Navigating Texas Nursing Regulations with Nurse Advocate and Expert Maggie Ortiz

Transcript

Narrator: 0:01

This podcast is for educational purposes only does not constitute legal advice and does not create an attorney-client relationship. If you need legal assistance about a legal problem, contact an attorney.

Cimone Murphree: 0:15

Thanks for joining us today on Know your Regulator, the podcast that inspires you to engage. Melissa Hooper and I are your hosts, and joining us this afternoon is nurse Maggie. Thanks for being here with us, maggie. How are you doing?

Maggie Ortiz: 0:28

I’m well, I’m well. How are you, ladies, doing good?

MJ Hooper: 0:31

doing good, enjoying the beautiful weather.

Maggie Ortiz: 0:35

We were just talking about this. I actually like it to be a little warmer.

Maggie Ortiz: 0:38

She likes to be cold, so

Cimone Murphree: 0:40

Well we’re really excited to have you here Today. We’re going to be talking about how you can expertly navigate Texas nursing and how important it is to stay engaged with your regulator, Maggie. Let’s begin by talking about what you’re currently seeing as a nurse advocate. What are some of the most common issues that nurses are facing today?

Maggie Ortiz: 1:02

A lot of stuff around digital technology, oftentimes around the electronic medical record, things like copying, pasting notes, which is something we’re not allowed to do, altering any kind of documentation. Deleting documentation is the equivalent of like ripping up a piece of paper. Sometimes I don’t think that they realize that that’s the equivalent of it, because there’s so many things that can be normalized in our environment and audit trails, which I’m sure we’re going to talk about in a minute, are, are very real and that stuff can be seen and that never looks good up on the big screen, the big screen. What we’re going to reference many times is going to be anytime you’re in a court of law, so that’s just like a you know, witty little phrase that I like to say, but the reality is when you’re sitting in a courtroom and that will be up on the big screen and you’re going to be asked about where you copy and pasting that. So that’s, that’s an issue.

Cimone Murphree: 2:01

I think sometimes, like you said, it is normalized in the workplace. You see one person do it, You’re trained that way. No one talks about it. Someone may know that that’s not the best practice, but is it truly the wrong practice?

Maggie Ortiz: 2:18

That’s really good. Say that again. That actually is really well-worded.

Maggie Ortiz: 2:22

Yeah, because that’s why nurses kind of mix culture and what is right, because nurses again get looped up in what is they see in their world and they analyze, because the average experience of the nurse and let’s just say a hospital setting is roughly about two and a half years. And remember, let’s, let’s do the math here. That’s just like right out of the pandemic, no-transcript. You’re just trying to save people’s lives. So you know, I think some of those things just play into that. And we have nurses now who have never seen like an actual paper chart. They’re like what do you mean? I’m like, wow, am I that old? Am I that old? Is that real? And so they don’t understand that just the ripping, you know, the deleting of it or the altering of it is a fraudulent. And again you ladies chime on in with that and I really want you to hone that down. Act, but they also in their defense. They act, but they also in their defense. They are.

Maggie Ortiz: 3:48

We allowed to use smart phrases that we create. Say I’m doing, for instance, a central line dressing change on a pick line. Let’s just say, you know, in the bicep area am I going to do that same dressing change every single time, per the policy? I am. So why am I making type it out every single time? I’m not. Can I create a smart phrase? Copy that, paste it into a chart? But the smart phrases from my own, like internal, you know, doc, not from another patient, not from another nurse, not from someone else’s documentation, and then I can alter it to. You know they had an allergy to the tagaderm, so I use the Opti 2000. I’m making adjustments or corrections to that that are adopted for that patient like a template.

Maggie Ortiz: 4:31

So I think that nurses see these tools that we use and then they can in their mind they almost like rationalize. Well, that’s not like a big deal, because you know I copied and pasted my smart phrase and you can’t do that. And I mean I know you, ladies, review medical records. I saw a e, uh, an er physician who’s an expert doctor who does medical malpractice, who was referencing a physician because he opines or gives his opinion on physician conduct, copy and pasting stuff that was even not even right, not even right. So it’s not even, it’s not even specific to nursing. It’s a problem in our industry and some of these things that we’re going to talk about, no one is blaming or wanting the nurse to feel like you know we’re having unrealistic expectations of you’re trying to shame you or blame you.

Maggie Ortiz: 5:23

The real reality is the environment that any provider is going to work in. It has nuances, workflows, there’s things that are truly happening around us, and so if you don’t know, you know you’re not engaged with your regulator and you don’t know the rules and regulations that dictate your professional practice, or even best practices to your point. The joint commission sets guidelines. If you deviate from those, if you don’t think you’re not going to stand in front of the board of nursing, I don’t know who you’re kidding. I was a prior investigator. You are held to that standard. There doesn’t have to be um injury or you guys speak about like duty, breach of duty, causation and damages for a nurse. There doesn’t have to be any damages in front of the board of nursing under administrative law.

Maggie Ortiz: 6:08

So I got really long winded, but there’s just a lot of things, and let’s go back to some of the digital technology, the use of this digital stuff that’s coming into our world, whether it’s AI, the EHR, texting doctors on your phone, some of these behaviors that we have normalized that are absolutely not appropriate Tick, tocking from work why you have a badge on and you’re clocked in. That’s theft of time and I hope you ladies, you know, hit on that a little bit that that’s a big, huge deal. So I mean there are quite a few things and just because of where we are in healthcare right now, there are just a lot of things. Technology, you know the state of affairs right now.

Cimone Murphree: 6:54

It’s just, it’s not. It’s not one thing. Yeah, no, I completely agree. I feel like there, you know, you definitely see a shift post pandemic, where you said everyone was in survival mode and those, those practices that are not best practices or right practices, were picked up and continue to move, and then you know the new nurse is coming and pick those up too. So, um, yeah, I know that is great to highlight and so important for you know. If you’re questioning whether you should be doing this or not, you should find clarification on that. You don’t want to have that looming over your shoulder.

MJ Hooper: 7:29

And set the example for others who may be practicing the other way. You be a leader and set the pace for everybody.

Maggie Ortiz: 7:39

And I want to double down on that. Mj, Thank you for that. And this is some of the stuff that I really do talk about. And how are you going to do that? Because it’s easy for us to sit here and talk about that, right, but what are you going to use? You’re going to use what we’re telling you, the rules and regulations.

Maggie Ortiz: 7:52

When I show up to my job and they’re trying to give me, let’s just say, an unsafe assignment, what am I going to say? Well, okay, you’re not going to get animated and activated. I have concerns about this. Not right to safe Harbor. Let’s talk about this. So two, 17, 11, one S says making an unsafe assignment, me you making that and tease me accepting that. So if I don’t have the education, training and knowledge is that that regulation says, how can I accept this unsafe assignment? And then, if we look at civil litigation, the definition of medical malpractice is no only willing to take on an unsafe assignment. And then, if we look at civil litigation, the definition of medical malpractice is no only willing to take on an unsafe assignment.

Maggie Ortiz: 8:27

So, before I do that, can we, you know, use the chain of command? Can we get the charge nurse here? Can we maybe get the house supervisor, Maybe there’s a nurse in pre-op or somewhere else that can come here and help task to alleviate things. But that’s going to be in part of your nursing foundation and your nursing portfolio that you’re going to build for yourself. And it’s not me, Maggie. It’s like I have the privilege to practice because the board of nursing gave it to me, or whatever state you’re in, it doesn’t matter. Honestly, you guys know this. What state? Every state gives you the privilege to practice, and it’s not you. You’re just going to use the board of nursing and I’m going to get real long winded for just one second, because really there’s only three sections standards of practice, unprofessional conduct and grounds for discipline. This is a 15 minute read, folks. This is nothing long. Our board does beautifully write out some of this stuff, as some others do not.

Maggie Ortiz: 9:23

And then I highly encourage every nurse to go to frequently asked questions. Again, done very well, very well. Like to your point, MJ, if you have a question, even as an LPN, if you’re supposed to be triaging, guess what it says right under frequently asked questions. That it says can a nurse, LPN triage? And it tells you why Because of the limited scope of practice because of the limited education. So it’s I used to teach LPNs. It’s based on their limited education. They can do an initial assessment. I love LPNs but their assessment is very different. That’s a focused assessment. Triage is a complex assessment only done by an RN. So I tell them go to frequently asked questions.

Maggie Ortiz: 10:06

I promise you and this state, even if you don’t practice in the state, oftentimes I will send nurses or even lawyers to the state, because some of my mentors, some of the people who I, you know, like Lolly Lockhart, hope to get some of those things into place, because the rules and regulations are written in graduate level. The NCLEX, the test that we take, is written in the 10th grade level, and so the frequently asked questions are a good place to go to just kind of give you some guidance, because those rules and regulations although I think for the most part I mean you ladies, you know probably deal with these, you know every day, like I do, intimately it’s. I don’t think here in our state that it’s that hard to navigate those three sections because you’re not going to those other sections, but that’s a good place to start.

Cimone Murphree: 10:54

Yeah, no, I agree. I actually have to give a little shout out to the board of nursing because of the state agency websites that I frequent. Um, there’s this easily navigatable, it is very, and they have a bulletin as well, which is their newsletters.

Maggie Ortiz: 11:09

Yeah, yes, so it wasn’t nurse that did that, I, when I was there for a short period of time. Again, I don’t know if it’s the same person, but you know it wasn’t nurse that came up with that. So I applaud him. I believe it was you know that that did that to your point. Yes, I, mad respect. I know it was a huge overhaul that was happening, like at the time I was there. I again, mad respect. I think that they’ve done a really well good job.

Cimone Murphree: 11:37

Maggie a really well good job in respect, maggie. Let’s take it back to the beginning of this process for a second. Are there some issues that prospective nurses can run into when applying for a license, or even nurses that hold a license, are there some issues that they can run into when renewing their license?

Maggie Ortiz: 11:52

Yes, that’s a great question and this is part of the education piece that you know I talk about. It does not matter, and this is part of the education piece that you know I talk about. It does not matter, and some of the stuff that we’re going to talk about it’s not right or we don’t. I me, I’m just speaking my opinion. I’m not going to speak for you two ladies, but if you’re 2021, 22, and you got a DUI let’s just say then you’re 54 and you decide that you want to be a nurse, you will have to disclose and fill out a declaratory order about your conduct when your brain was even barely developed and, more likely than not, you will be possibly disciplined by the board of nursing. So what’s discipline mean? That you’ll have to be evaluated for fitness to practice, and this is true across any state. If you do get a DUI, the board does have a duty to protect the public and not us. So they just have to make sure that you are fit to practice, and everyone’s going to be a patient. We do want the people that are touching us to be safe, so I don’t have a problem with that. So there’ll be evaluated to fitness to practice and then it does open up an investigation. That’s the. That’s the epitome of an investigation. I have to make sure you’re fit to practice.

Maggie Ortiz: 12:58

So to your point when you’re filling out, you decide that you want to go to nursing school. People have reached out to me and said, you know, I had X, y, z, and I say you need to go to the schools. Uh, uh, there’s going to be a handbook, there’s going to be a resource there that talks about the declaratory order that originates from the state. Because who tells the? Who gives the school the ability to offer you nursing education? It’s the board of nursing. So they give you that temporary, what we call sometimes like a blue number or a blue card, or a temporary number, that that the school gets that privilege from them. So the school has to take direction.

Maggie Ortiz: 13:39

They literally, for all intents and purposes, lift the language from the board and say hey, nurse, if you’re going to apply to school, you’re asking for that number. We have to know about any criminal conduct. If you were, you know it will be very specific and it is very different for every state. For example, florida doesn’t. It asks, it doesn’t ask if you’ve been arrested, has been asked if you’ve been charged, and you ladies know Texas is no joke, I mean they don’t want to know at all Like there’s no expungement. There is, literally and I’m not, it’s not quote me, I am you know reading. It’s the small print even says, under this six question, there’s no expungement. Don’t even try it. If you think there’s going to be expunged, nice try, cause some States do allow like expungement. But so I to your point. I tell nurses you got to read every word.

Maggie Ortiz: 14:31

You may have to seek out legal counsel to go over some of these things, to help you mitigate, or to um to help you navigate that process and to try to get you the best outcome, because when you were, you know your brain wasn’t developed. Should you be standing and be disciplined? You know, and you need someone to help you go through that process. More likely than not, unfortunately, because of some States do just discipline you, some don’t. But who’s going to help you understand that? You know. You know practices like yourself.

MJ Hooper: 15:04

Well, and I think an important part to add to that, miss maggie, is don’t lie, don’t lie on those applications because it is gonna, you’re gonna get caught and it’s going to make your case and your issue, your circumstance, even worse, and sometimes it may be too late at that point. So don’t lie people on these applications.

Maggie Ortiz: 15:24

And to your point, mj, when I was in my training, I actually was told to go back to the time that you were 18. And so that’s what the training within the agency, right? So? And I was in in.

MJ Hooper: 15:40

I Simone, you probably don’t know, but mj, I mean, I feel like you know, I was told michael guys, but I wasn’t, so we were looking.

Maggie Ortiz: 15:44

I was told to go to micro fish. I was like, wait what hold on yeah, okay, so do you know what this is, love like.

Maggie Ortiz: 15:50

You have to look under this like microscope thing. I was like I don’t even know if I know it. I mean. So to your point, MJ, if you don’t think that they’re not going to go, look in that they do. So please don’t. Don’t lie. Disclose, but don’t over disclose. Like I said, you want to make sure that you’re reading the languages. What is actually asking for you? I’m at no point telling you not to be forthright, but it does come down to what you are being asked. And so, with legal counsel, those are things that’s going to help you, you know, to mitigate those kinds of questions.

Cimone Murphree: 16:25

A professional licensed attorney can clarify the terms they can you know, just help you understand the process way more thoroughly.

Maggie Ortiz: 16:35

And you might have to write something up. You might have to write up a rebuttal saying, okay, yes, I, you know, I was arrested for a felony, whatever it was, because oftentimes nurses ask me I had a felony, I can’t get a license. That’s not true. That’s absolutely not true. Now, are there going to be hurdles? Yes, yes, yes, of course there are, but that doesn’t preclude you from being a nurse. You reach out to like a professional licensing attorney. They start helping you. It will, and you should be making those decisions before you go to nursing school, because let’s just label uh linked to um a patient abuse. Like someone reached out to me. They had um smack their child across the face, uh, and got arrested, and you know what that meant for that nurse, right? That ended up in front of a board of nursing and so some of the things that were tied were related to like abuse.

Maggie Ortiz: 17:41

So when a nurse comes or when someone comes to me, like this was on my, my previous life I just do education. So can you be a nurse? Yes, what’s this going to look like? You may not be able to be bonded, which may preclude you from working at some places, and you need to do some basic research. Are you on the OIG list, the Office of Inspector Generalist? Are you on the National Practitioner Database? That may get risky, and so you just may choose that. I don’t want to spend $60,000 on my nursing education and I get out of nursing school and that’s your parents, right? I mean, this is me and MJ, and now you know my child can’t work, or you can’t work and you spent $60,000 because that’s roughly what UT is, because I’m on all these lists or it’s now hard.

Maggie Ortiz: 18:32

30% of nurses leave the first year, 60% the second year. One of the leading causes of nurses and trigger warning who take their lives is a border nursing complaint, right? So these are all real things that you know to your point. Don’t lie. Be honest. Get a professional liability insurance. Just because you have a felony doesn’t mean it’s going to preclude you. But having all the knowledge before you make some of these decisions, as you move along and make what’s basically going to be a fiscal decision, you know you may just decide to do something different because you’re going to have restrictions on your license. You’ll always have to disclose it. You’ll be on nurses and maybe for you that’s just not something that you you want to do, you will be put under investigation. You, ladies, know that’s not optional and that you will have to go to a process, through a process which could be two to three years of your life.

MJ Hooper: 19:29

I’m glad you said that, cause I wanted to stress to people that it is not a fast process. The attorneys the phrase all the attorneys like to say is it is a marathon, not a sprint and you got to be patient. Yeah, that’s check your mail check your mail people. These agencies still are sending things out via usps. You got to check your mail, guys, and and pay attention to your stuff, because these things may have deadlines, so pay attention and stuff like that.

Maggie Ortiz: 20:03

They do have deadlines to your point, mj, and it is required for you. The board of nursing in every state does require to keep your address up to date. So you know what one thing was that I was told to add on, if your letter came back, certified mail to your point. For the third time, and every time it came back you’ve seen this on the orders I had to write in there like under five or six return mail. You didn’t keep your address up to date and in our state that is a violation. You’re required, and that’s just adding one more on to what you did. That’s now front facing. So it is required for you to do that.

Maggie Ortiz: 20:40

Some will do both. They’ll reach out to you from by email and or by certified mail. Texas does do certified mail, but they also oftentimes will do email. I’ve seen them do do both and you ladies could probably speak more to that as well. Once legal counsel is involved, they no longer speak to the nurse, they only speak to legal counsel, which is exactly how that should be. You shouldn’t be speaking to the board of nursing. That’s why you’ve hired the legal counsel, and the investigator knows that that is standard practice. That’s the expectation.

Cimone Murphree: 21:18

Yeah, I definitely know that there’s a lot of hesitancy sometimes and the investigator knows that that is standard practice. That’s the expectation. Attorney is really there to assist you, be your advocate, share this burden with you, because they will take over that communication, you know, and how great is it that you’ve got someone who is in your corner, knows what they’re doing, can speak that language that’s advocating on your behalf. I mean that. To me it seems like it would take a little bit of the stress off.

MJ Hooper: 21:53

Totally agree yeah.

Maggie Ortiz: 21:55

Well, and not only that, to your point, the attorney has stood in front of those attorneys, knows that some of the nuances, has worked with investigator Maggie, has worked with investigator Sally, or board attorney Bob, and is going to say, just like nurses know, when we show up to our jobs. And you’re like, like nurses know when we show up to our jobs and you’re like, ooh gosh, it’s this Dr Bob, it’s Dr Bob, or you know Sally. Today there are nuances that you know standing in front of her being in a certain modality or in courtroom. For you know, to your point, so we’ll say, you know, I don’t think that we should push with this or that because this attorney, you know they get a little bit. You know they will push back, but maybe we offer this. I’ve seen this work in the past. So, to your point, having a professional liability or having a professional licensing attorney to help with some of those nuances, because they do know the, you know the people that they stand in front of and the language where the nurse doesn’t. And we’re a nurse, to your point, just innately, we’re like I didn’t do anything wrong. And so they start saying stuff and they don’t understand the process and that they have rights, their due process, those kinds of things in their full and complete file. Because do you, ladies, remember what you had three days ago for lunch? I mean, so how am I being asked about what I did or did not do? I gave this medication three, four months ago. I mean, that’s not, that’s not realistic. So the attorney is the one who hopes you draft, you know, your general denial letter asking you for your full and complete file, you know, and then you’re getting that file back and then you and your attorney, to your point. Now I do tell a nurse you don’t get to just check out, you need to be working closely with your attorney. You, the attorney, doesn’t know the equipment in your area, it doesn’t know the nuances, doesn’t know about Bob or Sally Cause that that is pertinent things, but that will be drafted up in language, you know, that’s more concise and summarized to say, hey, you know she was the only one not going to the happy hours, or she was being ostracized, or sometimes there’s other nuances that maybe they don’t realize.

Maggie Ortiz: 24:05

Or the attorney sees that, like I do, that that investigator is not a nurse. So when a legal team, you know, hires me, you know I’m defining what is the pyxis or the omni-cell? Because I see the investigator is not a nurse, so I have to go the extra layer and say you know, this is a medication dispensing machine and some of those little nuances, because I have to paint the picture for that person who is reading that. And so the nurse has to say, actively involved with that, to say you know? That was my third day in the row I’ve had a nurse like spell out the map. The last time I testified for the nurse I said map the unit out. I didn’t say one word, she said it all. She was even saying you know, exhibit a. I was like, yes, I love it, there was 33, right, her attorney sat there and we just sat there. The judges were there and she just went through every single one of them, exhibit A, b. She had a map of the unit saying you know I was on this side, you know this was happening, the bed alarms, because some of those things do really paint a picture of what’s happening.

Maggie Ortiz: 25:07

So working closely with your attorney and being a part of that to draft up your response and understanding those things is just, I think, very, very important and to your point, MJ, it’s a marathon and every our state does it’s. It is dictated by law. It is not. It’s part of I’m trying to the word under administrative law and sunset. They talk about how long an investigation can be. It is not a deviation, unfortunately, for it to go past. I think the average was roughly about two years. So the legislators I mean that’s been brought before them, but you would want a robust investigation.

Maggie Ortiz: 25:47

As an investigator, I had two to 300 cases in various different stages, so you know what I mean. The investigator does have a different workflow and if there was a nurse who was risking a patient’s life, then you know Sally, who may or may not have gotten a DUI at 17, was not my priority, right? Bob, who was injecting air into someone who I had to actually leave the office to go and remove, was my priority. So there are also workflow things, and so the majority of the stuff that I do with nurses for you know, advocates is the educational piece. So where the lawyer goes all over all some of that stuff, where then the nurse is coming back to me and I’m like, okay, so I know that you got the cancer diagnosis, so the letter right, you got legal counsel, let’s go to the national council of boards of nursing. Let’s just watch the video. What does it mean to be under investigation? Council boards of nursing. Let’s just watch the video.

Maggie Ortiz: 26:37

What does it mean to be under investigation? Because for them it’s so anxiety, they feel ashamed, they don’t want to talk to anyone, they feel isolated. I already told you that they have thoughts of you know, unaliving themselves. So some of it is just I’m listening, right, I’m a nurse. I can help some with some of these nuances. You know, I let them unpack, it’s going to be okay.

Maggie Ortiz: 26:55

Do you have mental health services? You know where are you at. Let’s get you with some of the other resources and let’s just talk about yes, your investigation is going to be two to three years, but you got to put that aside. You have a lawyer. You’re doing all these things that you’re supposed to be doing. You’re going to get your file. You’re going to review it. You’re going to work with your lawyer every three months. You’re going to get a lawyer that says, hey, the board of nursing here we’re still looking at it, but it’s going to be two, three years. So sorry about that, but some nurses can’t even check the mail, but if they can anticipate that that letter is going to come they know that’s going to come.

Maggie Ortiz: 27:30

So then that helps them. I’m like you don’t necessarily have to open that mail. Ask your husband to do it. Let’s set up a plan for you. What’s going to work for you to help you with that? Letter does have to be opened and you can’t ignore it, right? So maybe someone else opens up for you. But let’s just get a plan in place. Is your address up to date? Once they know and understand that they’ve come back to me repeatedly.

Maggie Ortiz: 27:53

Um, you know, nurse, just reached out to me, her legal team. They got her case dropped, not in the state but another state, right, and she said I could not have done it without you because of the resources, the things that you provided, and just listening and helping to just educate, you know, getting her lawyer even some resources. He was like I didn’t even think about that, like that’s why I’m here, that’s why you got me, sir. You know what I mean? Because it’s about unpacking some of these resources or just going and looking at some of these nuances and sometimes even presenting up like that violation that’s going to link them to the MPDB and so maybe we offer up, you know, a medication error instead of like it looking like negligence. So helping unpack some of that stuff. So I got way long-winded. But education, having a professional liability insurance we’re going to talk about that. And then, because that will afford you a professional uh, attorney that can help you defend your license, because it’s going to be two, three years of life, and so let’s just say that you get fired and I don’t want that for you but, correct, that could be a reality. But now you can afford the law firm because your deductible is helping you, right, that’s now it’s fiscally responsible, that it can help you cover the malpractice. The attorney that’s going to help you, you know, defend your license. So that that’s just very important.

Maggie Ortiz: 29:18

And one of the things you know that we’re trying to do is just help educate nurses so that if this does happen and as I’m crossing over even to the nurse innovator space as well and on LinkedIn, and I’m not telling you anything that’s not already out there the walking ICU nurse I don’t know if you know this young lady, callie Dayton science supersedes rules and regulations by a decade. So science supersedes rules and regulations by a decade. She advocates and her she’s piling science and stuff away from patients being automatically put on life support and sedated like mobility. Get them off life support. So she’s got intubated patients walking around on life support on ECMO. But someone reported to her to to a board of nursing and she got investigated. So she’s openly speaking about some of this stuff and so, and, and on LinkedIn I highlighted her and I said thank you for talking about the things that we don’t talk about in this world.

Maggie Ortiz: 30:13

And she’s she’s got she’s nurse practitioner she’s I mean, she’s got all these words right, but it’s you know, she had a professional liability attorney or she had a professional defense attorney why do I keep saying this wrong, I’m so sorry Administrative attorney to help defend her professional. You know her professional license. You know what I mean, because it’s so very important. So it’s not just the nurse who makes the mistake, it’s the nurse innovator, creator. It could be any of us. If you hold a, if you have a practice, if you’re a nurse practitioner, if you’re calling yourself a nurse coach, you have to have professional liability insurance and people like yourself in the back pocket and listening to these, this kind of stuff, having you guys on speed dial to say, hey, I’m going to put this in writing, what do you think about it, and you’re like, no, stop it. Mj is like oh, probably not, probably not.

Maggie Ortiz: 31:03

No hold it right there Say this you know what I mean. And that’s when people come to me and I’m like okay, so you need to reach out to you know some other other people because that’s a contract or some of the stuff. As an RN, that you’re saying sounds like you’re an MD and the board of nursing will report you. You’re not a nurse practitioner, you’re not diagnosing, you’re not interpreting labs. So let’s get you with some people who can help you draft up some of that language.

MJ Hooper: 31:31

But that’s not it I was also wanting to say you were talking about. You know, if a person had gotten fired and they feel ashamed or don’t want to talk about what’s happened and that’s the reason they got fired. I just wanted to interject and say that if you, as a license holder, are going through a circumstance like that, just be open and honest with your attorney. Talk with them as to what’s going on in their life. You know, if it’s financial issues you never know there may be programs available. You know the attorneys do want to try to be maybe a best friend, you know, during such a horrible incident, but we’re here to help you and guide you through it and wanna try to make things as best or better for you as possible. So open communication is important. Don’t shy away from any detailed thinking. You’re going to look bad because the attorney needs to know ahead of time. That way the attorney isn’t side-blinded later on.

Maggie Ortiz: 32:35

They’re almost like they’re the attorney, but they’re also like the social worker or cause, even sometimes maybe it’s not just them necessarily, but they also have you guys, people, in their practice, and it’s just like for us. Now the doctor writes the order. We all know who’s doing some of the work. It’s the same situation. There’s ancillary stab, you know, there’s an x-ray, there’s a radiology technologist, there’s blood work. Right, Things don’t happen in a vacuum. So the attorney takes that information. And so maybe you know MJ gets them a resource, or you know, Simone, you do something else for them. But it’s the practice that hopes, you know, to your point, get you maybe lined up.

Maggie Ortiz: 33:10

Well, you know, have you thought about a GoFundMe? Or sometimes it is. And I tell nurses, sometimes you’re going to have to get a lien against your house. Now, do I want that for you? I do not. But let me just look with what this looks like five years from now, Cause when they reach out to me, I’m thinking about them calling me sleeping in their car and their kids in the car, which you know that this is a real story.

Maggie Ortiz: 33:34

And so what is going to get you to work now, right now, you don’t think that taking out a second mortgage is like realistic and I’m telling you, no, no, my God, it’s so is you have no idea? I mean, this could be like this huge animal, or maybe it is that you asked to borrow some money, you know, and then you start working on some things to help your attorney, like start drafting up some stuff, you know, so you’re not handing all the attorney like eight hours of work, maybe it’s six hours of work but that you’re negotiating with the attorney to say, hey, what are your thoughts on if I work on some stuff? We work on the stuff and we come to to your points and mj some things together, because I do have limited resources, or maybe they may be able to guide you to some resources in the community or grant or who knows something that you may be eligible, but it’s just really not optional. It will affect the rest of your life. A revocation of your license and this is nurse love, tough love to my nurse people will get you on and this is you, ladies, my audience.

Maggie Ortiz: 34:31

Most people don’t understand what I’m talking, but this is not hyperbole. A revocation of a nursing license will end you up on the office inspector general list, will end you up on the national practitioner database and can have far reaching ramifications to not only this license and to you know some of your points. If you want to hold another license, cause you’ll know I’ll have to tell the, the real estate board or the cosmetology board, all that stuff we already told you any board. So it’s, it’s a big, it’s a big, huge deal.

Cimone Murphree: 35:06

What are some of the best practices for nurses to avoid making these mistakes, avoid receiving a complaint? I mean, I know that there are people who will go and they will complain and they will say I did not like the way that she did that and you know, and, and in those situations, really you know what can you do. But what are some things that nurses can actively be working on right now so that they can make sure that they safeguard their license?

Maggie Ortiz: 35:27

So I’m going to go back and I know I keep beating this dead horse, but it’s going to be the rules and regulations that dictate your professional license, because you ladies know, when it comes down to the nutcracking, this is not civil or criminal law. You will be standing alone and then. So, just so we’re, we’re clear, and I’ve been on the both sides of it Now the nurse has to answer the questions the nurse doesn’t get to. There’s no objection. You know pleading the fifth. You ladies know, just like I do, that’s not a reality.

Maggie Ortiz: 35:58

So, knowing the rules and regulations that dictate your professional license, you have to own your own practice. You, when I come into a unit, you need to know policies. Am I asking you to memorize all the policies? No, but you have to know what policy is. What culture is if they’re saying no, we just take the patients off the telemonitor, that’s. That’s just the culture. In what world if? If you know it’s not right, you do need to question, but in respectful, professional manner.

Maggie Ortiz: 36:26

And there are going to be some things. Especially, you’re you’re. You know you’re 19,. You’re 2021, you’re going to have to learn some scripted language. It’s going to be very uncomfortable, it’s going to be hard at first because you’re just learning. There are going to be doctors that say things to you that are so egregious. There are going to be nurse leaders who say things to you that is just like so deplorable. You have to leave those environments. They don’t deserve you. They don’t. You are very valuable. Start talking to other people. Don’t take a job If 12 people are telling you that’s the most horrible place I’ve ever worked. Why are you going there? I mean, read the room here folks. Go to a place that’s going to support you. You are valuable and what you do is very hard. What we ask of nurses is very hard. So get into a place that’s going to support you. If you are new grads, research a nursing residency program, you want organizations to pour into you. It costs them a lot of money. It costs about $80,000 to $120,000 for a nurse to be like in a one-year residency. To onboard a nurse is roughly about 50 to $80,000, even not doing a nursing residency, like if I was on board and like cross train, just say the labor and delivery to onboard a nurse is a lot of money.

Maggie Ortiz: 37:45

So do your due diligence right. Invest in, make sure that you want to work there and that you, you know that’s a place that you’re going to stay so that they can pour into you. You deserve, you know, an orientation. If I cross train, a labor and delivery, I’m getting three months at least. I’ve never done that.

Maggie Ortiz: 38:04

If I’m going to, let’s just say, step down or back to the ICU, I may not need as much because I’m a seasoned nurse, but I need to ask for what I need, but my orientation is just going to be very different. Do you think I need to be told some you know, told this, you know some certain things? No, I need to know. Where’s the crash card, how, where do we document my? My training may be just a little bit different, because I do bring a level experience to the table, but ask for what you need. You know what I mean.

Maggie Ortiz: 38:33

Have some basic questions. Whether you’re a new grad, your questions are going to be different and you’re not going to have the same questions that I’m going to have. You have to learn the rules and regulations, some basic policies. I’m big on the nursing foundation. You can’t start building your house, and so what do I mean by that? Precepting being in charge, taking on any other layer of responsibility? If you don’t have a foundation. So don’t do that. You get to dictate that If someone comes to me and asks me to be in charge or to precept and I don’t have the A, the education, training and knowledge, or you’ve been a nurse for less than five years, no, you get to control that stuff.

Maggie Ortiz: 39:15

And I got asked to speak to the Texas Women’s University students who are graduating and I did get asked this question. So I turned my microphone back on and I said I just want to be real clear, because they were interviewing for places and they’re being told that they’re going to have to be in charge and precept under you know, like within six months. I’m like no, absolutely not. No. Plumbers, welders, not even Benner Dr Benner, who is a nurse for magnet, who talks about being an expert nurse. This is all five years, not even for our discipline. This is every discipline. You should not be layering on any other responsibility because again, you ladies know, just like I do.

Maggie Ortiz: 39:58

Can I say stand in front of the board of nursing and say, well, they made me be in charge. Really, show me how they made you. They didn’t. And so they’ll play into ego pay. And now let’s cross that over to civil or criminal law. They’re going to play out. So how much will you get paid in more an hour? It will look. They’re going to play you as being very ugly and say things about you that are not true. So you need to control your environment to a certain degree. Do not start laying on other things. Do not layer on charge, do not layer on precepting unless you’ve been play honestly a nurse for more than five years. You do not bring anything to the table and that is nurse love, tough love, love. So so don’t do it. Nurse practice, act. Know the rules and regulations because, when it comes down to it, the standard of care lady is what? What a prudent nurse, what it would not do and what dictates those? Is this the board of nursing?

MJ Hooper: 40:56

and continuing education is important to keep up with too, yep.

Maggie Ortiz: 41:00

Yep, I’m big on that and a lot of our state is the only state that requires jurisprudence. Jurisprudence is the intersection for for those that don’t know, I know we do uh, basically the license and the law. But to your point, mj, we’re so a lot of nurses are so far removed from that. So I teach nurses in online courses, charting courses, not trying to plug myself, but I tie in some of the stuff because it’s not just about charting, it’s about you know the rules and the regulations, what’s lurking out there, you know the joint commission, some of these other governing bodies that do dictate our practice. And if you don’t stay current on current education, then you just get roped up into the stuff and you can’t say I didn’t know, I’m so sorry, that’s not how it works. So I am big Thank you for that, mj. Continuing education and then, to your point, some nurses who come to the state don’t. Other states don’t require continuing education and they’re like what do you mean requiring education? I’m like, yeah, texas requires it. Um, so you got to make sure that you stay current, because why are we here? We’re talking about what could end you in front of a board of nursing, and I’ve seen nurses. To your point. I go to pre-op as an agency nurse in a surgery center and I frequently go to places and one nurse came like Maggie, I got reported to the board or I got aud name. She didn’t have her current CEs and now they gave her a smack and it went away. Cause again, you know she got a lawyer. She talked to me. You know we whittled that away. You know whatever it was, she really didn’t have the legitimate stuff going. You know her child was going through like brain surgery, some diet, some bad, bad stuff, right, and, and you know, ask the nurse for forgive, the board for forgiveness. And they were like, okay, but don’t, don’t, don’t forget, nurse. But to your point, that is a big deal. But nurses you got to don’t, don’t like take, if you’re going to do a CE, take mine. I mean literally. It’s not just about just checking a box off, because nurses unfortunately sometimes do some of the stuff we don’t get offered um CEs that are even legitimate. So just to your point, mj, and I am going to give some other nurse creators.

Maggie Ortiz: 43:26

There are podcasts. Welcome to the 21st century nurses. You can listen to other nurses tell you stuff about what we do in your modality and you can get a CE and adjust your practice to what is best practices. To your point, simone, and you’re learning via listening and real life stuff. But you’re staying on point with what continuing education is, so it doesn’t have to be this boring stuff that’s not even applicable to to what’s even real.

Maggie Ortiz: 43:56

Now there is stuff in our state Trafficking is required we do live in a border state and then jurisprudence, the full 60 for every provider, not just nursing, and then it’s, isn’t it three hours every third cycle correct me if I’m wrong there. For the jurisprudence that you have to make sure that you stayed again, I don’t quote me, I’d have to go read that off and I again, I do stay current with my stuff. But to your point, mj, you make sure that you go to the border nursing website, whatever it is that they’re requiring you. But there can be some other fun CEs that you can take to keep you current in your own modality that are done by nurses that are working in your environments the ICU, the ER, the recovery room to keep you current and avoid you from having to speak to any one of these ladies and myself.

Cimone Murphree: 44:45

Really big question for you, maggie. You, maggie, after all, we have said what would be, I want to say advice. Um, what should a nurse do if they realize that they have, in fact, made a mistake?

Maggie Ortiz: 45:02

Yeah, that’s a great question. First, integrity that’s like what our profession is built on, right. We can’t be the most trusted respect and respect to professional and that not own our behavior. I mean, some people have their opinions about Radonna’s case. You know, I do as well. But one of the things that I do respect is that she does own that. Immediately. She does say, hey, look, I caused an error, but we saw where that ended her, right. So what does that mean? What is my opinion? You do have to own your practice, right. So what does that mean? What is my opinion? You do have to own your practice. You do have to say I, you know, gave the wrong medication, this is what I did wrong and correct that.

Maggie Ortiz: 45:38

You don’t delete documentation. You can strike through it. If a patient you know you gave a wrong medication, a patient falls, something happens on your shift, you have to document it. You have to fill out an incident report. Those are not discoverable more often than not. Yes, redonda’s case is very unique, but you ladies know, in civil litigation that’s not discoverable. Most organizations do not hand that over. So you do need to fill out the MIDAS. You do need to follow your policy within your organization. If there is an error medication, you need to follow your policy within your organization. If there is you know an error medication, you need to go to the rules and regulations. I’m going to say it again the dictate your professional practice. I know I’m going to keep driving home, I mean, but you can’t stand in front of the board and say I didn’t follow that. So you just have to make sure that you’re following that.

Maggie Ortiz: 46:31

In our state you can be extended peer review. Our state is one of the only state that does have peer review, which is different from safe Harbor peer review. If they’re the organization employees, either six or eight I apologize, more than six or eight nurses, they have to have the peer review process where they’re able to bring collectively nurses, doctors, pharmacists together to say, to look at a nurse’s conduct, to say, hey, this is what happened, we can see this, how this happened or not, and they can put the nurse on a process improvement plan. Or they say, wow, no nurse would have ever done this, this was a gross deviation. This is not what a prudent nurse would or would not do. And we we are going to have ever done this. This was a gross deviation. This is not what a prudent nurse would or would not do, and we we are going to have to hand this over to a board of nurse, to the board of nursing, and then that sent.

Maggie Ortiz: 47:19

I did open up investigations based on what the peer review findings were sent, but I’m getting long winded. But that is another reason why they could reach out to you guys as well. If you are, you know, standing in front of peer review, you are allowed legal counsel, and that is something that you should not take lightly, because I just told you I was sent those findings when I was at the board of nursing and those will be sent to them, and so your, your attorney, can help with that. But you can be extended. You know the peer review process.

Maggie Ortiz: 47:50

Now, I did say safe harbor, so I just want to touch on that for just a minute. If you feel like, for example, your environment’s not safe, you’re taking on an unsafe assignment, you can say, hey, I want to file safe harbor in our state. You can say it verbally. Then you do have to fill out the long paperwork within your organization that they have to adopt from the board of nursing by the time that you leave your shift. So those are things that you can do to your point to protect yourself right now, while you’re standing there as a bedside nurse, having your professional liability insurance, understanding the rules and regulations that dictate your professional license, so that you can stand up and protect yourself in a respectful professional manner, but you’re doing it with smarticles when nursing. Smarticles because you’re building your foundation and you’re you’re having some scripted language and it’s more like I’m a dumb, dumb but you’re not saying hey, I, I think I read this on the board of nursing Um, quote me if I’m wrong, but two, 17, 11, one ST says you know what I mean, but it’s not about you. And they’re like wait, what did you say? Because if the, if I’m an agency nurse and they really don’t know who I am and I’m like Whoa, they’re like wait, what did she just say? And I can promise you, no one, they just don’t, they don’t bother with me. Folks, you know they don’t, they don’t like that. We’re good. So we’re going to move on to someone else. But you know, to your point, you can do this.

Maggie Ortiz: 49:16

You know, respectfully, being young, oftentimes we think about the newer nurse, let’s just say the new grad. Are they always the younger nurse? No, there are nurses who come to you know nursing older, and I see those are the ones that are able to stand up because they’ve adulted for a minute. Oftentimes they have kids. They’re like wait, what? No, this is not right.

Maggie Ortiz: 49:37

But the younger nurse oftentimes doesn’t have the like, the whereabout, with some of the life experience and maturity to even have that language. So that’s when you rely on the rules, regulations, knowing your practice, policies, just to say you know, in a witty, respectfully naivety manner, those kinds of things. And then you are finding the wolf nurse around you, you are finding the nurses around you, or or that unit may not be for you. You just go to another unit, you transfer another unit or another hospital because you do need to put yourself in an environment that’s going to support you. So those are some real life things that you can do right now. And you follow me, you reach out to me, I have free resources, you’re not alone. I never want a nurse to struggle alone, because I do know what we do is hard.

MJ Hooper: 50:24

Thank you, nurses, for all you do.

Cimone Murphree: 50:26

Yes, ditto, ditto. Thanks, maggie for joining us today. Yes, ma’am, Persam, perspective and your insights, um, I think we have given our viewers some really great takeaways I agree and thank you, ladies, for all you do for nurses, for any professional that you represent.

Maggie Ortiz: 50:43

I know it’s just not nurses that you represent, I’m sure it’s just anyone who’s got a professional license. So appreciate everything you do for nurses in my profession you as well, miss Miss Maggie.

MJ Hooper: 50:53

Yes, thank you, I think we throw hands in the hand.

Cimone Murphree: 50:56

Y’all, absolutely, absolutely. Thank you so much to our wonderful viewers for tuning into another episode of Know your Regulator. We hope you enjoyed today’s episode and gained some valuable insights. If you liked what you heard, subscribe, leave a comment below, share with your friends and colleagues.

Narrator: 51:14

Know your Regulator. The podcast that inspires you to engage.