Beyond the Bedside: The Hidden Legal Landscape of Nursing
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.
Transcript
Speaker 1: 0:01
This podcast is for educational purposes only, does not constitute legal advice and does not create an attorney-client relationship. If you need legal assistance about a legal problem, contact an attorney. Welcome back to Know your Regulator. The podcast that inspires you to engage. I am your host, simone Murphy, and today we’re looking at some of the biggest blind spots that nurses have when it comes to legal exposure what the Board of Nursing sees that you might not, and we’ll take a look at one court case that changed everything. I’m joined by CEO and founder of Advocates for Nurses, maggie Ortiz, msnrn, with what every nurse should hear Texas is one of the states that does require jurisprudence to hold a license.
Speaker 2: 0:42
Only two states do New Mexico and Texas. We’re drowning in medical terminology and care plans and we don’t see ourself and I’m liberally speaking. You know for a large, you know 5 million of us, but as a rule, we’re not criminals, we’re not going to do anything wrong. Therefore, we memorize what we need to know for the test as it pertains to those rules and regulations, but we’re not criminals. I need to know where the bones in the ear, I need to know the muscles when I’m drowning in these acronyms, but I’m not. I’m not a criminal, I’m not going to do anything unethically. So therefore, they don’t understand the rules and regulations.
Speaker 1: 1:20
So let’s break down what the board actually expects you to know.
Speaker 2: 1:24
What should nurses know? And I’m going to broaden it out a little bit, not just Texas, but I’m going to talk about every nurse in the United States or anyone who holds a professional license. There is going to be roughly three sections that every entity that gives someone the privilege to practice is going to have in their basic rules and regulations. Standards of practice that’s pretty obvious, right? That will give you the guidance whether you’re an RN, an LP, an MD, an NP, pt, insert, whatever letters you are the guidance right Under your standards of practice. Unprofessional conduct it’s going to list out what is some things that unprofessional conduct. You’re going to look at that as well. That should be a basic guide and then grounds for discipline. Those are three sections that anyone who holds a professional license, even if you’re a real estate agent or whatever you are every entity is going to list those things out.
Speaker 1: 2:22
One Texas court case redefined how boards evaluate nurse conduct. Here’s how Maggie explains it.
Speaker 2: 2:28
Then you hit on another thing policy. So 1514 in the state of Texas, which is a position statement different than a rule and a regulation. And again, her and I understand this stuff but we’re going to explain a little bit more for you because we’re in kind of this legal space as a legal nurse and you know you as this amazing legal project manager. But those are the things that you have to understand. 1514 passed in 1983 as Lunsford versus the Board of Nursing, where it does say that and I’m going to quote my license supersedes a hospital policy or physician order.
Speaker 2: 3:08
So if there’s a policy written but it doesn’t align with evidence-based science, it doesn’t align with standards of care, maybe it’s outdated you cannot stand on the principle as a nurse that the policy said that. No, your license always supersedes everything and people forget that. For instance, let’s just say you’re in a position and you’re in that position because you’re a nurse If your license or discipline or that license removed from you, you know what, you’re not any longer a nurse. Yeah, now I have a master’s degree in nursing, but I am no longer allowed to use nurse or allowed to write the two letters RN behind my name, because who’s afforded me the ability to do that, the board of nursing so that policy that I stood my ground on didn’t align with evidence-based science or rules or regulations. So I think that we’re pointing out as well that this can all get very tricky.
Speaker 1: 4:11
You can get the ombudsman involved. And I mean we’re talking there could be criminal charges, insurance sometimes. If you’re, you know, messing with insurance if insurance catches wind, you better bet they want to save money. They’ll come after you. You know there’s just a lot of different ways that things could go and they’ll come after you. You know there’s just a lot of different ways that things could go and they’ll all be happening at the same time. Don’t think it’ll be one right after 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: 4:44
happened? How did all these four letter agencies get into my life? Because all of a sudden you’re getting letters, and it’s not just from the board of nursing and I’m just using the board of nursing loosely because we’re talking about our state. But insert any state. If you come to this state and let’s just say that you have five other licenses, you and I know what that looks like. You come to this state and something happens here. You get reported to this board of Nursing. Those other boards could come after you. Let’s just say, for example, a medical record is open.
Speaker 2: 5:13
Let’s just say, an LPN does an admission assessment I know this is deviating just a hair away from this other thing, but I think it’s important to point this out which is not within their scope of practice because that falls under a comprehensive assessment. And in Texas, which is not within their scope of practice because that falls under a comprehensive assessment and that in Texas that is very well spelled out, state it is. And then the RN has signed off on that and the LPN. I personally have seen where that has risen to criminal conduct because it’s not within the scope of practice reported to CMS because it was an LPN who generated it in a long-term care facility. Rn signed off on that and then it did rise to the level of criminal conduct because then CMS got involved and was charging something insane like $5,000 worth of charges.
Speaker 1: 6:05
What are some other, maybe not so obvious things that nurses should be aware of?
Speaker 2: 6:11
So I’m going to plug myself just for a minute. I do offer a charting course. What you do or do not document is a big deal and if you don’t document it, you know, then it gets harder to validate. You know what was done. Now, obviously, with the growing you know staffing ratio, issues with us push to, you know, taking on more unsafe assignments. Of course we do the care first. No one’s asking you to chart in real time. That’s not a reality. What I’m saying is making sure that you’re advocating for yourself and you’re not taking on an unsafe assignment.
Speaker 2: 6:47
What does that look like in Texas? I’m going to say 217.11.1.S is the person making that assignment which I don’t feel is safe, and then T me accepting that assignment. Are you asking me to violate the 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 these tools 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 these three sections and then give me some guidance. I’m an LPN. Can I administer blood? Can I do some of these things I may be able to do in Alabama state over, but now I’m coming to Texas. Can I do that? So you utilize?
Speaker 1: 7:31
these tools. Don’t wait until you’re under investigation to learn what actually protects you. Visit our links below and explore Maggie’s advocacy resources, the Texas Board of Nursing Guidelines and more. Be sure to follow along with Know your Regulator. Like share. Subscribe Until next time. Continue engaging with your regulatory agency. Know.
Speaker 2: 7:51
Your Regulator. The podcast that inspires you to engage.