Health License Defense » Taralynn Mackay

Nursing Board Renewals-What to answer?

Taralynn Mackay — Tue, 24 Aug 2010 14:44:33 +0000

If a nurse is currently under investigation by the Texas BON and is renewing his/her license, what does the nurse answer to the question: “Are you currently the target or subject of a grand jury or governmental agency investigation?” According to the Board, the answer is “yes” even though the BON knows about the investigation since they are conducting it, a nurse still needs to answer “yes.”

This is a change from what we have always thought–that since the questions are meant to disclose unknown situations or occurrences, an investigation by the BON does not need to be disclosed to the BON. But the Board wants to make sure there are no areas of confusion and they want everything disclosed to them even if the nurse thinks the Board knows about an issue, the nurse should disclose it. The only exception is when the nurse receives a letter from the Board informing the nurse he/she no longer has to disclose a specific listed occurrence (Hint-Make sure you keep this letter forever in case it becomes an issue later on).

Don’t forget to disclose pending charges for criminal incidents as well as needing to disclose deferred adjudications, pleas of nolo contendere, or no contest. These questions continue to trip up nurses. Above all, read the questions carefully EACH time you renew. Questions change and a failure to answer truthfully will result in a BON investigation. Also, don’t wait until the last few weeks to renew. A nurse can renew up to 60 days prior to the end of the renewal period–early is better.

Texas BON issues report regarding the increasing age of Texas nurses

Taralynn Mackay — Fri, 16 Jul 2010 17:26:36 +0000

In the Texas Board’s strategic plan, the Board reports the following: “The median age for all Texas licensed RNs is 47 years of age. The median age for Texas female RNs is 47 years of age and 42 for male RNs. The median age for all LVNs is 45 years of age. The median age for Texas female LVNs is 45 years of age and 42 for male LVNs. The largest population group for female RNs is ages 45 to 54 (50,592 – FY 09). The largest population group for LVNs is ages 35-44 (18,692 – FY 09). The largest population group for male nurses is ages 35 to 44 (7,024 – RN, 2,670 – LVN). All age groups of RNs increased in size from 2000 to 2009 (See Appendix I).

Nurses ages 55 to 64 increased 142% and RNs over age 65 increased 158% in number from FY 2000 until FY 2009. The number of RNs ages 25 to 34 only increased 26%. The smallest increase from 2000 to 2009 among RNs was nurses under age 25. Among LVNs, two age groups decreased in number from FY 2004 to FY 2009. The number of LVNs under age 25 decreased 7% and LVNs ages 45 to 54 decreased 2%. LVNs ages 25 to 34 increased 13%, LVNs ages 35 to 44 increased 18%, LVNs ages 55 to 64 increased 25% and LVNs over 65 increased 32% from FY 2004 to FY 2009. Industry analysts express concerns that this shift in age will cause a decrease in the supply of nurses as licensees reach retirement age.”

This is very concerning because unless there is a shift towards getting more new, younger nurses there will a huge shortage as the general population becomes older. This is also in relation to the decreased size of the younger generation and that it is projected there will not be enough to support the older generation with Social Security. But the effect on one’s health care in older years is just as worrisome.

New rules for APRNs and PAs by the Texas Medical Board

Taralynn Mackay — Wed, 09 Jun 2010 22:18:16 +0000

There are new prescriptive delegation rules drafted by the Texas Medical Board and many physicians, APRNs or PAs may not be aware of the changes. The rules apply to prescriptions, delegation by physicians, practice sites, and review of charts. One of the big areas that can impact an APRN or PA is the requirement for registration (the forms and further info can be found on the Medical Board’s website). Physicians that delegate prescriptive authority to PAs or APNs are required to register with the Texas Medical Board. This became effective on 1/31/2010.

New proposed rules for Texas Board of Dental Examiners

Taralynn Mackay — Wed, 09 Jun 2010 22:07:59 +0000

On May 21, 2010, the Texas Board of Dental Examiners posted new proposed rules involving the following (the proposed rules may be found at the Texas Register):

GENERAL PROVISIONS

22 TAC §100.10

DENTAL HYGIENE LICENSURE

22 TAC §103.5

DENTAL BOARD PROCEDURES

22 TAC §§107.11, 107.15, 107.17, 107.21 – 107.25, 107.47, 107.48, 107.50, 107.54, 107.55, 107.63
22 TAC §107.59
22 TAC §107.102
22 TAC §107.203

PROFESSIONAL CONDUCT

22 TAC §§108.7 – 108.9

EXTENSION OF DUTIES OF AUXILIARY PERSONNEL–DENTAL ASSISTANTS

22 TAC §114.10

EXTENSION OF DUTIES OF AUXILIARY PERSONNEL–DENTAL HYGIENE

22 TAC §115.9

New Standard of Care Rules for Texas Dentists

Taralynn Mackay — Wed, 09 Jun 2010 22:02:26 +0000

The following rules were posted for adoption in the Texas Register (earliest possible date is June 20, 2010) and they expand the regulatory reach of the Texas Dental Board (the underline is the new language and the strikeout is the old language of the rules):

§108.9.Dishonorable Conduct.

The dishonorable conduct section is intended to protect the public from dangerous, unethical, and illegal conduct of licensees. The purpose of this section is to identify unprofessional or dishonorable behaviors of a licensee which the Board believes are likely to pose a threat to the public. Actual injury to a patient need not be established for a licensee to be in violation of this section. Behavior constituting dishonorable conduct includes, but is not limited to [A licensee is in violation of this rule if he or she]:

(1) Criminal conduct–including but not limited to conviction of a misdemeanor involving fraud or a felony under federal law or the law of any state as outlined in Chapter 101 of this title.

[(1) Aids or abets in the violation of a criminal statute or participates in a conspiracy to procure (by corruption, fraud, misrepresentation, or bribery, or both) a dental license for an unqualified person.]

(2) Deception or misrepresentation–engages in deception or misrepresentation:

(A) in soliciting or obtaining patronage; or

(B) in obtaining a fee.

(3) Fraud in obtaining a license–obtains a license by fraud or misrepresentation or participates in a conspiracy to procure a license, registration, or certification for an unqualified person.

(4) Misconduct involving drugs or alcohol–actions or conduct that include, but are not limited to:

(A) [(2)] providing [Provides ] dental services to a patient while the licensee is impaired through the use of drugs, narcotics, or alcohol ;[.]

(B) addicted to or habitually intemperate in the use of alcoholic beverages or drugs;

(D) [(3)] grossly [Grossly ] over prescribes, dispenses, or administers narcotic drugs, dangerous drugs, or controlled substances;[.]

(E) [(4)] prescribes [Prescribes ], dispenses, or administers narcotic drugs, dangerous drugs, or controlled substances to or for a person who is not his or her dental patient;[,] or [not for a dental purpose.]

(F) prescribes, dispenses, or administers narcotic drugs, dangerous drugs, or controlled substances to a person for a non-dental purpose, whether or not the person is a dental patient.

(5) Assisting another in engaging in the unauthorized practice of dentistry or dental hygiene–holds a dental license and employs, permits, or has employed or permitted a person not licensed to practice dentistry to practice dentistry in an office of the dentist that is under the dentist’s control or management.

(6) Failure to comply with applicable laws, rules, regulations, and orders–violates or refuses to comply with a law relating to the regulation of dentists, dental hygienists, or dental assistants; fails to cooperate with a Board investigation; or fails to comply with the terms of a Board Order.

(7) Inability to practice safely–is physically or mentally incapable of practicing in a manner that is safe for the person’s dental patients.

(8) Discipline of a licensee by another state board–holds a license or certificate to practice dentistry or dental hygiene in another state and the examining board of that state:

(A) reprimands the person;

(B) suspends or revokes the person’s license or certificate or places the person on probation; or

(9) Failure to comply with Medicaid, insurance, or other regulatory laws–knowingly provides or agrees to provide dental care in a manner that violates a federal or state law that:

(A) regulates a plan to provide, arrange for, pay for, or reimburse any part of the cost of dental care services; or

(B) regulates the business of insurance.

(10) Improper delegation–improperly delegates any task to any individual who is not permitted to perform the task by law, this chapter, or practice restrictions imposed by Board Order.

[(5) Indicates a fee for dental services on an insurance or other third party reimbursement claim form which is other than the fee which the dentist expects to collect for services rendered.]

(11) [(6)] Unprofessional conduct engages–[Engages] in conduct that has become established through professional experience as likely to disgrace, degrade, or bring discredit upon the licensee or the dental profession.

Live in one state and practice in another? BEWARE

Taralynn Mackay — Wed, 09 Jun 2010 21:37:11 +0000

Multistate Compact Licensure rules can impact a nurse even if the nurse is not working under a compact license. If you have a license in the state in which you practice, but live in another state, you may be affected by the compact rules for multistate licensing even if you are not working under a compact license. If a nurse moves to a compact party state, the nurse must obtain a nursing license in that state. The nurse has 30 days to obtain the new license. Wherever the nurse’s legal residence is located is where the nurse is considered to be living. For example, a nurse has a Texas nursing license and is working in El Paso. The nurse moves to New Mexico, but continues to work in Texas. Because Texas and New Mexico are both compact license states, the nurse would have 30 days to obtain a New Mexico license. The nurse would then work in Texas under the nurse’s New Mexico multistate nursing license. There are many nurses that live and work near Texas borders and they need to be aware of these rules (this also applies to other compact states as well). The compact states are found at the National Council of State Boards of Nursing

Ratio law in California is shown to prevent deaths

Taralynn Mackay — Thu, 06 May 2010 16:11:09 +0000

The ratio law in California that limits the number of patients per nurse was the subject of a research study and the findings support that the ratio is preventing deaths and improving nurse’s beliefs about their job performance. Victoria Colliver’s April 20, 2010 article “Pioneering Law on Nurses Found to Save Lives” describes the findings of the study conducted by the University of Pennsylvania. The California nurses on a medical-surgical floor have 5 patients to every nurse and the differences between California and non-ratio states examined is definitely fuel to support ratios.

When ratios were first discussed, I thought the law would be loosely written so that hospitals could “meet” the law, but there would be no visible improvement for nurses or patients. That seems to be the case with Texas’ staffing law; I just don’t see any improvement and still receive multiple complaints from nurses that are being forced to work under unsafe staffing numbers and when they refuse the unsafe assignments they are charged with abandonment. The article notes that other states are considering ratios. Perhaps Texas will also consider changes to the law to protect nurses and patients, but history does not support this. Nurses need to be politically active and join associations that promote nursing and fight for nursing laws; just complaining will do no good, nurses must take action and support the associations that work on legislative issues on behalf of nursing in Texas. National organizations/associations will not focus on individual state issues so be sure to check into any association/organization you are thinking of joining to see what their legislative mandates/agendas are.

I have an arrest in my background criminal history, what do I do?

Taralynn Mackay — Mon, 12 Apr 2010 20:46:42 +0000

There is not a simple answer to this question because there can be so many variables. The one sure thing is – DO NOT LIE TO THE BOARD!! Many nurses answer the Board’s application/renewal questions based on what they think a criminal background shows or what other employers/agencies/etc. have found when they ran criminal background checks. This is a dangerous decision because the Board can obtain criminal background information that other entities cannot seem to find. Do NOT assume that your background is clear because: someone told you that it would be (even if it was your attorney), that the criminal incidents occurred while you were a juvenile, that you completed deferred adjudication or pre-trial diversion or that your case has been expunged/sealed (unless you have the actual court paperwork showing the expunction/sealing of the records in your hand). Also, don’t think that the Board will not want to know about a particular incident because you think it has nothing to do with nursing practice–the BON wants to know about everything in your criminal background even if they decide not to take any action in response to the incident(s), the BON still wants to know. Remember that even if your non-disclosure to the Board is a mistake, you will still be found to have been deceptive to the Board and disciplinary action can be the result.

There are so many pitfalls associated with the questions posed on the Board’ s renewal/application paperwork, that it is prudent to speak to an attorney who has experience working with the Texas Board of Nursing before you complete the questions.

A Disciplinary Action or Agreed Order Is Forever

Taralynn Mackay — Mon, 01 Mar 2010 15:10:11 +0000

Disciplinary actions or Agreed Orders remain on a nurse’s license forever. When stipulations/restrictions are placed on the license, the nurse’s license is encumbered and those restrictions show up on the license when the license is verified (for example, the verification page will show “Warning with Stipulations” or “Remedial Education”). Once the stipulations/restrictions are completed and the Board sends a letter of completion to the nurse, the verification page will show clear; however, the disciplinary history remains. If asked if the nurse has ever been sanctioned or disciplined*, the nurse will have to answer “yes.”

Recently, I have received several inquiries regarding “setting aside board orders.” This cannot be done and this is misinformation. While criminal incidents can sometimes be expunged or sealed, administrative actions currently cannot be removed from one’s license. Once a disciplinary action occurs, the history remains even once the “probation” is complete.

* The Texas BON currently asks, “Has any licensing authority refused to issue you a license or ever revoked, annulled, cancelled, accepted surrender of, suspended, placed on probation, refused to renew a professional license, certificate or multi-state privilege held by you now or previously, or ever fined, censured, reprimanded or otherwise disciplined you?” to obtain information about past disciplinary actions.

Trial of Winkler County Nurse Who Reported Doctor-Finale?

Taralynn Mackay — Fri, 12 Feb 2010 01:04:48 +0000

Anne Mitchell was found not guilty. Yea!!!