When Standards of Care Are Breached with Ashley Hughes
The Legal Side of Nursing
Ashley Hughes has been a Legal Nurse Consultant for several years and is back this season to talk about implications when standards of care have been breached. She will share tips on documentation and how to learn more about standards of care. Ashley also discusses how this impacts travel nurses, and how to become familiar with the state or facility that they are working in. Don’t miss out on this very informative episode!
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About Ashley
Ashley Hughes has over 13 years of nursing experience in various ICU specialities, Nursing Management, and Emergency Room. She very well knows the navigations of the healthcare system and the various medical standards of care. During her years of nursing experience, she obtained her Legal Nurse Consultant Certification through the American Society of Legal Nurse Consultants (ASLNC) in May 2016, and since then has been practicing as a Legal Nurse Consultant and Nurse Expert Witness.
Ashley certifications includes the American Society of Legal Nurse Consultants (ASLNC), Critical Care Registered Nurse (CCRN), Trauma Nurse Core Course (TNCC), Basic Life Support (BLS), and Advanced Cardiac Life Support (ACLS). As an instructor she teaches as needed for Trauma Nursing Core Course (TNCC) and Basic Life Support (BLS).
Ashley is now utilizing her knowledge and experience to assist attorneys and their clients with any case involving health, illness, or injury for the plaintiff or defense. She also currently has a Legal Nurse Consulting Mentorship where she trains and mentors her fellow nurses to use their nursing expertise as a Legal Nurse Consultant. Ashley also helps Nurse Business owners to develop policies and procedures for their nursing business.
She is thankful to her Lord and Saviour Jesus Christ to have the opportunity to fill in the gap between the medical and legal worlds through legal nurse consulting.
Links
- True Vine Legal
- Ashley on LinkedIn and Instagram
- If you would like to schedule an appointment with Ashley, click on this link
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Narrator:
Welcome to Don't Eat Your Young: A Nursing Podcast, with your host Beth Quaas.
Before we get started, we have a few quick notes. Don't Eat Your Young is a listener-supported podcast. To learn more about becoming a member and the perks available to you for becoming a patron yourself, visit patreon.com/donteatyouryoung. You can learn more about the show, share your story to join Beth as a guest or connect with our wonderful community in our Facebook group. You can find all those links and more at donteatyouryoung.com.
And now, on with the show.
Beth Quaas:
Welcome to Don't Eat Your Young. I'm your host, Beth Quaas. I am excited again to have Ashley Hughes here. We had her here last season, and she just has so much information to share. I am very grateful that she's able to come back.
How are you, Ashley?
Ashley Hughes:
Oh, I am blessed. I give honor to my Lord Savior Jesus, and I'm glad to be here, especially, I think the last time I was with you, it was before the pandemic. So, it's a blessing to be here, and talking with you, and being in great health.
Beth Quaas:
So, last time we talked a little bit about your role as a legal nurse consultant.
Ashley Hughes:
Yes.
Beth Quaas:
Today, we're going to kind of talk a little bit more about legal implications for nurses' standards of care. Why don't you talk a little bit about that?
Ashley Hughes:
As you know, again, I'm a legal nurse consultant. I've been doing it for about six years, and I've been an RN going on about 14 years. Well, going on 15 years. This will make the 14th year. Wow! Time just flies, right?
So, there's a lot of standards of care that nurses need to make sure that they're adhering to in the healthcare system. As a legal nurse consultant, whenever there's a medical case that attorneys are being consulted on, either they're defending the plaintiff, which is the patient who's complaining that harm was done to, or they're defending the healthcare system, or the hospital, or whatever system. So, they're either representing the defense or the plaintiff.
And it's really important that nurses are making sure that they're adhering to the nursing standards of care so that they will not find themselves having to be subpoenaed to come and have to testify in a medical case due to something that they did wrong, which we call a breach in the standard of care.
Beth Quaas:
And do you think most nurses know what those standards are, and what they should be adhering to?
Ashley Hughes:
I think some nurses do, more of your seasoned nurses and some of the new grads, depending on your training and your education. And I think some nurses sometimes may not know what those breaches in the standards of care are, that they may be doing. So, yes. To answer your question, I don't think some nurses know.
Beth Quaas:
And without, of course, talking about any real cases that you've been involved in, what examples could you give us of maybe a breach of a standard of care?
Ashley Hughes:
So, a breach in a nurse's standard of care would be, for instance, not putting fall interventions in place. So, as nurses, we are supposed to do fall risk assessments when patients get admitted to the hospital, when there's a change in condition, and doing a fall risk every shift. And also, you need to be looking at your hospital policy in regards to your assessments as well with the fall risk.
However, a breach would be not doing a fall risk assessment, so you can see if your patient's a low-, moderate-, or high-risk fall, and then failing to put those interventions in place. And what happens is, what if the patient falls, and then there's injury that has occurred due to the fall, and you didn't put those fall interventions in place? You didn't do that fall risk assessment. So, that is a breach right there.
Beth Quaas:
So, not only is it putting the interventions in place, it's documenting what you've done, and what you should be doing. Correct?
Ashley Hughes:
Right. So, it's the assessment part, the fall assessment, putting the interventions in place, and then also the documentation.
Another breach in care that is going on in the legal arena is failing to notify the MD or the nurse practitioner or the PA, the mid-level provider, when there's a change in status with the patient. A lot of that is going on. And what happens is, over time, when something happens to the patient and you go back and you look at everything, there should have been notifications to the mid-level provider of what was going on the patient that could have prevented the patient from worsening to a worsening condition.
Also, mid-level communication is another breach in the standard of care that nurses seem to sometimes miss because sometimes, I think, nurses may think, "Oh, well. It's not a big deal." Sometimes they may think it's a little thing, something that doesn't warrant the mid-level provider's notification. But, as nurses, whenever there's a change in status with the patient, we are supposed to be notifying that mid-level about that change in status.
Beth Quaas:
So, if there's a code going on, and of course, there's providers there that are helping, but not every time, can we leave the patient to let someone know there's a change in status? Is there a hard timeframe that needs to be adhered to?
Ashley Hughes:
Well, yes. I mean, with that, if you ever have to go to court or anything like that, they're going to ask what would a reasonable nurse do? What, in that situation... Or if it's the MD or a mid-level provider, what would that provider, mid-level provider, nurse do? And what would a reasonable, whatever their discipline is... What would be reasonable? What would they do in that situation?
We know that if it's a stat notification, if it's something that needs to be done stat, then we know that needs to be done at least within an hour, no more than an hour. And if it's routine, sometimes you have a little bit more leeway with that. However, it's what a reasonable, prudent nurse would do in that situation.
So, it's different types of variables that weigh in on that. And then also, say for instance, the doctor is in a code and you need to notify them about a patient. That doctor is supposed to have a mid-level provider or someone else that they can also notify as well. So, they're responsible for that too.
So, it's different variables with that, but definitely notifying the MD, even if it's a abnormal vital sign or any change, and the nurse may think, "Oh, that's a little change. I don't think I need to warrant the mid-level provider with that or the MD." And it's like, no, you need to do that because that's a change in status because what the nurse doesn't see is that days later that patient's work condition has worsened, and maybe another nurse thought the same thing you thought, or maybe didn't even report it at all.
And so, what happens is, in a medical litigation case, they look at the whole story, the whole picture. And so, you definitely want to make sure that you are assessing correctly, making sure you're putting the right interventions in place, making sure you're notifying the MD, the nurse practitioner, the mid-level provider, the appropriate disciplines. If it's the surgeon, whoever it is, making sure you notify them in a timely manner that they're supposed to be notified. And always, always make sure you're documenting, because we all know the old saying, if you did not document it, you did not do it.
Beth Quaas:
Right. We've all heard that.
Ashley Hughes:
We've all heard it.
Beth Quaas:
Who sets those standards? Is it the organization? Is the Board of Nursing? Is it the unit policy?
Ashley Hughes:
That's a really good question. So, the standards of care, it just... So, if you work in critical care, there are standards of care with the American Association of Critical Care Nurses, policies or standards of care. Just it depends on what specialty that you are in. There are different standards of care with associations and whatever specialty you are in. If it's oncology, if it's med surg, if you're a emergency room nurse, there's the ENA. So, there's all these different standards of care out there.
And then also, just like you mentioned, the Board of Nursing. That's like your Bible, what you can do and what you can't do as a nurse. And then also, policies. And I think what's going on now... Well, I'll say this. As nurses, we should make sure we know our policies in the hospital. And sometimes, I think that that may get a little lackadaisical with not looking at policies because it's so much going on. And now, we've just been through a pandemic and there is a lot of stress variables out there that nurses are having to confront. Well, I like to say challenges. And you just need to be making sure you're updating with your policies, making sure you're aware of it.
And every nurse... I want to say this. Every nurse should definitely know where to go to look up policies. If you do not know where to go to look up your policies for your hospital, you're at a disadvantage. We're not expecting you to know all the policies. We can't know all the policies. But you are expected to make sure you know where to look for these policies, and make sure you follow them out.
Beth Quaas:
So, that brings me to a totally different point, kind of. So, right now in nursing, we have nurses going everywhere. Travel nursing is blowing up right now, and nurses working in states they haven't worked before, and units and facilities. And what are we doing about that? They can't learn all of that in a moment's notice.
Ashley Hughes:
You know what, Beth? You hear so many things. I hear so many things, and see some things. New grads are even starting out in the travel world after a year of experience. And I think that's quite interesting because I know when I was coming on as a new grad, for you to travel at that time, you had to have at least... They wanted at least three solid good years of nursing experience before you could travel.
But now, new grads can travel in a year's time. And it's just a lot of... I call it compromising. It's a lot of compromising going on, to me, in the travel world. I know I saw in a post somewhere on social media where someone put that they work in a skilled nursing facility, and they want to get a job traveling, and go into med surg. And they've never had med surg experience. And they're looking for a travel agency that will put them in a med surg setting. And I'm like, "Oh, my gosh. Like that is... That's dangerous for your patients.
Beth Quaas:
Right. Not that they're not good nurses but, when you're a traveler, you don't usually get much of an orientation to that unit.
Ashley Hughes:
Right. They expect for you to be experienced, ready to go, fill in the need, and not have challenges.
Beth Quaas:
I've worked in facilities, a shift here or there, helping out, and you don't know where everything is. And my experience helped me with that. But I can't imagine having someone come states away, no support.
We had a travel nurse on the show in the first season, Emily Mazurak. And she was a PICU and she loved it. And she did a great job and learned a lot. But she said the support wasn't always there, depending on-
Ashley Hughes:
Yeah.
Beth Quaas:
... which unit she was in. So, if you're new and you don't know anyone, and now you don't have the support maybe of other staff, because there's a lot of contention right now.
Ashley Hughes:
Yes.
Beth Quaas:
Between the nurses in hospitals working and those coming in as travelers and the pay differential.
Ashley Hughes:
Yes. That's going to be interesting to see how that weighs out because you have the staff nurses versus the travel nurses, the travel nurses versus the staff nurses. And the staff nurses feel like they are not... which they're not... getting adequate pay like the travelers. And some of them are saying, "Hey, I might as well do local travel. I might as well make the sacrifice and travel far because someone's working beside me, and is making three times more as me. And I'm only making bare minimum." And they feel like it's unfair.
And some of the hospital systems, they're not able to accommodate and pay them as well. And so, it creates this tension, like you said. And then, the travelers, they're just there to help fill in the need. They're not to blame because someone wants to pay them three times as much. So, it's creating this type of atmosphere, and it's going to be interesting to see how it's going to be played out. I wouldn't be surprised, going forward, we may see later that the normal may be a nurse has to be contracted through a agency to work in the hospital. Because, right now, working as a staff nurse is not popular right now.
Beth Quaas:
It is not. And the sad thing is, those nurses that have been at those institutions have created teamwork, and they know their providers,, and they know who to call when. And so, it's very sad that they feel slighted. But I totally understand why they would because of their loyalty. Yet, like you said, the travelers come in, and they're just filling a need, and they're not doing anything that many other people wouldn't do. So, how do you see us getting beyond this?
Ashley Hughes:
Right. Yes. It's going to be interesting to see. I don't know what the solution is with it, but a solution I do... I do believe this. There is a solution. I don't know exactly what that is. However, I do know that they... I believe that the healthcare systems need to figure out a fair way to pay all of the nurses because if they don't, it's going to create trusting issues. Because, right now, nurses feel like their loyalty is not being compensated.
Beth Quaas:
Correct.
Ashley Hughes:
And so, loyalty is not being compensated. And then, these nurses have families. They have lives, and everybody wants to be compensated fair across the board. Everybody does.
Now, I did hear... One nurse was telling me that a friend of hers somewhere up North somewhere, she's a nurse. One of the hospitals actually offered like 20,000 or 30,000 for the staff to stay. And there was some type of contract that they had to submit to or commit to. Now, I think that's good. Offer them something. You might as well keep your own staff because when I used to be a nurse in management, if you lose one person after all that orientation, and putting your time in, one person is like six figures.
Beth Quaas:
I've heard that as well.
Ashley Hughes:
Yes! And so, it's like, think about all these nurses that have left. I really don't know how the hospitals are handling this. And then, on top of that, I know that I have heard speculations from other providers or whatnot that they think that... It's speculation. Is this affecting the healthcare bills with the patients that are coming in? Are they seeing higher than normal bills, as before?
Beth Quaas:
And are they seeing poorer outcomes?
Ashley Hughes:
Right. Yeah, that's another thing, because quality... I've always said quality is better than quantity. You can have the quantity but, at the end of the day, if you don't have the quality, you're not going to get the good results. And you're going to have to invest in quality. You're going to have to compensate for quality. That's always been how I thought about it. So, it's definitely going to be interesting to see. However, I do think nurses should be compensated. We do a lot. When we're there in the hospital working as a nurse, we're not only doing the nursing part, you're coordinating things, you're case management, you're security, you wear many hats. You're the counselor. You're just wearing many hats.
Beth Quaas:
And it's only gotten more since the pandemic. We were the ones going into the rooms, and we were the ones gowning and gloving and all of our PPE. And so, I agree that it's gotten even more work for the same amount of time. We aren't given more time. We're not given more hands. And so, compensation is one way to help with that. And retention bonuses are one way. The pizza party has gone by the wayside. There is no more that you can get from a pizza party. It's not helping.
Ashley Hughes:
Pizza parties are not fixing it. They would offer us food, and they would get reps to come in and give us food, the pharmaceutical representatives. That is not in anymore. Right now, nurses are asking about the compensation, the money part. And so, that's what's in right now.
Beth Quaas:
And it's not that they're asking for anything over the top. They didn't set the rates that travel nurses are getting. They didn't set those rates. The hospitals are setting those rates, and the travel agencies are setting those rates. But the people out there working that aren't traveling deserve increased compensation as well. It's high time.
Ashley Hughes:
It's our time, right? It's the time, time to set. I mean, because if you work 13 weeks... I mean, I don't know how to get your email and I'm sure you got emails too. I don't know how they get all of our emails, the travel agencies, and phone numbers. Maybe they buy some databases or whatever may be, but they have these 13-week assignments for like $50,000 you can accumulate, or 60,000 in 13 weeks. And so, nurses look at that and they're like, "Hey, I've heard a lot of nurses that they paid off their student loan debt because they've been waiting..." Some of them have been waiting on the current administration to relieve those debts, and that hasn't happened at this time. I've heard they paid off student loans, they have paid off their car loans. They've used that money to get a house paid off, their spouse loans.
So, they have plans with this money. So, you really can't blame them. In a way, they're paying off their debts. So, they have to do what's best for them. But I do agree, there needs to be a solution where the staff nurses are getting paid as well. It needs to be fair across the board.
Beth Quaas:
I agree.
Ashley Hughes:
It just needs to be fair. And then, the new grads that are coming in... When me and you came in, we knew what the normal was in the healthcare system. However, new grads, they came in through the pandemic time. And that was their normal, you know.
Beth Quaas:
Right.
Ashley Hughes:
Seeing that, and experiencing that, they don't even know what it's like to nurse yet without a pandemic.
Beth Quaas:
Right. Absolutely. And they think they kind of got... They didn't get the training that they deserved either for what they paid-
Ashley Hughes:
Right.
Beth Quaas:
... for that education.
Ashley Hughes:
Right. So, preferably, the numbers will continue to go down, and things like that. And they'll get to see that normal. However, it's quite interesting. And with all what we're talking about, and it's said and done, at the end of the day, the person who is going to get affected is the patient and the hospital.
Beth Quaas:
Absolutely. And it will be interesting to see. And you will be one of the first to see it.
Ashley Hughes:
Yeah.
Beth Quaas:
If there are more lawsuits because of poor outcomes.
Ashley Hughes:
Poor outcomes, yes. And the thing about it is if they can prove there are damages or injuries to the standard of care being breached, that's going to go to court.
Unfortunately, some of these cases end up where the patient died. And I see those cases, and they call them wrongful death cases. And it's unfortunate. Sometimes you're going through the case, the medical records, and you're like, "Oh. Oh, my." You're looking at it from the outside in, and you're like, "Oh, wow. This could have been prevented." But it wasn't prevented and, unfortunately, the person has now died or has this major complication.
So, I believe we definitely need to make sure healthcare systems invest in quality, making sure education is still going on. And, at the end of the day, you have to invest the money.
Beth Quaas:
Right. And I see part of the problem. Some organizations have a lot of money and some don't, and I'm afraid now where the money is, where it's at. And so, those patients in smaller facilities, in rural organizations, and skilled nursing facilities, I hope we don't see the care suffer in those areas.
Ashley Hughes:
Right. And then, another thing too, it's going to be interesting to see if the government gets involved with this. Because, in Texas, I did hear that the governor there, he did prevent the nurses there that live in Texas from traveling within Texas. So, if you reside in Texas, you can't travel, you can't do local travel, you can't travel far within Texas. The governor has prevented them from doing that. So...
Beth Quaas:
I don't even know how to feel about that. Is that fair?
Ashley Hughes:
That's the question. But I'm wondering, is he looking at it from a standpoint of they are short of nurses? And so, he's making a executive decision.
Beth Quaas:
Right.
Ashley Hughes:
But on the same token, you have nurses on the other end that would like to be compensated for the care that they're giving, just like the traveler coming in. So, that's why I said there needs to be a solution to this.
And then, sometimes, when you see one state do something, other states like to tackle onto it, and then it becomes a state-regulated thing. Or end up, could be a federal regulation.
And so, that's something to think about.
Beth Quaas:
Absolutely. So, what I say to anyone out there listening, nurses out there listening, let's find our own solution. Let's not let someone outside of our profession make our decisions. Let's set our worth and let everyone know where it should be. So, we all kind of need to step up now and start this conversation, and come up with our own solutions.
Ashley Hughes:
Yes, because we're valuable. We've learned. Sometimes, at the end of the day, I don't think people that may not know, or be well-versed to help here know, everything that a nurse does.
Beth Quaas:
I agree.
Ashley Hughes:
And for years, nurses have, to me, been underpaid for... We go above and beyond our job because we're dealing with a person, and it's more than a paycheck. And so it... I don't see anything wrong with being compensated and appreciated because the nurses are what... They are what, I guess you call it, the rudder in the ship that helps drive the healthcare organization. If you don't have any nurses, you have no healthcare organization if you have no nurses.
Beth Quaas:
I agree. Well, Ashley, I so love this conversation. I think you're well-versed in what people need to do, what they need to look out for. And we're not choosing sides on-
Ashley Hughes:
Right.
Beth Quaas:
... this conversation. We talked about it before. We're just out there talking about it. And travel nurses are important, and nurses that are staying in their loyal organizations are important. And so, we just believe that everyone, like you said, Ashley, should be fairly compensated across the board.
Ashley Hughes:
Yes, yes. There's a solution to it, and it's going to be interesting to see. And, as they said, there's a nursing shortage. They've been telling us that for years. And, at this time, we need more nurses, people to go to nursing school. However, we're taking in all these nurses in the nursing school to prepare them to come out later. But the thing is, we need to make sure they get the proper training and education so they can be successful and provide great patient care.
And I will add this. I saw a article, and I just shared in a group that I'm in. It's called Legal Nurses of Justice. Somewhere in China, they have this robotic nurse that provides care to the patient. And I saw that, and I said, "Oh, my gosh. Like, is that what the wave is they're trying to create here is robotic nurses?"
And so, I think, as nurses, we need to wake up to what's going on because... And then, on another hand, I heard this too. They're wanting the hospital systems have... There's talks about it. I don't know how true it is, but I have heard this from other nurses. And this is something that's been voiced in social media groups and things like that, that they're wanting to bring in nurses from foreign countries to come over and fill in the needs here in the United States. And to me, standard of care is just screaming because... And I'm not saying those nurses can't give good quality of care, but here in the United States, we have different standards of care than the standards of care in foreign countries. And so, you have to operate... As a nurse in this country, you need to know what those standards of care are. And just filling in the needs, the quantity, and not providing that quality is dangerous because it's going to affect the patient.
So, those two things right there, the robotic nurse, and then bringing in foreign nurses to the United States without them having to go through any type of training like we did, you know that... Those are red flags.
Beth Quaas:
I agree. And I think the information that you share, like you said, everyone needs to get out there and do your research and find out what's going on because there's a lot going on that we need to stand up if we feel strongly about it.
I very much appreciate your time, Ashley. It was great to have you back again this season. And I'm sure this isn't the last we've heard of you.
You're also developing a course, or you're out teaching nurses now, how to become legal nurse consultants. Is that correct? You're still working on that?
Ashley Hughes:
Yeah. So, I do offer a legal nurse consultant mentorship for nurses who are interested in getting into legal nurse consulting. It's so many pathways that you can do with that. You can work in a firm. If you still want to be on the job, you can open up your own independent, legal nurse consultant business. And also, you could be a nurse expert as well and testify, if need be, in a medical case.
And, as nurses, I just feel like every nurse... And maybe I may be a little biased because I'm in legal nurse consulting. But I think every nurse, whether you're a nurse, nurse practitioner, CRNA, whatever your discipline is, LPNs because they have a lot of experience with nursing home and rehabilitation. Every nurse can use their expertise in the legal arena. And attorneys, whether defense or plaintiff, are looking for you.
And so, I do. That's one of my passions is helping nurses discover, use their expertise and start their legal nurse consultant business, or if they want to be a nurse expert witness, or if they want to work in a firm, whatever it may be. I do have a mentorship.
If anybody is interested, you can email me at info@truevinelegal.com. And you can reach out to me that way. I'm also on LinkedIn too, and some different platforms. So, I would be glad to introduce and help you navigate whatever pathway that you would like to go in.
Beth Quaas:
Thank you, Ashley. And all of her contact info will be in the show notes so you can find out how to reach her.
Ashley, thank you so much, and good luck to you.
Ashley Hughes:
Oh, thank you, and blessings to you. And I know this will not be the last. We'll be talking again.
Beth Quaas:
Absolutely. Thanks, Ashley.
Ashley Hughes:
Thank you.
Speaker 4:
(singing).
Narrator:
Don't Eat Your Young was produced in partnership with True Story FM. Engineering by Andy Nelson. Music by the Light Hearts.
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Speaker 4:
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