The Issue The issue for determination is whether Ferman Barrett committed unprofessional conduct and departed from minimal standards of acceptable nursing practice, in violation of Section 464.018(1)(f), Florida Statutes by abandoning his shift.
Findings Of Fact At all times material Ferman Barrett was licensed as a practical nurse, with State of Florida license number PN0628671. He was originally licensed by examination on December 14, 1981, and has regularly renewed' his license since then. Mr. Barrett was employed as a practical nurse at Westlake Hospital, in Longwood, Florida, from July 1987 until January 1988. Westlake is a psychiatric hospital serving individuals of all ages with complex psychiatric problems. On January 2, 1988, Mr. Barrett was assigned to the children's unit, consisting of 12-13 children with conduct disorders. He was given charge of three patients whose medication he was to maintain and whose activities he was to supervise. The children could have been combative and [illegible]. Barrett was scheduled to work a double shift on January 2, 1988 from 7:00 A.M. until 3:00 P.M., and from 3:00 P.M. until 11:00 P.M. At approximately 8:05 A.M., Barrett told Denise McCall, the charge nurse for that shift, that he "couldn't take it anymore" and was leaving. She asked him to wait until she could contact a supervisor to properly relieve him, but he left without permission. He was subsequently discharged by the hospital for abandoning his job. Diana Eftoda was qualified as an expert in the practice of nursing. She has been licensed as a registered nurse in Florida since 1978. She has 20 years experience in nursing, including beginning her nursing career as a licensed practical nurse. She has administered nursing staff of an entire hospital and has served in a policy making position with the Board of Nursing. Mrs. Eftoda established that abandonment of a shift without notice or permission is a breach of professional responsibility and constitutes misconduct. Ferman Barrett's action jeopardized the safety and well being of his patients and his license should be disciplined.
Findings Of Fact The Respondent, Cindy Louise Jirak, was licensed as a Registered Nurse pursuant to Florida law on May 14, 1979. Her license was last actively renewed to May 30, 1983, and now is in a lapsed status. P. Ex. 1. The Respondent was employed as a licensed Registered Nurse at the Central Florida Regional Hospital in Sanford, Florida, during the six month period up to and including October, 1986. On July 8, 1986, the Respondent was on duty as a licensed Registered Nurse and improperly set up intravenous fluids for a patient. The Respondent set up a previously ordered fluid, stating that the currently ordered fluid was not available. The correct procedure when a currently ordered fluid is not available is to hang a normal saline solution. By hanging the previously ordered solution, the Respondent's procedure was below minimally acceptable nursing practice. On October 6, 1986, the Respondent failed to turn on an intravenous solution pump after hanging an intravenous solution. The patient, therefore, did not receive the fluid that had been hung. The Respondent's action in failing to turn on the pump on October 6, 1986, was below minimally acceptable nursing practice. On August 23, 1986, the Respondent signed out 10 milligrams of morphine (one ampule) to be administered to a patient. Only 6 milligrams had been ordered for that patient. The procedure is to waste the excess before the narcotic is administered, and to have that act of wasting witnessed. The "waste and/or destroyed narcotic disposition record" shows that 4 milligrams were properly wasted since only 6 milligrams had been ordered for this patient. The records show that the 6 milligrams were then refused by the patient, but there is no subsequent entry to show that the 6 milligrams of morphine were properly wasted by the Respondent. The Respondent's failure to record the wasting of the 6 milligrams of morphine on August 23, 1986, was below minimally acceptable nursing practice. On August 22, 1986, the Respondent left two doses of Bumax in her cart with no explanation as to why the medication was not given. She was responsible for administration of that medication to a patient under her care, and the medication had been ordered for the patient. The medication was not given to that patient as ordered on that evening, and the Respondent did not make an entry in the records that the medication had not been administered. The Respondent's failure to administer the prescribed medication, or to chart that failure to do so, is below minimally acceptable nursing practice.
Recommendation It is recommended that the Department of Professional Regulation, Board of Nursing, enter its final order suspending the registered nursing license of Cindy Louise Jirak for a period of two years. DONE and ENTERED this 31st day of August, 1987. WILLIAM C. SHERRILL, JR. 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 31st day of August, 1987. COPIES FURNISHED: Judie Ritter, Executive Director Board of Nursing Department of Professional Regulation Room 504, 111 East Coastline Drive Jacksonville, Florida 32201 Van Poole, Secretary Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750 Joseph Sole, Esquire Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750 John Namey, Esquire 22 East Pine Street Orlando, Florida 32801 Cindy Jirak 2718 Dellwood Drive Eustis, Florida 32726 =================================================================
Findings Of Fact At all times pertinent to this proceeding, Respondent was a licensed practical nurse licensed in the State of Florida and holding license number 0504051. The Petitioner is an agency of the State of Florida and is charged with enforcing the provisions of Chapter 464, Florida Statutes (1981), related to regulating and enforcing the licensure and professional practice standards for nurses of various categories enumerated therein in the State of Florida. During times pertinent to the allegations of the amended administrative complaint, the Respondent was employed as a licensed practical nurse at Ocala Geriatric Center, Inc. On September 16, 1982, the Respondent was the "float nurse" at Ocala Geriatric Center, meaning that she was a nurse assigned to various portions of the Geriatrics Center on an impromptu basis, which assignments to the various wings of the facility would be communicated to her by notations on her timecard which she would receive when she reported to duty for a particular shift. On September 16, 1982, she was previously scheduled by her supervisor to work on the north wing of the Ocala Geriatric Center. When Respondent reported to work for the 11:00 p.m. to 7:00 a.m. shift for September 16 - September 17, 1982, she was told by her supervisor, Deloris Jamison, to work instead on the east wing of the facility. Respondent, upon learning this, became engaged in a dispute with Mrs. Jamison regarding this assignment, refused to fulfill the assignment and indicated that she preferred to report herself as sick and return home rather than work at her assigned location on the east wing that evening. The Respondent was told to shift her duties from her customary station on the north wing to the east wing that evening due to a shortage of nurses on duty on that shift. The director of nurses of the Ocala Geriatric Center, Ellen Cain, had already arranged for nurse Phyllis Shepard to work half of the 11:00 to 7:00 shift on the north wing of the facility. When nurse Shepard duly reported for duty at the north wing she found the Respondent present at the north wing even though the Respondent had previously been informed that she was to work on the east wing. At this time the Respondent announced her intentions to nurse Shepard to remain on duty at the north wing and not to report to duty on the east wing, contrary to her supervisor's direction. At this point nurse Shepard went to the south wing of the facility and conferred with nurse Jamison regarding the Respondent's assignment and her own assignment, and had the instructions confirmed by supervisor Jamison. Upon nurse Shepard's return to the north wing, the Respondent indicated to her also that she intended to report herself sick and go home rather than work on the east wing. Only upon calling the Director of Nurses, Ellen Cain, at her home and again receiving instructions to work on the east wing that evening, did the Respondent ultimately elect to proceed to her assigned duty station. Patients Whitehurst and Rubright were classified on September 16, 1952 and September 17, 1982, "as critical geriatric patients" inasmuch as they were nasal-gastric or "tube-fed" patients and both had "indwelling" catheters for elimination of urine. On or about September 16, 1982, the Respondent charted a "dash" on the fluid intake and output record of patient Whitehurst, rather than specifying actual fluid, if any, taken in by the patient. This is an improper method of notation of fluid intake and output for such a patient, since this does not accurately reflect any information one way or the other regarding fluid intake or output for that patient for that shift. At best it might lead to a presumption that that patient had received no fluid, which is a potentially serious problem with such a patient since if a catheterized patient does not receive adequate fluid from time to time during the day, then the catheter is at risk of being blocked, with potentially serious health consequences to the patient. On that same date Respondent also failed to chart any information in her nurses' notes for patient Whitehurst. Both nurses Shepard and the Director of Nursing at Ocala Geriatric Center, Ellen Cain, were accepted as expert witnesses in the field of nursing and specifically with regard to minimal standards of professional nursing practice in Florida. It was thus established that the failure to chart in her nurses' notes any information for patient Whitehurst was conduct not comporting with minimal standards of nursing practice, especially in view of the fact that the patient Whitehurst was a naso-gastric tube patient who was also catheterized. It is imperative to note any reason why such a patient does not receive fluid during a single shift or alternatively, when a patient does receive fluid, to note on the chart the amount and type of fluids received. Further, the use of a dash on the nursing chart makes it even more imperative that the nursing notes explain what occurred on that shift regarding the patient's fluid intake, so that the nurse charged with the responsibility of that patient on the ensuing shift would be aware of the patient's fluid status and aware of any abnormality that may have occurred on the previous shift. Although the Respondent may have, in fact, administered the proper fluids to patient Whitehurst on that shift, she failed to record whether or not that duty was performed. On September 16, 1952, the Respondent also charted a for fluid intake on patient Rubright, but again failed to make any notation on the nurses' notes as to why this patient actually received no fluids. This failure to properly chart and make notes regarding the patient's fluid intake and failure to administer fluids without explanation does not comport with minimal standards of nursing practice, especially inasmuch as patient Rubright was also a naso- gastric tube-fed and catheterized patient. The Respondent also failed to chart or record any nurses' notes with regard to patient Lesimby on September 16, 1982. Failure to chart was established to be a violation of federal medicare regulations and a violation of this particular facility's policies with regard to such medicare patients. Although daily charting and notes from each shift for such critical care patients as patients Whitehurst and Rubright is required by minimal standards of professional nursing practice, failure to chart nurses notes for other patients, simply because they are medicare patients, does not necessarily depart from proper standards of nursing practice, although federal regulations require that medicare patients be the subject of daily charting, including recording of vital signs. Compliance with such federal standards is of course, not the subject of the administrative complaint in this proceeding, however. Respondent's failure to properly record fluid intake and output for patients Whitehurst and Rubright, and her failure to properly chart nursing notes for those patients on the above dates, as well as her failure to order medications for patients as required by her position at Ocala Geriatric Center, Inc., could have resulted in serious harm to the oat' ants. It was not established that the Respondent has committed acts or omissions that could have jeopardized safety in the past, however, and it was not shown that any other violations of the nursing practice act or failures to comport with minimal standards of nursing practice have ever been charged or proven with regard to the Respondent's licensure status and nursing practice in the past.
Recommendation Having considered the foregoing Findings of Fact and Conclusions of Law, the evidence of record, the candor and demeanor of the witnesses and the pleadings and arguments of the parties, it is, therefore RECOMMENDED that a Final Order be entered by the Board of Nursing finding the Respondent guilty of the violations charged with respect to Section 464.018(1)(f), Florida Statutes (1981), with the exception of the violation charged with regard to patient Lesimby, and that the penalty of a reprimand and 90-day suspension of her licensure be imposed. DONE and ENTERED this 19th May of July, 1984 in Tallahassee, Florida. P. MICHAEL RUFF 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 20th day of July, 1984. COPIES FURNISHED: Julia P. Forrester, Esquire Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301 Linda Sears Gibson 2003 Southwest Seventh Street Ocala, Florida Helen P. Keefe, Executive Director Board of Nursing 111 East Coastline Drive, Room 504 Jacksonville, Florida 32202 Fred M. Roche, Secretary Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301
The Issue The issue in this proceeding was whether Respondent violated the Nurse Practice Act, Subsections 464.018(d) and (f), Florida Statutes, by making a false record and by abandoning the care of her patient and thereby departing from minimal standards of acceptable and prevailing nursing practice.
Findings Of Fact At all times relevant, Respondent was licensed as a practical nurse with license number 0797251. (Petitioner's Exhibit #1, T-22). Respondent, Sheri Ward, was employed by Bayshore Registry, a private-duty nursing service. (Petitioner's Exhibit #3). On August 3, 1985, Ms. Ward was assigned to Villa Maria Nursing Center, Bon Secours Hospital in Miami, to fill in for the regular LPN who was on leave. (T-26) Her only assigned patient was Estelle Crocoll. (T-10) The patient needed continual care because she remained either comatose or semi-conscious and had to be fed by a tube. She had to be watched to ensure that she didn't regurgitate the feeding. She also had bed sores and muscle contractures and had to be turned every couple of hours. (T-11, 26-28) When she checked in for her shift around 7:00 a.m., Ms. Ward learned that Cleo Bell, the nurse in charge of the unit, was the one who would sign her time sheet. She asked Ms. Bell if she could get off a little early, like around 2:00 p.m. Ms. Bell said okay and asked that she be notified when she (Ms. Ward) left. Ms. Ward's shift was supposed to end at 3:00 p.m. that day. (T-10, 42) Ms. Bell checked on the patient at 11:00 a.m. and around 12 noon but did not see Ms. Ward. (T-l1) Helen Bushey, R.N. is the head nurse on the wing where Ms. Ward was working on August 3, 1985. (T-23) She has thirty years of nursing experience and at the hearing was qualified as an expert to testify regarding nursing standards. (T-24, 26) Among her other duties, Ms. Bushey makes the rounds to check on the patients and to introduce herself to any new private duty nurse assigned to a patient. (T-29) On August 3, 1985, Ms. Bushey checked Estelle Crocoll's room at 8:30 a.m., between 11:00 and 11:30 a.m., and again around 12 noon, but at no time saw Sheri Ward. (T-29, 30) Ms. Ward failed to answer a page and members of the staff told Ms. Bushey they could not recall seeing her after 11:00 a.m. (T-31, 33) Ms. Bushey reviewed the notes on the patient's chart around 1:45 p.m., and found that notations for 3:00 p.m. had been written up already. (Petitioner's Exhibit #3, T-31) She notified Ms. Ward's employer and Ms. Ward was barred from practicing at Villa Marie. (Petitioner's Exhibit #3, T-32) Ms. Ward claimed that she left the patient's room only to help another nurse ("Virginia") move a patient and to get the nurse to come help her move Estelle Crocoll. (T-44) She claimed that the chair in which she sat was obscured from view by a person entering the room. (T-44) She admitted that she left the job no later than 1:25 p.m., and since she could not find Ms. Bell she told "Virginia" to tell Ms. Bell she was leaving. (T-51, 52) Sheri Ward also admitted that she pre-entered notes for 3:00 p.m., having learned that "little bad habit" (her characterization) from working and training in a county hospital where ". . . you are really pressed for time." (T-46, 53) The reason she left early was to go to a wedding. (T-13, 48) It is unnecessary to determine Ms. Ward's whereabouts during the day or the exact time she left her duty; clearly, by her own admissions, Sheri Ward falsified her patient's record and abandoned the care of that patient without proper notification. Ordinary common sense would conclude that, given the uncontroverted circumstances, these actions constitute extremely bad judgement. Competent expert opinion concluded that these actions constitute a departure from minimal standards of acceptable nursing practice. (T-36)
The Issue Whether the Respondent committed the offenses set forth in the Administrative Complaint and , if so, what disciplinary action should be taken.
Findings Of Fact Respondent, Dalia V. Gonzalez, was at all times material hereto, licensed as a registered nurse in the State of Florida, having been issued license number RN 88664-2. On August 16, 1988, Respondent was employed as a charge nurse for the skilled unit portion of a floor at Coral Gables Convalescent Center. The remaining portion of the floor was a long term intermediate care unit with a licensed practical nurse, Ms. Jane Reilly Perkins, serving as charge nurse for said unit. During the change of shifts and between 6:30 a.m. and 7:00 a.m. on August 16, 1988, a threatening argument, over the number of personnel assigned to each portion of the floor, arose between Respondent and Ms. Reilly who was accompanied by another licensed practical nurse. Ms. Reilly is a female of physically imposing stature; therefore, Respondent, reasonably fearing her safety, locked herself in her office and called her supervisor to ask for assistance. Respondent remained locked in her office for approximately two hours awaiting the arrival of her supervisor. During this time, Respondent was in constant contact with the other medical personnel on her floor. Although she was the only registered nurse present, her personal service as a registered nurse was not required at the time nor was she prohibited from giving it had the necessity arisen. When Respondent's supervisor, a registered nurse, arrived, they discussed the situation with Ms. Reilly. During this discussion, Respondent gave her first notice of intent to leave her position. After being informed that if she left, she would lose her position at Coral Gables Convalescent Center, Respondent handed her keys to her supervisor and left the facility not completing her assigned shift. While Respondent was available to her patients, although locked in her office during her shift, she did leave her nursing assignment without notifying her supervisor of her intent to leave within sufficient time to allow substitute arrangements to be made. Respondent's notice was improper Consequently, Respondent acted with unprofessional conduct.
Recommendation Based on the foregoing findings of fact and conclusions of law, it is RECOMMENDED the a final order be entered reprimanding Petitioner. DONE AND ENTERED in Tallahassee, Leon County, Florida, this 19 day of June 1989. JANE C. HAYMAN 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 Administrative Hearings this 19 day of June 1989. APPENDIX TO RECOMMENDED ORDER CASE NO. 89-325 Petitioner's proposed findings of fact are addressed as follows: Addressed in paragraph 1. Addressed in paragraph 1. Addressed in paragraph 2. Addressed in paragraph 2. Addressed in paragraph 3. Not necessary to result reached. Addressed in paragraph 2. Addressed in paragraph 3. Addressed in paragraph 3. To the extent supported by competent proof, addressed in paragraph 3. Addressed in paragraph 4. Subordinate to the result reached. Subordinate to the result reached. Addressed in paragraph 6. Not supported by competent and substantial evidence. Addressed in paragraph 5. Not supported by competent and substantial evidence. Not supported by competent and substantial evidence. Addressed in paragraph 6. Addressed in paragraph 6. Addressed in paragraph 5. Not supported by competent and substantial evidence. Not supported by competent and substantial evidence. Not supported by competent and substantial evidence. Addressed in paragraph 6. COPIES FURNISHED: Lisa M. Basset, Esquire Department of Professional Regulation 1940 North Monroe Street Suite 60 Tallahassee, Florida 32399-0729 Santiago Pellegrini, Esquire 1570 Northwest Fourteenth Street Miami, Florida 33125 Judie Ritter Executive Director Board of Nursing 504 Daniel Building 111 East Coastline Drive Jacksonville, Florida 32201 Kenneth E. Easley General Counsel Department of Professional Regulation 1940 North Monroe Street Suite 60 Tallahassee, Florida 32399-0729 =================================================================
The Issue Whether Respondent violated Section 464.018(1)(h), Florida Statutes (2000), covering unprofessional performance of nursing duties and failure to conform to minimal standards of nursing practice, and if so, what penalty should be imposed.
Findings Of Fact Respondent Jane Wickham is a Licensed Practical Nurse in the State of Florida, having been issued license number PM1227531. Petitioner is the State Agency charged with regulation of the practice of nursing, pursuant to Chapters 20, 456, and 464, Florida Statutes (2000). On June 6, 2001, Respondent was a nurse employed by and/or working at Daytona Health and Rehabilitation Center (DHRC), Daytona Beach, Florida. On June 6, 2001, Respondent was assigned to provide patient care to patient M. M., an 81-year-old female patient, who suffers from Alzheimer's Dementia and/or Alzheimer's Disease and dementia. M. M. had been recently admitted to DHRC on May 23, 2001. Her records indicate she was very combative. Respondent had worked with M. M. between May 23, 2001, and June 6, 2001. On June 6, 2001, Respondent attempted to administer oral medication to M. M.. M. M. said the medicine upset her stomach and refused it. She was heard repeatedly saying, "I don’t want it!" Respondent enlisted assistance from a Certified Nursing Assistant (CNA), who helped Respondent give M. M. a portion of the medicine, which M. M. then spat into Respondent's face. Some medicine struck Respondent. Respondent wiped herself off with a towel. She then grabbed M. M. forcibly by the arm, and briskly walked her into the dayroom and sat her on the couch. Lynn Peabody, Physical Therapy Assistant, observed M. M. and Respondent in the dayroom. M. M. attempted to get up from the couch and away from Respondent. M. M. and Respondent were swinging at each other, but Ms. Peabody was unable to see any "striking" by Respondent. M. M. swung the towel and knocked off Respondent's glasses. At that point, Respondent one again grabbed M. M. forcibly by her arm, wrenched her up from the couch, and briskly walked her to her room. Respondent used such force that M. M.'s slipper was pulled off as she tried to resist being pulled down the hall by Respondent. Respondent put patient M. M. in her room, shut the door, and held the door shut, trapping patient M. M. inside. While trapped in the room, M. M. was yelling, screaming, and trying to get out of the room. M. M. was upset and crying. Judy Kiziukiewicz, Marketing Director, was in the restroom across the hall from M. M.'s room. She heard screaming and banging from the altercation. She heard M. M. calling, "Help! help! help!" She also heard Respondent saying, "I'll kill you! I'll kill you!" Ms. Kiziukiewicz exited the restroom and went to M. M.'s aid. M. M. was shaky, tearful, frightened, and holding her arm, which was very red. M. M. said to Ms. Kiziukiewicz, "She won't let me out." Ms. Peabody testified without refutation that she observed Respondent shut M. M. in her room and hold the door closed, while M. M. shouted "Let me out!" Ms. Peabody also heard Respondent say, "I've had enough of this shit." About 3:00 p.m. on June 7, 2001, Janice Ullery, Licensed Practical Nurse, documented in patient M. M.'s records that M. M.'s right thumb was swollen and noted bruising. On June 8, 2001, Thomas Mistrata, an Investigator for the Department of Children and Families, interviewed patient M. M. He did not testify, but his report was admitted, pursuant to Section 120.57(1)(c), as explaining or supplementing direct evidence. His report indicates bruising to M. M.'s right hand, along the thumb extending to the wrist, and small circular bruising to M. M.'s arm, which appeared to him to be a hand print. His report also indicates observation of bruising to the top of M. M.'s left hand that was circular and approximately four centimeters wide. He took photographs of the bruises. Ms. Kiziukiewicz, who did testify, observed that these photographs did not fully show the redness of M. M.'s arm on June 6, 2001, when she observed M. M.'s injuries immediately after M. M.'s altercation with Respondent. On June 9, 2001, M. M. was examined by James R. Shoemaker, D.O. Dr. Shoemaker observed and documented in M. M.'s DHRC medical records a bruise on M. M.'s right hand. Upon the expert testimony of Meiko Miles, Licensed Nurse Practioner and Registered Nurse, it is found that Respondent's conduct with regard to Alzheimer's Patient, M. M., was below prevailing standards of nursing, constituted negligence, and further constituted a failure to conform to the minimal standards of acceptable and prevailing nursing practice for elderly, fragile patients or for patients refusing medications. Even though Ms. Miles was not present for all of the witnesses' testimony concerning the actual altercation between Respondent and M. M., I accept Ms. Miles' testimony based upon her review of medical records, nursing notes, and medical administration reports, and given her answers in response to questions which conformed to the facts as related by the witnesses who had observed the actual event. I also accept the testimony of Ms. Miles and other witnesses to the effect that Respondent's training and experience had or should have provided her with less extreme methods upon which to rely in dealing with M. M.'s resistance and combativeness.
Recommendation Based on the foregoing Findings of Facts and Conclusions of Law, it is RECOMMENDED that the Department of Health, Board of Nursing enter a final order which finds Respondent, Jane Wickham, guilty of violating Section 464.018(1)(h), Florida Statutes, and of violating Rule 64B9-8.005 (12) and (13), Florida Administrative Code; and imposing a penalty as follows: Issues a reprimand; Assigns a fine of $300.00, plus the cost of investigation; Requires that Respondent complete a specified number of hours of continuing education course work in the subject areas of anger management and patient rights; Places Respondent on probation until such fine is paid and such course work is completed, the probation to be upon such conditions as the Board deems appropriate to protect the public health, safety and welfare; and Requires, after the fine is paid and the course work is completed, that Respondent appear before the Board to determine if she is safe to practice and to determine if any further probation is warranted, and if so, to determine the terms of that probation. DONE AND ENTERED this 9th day of July, 2003, in Tallahassee, Leon County, Florida. S ELLA JANE P. DAVIS 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 9th day of July 2003.
The Issue exceptions to this Recommended Order should be filed with the agency that will issue the final order in this case.
Findings Of Fact 1 At all times relevant to the inquiry Respondent has held license no. PN 12946-1 issued by the Board of Nursing in Florida. Petitioner is empowered to discipline that license if Respondent is shown to have violated her responsibilities as a nurse practitioner. Disciplinary action is taken in accordance with Chapter 464, Florida Statutes. Respondent had been referred to Memorial Medical Center a Jacksonville, Florida, hospital to work as a nurse on the 3:00 p.m. to 11:00 p.m. shift of April 9, 1988. This referral was from Consolidated Staffing and Home Health Services, a division of St. Vincent's Health Care System. Jacqueline L. Cumbie who is a registered nurse in Florida and a certified nursing administrator and the administrator and director of the nurses for the referring group was responsible for coordinating the assignment of this nurse. The referral here was consistent with that process. When Respondent reported for work at the hospital she was given a brief orientation by Debra Ellen Bearup, the staff R.N. on the floor where Respondent was assigned. That floor was Two Central, a surgical floor. The orientation included the location on the floor where materials could be found that the Respondent would need to carry out her duties to include an explanation about the medication room, supply room, an explanation of patient charts and the nursing flow sheets where the Respondent would have to do her charting and an indication of where the medications were being held that would have to be administered by the Respondent. In fulfilling this role Ms. Bearup was acting as the charge nurse. The assignment that Respondent had was to care for five patients in rooms 205, 209, 210, 214 and 215. The duties Respondent had with those patients was to assess the patients and to provide them with a level of care that they were supposed to be afforded to include monitoring vital signs, doing cepho-caudal assessment, administering medications, recording anything unusual that transpired and in general caring for the patients. Ms. Bearup's shift began at 7:00 a.m. on that date and ended at 7:00 p.m. Ms. Bearup was not at the hospital when the Respondent left the hospital. Ms. Bearup was not aware of any problems that the Respondent was experiencing in carrying out her duties while Ms. Bearup was in attendance with Respondent at the hospital. At times Ms. Bearup would approach the Respondent and state "are you doing o.k., are there any questions, are you running into anything that you do not understand." Respondent would reply that she was "doing fine." The contact between Ms. Bearup and the Respondent did not include any attempt on the part of Ms. Bearup to verify the treatment provided by Respondent for the benefit of the patients assigned to the Respondent such as looking at the patient charts. Ms. Bearup took the Respondent's word for the fact that things were proceeding as they should. Subsequently, Ms. Bearup did examine the charts of the patients that Respondent was responsible for and discovered that the patient in Room 205 had not had vital signs taken as called for and that Respondent had failed to administer antibiotics at 5:00 p.m. Ms. Bearup also discovered that the patient in Room 209 had not had vital signs taken at 4:00 p.m. and 8:00 p.m. and that medication was not given at 5:00 p.m. for that patient. Related to the patient in Room 209, Ms. Bearup found that the Respondent had not completed charting for the patient. Concerning the patient in Room 210, Ms. Bearup found that the Respondent had failed to take the patient's vital signs at 4:00 p.m. and 8:00 p.m. and had failed to complete the charting on the patient. Concerning the patient in Room 214, Ms. Bearup found that the Respondent had failed to take the patient's vital signs at 4:00 p.m. and 8:00 p.m. and had failed to complete the patient's charting. Concerning the patient in Room 215, Ms. Bearup discovered that the Respondent had failed to complete the charting on this patient. In all instances referred to Respondent was aware of her obligations. Ellen Lederman was a staff nurse who came on duty at 7:00 p.m. April 9, 1988 and whose shift was to end at 7:00 a.m. on April 10, 1988. After Ms. Lederman came on duty she had contact with the Respondent and the Respondent became tearful with complaints of pain in her knees and that she was very tired. Ms. Lederman and Katherine Mitchell, another nurse working on the floor at that time, Ms. Mitchell being since deceased, asked the Respondent if she wanted to go home. The Respondent told them that she would like to go home and the nursing supervisor was called and permission was granted to the Respondent to leave her duties at the hospital. Respondent left shortly after 9:00 p.m. Nurse Cumbie who was accepted as an expert in nursing practice gave the opinion that the performance by Respondent did not meet minimal standards for nursing practice related to the oversights in the patient care that have been previously described.
Recommendation Based upon the findings of fact made and the conclusions of law reached, it RECOMMENDED: That a Final Order be entered which dismisses the Administrative Complaint. DONE and ENTERED this 24th day of February, 1992, in Tallahassee, Florida. CHARLES C. ADAMS, 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 24th day of February, 1992. APPENDIX TO RECOMMENDED ORDER The following discussion is given concerning the proposed facts of Petitioner: The first 10 paragraphs in the proposed fact finding and paragraphs 12 through 14 are subordinate to facts found. Paragraph 11 is not necessary to the resolution of the dispute. COPIES FURNISHED: Roberta Fenner, Esquire Department of Professional Regulation 1940 North Monroe Street, Suite 60 Tallahassee, FL 32399-0792 Olean S. McCall Johnson 12929 Mandarin Point Jacksonville, FL 32223 Jack McRay, Esquire Department of Professional Regulation 1940 North Monroe Street Tallahassee, FL 32399-0792 Judie Ritter, Executive Director DPR Board of Nursing 504 Daniel Building 111 East Coast Line Drive Jacksonville, FL 32202
Findings Of Fact The Respondent Mary Ambroz is a registered nurse having been issued license number 129 070-2. Her last known address is 3304 S.W. LeJeune Road, Coral Gables, Florida. At all material times, the Respondent Ambroz was employed as a nurse at Variety Children's Hospital (now known as Miami Children's Hospital), and Mount Sinai Hospital, in Miami, Florida. On or about June 14, 1981, the Respondent Ambroz was working at Mount Sinai Hospital under the supervision of Cindy Shoard, R.N. On that date, an emergency arose with a patient who suffered a lethal arrhythmia which required Shoard and another nurse to begin emergency procedures including starting an IV and placing vital sign monitors on the patient. The Respondent Ambroz entered the room after Shoard had begun emergency treatment and pushed her aside stating that the patient was hers and she would take over. Shoard asked the Respondent to leave the room. The Respondent did not leave and instead picked up drugs which had been placed by Shoard on a table for administration to the patient after the IV procedure, and attempted to administer the drugs herself. Shoard informed the Respondent that the drugs were to be administered in a different manner from the way which she was attempting, and again asked her to leave the room. The Respondent then left the room and the patient was stabilized. On or about July 7, 1981, while employed at Mount Sinai Hospital, the Respondent was absent without leave four days in a row. This incident resulted in her termination of employment from Mount Sinai. Additionally, while still employed at Mount Sinai, the Respondent failed to properly chart physicians' orders concerning medication on four separate occasions and reported to an oncoming nurse, that an IV bag of a patient in her care had been filled when the Respondent had in fact failed to fill the bag. In August of 1982, while employed at Miami Children's Hospital, the Respondent Ambroz was caring for an extremely ill premature infant, K. Kuehnart, who was being treated by endotracheal tube. The Respondent was aware that the infant was classified as "limited touch" due to her serious condition and the risk that movement could kink or dislodge the tube and cause a life-threatening situation. The Respondent handled this infant without adequate justification and after being repeatedly told not to do so by her supervisor, Mary Mulcahy. Moreover, in her care and treatment of baby Keuhnart, the Respondent Ambroz failed to observe basic aseptic techniques including insuring that the inside of the endotracheal tube remained sterile. On August 17, 1982, the Respondent Ambroz, while under the supervision of Andrea Prentiss, R.N., was caring for a premature infant with a tracheal problem which required that the infant be placed on a ventilator. It was extremely important that this infant be handled minimally and carefully so the tube in the infant's throat would not become dislodged. Despite Prentiss' instructions, the Respondent moved the infant in a manner which caused the tube to become dislodged. A neonatologist was present to reinsert the tube and no permanent damage occurred. However, even following this incident, the Respondent handled the infant contrary to Prentiss' instructions. Subsequently, the infant's mother arrived from out-of-town to visit her child. The mother was instructed to wash her hands and put on a surgical gown before entering her child's room. When the mother entered the room, the Respondent Ambroz refused to allow the mother to touch her baby, brushed her hand away from the child, and stated that the mother had an infected cuticle. Prentiss examined the mother's hands, saw no evidence of infection, and ordered the Respondent to allow the mother to touch her child. Also, during this visit, the Respondent requested that the mother change her child's socks since they were, in her opinion, an ugly shade of green. These incidents upset the baby's mother and resulted in her requesting that Prentiss prohibit the Respondent Ambroz from caring for her baby. The actions of the Respondent Ambroz, while employed at Mount Sinai and Miami Children's Hospital, departed from, or failed to conform to, acceptable and prevailing minimal standards of nursing practice.
Recommendation Based on the foregoing findings of fact and conclusions of law, it is RECOMMENDED: That the Board of Nursing enter a Final Order revoking the nursing license of the Respondent Mary Ambroz. DONE and ENTERED this 17th day of October, 1983, in Tallahassee, Florida. SHARYN L. SMITH, 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 17th day of October, 1983.
