00:00:00Legal Risks for Nurses
00:01:23What Boards Expect You to Know
00:02:25Landmark Texas Court Case
00:04:31Multi-Agency Investigations
00:06:11Documentation and Unsafe Assignments
00:07:43Episode Closing
ABOUT THIS EPISODE
Legal exposure remains one of the most significant yet overlooked aspects of nursing practice. While nurses excel at memorizing complex medical terminology and interventions, many remain dangerously uninformed about the regulations governing their licenses until it's too late.
Maggie Ortiz, MSN, RN, CEO and founder of Advocates for Nurses, joins us to unpack this critical knowledge gap. She explains why nurses often develop a dangerous mindset: "We're not criminals, so we won't do anything wrong" – leading many to merely memorize regulatory requirements for exams without truly understanding their implications. This approach creates significant blind spots that can devastate careers when nurses encounter real-world ethical dilemmas or policy conflicts.
The conversation reveals how a single 1983 Texas court case (Lunsford v. Board of Nursing) fundamentally changed nursing practice by establishing that a nurse's license supersedes hospital policies and physician orders. This means nurses cannot defend themselves by simply stating they followed policy if that policy contradicts evidence-based practice or current standards. The podcast also explores how seemingly minor documentation issues or scope of practice violations can rapidly escalate across multiple agencies, potentially involving criminal charges, insurance fraud investigations, and board actions across multiple states simultaneously.
Whether you practice in Texas or elsewhere, understanding the three fundamental sections of nursing regulation – standards of practice, unprofessional conduct definitions, and grounds for discipline – is essential for protecting your career. Learn how to use documentation as a defensive tool, properly refuse unsafe assignments, and leverage resources (including AI) to simplify complex regulations before you face an investigation. Don't wait until you're under scrutiny to understand what protects your license and livelihood.
Watch Here: https://www.belolaw.com/know-your-regulator/beyond-the-bedside-the-hidden-legal-landscape-of-nursing/
Get more information, details and resources on Know Your Regulator - https://www.bertolinolaw.com/know-your-regulator/
English
United States
SHOW NOTES 🔗
TRANSCRIPT 🔗
WEBVTT
00:00:01.100 --> 00:00:07.767
This podcast is for educational purposes only, does not constitute legal advice and does not create an attorney-client relationship.
00:00:07.767 --> 00:00:11.711
If you need legal assistance about a legal problem, contact an attorney.
00:00:11.711 --> 00:00:14.244
Welcome back to Know your Regulator.
00:00:14.244 --> 00:00:16.190
The podcast that inspires you to engage.
00:00:16.190 --> 00:00:28.693
I am your host, simone Murphy, and today we're looking at some of the biggest blind spots that nurses have when it comes to legal exposure what the Board of Nursing sees that you might not, and we'll take a look at one court case that changed everything.
00:00:28.693 --> 00:00:42.347
I'm joined by CEO and founder of Advocates for Nurses, maggie Ortiz, msnrn, with what every nurse should hear Texas is one of the states that does require jurisprudence to hold a license.
00:00:42.807 --> 00:00:45.432
Only two states do New Mexico and Texas.
00:00:45.432 --> 00:00:53.133
We're drowning in medical terminology and care plans and we don't see ourself and I'm liberally speaking.
00:00:53.133 --> 00:01:00.082
You know for a large, you know 5 million of us, but as a rule, we're not criminals, we're not going to do anything wrong.
00:01:00.082 --> 00:01:06.605
Therefore, we memorize what we need to know for the test as it pertains to those rules and regulations, but we're not criminals.
00:01:06.605 --> 00:01:14.114
I need to know where the bones in the ear, I need to know the muscles when I'm drowning in these acronyms, but I'm not.
00:01:14.114 --> 00:01:17.003
I'm not a criminal, I'm not going to do anything unethically.
00:01:17.003 --> 00:01:20.552
So therefore, they don't understand the rules and regulations.
00:01:20.760 --> 00:01:23.730
So let's break down what the board actually expects you to know.
00:01:24.490 --> 00:01:25.591
What should nurses know?
00:01:25.591 --> 00:01:33.097
And I'm going to broaden it out a little bit, not just Texas, but I'm going to talk about every nurse in the United States or anyone who holds a professional license.
00:01:33.097 --> 00:01:43.106
There is going to be roughly three sections that every entity that gives someone the privilege to practice is going to have in their basic rules and regulations.
00:01:43.106 --> 00:01:46.634
Standards of practice that's pretty obvious, right?
00:01:46.634 --> 00:01:58.808
That will give you the guidance whether you're an RN, an LP, an MD, an NP, pt, insert, whatever letters you are the guidance right Under your standards of practice.
00:01:58.808 --> 00:02:04.733
Unprofessional conduct it's going to list out what is some things that unprofessional conduct.
00:02:04.733 --> 00:02:07.364
You're going to look at that as well.
00:02:07.364 --> 00:02:11.973
That should be a basic guide and then grounds for discipline.
00:02:11.973 --> 00:02:22.056
Those are three sections that anyone who holds a professional license, even if you're a real estate agent or whatever you are every entity is going to list those things out.
00:02:22.298 --> 00:02:25.849
One Texas court case redefined how boards evaluate nurse conduct.
00:02:25.849 --> 00:02:27.306
Here's how Maggie explains it.
00:02:28.381 --> 00:02:31.570
Then you hit on another thing policy.
00:02:31.570 --> 00:02:38.334
So 1514 in the state of Texas, which is a position statement different than a rule and a regulation.
00:02:38.334 --> 00:02:51.388
And again, her and I understand this stuff but we're going to explain a little bit more for you because we're in kind of this legal space as a legal nurse and you know you as this amazing legal project manager.
00:02:51.388 --> 00:02:54.689
But those are the things that you have to understand.
00:02:54.689 --> 00:03:07.741
1514 passed in 1983 as Lunsford versus the Board of Nursing, where it does say that and I'm going to quote my license supersedes a hospital policy or physician order.
00:03:08.424 --> 00:03:23.085
So if there's a policy written but it doesn't align with evidence-based science, it doesn't align with standards of care, maybe it's outdated you cannot stand on the principle as a nurse that the policy said that.
00:03:23.085 --> 00:03:30.284
No, your license always supersedes everything and people forget that.
00:03:30.284 --> 00:03:44.276
For instance, let's just say you're in a position and you're in that position because you're a nurse If your license or discipline or that license removed from you, you know what, you're not any longer a nurse.
00:03:44.276 --> 00:04:06.433
Yeah, now I have a master's degree in nursing, but I am no longer allowed to use nurse or allowed to write the two letters RN behind my name, because who's afforded me the ability to do that, the board of nursing so that policy that I stood my ground on didn't align with evidence-based science or rules or regulations.
00:04:06.433 --> 00:04:11.072
So I think that we're pointing out as well that this can all get very tricky.
00:04:11.219 --> 00:04:12.847
You can get the ombudsman involved.
00:04:12.847 --> 00:04:19.403
And I mean we're talking there could be criminal charges, insurance sometimes.
00:04:19.403 --> 00:04:25.267
If you're, you know, messing with insurance if insurance catches wind, you better bet they want to save money.
00:04:25.267 --> 00:04:27.064
They'll come after you.
00:04:27.064 --> 00:04:30.132
You know there's just a lot of different ways that things could go and they'll come after you.
00:04:30.132 --> 00:04:34.110
You know there's just a lot of different ways that things could go and they'll all be happening at the same time.
00:04:34.110 --> 00:04:36.735
Don't think it'll be one right after another.
00:04:36.735 --> 00:04:38.184
You'll be out money.
00:04:38.184 --> 00:04:39.790
You'll be searching for lawyers.
00:04:39.790 --> 00:04:44.103
You'll be calling Maggie saying, hey, what can I do?
00:04:44.103 --> 00:04:44.524
What?
00:04:44.524 --> 00:04:44.764
Just?
00:04:44.805 --> 00:04:45.225
happened?
00:04:45.225 --> 00:04:47.952
How did all these four letter agencies get into my life?
00:04:47.952 --> 00:04:56.786
Because all of a sudden you're getting letters, and it's not just from the board of nursing and I'm just using the board of nursing loosely because we're talking about our state.
00:04:56.786 --> 00:04:58.206
But insert any state.
00:04:58.206 --> 00:05:03.690
If you come to this state and let's just say that you have five other licenses, you and I know what that looks like.
00:05:03.690 --> 00:05:06.452
You come to this state and something happens here.
00:05:06.452 --> 00:05:08.074
You get reported to this board of Nursing.
00:05:08.074 --> 00:05:10.415
Those other boards could come after you.
00:05:10.415 --> 00:05:13.396
Let's just say, for example, a medical record is open.
00:05:13.757 --> 00:05:30.971
Let's just say, an LPN does an admission assessment I know this is deviating just a hair away from this other thing, but I think it's important to point this out which is not within their scope of practice because that falls under a comprehensive assessment.
00:05:30.971 --> 00:05:36.511
And in Texas, which is not within their scope of practice because that falls under a comprehensive assessment and that in Texas that is very well spelled out, state it is.
00:05:36.511 --> 00:05:40.752
And then the RN has signed off on that and the LPN.
00:05:40.752 --> 00:05:52.648
I personally have seen where that has risen to criminal conduct because it's not within the scope of practice reported to CMS because it was an LPN who generated it in a long-term care facility.
00:05:52.648 --> 00:06:04.882
Rn signed off on that and then it did rise to the level of criminal conduct because then CMS got involved and was charging something insane like $5,000 worth of charges.
00:06:05.023 --> 00:06:10.413
What are some other, maybe not so obvious things that nurses should be aware of?
00:06:11.862 --> 00:06:13.408
So I'm going to plug myself just for a minute.
00:06:13.408 --> 00:06:15.386
I do offer a charting course.
00:06:15.386 --> 00:06:24.247
What you do or do not document is a big deal and if you don't document it, you know, then it gets harder to validate.
00:06:24.247 --> 00:06:25.428
You know what was done.
00:06:25.428 --> 00:06:35.827
Now, obviously, with the growing you know staffing ratio, issues with us push to, you know, taking on more unsafe assignments.
00:06:35.827 --> 00:06:37.250
Of course we do the care first.
00:06:37.250 --> 00:06:39.286
No one's asking you to chart in real time.
00:06:39.286 --> 00:06:40.170
That's not a reality.
00:06:40.170 --> 00:06:46.625
What I'm saying is making sure that you're advocating for yourself and you're not taking on an unsafe assignment.
00:06:47.086 --> 00:06:48.608
What does that look like in Texas?
00:06:48.608 --> 00:06:58.901
I'm going to say 217.11.1.S is the person making that assignment which I don't feel is safe, and then T me accepting that assignment.
00:06:58.901 --> 00:07:02.449
Are you asking me to violate the Nurse Practice Act?
00:07:02.449 --> 00:07:04.252
There's a tool I just gave you.
00:07:04.252 --> 00:07:07.350
Knowing the Nurse Practice Act, our state is very specific.
00:07:07.350 --> 00:07:16.440
But use AI or some of these tools to dumb it down for you and just say hey, I'm in Texas, I'm going to be coming to Texas, I'm taking an assignment there.
00:07:16.440 --> 00:07:21.052
Dumb it down for me under these three sections and then give me some guidance.
00:07:21.052 --> 00:07:22.141
I'm an LPN.
00:07:22.141 --> 00:07:23.865
Can I administer blood?
00:07:23.865 --> 00:07:29.648
Can I do some of these things I may be able to do in Alabama state over, but now I'm coming to Texas.
00:07:29.648 --> 00:07:30.329
Can I do that?
00:07:30.329 --> 00:07:31.944
So you utilize?
00:07:31.983 --> 00:07:32.706
these tools.
00:07:32.706 --> 00:07:36.971
Don't wait until you're under investigation to learn what actually protects you.
00:07:36.971 --> 00:07:43.108
Visit our links below and explore Maggie's advocacy resources, the Texas Board of Nursing Guidelines and more.
00:07:43.108 --> 00:07:45.367
Be sure to follow along with Know your Regulator.
00:07:45.367 --> 00:07:46.161
Like share.
00:07:46.161 --> 00:07:48.329
Subscribe Until next time.
00:07:48.329 --> 00:07:50.827
Continue engaging with your regulatory agency.
00:07:50.827 --> 00:07:51.701
Know.
00:07:51.721 --> 00:07:52.466
Your Regulator.
00:07:52.466 --> 00:07:54.879
The podcast that inspires you to engage.
00:00:01.100 --> 00:00:07.767
This podcast is for educational purposes only, does not constitute legal advice and does not create an attorney-client relationship.
00:00:07.767 --> 00:00:11.711
If you need legal assistance about a legal problem, contact an attorney.
00:00:11.711 --> 00:00:14.244
Welcome back to Know your Regulator.
00:00:14.244 --> 00:00:16.190
The podcast that inspires you to engage.
00:00:16.190 --> 00:00:28.693
I am your host, simone Murphy, and today we're looking at some of the biggest blind spots that nurses have when it comes to legal exposure what the Board of Nursing sees that you might not, and we'll take a look at one court case that changed everything.
00:00:28.693 --> 00:00:42.347
I'm joined by CEO and founder of Advocates for Nurses, maggie Ortiz, msnrn, with what every nurse should hear Texas is one of the states that does require jurisprudence to hold a license.
00:00:42.807 --> 00:00:45.432
Only two states do New Mexico and Texas.
00:00:45.432 --> 00:00:53.133
We're drowning in medical terminology and care plans and we don't see ourself and I'm liberally speaking.
00:00:53.133 --> 00:01:00.082
You know for a large, you know 5 million of us, but as a rule, we're not criminals, we're not going to do anything wrong.
00:01:00.082 --> 00:01:06.605
Therefore, we memorize what we need to know for the test as it pertains to those rules and regulations, but we're not criminals.
00:01:06.605 --> 00:01:14.114
I need to know where the bones in the ear, I need to know the muscles when I'm drowning in these acronyms, but I'm not.
00:01:14.114 --> 00:01:17.003
I'm not a criminal, I'm not going to do anything unethically.
00:01:17.003 --> 00:01:20.552
So therefore, they don't understand the rules and regulations.
00:01:20.760 --> 00:01:23.730
So let's break down what the board actually expects you to know.
00:01:24.490 --> 00:01:25.591
What should nurses know?
00:01:25.591 --> 00:01:33.097
And I'm going to broaden it out a little bit, not just Texas, but I'm going to talk about every nurse in the United States or anyone who holds a professional license.
00:01:33.097 --> 00:01:43.106
There is going to be roughly three sections that every entity that gives someone the privilege to practice is going to have in their basic rules and regulations.
00:01:43.106 --> 00:01:46.634
Standards of practice that's pretty obvious, right?
00:01:46.634 --> 00:01:58.808
That will give you the guidance whether you're an RN, an LP, an MD, an NP, pt, insert, whatever letters you are the guidance right Under your standards of practice.
00:01:58.808 --> 00:02:04.733
Unprofessional conduct it's going to list out what is some things that unprofessional conduct.
00:02:04.733 --> 00:02:07.364
You're going to look at that as well.
00:02:07.364 --> 00:02:11.973
That should be a basic guide and then grounds for discipline.
00:02:11.973 --> 00:02:22.056
Those are three sections that anyone who holds a professional license, even if you're a real estate agent or whatever you are every entity is going to list those things out.
00:02:22.298 --> 00:02:25.849
One Texas court case redefined how boards evaluate nurse conduct.
00:02:25.849 --> 00:02:27.306
Here's how Maggie explains it.
00:02:28.381 --> 00:02:31.570
Then you hit on another thing policy.
00:02:31.570 --> 00:02:38.334
So 1514 in the state of Texas, which is a position statement different than a rule and a regulation.
00:02:38.334 --> 00:02:51.388
And again, her and I understand this stuff but we're going to explain a little bit more for you because we're in kind of this legal space as a legal nurse and you know you as this amazing legal project manager.
00:02:51.388 --> 00:02:54.689
But those are the things that you have to understand.
00:02:54.689 --> 00:03:07.741
1514 passed in 1983 as Lunsford versus the Board of Nursing, where it does say that and I'm going to quote my license supersedes a hospital policy or physician order.
00:03:08.424 --> 00:03:23.085
So if there's a policy written but it doesn't align with evidence-based science, it doesn't align with standards of care, maybe it's outdated you cannot stand on the principle as a nurse that the policy said that.
00:03:23.085 --> 00:03:30.284
No, your license always supersedes everything and people forget that.
00:03:30.284 --> 00:03:44.276
For instance, let's just say you're in a position and you're in that position because you're a nurse If your license or discipline or that license removed from you, you know what, you're not any longer a nurse.
00:03:44.276 --> 00:04:06.433
Yeah, now I have a master's degree in nursing, but I am no longer allowed to use nurse or allowed to write the two letters RN behind my name, because who's afforded me the ability to do that, the board of nursing so that policy that I stood my ground on didn't align with evidence-based science or rules or regulations.
00:04:06.433 --> 00:04:11.072
So I think that we're pointing out as well that this can all get very tricky.
00:04:11.219 --> 00:04:12.847
You can get the ombudsman involved.
00:04:12.847 --> 00:04:19.403
And I mean we're talking there could be criminal charges, insurance sometimes.
00:04:19.403 --> 00:04:25.267
If you're, you know, messing with insurance if insurance catches wind, you better bet they want to save money.
00:04:25.267 --> 00:04:27.064
They'll come after you.
00:04:27.064 --> 00:04:30.132
You know there's just a lot of different ways that things could go and they'll come after you.
00:04:30.132 --> 00:04:34.110
You know there's just a lot of different ways that things could go and they'll all be happening at the same time.
00:04:34.110 --> 00:04:36.735
Don't think it'll be one right after another.
00:04:36.735 --> 00:04:38.184
You'll be out money.
00:04:38.184 --> 00:04:39.790
You'll be searching for lawyers.
00:04:39.790 --> 00:04:44.103
You'll be calling Maggie saying, hey, what can I do?
00:04:44.103 --> 00:04:44.524
What?
00:04:44.524 --> 00:04:44.764
Just?
00:04:44.805 --> 00:04:45.225
happened?
00:04:45.225 --> 00:04:47.952
How did all these four letter agencies get into my life?
00:04:47.952 --> 00:04:56.786
Because all of a sudden you're getting letters, and it's not just from the board of nursing and I'm just using the board of nursing loosely because we're talking about our state.
00:04:56.786 --> 00:04:58.206
But insert any state.
00:04:58.206 --> 00:05:03.690
If you come to this state and let's just say that you have five other licenses, you and I know what that looks like.
00:05:03.690 --> 00:05:06.452
You come to this state and something happens here.
00:05:06.452 --> 00:05:08.074
You get reported to this board of Nursing.
00:05:08.074 --> 00:05:10.415
Those other boards could come after you.
00:05:10.415 --> 00:05:13.396
Let's just say, for example, a medical record is open.
00:05:13.757 --> 00:05:30.971
Let's just say, an LPN does an admission assessment I know this is deviating just a hair away from this other thing, but I think it's important to point this out which is not within their scope of practice because that falls under a comprehensive assessment.
00:05:30.971 --> 00:05:36.511
And in Texas, which is not within their scope of practice because that falls under a comprehensive assessment and that in Texas that is very well spelled out, state it is.
00:05:36.511 --> 00:05:40.752
And then the RN has signed off on that and the LPN.
00:05:40.752 --> 00:05:52.648
I personally have seen where that has risen to criminal conduct because it's not within the scope of practice reported to CMS because it was an LPN who generated it in a long-term care facility.
00:05:52.648 --> 00:06:04.882
Rn signed off on that and then it did rise to the level of criminal conduct because then CMS got involved and was charging something insane like $5,000 worth of charges.
00:06:05.023 --> 00:06:10.413
What are some other, maybe not so obvious things that nurses should be aware of?
00:06:11.862 --> 00:06:13.408
So I'm going to plug myself just for a minute.
00:06:13.408 --> 00:06:15.386
I do offer a charting course.
00:06:15.386 --> 00:06:24.247
What you do or do not document is a big deal and if you don't document it, you know, then it gets harder to validate.
00:06:24.247 --> 00:06:25.428
You know what was done.
00:06:25.428 --> 00:06:35.827
Now, obviously, with the growing you know staffing ratio, issues with us push to, you know, taking on more unsafe assignments.
00:06:35.827 --> 00:06:37.250
Of course we do the care first.
00:06:37.250 --> 00:06:39.286
No one's asking you to chart in real time.
00:06:39.286 --> 00:06:40.170
That's not a reality.
00:06:40.170 --> 00:06:46.625
What I'm saying is making sure that you're advocating for yourself and you're not taking on an unsafe assignment.
00:06:47.086 --> 00:06:48.608
What does that look like in Texas?
00:06:48.608 --> 00:06:58.901
I'm going to say 217.11.1.S is the person making that assignment which I don't feel is safe, and then T me accepting that assignment.
00:06:58.901 --> 00:07:02.449
Are you asking me to violate the Nurse Practice Act?
00:07:02.449 --> 00:07:04.252
There's a tool I just gave you.
00:07:04.252 --> 00:07:07.350
Knowing the Nurse Practice Act, our state is very specific.
00:07:07.350 --> 00:07:16.440
But use AI or some of these tools to dumb it down for you and just say hey, I'm in Texas, I'm going to be coming to Texas, I'm taking an assignment there.
00:07:16.440 --> 00:07:21.052
Dumb it down for me under these three sections and then give me some guidance.
00:07:21.052 --> 00:07:22.141
I'm an LPN.
00:07:22.141 --> 00:07:23.865
Can I administer blood?
00:07:23.865 --> 00:07:29.648
Can I do some of these things I may be able to do in Alabama state over, but now I'm coming to Texas.
00:07:29.648 --> 00:07:30.329
Can I do that?
00:07:30.329 --> 00:07:31.944
So you utilize?
00:07:31.983 --> 00:07:32.706
these tools.
00:07:32.706 --> 00:07:36.971
Don't wait until you're under investigation to learn what actually protects you.
00:07:36.971 --> 00:07:43.108
Visit our links below and explore Maggie's advocacy resources, the Texas Board of Nursing Guidelines and more.
00:07:43.108 --> 00:07:45.367
Be sure to follow along with Know your Regulator.
00:07:45.367 --> 00:07:46.161
Like share.
00:07:46.161 --> 00:07:48.329
Subscribe Until next time.
00:07:48.329 --> 00:07:50.827
Continue engaging with your regulatory agency.
00:07:50.827 --> 00:07:51.701
Know.
00:07:51.721 --> 00:07:52.466
Your Regulator.
00:07:52.466 --> 00:07:54.879
The podcast that inspires you to engage.
SEARCH PAST EPISODES
Search past episodes of Know Your Regulator: The Podcast that Inspires You to Engage.
Disclaimer: The podcast and artwork embedded on this page are from Team Bertolino, which is the property of its owner and not affiliated with or endorsed by Listen Notes, Inc.
EDIT
Thank you for helping to keep the podcast database up to date.
