Legal Questions from Nurse Practitioners Answered

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Show notes:

It’s hard not to worry about malpractice when you’re taking on new levels of responsibility as a new nurse practitioner.

Irnise Williams is not only a health law lawyer, she now focuses on the education and legal work to help prevent malpractice cases in the first place.

AAAAAND she’s a nurse herself! Still taking care of patients as a covid float nurse while also running her legal practice, she’s truly a unicorn.

She and I sat down and discussed the questions nurse practitioners and students had in the Real World NP community!

(PS. if you want the chance to submit questions for future interviews, join the email list here!)

Nurse Practitioner Legal Questions Answered

We covered so many things, including:

• Most common reasons for malpractice cases

• How to document appropriately

• Should I have my own malpractice insurance?

• Scope of NP Practice and more

Note, some of the audio came out uneven, so apologies about that. 

If you liked this post, also check out: 

• LGBTQIA+ Competency for Healthcare Providers: Interview with Terra Anderson

• Nurse Practitioner Clinical Tips: Prepare Your First Clinical Rotation

• Billing and Coding for Nurse Practitioners: 2021 Updates 

• Read the Full Transcript Here

  0:00

  well hey there it's liz rohr from real world np and you're watching np practice made simple the weekly videos to help save

  0:06

  you time frustration and help you learn faster so you can take the best care of your patients

  0:11

  so in this week's video it is an interview with my personal lawyer ernest williams and we had such an

  0:18

  amazing conversation so we gathered the questions from the real world np community of questions that you'd like

  0:23

  to ask an a lawyer and really kind of went through piece by piece and we've got to a lot a lot of

  0:29

  things but a lot of big questions that people have should i have my own male practice insurance what are the most common reasons to be

  0:36

  sued um how to document things appropriately and like a whole bunch of other like big

  0:42

  big questions that people really worry about as nurse practitioners newer and experienced so i really hope you enjoy

  0:47

  this episode of np practice made simple and you can find your nurse lawyer

  0:53

  on instagram at your nurse lawyer and if you haven't signed up for the ultimate resource guide for the new np

  0:59

  be sure to do so at realworldnp.com guide you'll get these videos and straight to your inbox every week with

  1:05

  notes from me patient stories and bonus content that i really just don't share anywhere else including the opportunity

  1:11

  to submit your questions for future upcoming interviews without further ado though i'm going to share my

  1:17

  interview with ernest thank you so much for being here i'm so excited i'm so excited

  1:23

  so do you want to introduce you do you want to introduce yourself yes i'm ernest um i am

  Irnise Williams, Your Nurse Lawyer

  1:30

  a nurse and a lawyer i've been a nurse for 12 years i'm an attorney for six years and i work with healthcare providers and

  1:38

  healthcare entrepreneurs who have their own practices or their own businesses to ensure that they

  1:43

  understand their risk and liabilities i do some community education as well

  1:48

  i'm a mom i'm a wife and i'm a current new yorker and travel nurse

  1:54

  currently uh during the program that's so cool that is so cool thank you so much for being here i

  2:00

  cannot wait to answer all of these questions um we're gonna um so we i asked the real world np community

  2:07

  what their legal questions were and we broke it down into the categories of the kind of general most common things

  2:13

  um and do you have any disclaimers you want to you know yes i will add that

  Disclaimers

  2:19

  none of the advice that i give here medical or legal um qualifies as attorney client

  2:27

  privilege or establishes any relationship of attorney client um it is general advice that i would

  2:34

  give in any type of public setting and if there are any specific questions or scenarios i would

  2:40

  definitely tell you to consult with an attorney in your area totally and you have such great resources to direct people

  2:46

  too so um absolutely so i think that we broke down kind of like the major

  2:52

  questions that people had so the first one is about kind of like the general topic of documentation like i think that people

  General Topic of Documentation

  2:58

  are so worried about what to chart what not to chart like what is your what are your thoughts about that

  3:04

  yeah documentation is a conversation i think for all nurses nurse practitioners even some providers

  3:09

  who um are just unsure about what is enough and what is acceptable

  3:14

  i always lead with if you have to take this into court you want to be able to back yourself up

  3:20

  because when someone sues a provider or an organization the only thing you have is your chart i

  3:26

  think sometimes people think they will have their memory but it can be it could be five years it

  3:32

  could be ten years depending on what the situation is and so the only thing that you will have is within that chart

  3:38

  and you want to be able to cover yourself with the information that's in the chart because that's all you're going to be

  3:43

  able to bring into court um there are some instances where there will be some external information that could potentially be

  3:49

  provided but in health care cases all we have is the documentation of the conversations

  3:55

  that we have with our patients the treatments that we've provided their refusals or their if they agreed to go forward

  4:02

  with that all of those decisions need to be in the chart i know as new providers they struggle

  4:08

  with time management because you're trying to see a lot of patience the expectations on you

  4:14

  are extremely high even if you have three six months nine months worth of training the expectations are high and the

  4:20

  pressure is there and so you may not have all of the time to document right there on the spot but

  4:26

  i think there are some tools and resources that are out there depending on what emr system you use to kind of recharge some items to

  4:33

  um do some shortcuts to do some short notes and to find figure out ways to help you centralize some of the very

  4:41

  very important and critical information and then maybe kind of go back and review and edit later um i think that's

  4:47

  the key thing i think when there are situations where you are asking or advising your patient

  4:55

  to do something that they're not agreeing to those are the things you want to put in the chart as well

  5:00

  so if you're telling the patient they need to see a specialist and they're saying i'm not going to see a specialist i don't think that is important

  5:06

  those exact words should probably go in the chat it happens all the time and it will be

  5:13

  like okay fine but we'll talk about it later um and adding that as well saying patient said

  5:19

  quote i'm not going to see a specialist and then i unders you know i understood

  5:24

  what they said i validated that that was the okay option for now and that we would follow back up on it later

  5:31

  right so now that you're even allowing that to pass and just say like fine we're just leaving at that that you're

  5:37

  saying i want to give the patient autonomy but i also want to reiterate to them the importance of

  5:43

  going to do whatever i'm advising them to do um so that is a type of documentation i think that becomes critical

  5:49

  when patients say oh there's a delayed diagnosis um or you know i didn't know that i had

  5:56

  this disease no one ever told me that and that comes up like someone will say they don't know they have diabetes but they're taking medication for their

  6:02

  diabetes and i'm like you know you picked up the medication someone had to have told you along the way

  6:08

  yeah but if there's no edge information in the chart that said i educated the patient or i referred the

  6:13

  patient to speak with the diabetes specialist or um with someone on the team to have a

  6:19

  specific conversation about this then that's where providers get caught up

  6:24

  based on their actual documentation and what steps they took to ensure that the patient knew

  6:30

  understood verbalized understanding and then were in they were in a position

  6:36

  to take the next steps um so i think sometimes where providers struggle as well as

  6:41

  you will advise the patient to do something and not ensure that they're able to do it someone i need to go see

  6:48

  the specialist and they say okay they take the referral but they never go and then they come back and you say hey

  6:54

  you can go to the to the specialist here's another referral no one ever asked them why they didn't go it could

  7:03

  it could be because it's outside of where an area that they can get to easily it could be that the hours are limited

  7:09

  or that they couldn't get an appointment those conversations have to be documented and those

  7:15

  questions need to be asked um there are a lot of assumptions that go into having these conversations with patients where

  7:21

  oh patient is just not compliant never say a patient's not complying in the chart right yeah like you you do want to speak

  7:28

  to the reasons like a patient is unhomicided so picking up medication may not be

  7:33

  something that is valued you know that they can do at the time like sending sending medication to a specific

  7:39

  pharmacy may be difficult for them because if they're moving from shelter to shelter they may not have access to that

  7:46

  pharmacy like in another month or in another few weeks or they may not have access to

  7:51

  money in another few months or another few weeks even if you give them a 60 or a 90 day supply

  7:56

  right and so and so providers are reliable in those situations not necessarily liable or not but if

  8:03

  it's not documented and something happens to that patient you could be brought to court in a case

  8:10

  where a family member may say well they didn't take care of my my family because they weren't there they didn't take care of my family

  8:16

  member because of x y and z you want to be able to say i offered the patient a 90 day supply

  8:21

  let them know that if they ran out and weren't able to go to the pharmacy to come back and we would give them another number

  8:27

  right so you want to have those very specific conversations documented i think when i read a lot of charts there's a

  8:33

  lot of general information yes you know putting in the hmp is important but the h p is in a whole bunch of other

  8:39

  places so yes that is of course an easy um information that you can add to the chart

  8:44

  but some of the specifics of the conversations that you're having with the patient have to be there to show that there is a progression um in the

  8:52

  care that you're providing you don't want a patient to continue to come to see you week after week month after month and nothing is getting better and

  8:58

  there's no information in a chart as to why right so you know i in a job that i

  9:04

  worked before we had a patient who was a diabetic everything was under control she switched insurances and they began

  9:10

  to deny the medication she needed the provider began to document every single time the patient came

  9:17

  how much work was put into trying to get that patient help the patient ended up dying because the insurance denied their

  9:23

  medications and if the provider and the diabetes coordinator and all these people

  9:28

  didn't put document the reason why this patient no longer had access to the

  9:34

  medications that they needed it could have looked like we were neglectful in that situation they went above and beyond and ensure

  9:40

  that they document every phone call to the insurance company every letter every um

  9:47

  outreach to an organization to attempt to help this patient to get access to that to try to change her

  9:52

  insurance all of those specifics were put in the chart so when she was literally on her deathbed and the family told the

  10:00

  provider you know we knew exactly why this happened um and it was not the provider's fault it was not the

  10:06

  organization's fault it really spoke to the the struggles and the failures of the insurance company

  10:11

  um but if you work in a federally qualified person or there are times when you get audited by the federal government

  10:16

  and when they see those types of things they're going to dig deep they're going to want to know why this happened um especially if they're getting a bill

  10:23

  for uh you know weeks to weeks of care and an intensive care unit for someone who you're managing and who you're caring

  10:29

  for they want to know how did this patient go from being well managed never being hospitalized for five years and then all

  10:35

  of a sudden being in an icu for six months right so that's horrifying even that is so

  10:41

  enraging and horrifying it was one of the hardest situations i think we all the provider was so

  10:46

  heartbroken the family was heartbroken i mean every person involved because they really had worked so hard

  10:52

  to get this person to that point of being well controlled and that little simple decision to change her insurance

  10:57

  because she thought it would be a better option literally led to her death right and so it's tragic there's so many

  11:05

  tragedies that happen and i think as providers we make assumptions that everyone knows why

  11:12

  we make assumptions that you know um even during total if you're sending someone a referral for

  11:17

  the longest radiology centers have closed and they weren't seeing anyone they didn't care code negative

  11:23

  how severe like those that needed to be documented right so there have been

  11:28

  so many delays in care this year and if your patient had some a disease process that needed to

  11:34

  see a specialist or see a radiologist or get an mri or something that could not be done you

  11:40

  need to speak to that because 10 years from now hope it's going to seem like it never really happened like

  11:45

  as much time right you know like it is a very um intense situationality is all our life

  11:53

  our life revolves around yeah in 10 years it's going to be a figment of our imagination

  11:58

  we're going to forget how hard we labored having a baby like yeah you know like oh

  12:04

  my god that was so terrible and then two years ago oh my goodness i think i can have another baby after you complain

  12:11

  so it's so true and i think about that when i'm doing my documentation now and the like boundaries where i feel

  12:17

  like we're pushing because people don't want to be seen in person we're trying to keep them on a telemedicine visit because they don't

  12:23

  want to expose themselves and i'm just documenting like this is in the copic pandemic patient declines you know um but it

  12:31

  makes me nervous thinking about that future thing you know that future back dating i think what would be really helpful um if we

  12:37

  can kind of like keep with the documentation but kind of like incorporate um what like the most i think because i

  12:43

  think that if i i'm obsessed with the lived experience of the new nurse practitioner and i can already hear the panic i'm getting a little bit of

  12:50

  panic too um but in terms of like so like the documentation thing the time management thing is so hard right

  12:56

  but like i think if we work backwards like what are the most common things that people get um sued for and i think

  Common Things That NPs Are Sued For and How To Avoid Them

  13:03

  that that because obviously we want to give that maximum optimal care at all times but if we're talking about like the frame of documentation what do you feel like in

  13:09

  your perception and your experience like the most common things are it sounds like delay and care is one

  13:14

  neglect is another like if you can kind of like lay that out like the most common reasons that people get sued and like how to avoid them

  13:20

  i think that would be super helpful to tie into that documentation conversation um so yeah most family

  13:27

  practitioners providers um get to incredible and federally qualified healthcare centers like those

  13:34

  you know groups of people who treat patients on a daily basis mostly get super delayed in diagnosis no

  13:41

  skip what get super delayed in diagnosis oh oh um that is the biggest one that one

  13:48

  costs the most and goes to court um so if someone is diagnosed with breast cancer

  13:55

  you feel a lump they go to you know cardiology or you know whatever you guys call them you

  14:01

  know to go get further care yeah and you don't follow up to make sure that they follow through

  14:07

  with the entire process and then six months later they went from stage one to stage three

  14:14

  and now they're having a mastectomy and now they're like all these other things that are happening that is a lot of what usually happens

  14:20

  and it's usually cancer cancer is usually the one that causes you the most um

  14:27

  i i feel like there have been very few lawsuits about like the chronic illnesses right so i think

  14:34

  some people assume that those people who have chronic illnesses may come back and see um but i think chronic illnesses it

  14:41

  looks so different in every single person and it's just a long process that it's very rare that

  14:47

  someone has a chronic illness necessarily and they come back and see because they had a chronic illness that

  14:53

  eventually led to either an amputation or someone's death that's really rare because we know

  14:59

  that it's so much that goes into a chronic illness and managing a chronic illness um that it's usually not the provider's

  15:05

  fault uh and very something that's very hard to prove yeah

  15:10

  the other i think big one that i think people see about is

  15:18

  treatment like how they're treated like discrimination uh oh they discriminated

  15:24

  against me because i was homeless so because i was black hispanic transgender like those

  15:30

  are big because they people feel like they're not being treated appropriately or given the appropriate

  15:36

  care and because of that it led to whatever outcome has happened

  15:41

  yeah that's the other big one in like family practitioner for any nurse practitioners

  15:47

  that work in the hospital um a lot has to do with um

  15:52

  prescriptions and things i mean i guess providers can't wait for nurse practitioners for prescriptions as well

  15:57

  um appropriate prescription so not necessarily for the patient but the federal

  16:03

  government will come after people who are writing appropriate prescriptions so your dea license you do want to protect it yeah

  16:10

  of course you want to make sure that there aren't pads laying around that it's not easy access to print um

  16:17

  prescriptions illegally like someone may have access to the office or to the documents things like that

  16:23

  um and not necessarily people being held i think people assume that if you get student that people

  16:28

  automatically are guilty that's not it's a process and it's a very long process so

  16:34

  [Music] where someone brings a case against a provider because of something they did

  16:40

  or didn't do there's an initial investigation that goes into that

  16:45

  and if there's some system substantial evidence that really um can be decided by

  16:52

  a judge basically um then that's when it goes to court but people may you know make a claim and

  17:00

  uh you know call the board on you and do all those different things but that doesn't mean it always goes somewhere

  17:05

  but i think the anxiety that people have is understandable because it's your life your livelihood your license

  17:11

  and you want to do everything to protect it but in that they practice defensive documentation so

  17:16

  defensive documentation is where you are basically saying the patient input is the patient

  17:22

  like it's very and it's not showing what it is that you're doing as

  17:28

  a provider it's putting all the onus on the patient right so you're saying

  17:33

  i told the patient to do these things and the patient didn't do any of these things you're not really talking about the relationship

  17:38

  and like the education the support the resources you're focused more on the outcome

  17:45

  right and so it's like i told the patient to do this the patient didn't do this and now this is what's happening but in reality healthcare and is a

  17:53

  continuous conversation so if you're educating a patient today you still may need to re-educate

  17:59

  next month and one month after that it's like a continual process i think we can't just assume or count

  18:04

  people out just because um they're not agreeable to something because i am a

  18:09

  very difficult patient i think all nurses are and it may take me two or three visits to really accept

  18:16

  what it is that you're saying um i talked about this when uh i was talking a little bit about diabetes and i had gestational diabetes and i was

  18:23

  like i am not checking my blood sugar like and she was like no you have to i was like i'm not doing that

  18:29

  i work i'm busy she was just like okay so the next time i came back she

  18:36

  was like have you been checking your blood sugar it's like girl i'll tell you and you know and so it's like you have

  18:42

  to not just say patient said no we left it at that just say you know

  18:48

  i re-educated the patient i made them understand how important it was and then i followed back up on the next visit and

  18:54

  that's how you document you don't document all of the negative things that are happening in the conversation the negative

  19:00

  relationship yeah that the patient may have with their disease process or with you or with healthcare but you have to document the what you're

  19:08

  doing to get them on the right track even if they never get there um totally i guess i guess one of the

  19:15

  things that i i was thinking is that because i struggle with this especially with patients like if they don't want to do

  19:20

  things they have their full right to right um i guess like i guess i'm i'm finding myself a little bit surprised by

  19:26

  the um uh like if you're telling somebody to go get imaging or advising to get imaging

  19:32

  they agree to it but then they don't go i guess in my mind i've always thought that if they're an adult if they're like a consenting adult like they had their

  19:38

  cognition intact that like that is enough but it sounds like it's not it sounds like you kind of i'm curious

  19:45

  about that because i think that i well this could open up a can of worms but i feel like there's a lot of conversations that i have about

  19:52

  empowering patients having conversations with them and encouraging their own responsibility versus that like kind of like

  19:57

  like what is that word the i don't know patriarchal patronizing i don't know whatever that term is of like you telling them what to

  20:03

  do um so that's interesting that's interesting that it's like a lot more yeah and i think that's what saves

  20:11

  people and so that's why you know when i ask people like do you know how to have difficult conversations

  20:17

  with people is because sometimes you think you're saying something and you're relaying some concept to a patient

  20:24

  and they understand and they may just be like okay i hear you and they don't really understand yeah i give you an example

  20:32

  of like recently where a patient was dying like we know that knew the patient was dying and we're doing

  20:37

  just ridiculous things and that everyone was afraid to tell the family that the patient was dying

  20:43

  and time we're on a phone call with the family the doctor the attending the pa other nurses and i

  20:49

  thought he was like ma'am i don't know you and i don't know this patient but i'm telling you

  20:54

  what the outcome is going to be if we don't stop what we're doing and take care of where she is right now

  21:01

  and then the daughter finally sat back and was like okay i hear what you're saying because everyone was just skirting around the issue and

  21:08

  assuming that she knew that her mother was gonna die and i'm like did you tell her that her mother is

  21:14

  going to die and that her mother is dying and that her state that her mother in means that this can be a very

  21:20

  quick death that leaves no closure right and so i think there is this

  21:26

  assumption that we're saying things clearly and sometimes you have to say things just different ways

  21:31

  or someone has to hear someone else's voice you want you know the nurse to come back and follow up or you want you know sometimes it's the

  21:39

  the medical office assistant who has a great relationship with the patient yeah you can go in and say you really need to listen to what the

  21:44

  doctor is telling you right i think we can never discredit

  21:50

  anyone's value in educating their patient it starts from the minute they walk into the building to the minute

  21:56

  that they leave um and empowering everyone to be able to build that relationship with the

  22:01

  patients allows the provider more room to be the provider and not to have all of these

  22:07

  extra things right because the more time you spend trying to convince someone to do something the less you're really able

  22:12

  to actually do the work that you're there to do yeah yeah totally totally and i wonder

  How To Tell Patient That You’ve Made A Mistake

  22:18

  um and speaking of difficult conversations uh we can we can go in any direction you want but i think it just kind of ties

  22:24

  really nicely into um how to tell a patient when you've made a mistake

  22:30

  that's like a general que we don't have to go into that if you don't want to when we can i mean i think that's real um i've been

  22:36

  there when like gave the wrong vaccine to someone's child and they're like oh you wanted this vaccine and not that one

  22:42

  yeah um you know it happened so i told i told them the community about a mistake i made

  22:48

  recently about uh like uh uh i guess i can say it here too i had a woman who was pregnant who had a

  22:54

  uti and i just didn't order the repeat uti you repeat culture a week later because i just was i was moving fast and

  23:00

  i wasn't thinking it was the end of the day it was a really long day and she like really want to get out you know and so and it's like having that conversation of like

  23:07

  luckily it was nothing bad happened you know but like that was uncomfortable i was like oh that does not feel good you know but

  23:14

  yeah any any thoughts you have about yeah so the last hour we made a lot of mistakes so we had a lot of these

  23:19

  conversations um and i think the first thing is to be gentle with yourself right like i think

  23:26

  we put so much pressure on ourselves as if we have to be perfect as if the patient expects us to be

  23:31

  perfect um as if we're not human and the anxiety that you feel when you make a mistake

  23:37

  is not necessarily that the mistake was made or what the outcome may be for the patient it's how they're going to make you feel

  23:42

  and how you feel about yourself and so all that energy that is like the hotness the sweats

  23:49

  the like anxiety that you feel is more about like what are they what are they gonna say or how they're gonna

  23:55

  respond um and so i think if you go in and take a deep breath and really relax and say okay to

  24:01

  yourself i made a mistake and really assessed like how this happened because it's never usually intentional

  24:07

  it's usually that they're busy we're fat you know or moving too fast we have too many

  24:12

  patients um someone called your name in the middle of you doing something that you meant to do and then you just

  24:17

  went to the left instead of the right like it happens um and to explain to people like you

  24:23

  know to be honest i think for me when i've ever when i've made a mistake or

  24:28

  in a situation where um someone else has made a mistake and i had to call the patient myself

  24:33

  i always start with saying who i am and you know that how long i've been working in healthcare why i work in healthcare why

  24:40

  it's important to me to take care of you appropriately and then to admit the mistake i made and

  24:45

  say i'm so sincerely apologized for that um and this is how we're working to make sure

  24:52

  that never happens to any other patient i feel like if you told me you made a mistake i like want to cry right now

  24:57

  because of like yeah it's just so beautiful to say it that way because it's like like clearly like you are a very caring

  25:04

  person right and so like you would never want to intentionally hurt somebody so like i feel like as a patient receiving that i'd be like oh yeah

  25:11

  [Laughter] i always were the one who was put on the spot like can you call this patient and tell them we took the wrong level i was

  25:17

  like hey we've been working to improve the clinic for the last two years and we have made

  25:25

  a lot of strides in doing so um but yesterday that was expired

  25:32

  yeah yeah it has happened the only time that i think i exploded was we drew

  25:38

  like the wrong laps on someone like three times it was absolutely insane and i literally had

  25:45

  just had that conversation and so then i just started screaming and i was like i was a manager i was like

  25:53

  i hate me that doctor's gonna kill me i was acting so crazy like the staff

  25:58

  were just looking at me and then i got caught my boss and i was just crying like i can't believe they can do this to me like you know those

  26:05

  instances where you keep making the same mistake over and over it's just no excuse yeah that's like you got to figure out a better way

  26:12

  um and then that's where like the risk management compliance team comes in because it's like if this saying

  26:17

  if three or four people are making the same mistake over and over something is missed something is happening let's figure out why i think it's easy

  26:24

  sometimes to say people are making this mistake um and there's something wrong with them but

  26:30

  sometimes you have to look at it from a systemic level and say okay totally this mistake is happening continuously

  26:36

  what can we do to either fix it or put enough a red flag in place um that um

  26:42

  you know makes people double check or figure out why this is happening over and over um and then you fix the system and then

  26:49

  hopefully people don't make the same yeah totally um i guess a question i have about that is like

  Thoughts of Documentation of Mistakes

  26:55

  what is your do you have any like thoughts about like the documentation around it it doesn't sound like that's a huge malpractice

  27:00

  risk of like you making a mistake in terms of like the the volume of lawsuits but do you have any

  27:05

  thoughts about documentation of mistakes yeah so never go back and delete what you originally did

  27:12

  um go in and of course write an addendum to what it is that you're making and i would never say like

  27:19

  when you document you don't have to say i made a mistake like out of document you know um

  27:26

  order was not placed yeah you know followed up with the patient um and then say patient came in

  27:34

  did the order period like yeah no one can tide that was a mistake like if i'm you know and i always try to tell people

  27:41

  when i look at charts as an attorney or consultant with other attorneys i look for wording that's like yes i'm

  27:48

  gonna read through 500 pages of documents but i'm really looking for like things that stick out to me so if

  27:54

  you wrote order was not placed you know followed up with the patient informed them that the order should have

  28:00

  been placed um it's two days delayed patient came back returned this happened you know whatever

  28:06

  happened and the outcome what am i going to say to that right like that health that is what and

  28:12

  i think we assume that healthcare is a perfect situation healthcare is extremely imperfect

  28:18

  because it's run by people yeah right it's not run by a machine and so there are going to be outcomes where

  28:24

  it's not perfect but that doesn't necessarily mean you're going to get sued yeah and i also try to explain that the

  28:29

  most time when people usually sue it's not normally just because they had a bad outcome it's because of how they were

  28:35

  treated so if i had a delayed diagnosis but you

  28:40

  treated me so well you when we finally got to the point of getting care and treatment you made sure that i

  28:47

  was everything was expedited that i got all of the best care and got the best surgeons in the bed

  28:53

  like who am i going to come back and see like it happens like people are understanding of that

  28:58

  it's when people are dismissive disrespectful and demeaning to patients yeah

  29:04

  and they come back or they're completely silent about the mistake or the issue and they don't

  29:09

  say anything and it's like no one expects you to go say i'm sorry and to grovel and to ask

  29:14

  for forgiveness like we're not asking you know patients don't ask for that patients usually just ask for some some type of transparency

  29:21

  yeah they want to know that someone knew that it was a mistake you realize the

  29:26

  mistake and self-corrected that they weren't telling you as a patient how to take care of them

  29:32

  totally and so i think that's really the disconnect and so people healthcare providers feel like

  29:39

  people sue too much but healthcare care providers forget that people sue because you disrespected them and made

  29:45

  them feel less of a person right and so like i've been in situations where people have

  29:50

  made mistakes and i've been like it ain't a big deal like it happened yeah and then i've been in situations

  29:56

  where people have done things where i'm like i am going to drag you you know like and you have just

  30:01

  angered me yeah right and so um that's when people do is when you take them to that

  30:07

  point where you're not giving them the level of respect that they deserve um and so that's that's the disconnect

  30:14

  so i think a lot of good providers who have all of this anxiety aren't usually the people who get sued

  30:20

  it's the arrogant the cocky that i'm better than you uh the

  30:25

  i make no mistakes right so surgeons get sued a lot because they have this air of i

  30:32

  don't make mistakes there is no way that i did this wrong if this was done wrong it was because you

  30:37

  know yeah and that's why the operating room is a very dangerous place you know for egos emotions and outcomes

  30:46

  because of those types of attitudes yeah and so i think a lot of family providers feel like they are like it's not a lot

  30:52

  of lawsuits that can go on in family health because it's just only but so much you can do and there are

  30:58

  so many players involved it's never just a provider it's so many other things so many other layers insurance

  31:04

  red tape you know social workers trying to get it's a lot it's never just usually one

  31:09

  person yeah um but in health care settings where it's usually the mistake of one person those

  31:15

  are very rare and you people will come to the hospital and say i just want

  31:22

  to know what happened to my family member and the hospital will be like we can't give you any information and now you have to sit because that's

  31:28

  the only way you're going to be able to get the chart the only way you'll be able to figure out what happens the only way that

  31:34

  you'll get some type of closure for someone who either you know had some type of long life changing damage done or who passed

  31:41

  away yeah and it's like i just keep coming back to like and and this comes up a lot i think with

  31:47

  new nurse practitioners is that and i had this myself when i was new it was like i was so focused on like the

  31:53

  medical and the doing and i was still of course thinking about the emotional aspects but i remember as a new grad being like

  31:59

  i don't want to hear about the fluffy stuff i just want to be able to learn and how to do my job but it's like this is so inherent

  32:04

  like it's just wild that like emotional connection closure validation all of that stuff

  32:10

  like that is like integral you know it's like the outcomes are important too but like

  32:15

  those are the foundations you know um yeah and the in the as of this recording the last

  32:20

  week's video um i talked about trauma informed care where it's basically like

  Trauma-Informed Care

  32:25

  i don't know some people i feel like could write it off as this touchy-feely thing but it's like honestly this is the foundations like if you're sensitive to

  32:31

  people's like needs and rapport and relationship like yeah that is it and i think

  32:38

  you know we would put a lot of lawyers out of business if we tapped into that more yeah i think there

  32:45

  is this conversation that's happening now in birth you know in in like the birth

  32:50

  world where they're starting to understand trauma-informed care because they have the some the hardest outcomes like it you do

  32:58

  have to have a happy ending for people to feel good about it um but there's so much trauma that goes

  33:03

  on in the care from you know conception all the way to birth that people bring to

  33:09

  the table that then if the outcome isn't perfect that becomes someone's fault right yeah and if that isn't treated in the

  33:16

  beginning or dealt with in the beginning that negative outcome is then related to all of the trauma that has happened to

  33:22

  that patient totally i think if healthcare providers can understand that people bring to you whatever experiences that

  33:29

  they have had with providers when i go to the dentist i'm always like i have had terrible

  33:34

  experiences with the dentist and they're just like but not with us and i'm like it doesn't matter it matter

  33:40

  like take good care of you be gentle right um and the dentist has to take that into

  33:46

  consideration and be gentle with you right right and so it's like if we put that into like a healthcare setting and

  33:51

  say people who come to see you could have experienced so many different types of

  33:57

  trauma whether it be health care related or personal we have to take that and to

  34:02

  consider we do have to take a second and step back and say how are you yeah you know and yes sometimes

  34:08

  people will go on and on but you have to be you know bold enough to say you know what i'm so glad to hear that you're doing

  34:14

  well but let's get to your your your visit and why you're here i don't want to waste your time i know give it

  34:20

  right right like being able to you know give that relationship building aspect of your

  34:25

  care definitely leads to people feeling like i love my provider they're the best in the world

  34:30

  and when you make a mistake they're like don't worry about it i know you didn't need to like you know and that happens where you make

  34:36

  the mistake and people are just like oh i wasn't intentional i knew you were busy you took that second to really see who

  34:43

  they are as a person and not just who they are as a patient yeah and i think that like so many new grads and i work with some mentees

  34:49

  one-on-one and like they all have that experience of like their patients love them

  34:54

  because they give them the time to give them their heart like all that stuff so uh so yeah because i think so many other

  35:00

  new mps in this context specifically beat themselves up about not knowing all the things and they worry about all the

  35:05

  missing things and and documenting things wrong and you know there's always things to worry about right but if we have the

  35:11

  foundations of relationship then we definitely like have a strong hold to to put on

  35:17

  um i wanna i wanna we have so many questions we don't have to address all of them but i wanna i wanna address some of the other ones

  35:23

  so um what uh what about

  35:29

  uh so i'm gonna pause here and we can edit this out oh what do you what do you wanna where how are we doing with time for you and um where do you think you wanna i'm

  35:36

  over one time um i think we can go into like the medical malpractice insurance and personal legal representation

  35:42

  uh i think those two because we've kind of touched on a couple of them yeah i think we did okay okay

  35:49

  um okay so back to recording um so with medical malpractice insurance

  Medical Malpractice Insurance

  35:55

  this question comes up like all the time and i'm sure you get this question a million times a day too of like malpractice insurance when do

  36:02

  you need it like do i need it because of my employer like what are the flavors of that kind of conversation of

  36:07

  separate medical malpractice insurance or medical malpractice insurance in general so this is such a common topic that i

  36:15

  don't understand how nurse practitioner com you know schools and programs and nursing programs

  36:21

  aren't having this conversation at the week before graduation or the month before graduation right like it's a

  36:28

  huge issue and the deal if you don't know anything about it you would just like oh i'm just gonna

  36:33

  get it just in case so if you work for a healthcare organization that provides medical

  36:39

  malpractice insurance and that's all you do your full-time job is with this organization

  36:44

  that is insured and covered then you're fine you don't need anything actually

  36:51

  and the reason is that if you have it and someone sees either your organization or decides to

  36:56

  try to see you and they find out you have to disclose it that you have it they're going to keep you in the case

  37:03

  instead of kicking you out because that's more money to them right healthcare organization has

  37:09

  whatever millions of dollar policy and if you have a one million dollar policy that's one more million that that client could

  37:17

  potentially get oh my god this is blowing my mind oh you don't and the way that hospitals

  37:24

  negotiate to get people's names off of cases

  37:30

  is by saying they don't have anything to lose they don't have anything to offer if you take this from them

  37:35

  you know they don't have any insurance we're going to pay you whatever it is that you want to get it but if you take our providers off you

  37:41

  take our nurses off if you take our radiologists off then we can get to the

  37:46

  conversation which is basically the money like settling with without exactly either settling or even

  37:52

  if they go to court the negotiation doesn't they don't go anywhere unless they say like take these people's names off right

  37:59

  and so nurses in the hospital who have who document defensively i have this conversation with a couple of different

  38:05

  nursing groups sometimes it's like don't like you don't have a reason to the legal team is going to get you out

  38:11

  one they don't want you on or in a seat answering questions

  38:17

  because they know you know how bad it is right so they don't want a nurse involved at all because your

  38:24

  interest is stealth and is not protecting the organization the doctor if they have to keep the doctor the

  38:30

  doctor is going to defend themselves and they're also going to defend the hospital because that's who pays them

  38:35

  that protects them and it's a lot harder to get a job as a doctor than it is of a nurse

  38:40

  whereas a nurse will be like i'm about to throw everybody under the bus and i'll just go get another job right like and so they do not

  38:47

  want nurses on these cases at all they don't want them to pose they don't want to testify they don't

  38:53

  want them near an attorney because so much more could happen whereas the patient or the client can be

  39:00

  coming for one issue and the nurse is like and then they forgot to draw labs and then and uh

  39:05

  you know that's how embarrassing i don't understand why nurses are like this like i don't know they're so intense when it comes to

  39:12

  like documentation and like protecting themselves and i'm like trust me honey the attorney at the hospital does not want you

  39:18

  on their team like they don't see you as an ally at all right so god don't if you're

  39:25

  a nurse practitioner you don't want to have that extra coverage if you're doing something outside of

  39:30

  that if you're doing per diem work for a company um if you have your own business if

  39:36

  you're doing like suboxone treatments in a separate clinic or flu clinics things like that that may not be fully

  39:43

  insured yes you should have some type of coverage i wouldn't go have million dollar coverage

  39:48

  i would maybe have like a hundred thousand dollars or maybe half a million dollars if you're doing some very intensive work but if

  39:55

  you're doing like a food planning you don't need million dollar coverage right you just do something called just in case you know something

  40:02

  happens someone has a negative outcome and they just may you know bring something to the table

  40:07

  because malpractice insurance just isn't about the money they also provide

  40:12

  other resources to you um under your coverage so just like homie

  40:17

  friends so home insurance isn't just about like covering just the outside of the house they may cover different aspects of your

  40:23

  home or if you have a fire they may put you up in a hotel like those different tenants of it

  40:28

  um it's so in medical malpractice insurance they provide other things coverage as well so like if

  40:33

  they provide malpractice insurance sometimes like if you work in a suboxone clinic if there's a flood and everything

  40:40

  is damaged and you can't work they may give you money to help cover that or repair the cost of those things so there

  40:46

  are little things that they cover outside of just someone coming to see you or trying to

  40:51

  be like um they do provide resources to risk managers so like if you

  40:57

  um are working with a medical malpractice insurance they'll give you a number to call if you're running into an issue to be able to ask questions

  41:04

  because you don't have a risk manager that works for you so they'll give you resources and access to those people so that you can ask

  41:10

  those questions as you may be having an issue when you're out in the field if that makes sense i understand i understand

  41:16

  yeah so that's really the only time you need it and then when you talk about having an

  41:22

  attorney at your side as a new nurse practitioner i think a lot of people you know see a contract

  41:28

  hopefully you read every word of the contract uh people don't have contracts actually i've i it's yeah this is like i have little

  Contracts

  41:35

  wild west like i feel like i learned about contracts like i was interviewed for a job and they gave me a contract and i was like oh

  41:41

  okay i didn't know there was a contract to sign i read through it it seems fine you know but some people don't even have

  41:46

  contracts so anyway any thought i love welcome all the thoughts yeah so i think as if you're in a

  41:53

  situation where you are going to be uh held responsible for a certain amount

  41:58

  of patience um for a certain like outcomes for either income like some providers have

  42:05

  to bring in a certain amount see a certain amount of patients and reach a certain amount of like money like i you know you have to see

  42:12

  this amount of patients and then bring in this amount of money by doing x y z if you have those type of

  42:18

  responsibilities you need to have a contract ah because you want someone to say like

  42:23

  what happens if that doesn't happen right like there are no protections for you there's no what you know it ends

  42:29

  up but there's no um really detailed explanation and i think that's what happens with a lot of

  42:35

  providers that go into a situation where you're like i don't know that i had to see that many patients or i didn't know that i had to commit to

  42:41

  that many hours of following up on my referrals so like other aspects of the job that isn't just

  42:46

  patient care there may be other responsibilities that you have if it's teaching if it's you know

  42:52

  precepting whatever the case may be you would like those things to be detailed out you also like to know where

  42:57

  you might get a raise how how is this structured because if you don't have a contract they don't have to give you a raise yeah

  43:03

  yeah right so like if you work for me and i say you come and make it 150 000

  43:10

  when do you get a raise when do you get a performance evaluation when we look at you know your load and

  43:16

  see if we need to provide more um office hours for you to be able to do different types of work or just

  43:22

  put your account with telemedicine and in person like when do we discuss that you as a new

  43:29

  practitioner are going to come to me and say hey i've been working here for two years i think i need a raise i'm going to look at you like you're

  43:34

  crazy right and so like of course i think any new provider is

  43:39

  not going to say i need a contract um but i think as a provider if

  43:44

  someone's not offering a contract then you should be asking some detailed questions of like

  43:50

  whether when would my performance evaluation occur you know how do raises work how

  43:57

  um our payment structure like i know a recently an organization i worked for

  44:04

  it was like everyone was paid you know across the board a salary and now it's tied to how many patients you see right

  44:10

  and then it was tied to like your patient outcomes like your the numbers the like quality measure yeah your quality

  44:18

  measures like that you want that detail because if it's not then they can automatically and it could

  44:24

  be arbitrary on like oh you didn't do this and you didn't do that and so no you might never stop but you have nothing to bring to an

  44:31

  attorney to say hey i lost my job this was our contract like what should i do if you don't have a contact no

  44:36

  attorney's gonna talk to you yeah yeah so quality measures being things like number percentage of patients with diabetes a1c less than

  44:43

  nine percent and colon cancer screening may be and depends i think what the measures are that they're looking for like what

  44:49

  percentage of those metrics generally speaking so if you if if your pay is tied to those metrics

  44:58

  protect yourself um in case of someone who tries to say that you're not doing what it is that you're doing um

  45:05

  you can say well this was a contract that i had and this is what we agreed to um and it also things change like people

  45:11

  will get you into a job and tell you that you'll be doing one thing and then you get there and all of a sudden you're doing another

  45:18

  and if you don't have anything to protect you or to say like this is what we originally agreed to

  45:23

  yeah you're stuck doing whatever it is that they tell you to do yeah yeah and i think a couple people had

  45:29

  asked about hiring a contract lawyer and they found it to be a little cost prohibitive um

  Hiring a contract lawyer

  45:34

  so like i don't know i i don't it depends i think the rates are different and what do what is your perspective like do

  45:39

  you think that that should be requisite because i feel like i i didn't i had no idea what a contract lawyer was i had no i was so i was clueless

  45:46

  when i had a brand new job as an np so i think one of the things i think is is hard and

  45:53

  why i try to have more conversations about health care in the legal world and where the why that connects

  45:58

  it's very secretive and a mystery unless you are an attorney and you know attorneys or you have attorneys in your

  46:05

  family you really don't know what goes on you don't know what what is a good rate or what is it not so good rate if it's inflated you

  46:11

  don't know what you're gonna get for 750 if that's what someone's asking right

  46:16

  right so some attorneys are charging 350 an hour up to a thousand dollars an hour

  46:22

  depending on like how big of a law firm that they work for so no a nurse practitioner should not necessarily go and work for a

  46:28

  go find an attorney at a law firm because they're gonna build you and it's gonna be something

  46:34

  that you just can't afford and it's very discouraging um and then there are a lot of solo practitioners or providers like

  46:40

  attorneys who have their own practices who just don't advertise well enough so you just don't know where to look or where to start

  46:45

  they'll trust you know we've had a conversation about working with attorneys who just don't understand you know what it is that you do yeah um

  46:53

  and so we as attorneys sometimes struggle with trying to find other resources of other attorneys there

  46:59

  are so many attorneys in this country but yet you're looking for something very specific all of a sudden you can't find

  47:04

  anyone yeah but i do feel like yes like a lot of people use things like legalzoom and

  47:10

  like these different um apps and websites to create contracts or to um use their services and not to say

  47:17

  they're not bad but sometimes they don't have your best interest at mine yeah okay and so they

  47:22

  don't understand health care they're just a lawyer who's contracted to work with legal zone and they're just gonna

  47:28

  do whatever they feel is okay and they don't have any health or legal experience so

  47:34

  there are like if you're in a position where you need an attorney you don't have

  47:40

  resources um you can reach out to like law schools surprisingly um a lot of law

  47:48

  schools have clinics and that is like right up their alley like if you follow a law school and then the students are

  47:53

  in clinic usually during the school year and sometimes in the summer and say hey um is there anyone available to

  47:59

  review my contract so it would be maybe a student reviewing your contract you know who's probably going to be more

  48:05

  detailed than a regular attorney because they don't have anything else to do yeah but they're supervised by a licensed attorney so it's not

  48:11

  necessarily outside of you know like it's not just a student doing the work for you it's actually two attorneys

  48:17

  or a future attorney and the actual license attorney doing that work that sounds great that's a good place to

  48:22

  start into this position um it's or if they can refer you they it like a lot of times like i went to

  48:29

  howard law which was in dc if it was something that we couldn't do they would make it their business to

  48:34

  connect you with a lawyer and get you the resources that you need so that's a good place to start is to

  48:40

  find a law school in your area in your city and your state to find some resources to help you

  48:46

  even though people aren't in the office they're still connected via email um even sometimes via phone um to make

  48:52

  sure that people are getting what it is you know what they need um and there also are like legal aid offices like you

  48:58

  may not feel like you qualify for the way but you also don't want to pay somebody a thousand dollars an hour to look at a contract

  49:04

  that may take them five hours to them right like that's not acceptable but

  49:10

  is a great resource right so legal aid yes are for people who cannot afford a

  49:15

  lawyer but if you call them and say hey i'm looking for a lawyer who does xyz they have a list

  49:22

  of lawyers who either does inexpensive work or he does pro bono work

  49:27

  but a lot of times those lawyers who sign up to do pro bono work is what they do voluntarily but they also work as

  49:33

  regular lawyers so yeah they're usually the ones who have lower rates yeah and you can have access to to provide you whatever

  49:40

  resources that you need so don't i would say yes if you can read your own contract

  49:45

  you can take the risk to do it but there are times like i've read a contract for nurse practitioners specifically and i'm

  49:51

  like what happens when that like what would you do if that happened right like

  49:56

  like they didn't mention anything about pay or they didn't mention anything about that like let's talk about the structure um or the

  50:02

  requirements are so high i'm like you really don't see 100 patients in a month like is that like

  50:08

  how is that going to work that volume you know what does that look like what support do you have you know those

  50:14

  kind of things and so going and then they're able to go back to the table and say what support do i have how am i supposed

  50:19

  to get it done how many hours am i supposed to commit to that if i you know or you know people are now giving

  50:25

  unlimited pto that may maybe a little bit rare in healthcare but in certain situations

  50:30

  if you're getting unlimited pto how do i request that do i get paid you know like they're just other

  50:36

  questions that you have to ask that you wouldn't think of as a normal person because you're so excited about the opportunity and that

  50:42

  excitement kind of sometimes puts a block in front of you um it doesn't allow you to necessarily

  50:48

  uh ask the appropriate question totally totally um so a couple other things we

  50:55

  wanted to to cover um scope of practice do you want to talk about scope of practice

  Scope of Practice

  51:00

  yeah i think nurse practitioners you know are just to me the best care

  51:06

  providers i love so nice exciting no they are just so detailed and so good

  51:12

  and you know they just have a heart because some providers are just like you don't care about me

  51:17

  um and i think of course a state base it depends what your state allows like i am a maryland bar attorney

  51:25

  so maryland is a full practice state where nurse practitioners can work independently so they have the autonomy

  51:31

  to do a lot of different things whereas certain states have not passed those rules so you have to look at the scope that is

  51:38

  laid out by the board of nursing or whoever governs you in your state as to what it is that you can do

  51:44

  if you're in a situation where providers asking you to do something that you feel like maybe out of your scope

  51:49

  if you work in a setting where you have a risk manager or compliance officer or an attorney on this team you should

  51:55

  reach out to them because they're the ones who are going to write the policies and they're going to say oh no that's not okay i'll talk to

  52:02

  them i'll make sure you're protected yeah if you're in a situation where you don't have that

  52:07

  you can always call the board and ask or email the board and say like you know it's just within

  52:12

  my scope can i do that but they're not going to penalize you for asking questions even if you are did

  52:18

  it no one's going to say like you know you didn't know and that's why you're asking the question yeah um and so making sure that you're

  52:25

  comfortable with your scope i think is what it's really some of the challenges i feel like nurse practitioners have it's like

  52:31

  this is all you can do make sure you're comfortable in those things right so like if they're

  52:36

  asking you to do we didn't really talk about specifically about fmla paperwork

  52:41

  that is your scope right how do you do that effectively and efficiently

  52:46

  is not up to someone to explain to you that's up to you as a provider to learn the best tips the tools how you know how

  52:53

  to protect yourself how to make sure that everything that is true is documented and what is not true that the patient may be asking you to

  52:59

  write down um is not documented like those kind of things so there is also some responsibility on the

  53:06

  nurse practitioner to get educated to find the resources that they need to that's what seeing credits are for um

  53:13

  you know when they're you know you're going to sign a contract and hopefully they're giving you thousands of dollars

  53:18

  to use oc credits use them for things that you know that you're struggling with but those areas would

  53:24

  have lots of questions use that money to dig deeper because there are so many resources out there

  53:29

  yeah and i say to be careful like i think social media is an amazing tool um but in the recent weeks i'm realizing

  53:36

  that people are taking that as like the information that is shared on social media as gold um

  53:42

  you know and it's not right i mean my stuff is gold of course but it's not just social media

  53:48

  you're actually providing curriculum that is rounded and nuanced

  53:53

  and information that provides people an opportunity to ask more questions yeah right there are some resources that

  54:01

  are out there that is just spewing information that is not necessarily nuanced and it's not

  54:06

  allowing people to ask questions so i feel like more people are asking about medical malpractice insurance

  54:11

  because people are saying you need medical malpractice insurance so they're hearing that from somewhere i

  54:17

  never thought about having medical malpractice insurance that was it under like 12 years ago why i work for

  54:23

  organization right um and so it's like someone is saying that somewhere that information is being

  54:28

  spewed somewhere saying that you need to protect yourself you need this you need why right and so there's no and then

  54:34

  there's no opportunity to ask the question why which then leads people to make decisions that may not be appropriate

  54:40

  for them yeah no totally and i think like the question kind of with scope i think was there a couple of example

  54:46

  questions we weren't trying to do like too specific stuff um but like kind of like if you have a

  54:52

  family nurse practitioner and you're working in a psych setting like a psychiatric mental illness mental wellness health setting like

  54:59

  versus you know if you're i don't know there's there's so many there's so many like branches off of examples but i think

  55:05

  you're like it really just sounds like it comes down from to state to state and the board of nursing

  55:10

  and yeah hopefully yeah it comes out to the support so for providers ask you to do something

  55:16

  independently and never checking back up and never giving you the training that you need and you don't

  55:22

  have anybody to partner with to make these types of very crucial decisions that you don't feel

  55:27

  like you're trained on scope or no scope like don't do it right like that's not appropriate

  55:32

  but if they're giving you extensive amount of training like there are giving you access to

  55:38

  someone who has extensive you know experience working with that patient population

  55:44

  then and you're doing the care as a partner practitioner that's within your scope

  55:50

  i don't think that's wrong right like i think that you have the resources that you need to ask questions

  55:56

  when you run into a situation that you're not comfortable with that you received extensive amounts of

  56:02

  training um that you should you know make you more comfortable with the patient population that you'll be taking care of

  56:09

  like that's okay as long as that's within your state within your scope that may be a new environment

  56:14

  yeah like but that doesn't necessarily mean it's without outside of your scope so that's like a nurse practitioner

  56:20

  who's done med surg and now they're being put in a critical care unit but all of a sudden you know you've

  56:25

  gotten three months of training and you have a provider who can answer every single one of your questions

  56:31

  like that's okay like it's not easy it may be tough we've seen it happen in the hospitals people have been thrown all

  56:37

  over the place we get it it's not ideal yeah but if you have the resources and the

  56:42

  support then it doesn't mean that it's outside of your space absolutely well i think i think what is

  56:49

  what is one more question we can tackle um what do you what what do you think

  56:54

  grab bag yeah so i think there are a couple like things we wanted to highlight i think we were talking about the

  57:00

  beginning but we forgot um so i'm gonna ask something about like estate planning and protecting your assets

  57:05

  yeah you we're in a situation where someone attempted to sue you but how do you do that you have to talk to a

  State Planning & Protecting Your Assets

  57:11

  state planning lawyer i do not do estate planning at all um there are some amazing resources out

  57:16

  there um the just in case lawyer is someone who i follow who does estate planning she's in texas though but um is she

  57:23

  right yeah she's great i know i i think i think i was going to ask that if it was state-based i think she

  57:28

  think yeah it's definitely state-based but she would at least be able to put to point you in the right resources

  57:35

  to the right resources totally um because she's been a state planning lawyer and they have their own communities and things like that so yes there are

  57:42

  some things i think that you should do but that's very specific and you have to meet with an estate planning lawyer to figure

  57:48

  out what you have and what should be protected um and what's that yeah what can be left

  57:54

  out or what can be about putting right so that's a very specific question but i think meeting with an estate planning

  58:00

  lawyer is is crucial at that point um and usually statement lawyers aren't as expensive

  58:05

  as people think yeah i think we assume all attorneys are really expensive but estate planning lawyers

  58:10

  you know they the value of estate planning is so valuable and that when you treat people

  58:17

  well they're going to continue to come back so state penalties usually don't you know charge crazy amounts of money

  58:22

  because you have to come back and update your paperwork like every year every few years you may have more kids or you may have bought a house

  58:28

  so like if someone's paying you know thirty thousand dollars for an estate plan they're never gonna come back to

  58:34

  update yeah and that doesn't help the estate planning lawyer so i feel like don't ever assume that someone's more expensive than they may

  58:41

  be right just because it may be something that you're not familiar with and you can always shop around and say you know

  58:47

  what are your rates and then compared to them to other people as well totally it's just it is such a valuable

  58:53

  thing that it's like it's like a grown-up thing that i've been putting off um i mean i'm a bad lawyer and i'm also

  58:59

  better i move so much so i'm like i don't want to say here i need to move i love it

  59:05

  and then i've been i've been in new york for three years i should have had an estate

  59:11

  so it's so valuable it's like so it's so important it's like hard to see sometimes that there's like the work and

  59:16

  the effort and the money and like how much it pays off eventually but um you were that did we did you want to

  59:22

  touch on um kind of like the fmla pre-op covered work letter question

  FMLA, Pre-Covid Work Letter

  59:27

  yeah in more detail when you're talking about it's a little bit of documentation

  59:32

  and ethically people are pre-appointed so i think with smla paperwork you just have to be very specific

  59:38

  and honest about the symptoms that the patient is having um where i used to work people would just be like so vague and then the

  59:45

  patient will have to come back and come back and come back a little corrected what the

  59:51

  uh job or you know the employer is looking for is like can they come back to work like

  59:59

  so if you're saying you know patient is having difficulty walking that does not mean anything to the employer because they

  1:00:06

  may be at a job that they're seated so okay you may have to take a while to walk in here but if you can

  1:00:11

  get in here and get to a chair you can work right so you need to be detailed and speak enough so

  1:00:17

  if that patient can sit in a chair for eight hours you know the patient what type of work

  1:00:23

  environment that they work in what it is that they do and what it what their job is asking them to do like if they're on

  1:00:31

  light duty some people can go back to work online that makes sense but for some people that's not

  1:00:36

  even an option yeah oh and so when it's not an option you have to speak specifically so what

  1:00:42

  that person can do they cannot walk more than 500 feet without having severe pain

  1:00:47

  right but it should be that specific they cannot sit in a chair for more than two hours

  1:00:53

  without you know having crippling pain so they may need to be at home in a bed

  1:00:58

  lay down in their house because it just doesn't make sense right um you need to be able to speak specifically to

  1:01:05

  what it is that their job description is and what is their job is asking them to do

  1:01:10

  and then you know whatever symptoms or issues that they may be having medically and how that's impossible for them to

  1:01:16

  you know be able to manage their health while at work totally because that's what the job that

  1:01:21

  no the job doesn't want to be responsible at work for someone who you know comes in and has a stroke or a

  1:01:27

  heart attack because they can't manage their care uh but they also want to know like they also don't want to put someone out who

  1:01:32

  may not need to be put out of work right um because that cost is costly for them so i think those

  1:01:38

  specifics i think would be more helpful um on fmla and pre-op appearances

  1:01:43

  um i see crazy things with those two but the surgeon wants to know that they're

  1:01:51

  not going to get in trouble for taking care of a patient it's not really medically ready yeah um

  1:01:56

  and so you know it is important that we're doing the hemoglobin a1c in the blood sugars and um whatever other pre-testing that needs

  1:02:03

  to be done the ekgs and all of those things and ensuring that they're accurate and correct

  1:02:08

  or done in a timely manner so that the surgeon's not put at risk because i think what people don't understand

  1:02:14

  about a pre-op clearance it really gives the surgeon an idea and the anesthesiologist an idea of what protections they need to put in

  1:02:20

  place to protect themselves to make sure that the patient doesn't die on the table and now they're being sued right right

  1:02:26

  like if we have to think of these documents as a team effort it's not just you protecting yourself it's not you just

  1:02:32

  protecting the patient you're also protecting the next provider when it comes to the pre-op clearance it does need to be detailed all the

  1:02:39

  sections should be filled out um didn't just see you know sometimes you can say see

  1:02:44

  you know attachments or things like that when it's too wordy but you want to make sure that you're referring them back to something that

  1:02:51

  you're not just yeah um and then you know asking them to assume that

  1:02:56

  that hasn't been done yeah i think like the understanding that i've pulled and correct me if i'm wrong i

  1:03:02

  think like i think there's like kind of like two things one is like making sure that it's documenting their kind of current

  1:03:09

  clinical status appropriately um doing the testing that they've requested

  1:03:14

  and then um which is like actually kind of a side conversation there's like a i think curbsiders has a podcast about

  1:03:19

  like the evidence around how much document how much testing we actually need to do versus like what makes us feel better

  1:03:26

  whatever i just kind of go based on their what they need from me and then the other thing is like

  1:03:31

  is like um you can say like no contra indications for surgery but like not to say clearance and i don't correct me if

  1:03:37

  i'm wrong i don't know if you have any thoughts about the verbiage to say like you know because if you say clearance then that

  1:03:42

  you're more on the hook or something i don't know it may be totally false yeah i don't think that's true i don't

  1:03:48

  think i wouldn't say no conscious indications because there may be a conjugation of why they may not need that surgery but

  1:03:54

  it may the you know benefit analysis may be that it's more important that they get the surgery you know maybe a risk that they may die

  1:04:01

  so i was in no conscious indication because a lot of times patients do have conscious indications of why they shouldn't go to surgery right um but it's more like a risk

  1:04:08

  benefit discussion it sounds like definitely is really up to the surgeon to have

  1:04:13

  i'm sorry i definitely want to write no conjugation and i don't think clearance or anything you know

  1:04:21

  that that those specifics make you more on the hook or not relax all you're i think the pre-op clearance

  1:04:28

  really is what the provider is at like what the surgeon is asking for the surgery he may be asking for it's not asking you

  1:04:34

  to say like this patient is not going to die they get to certainly like that's not their expertise is that

  1:04:40

  you just do whatever it is that we ask you to do to make sure that we're protected and we have a good idea and i think sometimes people

  1:04:46

  underestimate the power of those documents because the anesthesiologist really is the person who takes

  1:04:52

  consideration some of that information for themselves and how they're going to manage the patient you know you don't put that the patient

  1:04:58

  has sleep apnea yeah yeah oh yes that they are not on their machine

  1:05:04

  and they're not taking it seriously and they're not you know that's good it's important very important for an

  1:05:11

  anesthesiologist or nurse necessity to um take into consideration when they're

  1:05:16

  putting someone to sleep right so um like that's what it really is it's like making sure you're putting enough

  1:05:22

  information for the next provider totally and then i think like the clinical because i can hear the

  1:05:27

  questions of like the clinical questions like your decision like there's that is a separate topic i think for mps to dig into is

  1:05:34

  like having the conversations about the risk benefits and deciding if it's appropriate like that's a separate conversation

  1:05:39

  we're mostly talking about like once you've had that conversation what you're documenting and all that stuff i don't think it's

  1:05:44

  really up to you when the primary provider to decide if it's appropriate it's up to the surgeon yeah

  1:05:50

  are risky and then like yeah you've had five open heart surgeries and you have all these

  1:05:55

  stunts but and you have a high risk of getting blood flow right but if you don't fix your aneurysm you're gonna die tomorrow

  1:06:01

  right you as a provider may say this patient may not be ready to be cleared but the surgeon may

  1:06:07

  say you know it may have reasons as to why they want to move forward right right so yes like i yeah

  1:06:14

  definitely both but it's like i don't think that you guys should take on so much right because the risk that comes out of

  1:06:21

  it i feel like there's very rarely been instances where the pre-appearance is why someone

  1:06:27

  gets sued yeah they never really go back to that like even the surgery

  1:06:32

  yeah if yeah the surgeries that i've seen have been really big payouts or really big

  1:06:37

  cases um it never really boils down to the pre-op to the primary provider

  1:06:43

  is what the surgical team did or didn't do and never what they took into consideration usually has to do with the outcome so

  1:06:49

  was the surgeon actually capable of you know well-trained or had

  1:06:54

  the resources or whatever to do the surgery that they did and was the outcome a part of the risk that were explained

  1:07:01

  to the patient right right right right that's right i think that that is usually what happens

  1:07:07

  when i've seen the ugliest cases it's usually like the surgeon did something egregious

  1:07:13

  are cleared or not it was not the primary care providers

  1:07:18

  you know problem and i think like it's hard to to go far that far back for an attorney

  1:07:24

  like yeah i think people think that people are looking for people to sue no i know so many

  1:07:30

  attorneys who will turn down a case in a second like they're like i'm not doing that like it's too like

  1:07:35

  because it's costly to try to go after and find out the right information to review the because

  1:07:43

  you don't get paid unless they get paid so unless it's a straight shot it's very rare that an attorney is

  1:07:49

  going to invest the time and the money to go after a primary provider in a situation with a surgeon

  1:07:54

  who has more coverage we have more practice insurance we cover our hospital right right we don't want

  1:08:01

  the primary care provider right so i think when you think about it like that not to say you should completely relax about it

  1:08:07

  but i think you should take into consideration that like people aren't gonna backtrack that far and try to put some type of

  1:08:13

  blame on you because then it's gonna be like okay i said that they were cleared they hadn't

  1:08:19

  really worked like that yeah yeah it doesn't it it rarely ever works it goes that far back

  1:08:25

  totally um well should we wrap up yeah oh though i think

  1:08:31

  someone was asking a little bit about fraud oh yeah i want to talk about like fraud i do some things on instagram

  Office of the Inspector General

  1:08:37

  talking about fraud yes the office of the inspector general puts out a report every

  1:08:42

  day pretty much but you can go to the office of the inspector general which is the feds

  1:08:48

  basically and look at the cases that they're going like the people who they're either indicting or

  1:08:53

  sending to jail or i'm like so nosy that's like serious they're so good and so funny

  1:09:00

  people are i've seen some of your posts we were like alright girl how did you think you were going to get a kickback

  1:09:06

  oh come on a hot mess so and fun like so but literally it's the

  1:09:14

  same thing happening over and over like people are doing crazy things and like

  1:09:20

  someone is now looking for the money and trying to account for that and now all of a sudden their whole plan is exposed

  1:09:25

  so if you have questions about fraud that's a good place to start because the feds are way more aggressive than the states when

  1:09:32

  it comes to fraud um but the beds are aggressive so yeah

  1:09:37

  they do not play they don't play if it's a if they review 100 charts and two charts

  1:09:42

  show that they overbuild they're going to take that whatever that percentage is in times at times

  1:09:47

  all of your patience oh my past year and you're gonna pay for that money back oh my

  1:09:54

  so this applies to me too oh definitely about over billing is like we can have a

  1:10:00

  whole conversation about building yes usually in the hospitals that's what really happens um

  1:10:06

  and then in this conversation we talked a little bit about um decreasing liability and mitigating

  1:10:13

  risk um but i'm working on something to really educate people on how to do that because i think that is a

  1:10:20

  it's what you what we're kind of talking about today people want to know like how can i prevent this from happening

  1:10:26

  and i think that most people are doing the right things i think most providers are doing the

  1:10:32

  right thing yeah you know i think in six years maybe six thousand nurses and nurse

  1:10:38

  practitioners have lost their license like and there are thousands and thousands

  1:10:43

  you know so it's like and usually the reasons why people lose their license it's because they did something really

  1:10:49

  egregious like kill somebody or you know drunk driving like it's you

  1:10:55

  it's never usually like i forgot to document it it is never that small

  1:11:00

  it is usually like a pattern of bad behavior yeah um or

  1:11:06

  people thinking that they're getting away with something and they're not so i do hope that this conversation gives

  1:11:12

  people an ability to relax a little bit and be the provider that you dreamed of yeah i think if you get back to that

  1:11:18

  like i when i began respecting i wanted to be this person be that person yeah and then all the other issues and

  1:11:24

  the things that you have and the skills that you're learning as a new nurse practitioner as even as an experienced nurse practitioner because things change

  1:11:30

  every single day and you're always learning something new will come with time and you'll become better at it and more proficient at it

  1:11:37

  and if you take the pressure off of yourself i think you can be really become a better provider because you can see people for who they

  1:11:44

  are and not just the disease that they have totally totally thank you so

  1:11:49

  much for being here i this is just so wonderful um do you want to tell people where um

  1:11:56

  where they can find you and yeah um on instagram facebook twitter linkedin

  1:12:03

  pinterest don't go pinterest because i'm a little but i'm your nurse lawyer on

  1:12:09

  everywhere awesome you can reach out to me on instagram if you have any other questions following up with this

  1:12:14

  if you listen to the podcast um i can of course always send people resources and things

  1:12:20

  like other referrals um i help people find other attorneys that need specifically

  1:12:26

  so you can reach out to me and i definitely will get back to you and then on my instagram page all my contact

  1:12:31

  information is there but yes i'm your nurse lawyer and i hope to really build a better

  1:12:38

  health care system for healthcare providers where they have a little bit more information than they know about these legal aspects so that they

  1:12:44

  can be more comfortable with doing what it is that they do best totally i'm so so excited for everything

  1:12:50

  you have coming up and all that education coming i can't wait so thank you so much again

  1:12:56

  i so appreciate it

  1:13:07

  [Music] you

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