In every proceeding before the Texas Board of Nursing (BON), the first thing that you need to remember is to get the assistance of a nurse attorney. At this point, it is important to note that exercising your right to legal counsel will be beneficial on your part. Keep in mind that even if a nurse attorney does not represent you, the proceeding or hearing of your case will continue. When this happens, there is a high probability that you will eventually lose in the case.

An RN was employed as a Labor and Delivery Nurse at a hospital in San Angelo, Texas, and had NUre been in that position for two (2) months.

It was on or about April 10, 2017, through April 11, 2017, while employed as a Labor and Delivery Nurse and caring for a patient, a high-risk preterm patient with twin gestation, the RN failed to monitor the mother and fetuses, including intermittent fetal heart monitoring, for five (5) hours. The RN’s conduct could have exposed the patients to a risk of harm from potentially adverse complications of undetected and untreated changes in fetal heart tone.

And on or about April 10, 2017, through April 11, 2017, the RN failed to document hourly assessments of blood pressure, pulse, respiratory rate, oxygen saturation, and deep tendon reflexes for the patient, a high-risk preterm patient with twin gestation, as required during the administration of magnesium sulfate. Additionally, the RN failed to completely document fetal heart tone assessments that were completed, in that heart rate variability, accelerations, and decelerations were not included in the documentation with the fetal heart rate baseline. The RN’s conduct resulted in an incomplete medical record and could have exposed the patients to a risk of harm in that subsequent caregivers would not have accurate and complete information on which to base their care decisions.

In regards to the incident, the RN states that this issue is an orientation issue, rather than a competency issue. The RN states that she performed a shift assessment on the patient and conducted hourly assessments. The RN states that she expected the patient to be on continuous fetal monitoring, but there were no parameters given by the doctor. The RN states that she later told the Director of Nursing that she expected “intermittent” to mean every 4-6 hours, but she was not given any parameters for this. The RN states that she auscultated the heart tones, which was difficult since they were 27-week twins, but she neglected to change the time in the computer properly, resulting in a discrepancy between time charter and time assessed.

In addition, the RN states that she pushed a button on the monitor to discontinue fetal monitoring, but thought it would continue to take the mother’s vital signs. The RN states that the patient was on magnesium, but she did not have pre-eclampsia, so she did not look for blood pressures until morning. The RN states that she did check deep tendon reflexes and respirations every hour. The RN states that she could have made corrections to the documentation the following day, but she was not allowed to. The RN states no specific orientation was provided, even after she requested, regarding how to document the care of the patient on a magnesium infusion in the computer documentation system used by the facility. The RN states on the night of the incident, although still on orientation, no preceptor was available to her and since the charge nurse had several patients, she was not available to assist with documentation questions. The RN states she was assigned five additional patients to care for that night. The RN states no adverse outcome occurred nor was the patient’s plan of care changed by the physician.

Therefore, as a result, the Texas Board of Nursing then decided to subject the RN and her license to disciplinary actions. The said discipline shall ensure the safety of the patient, along with a better future for the RN’s career. However, she should have contacted a nurse attorney in order to receive assistance regarding the case, especially if the RN sincerely thinks of it as an accusation.
For more details or for a confidential consultation regarding accusations, it’s best to contact an experienced nurse attorney. Nurse Attorney Yong J. An is an experienced nurse attorney who has helped RNs and LVNs defend against several cases since 2006. You can call him at (832) 428-5679 to get started or to inquire for more information regarding nursing license case defenses.