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
The Issue Whether Respondent violated Section 464.018(1)(h), Florida Statutes, as alleged in the Administrative Complaint? If so, what disciplinary action should be taken against her?
Findings Of Fact Based upon the evidence adduced at hearing, and the record as a whole, the following Findings of Fact are made: The Agency is a state government licensing and regulatory agency. Respondent is now, and has been since June 18, 1993, licensed as a practical nurse in the State of Florida. Her license number is PN 1113121. Respondent trained to be a practical nurse at the Sheridan Vocational School (hereinafter referred to as "Sheridan") in Hollywood, Florida. She graduated from Sheridan in January of 1993, the recipient of the Jeanette Lindsey Shirley Nursing Service Award. Respondent was employed by Aventura Hospital and Medical Center (hereinafter referred to as "Aventura") from approximately March of 1993, to January of 1994, when she was terminated as a result of the incident which led to the issuance of the Administrative Complaint that is the subject of the instant case. For the first three months of her employment at Aventura Respondent worked as a GPN (Graduate Practical Nurse). After receiving her nursing license in June of 1993, Respondent was promoted to an LPN (Licensed Practical Nurse) position. She held this LPN position until her termination in January of 1994. Throughout the period of her employment, Respondent was assigned to the hospital's mental health unit. Respondent was a dedicated and loyal employee who, as general rule, got along well with the patients under her care, as well as her coworkers. Not infrequently, she would voluntarily remain on the unit after the end of her shift to make sure that her patients received the care and attention their physicians had ordered. Prior to the incident that resulted in the termination of her employment, Respondent had an unblemished employment record at Aventura. The incident in question occurred on or about January 17, 1994. On the day of the incident Respondent was working the 12 midnight to 8:00 a.m. shift at the hospital. One of the patients under her care that day was B.H. B.H. was an elderly woman receiving treatment for depression. She required the nursing staff's assistance with Activities of Daily Living (ADLs), including dressing. B.H. was a "very difficult" patient. She was generally uncooperative and frequently resisted, with physical force and violence, the nursing staff's efforts to provide her the help and assistance she needed with her ADLs. On the day in question B.H. had a scheduled, early morning appointment to see her attending physician, Dr. Greener. Dr. Greener had given explicit instructions to the nursing staff that B.H. be awakened and dressed before the scheduled appointment. Toward the end of her shift, Respondent went into B.H.'s room to get her ready for Dr. Greener. Respondent was able to awaken B.H., but B.H. refused to get out of bed. Respondent decided to leave B.H. and take care of the other tasks she needed to complete before the end of her shift. When Respondent returned to B.H.'s room it was after 8:00 a.m. Although her shift had ended, Respondent felt an obligation to remain at the hospital and follow through with her efforts to fully comply with the instructions that Dr. Greener had given concerning B.H. Dr. Greener had already arrived at the hospital and was ready to see Respondent. Respondent pleaded with B.H. to cooperate with her. B.H., however, ignored Respondent's pleas and remained in bed. Dr. Greener was a demanding physician who expected the nursing staff to timely comply with his every instruction. He expressed, in no uncertain terms, his disappointment when these expectations were not met. Respondent did not want to disappoint Dr. Greener. She therefore attempted to dress B.H. even though B.H. would not get out of bed. B.H. responded to Respondent's efforts to dress her by kicking, swinging her arms and spitting at Respondent. Despite receiving such resistance, Respondent continued to try to dress B.H. She did call for assistance, however. Todd Sussman, who was employed as a Mental Health Technician at the hospital, was on the unit that morning and responded to Respondent's call for help. When Sussman discovered the nature of the assistance Respondent required, he left B.H.'s room to obtain surgical gloves. Shortly thereafter, he returned to the room wearing such gloves. As Sussman walked back into the room, he saw Respondent, who was still struggling with B.H., slap B.H. in the face and pinch B.H.'s lips together in an effort to prevent B.H. from spitting at her. Sussman helped Respondent attempt to dress B.H. by holding B.H. by the arm. At one point, he let go of B.H. to allow Respondent to remove B.H.'s night shirt. Once her arm was free, B.H. swung it in Respondent's direction and hit Respondent in the face. Respondent reacted by slapping B.H. "fairly hard" on or slightly above the wrist, a reaction that was witnessed by Sussman, as well as another employee of the hospital, Barry Butler, an LPN who had entered the room shortly before B.H. had struck Respondent in the face. Both Sussman and Butler reported to their supervisor what they had observed take place in B.H.'s room that morning. Respondent's employment with the hospital was subsequently terminated based on the information Sussman and Butler had provided. At no time while struggling to dress B.H. on or about January 17, 1994, did Respondent intend to, nor did she actually, harm or injure B.H. Nonetheless, during the struggle (specifically when she purposefully slapped B.H. in the face and on or slightly above the wrist and pinched B.H.'s lips together), 2/ Respondent acted in an unprofessional manner that did not conform with the minimal standards of acceptable and prevailing nursing practice. 3/ The use of such physical force against B.H. was unnecessary and therefore inappropriate. 4/ There were other, safer (and therefore more appropriate) options (of which Respondent should have been aware in light of her training) that were available to Respondent to deal with the difficult situation she faced.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is hereby RECOMMENDED that the Board of Nursing enter a final order finding Respondent guilty of the violation of subsection (1)(h) of Section 464.018, Florida Statutes, alleged in the Administrative Complaint and disciplining her for having committed this violation by fining her $250.00 and placing her on probation (of the type specified in subsection (1)(g) of Rule 59S-8.006, Florida Administrative Code: "[p]robation with specified continuing education courses in addition to the minimum conditions") for a period of eighteen months. DONE AND ENTERED in Tallahassee, Leon County, Florida, this 4th day of January, 1996. STUART M. LERNER, 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 4th day of January, 1996.
Findings Of Fact Respondent, Ann Claycomb (Claycomb), was at all times material hereto a licensed practical nurse in the State of Florida, having been issued license number 39853-1. On December 24, 1987, Claycomb was employed as an agency nurse by Alpha Health Care, Inc., and was on assignment to Health South Rehabilitation, a skilled nursing and rehabilitation facility in Miami, Florida. While at the facility on that date, Claycomb worked the morning shift 7:00 a.m. to 3:30 p.m., and was assigned to the skilled nursing floor. The skilled nursing floor contained 20-25 elderly, though mostly alert patients. At the commencement of Claycomb's shift, it was her responsibility to administer medications to these patients which conformed with that prescribed by their medication administration record (MAR). Shortly after Claycomb began her rounds, Elaine Wood, the Unit Manager at Health South Rehabilitation, began to receive complaints from patients for what they perceived to be errors in the medicinal drugs administered or attempted to be administered to them by Claycomb. Upon investigation, the following medication errors were discovered. Claycomb administered what she believed to be two Tylenol tablets to patient H.B. Following administration, the patient became lethargic and her vital signs deteriorated but later returned to normal. Lethargy is not a side effect of Tylenol. Although the MAR prescribed two Slow K tablets at 9:00 a.m., and Lilbrax as needed, Claycomb recorded having administered one Slow K tablet and Atarax to patient H.R. Claycomb dispensed Atarax to patient A.J. at 9:00 a.m. when the MAR prescribed dose to be given at 1:00 p.m. Patient refused medication because given at the wrong time. In committing the foregoing medication errors Claycomb's practice fell below the minimal standards of acceptable and prevailing nursing practice in the administration of medicinal drugs. Verification of other complaints received by Ms. Wood could not be verified because, contrary to accepted and prevailing nursing practice, Claycomb did not annotate some patients' MAR upon dispensing medications.
Recommendation Based on the foregoing findings of fact and conclusions of law, it is RECOMMENDED that a final order be entered suspending the license of respondent, Ann Claycomb, until such time as she submits proof satisfactory to the Board of Nursing that she can practice nursing safely. DONE AND ENTERED in Tallahassee, Leon County, Florida, this 27th day of December, 1988. WILLIAM J. KENDRICK 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 27th day of December, 1988. APPENDIX TO RECOMMENDED ORDER, CASE NO. 88-3603 Petitioner's proposed findings of fact are addressed as follows: 1. Addressed in paragraph 1. 2-4. Addressed in paragraphs 2 and 3. 5 & 6. Addressed in paragraphs 46. Addressed in paragraph 4c. Subordinate or not necessary to result reached. Not necessary to result reached. Not necessary to result reached. To the extent supported by competent proof addressed in paragraph 4. Proposed findings 11a and 11d are based on hearsay which does not supplement or explain any competent proof. 12-15. Not pertinent nor necessary to result reached. COPIES FURNISHED: Michael A. Mone', Esquire Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750 Ms. Ann Claycomb 4175 South West 98th Avenue Miami, Florida 33165 Lawrence M. Shoot, Esquire 6011 West 16th Avenue Hialeah, Florida 33012 Judie Ritter, Executive Director Board of Nursing 504 Daniel Building 111 East Coastline Drive Jacksonville, Florida 32201 Bruce D. Lamb, Esquire General Counsel Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750
Findings Of Fact Respondent, Carol O'Donnell (O'Donnell), was at all times material hereto licensed as a registered nurse in the State of Florida, and held license number 1498442. On May 15, 1986, O'Donnell was employed as a registered nurse at Broward General Medical Center, Broward County, Florida, on the 3:00 p.m. to 11:00 p.m. shift. At or about 7:30 p.m., O'Donnell abandoned her employment, without notice or authorization, and thereby left her patients unattended. Although the period that elapsed between the time O'Donnell abandoned her position and the time her absence was discovered was apparently of short duration and there was no proof any patient suffered from her absence, her conduct constituted a departure from and failure to conform to the minimum standards of acceptable and prevailing nursing practice in the community.
Recommendation Based on the foregoing findings of fact and conclusions of law, it is RECOMMENDED that Respondent, Carol O'Donnell, be reprimanded, and that an administrative fine of $500.00 be imposed upon her. DONE and ENTERED this 20th day of August, 1987, in Tallahassee, Florida. WILLIAM J. KENDRICK 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 20th day of August, 1987. APPENDIX Petitioner's proposed findings of fact are addressed as follows: 1. Addressed in paragraph 1. 2-4. Addressed in paragraph 2. 5. Addressed in paragraph 3. COPIES FURNISHED: William M. Furlow, Esquire Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750 Ms. Carol O'Donnell 109 North Birch Road, #4 Ft. Lauderdale, Florida 33312 Judie Ritter, Executive Director Board of Nursing 111 East Coastline Drive Room 504 Jacksonville, Florida 32201 Van Poole, Secretary Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750 Joseph A. Sole General Counsel Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750
Findings Of Fact The Respondent, Bonnie Jean Hutcheson, is a licensed practical nurse, who holds License No. 19002-1. In June and July of 1978, the Respondent was employed at The Abbey Nursing Home in St. Petersburg, Florida. On July 4, 1978, the Respondent was terminated from her employment at The Abbey Nursing Home by the Director of Nursing. Respondent Hutcheson was employed as a licensed practical nurse at North Horizon Convalorium in St. Petersburg, Florida in April, 1979. On February 16, 1979, an Administrative Complaint was filed alleging that Respondent Hutcheson was guilty of unprofessional conduct. The Respondent requested an administrative hearing in May of 1979, and a hearing was scheduled for July 25, 1979, but was continued by Motion of the Petitioner. Thereafter, the Administrative Complaint was amended on August 12, 1979, to add additional charges. On June 17, 23 and 24, 1978, while employed at The Abbey, Respondent Hutcheson signed out for Dalmane, a controlled substance, for a patient, Josephine Miracky, and failed to chart the administration of same on the patient's medication record. On July 2, 1978, Respondent reported to work at The Abbey for the 3:00 p.m. to 11:00 p.m. shift. Alice Henderson, a registered nurse who was going off duty at 3:00 p.m., noticed the Respondent and reported to the nursing office that Respondent's speech seemed slurred, that she seemed unsteady on her feet and slow to respond, and that she had counted medications very slowly. On July 4, 1978, the Director of Nursing terminated the employment of Respondent Hutcheson for the reason that she felt the Respondent's performance was unsafe as a practitioner. In April of 1979, while employed at North Horizon Convalarium, Respondent Hutcheson signed out for Tylenol No. 3, a narcotic and controlled substance, at an interval of one hour for a patient, Emma Jackson, when the physician's order for this medication was that it be administered no more frequently than every four (4) hours. On three (3) or four (4) occasions during the month of April, 1979, the Respondent took from the patients' medication stock three (3) or four (4) Tylenol No. 3 tablets and left the facility with them to give to her son at home. Respondent Hutcheson did not deny the allegations in the Administrative Complaint. In defense of her actions she testified that she knew Alice Anderson, the witness for Petitioner, but that she had not worked with her and did not work with her on the same shift. (Ms. Anderson's report is contained in Paragraph 2) Respondent Hutcheson acknowledged that she knew Eris J. Frye, the Director of Nursing at The Abbey Nursing Home, and admitted that she might have made a "common error" by failing in June of 1978, to chart medication on a patient's medication record. She did not know she had been terminated as "an unsafe practitioner." Respondent Hutcheson recalled the day of July 2, 1978, when she came to work, and she stated she had developed a back problem, having a chronic type of arthritis. She stated that she had taken a pain medication prescribed for her by her physician, Dr. Spatapora, which was a medication called Anexsia-D. Respondent stated that at that time she had just learned that her daughter, who was fifteen (15) years of age and unmarried, was pregnant, and that she in fact was exceedingly disturbed over her daughter's condition and could not sleep, and had taken the medication prescribed for her by her physician. She said she had not taken any of the medication at work, but that she was so over-whelmed by her problems she was ready to resign her position at The Abbey at the time she was terminated on July 4, 1978. Respondent Hutcheson stated that in April of 1979, while working at North Horizon Convalarium, she took several tablets of Tylenol No. 3 from the medication supplies to give to her son, who had recently come out of the hospital after having been seriously injured in an automobile accident. She testified that her son was in a great deal of pain, that she had to leave him alone in the house, and that she used the tablets to help him get to sleep for a few nights because she could not get in touch with his physician and could not afford to take him to another physician. She said her son used the nine (9) to eleven (11) tablets only, and was not and is not addicted to drugs. Respondent Hutcheson is not addicted to drugs. Witnesses for the Petitioner Board stated that it was contrary to acceptable and prevailing nursing practice for the Respondent to fail to accurately chart all medications signed out by her, and that it is contrary to acceptable and prevailing nursing practice to take Tylenol No. 3 tablets from the patients' medication supplies. Witnesses for the Respondent testified that she is a good neighbor and a hard-working, conscientious nurse, and that she is a devoted mother to her son and daughter. They stated Respondent is divorced and has the responsibility for her children. Petitioner and Respondent submitted proposed findings of fact and recommended orders. These instruments were 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 on the foregoing Findings of Fact and Conclusions of Law, the Hearing Officer recommends that the Respondent, Bonnie Jean Hutcheson, be placed on probation for a period of two (2) years from the date hereof. DONE and ORDERED this 7th day of November, 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 Jean M. Flanagan, Esquire Gulfcoast Legal Services, Inc. 641 First Street, South Post Office Box 358 St. Petersburg, Florida 33731 Geraldine B. Johnson, R. N. Board of Nursing 111 Coastline Drive East, Suite 504 Jacksonville, Florida 32202
Findings Of Fact The Respondent, Daniel E. Gallagher, is a licensed practical nurse, holding license number 41727-1 issued by the Department of Professional Regulation on June 1, 1985. From May 28, 1985, to August 29, 1985, the Respondent was employed at Care Unit of Jacksonville Beach, Florida, as a licensed practical nurse. During this employment, the Respondent appeared for work frequently with the odor of alcohol on his breath, with bloodshot eyes, and in a disheveled condition. He frequently used mouth wash and mints. The odor of alcohol was smelled by other employees and by patients. This behavior started shortly after the Respondent began working at Care Unit, and it became progressively more evident until August, 1985, when the Respondent was terminated from his employment. Coming to work as a licensed practical nurse in the condition described above is unprofessional conduct which departs from the minimal standards of acceptable and prevailing nursing practice. A licensed practical nurse who assumes the duties of his employment under the effects of the use of alcohol, with the odor of alcohol on his breath, with bloodshot eyes, and in a disheveled condition, is unable to practice nursing with reasonable skill and safety to patients.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that license number 41727-1, held by the Respondent, Daniel E. Gallagher, be suspended for 30 days; and that following this period of suspension the Respondent be placed on probation for one year, subject to such conditions as the Board may specify. THIS RECOMMENDED ORDER entered this 11th day of September, 1986 in Tallahassee, Leon County, Florida. 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 11th day of September, 1986. COPIES FURNISHED: William M. Furlow, Esquire 130 North Monroe Street Tallahassee, Florida 32301 Mr. Daniel E. Gallagher 379 East 5th Street Mount Vernon, N.Y. 10550 Fred Roche Secretary Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301 Wings S. Benton, Esquire General Counsel Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301 Judie Ritter Executive Director Department of Professional Regulation 111 East Coastline Drive Room 504 Jacksonville, Florida 32201 =================================================================
The Issue 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.
Findings Of Fact 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.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED: That the Respondent's license as a registered nurse be suspended for a period of three (3) months. It is further RECOMMENDED that upon completion of the three-month suspension period, Respondent be placed on probation for a period of one (1) year working only under the supervision of another licensed nurse and upon such other conditions as the Board may specify. DONE and ENTERED this 29 day of August, 1983, in Tallahassee, Florida. MARVIN E. CHAVIS Hearing Officer Department of Administration Division of Administrative Hearings Oakland Building 2009 Apalachee Parkway Tallahassee, Florida 32301 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 29 day of August, 1983. COPIES FURNISHED: Julia P. Forrester, Esquire Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301 Arthur Baron, Esquire Attorney at Law 14 East Washington, Ste. 623 Orlando, Florida 32801 Helen P. Keefe, Executive Director Florida Board of Nursing Room 504, 111 East Coast Line Drive Jacksonville, Florida 32202 Frederick Roche, Secretary Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301
Findings Of Fact The Respondent, Betty Jean Dempsey Hatton, L. P. N., holds License No. 29095-1. She was employed as a licensed practical nurse at Riverside Convalescent Center in Jacksonville, Florida, during the month of January, 1979. An Administrative Complaint was issued against Respondent Hatton on April 20, 1979, alleging that she was guilty of unprofessional conduct. The Respondent requested an administrative hearing. On or about January 27, 1979, Respondent Hatton had become unhappy with her work at the convalescent center and had decided to resign. She was requested to work 11:00 o'clock p.m. to 7:00 o'clock a.m. shift beginning the night of January 27, 1979. The Respondent agreed to work that shift, although she informed Eleanor L. Hennessey, the evening supervisor, that she intended to resign. The Respondent had not submitted a written resignation at that time. Ms. Hennessey finished her work at 11:00 o'clock p.m. and expected the Respondent to begin work at that time pursuant to her work schedule and pursuant to her agreement. The Respondent did in fact report to work at the convalescent center as agreed on the night of January 27, 1979. Fiona M. Morris, R. N., the Director of Nursing at Riverside Convalescent Center, was notified by Ms. Hennessey that Respondent Hatton had quit work, but Ms. Morris did not receive either an oral or a written resignation from the Respondent. Introduced into evidence was a copy of an official time and signature sheet for the month of January, 1979, for the employee, Respondent Hatton. The Respondent signed in for work on the night of January 27, 1979, at 10:45 o'clock p.m. and signed out at 4:00 o'clock a.m. January 28, 1979. The Respondent had previously agreed by conversation with Ms. Hennessey that evening to work the 11:00 p.m. to 7:00 a.m. shift for which she had been employed and from which she had not resigned. Respondent Hatton in fact did not work all of said shift, leaving some three (3) hours early. She left without informing her supervisor, Ms. Hennessey, and left her floor unattended. In mitigation of leaving her night shift early, Respondent Hatton contended that she told someone on the floor she was leaving, and that she had injured herself the day before and was suffering pain from her back. The Respondent also said she had informed several people that she was resigning as of January 27, 1979. Neither party submitted proposed findings of fact, memoranda of law or proposed recommended orders.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, the Hearing Officer recommends that the Petitioner Board reprimand the Respondent, Betty Jean Dempsey Hatton. DONE and ORDERED this 16th day of October, 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 Betty Jean Dempsey Hatton 8201 Styers Court Jacksonville, Florida 32221 Geraldine B. Johnson, R. N. Board of Nursing Ill Coastline Drive East, Suite 504 Jacksonville, Florida 32202
The Issue The issue is whether Ms. Battaglia is guilty of violations of the Nursing Practice Act by being unable to account for controlled substances at the close of her shift at a nursing home and by being under the influence of controlled substances during her shift.
Findings Of Fact All findings have been adopted except proposed findings 27 through 33, which are generally rejected as unnecessary. COPIES FURNISHED: Judith V. Battaglia 7819 Blairwood Circle North Lake Worth, Florida 38087 Lisa M. Bassett, Senior Attorney Department of Professional Regulation 1940 North Monroe Street Tallahassee, FL 32399-0792 Kenneth E. Easley, General Counsel Department of Professional Regulation 1940 North Monroe Street Tallahassee, FL 32399-0792 Judie Ritter, Executive Director Department of Professional Regulation Board of Nursing 504 Daniel Building 111 East Coastline Drive Jacksonville, FL 32202
Recommendation It is RECOMMENDED that: Ms. Battaglia be found guilty of the charges of unprofessional conduct in the delivery of nursing services, unlawful possession of controlled substances and impairment; She be fined $250, that she be required to participate in the treatment program for impaired nurses, that her licensure be suspended until she successfully completes that program, and demonstrates the ability to practice nursing with safety, and that she be placed on probation for a period of five years. DONE and ENTERED this 11 day of October, 1989, at Tallahassee, Florida. WILLIAM R. DORSEY, JR. 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 11 day of October, 1989.
