Patients as FaceBook friends?

By Attorney Michael J. Sacopulos and Dr. Erik P. Southard DNP, FNP-BC

Social media

Q: My patient sent me a friend request on Facebook.  I did not respond to
the request. She then sent me a private message on Facebook. I don’t want her
to think I am being rude. How should I respond?

A: Good question. Since the advent of social media, more and more medical
professionals like yourself have been faced with this question.  According to a survey published in 2011 in the Journal of General Internal Medicine, 68 percent of nurses as well as 94 percent of medical students, 79 percent of residents and 42 percent of practicing physicians reported some use of online social networks, nearly all for personal reasons.

Among healthcare professionals, 35 percent said they had received a “friend” request from a patient or family member— and 58 percent of those who had
received those “friend” requests said they always rejected them.

While it may not be necessary to reject your patient, in 2011 The American
Medical Association’s Council on Ethical and Judicial Affairs published guidelines
suggesting medical professionals need to “maintain appropriate boundaries of the patient relationship” online and to consider separating professional and personal content online.

The most proactive way to avoid liability is to never friend a patient on Facebook. As hard as this may be, it opens up a whole new can of worms by allowing them into your personal life. From the moment you click accept they now have the capability to pass judgment on you. Their opinions can change how they view you in the your healthcare facility, which in turn could bring matters up during litigation.

A way many healthcare facilities combat this issue is to create a “fan” page. When a patient requests your friendship on Facebook, you simply direct them to your employer’s “fan” page. While a “fan” page is not as personal as connecting via your Facebook account, it does maintain professional boundaries.  Further, it helps avoid issues on electronic communications with patients. These issues trigger federal laws such as the HITECH Act which you want to avoid. One final thought… remember to check if your employer has a social media policy. Social
media policies are becoming increasingly common place and often directly address questions like yours.


Dr. Erik P. Southard DNP, FNP-BC is the President and CEO of Southard & Associates L.L.C. Erik, Director of the Doctor of Nursing Practice Program and Assistant Professor in the Department of Advanced Practice Nursing at Indiana State University, enjoys teaching and serving his Alma mater. He continues to work as a family nurse practitioner treating patients of all ages for acute and chronic health conditions.  He is a proud graduate of Vincennes University, Indiana State University and Johns Hopkins University. He is an avid outdoors-man

and loves spending time with his family.

A dirty little secret

A nurse may enter a room six times during a shift for med pass, accuchecks, vitals, meals, incontinent care and a dressing change. It would require the nurse to wash her hands upon entering and exiting the room each time.  The procedure should take about 90 seconds to complete as touted by most in-service teaching. That would be a grand total of 18 minutes per shift for one patient. It seems rather innocent until you crunch the numbers.

The devil is in the details. No matter what you do you are causing risk and harm to yourself as well. If you were to wash your hands over 400 times during an eight hours shift, not only would your hands be extremely raw but those very abrasions you would obtain from such frequent hand washing with cheap caustic soap and rough paper towels will increase your chance of infection getting into your body.

However if you do not wash your hands as required you risk cross contamination to your patients, and possible loss of employment.
Here is how it all works out.

You can use an alcohol-based hand sanitizer, but you need to be aware it doesn’t kill C. difficile. This product is less drying and hand washing.  However, you can’t use this all the time.  There needs to be a balance.

The most important thing to remember is to clean your hands.  The goal is 40 to 60 seconds with soap and water, 20 to 30 seconds with hand sanitizer.

Nurse supervisor gets legal advice on dealing with thieving nurses

By Attorney Michael J. Sacopulos and Dr. Erik P. Southard DNP, FNP-BC

Q: I am a supervisory
nurse who works at a plastic
surgeon’s office. We
recently had another nurse
take a list of 70 patients
from our office to an interview
with a competing dermatologist.
What should I
A: This is an issue that seems to
come up at least three or four times
a year. Why so many nurses feel the
need to steal patient charts from a
former employer is beyond me. If
the nurses in question did not learn
that thievery was wrong as children,
they certainly would have learned
about the consequences of their actions
in nursing school.
Regardless, as a supervisory nurse,
you cannot assume that employees
and new hires are fully aware of
policies governing the appropriate
handling of protected health information.
To safeguard the practice
against future legal liability supervisory
nurses need to be proactive.
Practice policies and procedures
must be written to include a process
that clearly communicates the office’s
commitment to patient confidentiality.


All employees must be required to participate
in standardized HIPAA training upon

their hire and on an annual basis in perpetuity.
The training should include information about
what constitutes protected health information,
each individual employee’s legal obligation to
protect sensitive information as well as, the
possible criminal, civil, and professional repercussions
for failing to uphold the confidentiality
standards. Completion of the training
should be marked with a form which spells out
the employee’s responsibilities and documents
the employee’s signed, dated and witnessed
promise to uphold the standards.
The practice also needs to look at state and
federal laws to formulate a plan for how to
handle even the smallest unauthorized release
of protected health information. These simple
steps will likely prevent the practice and its
employees from the following potential outcomes:
1) A HIPAA violation has occurred because
medical records have been taken out of
the practice (presumably for distribution
to another physician/practice). This may
trigger breach notification requirements,
which can be costly. The nurse can legally
be held responsible for reimbursing
these expenses.
2) The taking of the charts is conversion
in every state law I am aware of. Conversion
is the unauthorized use or control of
someone else’s property and is a criminal
act. Most states allow for three times the
value of the property, attorney fees, and
related costs necessary for the recovery.
Nurses or other healthcare professionals
found guilty of conversion
can be made to pay through the nose for their

Is it Legal?

3) The event clearly should be reported
to the state nursing board for discipline
to prevent this from happening
to patients in the future. The nurses’
licenses could be in jeopardy for this
behavior. Bear in mind that threatening
to turn the nurses in to gain a persuasive
advantage could be viewed as
4) Next, the dermatologist/new employer
may have liability. The plastic
surgeon has a “contractual relationship”
with these patients. Contacting
these patients in an effort to solicit
them could be viewed as an interference
with established contractual relationships.
Further, the patient information
(names, addresses, conditions,
etc.) in many states could be considered
a trade secret/proprietary to the
plastic surgeon. This means the plastic
surgeon could legally force the return
of the information from either
(or both) the dermatologist or the RN.
This is a long way of saying that the
dermatologist/new employer has potential
liability here.

The next steps for you, as the
supervisory nurse, would be to
suggest to your employer that
1) Send a certified letter (to prove
receipt and establish the seriousness
of the matter) to the nurse or nurses
involved. The letter should require
the a) immediate return of all patient
charts; and b) require an affidavit from
the RN describing whom she has shown
the charts to (hopefully no one). This
will help determine obligations under
2) Send a certified letter to the
dermatologist threatening legal action if
the information/charts are not returned.
Further, the contacting of any patient
would be a HIPAA violation which will
be reported. This will, undoubtedly, get
the dermatologist/new employer to read

the Riot Act to his/her new RN.

the President and CEO of Southard & Associates
L.L.C. He is also the Director of
the Doctor of Nursing Practice Program
and Assistant Professor in the Department
of Advanced Practice Nursing at Indiana
State University and he continues to work as
a family nurse practitioner. He is a graduate
of Vincennes University, Indiana State
University and Johns Hopkins University


Attorney Michael J. Sacopulos is the CEO of Medical Risk Institute
(MRI) a firm formed exclusively to provide proactive counsel to the
healthcare community. He is a member of the Indiana Defense Lawyers
Association as well as several other legal associations and was honored
in 2009 and 2010 as a Best Lawyer in America for Corporate Law.

Not enough sleep?

Get Some Sleep

How does Lack of sleep affect nurses?  It can adversely affect their job performance.    Nurses who are fatigued are more likely to lack energy, and  develop apathy.  Nurses can communicate less effectively or difficulty concentrating when not sleeping adequately.

Lack of sleep slows your reaction time, and hinders memory recall.  It can affect psycho-motor coordination.

A lack of appropriate sleep can lead to near misses in regard to patient care and also poor job perforce.  Resiliency, skill, accuracy, and appropriate sleep are a few important functions in nursing.

So, develop a bed time routine.  Make sure you get an appropriate amount of sleep and allow yourself enough time in the morning to easily manage all of your morning chores.


Mandatory overtime

By Attorney Michael J. Sacopulos and Dr. Erik P. Southard DNP, FNP-BC

Q: We can call in sick up to three hours before our shift. I woke up sick last

I became weak with cold symptoms and past the magic three hours, so I went to work. It was an exhausting shift. I could hardly think straight and my replacement nurse did not show up.

The scheduler said that no per diem nurse will come in for this shift. My supervisor said I will be fired for job abandonment if I went home. I had to work another eight hours. I was really concerned I was not giving proper care.
Who would be liable, if I made a mistake? Does just stating that I don’t feel capable of doing another shift enough to protect me?

A:  While your situation is unfortunate, it is not shocking. We hear of nurses forced to work overtime with some regularity. Your questions need to be examined on two fronts; the duties to your employer and the duties to your patients.  Federal Law states that more than 40 hours per week is considered overtime. Federal Law does not specify hours per day or shifts in a row, but
simply looks at a 40 hour work week. However, many states have specific laws that relate to the number of hours worked in a day. Your question does not specify where you live so we recommend you check with a local attorney.
We can tell you that 16 states have statues and regulations specifically addressing overtime requirements for nurses. How many hours one can work and compensation rates vary by state.  Your questions seem to get at the heart of the
matter. As a nurse you have both legal and ethical duties to your patients. We can tell you that both could be liable if you make a mistake while treating a patient. Your actions will be judged by the normal standard of care for a nurse performing the duties in question. The standard of care does not factor in how tired or overworked you were at the time.

You owe both a legal and ethical duty to your patient to provide quality care. Those duties do not change because a supervisor requests you work a
double shift.  We point out that a number of states have specific regulations that address this topic. Further, the American Association of Critical-Care Nurses
offers some assistance on this topic. While every situation is different, as a general rule we advise that the downside risks of working beyond what you feel is safe are far greater than negative employment consequences. Be safe and thanks for the question.

The President and CEO of Southard & Associates L.L.C. Erik, Director of the Doctor of Nursing Practice Program and Assistant Professor in the Department of Advanced Practice Nursing at Indiana State University, enjoys teaching and serving his alma mater. He continues to work as a family nurse practitioner treating patients of all ages for acute and chronic health conditions.  He is a proud graduate of Vincennes University, Indiana State University and Johns Hopkins University. He is an avid outdoors man and loves spending time with his
family. Erik resides in Terre Haute, IN with his wife Rebekah and daughter Breanna.

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Nursing Assessment

Nursing Assessment

Every patient is assessed by an nurse upon admission. This nursing assessment will cover every system of the body. This is the first time your loved ones wishes and history are recorded.

There are two parts to the  nursing assessment.  If an LPN is deemed competent by the RN the LPN can do the one part. This assessment will cover every system of your body.  Depending upon your nurses experience and time allotted, your assessment can either be thorough or hurried and incomplete.   Every RN has to have their first job, and your family may very well be one of their first patients. In college the RN will likely have clinical experience in a hospital, but that’s not true in every college. They may be receiving training from the LPN.

This the first time your wishes are heard and your history recorded.  It is important to get the nursing assessment done correctly if you should ever go to court over your care. Your care plan will be made upon the information in your assessment. A family may request a copy in writing, but most likely will only be allowed to read certain parts of it with a RN or LPN watching. The facility will most likely tell you they are there to help explain medical jargon; however it is so you don’t take pictures or remove parts of the chart. The nursing home may make copies of only the parts they are willing to let you see.

Depending upon your specific illness or problems, the nursing assessment should take at least 2 hours. It may take more for instance if you have several wounds to measure and dress, or a long cardiac history.  Based upon the assessment the nurse may ask the doctor for more lab work, scans or x-rays



Body Systems and the Nursing Assessment:


Your nurse should listen to your heart with a stethoscope.  If you brought cardiac strips, or EKG’s, showing their heart rhythm, they should be attached to your chart at this time.  You will be asked about your cardiac history, medicines and pain.


Your nurse will listen to your lungs.  Your 02 saturation, which shows how well your body is using the oxygen you are breathing in, will be taken as well.  Your respiratory history and medicine list will be written down, including notations about any shortness of breath and pain you are experiencing.


You may be given a mini mental exam and a neurological test.  You will be asked about your memory, any dizziness and headaches.  Caution:  you may be categorized on your whole visit based on this one set of questions.  It is a big deal, especially if you are not in your peak condition when this assessment is taking place.  While it is necessary to have this done on admission, you may want to request a reassessment later to get a truer picture of who you really are.


Categorization means how the nursing population will think about you. It will not be written down, however passed on between nurses. They may say, this one is a drug seeker, or has a history of beating his wife. These things can make a difference in how the nurses view and treat a person.


This assessment includes your abdomen and bowel status.  Your diet will be discussed, including food preferences and allergies.  Your nurse will listen to four areas of your abdomen, and to your bowel sounds which may vary in pitch and intensity.  Your nurse will ask about your stool habits.


You will be asked about pain and any problems.   You may be asked to give a urine sample.


Your entire body should be checked.  Wounds will be inspected and measured, scars noted as well.


These areas will be inspected and any questions should be asked in a respectful manner.  Be sure to be candid about infection and discharges.


Your gait and balance will be inspected.  Be sure to discuss pain or weakness so a plan can be put in place to strengthen you.  In fact, this should be a main focus for any facility.  Tell your nurse of any history of falls.

Pain Control

Does your doctor know where you hurt?  Here are some tips which will help you communicate more effectively with your physician about pain control.
Types of Pain:
Short-term (accidents and surgery)
Long-term (cancer)
Chronic (back pain)
Ways to treat pain
Tens Unit


How to talk about your pain so your doctor will understand:

  • Be specific about where you feel your pain
  • Describe the feeling: sharp, dull, burning, throbbing, steady, intermittent
  • How severe is it on scale of 1-10
  • How often do you experience it
  • How does it restrict your life
  • What you have done to relieve the pain
  • Is there anything which makes the pain appear or worsen

Know your PRN or medicines that you can request if the need arises. Don’t allow your pain to get out of control because you think you can handle it. It then takes more medicine and more time to bring severe pain back under control.




Response to working the holidays

By Kathleen S. Martin, M.S.W, L.C.S.W

Kathy Martin does individual, marriage and family psychotherapy in Palm Beach
Gardens, FL. Her new book God and Psychobabble is available where books are
sold. Have


Thank you friend for your question concerning working nights, weekends and holidays.  OUCH!!!!  Who among us wants those shifts!  No one.  One of the problems we have however is that certain jobs must be covered on weekends, holidays etc.  What ever would we do without a police force on duty over Christmas?  I suspect all honest people would have their Christmas presents stolen!  And what about all those drunk drivers and car accidents over the holidays especially New Year’s Eve?  Ambulances off duty?  Hospitals closed?  Nurses and doctors home for the holidays?

Now the number one common denominator for all depression is unrealistic expectations.  What that tells me is that perhaps you entered the nursing field with such unrealistic expectations.  Anotherwards, you chose a field of work that clearly required these undesirable work shifts.  But now you are fully trained and employed as a nurse.  Did you unrealistically think the rules of the game were suddenly going to change?  Of course they weren’t going to change therefore the only change that needs to occur is with you, with what goes on between those earlobes of yours.  🙂

First of all realize

you have chosen

a profession that is of utmost importance hence it is hardly a nine to five job.  It is a job with deep purpose and commitment.  Patients and families of your patients you’ve worked with REMEMBER you for your sacrifice, compassion and work ethic.  That’s a gift given to very few professions.  When I see a former client whose marriage

has been restored or whose depression has been lifted due in part to my efforts, that truly goes a long way in working past the late calls or interrupted family functions.  Take time to meditate on what you HAVE, on the many benefits and blessings derived from your profession, rather on all that you DON’T have the better work schedule.

Next you can realize that we are in a marvelous country where we are for the most part in control of our work situations.  If the nights, weekends and holidays are simply too problematic for you your nursing skills can certainly be used in an office setting.  Many nurses move to office settings due to such family issues or scheduling conflicts for children etc.  Like every job out there we have benefits and deficits.  You might find the office more or less rewarding, more or less stressful, etc.  There might be a change in your pay scale or benefits package however no situation gives us everything we want.  Therefore, compromise is always the key to a well life.  Figure your priorities and the adjust your job situation accordingly.

A final possibility might be to work within the job situation you already have.  Have you approached your supervisor concerning taking turns working weekends or holidays?  I have rarely seen a nurse be pressured to work on both Thanksgiving as well as Christmas.  And if you do get ALL the holiday shifts it is probably due to the fact that you are the most recently hired employee.  Anotherwards, be patient.  In time the shifts should adjust as you acquire more time at your place of work.  You can also talk to fellow nurses to exchange holidays—the Passover shift for the Christmas shift, Memorial Day when you have that big family picnic for July fourth which perhaps has been a less celebrated day in your family.  When you approach supervisors with SOLUTIONS rather than just PROBLEMS they are far more apt to adopt your solutions as it is their job to run a smooth ship!  The most important issue however, is for you to MAKE a decision as to what you want to do and then MAKE that decision work!  Contentedness concerning your job situation will be achieved between those two earlobes of yours realizing no job has it all.  REALISTIC thinking is the key.  Whatever you decide, I thank you for the times you have been there for all of us on those very inconvenient times.

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Working the holidays

Enjoy the holiday, even when you work.


Working the holidays?  Have the holidays have lost their luster?  Traditions, holidays and parties make our lives special.   They are a necessary activity for healthy nurses to participate in.  But, we give them up, or at best squeeze into them at the last minute – out of breath and exhausted, as if just barely showing up is good enough.

If you are working the holidays, you will have to find a way to put the joy back into your day.  There are several things you can make it through.  The good news is that you will enjoy it better if you plan ahead.

An important part of your holiday is food preparation. There are many supermarkets and restaurants that sell quality pre-made food. Using these give you a chance to make only your star dishes.   Also, you can also teach older children or family to cook part of the meal.  Or, you may want to cook ahead, and freeze or refrigerate items.  If you are working an especially long shift, you may want to eat out.

Little touches are important.    Don’t forget to decorate the table, and add some nice music.  If eating out, bring items to put on the table to personalize your time.  Don’t worry what other people think; most of them will be jealous.   I have brought a table cloth, candles, and ornaments, and decorated my table.  Many people came by and commented on how nice my table looked, and wished they had the foresight to do the same.

Dress up, and wear makeup even if you have to pack your clothes and change at work.  Always dress for your special days.  It gives you a much needed emotional boost when you look in sync with the holiday.

Documentation is not only important at work, but during your holiday.  Take pictures, videos and keep mementos.  Write in a book or on your computer how it all went down.  You will be glad you did, later when you have enough energy to review it.  You can then create the memory books that you and your family will enjoy year after year.

Consider that even if you had a couple days off, you may still feel stressed during the holidays, so while feeling no stress is an achievable goal, most of your stay at home friends and neighbors are still feeling stress trying to get their long lists done.  Don’t waste your emotional energy comparing the perky energetic people who may have shown up at your party or fest.  Pat yourself on the back, relax, and ask them do a little serving and management for you.  Your job, now that you have arrived is to relax and enjoy.

A lot of nurses will celebrate either ahead of / or after the holiday.  Many are happy with that, and in many ways it can make you feel special to be celebrating against the traditional day.  I would however recommend doing this as a last resort, as a lot of people report this just makes them feel more out of sync with the society.  But, if you are working a 16 hour shift, it isn’t always appropriate to celebrate Christmas with your young children at two in the morning.

It may be too late for this year, but consider the best alternative for next year.  It is important that you schedule your holidays off now for next year.  Pull out your new calendar and mark out your work schedule, and your paydays.  That way you will be able to see quickly what days you need off.  Consider birthdays, anniversaries, graduations and weddings. Request them off now – January 2nd.  Don’t wait until someone else beats you to the day you want.

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