The Issue The issue is whether Petitioner meets the academic requirements to sit for the practical nursing equivalency examination in Florida.
Findings Of Fact Petitioner attended the registered nursing program at HCC. On or about March 1, 2007, Petitioner applied to sit for the practical nursing licensure examination. By letter dated May 8, 2008, the Board notified Petitioner that additional information was required to complete her application. According to the letter, two submissions were required. First, the director of nursing at HCC needed to submit a letter stating that Petitioner's coursework meets the practical nursing educational equivalency. Second, Petitioner needed to submit verification that she completed coursework in medical-surgical nursing (oxygenation, circulation and hematology). Rise Sandrowitz, program manager of the nursing program at HCC, submitted a letter to the Board. In the letter dated June 8, 2008, Ms. Sandrowitz stated that while Petitioner was a student at HCC, she "twice attempted but was unsuccessful in Adult Health III." The Adult Health Care III course is a 5.5 credit hour course and covers topics of oxygenation, circulation and hematology. Ms. Sandrowitz' letter does not state that the courses Petitioner completed in the professional nursing program at HCC met the requirements for the practical nursing equivalency. Ms. Sandrowitz testified credibly that the intent of her letter was to recommend that Petitioner be allowed to sit for the examination, if the Board determined that Petitioner's coursework met the practical nursing equivalency requirements. The Board determined that Petitioner's failure to successfully complete the course that covered the oxygenation (respiratory), circulation, and hematology systems demonstrated that she did not meet the practical nursing equivalency requirements. Petitioner testified credibly that each time she took the Adult Health Care III course, she attended "all lectures and every clinical," took every test and quiz, and completed all assignments. Nevertheless, Petitioner did not successfully complete the course. Each time Petitioner took the course, she was "just short of the 80%" needed to pass the lecture part of the course. Despite her failure to pass Adult Health Care III, Petitioner argues that she has adequate knowledge in all nursing areas, including those systems covered in that course and, thus, should be allowed to sit for the practical nursing examination.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that a final order be entered which denies Petitioner, Angela Sessa's, application to sit for the examination for licensure as a practical nurse in Florida. DONE AND ENTERED this 6th day of June, 2008, in Tallahassee, Leon County, Florida. S 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 June, 2008. COPIES FURNISHED: Lee Ann Gustafson, Esquire Office of the Attorney General The Capitol, Plaza Level 01 Tallahassee, Florida 32399-1050 Angela Sessa 3505 Sandburg Loop Plant City, Florida 33566 Rick Garcia, Executive Director Board of Nursing Department of Health 4052 Bald Cypress Way, Bin C-02 Tallahassee, Florida 32399-1701 Dr. Patricia Dittman, Chairman Board of Nursing Department of Health 4052 Bald Cypress Way, Bin C-02 Tallahassee, Florida 32399-1701 Josefina M. Tamayo, General Counsel Department of Health 4052 Bald Cypress Way, Bin A-02 Tallahassee, Florida 32399-1701 R.S. Power, Agency Clerk Department of Health 4052 Bald Cypress Way, Bin A-02 Tallahassee, Florida 32399-1701
Findings Of Fact On 22 June 1982 DHRS, Office of Licensure and Certification, conducted an inspection of Respondent's facility known as Regency Oaks at Gainesville, Florida. During this inspection the nurses' schedule was not produced and the inspector, with the assistance of Respondent's staff, attempted to reconstruct the nurses' schedule for the month of June, 1982, up to the date of the inspection. From the data received it was determined that on the 7:00 a.m. to 3:00 p.m. shift on June 5, 1982, Respondent was staffed with one registered nurse (RN) and three licensed practical nurses (LPN) on June 6 there were two RN's and two LPNs; on June 12 there were three RNs and one LPN; and on June 19 there were three RNs and one LPN. Staffing requirements for nursing homes are determined by the shift and census of the nursing home. All of the shortages here involved the day shift. On each of the days of 5, 6, 12, and 19 June the regulations required two RNs and three LPNs on the day shift. The regulations also permit the substitution of an RN for an LPN. Accordingly, from the evidence gathered bv Petitioner's evaluation at the June 22 inspection, Respondent was short one RN on June 5 and one LPN on June 6, 12, and 19. Respondent presented time cards for the periods here involved. These time cards, which were accepted in evidence as business records of Respondent, show that on June 12 Respondent had two RNs and three LPNs on duty on the day shift. Respondent's one witness admitted the nursing home was understaffed one RN on June 5 and one LPN on June 6 and 19.
Findings Of Fact Petitioner, Carolyn A. Keegan, is a licensed Practical nurse in the State of Maine and has been since October 10, 1947, when that State first began licensing nurses. Petitioner attended the Eastern Maine General School of Nursing between September, 1940, and June, 1942, but did not graduate. She has been employed as a nurse since that time. When the State of Maine began licensing nurses in 1947, Petitioner was grandfathered in as a licensed practical nurse without being required to take an examination or graduating from an accredited nursing program. On June 12, 1980, Petitioner applied for licensure as a licensed practical nurse in the State of Florida by endorsement. This application was denied by the Board of Nursing on July 11, 1980.
Recommendation Based on the foregoing findings of fact and conclusions of law, it is RECOMMENDED that the application of Carolyn A. Keegan for licensure as a licensed practical nurse be denied. It is further RECOMMENDED that Petitioner be permitted to take the appropriate examination at the earliest practicable time. DONE and ENTERED this 8th day of January 8, 1981, in Tallahassee, Florida. DONALD R. ALEXANDER Hearing Officer Division of Administrative Hearings Room 101, Collins Building Tallahassee, Florida 32301 (904) 488-9675 COPIES FURNISHED: Ms. Carolyn A. Keegan 11839-108th Avenue, North Largo, Florida 33540 Linda A. Lawson, Esquire Assistant Attorney General The Capitol, LL04 Tallahassee, Florida 32301
The Issue The issue is whether respondent's license as a practical nurse should be disciplined for the reasons cited in the administrative complaint.
Findings Of Fact Based upon the entire record, the following findings of fact are determined: At all times relevant hereto, respondent, Ruthie Mae Owens Brooks (Brooks or respondent), was licensed as a practical nurse having been issued license number PN 0877941 by petitioner, Department of Professional Regulation, Board of Nursing (Board). She has been licensed as a practical nurse since 1987. There is no evidence that respondent has been the subject of disciplinary action prior to this occasion. When the events herein occurred, respondent was an agency nurse for Underhill Personnel Services, Inc., an agency that furnished nurses to various health care facilities, including Methodist Medical Center in Jacksonville, Florida. She was employed at all times as a licensed practical nurse. On November 17, 1990, respondent was scheduled to work the 11 p.m. - 7 a.m. shift at Methodist Medical Center. Although her duty shift began at 11:00 p.m., respondent arrived a few minutes late and reported directly to the medical-surgical- orthopedic wing instead of signing in at the nursing office as required by hospital rules. After reporting to her work area, respondent went to the assignment board to review her assignment for that evening. Her specific duties that evening were to care for five patients in the medical-surgical-orthopedic wing. While respondent was at the assignment board, a registered nurse, Lynn Ivie, came to the board to ascertain her assignment. At that time, Ivie reported that she smelled a "strong odor of alcohol" on respondent's breath. However, Ivie said nothing at that time since she wanted to give respondent the benefit of the doubt. Around midnight, one of respondent's patients awoke in his room with severe chest pains. Both Ivie and respondent immediately went to the room. Although Ivie instructed Brooks to get a vital signs machine (also known as the Dynamap), Brooks ignored the instruction and "wiped the patient's face with a wet cloth". Ivie then brought the machine into the room and respondent was instructed by Ivie to take the patient's vital signs (blood pressure, temperature and pulse). This merely required her to place an attachment around the patient's arm and push a button to start the machine. The operation of the machine is considered a basic nursing skill. According to Ivie, respondent could not focus on the machine and did not seem to remember how to operate it. After waiting a few moments with no response from Brooks, Ivie finally took the patient's vital signs herself. During this encounter, Ivie again smelled alcohol on respondent's breath and concluded that her inability to assist in the care of the patient and to operate the machine was due to alcohol. Within a few moments, the patient was transferred to the intensive care unit (ICU) on another floor. Before accompanying the patient to the ICU, Ivie instructed respondent to chart the incident and action taken in the nurse's notes and then meet her in the ICU with the completed notes. These notes should be completed in an expedited manner so that the nurses in the ICU wing can utilize them in providing follow-up care to the patient. However, respondent did not chart the incident nor bring the notes to the ICU. Indeed, she failed to chart the notes on any of the patients assigned to her that night. By failing to chart any notes that evening, respondent contravened the requirement that a nurse file a report or record (nursing notes). Around 1:30 a.m. on November 18, Ivie and Joyce Biddix, the nursing supervisor, went to the room of one of the patients assigned to respondent and found the patient, a confused elderly male, sitting nude in a chair with the bed stripped of all linens. He had previously been tied to the bed to prevent him from falling. The linens were soiled with urine and were lying in a heap on the floor. Although respondent had taken the patient out of the bed, disrobed him, and removed the linens, she had left him unattended in the room and had not returned. Biddix called down the hall for someone to bring fresh linens and observed respondent "floating" down the hall saying "I can't find the linens" in a "singsong" voice. When she got closer to respondent, Biddix smelled alcohol on respondent's breath. It may reasonably be inferred from the evidence that respondent's conduct with this patient was unprofessional and constituted a departure from acceptable and prevailing nursing practice. After being confronted by Biddix regarding the alcohol, respondent told her she had drunk one beer with her meal around 10:30 p.m., or just before reporting to duty that evening. However, she denied she was intoxicated or unable to perform her duties. Respondent was then told to leave work immediately. The incident was later reported to Underhill Personnel Services, Inc. and that agency contacted the Board. After an investigation was conducted by the Board, an administrative complaint was filed. At hearing, respondent did not contest or deny the assertion that by reporting to work with alcohol on her breath, she was acting in an unprofessional manner and deviated from the standards of acceptable and prevailing nursing practice. In this regard, she acknowledged that she had drunk alcohol (which she claimed was only one tall beer) with her meal around 10:30 p.m., or just before reporting to duty. However, she contended that all of her previously scheduled shifts at the hospital had been cancel led and she assumed her shift that evening might also be cancelled. In response to the allegation that she could not operate the vital signs machine, respondent offered a different version of events and suggested that the machine in the patient's room was inoperative. Therefore, it was necessary for Ivie to bring a Dynamap into the room and Ivie took the vital signs without respondent's assistance. She justified leaving the elderly patient alone without clothes in his room on the grounds there was no clean gown, the patient was not combative, and she was only gone from the room for a few moments. Finally, she contended that she charted the notes for one of her patients but did not chart the others because the remaining patients were removed from her care by Ivie and Biddix when she was sent home at 1:30 a.m. However, these explanations are either deemed to be not credible or, if true, nonetheless do not justify her actions. Although there was no testimony concerning the specific issue of whether respondent is unable to practice nursing with reasonable skill and safety by reason of use of alcohol, taken as a whole respondent's conduct on the evening of November 17, 1990, supports a finding that her capacity was impaired that evening by virtue of alcohol. Accordingly, it is found that respondent was unable to practice nursing with reasonable skill and safety by reason of use of alcohol.
Recommendation Based upon the foregoing findings of facts and conclusions of law, it is, RECOMMENDED that respondent be found guilty of violating Subsections 464.018(1)(f), (h), and (j), Florida Statutes (1989), and that her nursing license be suspended for six months but that such suspension be stayed upon respondent's entry into and successful completion of the Intervention Program for Nurses. Respondent's failure to remain in or successfully complete the program will result in the immediate lifting of the stay and imposition of the six-month suspension. Thereafter, said license shall not be reinstated until such time as respondent appears before the Board and can demonstrate that she can engage in the safe practice of nursing. DONE and ENTERED this 16th day of December, 1991, in Tallahassee, Florida. DONALD R. ALEXANDER 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 16th day of December, 1991. APPENDIX TO RECOMMENDED ORDER CASE NO. 91-5033 Petitioner: Partially adopted in finding of fact 1. Partially adopted in finding of fact 3. Partially adopted in finding of fact 8. Partially adopted in finding of fact 3. 5-6. Partially adopted in finding of fact 4. 7-10. Partially adopted in finding of fact 5. 11-14. Partially adopted in finding of fact 6. 15-16. Partially adopted in finding of fact 7. 17-18. Partially adopted in finding of fact 8. COPIES FURNISHED: Roberta L. Fenner, Esquire 1940 North Monroe Street, Suite 60 Tallahassee, Florida 32399-0792 Ruthie Mae Owens Brooks 1604 S.W. 40th Terrace, #A Gainesville, Florida 32607 Jack L. McRay, Esquire 1940 North Monroe Street, Suite 60 Tallahassee, Florida 32399-0792 Judie Ritter, Executive Director 504 Daniel Building 111 East Coastline Drive Jacksonville, FL 32202
Recommendation It is recommended that the license held by the Respondent, Rachael Ross Washington, to be a licensed practical nurse in the State of Florida, number 15136-1, be revoked. DONE and ENTERED this 22nd day of December, 1976, in Tallahassee, Florida. CHARLES C. ADAMS, Hearing Officer Division of Administrative Hearings Room 530, Carlton Building Tallahassee, Florida 32304 (904) 488-9675 COPIES FURNISHED: Julius Finegold, Esquire 1130 American Heritage Life Building Jacksonville, Florida 32202 Ms. Rachael Washington 2461 West 25th Street Jacksonville, Florida 32209 Duval County Legal Aid Association 205 East Church Street Jacksonville, Florida 32202
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.
Findings Of Fact This cause comes on for hearing based upon the petition of Jeanne Fried, R.N. filed with the State of Florida, Department of Professional and Occupational Regulations, Board of Nursing, Respondent. This petition was received by the Respondent on October 4, 1978 and referred to the State of Florida, Division of Administrative Hearings for consideration in accordance with the provisions of Section 120.57(1), Florida Statutes. The Petitioner is a Registered Nurse licensed to practice in Florida. The Respondent is an Agency of the State Of Florida which has among its responsibilities the licensure, certification and regulation of certain individuals who wish to practice nursing in the State of Florida, to include the Petitioner. In 1968, the Petitioner received a Baccalaureate degree from the Medical College of Georgia. Her degree was in nursing and she became a Registered Nurse at that time. Since 1968, the Petitioner has worked in the field of nursing. In addition, she has received a Masters of Education degree from the University of Florida with a minor in nursing. This latter degree was earned in December, 1975. Subsequent to receiving the Masters of Education degree, Ms. Fried attended a course entitled Studies for Nurse Practitioners for Adult Care, and was awarded a certificate of completion in that course. That certificate was received in March, 1976 and a copy of the certificate may be found as the Petitioner's Exhibit Number One (1), admitted into evidence. After receiving that certificate, she worked in the capacity of an Advanced Registered Nurse Practitioner at the Lake Butler Reception and Medical Center, Lake Butler, Florida from April, 1976 through August, 1976. From August, 1976 to the present, the Petitioner has worked in a similar position in the Veterans Administration Hospital at Lake City, Florida. Until July 17, 1977, the Respondent had not recognized nor established guidelines for the position known as Advanced Registered Nurse Practitioner. On that date, the Respondent enacted an item entitled Appendix to Chapter 210-11, Guidelines for Advanced Registered Nurse Practitioner Programs of Study. This item appears as a rule set forth in the Florida Administrative Code. The authority for the passage of the rule is found in Subsection 464.051(3), Florida Statutes and it implements Subsections 464.021(2)(a), 4 and 464.051(3)(d) and (e), Florida Statutes. To receive the necessary certification to become an Advanced Registered Nurse Practitioner, an applicant must comply with the guidelines set forth in the aforementioned appendix. The only aspect of the guidelines which is in dispute between the parties is found in that section of the appendix entitled, "Curriculum" and specifically (3) which reads: The program shall be at least one (1) academic year in length (nine months full time) which shall include a minimum of one (1) academic quarter of theory in the biological, behavioral, nursing and medical sciences relevant to the area of advanced practice, in addition to clinical experience with a qualified preceptor . . . The petitioner does not disagree with the fact that the course that she was certified in from the University of Florida in March, 1976 does not constitute an academic year within the meaning of the appendix; however, she is of the persuasion that she is entitled to certification as an Advanced Registered Nurse Practitioner because individuals who also attended the University of Florida course, Studies for Nurse Practitioner for Adult Care, have been certified by the Respondent as Advanced Registered Nurse Practitioners. (This certification for the other individuals has occurred notwithstanding their failure to complete a full academic year as prescribed in the guidelines for the Advanced Registered Nurse Practitioners found in the Appendix to Chapter 210-11, Florida Administrative Code.) The basis for the certification of these other unnamed individuals transpired through an apparatus of the Respondent, in which, by meeting of its governing board, it was determined that individuals who did not meet the academic requirements of the Appendix to Chapter 210-11, Florida Administrative Code, nonetheless would be given an opportunity for certification as Advanced Registered Nurse Practitioners. This special dispensation on behalf of these unnamed parties was granted in the face of the clear requirements of the established rule, which is the Appendix to 210-11, Florida Administrative Code. By that, it is meant that the rule was passed effective July 17, 1977, but its application to these unnamed individuals who received certification as Advanced Registered Nurse Practitioners without complying to the terms and conditions of the rule, was withheld. The technique for withholding it was to extend the period of enforcement of the guidelines to become effective March 31, 1978 as opposed to the prescribed date of July 17, 1977. Any applicants who applied prior to that date would be considered on a basis which did not require strict compliance with the academic requirements of the "Curriculum" guideline, which could be and was waived in the instances of some of the applicants, to include applicants in a similar factual circumstance to the Petitioner in that they had attended the University of Florida, College of Nursing course, Studies for Nurse Practitioner for Adult Care. The way prospective applicants were notified of the "grace period" allowing noncompliance with the academic requirement for certification in the subject field, was through the publication of that information in the newsletter of the Respondent which is forwarded to hospitals, public health clinics, colleges of nursing in Florida and the Florida Nurses Association. In addition, the Florida Nurses Association attempted to make its members aware of the "grace period." Also, it was the policy of the Respondent to advise the prospective applicants for certification as Advanced Registered Nurse Practitioners of the opportunity for consideration during the "grace period." This information sheet was typically mailed to the applicant with the application form, once an inquiry on the question of application had been received from the applicant. The Petitioner did not receive notice of the "grace period" through any published newsletter or bulletin and did not receive a copy of the information sheet which would have apprised her of the fact of the "grace period." She inquired about making application in February, 1978 and began to execute her application form on March 13, 1978 and completed the form on June 14, 1978. This can be seen by an examination of the Petitioner's Exhibit Number Five (5) admitted in evidence, which is a copy of the application for certification as Advanced Registered Nurse Practitioner filed by the Petitioner with the Respondent. Due to the fact that the application was received subsequent to March 31, 1978, and the fact that the Petitioner did not meet the academic requirements established in the Appendix of Chapter 210-11, Florida Administrative Code, her application to be an Advanced Registered Nurse Practitioner was denied through correspondence dated September 13, 1978.
Recommendation It is recommended that the application by the Petitioner, Jeanne Fried, R.N., be denied by the Respondent, State of Florida, Department of Professional and Occupational Regulations, Board of Nursing. DONE and ENTERED this 30th day of January, 1979, in Tallahassee, Florida. CHARLES C. ADAMS, Hearing Officer Division of Administrative Hearings Room 101, Collins Building Tallahassee, Florida 32301 (904) 488-9675 COPIES FURNISHED: Julius Finegold, Esquire 1107 Blackstone Building Jacksonville, Florida 32202 Ms. Jeanne Fried, R.N. Post Office Box 932 Alachua, Florida 32615 Geraldine Johnson, R.N. Board of Nursing 6501 Arlington Expressway Jacksonville, Florida 32211
Findings Of Fact Between November 30, 1977, and December 6, 1977, Prado completed the Board's application for certification as an advanced registered nurse practitioner, in the category of family nurse practitioner. Prado was under the impression that her application was mailed shortly after its completion, however, the person to whom Prado gave the application for mailing did not do so. The application was discovered in Prado's desk on or about April 16, 1978. The application was then mailed to the Board and it was received on May 2, 1978. Among the requirements for certification of advanced registered nurse practitioners contained in Rule 210-11.04, Florida Administrative Code, is satisfactory completion of a formal education program conforming to program guidelines contained in the appendix to the cited Rule. The appendix provides in part that the program of study shall be at least one academic year in length (9 months full-time). On January 1, 1974, Prado completed the University of Miami School of Nursing and Medicine's six month advanced nursing practice course. At one of its meetings the Board established a policy that nurses completing such a program with all requirements except the one academic year length stipulation would, if otherwise qualified, be accepted if their application was made by March 31, 1978. This policy was never adopted as a rule. In fact, all nurses who had taken the same course as that taken by Prado, and who submitted their applications by March 31, 1978, were accepted for certification as advanced registered nurse practitioners. Thee evidence shows that the only difference between the six month course attended by Prado and others and the one year course now required as a condition for acceptance is its calendar length. The substantive content of the two courses is identical. That is to say, the one year course simply takes three months longer to teach the same subject matter as the six month course. The evidence further indicates that, had Prado's application been timely filed, she most probably would have been certified by the Board.
