is not subject to discipline under this standard.
Recommendation Based upon the foregoing Proposed Findings of Fact and Conclusions of Law, it is: RECOMMENDED that Petitioner enter a Final Order reprimanding the Respondent's license, and requiring her to take courses in the Legal Aspects of Nursing and in Stress Management within a 6 month time period. DONE and ENTERED this 19 day of October, 1989, at Tallahassee, Florida. DIANE CLEAVINGER Hearing Officer Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 19 day of October, 1989.
The Issue Whether Petitioner should be issued a license as a Licensed Practical Nurse, pursuant to Chapter 464, Florida Statutes.
Findings Of Fact Petitioner Mary Ellen Stone Zirkle, Huntington, West Virginia, submitted an application for Licensed Practical Nurse by Endorsement to Respondent Florida State Board of Nursing, dated August 29, 1978. The application was denied by Respondent by letter of September 28, 1978, for the reason that Petitioner had not completed a program approved by the Board for the preparation of Licensed Practical Nurses and had not completed the 12th grade. Petitioner, through her counsel's letter of October 19, 1978, requested an administrative hearing. (Exhibit 1, Case File) Petitioner attended high school in West Virginia for three years from 1940 to 1943. In November, 1958, she received a certificate from the Huntington East High Trades School, Huntington, West Virginia, certifying that she had completed the requirement in practical nursing prescribed in the adult trade extension program sponsored by the Practical Nurses of West Virginia, Inc., District No. II, and the National Association for Practical Nurse Education. The course in practical nursing consisted of 285 hours of classroom work which involved class attendance for two nights a week for approximately one and one- half years. Although the school was not accredited by the West Virginia State Board of Examiners for Practical Nurses until 1961, West Virginia permitted individuals who had engaged in practical nursing for a period of three years to be issued a license as a practical nurse by waiver. It further authorized such individuals who had completed extension courses equal in theory to those for the graduate practical nurses to thereafter take the examination prescribed by the Board and obtain a license without the designation of "waiver" thereon. In this manner, Petitioner obtained her West Virginia license by waiver on November 6, 1958 and, in 1959, she passed the State Board examination. During the time Petitioner attended the extension course at Huntington East High Trades School, she was simultaneously employed at Cabell Huntington Hospital performing the duties of a practical nurse. During the period March - September, 1960, she attended a "post graduate educational program" at the hospital in operating room technique and was awarded a certificate of graduation. She thereafter was employed as a licensed practical nurse at Doctor's Memorial Hospital, Huntington, West Virginia, from 1962 until 1976. Her duties included working in all areas of surgery as well as general central service type functions in the general nursing units. In 1974, she satisfactorily completed a required course of studies in operating room technician refresher program which consisted of 80 hours of classroom work. She was also certified as an Operating Room Technician in 1974. (Exhibits 2-6, 7-8) Petitioner submitted letters from the various physicians familiar with her performance of duty at Doctor's Memorial Hospital who "found her to be reliable and efficient in the Operating Room and seemingly quite knowledgeable as a Staff Nurse in the general nursing departments." Her former supervisor at Doctor's Memorial Hospital also submitted a letter in which she commented favorably on Petitioner's efficiency and reliability. The letter stated in part as follows: When assigned to other areas, she worked with as much efficiency as she did in the Operating Room. It was very evident she had been trained well to function as a L.P.N. Her knowledge of nursing procedures and medications was quite adequate even with long periods of absence from general duty. (Exhibit 7) In determining qualifications for licensure by endorsement, Respondent considers that an applicant's graduation from an "approved school of practical nursing" in another state is acceptable as meeting Florida's requirements and does not inquire into the number of hours of instruction required for such graduation. Its inquiry into Petitioner's qualifications in this respect was caused by the fact that the West Virginia State Board of Examiners for Practical Nurses indicated on Respondent's application form that Petitioner's education had been an extension course. It is a policy of Respondent that the equivalent of a four year high school education is completion of the General Education Development Test (GED). Petitioner has not taken such a test. (Testimony of Johnson, Zirkle)
Recommendation That Petitioner's application for license to practice practical nursing without examination pursuant to Section 464.121 (2), F.S., be approved. DONE and ENTERED this 21st day of February, 1979, in Tallahassee, Florida. THOMAS C. OLDHAM Division of Administrative Hearings Room 530, Carlton Building Tallahassee, Florida 32304 (904) 488-9675 COPIES FURNISHED: Julius Finegold, Esquire 1107 Blackstone Building 233 East Bay Street Jacksonville, Florida 32202 Peter S. Penrose, Esquire 3175 South Congress Avenue Suite 103 Lake Worth, Florida 33461 Geraldine Johnson, R.N. Licensing and Investigation Coordinator State Board of Nursing 6501 Arlington Expressway, Bldg B Jacksonville, Florida 32211
