Findings Of Fact Respondent, Barbara Jiminez, is a licensed practical nurse (LPN) in the State of Florida, having been issued license number PN 0812181. At the time of the incident involved in this case, Respondent was a LPN. In 1987, Respondent was employed as a licensed practical nurse by Holly Point Manor, a nursing home located in Orange Park, Florida. Respondent was also employed as a LPN by another nursing home in the area. She was scheduled to work the 3:00 p.m. to 11:00 p.m. shift at Holly Point Manor. Holly Point Manor was a new facility and had opened in November, 1987. Only one wing of the facility was open and in December, 1987, Holly Point Manor serviced approximately 50 patients. On December 21, 1987, Respondent presented a letter of resignation to Tom Burrell, Director of Nursing at Holly Point Manor. The resignation was effective December 20, 1987. The resignation was precipitated by a verbal altercation with Liz McClain, a certified nursing assistant (CNA) at Holly Point Manor. The verbal exchange occurred on December 20, 1987. However, difficulties between Respondent and Ms. McClain had been brewing for a period of time prior to the verbal exchange of the 20th. After discussing the letter with Burrell, Respondent agreed to work on an as-needed basis at the facility. Burrell indicated that he needed Respondent to work until the beginning of the year, and therefore scheduled the Respondent for the remainder of December. Respondent was scheduled to work her usual shift on December 23, 24, and 25, 1987. She was scheduled to work with Virginia Anderson. Ms. Anderson is also a LPN. On December 23, 1987, Respondent clocked in for work at approximately 2:40 p.m. EST and clocked out the same day at 3:40 p.m. EST. On December 23, 1987, the Respondent and Virginia Anderson began work before the 3:00 p.m. change-of-shift. At shift change, both nurses went into the medication room to "take report" from Nurse Jan Sturgeon, the LPN who had worked the previous shift. A "report" at the change of shift consists of the previous shift's nurse going down the list of each resident/patient and reporting each patient's respective condition to the on-coming nurse. Part of the report includes counting the medications on the medication cart to ensure a correct count in the narcotic drawer of each cart. In this case, there were two medication carts, one for each of the on-coming nurses. These carts are locked and the nurse responsible for the cart maintains possession of the keys to that cart. Ms. Sturgeon "reported off" first to Ms. Anderson, and then to Respondent. Ms. Anderson began her rounds after receiving a report and keys to her cart from Ms. Sturgeon. Subsequently, Respondent received a report and keys to her cart from Ms. Sturgeon. At some time during Respondent's clocking in and taking report, a problem arose over the staffing assignments of the C.N.A.'s. Respondent was the nurse responsible for making the CNA assignments. However, Nurse Anderson had already created patient-care assignments for the CNAs after one C.N.A. had failed to report for work.1/ The Respondent was not satisfied with the assignments created by Anderson and either requested that they be changed or changed them herself. The request or change immediately caused a bad atmosphere between the employees on the wing. Around 3:30 p.m., Respondent telephoned Tom Burrell. Respondent told Burre11 that she couldn't take it anymore and that she was leaving. Burrell told Respondent that she was scheduled to work and if she left she would be reported for what was, in his opinion, a violation of the Nurse Practice Act. Burrell did not give Respondent permission to leave. Either before or after the call to Burrell, Nurse Eppert, the Assistant Director of Nursing, told the Respondent that in her opinion there was nothing wrong with the C.N.A. assignments. Respondent stated, "Here's my keys - - I'm leaving." Eppert informed Respondent that she had no replacement nurse and did not want her to leave. Respondent pointed out that Ms. Sturgeon was still present. Eppert reminded Respondent that Sturgeon was off duty. Eppert then told Respondent to give a report to Nurse Anderson. She refused and told Ms. Anderson to get the report from Ms. Sturgeon who had just given the report to Respondent. Since Respondent had not begun her rounds, Ms. Sturgeon's report was still valid and the narcotic count had not changed. Respondent left Holly Point Manor. The Respondent did not positively know at the time she left whether Nurse Sturgeon would remain to assist. The Respondent did not stay to determine whether Sturgeon would, in fact, cover the shift. However, the evidence did show that Ms. Sturgeon tacitly agreed to stay before Respondent left the facility. Nurse Sturgeon was not the type of person to decline to help when the need arose. After the Respondent left, Jan Sturgeon formally agreed to stay to assist with the 5 p.m. medication pass. She agreed because Ms. Eppert could not find anyone to work due to the closeness of the holidays. After the medication pass, Ms. Sturgeon left for the evening and Ms. Anderson handled the shift by herself. One nurse working the night shift alone was not an unusual event at Holly Point and occurred frequently. In fact, Ms. Anderson had worked the previous evening's shift by herself. One nurse to 50 patients meets HRS staffing requirements for nursing home facilities. However, the hardest part of the evening shift for a solo nurse was the 5:00 p.m. medication pass. Later, the facility was able to retain a replacement nurse for the 24th and 25th. It is not an acceptable nursing practice for a nurse to leave his or her employment until that nurse is sure that somebody else is going to take care of the patients the nurse is responsible for. In this case, Respondent failed to positively ensure someone would replace her. Reliance on tacit agreement by either of the other two nurses is not enough. Likewise, past practice of the facility is not enough. Reliance on tacit agreement or past practice is too amorphous to insure protection and the safety of the patients the nurse is responsible for. However, tacit agreement and past practice do go towards mitigation of any disciplinary penalty in this case. Respondent's actions by not ensuring her replacement or at least the need for such a replacement constitutes unprofessional conduct in the practice of nursing Likewise, it is not an acceptable nursing practice for an LPN to leave without giving another nurse a report on patients that that nurse would be assuming and before counting the medications on the medication cart. However, in this case, the evidence demonstrated that a replacement was there whose earlier report was still accurate and valid. Therefore, formal patient reporting and narcotics counting was not necessary or required. 2/ Respondent is not subject to discipline under this standard.
Recommendation Based upon the foregoing Proposed Findings of Fact and Conclusions of Law, it is: RECOMMENDED that Petitioner enter a Final Order reprimanding the Respondent's license, and requiring her to take courses in the Legal Aspects of Nursing and in Stress Management within a 6 month time period. DONE and ENTERED this 19 day of October, 1989, at Tallahassee, Florida. DIANE CLEAVINGER Hearing Officer Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 19 day of October, 1989.
The Issue Whether Respondent should take final action to deny Petitioner's application for licensure as a practical nurse on the grounds set forth in Respondent's Notice of Intent to Deny.
Findings Of Fact Background On May 1, 2011, Petitioner graduated from Southeastern Community College (West Burlington, Iowa) with a certificate in Practical Nursing (PN). Thereafter, Petitioner received a passing score on the Iowa PN licensure examination, and was issued an Iowa PN license on June 13, 2012. Although both he and his wife hail from Iowa, Petitioner desired to relocate to Florida and seek employment as a practical nurse. In pursuit of that goal, Petitioner submitted an application for PN licensure by endorsement on October 19, 2012. Petitioner’s Criminal History Prior to submitting the Florida application, Petitioner had run afoul of the law on three occasions, only two of which are relevant to the application at issue. On May 10, 2007, Petitioner entered a plea of guilty to misdemeanor battery in Henderson County, Illinois. As a result of this plea, Petitioner was sentenced to two years of supervision and was required to complete anger management counseling. At the request of the Florida Board of Nursing (Board), Petitioner provided a written account of the circumstances surrounding the battery charge as follows: I had just gotten married and my wife and I were out celebrating her birthday at a club. A bouncer came to me and said that the person I had came in with was being bothered by someone else and that I should go check on her. I got my wife and we were in the process of leaving along with the rest of our group. The person bothering my wife continued talking and fussing. As I turned my back to leave, the person grabed [sic] me by the shoulder and lunged at my wife. In reaction I instinctively protected my wife feeling that she was in danger. Everyday since then this has haunted me. If I had taken a different path I would not be writing you this letter today. I feel I have learned the hard lesson from this mistake. I completed the requirements of the court for this along with my own self evaluation of life of how better to handle the situation or avoid them all together. Petitioner’s unrebutted testimony at hearing regarding the circumstances of the battery incident was consistent with his written account above, and is found to be credible. Henderson County court records reflect that Petitioner was accused of striking the person who had been bothering his wife “in the face with his fist.” On July 27, 2011, Petitioner was charged with driving under the influence, also in Henderson County, Illinois. On August 30, 2011, Petitioner entered a plea of guilty to the misdemeanor charge. In his written submission to the Board, Petitioner explained the circumstances surrounding this incident as follows: Regarding my DUI, I had just finished my semester for LPN. I was out celebrating with some classmates. I was pulled over because my oversized tires went over the white line. I was arrested for DUI. I went to the states attorney and explained my situation. He informed me that he would allow me to have court supervision if I pled guilty and pay a hefty fine. My lawyer informed me that this was not a reasonable means for stopping me, but since I had already talked to the states attorney, he informed me that it would not be wise to fight this case because I had already spoke with the states attorney and gave a verbal agreement of what I agreed to do. I have completed all of my classes, I am still paying monthly on my fine, which will be finished this year. I have learned my lesson from this situation. As a nurse I have a high standard to uphold to help people get better and by drinking and driving I was endangering many lives which is the opposite of my civic, humanitarian and the basic oath I took when I decided to become a nurse. Petitioner’s unrebutted testimony at hearing regarding the circumstances of the DUI charge was consistent with his written account above, and is found to be credible. As a result of his guilty plea, Petitioner was ordered to pay a fine and attend a substance abuse class, which he successfully completed. Petitioner’s Application Respondent introduced a copy of Petitioner’s “Initial Application for Licensure” which was submitted by Petitioner through the Board’s online website. The online application contains the following question: Criminal History Have you ever been convicted of, or entered a plea of guilty, nolo contender, or no contest to, a crime in any jurisdiction other than a minor traffic offense?2/ Your answer: NO At hearing, Petitioner testified that although he carefully reviewed his application before submitting it, he did not intend to answer the above question in the negative, and that “he made a mistake” when he did so. On cross-examination Petitioner confirmed that he read and understood the Affirmation Statement at the end of the application, and that he affirmed that the information he provided was true and correct. There is no question that Petitioner provided a false response on his application regarding his criminal history. However, the evidence of record does not support a finding that the false statement was intentional. At hearing, Petitioner presented as an articulate, intelligent, and well-educated individual. Petitioner had also successfully undergone the PN application process in Iowa, and was therefore familiar with the application review process. As such, it is reasonable to infer that Petitioner was aware that the information he provided on his application would be verified by Board personnel. This makes it increasingly unlikely that Petitioner intentionally falsified his application, since he could have no reasonable expectation of successfully perpetrating a fraud on the Board. Petitioner was notified by correspondence dated November 10, 2012, that he was required to provide information concerning his criminal history. As noted, it was not until after the notification that Petitioner provided explanations regarding his criminal charges to the Board. Petitioner included several letters of reference with his application to the Board. One of those letters was from his former employer in Iowa, Wayland Mennonite Home Association. In that letter, the facility’s director of nursing wrote: December 4, 2012 To Whom it may Concern: Hosea Pratt has been employed as a licensed practical nurse, at Parkview Home, Wayland, Iowa. He started employment September 11, 2012. Our pre-employment criminal background evaluation revealed a court proceeding regarding the suspension of his Iowa driver’s license. There was no disposition on this case and Iowa Department of Human Services ruled this did not preclude him from practicing nursing. He had a valid Iowa driver’s license at the time of hire. Hosea functioned independently as a night shift charge nurse. He assisted with orientation of new nursing staff. He completed assigned tasks during his scheduled shift. He proved to be a thoughtful young man, who demonstrated kindness towards our residents. He had good assessment skills and excellent computer technical abilities. He would be welcomed back to work in this facility. On April 9, 2013, the Board informed Petitioner that it intended to deny his Florida application. Petitioner thereafter challenged the intended denial of his application, and the instant proceeding ensued.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is hereby RECOMMENDED that the Board of Nursing issue a final order approving Petitioner's pending application for licensure as a practical nurse without conditions. However, should the Board determine that approval with conditions is warranted, a one-year probationary period is recommended. DONE AND ENTERED this 22nd day of October, 2013, in Tallahassee, Leon County, Florida. S W. DAVID WATKINS Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this 22nd day of October, 2013.
Findings Of Fact The Respondent, Jo Ann Murphy, is a licensed registered nurse in the State of Florida, holding license number 69367-2. The Respondent received her nursing education and training in Albany, Georgia, and became a registered nurse in Florida in 1973. In 1977 she became certified by the American College of Obstetrics and Gynecology as a nurse clinician. In 1981 she was certified as a clinical nurse practitioner in ambulatory gynecology and obstetric care. Until 1979, the Respondent was head nurse of OB/GYN Labor and Delivery, Postpartum Unit, at West Florida Hospital in Pensacola. From 1979 to 1983 she was office nurse and nurse practitioner in the office of Thomas H. Wyatt, M.D., in Pensacola. The Respondent became employed at University Hospital in Pensacola on April 25, 1983, primarily because of her knowledge in the field of Caesarian Sections. She was terminated less than one month later, on May 23, 1983, while still in her probationary period, for unsatisfactory nursing performance. On May 18, 1983, another registered nurse on the morning shift with the Respondent, testified that she smelled alcohol on the Respondent's breath at 7:30 A.M. Although this witness worked with the Respondent each day, this is the only time she contends that she smelled alcohol on her breath, and this witness did not see the Respondent stagger or exhibit any other symptom of alcohol use. This witness testified that the Respondent showed a lack of initiative, but that when the Respondent was told to do something she would do it well, and that she never had any concern regarding the Respondent's ability to function as a nurse. Two other hospital employees, a Licensed Practical Nurse (LPN) and a nurses aide, testified that they smelled alcohol on the Respondent's breath on a date unknown. The nurses aide, however, never saw the Respondent stagger, or exhibit any other sign of intoxication, and she says she only smelled alcohol on the Respondent's breath on one occasion. The LPN testified that she also saw the Respondent sitting at her desk in a daze or stupor, but this symptom was not observed or described by any other witness. Both of these witnesses worked with the Respondent each day, but only claimed to have smelled alcohol on her breath on one occasion. The Respondent denied having any alcohol to drink on or before any shift that she worked while employed at University Hospital. Her husband and her daughter confirmed that the Respondent had not consumed alcohol on the morning of May 18, 1983, before going to work. Another witness, a physician who was in the residency program at University Hospital while the Respondent worked there, had the opportunity to work in close contact with the Respondent on five or six occasions in the labor and delivery suite, and never smelled alcohol on her breath, or saw her stagger or exhibit any other sign of intoxication. This doctor found her to be alert, she performed her functions with no problems, and he had no complaints with her. The nursing director at University Hospital, who conducted the termination interview of the Respondent, observed what she characterized as red, blotchy skim on the Respondent, and the Respondent appeared to be nervous. However, this witness did not smell alcohol on the Respondent's breath, and she saw no other symptoms of alcohol use. Both the Respondent and the physician who employed her for four years confirmed the Respondent's skin blotches, but this is an inherited tendency having nothing to do with medical problems or alcohol use. The nursing director and the patient care coordinator both testified that the Respondent stated at her termination interview that she used to have an alcohol problem, but that she had been rehabilitated. The Respondent denies having made such a statement. Another physician, in addition to the one mentioned in paragraph 7 above, who was in labor and delivery with the Respondent more than ten times, and probably every day she worked at University Hospital, did not smell alcohol on her breath although they worked together closely. This witness found the Respondent's nursing abilities to be competent and very professional. Likewise, the physician who employed the Respondent for four years had no problems with her or her work, he found her prompt and attentive in her duties, and an excellent nurse. On another occasion, not specifically dated, but separate from the instances of the alleged alcohol breath, the Respondent is charged with having "defied an order to stay with a critically ill patient". The evidence is completely devoid of any explicit order given to the Respondent to stay with any patient during the time she worked at University Hospital. Instead, it is contended that the Respondent violated what are characterized as "standing orders" that a nurse should not leave a patient who has been assigned to her. These "standing orders" are supposed to have been set forth in policy manuals given to employees of the hospital, but no such manual was offered in evidence; nor was the nature of the "standing orders" explicitly described by the witnesses. On the one occasion when the Respondent is charged with defying orders to stay with a patient, the patient was being attended also by an LPN when the Respondent left to telephone the patient's physician. In the same general area, but behind the curtains of an adjoining cubicle, another registered nurse was attending a patient there. The patient whom the Respondent and the LPN attended went into deceleration after the Respondent had left to telephone her physician. The LPN needed help with the oxygen and to turn the patient. The other registered nurse in the adjoining cubicle came in and the patient was stabilized. The Respondent returned in a few minutes. It is below minimum standards of acceptable and prevailing nursing practice for a registered nurse to leave a patient, whose condition is considered critical, in the care of an LPN. Yet the patient was not in critical condition when the Respondent left to call the physician, and there was another registered nurse in close proximity who responded when the need for her arose. Thus, there is not sufficient competent evidence to support a finding of fact (1) that the Respondent either had alcohol on her breath or was in a drunken condition while on duty; (2) that the Respondent defied an order to stay with a critically ill patient; or (3) that the Respondent left a patient whose condition is considered critical in the care of an LPN. The competent evidence in the record supports a finding of fact (1) that the Respondent did not have alcohol on her breath at any time while employed at University Hospital; (2) that the Respondent did not defy an order to stay with a critically ill patient; and (3) that the Respondent did not leave a patient whose condition is considered critical in the care of an LPN.
Recommendation Based upon the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Administrative Complaint against the Respondent, Jo Ann Murphy, be dismissed. THIS RECOMMENDED ORDER entered this 10th day of January, 1985, in Tallahassee, Florida. WILLIAM B. THOMAS Hearing Officer Division of Administrative Hearings The Oakland Building 2009 Apalachee Parkway Tallahassee, Florida 32301 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 10th day of January, 1985. COPIES FURNISHED: Julia P. Forrester, Esquire 130 North Monroe Street Tallahassee, Florida 32301 Thomas C. Staples, Esquire P. O. Box 12786 Pensacola, Florida 32575 Ms. Helen P. Keefe Executive Director, Board of Nursing Department of Professional Regulation Room 504, 111 East Coastline Drive Jacksonville, Florida 32202 Mr. Fred Roche Secretary Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32301
The Issue The issue in this case is whether Respondent is guilty of violating Rule 59S-8.005(1)(e)2, Florida Administrative Code, for administering medications or treatments in a negligent manner and subject to discipline for unprofessional conduct under Section 464.018(1)(h), Florida Statutes. If so, another issue is what penalty should be imposed.
Findings Of Fact In June 1994 Respondent was licensed as a registered nurse, holding license number RN 2740932. Respondent had been licensed as a registered nurse since 1993 and as a licensed practical nurse since 1987. Respondent's license as a registered nurse became inactive June 21, 1995 after she failed to renew it. In the fall of 1993 East Pointe Hospital hired Respondent as a charge nurse in the transitional care unit, which had recently been started. Although Respondent had only recently become licensed as a registered nurse, the hospital hired her based partly on her current licensing and partly on her previous experience as a licensed practical nurse and respiratory therapist. During the weekend of June 24-26, 1994 Respondent worked the 7:00 pm to 7:00 am shift. As a charge nurse Respondent supervised several other nurses, typically licensed practical nurses. The charge nurse and nurses whom the charge nurse supervised sometimes divided up the patients in the unit, but the charge nurse retained supervisory authority over the other nurses and always remained directly responsible for patients with more complex problems. Patient C. P. had recently been transferred to the transitional care unit from the acute care unit. On the evenings in question, C.P. was among the patients for whom Respondent was directly responsible. Several IVs were being administered the evening of June 24 and early morning of June 25. One patient was having problems with an IV pump and his veins. Respondent asked another nurse, who was under Respondent's supervision, to do the accuchecks on the other patients, including C. P. Accuchecks are finger stick glucose monitors. As was the case with C. P., physicians typically order accuchecks every six hours for patients receiving their total nutrition intravenously. The purpose of the accucheck is to ensure that the patient receiving all his nutrition intravenously does not develop low or high blood sugar, which could have very serious implications. The other nurse failed to perform the accuchecks for midnight at the start of June 25 and 6:00 am on June 25. Respondent failed to follow up to ensure that they were done. Respondent's failure to perform the required accuchecks or to check to make sure that the other nurse performed them constitutes the negligent treatment of a patient. A physician had also ordered that C. P. receive antibiotics intravenously every eight hours, at about 6:00 am, 2:00 pm, and 10:00 pm. Petitioner alleges that Respondent failed to administer two consecutive doses. However, nothing in the nurses' notes documents what would have been a material omission, and no one on the nursing staff bothered to contact the physician who had ordered the antibiotics. There is also a reasonable possibility that IV bags bearing dates and times were mixed up so as to preclude a determination of which registered nurse failed to administer IV medication, if in fact two doses of antibiotics were missed. Respondent later admitted not performing the accuchecks, but never admitted failing to administer the IV antibiotics. Petitioner has failed to prove that Respondent failed to administer the IV medications as ordered. The hospital terminated Respondent's employment shortly after the incidents involving C. P. Respondent has since held two temporary nursing jobs and has applied unsuccessfully for 12 other nursing jobs. She now lives with her mother in Virginia where she earns $100-$200 weekly in employment unrelated to nursing. C. P. suffered no injury as a result of the failure to conduct ordered accuchecks and the failure, if any, to administer the prescribed IV. Respondent has not previously been disciplined as a licensed practical nurse or registered nurse.
Recommendation It is RECOMMENDED that the Board of Nursing enter a final order finding Respondent guilty of violating Rule 59S-8.005(1)(e), Florida Administrative Code, and Section 464.018(1)(h), Florida Statutes, for her failure to perform two accuchecks or make sure that another nurse had performed them and issuing a reprimand to Respondent. ENTERED on December 21, 1995, in Tallahassee, Florida. ROBERT E. MEALE Hearing Officer Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 21st day of December, 1995. APPENDIX Rulings on Petitioner's Proposed Findings 1-4: adopted or adopted in substance. 5: rejected as irrelevant. 6-12 (first sentence): adopted or adopted in substance. 12 (second sentence): rejected as subordinate and irrelevant. 13-15: rejected as subordinate. 16: rejected as subordinate and irrelevant. 17-18: adopted or adopted in substance. 19-21: rejected as subordinate and recitation of testimony. 22-23: rejected as irrelevant and subordinate. 24: rejected as subordinate. 25: rejected as subordinate and irrelevant. 26-28: adopted or adopted in substance. 29: rejected as irrelevant. Rulings on Respondent's Proposed Findings 1-3 (first sentence): adopted or adopted in substance. 3 (first sentence)-4: rejected as subordinate and irrelevant. 5-6: adopted or adopted in substance, although not as to the identify of the other nurse. 7: adopted or adopted in substance, except that the failure either to perform the accuchecks or ensure that the other nurse did is negligence. 8-14: rejected as subordinate. 15-18: adopted or adopted in substance. COPIES FURNISHED: Laura P. Gaffney, Senior Attorney Agency for Health Care Administration General Counsel's Office Department of Business and Professional Regulation 1940 North Monroe Street, Suite 60 Tallahassee, FL 32399-0792 Robert E. Tardif, Jr. Duncan & Tardif, P.A. P.O. Drawer 249 Ft. Myers, FL 33902 Linda Goodgame, General Counsel Department of Business and Professional Regulation 1940 North Monroe Street Tallahassee, FL 32399-0792 Judie Ritter, Executive Director Board of Nursing Daniel Building, Room 50 111 East Coastline Drive Jacksonville, FL 32202
Findings Of Fact Respondent, Jean L. Hammer, was at all times material hereto a licensed practical nurse in the State of Florida, having been issued license number 0588011. In October 1986, respondent was employed by Pinewood Lodge, a treatment center for alcohol and drug rehabilitation, as a staff nurse on the midnight to 8:00 a.m. shift. Respondent was the only employee on duty during her shift, and was responsible for monitoring the patients for signs of distress, noting their progress on the medical records, and administering prescribed medications. For such services, respondent was paid $27,000 per annum; a salary consistent with that paid a registered nurse (R.N.) at the facility. In January 1987, respondent was offered and accepted the position of Supervisor of Nurses at Pinewood Lodge. The staffing of this position required the services of and provided an annual salary of $25,000 and other benefits. Respondent occupied this position until July 1987 when it was discovered that she was not a registered nurse and was discharged. The respondent's personnel file at Pinewood Lodge demonstrates that in seeking and gaining employment at the facility respondent represented herself to be a licensed registered nurse, the recipient of a Bachelor of Science degree from the University of Pittsburgh, and the recipient of an Associate in Science Nursing degree from Broward Community College. Such representations were false, and the documents submitted to support such representations were forgeries. The proof further demonstrates that respondent assumed the title of R.N., routinely signed documents in a manner that identified her as an R.N., and otherwise led the public and associates to believe that she was licensed as a registered nurse; all for pecuniary gain. While there was no showing that anything untoward occurred during the course of her tenure at Pinewood Lodge, respondent knew her actions were improper.
Recommendation Based on the foregoing findings of fact and conclusions of law, it is RECOMMENDED that a final order be entered suspending respondent's license for one year, that following such suspension respondent be placed on probation for two years subject to such terms and conditions as the board may specify, and imposing an administrative fine against respondent in the sum of $1,000. DONE AND ENTERED in Tallahassee, Leon County, Florida, this 15th day of August, 1988. WILLIAM J. KENDRICK Hearing Officer Division of Administrative Hearings The Oakland Building 2009 Apalachee Parkway Tallahassee, Florida 32399-1050 Filed with the Clerk of the Division of Administrative Hearings this 15th day of August, 1988. APPENDIX Petitioner's proposed findings of fact have been addressed as follows: Addressed in paragraph 1. Addressed in paragraph 4. 3-4. Addressed in paragraph 3. 5-6. Addressed in paragraph 4. 7-8. Addressed in paragraphs 3 and 5. 9. Addressed in paragraph 5. COPIES FURNISHED: E. Raymond Shope, Esquire John S. Cobb Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750 Richard Smith, Esquire 1258 South State Road 7 Fort Lauderdale, Florida 33317-5989 Judie Ritter, Executive Director Board of Professional Nursing 111 East Coastline Drive Room 504 Jacksonville, Florida 32201 William O'Neil, Esquire General Counsel Department of Professional Regulation 130 North Monroe Street Tallahassee, Florida 32399-0750
Findings Of Fact On December 9, 1980, Petitioner was working as a student nurse at University Community Hospital, Tampa, Florida. She was in her next to last quarter as a student in the Registered Nurse Program at Hillsborough Community College. Her supervisor had assigned Petitioner to provide exclusive care to a comatose patient who had both a tracheostomy and a gastrostomy. Attached to the trachea of this patient was a tube into which oxygen and water were added to help patient's respiration and to keep the proper moisture content in his lungs. The hole was covered by a mask which could be slipped aside by the nurse to suction fluids emerging from the lungs. This suctioning around the trachea was required every few minutes, hence the assignment of Petitioner to only one patient during this shift. Petitioner was informed she would get this assignment one or two days prior and had visited the patient's room, read his charts, and studied the nursing required before reporting for duty on 9 December 1980. She was fully aware of the tracheostomy, gastrostomy, and the purpose and function of each. Petitioner reported for work at 6:00 a.m. on December 9, 1980, and was assigned to the comatose patient as noted above. She spent most of the first two hours suctioning and cleaning around the tracheostomy and generally caring for the patient, which included turning the patient. From her observation and study Respondent was aware of the tube into the abdomen of this patient by which he was to be fed. Shortly after 8:00 a.m. on December 9, 1980, Petitioner prepared the bag for liquid feeding of the patient and hung it on the IV pole alongside the patient's bed. She then connected the tube from the feeding bag to the tracheostomy tube. Around 8:45 a.m. James Holly, a respiratory therapy technician, entered the room and saw Petitioner standing alongside the patient's bed with the feeding bag on the IV pole and the tube from the bag leading to the tracheostomy of the patient. He immediately yelled words to the effect that the feeding tube is connected to the treach and ran to the opposite side of the bed from which Petitioner was standing. Petitioner heard a noise, immediately realized what was happening and removed the feeding tube from the trachea. Holly testified the patient coughed once violently; Petitioner testified-the patient did not cough violently. In either, event the patient's lungs were checked immediately with a stethoscope, the supervising nurse was sent for and Petitioner's supervisor was called. The patient received very little, ,if, any, feeding fluid into his lungs and suffered no adverse effects from this incident. Petitioner's supervisor discussed the incident with Petitioner, assisted her in giving the patient his morning feeding and concluded Petitioner was capable of caring for the patient for the rest of the shift. Petitioner remained with the patient throughout the shift and gave the patient his twelve o'clock feeding without assistance or incident. Petitioner's supervisor reported the incident to the Director of Nursing at Hillsborough Community College, who called a meeting of the evaluating committee the following day. At the evaluation hearing Petitioner could give no explanation of why she had connected the feeding tube to the tracheostomy tube rather than the gastrostomy tube, nor could she explain at this hearing why she did it. In Petitioner's words, "If I knew why I did it, it wouldn't have happened." Following the meeting of the evaluating committee Petitioner was dismissed from nursing school and her subsequent application for readmission was denied. Her application to take the licensed practical nurse examination, for which her time as a student nurse qualified for the licensed practical nurse training requirements, was denied by Respondent and Petitioner requested this hearing. Prior to the incident of 9 December 1980 Petitioner was regarded by her supervisors as well motivated, good with patients, and well organized. Petitioner is 37 years old and has wanted to be a nurse for a long time. She readily acknowledges that she knew the patient was to be fed through the gastrostomy tube, that the patient could not be fed through the tracheostomy tube and that it would be very dangerous to attempt to do so. Her inability to give any explanation of why she attached the feeding tube to the tracheostomy was a major factor in the evaluation board's determination to dismiss Petitioner from nursing school. Transmitting liquid into a patient's lungs through a tracheostomy tube constitutes a very dangerous procedure which could prove fatal to the patient either from suffocation (if a sufficient quantity of fluid was injested) or through infection in the lungs from the unsterilized liquid. Committing such act constitutes a failure to conform to minimum standards of acceptable and prevailing nursing practices. Petitioner was sufficiently advanced in her training to know the proper procedures to be followed in such a case, and Petitioner readily acknowledges that she did know the proper procedures to follow and is unable to account for her deviation therefrom.
The Issue The issue is whether Respondent's license to practice nursing should be revoked, suspended, or otherwise disciplined under the facts and circumstances of this case.
Findings Of Fact Upon consideration of the oral and documentary evidence adduced at the hearing, the following relevant findings of fact are made: At all times material to this proceeding, Respondent Rita Flint (Flint) was a licensed practical nurse in the State of Florida, holding license number PN0655201. Flint's last known address is 6494 South West 8th Place, North Lauderdale, Florida 33068. At all times material to this proceeding Flint was employed by North Broward Medical Center (NBMC) located in Pompano Beach, Florida, as a practical nurse. On August 3, 1990, Flint was assigned to care for patients J. C. and J. K. including administering their medications and charting same on their Medication Administration Record (MAR). On August 3, 1990, J. C.'s physician prescribed one (1) nitroglycerine patch each day. Flint failed to administer the patch on this date. On August 3, 1990, J. C.'s physician prescribed 100 mg. of Norpace every six (6) hours. Flint failed to administer the 2:00 p.m. dosage of Norpace to J. C. On August 3, 1990, J. C.'s physician prescribed 120 mg. of Inderal each day. Flint failed to administer the 9:00 a.m. dosage of Inderal until 1:30 p.m. without noting any explanation on J. C.'s MAR. On August 3, 1990, Flint failed to document the administration of J. K's own medications on the MAR. On August 3, 1990, Flint failed to sign the MARs for J. C. and J. K. as required by hospital policy. On August 15, 1990, Flint left an intravenous bag with an exposed needle hanging at the bedside of a patient. On August 29, 1990, Flint was assigned to care for patient R. R. including administering his medications. Flint failed to administer the following medications leaving all of them at R. R.'s bedside: (a) Timolo (9:00 a.m. and 2:00 p.m. doses); (b) Mixide (9:00 a.m. dose); (c) Zantac (9:00 a.m. and 4:00 p.m. doses); (d) Lasix (9:00 a.m. dose); and, (e) Entozyme (8:00 a.m. and 12:00 noon doses). On August 30, 1990, NBMC terminated Flint's employment as a result of the aforementioned conduct. There is no evidence that any patient suffered any actual harm as a result of Flint's errors. In September of 1990, NBMC referred Flint to the Intervention Project for Nurses. At all times relevant to this proceeding, Flint's job performance was adversely affected by long work schedules necessitated by severe financial problems. During the week of August 3, 1990, Flint worked a ninety-two-hour week. The acute financial stress was due to domestic problems including the breakup of her twenty-two-year-old marriage. Flint had no problems involving substance abuse. Flint attended individual therapy sessions with a clinical psychologist, Priscilla Marotta, Ph.D., and participated in group therapy designed primarily for persons with substance abuse problems. Flint attended weekly therapy sessions for approximately one month after which she could no longer afford treatment. Even though Flint was financially unable to continue treatment with Dr. Marotta or any other counseling program recommended by the Intervention Program for Nurses, she diligently undertook a self-help program to educate herself on stress management techniques, to develop self-reliance, and to improve self-esteem. Flint's effort to participate in therapy, to the extent financially possible, and to rehabilitate herself shows a strong commitment to her profession. Flint has been licensed to practice nursing since May 31, 1982. There is no evidence of any disciplinary action against her license prior to or after the incidents herein described. Flint is currently employed as a nurse in a hospice. Her recent performance appraisal reports indicate that, on an average, she fully meets all job requirements.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is, therefore recommended that the Board of Nursing enter a Final Order finding Respondent guilty of violating Section 464.018(h), Florida Statutes (1989), as defined in Rule 210-10.005(1)(e)1 and Rule 210-10.005(1)(e)2, Florida Administrative Code, and not guilty of violating Section 464.018(1)(j), Florida Statutes. It is further recommended that the Board's final order: (1) place the Respondent on probation for one year subject to such requirements as the Board may require; and (2) require the Respondent to pay an administrative fine in the amount of two hundred fifty dollars ($250). DONE AND ENTERED in Tallahassee, Leon County, Florida, this 21st day of November 1994. SUZANNE F. HOOD, Hearing Officer Hearing Officer Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-1550 (904) 488-9675 Filed with the Clerk of the Division of Administrative Hearings this 21st day of November 1994. APPENDIX TO RECOMMENDED ORDER IN CASE NO. 93-2715 The following constitutes my specific rulings pursuant to Section 120.59(2), Florida Statutes, on all of the Proposed Findings of Fact submitted by the parties to this case. FOR THE PETITIONER: Incorporated into Findings of Fact 1. Incorporated into Findings of Fact 2 and 11. Incorporated into Findings of Fact 4. Incorporated into Findings of Fact 5. Incorporated into Findings of Fact 6. Incorporated into Findings of Fact 7. Incorporated into Findings of Fact 8. Incorporated into Findings of Fact 9. Incorporated into Findings of Fact 10. The first sentence is incorporated into Findings of Fact 13. The remaining portion of this proposed fact is not supported by competent substantial evidence. Furthermore, Respondent's Exhibit 3, as it relates to a diagnosis of a mental condition, is hearsay which does not supplement or explain any other psychological or medical evidence. Thus, any reference in Exhibit R3 to a generalized anxiety disorder is insufficient to support Petitioner's proposed finding. Unsupported by competent substantial evidence. Unsupported by competent substantial evidence. See number 10 above. FOR THE RESPONDENT: 1. Respondent did file proposed findings of fact or conclusions of law. COPIES FURNISHED: Laura Gaffney, Esquire Natalie Duguid, Esquire Agency for Health Care Administration 1940 North Monroe Street Tallahassee, Florida 32399-0792 Rita Flint 3313 South East Second Street Pompano, Florida 33063 Judie Ritter Executive Director Board of Nursing AHCA 504 Daniel Building 111 East Coastline Drive Jacksonville, Florida 32202 Harold D. Lewis General Counsel The Atrium, Suite 301 325 John Knox Road Tallahassee, Florida 32303
The Issue The issue in this matter is whether the Department of Health should discipline Respondent’s certified nursing assistant license.
Findings Of Fact The Department is the state agency charged with regulating the practice of nursing assistance in Florida. See § 20.43 and chs. 456 and 464, Fla. Stat. Respondent is a certified nursing assistant (“CNA”) in the State of Florida, having been issued certification number CNA 16962. The Department seeks to sanction Respondent based on an incident that occurred on January 16, 2018. The Department’s Administrative Complaint specifically alleges that “Respondent struck Patient J.H. at least one time on Patient J.H.’s head.” The Department asserts that Respondent violated section 464.018(1)(h) by committing “unprofessional conduct” as defined by a rule of the Board of Nursing. Rule 64B9-8.005(13) defines “unprofessional conduct” to include using force against a patient or striking a patient. Section 464.204 authorizes the Department to discipline Respondent up to and including permanent revocation or suspension of her assistant nursing certificate. On the date of the incident, Respondent was working as a CNA at Avante, a rehabilitation center located in Melbourne, Florida. At that time, J.H. was a patient on hospice care at Avante. J.H. was staying in a semi-private room with two beds. J.H.’s roommate was D.D. At the final hearing, the Department represented that J.H. is mentally incapacitated. J.H.’s records from Avante indicate that she suffers from a variety of ailments which have resulted in an altered mental status, impaired ability to communicate, and impaired ability to control sporadic movements of her limbs. (Both D.D. and Respondent testified that J.H. had difficulty speaking.) Therefore, she is not able to testify about the incident. D.D., however, was present in the room on January 16, 2018. D.D. testified at the final hearing about what she observed between Respondent and J.H. on the evening of January 16, 2018. Initially, D.D. explained that the beds in the room she shared with J.H. were positioned side-by-side, about four-to-six feet apart. The beds were also separated by a privacy curtain. A sink was located on the wall opposite the beds. Above the sink was a mirror. When the encounter between Respondent and J.H. occurred, D.D. was sitting at the sink facing the mirror. Respondent was tending to J.H. in her bed. At some point, D.D. heard a sound coming from J.H.’s bed. When she turned to look, D.D. saw that J.H. seemed annoyed, and Respondent’s glasses were askew on top of her head. Respondent then left the room. About an hour later, after D.D. had returned to her bed, D.D. stated that Respondent reentered the room. Respondent walked over to J.H. who was lying in her bed. D.D. testified that she then heard Respondent say, “Don’t you ever hit me again.” D.D. then saw Respondent hit J.H. twice on her forehead with her balled-up fist. D.D. did not see J.H. move or react after Respondent struck her. At the final hearing, D.D. disclosed that she did not directly observe the incident because she was sitting in her bed, and the privacy curtain obstructed her line of sight. Instead, D.D. revealed that she watched Respondent’s actions through the mirror over the sink. D.D. commented, however, that when she sat up in her bed, she had a clear view through the mirror to J.H.’s bed. D.D. exhorted that she had no difficulty seeing Respondent hit J.H. D.D. was astounded by what she saw. She had no way of notifying anyone of the incident that night. The next morning, however, D.D. promptly reported the incident to her physical therapist. No evidence indicates that J.H. suffered any injuries from the encounter. At the final hearing, Respondent adamantly denied hitting J.H. Respondent further denied that she has ever abused a patient in her care or been accused of hitting a patient. Respondent asserted that she did not do anything wrong involving, or use any force against, J.H. Respondent stated that she has held a CNA license for over 20 years. She has worked at Avante since 2007. Respondent explained that when she approached J.H. in her bed on the evening of January 16, 2018, she discovered that J.H. had wet herself. Therefore, Respondent proceeded to change her. In that process, J.H. knocked Respondent’s glasses off her head. The glasses fell onto the bed. Respondent then reached down, grabbed her glasses, and replaced them on her face. She then finished changing J.H. and left the room. At the final hearing, Respondent claimed that D.D.’s statement is false. Respondent declared that D.D. is confused about the incident and, maybe, does not care for Respondent. Respondent also asserted that, because she was sitting in her bed, D.D. could not accurately see what happened when she changed J.H. Following the incident, Avante terminated Respondent’s employment. Based on the competent substantial evidence presented at the final hearing, the clear and convincing evidence in the record does not establish that Respondent hit J.H. on January 16, 2018. Accordingly, the Department failed to meet its burden of proving that Respondent committed “unprofessional conduct,” which would support discipline under section 464.204, Florida Statutes.
Recommendation Based on the foregoing Findings of Fact and Conclusions of Law, it is RECOMMENDED that the Department of Health, Board of Nursing enter a final order dismissing the Administrative Complaint against Respondent, Jacqueline Jean. DONE AND ENTERED this 30th day of January, 2019, in Tallahassee, Leon County, Florida. S J. BRUCE CULPEPPER Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 (850) 488-9675 Fax Filing (850) 921-6847 www.doah.state.fl.us Filed with the Clerk of the Division of Administrative Hearings this 30th day of January, 2019.
Findings Of Fact At all times relevant hereto Respondent was licensed as a licensed practical nursing in Florida and was employed at the Lake Wales Convalescent Center. On the evening of December 29, 1983, Respondent was called into patient Allen's room by the nurses aide because Allen had refused to get into his pajamas as requested and was verbally abusing the aide. Respondent approached Allen, who began swearing at her, whereupon Respondent rolled up a towel and struck Allen several times on the left arm causing some bleeding and bruises which were visible to another witness two days later. Respondent does not deny striking Allen with the towel but contends Allen picked up a pitcher and called her a nigger before she picked up the towel. Respondent denies any intent to hurt the patient and testified she has worked as a licensed practical nurse for 15 years and has never before struck a patient. Allen is senile, often verbally abusive, but has never been violent while a patient at Lake Wales Convalescent Center. He does not bruise as easily as do many elderly patients. It is below the minimal standards of acceptable and prevailing nursing practice to strike a patient and, especially, a senile patient who is not violent.
