The Division also failed to present evidence that Ms. Miller's patients required care between the time she left the hospital and the end of her shift. b) Severed that nurse-patient relationship without giving reasonable notice to the appropriate person (e.g., supervisor, patient) so that arrangements can be made for continuation of nursing care by others. See Tenn.Code Ann. While Ms. Miller reported that all of her patients were stable, she was concerned about the prenatal patient because she had been trying unsuccessfully since the beginning of her shift to have someone from obstetrics listen to the fetal heart tones. § 4-5-322(a)(1) (2005). The Board clearly has the statutory authority to revoke or suspend a nurse's license on the ground that the nurse is not psychologically competent to practice nursing. Both have the force of law and may be used in the regulation of a profession. State v. Sims, 746 S.W.2d 191, 199 (Tenn.1988). 1. She testified later that, as she left, she was not concerned about any of her patients, except for the prenatal patient whose fetal heart tones had not been monitored before she left. R. & Regs. 1000-1-.13(1)(c). Ms. Miller is correct with regard to the legal effect of an expungement order;  however, she failed to present admissible evidence that the public records of these two convictions for minor expenses had been expunged. Ms. Miller sought counseling and treatment following the incident but eventually decided to “work it out” herself at home because she was not satisfied with the treatment she was receiving. The Division charged that Ms. Miller should be disciplined because she was “guilty of a crime” based on her conditional guilty pleas to vandalism and resisting arrest and because she was mentally incompetent and had engaged in unprofessional conduct. Stay up-to-date with FindLaw's newsletter for legal professionals. Pizzillo v. Pizzillo, 884 S.W.2d 749, 754 (Tenn.Ct.App.1994). A thorough understanding of expectations and requirements in this regard is central to ensuring the best interests of patients and practitioners alike. Practice Information Abandonment in Nursing. Inquiries have been received by the Board of Registered Nursing (BRN) regarding which actions by a nurse constitute patient abandonment and thus may lead to discipline against a nurse's license. 615-532-5166 local or 1-800-778-4123 nationwide Nursing.Health@tn.gov Tennessee Board of Nursing 665 Mainstream Drive, 2nd Floor The following day, Cookeville Regional Medical Center informed Starmed that it was terminating Ms. Miller's contract, and Starmed, in turn, informed Ms. Miller than her services were no longer required. We may not reverse an administrative decision supported by substantial and material evidence solely because the evidence could also support another result. Firefox, or The trial court also expressed concern regarding the adequacy of the Division's evidence that Ms. Miller had committed a crime and the inelasticity of the penalty for violating Tenn.Code Ann. R. & Regs. She also asserts that the record does not support the Board's conclusion that she was “guilty of a crime.”. The statutes pertaining to this Board are found at T.C.A. of Equalization, 682 S.W.2d 196, 199 (Tenn.1984);  Papachristou v. Univ. The Tennessee Board of Nursing has filed a petition in accordance with Tenn. R. App. The issue that boards of nursing run into is the distinction between patient abandonment and employment abandonment. 1400, 1411, 3 L.Ed.2d 1377 (1959); McNiel v. Cooper, 241 S.W.3d 886, 895 (Tenn. Ct. App. We turn first to the most serious charge against Ms. Miller-patient abandonment. The only evidence in the record regarding Ms. Miller's fitness to practice nursing consisted of three reports prepared in 2003 and 2004 that failed to point to any basis for concluding that Ms. Miller was “mentally incompetent.”. Nursing students are held to the same standards of care as licensed nurses, and must therefore understand the ins and outs of patient abandonment just as well. Ms. Miller left the floor and got on the elevator. § 63-7-115(a)(1)(E) (2004) because she was mentally incompetent. C. Disciplinary Proceedings and Sanctions (1) If the Board of Nursing determines that further action is warranted, the Board may request an informal conference with the licensee. A nurse can be found to have abandoned a patient if the nurse severs the nurse-patient relationship without giving reasonable notice to the appropriate person so that arrangements can be made for the continuation of nursing care by others. It might be helpful to explore the definition of patient abandonment, how it applies to nursing practice, and considerations to avoid such an allegation. The nurse appealed. 1000-1-.03(1)(a) (2006). We recommend using Position Statement . the series of events that have occurred with the Respondent have caused her great emotional and mental stress to the point where it did interfere with her ability to perform her job appropriately;  for not coming in for certain shifts and also for leaving. She characterizes herself as a “traveling nurse,” and she has frequently worked for staffing agencies that would find her temporary assignments at different institutions and locations. The board meets quarterly for regular meetings and as needed for special or called meetings. Accordingly, Ms. Miller simply left the hospital without talking with anyone else. Despite the trial court's avoidance of the issue, we will address the adequacy of the evidence supporting the Board's conclusion that Ms. Miller was guilty of a crime for the purpose of Tenn.Code Ann. The incident that precipitated this dispute took place on April 15, 2002. For client abandonment to occur, the nurse/registrant must: Have first ACCEPTED the client assignment, thus establishing a nurse client relationship; AND then DISENGAGED the nurse client relationship without giving reasonable notice to the qualified person (supervisor, colleague, etc) so that others can make arrangements for continuation of nursing care. Its not abandonment if she doesn't accept the assignment once her … In fact, Ms. Miller herself stated that her patients required care that night and that she had provided all the care they required until the time she left the hospital. Following the hearing, the Board ordered the nurse to pay a $1,000 civil penalty and also immediately suspended the nurse's license pending a psychological evaluation. Patient Abandonment POSITION STATEMENT The Mississippi Board of nursing is a consumer protection agency with the authority to regulate the practice of nursing provided for by Mississippi Code of 1972, Annotated, Title 73, Chapter 15. However, to protect our staff from exposure to the virus, the Board of Nursing will no longer allow visitors to the agency offices. I can't give you specifics. Microsoft Edge. § 4-5-322(h)(5). The Board, like the trial court and this court, had an opportunity to observe Ms. Miller's demeanor and to read the voluminous papers she prepared. In cases of this sort, appropriate notice includes not only notice of offending conduct but also notice of the penalties being sought. These are distinct from unprofessional or unsafe conduct while caring for patients. Begin typing to search, use arrow keys to navigate, use enter to select. Exam'rs v. Schutzbank, 94 Ariz. 281, 383 P.2d 192, 193-94 (1963) (setting aside the revocation of a physician's license because of notice of hearing referred only to a suspension). Patient Abandonment refers to withdrawal from treatment of a patient without giving reasonable notice or providing a competent replacement. Patient abandonment is defined as "leaving a patient requiring nursing care without properly notifying appropriate personnel." Clay County Manor, Inc. v. State, 849 S.W.2d 755, 759 (Tenn.1993);  Southern Ry. Ms. Miller was informed of this policy, but she chose to ignore it. While the letter proves Ms. Miller has not mastered the fine points of the rules of grammar and spelling, the mere length, organization, and content of the letter provided insufficient basis for concluding that Ms. Miller is unfit to practice nursing. In February 2002, while employed at a home health agency, Ms. Miller became convinced that several of her paychecks had been stolen and reported the thefts to the Metropolitan Police Department. of Regents, 921 S.W.2d 684, 693 (Tenn.1996);  Humana of Tenn. v. Tenn. Health Facilities Comm'n, 551 S.W.2d 664, 667 (Tenn.1977);  Jackson Mobilphone Co. v. Tenn. Pub. This finding is supported by substantial and material evidence, and, therefore, the Board did not act arbitrarily when it ordered Ms. Miller to pay a $1,000 civil penalty and costs.3, The Division's original notice of charges included an assertion that Ms. Miller was “mentally incompetent” and requested, in general terms, the Board to determine “whether ․ [her] license should be suspended or revoked and/or whether other discipline should be imposed.”   However, the Division did not present any evidence regarding Ms. Miller's psychological status during the hearing, and the Board's order contains no findings of fact or conclusions of law regarding Tenn.Code Ann. When the factual support for an administrative decision is challenged, the courts must examine the entire record to determine whether the decision is supported by substantial and material evidence. In addition to the civil penalty, Ms. Miller also must pay the costs of the proceeding in accordance with Tenn.Code Ann. Fuentes v. Shevin, 407 U.S. 67, 80, 92 S.Ct. The Division of Health Related Boards made that strategic decision to address its concerns regarding Ms. Miller's psychological condition in the context of a disciplinary hearing. Every nurse should obtain instruction and su­pervision when implementing nursing procedures [Board Rule 217.11(1)(G)] and make reasonable efforts to obtain orientation and training to develop or maintain competency [Board Rule 217.11(1)(H)]. She believed that the patients would not require much care before the end of her shift, and that the other nurses could take care of them because they were not busy. She got into a disagreement with the police officer to whom she was reporting these thefts. R. & Regs. But I completed most of my nursing coursework in FL, and I understand it that you can't refuse an assignment or even a patient unless there is someone else who can/will take your place. Click here to review the Tennessee Code Annotated. Greene v. McElroy, 360 U.S. 474, 492, 79 S.Ct. Like the trial court, we affirm the Board's finding that Ms. Miller abandoned her patients and the Board's decision requiring her to pay a $1,000 civil penalty and the costs of the administrative proceeding. Accordingly, our review is limited to determining the sufficiency of the evidence under Tenn.Code Ann. The charge nurse informed her that she must inform a supervisor that she was leaving the hospital, but Ms. Miller purposely decided not to tell the supervisor that she was leaving. However, we have determined that the Board acted arbitrarily when it immediately suspended the nurse's license pending a psychological examination in the absence of any evidence or finding that the nurse was presently mentally unfit to practice nursing. The Board also asserts that it has the authority to impose “sanctions that go beyond any sanctions requested by the Division.”. Patient abandonment is included as a specific ground for disciplinary action under the Nurse Practice Act Section 40-33-1 l0 .(A)(24). While the terms “abandonment” and “patient abandonment” are not used in the Kentucky Nursing Laws (Kentucky Revised Statutes Chapter 314), the Board has authority to take disciplinary action in specific P. 30 requesting a rehearing in this case. The record also contains a revised “position statement” issued by the Board in December 2002 drawing a distinction between patient abandonment and “employment abandonment.”   This document states: For patient abandonment to occur, the nurse must: a) Have first accepted the patient assignment, thus establishing a nurse-patient relationship, and then. The Division's original notice of charges requested that two $500 civil penalties be assessed against Ms. Miller for her guilty pleas and convictions for vandalism and resisting arrest. § 63-7-115(d) and Tenn. Comp. The statutes pertaining to this Board are found at T.C.A. 1000-2-.13(1)(c) (2006). First, CNA "abandonment" is not an issue unless it was a home care aide who actually left a patient. Procedural due process required a government entity to employ fundamentally fair procedures whenever it acts to deprive a person of a right to or interest in life, liberty, or property. 63-1 (Division of Health Related Boards) and T.C.A. Tennessee Board of Nursing • 665 Mainstream Drive • Nashville, TN 37243 Tel: 615-532-5166 • Fax: 615-741-7899 • tn.gov/health 6 * No new offers of admissions may be extended - effective immediately. Generally for patient abandonment to occur, the nurse must: After receiving a report that a registered nurse left her patients in a hospital's medical/surgical unit before the end of her shift, the Tennessee Board of Nursing commenced a contested case proceeding to discipline the nurse. Comm'n, 15 S.W.3d 486, 490 (Tenn.Ct.App.1999);  Ware v. Greene, 984 S.W.2d 610, 614 (Tenn.Ct.App.1998). The Division argues for the first time in its petition for rehearing that a “long, rambling letter” written by Ms. Miller provides ample evidence that she is sufficiently psychologically impaired to be suspended from nursing. § 63-7-115(a)(1)(E). However, Ms. Miller did not present any evidence to demonstrate that her record was, in fact, expunged in accordance with Tenn.Code Ann. Please feel free to contact A'lise Williams, R.N. Ct. App. PATIENT ABANDONMENT . After she tore up the report and spit in the officer's face, she was charged with the misdemeanor offenses of vandalism and resisting arrest. M.S., Director of Nursing Practice at (410)585-1927 should you require further clarification of this document. McClellan v. Bd. Both have the force of law and may be used in the regulation of a profession. Jean Louise MILLER v. TENNESSEE BOARD OF NURSING. Patient and Employer Abandonment - Frequently Asked Questions & Answers. The Board, following specific notice requirements and hearings, adopts rules. of Tenn., 29 S.W.3d 487, 490 (Tenn.Ct.App.2000). During the present crisis, phone lines may be very busy. 63-7 (Nursing). A quorum of six members is required to conduct business. Courts may reject an administrative agency's factual findings only if a reasonable person would necessarily draw a different conclusion from the record. The National Council of State Boards of Nursing (NCSBN) is a not-for-profit organization whose purpose is to provide an organization through which boards of nursing act and counsel together on matters of common interest and concern affecting the public health, safety and welfare, including the development of licensing examinations in nursing. Jones v. Greene, 946 S.W.2d 817, 828 (Tenn.Ct.App.1996). On August 16, 2005, the trial court filed a memorandum and order concluding that Ms. Miller had “walked out before the end of her nursing shift at Cookeville Regional Medical Center, disobeying the charge nurse who instructed her to notify a supervisor that she was leaving.”   The court, like the Board, concluded that “once Ms. Miller accepted the job at Cookeville Regional Medical Center and accepted the role of caretaker for the patients on her shift, she was bound by her statutory and regulatory duty to care for them or make sure that others assumed the caretaker role before she left.”   Accordingly, the trial court affirmed the Board's conclusion that Ms. Miller had engaged in unprofessional conduct in violation of Tenn.Code Ann. A nurse-patient relationship begins when responsibility for nursing care of a patient is accepted by the nurse. In order to assist licensees and employers, the Board One patient had chronic obstructive pulmonary disease;  one was recovering from surgery;  and one was a prenatal patient who required monitoring of her fetal heart tones. However, in light of the absence of any evidence or factual findings regarding Ms. Miller's current psychological condition, we have concluded that the Board acted arbitrarily and capriciously by immediately suspending her license as part of this disciplinary proceeding. Tenn.Code Ann. Instead, the Board noted that. A medical/surgical or “med/surg” unit provides care to patients recovering from a wide variety of medical conditions, including those recovering from diagnostic, therapeutic, or surgical interventions, those hospitalized for acute conditions, and those who may be in the final stages of progressive and chronic disease. This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. Behavior that demonstrates professional misconduct includes abandoning a client who is in need of or receiving nursing care and may be grounds for disciplinary action (NDAC 54-02-07-01.1 (10). Even though the Board determined that Ms. Miller was guilty of two crimes, it decided not to require Ms. Miller to pay the civil penalties requested by the Division. We certainly do not find that the Board erred by declining to assess a civil penalty against Ms. Miller for committing these two offenses. § 63-7-115(a)(1)(B) (2004) and had engaged in unprofessional conduct by abandoning or neglecting a patient requiring nursing care in violation of Tenn.Code Ann. Her primary defense was that these convictions had been expunged and that the effect of the expunction was to clear her record. There is no dispute that Ms. Miller accepted the obligation to care for four to five patients when she reported for work at Cookeville Regional Medical Center's med/surg unit. Both the nurse leader and the caregiver have legal duties in this area. The Board made no findings with regard to Ms. Miller's mental competency. As defined in the Board's rules, patient abandonment occurs when a nurse abandons or neglects a patient requiring nursing care. The Board of Examiners for Nursing feels that the definition of “patient abandonment” should be consistent throughout the health care delivery system, and has on occasion The Division initially charged that Ms. Miller was “mentally incompetent” for the purpose of Tenn.Code Ann. of Comm'rs, 204 Tenn. 298, 305, 319 S.W.2d 481, 484 (1958);  Metropolitan Gov't v. Tenn. Serv. The Board also found that Ms. Miller was “guilty of a crime” as proscribed by Tenn.Code Ann. 1984) (setting aside the five-year suspension of a physician's license when the notice of charges referred only to probation); Bd. Tangential to withdrawing from a case in which treatment has already begun is the refusal to initiate treatment, which many patients also take as an act of abandonment. The email address cannot be subscribed. Many lawyers and judges would not rest easily if they thought that the length, organization, and content of their writings provided a basis to question their psychological competence. This question is answered by reviewing the essentially undisputed facts in light of the Board's revised position statement. R. & Regs. AZ 85007 Phone (602) 771-7800 § 40-35-313 (2006). While Ms. Miller testified that the records regarding the vandalism and resisting arrest charges had been expunged, she failed to present evidence supporting her claim. Though the Board rules do not define the term “abandonment,” the Board has investigated and disciplined nurses in the past for issues surrounding the concept of abandonment as it relates to the nurse’s duty to the patient. The Board's petition for rehearing is respectfully denied. According to Ms. Miller, she eventually completed her probation satisfactorily. The nurse sought judicial review of the Board's decision by the Chancery Court for Davidson County, and the trial court affirmed the Board's finding that the nurse had abandoned her patients, the assessment of the civil penalty, and the immediate suspension of the nurse's license. § 63-7-115(a)(1)(F) and Tenn. Comp. Trial and appellate courts use the same standard of review. § 40-35-313(a). Ms. Miller sought judicial review of the Board's decision in the Chancery Court for Davidson County. Thus, as this record stands, it lacks any evidence at all that Ms. Miller is “mentally incompetent” to practice nursing. This appeal involves a disciplinary proceeding against a registered nurse. However, nowhere in its notice of charges did the Division request that Ms. Miller's license be suspended because she was psychologically impaired.1 During the contested case hearing, the Division presented no evidence, in the form of expert opinions, that Ms. Miller was psychologically unfit to practice nursing. She testified that she felt “defenseless” and that she became “deliberately paranoid.”   She feared that the police were tapping her telephone and keeping her under surveillance. The effect of expunging the records of a criminal charge is to restore the person to the position he or she occupied prior to the arrest or charge. If there is no one to do this and you leave, that is abandonment. The right to engage in one's chosen profession or occupation without unreasonable government interference or deprivation is both a property and a liberty interest protected by the Due Process Clause of the Fourteenth Amendment and Article I, Section 8 of the Constitution of Tennessee. She never worked very long at any particular job. Many complaints (and threats to report) are employment issues. Between June 1997 and May 2000, she worked at five different hospitals in the Nashville area. 4. Instead, they review the record for such relevant evidence as a reasonable mind might accept to support a rational conclusion and such as to furnish a reasonably sound basis for the action under consideration. The record also contains a revised “position statement” issued by the Board in December 2002 drawing a distinction between patient abandonment and “employment abandonment.” R. & Regs. Ms. Miller was satisfied that the written notes in her patients' charts would adequately acquaint the hospital staff with the status of her patients and the care they had received during her shift. She was briefly incarcerated and later entered a conditional plea of guilty in the Metropolitan Nashville General Sessions Court and was placed on probation under Tenn.Code Ann. 3. As a final matter, Ms. Miller asserts that the Board acted arbitrarily and capriciously by suspending her nursing license pending a psychological evaluation of her suitability to continue to practice nursing and by requiring her to pay a civil penalty and costs. However, while she was on the elevator, she decided that she would not inform the supervisor that she was leaving the hospital. Based on our examination of the Division's notice of charges, we concluded in our September 26, 2007 opinion that the notice did not fairly appraise Ms. Miller that the Division was seeking either the revocation or the suspension of her nursing license. 1983, 1994 (1972); Abdur'Rahman v. Bredesen, 181 S.W.3d 292, 309 (Tenn. 2005). A position statement is a scope of practice determination made by the Bo ard, as to Ms. Miller moved to Tennessee in 1997. Following the submission of the evidence, the Board concluded that Ms. Miller was guilty of a crime in violation of Tenn.Code Ann. 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