Licensed to Advocate: Texas Nurses, Unions, and Knowing the Law

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 to Know your Regulator, the podcast that inspires you to engage. I am your host, Simone Murphy, and co-hosting with me today is the Director of Legal Services at Bertolino Law Firm, Troy Bollier. Hey, Troy.

Speaker 2: 0:26

Hi Simone. Looking forward to our conversation today. I think we have a real meaningful episode where we’re going to talk about nurses and how you can engage in union activity but also stay compliant and aligned with the obligations. You know the rules and the laws from the Texas Board of Nursing, so really excited to have our guests here today.

Speaker 1: 0:51

Yes, absolutely. We both know there is a ton of value in nurses knowing and understanding the rules that govern them, but beyond that, it is so important that nurses know and understand their rights. We’re thrilled to be joined by two brilliant nurses who bring real world expertise in union leadership and advocacy. I’m very pleased to welcome Jessica Walford and Lindsay Spinney. Thanks for joining us today, y’all. Yeah, we’re excited. Yeah, thanks for having us. Absolutely, we’re really glad to have you. Thanks for being here. So, troy, before we dive in, can you kind of set the stage for our listeners? What exactly does the Texas Board of Nursing regulate?

Speaker 2: 1:34

Yeah, absolutely so. The Texas Board of Nursing is the statewide regulatory body that licenses and regulates anyone who’s acting as a nurse in Texas. Right, you have to have a license from the Board of Nursing to engage in nursing activity, otherwise it’s unlicensed activity. That’s a danger to the public, right? So nurses have to go to school, they have to meet certain minimum requirements and go through an application process where they demonstrate that they’re qualified, including completing an exam, any required coursework demonstrating that they have the right degree and that kind of thing. So that’s one big public protection aspect of the board.

Speaker 2: 2:19

The other aspect is the enforcement kind of regulatory process. Right, they’re the ones if there is a complaint, if there is a concern about a breach of the standard of care that nurses have to uphold, that the public can file a complaint with the board and they’ll investigate it and determine whether there were any violations and if there is any action that needs to be taken to protect the public. I mean, sometimes it’s just a matter of maybe action that needs to be taken to protect the public. I mean, sometimes it’s just a matter of maybe a nurse needs to brush up on some training about certain aspects of care. Other times there could be more serious allegations involving ethics or deliberate misconduct, but those are the two primary functions of the board is to make sure that the right people are licensed, that people that are competent and have the training, skills and knowledge, and then, as they go forward, they maintain those minimum standards when they’re caring for patients and if there is a problem, there’s a process to address it.

Speaker 1: 3:18

Thank you, Troy, for that wonderful explanation. Now let’s kind of get back to how that fits in to union involvement, because we know that those responsibilities don’t take a backseat when nurses advocate for change. So, Jessica, I’d like to start with you. Can you walk us through what union participation looks like in the nursing profession?

Speaker 3: 3:47

So it kind of goes along. I mean, everything that we do is still within the Board of Nursing regulations. You still do your job, your job is still first. Your job doesn’t change. It’s really just communicating and talking to your peers about unions, because, especially here in Texas, about unions, because especially here in Texas most nurses have have no experience with unions. I did, I do from previous jobs, previous states that I’ve worked in, so communicating with them about that was a big part of it. And you just vote, you vote and you support your union really and it’s.

Speaker 3: 4:23

It’s pretty separate from your job. You still do your job, just like you would before, just like you would as a non-union nurse. You’re just advocating for yourself and for your patients to have safe staffing ratios, things like that yeah, so kind of just making sure that you’re educated and involved with your union.

Speaker 2: 4:46

Yeah.

Speaker 1: 4:47

Makes sense and, lindsay, as nurses are organizing and they’re advocating, what types of regulatory awareness or trainings do you think are really helpful?

Speaker 4: 4:58

So in my experience, the union really educated me a lot at the beginning and then I educated myself. Unfortunately, there’s not a lot out there. There’s nothing from the board of nursing. The board of nursing is to protect the public, and then to all of the things that Troy already went over. But you know, from my perspective, that’s kind of what they’re there for and the unions do, and the labor movement in general, I think in this particular case, is there to protect nurses but also protect and advocate for patients. So there’s a lot of education that comes from them past practice, there’s legal education in some areas, but it’s also it’s very important and it’s stressed from the very beginning when you start talking about this, that first and foremost, you protect your license, which means doing your job as a nurse and hearing to all the things, so practicing within scope and things like that. But I think that’s part of the movement and why it’s happening right now is people are really wanting to have more of a voice and trying to seek out ways to do that.

Speaker 1: 6:20

And even in Texas, where it’s so rare having access to unions and to really crucial just overall and kind of doing your research, making sure that you’re involved and you know if you see something kind of reading up on that or going a little bit further than just what’s presented at face value, that makes sense. Yeah, and it’s kind of a bummer that there’s not a lot of you know of education out there. I think, like you said, that’s probably a big reason for the movement and hopefully we can see some of that come about in the future. What are some of the biggest challenges that y’all are seeing with nurses? When the union activities are kind of intersecting with regulations, are you seeing a lot of challenges or is it kind of pretty straightforward being unionized and still being under those governing rules?

Speaker 3: 7:11

It’s it’s pretty easy to still be under your scope of practice and be because that’s what the union supports. So to help supposed to help support you to do that even better by having ratios and stuff. I think one of the biggest like roadblocks is the lack of knowledge and the false information that you get from the hospitals and from management.

Speaker 1: 7:37

I’ve heard that before and or just really kind of lie to you about what what the rules really are, and sometimes have their policy govern what the board of nursing says, and obviously that can be really frustrating and confusing, especially to those younger nurses. And you know, are there any, are there any tips that you guys would have to kind of navigate? Something like that.

Speaker 4: 8:02

I think communication is key and it’s the word that I’ll keep coming back to honestly in this entire podcast, because I do think that that’s key. I think what Jessica is saying is true. I’ve witnessed it. I think that it’s really confusing to nurses when you have other nurses lying to them.

Speaker 4: 8:23

A lot of times there are nurses that are in management and so they have whatever priorities or agenda or policies that they need to push from the people that are above them and it’s a there’s it supports like a culture of fear, which, in my opinion, should never even exist in healthcare, because this is a you like, see something, you say something, where all our patients come first, all of that.

Speaker 4: 8:48

So there shouldn’t be any fear, in my opinion, in the field. I just don’t think there’s room for it. So I understand that the hospital is a business and has to function and support itself and things like that. I do think that there’s a way to do both to have good health care and to also stay afloat as a hospital. I just think that we have to take the power back as nurses. I mean, we are a huge part of the hospital functioning and I think we just need a culture change. I think that’s what we’re seeing right now is new generation people with different views coming in and taking it upon themselves to educate themselves. Nursing, know, nursing in general, I think, is a field that’s ever evolving. Healthcare is ever evolving and so, by default, our rights and our practice and stuff is also ever evolving, so it just requires us to stay educated, keep communicating and take the initiative upon ourselves communicating and take the initiative upon ourselves.

Speaker 2: 9:57

You know, to amplify off of what Lindsay and Jessica are saying, there are legal provisions in Texas law.

Speaker 2: 10:01

It’s, you know, it’s chapter 301 of the Texas Occupations Code is the chapter in state law that governs the Board of Nursing, and they do have safe harbor provisions.

Speaker 2: 10:11

They do have provisions and they’re spelled out also in the board’s rules where nurses can, when they see something unsafe, when they’re concerned about inadequate staffing or lack of training such that they don’t think they’re qualified to do something, they can go to management, go to management and they can say hey, I have this concern, I need to notify you that I think this is unsafe and it’s going to expose the patient to risk. So the law in that sense is supportive, I think is consistent with a lot of the union’s goals in making sure that nurses are meeting that primary duty of patient care. And so there’s ways to do that. I think that’s the real key is, people need more education and knowledge about hey, what’s the safe harbor process? How do I make that written notice? How do I follow through on that process if it needs peer review committee to look at it? But there’s a process for that so that nurses don’t just feel like they’re kind of alone at sea and don’t have any resources or any help when a difficult situation comes up.

Speaker 3: 11:20

Sure, that is a good thing that we have that we can do, but I can speak on that from personal experience. The first hospital I worked at, I thought that we were doing that every shift. We were supposedly calling safe harbor and it never actually. It was never actually happening, first off. Second off, I, at the hospital that I work at now, I called safe harbor about a year ago.

Speaker 3: 11:47

It’s very difficult to do. You are very pressured into not doing it and almost almost like they’re trying to. The manager came to me and was like, are you sure you want to do this? Basically like threatening me and I said yeah, I do want to do this because I’m not scared of doing it, but it’s a scary thing to do, especially for new nurses who don’t necessarily know what a unit should look like and how a unit should run. And it’s education, like you’re saying, knowing how to do it, because it’s not easy to do, especially when you have a full load of patients that you have to be taking care of as well, and it’s a scary thing. You have to be brave.

Speaker 4: 12:32

I think it’s a in practice it’s like it’s. It’s great that that exists, that that law is there and explicit. I think in practice it’s very different. I would be hard pressed to find very many nurses that were able to successfully call safe harbor, put the paperwork through, do everything and have it actually go through. You know, being on monthly meetings at the hospital you’ll hear Safe Harbor was called on this floor at this time and it wasn’t processed because something wasn’t filled out right, the chain of command wasn’t followed exactly.

Speaker 4: 13:12

The burden is very high on the nurse. It’s a time-consuming process, it’s fairly tedious and, like Jessica said, my experience as well. I’ve not personally called Safe Harbor but I’ve been present and supported that on my unit and there was immediate pressure and questioning and it’s it is sort of threatening, it’s more of a bullying kind of thing. It’s a cultural situation where, honestly, the again it’s a chain of command thing and you know the manager of the unit doesn’t want safe Harbor to be on their record. The nurse soup, the house soup, doesn’t want it on their record with the company. So in in practicing it’s really difficult.

Speaker 2: 14:00

I completely agree with what you guys are saying and I think that’s where the union’s role, with advocacy and education and training, is so important because, just like Jessica said, it’s a scary thing to have to tell somebody in a position of authority respectfully, I can’t do this, I’m not allowed to do this. Let me explain to you why and let me document it properly. Because, like you said, one I is not dotted or one T is not crossed and it can create issues where it’s not a valid invocation.

Speaker 1: 14:32

It really speaks to that kind of culture shift, that or this, like it’s systemic, a valid invocation, and it really speaks to that kind of culture shift, that or this, like it’s systemic. Now, you know, and it’s the. There’s so much pressure and pushback that you know, not to mention while y’all are on the floor, like treating patients in real time, there’s so much pushback that, yeah, I mean, if you don’t know your rights, you don’t know how to safely advocate for yourself, that you could just say okay and you know, and then nothing ever becomes of it.

Speaker 2: 15:03

Well, and Simone, that’s what I was going to say. You know, to Jessica and Lindsay’s point if somebody feels that pressure and kind of backs off and says, well, I’m just going to go do this, then they run that risk of did I do something that was unprofessional conduct, did I violate that standard of care, and maybe something bad happens, and then they do get reported. So it’s a really challenging, difficult dynamic and I really appreciate both of y’all for being advocates and trying to get the word out and educate people, because that’s really what it’s all about.

Speaker 1: 15:39

We’ve kind of touched on this already throughout the episode briefly, but what kind of support do you think is the most important for nurses to understand their regulatory landscape? I’m thinking probably union involvement and just.

Speaker 4: 15:57

Yeah, I think that’s definitely a go-to for me at this point. But I also, you know, I will say, in nursing school you get very little in the state of Texas some hearings, but they were all disciplinary hearings and they were for very different things. But it wasn’t like patient neglect, it wasn’t things that we’re talking about today. It was very specific individual nurses and implications for their license. But I think the board of nursing, from my perspective, is a little bit of a scary topic for people because it feels like they’re only there if something bad happens to you as a nurse. It doesn’t feel like an approachable entity. And I’ll be very transparent that this is the first professional license that I’ve personally had, so I don’t know what what other entities are like. But you know all that we got in nursing school was here’s the Nursing Practice Act, which is about, I want to say, like 65 pages. It’s pretty complex language in some areas. Learn it, abide by it, go on with your life, kind of thing. And you know we apply for a license and then we renew with our CEs and go about our business and for a lot of people, until you’re put in a situation you don’t revisit it.

Speaker 4: 17:32

I feel pretty confident in saying that it’s not an easy document to read. It’s hard sometimes to see how it applies specifically, like if you’re in a hospital, certain things just don’t apply or maybe not relevant. So I think it’s something that you know people again are going to have to go educate themselves on, and I would recommend doing that because you don’t want to be in the position of waiting until something happens so you can go to the Board of Nursing website and look at the Practice Act periodically. It changes every few years, they update things but it’s definitely about educating yourself and I also think, on top of the Nursing Practice Act, just being really aware of what your scope of practice is. That’s also something on the Board of Nursing website.

Speaker 4: 18:19

I think it’s really easy in this current climate, with things like short staffing but just in general, like the progress that health care is making and then all of the documentation and the technology, I think it’s really easy to get into something called like scope creep and to do things that are like they seem okay and this you know, somebody of authority is asking you to do this or telling you it’s okay, or you’re seeing other people do it. I think it’s just really important. That’s a very short, like one pager. I think that’s a very easy thing to you know. At minimum, when you’re you know, like once a year kind of thing, part of your CEs for yourself would be to kind of look at these documents and at least familiarize yourself to some degree.

Speaker 1: 19:04

Yeah, that’s fantastic advice, absolutely.

Speaker 2: 19:07

Simone. To Lindsay’s point, not just the Nurse Practices Act but the board rules too. The board does a ton of explaining what the law means, filling in the gaps in the statute. There’s a whole host of obligations and requirements that are not even in the statute, that are in the board’s rules. So definitely education is a big part of that.

Speaker 1: 19:31

And I know that nurses are crazy busy. So that’s why we’ve, you know, got know your regulator. We can, you know, kind of put that in layman’s terms for you to better understand the rules and regulations that you know you’re bound to. Well, this has been a really great conversation, guys. Thank you very much for joining us and giving us this insight and knowledge into how nurses can really protect themselves and advocate for safe assignments and, you know, just doing better overall in the industry.

Speaker 2: 20:04

Yeah, thanks for having me. Yeah, definitely, the more you know your regulatory boundaries, I think, the more powerfully you can advocate, and I really appreciate both of y’all coming on the podcast and, you know, talking about these important, challenging things that I think are going to be at the forefront of issues that nurses are dealing with over the next several years.

Speaker 3: 20:23

Yeah, of course, I hope to see it get better. I hope to see more unions and stronger unions in Texas, similar to California, which is my favorite place to work so far.

Speaker 1: 20:34

Well, that’s awesome. Yes, I hope we can kind of see that bureaucracy go out the window, especially with the safe harbor. I mean, that’s just insane. You’ve got to run it up the chain and by the time it gets there, is it even you know? Is that even still applicable? So well, a big thanks to our lovely guests and thank you so much to our listeners. Stay engaged with your regulatory board, connected in your workplace, and if you need help find professionals who understand both sides of the coin, be sure to subscribe to Know your Regulator and check out our resources in the description below. Until next time, stay inspired and continue engaging with your regulatory agency. Know your Regulator the podcast that inspires you to engage.