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.
The Issue Whether the Petitioner's application for licensure by examination as a registered nurse should be granted or denied.
Findings Of Fact Based on the oral and documentary evidence presented at the final hearing and on the entire record of this proceeding, the following findings of fact are made: The Board is the state agency that issued the Notice of Intent to Deny Ms. Perez's application for licensure by examination as a registered nurse.1 Ms. Perez graduated from nursing school in Cuba in 1979, and was awarded a nursing degree. Ms. Perez emigrated from Cuba to the United States in 1980. She left Cuba with virtually no notice and did not have the opportunity to take with her any documents or other papers. At some point, Ms. Perez decided to apply to take the examination required for licensure as a registered nurse in Florida. She asked a neighbor who was going to Cuba for a 90- day visit to go to the school from which she graduated and obtain the documents needed to establish that she was eligible to take the Florida examination. Ms. Perez's neighbor sent Ms. Perez the documents obtained in Cuba on Ms. Perez's behalf, and Ms. Perez submitted to the Board the originals of the documents she had received together with her application for licensure by examination.2 The documents provided to the Board by Ms. Perez included the original of a document she received from Cuba that carries the date of July 14, 1979, and reflects that Ms. Perez had received, under her maiden name, a degree from the Instituto Politecnico de Enfermeria "Flores Betancourt" entitled "Tecnico de Nivel Medio en Enfermeria." The Board's staff recognized this document as a diploma; it kept a copy of the document for its files and returned the original to Ms. Perez.3 Ms. Perez also provided with her application the original of a document identifying her by her maiden name. The document is entitled "Certification de Estudios Terminados"; it identifies the school Ms. Perez attended as the Instituto Politecnico de Enfermeria "Flores Betancourt"; it identifies the degree Ms. Perez received upon completion of her studies as "Enfermero (A)"; it lists all of the courses offered by the Instituto Politecnico de Enfermeria "Flores Betancourt"; and it includes grades for the courses Ms. Perez took a period of two years, which included all of the courses offered except for surgical nursing practice. The information provided was hand- written on what is identified as a Ministerio de Educacion form "Certificacion de Estudios Terminados," and it carries the seals and signatures of the "Director" and the "Secretario," as well as a handwritten notation that appears to be the location of the document in the official records. The Board's staff accepted the document as the transcript of Ms. Perez's nursing program in Cuba, and the Board did not question the authenticity of the transcript. At the time Ms. Perez's application was reviewed by the Board's staff, the Board used guidelines entitled "Levels of Nursing Licensure in Cuba" to determine equivalencies of Cuban programs and programs recognized in Florida. Those guidelines showed that the Cuban titles equivalent to a registered nurse in Florida were "Licentiate en Enfemeria," "Technico Medico Enfemeria," or "Enfemeria Technico." The Board considered the degree of "Tecnico de Nivel Medio en Enfermeria" that appears on the diploma provided by Ms. Perez to be the equivalent of a registered-nurse degree in Florida. The degree of "Enfermero (A)" is not listed on the guidelines and is not familiar to the Board's staff. Because the diploma and the transcript submitted by Ms. Perez with her application identified different degrees, the Board was unable to determine that Ms. Perez had completed a nursing program was substantially equivalent to a registered- nurse program, and it made the preliminary decision to deny her application for licensure by examination because she failed to establish that she was eligible to take the examination that is a prerequisite to licensure. The documents submitted by Ms. Perez to the Board after the final hearing on January 25, 2008, consisted of a "Certificacion de Estudios Terminados"; a translation into English of this document; a Statement of Accuracy from a Certified Translator; an English translation of the "Certificacion de Estudios Terminados"; a letter to the Board from Ms. Perez; and a "Certifico" from the Cuban Ministerio del Interior showing that documents relating to Ms. Perez had been provided to Violeta Pedroso Hernandez" on September 26, 2007. Ms. Perez received these documents on September 30, 2007.4 This second "Certificacion de Estudios Terminados," or "Certification of Completed Studies," contains handwritten information entered on a form identical to the form used for the transcript Ms. Perez submitted along with her application for licensure. The transcript contains the identical information as that contained in the first "Certificacion de Estudios Terminados" provided to the Board by Ms. Perez and accepted by the Board as authentic, except that the handwriting on this document is different from the handwriting on the first transcript provided by Ms. Perez and the degree identified in the second transcript was "Tecnico de Nivel Medio en Enfermeria," or "Intermediate Level Nursing Technician" rather the "Enfermero (A)." The "Tecnico de Nivel Medio en Enfermeria" degree is recognized by the Board as the equivalent of a registered nurse degree in Florida and would be sufficient to establish eligibility to take the registered-nurse examination. The documents provided to the Board by Ms. Perez after the January 25, 2008, hearing were reviewed by Shelley Young, an Educational Consultant for the Board. Among her other duties, Ms. Young reviews the credentials of foreign-educated nurses, including Cuban-educated nurses. Ms. Young testified that she reviewed the second "Certificacion de Estudios Terminados" provided by Ms. Perez and that she "has doubts about this being an authentic transcript" because the document looks like "a Xerox copy of a transcript written in Spanish with scores put in." Ms. Young concluded that the document submitted by Ms. Perez was not an authentic transcript because it "doesn’t look like it's an original" transcript.5 In Ms. Young's experience, original transcripts from Cuba are "generally" 11 inches wide by 14 inches long; the document submitted by Ms. Perez was eight-and-a-half inches wide and 11 inches long. The evidence presented by the Board at the June 24, 2008, hearing is not sufficiently persuasive to support a finding that the second transcript provided by Ms. Perez is not authentic. The evidence establishes that Ms. Perez provided the Board with the original documents she received from Cuba and that she has no other means of obtaining the documents the Board requires from foreign-educated nurses to establish that they completed a program equivalent to a program approved by the Board and are, therefore, eligible to sit for the registered- nurse examination. The diploma and second transcript Ms. Perez received and transmitted to the Board are sufficient to establish that the nursing degree Ms. Perez was awarded in Cuba was a "Tecnico de Nivel Medio en Enfermeria" degree that is recognized by the Board as the substantial equivalent of the registered-nurse program approved by the Board.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Board of Nursing enter a final order finding that Magdalena Perez is eligible to take the examination required for licensure as a registered nurse in Florida. DONE AND ENTERED this Tallahassee, Leon County, Florida. day of August, 2008, in PATRICIA M. HART 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 day of August, 2008.
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 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.
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 The petition herein was filed by Petitioner with PERC on April 18, 1975. (Hearing Officer's Exhibit 1). The hearing in this case was scheduled by notice dated June 4, 1975. (Hearing Officer's Exhibit 2). The Southeast Volusia Hospital District d/b/a Fish Memorial Hospital is a public employer within the meaning of Florida Statutes, Section 447.002(2). (Stipulation TR 5-6). The Petitioner is an association which has sought to represent public employees in matters relating to their employment relationship with a public employer. The Petitioner has been certified by PERC to serve as the bargaining representative for public employees in Dade County. (TR Volume 3, 96-99). The Petitioner has requested recognition as the bargaining agent in the proposed unit. (Stipulation TR, Volume 1, 6). There is no contractual bar to holding an election in this case. (Stipulation, TR Volume 1, 6). There is no pertinent collective bargaining history that will affect this case. (Stipulation, TR 6, 7). PERC has previously determined that the petitioner is a duly registered employee organization. (Hearing Officer's Exhibit 3). No evidence was offered at the hearing to rebut the administrative determination previously made by PERC. PERC has previously determined that the Petitioner filed the requisite Showing of Interest with its petition. (Hearing Officer's, Exhibit 4). No evidence was offered at the hearing to rebut the administrative determination previously made by PERC. Registered Nurses are professional employees within the meaning of Florida Statutes, Section 447.002(13). (Stipulation, TR volume 1, 32-33). The Public Employer is a special taxing district created by the Florida Legislature. See: Laws of Florida, Chapter 65-2362 (1965). The governing body is a five member board of commissioners. The purpose of the district is to operate the Fish Memorial Hospital. It is a small hospital in the industry parlance, having 74 beds. The hospital offers traditional medical services, and is licensed by the State of Florida as a general acute care hospital. The hospital employs between 180 and 200 persons. Approximately 140 of the employees are involved directly in patient care. 109 of the employees are within the Department of Nursing Services. (TR Volume 1, 10-16). The hospital's chief executive officer is the Administrator, Mr. William Schneider. The Administrator reports directly to the Board of Trustees. He has the authority in the interest of the public employer to hire and discharge employees, and to finally resolve employee grievances. He is responsible for preparing a proposed budget, and has authority to authorize expenditures of up to $1,000. He is charged generally with the responsibility of managing the operation of the hospital. (TR, Volume 1 10-25). The Director of Nursing Services has the authority to hire and discharge employees within her department. She is the top management official within the Nursing Services Department, and is responsible, for evaluating, promoting, or suspending employees in her department. She prepares the budget for her department. In the absence of the Hospital Administrator she has charge of the total hospital operations. She participates in the planning and development of administrative and personnel policies and procedures effecting her department, and other hospital services. (TR Volume 1 26-48, 67-72, Public Employer's Exhibit 2-G). Shift supervisors report directly to the Director of Nursing Services. They are responsible for supervising nursing activities on the wards during their shifts. They allocate the available staff of registered nurses, licensed practical nurses, and other employees. Depending upon which shift they work, the shift supervisor may have from 3 to 5 registered nurses working under her. Shift supervisors participate in the evaluation of employees on their shift. The evaluations must ultimately be approved by the Director of Nursing Services. The evaluations are used by the Public Employer to determine whether pay increases will be granted to an employee. Shift supervisors give some input into the budgetary process by advising the Director of Nursing as to needs. Shift supervisors attend regularly scheduled meetings with the Director of Nursing, and head nurses. During these meetings the performance of individual employees, and policies or potential policies which would apply throughout nursing services are discussed. (TR Volume 1 10-94, Volume 2 3-40, Public Employer's Exhibit 2-G). The head nurses answer to the shift supervisors, and are generally charged with administering nursing services on a hospital floor, or in a specialty area, such as the Intensive Care Unit or Emergency Room. At the beginning of each shift, the head nurse is responsible for securing information from the prior shift with respect to patients on the floor. Head nurses typically have one or two registered nurses under their supervision. One head nurse has four registered nurses under her supervision. The head nurse cannot hire, fire, transfer, suspend, or promote employees; however, she can make recommendations to the shift supervisors or to the Director of Nursing. In the case of specialized units, such as the Intensive Care Unit, head nurses may conduct job interviews, and their evaluations respecting new employees and old employees are given special consideration. Head nurses evaluate registered nurses and licensed practical nurses who work on their shifts. These evaluations are subject to review by the shift supervisor, and by the Director of Nursing Services, and are not routinely adopted by the Director of Nursing Services if the evaluation is a negative one. The evaluations are used to determine whether pay increases should be granted, and can be used in making a decision respecting continued employability. The head nurse serves as the first step in the grievance procedure. If she is unable to resolve grievances she refers them to the Director of Nursing Services. The head nurse can remove an employee from duty on the spot if special circumstances, such as intoxication, warrant it. The head nurse has access to the personnel files of other other employees. The head nurse makes holiday schedules, which must be approved by the supervisor, and by the Director of Nursing. The head nurse does not have a private office. In the absence of the shift supervisor a head nurse will serve as shift supervisor. This regularly occurs during weekend shifts. Head nurses are requested to provide information respecting budgetary needs. Head nurses spend a good portion of their active duty working day rendering direct patient services. (TR Volume 1 30-32, 77-94, volume 2 15-20, 42-60, Volume 3 4-95, Public Employer's Exhibit 2-G, Public Employer's Exhibit 6). Licensed practical nurses work at the hospital with registered nurses. Generally a registered nurse can perform every task that a licensed practical nurse is authorized to perform, but a licensed practical nurse cannot perform many functions that are performed by a registered nurse. For example, a licensed practical nurse cannot perform intravenous injections, or dispense drugs to a patient. A licensed practical nurse reports to a registered nurse for decision making respecting patient care. Registered nurses supervise the activities of licensed, practical nurses. Generally licensed practical nurses dispense medication, including administering shots, give bed baths, BM care, and are assigned to postpartum and nursery care. In order to be classified as a licensed practical nurse, a person must pursue a one-year course off study. The educational program includes a basic introduction to nursing, practical theoretical instruction, and applied practice in hospital study. They study basic nursing skills, specific diseases, and basic pharmacology. The curriculum is not so in depth as the course of study pursued by registered nurses, which includes basic college courses, and courses relating to specific kinds of nursing assignments. Occasionally a licensed practical nurse will be in charge of a floor at the Fish Memorial Hospital, but this is not routine, and they generally report to a registered nurse. (TR Volume 1 57-67, Volume 2 6-14, Volume 3 22-26, 32-33, public Employer's Exhibit 2-G). Radiological Technicians pursue an 18 month training and educational program. Nuclear Medicine Technicians pursue an Associate Degree program in nuclear medicine. Pharmacists pursue a Baccalaureate Degree program followed by an internship. Radiological Technicians, Nuclear Medicine Technicians, Laboratory Technicians, and Pharmacists are all directly engaged in patient care as are Registered Nurses and Licensed Practical Nurses. There is considerable communication and contact among these people. Their functions are not, however, identical. Although a registered nurse may, under certain circumstances, perform the functions of a pharmacist, she would not perform the functions of a radiological technician, a nuclear medicine technician, or a laboratory technician. Nor would pharmacists, laboratory technicians, nuclear medicine technicians or radiological technicians serve as registered nurses. Radiological technicians, nuclear medicine technicians, laboratory technicians, and pharmacists are all licensed by the State of Florida. (TR Volume 1 28-29, 43-45, 49-66, Volume 2 7-9, Volume 3 22-46, Public Employee's Exhibits 2-C, 2-E, 2-F). ENTERED this 20th day of October, 1975, in Tallahassee, Florida. G. STEVEN PFEIFFER, Hearing Officer Division of Administrative Hearings Room 530, Carlton Building Tallahassee, Florida 32304 (904) 488-9675
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
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
