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The creation of this cartoon by Protect Patients Now speaks volumes about the intellectual underpinnings of its side of the debate. In very primitive cultures (on a stone age level) we are told it is customary to blame any kind of disease on someone else. That's true, physicians make more money by nearly 50% than any other profession in the United States.
Physicians are the number three cause of death in America and the number one cause of bankruptcy. Funny how no physican's group ever discusses the role of malpractice in the cost of malpractice insurance.
I will order unnecessary tests and proceedures all the time because of the fear of getting sued. Hello, i think that this post is the best that i have read in my life because has useful information. As you can bet richer people have better health system because it has gotten pretty expensive. Yeah but is because they want money and money and just money no one cares about human healthy I agree that is a business but not to play with human.
Carl Hanson, chief operating officer of the county-run Minidoka Memorial Hospital in southern Idaho hospital's, explained as they get out of the baby business.
Rosalinda Elison, a former patient at the UC Irvine Medical Center’s fertility clinic, said after learning that that her eggs and embryos had been stolen and implanted in another woman who then gave birth to twins. Amount raised by Fairness and Accountability in Insurance Reform to oppose malpractice limits in Arizona.
Amount the Arizona Medical Association says Arizonans for Access to Health Care has raised to decide whether to push for montetary limits on lawsuits.
The purpose of this position statement is to provide guidance to nurses with regard to carrying out orders from Physician Assistants (PAs).
LVNs do not have the authority to legally determine death, diagnose death, or otherwise pronounce death in the State of Texas.
There is presence of livor mortis (venous pooling of blood in dependent body parts causing purple discoloration of the skin which does blanch with pressure).
Employers are also encouraged to develop policies and procedures directing staff in postmortem care and procedures, including appropriate measures that can be completed while waiting for a return call from the attending physician.
The BON has no jurisdiction over physician practice, facility policies, or the laws regulating pronouncement of death in Texas. The basic educational curriculum for Licensed Vocational Nurses (LVNs) does not mandate teaching of principles and techniques of insertion for peripheral intravenous catheters, or the administration of fluids and medications via the intravenous route.
Position Statement 15.27, The Licensed Vocational Nurse Scope of Practice provides additional clarification of the Standards Rule as it applies to LVN Scope of Practice. The Board of Nursing (Board) supports educational mobility for nurses prepared at the VN, ADN, Diploma and BSN levels and encourages the elimination of needless repetition of experiences or time penalties. The Board honors and supports military personnel and veterans and their educational mobility. A nurse responsible for initiating physician's standing medical orders or standing delegation orders may select specific tasks or functions for patient management, including the administration of a medication required to implement the selected order provided such selection is within the scope of the standing orders. The written standing orders under which nurses function shall be commensurate with each nurse’s educational preparation and experience. The Texas Board of Nursing (BON or Board), in keeping with its mission to protect the public health, safety, and welfare, holds nurses accountable for providing a safe environment for patients and others over whom the nurse is responsible [22 TAC A§217.11(1)(B)].


There is also no routine answer to the question, "When does the nurse's duty to a patient begin?" The nurse's duty is not defined by any single event such as clocking in or taking report. Though the Board has no jurisdiction over employers or employment-related issues, other laws regulating facility licensure may apply certain responsibilities to the employer for provision of patient safety, such as development of effective patient care systems or provision of adequate numbers of qualified staff. The Board believes nurses should be vigilant and exercise sound professional judgment when accepting assignments that may be requested by employers who need nurses to fill vacant shifts for licensed nursing staff, or other staffing-related situations.
Some actions may be more obvious examples of unprofessional conduct that could result in sanctions on the nurse’s license.
Sleeping on the job, which effectively makes the nurse unavailableto observe the patient or respond to the patient's needs, eventhough the nurse is physically present. The Board may impose sanctions on a nurse’s license for actions that potentially place patients at risk for harm, or when harm has resulted because a nurse violated his or her duty to the patient by leaving a patient care assignment in a manner inconsistent with the Board Rules.
A nurse may have to choose between the duty to provide safe patient care and protecting the nurse's own life during an emergency, including but not limited to disasters, infectious disease outbreaks of bioterrorism.
As with all allegations received by the Board, the alleged conduct by a nurse will be thoroughly investigated to determine what, if any, violations of the NPA and rules have occurred. The LVN can provide basic nursing care to patients with epidural or intrathecal catheters.
The Board has determined that it may be within the scope of practice of a registered professional nurse to administer analgesic and anesthetic agents via the epidural or intrathecal routes for purposes of pain control. The Board believes that only licensed anesthesia care providers as described by the American Society of Anesthesiologists and the American Association of Nurse Anesthetists, as authorized by applicable laws should perform insertion and verification of epidural or intrathecal catheter placement. In the increasingly contentious battle over medical liability, lawyers and doctors too often find themselves in separate corners. You have an enemy who has put a hex on you, and the only thing you can do to get well is to get your witch doctor to put a counter-hex on your enemy, or kill him yourself.
If the Western world's lawyers have nothing else to atone for, their bringing back this kind of primitive, muddled reasoning into what used to be a rational, civilized world is reason enough for outlawing their profession.
The truth is that trial attorneys are winning, attacks on trial attorneys are backfiring and opponents of the civil justice system are losing."The CEO of the Association of Trial Lawyers of America said.
Although PAs are not included in the NPA, the Board recognizes that nurses work collaboratively with PAs to provide patient care in various practice settings. Regardless of practice setting, the importance of initiating CPR in cases where no clear Do Not Resuscitate (DNR) orders exist is imperative. Additional information on Texas regulations regarding pronouncement of death may be found in Chapters 193 and 671 of the Texas Health and Safety Code, as well as through the Department of State Health Services. Knowledge and skills relating to maintaining patency and performing dressing changes of central line intravenous catheters is also not mandated as part of basic LVN education. 22 TAC A§217.11, Standards of Nursing Practice, is the rule most often applied to nursing practice issues.
The LVN’s practice relative to IV therapy must also comply with any other regulations that may exist under the jurisdiction of other regulatory agencies or entities. These orders, rules, regulations or procedures are authority and direction for the performance for certain prescribed acts for patients by authorized persons as distinguished from specific orders written for a particular patient or delegation pursuant to a prescriptive authority agreement.
The term protocols is separate and distinct from prescriptive authority agreements as defined under the Act and this chapter. The selection of such tasks or functions for patient management constitutes a nursing decision that may be carried out by a LVN or RN. Persons who are especially vulnerable include the elderly, children, the mentally ill, sedated and anesthetized patients, those whose mental or cognitive ability is compromised, and patients who are physically disabled, immobilized, restrained, or secluded.


From a BON standpoint, the focus for disciplinary sanctions is on the relationship and responsibility of the nurse to the patient, not to the employer or employment setting.
Specific requirements for a given facility may be obtained by contacting the applicable licensing authority for the institution.
Clear communication between staff and supervisors is essential to arrive at solutions that best focus on patient care needs without compromising either patient safety or a nurse’s license.
These situations are challenging for all nurses and their employers, therefore the Board recommends policies and procedures be developed, and periodically reviewed to provide clear guidance and direction to nurses in order for patients to receive safe and effective care. A nurse may have to choose between the duty to provide safe patient care and protecting the nurse's own life during a violent situation that may occur in the workplace. If evidence of violations exists, the Board must then determine what level of sanction is appropriate to take on the nurse’s license, and what specific stipulation requirements will be applied.
It is the opinion of the Board that the licensed vocational nurse shall not be responsible for the management of a patient's epidural or intrathecal catheter including administration of any medications via either epidural or intrathecal catheter routes. As with all areas of nursing practice, the RN must apply the Nursing Practice Act (NPA) and Board Rules to the specific practice setting, and must utilize good professional judgment in determining whether or not to engage in a given patient-care related activity. Consistent with state law, the attending physician or the qualified provider must order the drugs, dosages, and concentrations of medications to be administered to the patient through the catheter.
The Board of Nursing (BON) has investigated cases involving the failure of a LVN to initiate CPR in the absence of a DNR order. A LVN is not responsible for the actions of a physician who elects to pronounce death by remote-means. Therefore, it is the Board’s position that insertion of PICC lines or midline catheters is beyond the scope of practice for LVNs. However, prescriptive authority agreements may reference or include the terms of a protocol(s). For example, when an active shooter is present in the workplace, the nurse should take steps to protect the patients if there is time and using a method that does not jeopardize the nurse's personal safety or interfere with law enforcement personnel. These interventions are beyond the scope of the registered professional nurse in that independent medical judgment and formal advanced education and skills training are required to achieve and maintain competence in performing these procedures. A web-cartoon by Protect Patients Now (a project of a 230,000-strong medical specialist outfit) calls out lawyers as the reason that malpractice rates skyrocket, doctors flee and health care options deteriorate. Physicians are licensed by, and must comply with, rules promulgated by the Texas Medical Board as well as other laws applicable to the physician’s practice setting. These steps may include evacuating the area or preventing entry to an area where the active shooter is located.
Protocols shall be defined to promote the exercise of professional judgment by the advanced practice registered nurse and physician assistant commensurate with their education and experience. However, during an active shooter situation a nurse may find there is not sufficient time to do anything but to ensure his or her own safety.
The protocols used by a reasonable and prudent physician exercising sound medical judgment need not describe the exact steps that an advanced practice registered nurse or a physician assistant must take with respect to each specific condition, disease, or symptom. In this instance, as soon as the situation has resolved the nurse should promptly resume care of patients.
The concept of the nurse’s duty to promote patient safety also serves as the basis for behavior that could be considered unprofessional conduct by a nurse.



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