Beyond the Bedside: The Hidden Legal Landscape of Nursing

Legal exposure remains one of the most significant yet overlooked aspects of nursing practice. While nurses excel at memorizing complex medical terminology and interventions, many remain dangerously uninformed about the regulations governing their licenses until it's too late.

Maggie Ortiz, MSN, RN, CEO and founder of Advocates for Nurses, joins us to unpack this critical knowledge gap. She explains why nurses often develop a dangerous mindset: "We're not criminals, so we won't do anything wrong" – leading many to merely memorize regulatory requirements for exams without truly understanding their implications. This approach creates significant blind spots that can devastate careers when nurses encounter real-world ethical dilemmas or policy conflicts.

The conversation reveals how a single 1983 Texas court case (Lunsford v. Board of Nursing) fundamentally changed nursing practice by establishing that a nurse's license supersedes hospital policies and physician orders. This means nurses cannot defend themselves by simply stating they followed policy if that policy contradicts evidence-based practice or current standards. The podcast also explores how seemingly minor documentation issues or scope of practice violations can rapidly escalate across multiple agencies, potentially involving criminal charges, insurance fraud investigations, and board actions across multiple states simultaneously.

Whether you practice in Texas or elsewhere, understanding the three fundamental sections of nursing regulation – standards of practice, unprofessional conduct definitions, and grounds for discipline – is essential for protecting your career. Learn how to use documentation as a defensive tool, properly refuse unsafe assignments, and leverage resources (including AI) to simplify complex regulations before you face an investigation. Don't wait until you're under scrutiny to understand what protects your license and livelihood.

Get more information, details and resources on Know Your Regulator - https://www.belolaw.com/know-your-regulator

Episode Transcript

Speaker 1 (00:01):
This podcast is for educational purposes only, does
not constitute legal advice anddoes not create an
attorney-client relationship.
If you need legal assistanceabout a legal problem, contact
an attorney.
Welcome back to Know yourRegulator.
The podcast that inspires youto engage.
I am your host, simone Murphy,and today we're looking at some
of the biggest blind spots thatnurses have when it comes to

(00:21):
legal exposure what the Board ofNursing sees that you might not
, and we'll take a look at onecourt case that changed
everything.
I'm joined by CEO and founderof Advocates for Nurses, maggie
Ortiz, msnrn, with what everynurse should hear Texas is one
of the states that does requirejurisprudence to hold a license.

Speaker 2 (00:42):
Only two states do New Mexico and Texas.
We're drowning in medicalterminology and care plans and
we don't see ourself and I'mliberally speaking.
You know for a large, you know5 million of us, but as a rule,
we're not criminals, we're notgoing to do anything wrong.
Therefore, we memorize what weneed to know for the test as it

(01:03):
pertains to those rules andregulations, but we're not
criminals.
I need to know where the bonesin the ear, I need to know the
muscles when I'm drowning inthese acronyms, but I'm not.
I'm not a criminal, I'm notgoing to do anything unethically
.
So therefore, they don'tunderstand the rules and
regulations.

Speaker 1 (01:20):
So let's break down what the board actually expects
you to know.

Speaker 2 (01:24):
What should nurses know?
And I'm going to broaden it outa little bit, not just Texas,
but I'm going to talk aboutevery nurse in the United States
or anyone who holds aprofessional license.
There is going to be roughlythree sections that every entity
that gives someone theprivilege to practice is going
to have in their basic rules andregulations.
Standards of practice that'spretty obvious, right?

(01:46):
That will give you the guidancewhether you're an RN, an LP, an
MD, an NP, pt, insert, whateverletters you are the guidance
right Under your standards ofpractice.
Unprofessional conduct it'sgoing to list out what is some
things that unprofessionalconduct.
You're going to look at that aswell.

(02:07):
That should be a basic guideand then grounds for discipline.
Those are three sections thatanyone who holds a professional
license, even if you're a realestate agent or whatever you are
every entity is going to listthose things out.

Speaker 1 (02:22):
One Texas court case redefined how boards evaluate
nurse conduct.
Here's how Maggie explains it.

Speaker 2 (02:28):
Then you hit on another thing policy.
So 1514 in the state of Texas,which is a position statement
different than a rule and aregulation.
And again, her and I understandthis stuff but we're going to
explain a little bit more foryou because we're in kind of
this legal space as a legalnurse and you know you as this

(02:49):
amazing legal project manager.
But those are the things thatyou have to understand.
1514 passed in 1983 as Lunsfordversus the Board of Nursing,
where it does say that and I'mgoing to quote my license
supersedes a hospital policy orphysician order.
So if there's a policy writtenbut it doesn't align with

(03:12):
evidence-based science, itdoesn't align with standards of
care, maybe it's outdated youcannot stand on the principle as
a nurse that the policy saidthat.
No, your license alwayssupersedes everything and people
forget that.
For instance, let's just sayyou're in a position and you're

(03:34):
in that position because you'rea nurse If your license or
discipline or that licenseremoved from you, you know what,
you're not any longer a nurse.
Yeah, now I have a master'sdegree in nursing, but I am no
longer allowed to use nurse orallowed to write the two letters
RN behind my name, becausewho's afforded me the ability to

(03:57):
do that, the board of nursingso that policy that I stood my
ground on didn't align withevidence-based science or rules
or regulations.
So I think that we're pointingout as well that this can all
get very tricky.

Speaker 1 (04:11):
You can get the ombudsman involved.
And I mean we're talking therecould be criminal charges,
insurance sometimes.
If you're, you know, messingwith insurance if insurance
catches wind, you better betthey want to save money.
They'll come after you.
You know there's just a lot ofdifferent ways that things could
go and they'll come after you.
You know there's just a lot ofdifferent ways that things could
go and they'll all be happeningat the same time.

(04:34):
Don't think it'll be one rightafter another.
You'll be out money.
You'll be searching for lawyers.
You'll be calling Maggie saying, hey, what can I do?
What?
Just?

Speaker 2 (04:44):
happened?
How did all these four letteragencies get into my life?
Because all of a sudden you'regetting letters, and it's not
just from the board of nursingand I'm just using the board of
nursing loosely because we'retalking about our state.
But insert any state.
If you come to this state andlet's just say that you have
five other licenses, you and Iknow what that looks like.
You come to this state andsomething happens here.

(05:06):
You get reported to this boardof Nursing.
Those other boards could comeafter you.
Let's just say, for example, amedical record is open.
Let's just say, an LPN does anadmission assessment I know this
is deviating just a hair awayfrom this other thing, but I
think it's important to pointthis out which is not within

(05:28):
their scope of practice becausethat falls under a comprehensive
assessment.
And in Texas, which is notwithin their scope of practice
because that falls under acomprehensive assessment and
that in Texas that is very wellspelled out, state it is.
And then the RN has signed offon that and the LPN.
I personally have seen wherethat has risen to criminal
conduct because it's not withinthe scope of practice reported
to CMS because it was an LPN whogenerated it in a long-term

(05:52):
care facility.
Rn signed off on that and thenit did rise to the level of
criminal conduct because thenCMS got involved and was
charging something insane like$5,000 worth of charges.

Speaker 1 (06:05):
What are some other, maybe not so obvious things that
nurses should be aware of?

Speaker 2 (06:11):
So I'm going to plug myself just for a minute.
I do offer a charting course.
What you do or do not documentis a big deal and if you don't
document it, you know, then itgets harder to validate.
You know what was done.
Now, obviously, with thegrowing you know staffing ratio,
issues with us push to, youknow, taking on more unsafe

(06:35):
assignments.
Of course we do the care first.
No one's asking you to chart inreal time.
That's not a reality.
What I'm saying is making surethat you're advocating for
yourself and you're not takingon an unsafe assignment.
What does that look like inTexas?
I'm going to say 217.11.1.S isthe person making that
assignment which I don't feel issafe, and then T me accepting

(06:58):
that assignment.
Are you asking me to violatethe Nurse Practice Act?
There's a tool I just gave you.
Knowing the Nurse Practice Act,our state is very specific.
But use AI or some of thesetools to dumb it down for you
and just say hey, I'm in Texas,I'm going to be coming to Texas,
I'm taking an assignment there.
Dumb it down for me under thesethree sections and then give me

(07:20):
some guidance.
I'm an LPN.
Can I administer blood?
Can I do some of these things Imay be able to do in Alabama
state over, but now I'm comingto Texas.
Can I do that?
So you utilize?

Speaker 1 (07:31):
these tools.
Don't wait until you're underinvestigation to learn what
actually protects you.
Visit our links below andexplore Maggie's advocacy
resources, the Texas Board ofNursing Guidelines and more.
Be sure to follow along withKnow your Regulator.
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Subscribe Until next time.
Continue engaging with yourregulatory agency.
Know.

Speaker 2 (07:51):
Your Regulator.
The podcast that inspires youto engage.