Board of Nursing - Crossing Boundaries & Solicitation

[blakem]

What is the name of your state (only U.S. law)? Massachusetts

A nurse worked for over a year a home health care agency. She was terminated because of so called "solicitating" a client for the business she was working on creating. This agency did not have a non-solicitation policy or a signed agreement with this nurse. Also this nurse didn't even solicit this agencies client. This client wanted to go with this nurse when her company was operational and contacted her lawyers who then contacted the nurse. Anyways,a few days after she was terminated she got a letter from the Board of Nurses stating that a complaint from this agency was filed against her for "soliciting clients” and putting a “psychiatric client at risk of harming herself” by not taking her out to dinner. Now here are the facts and response about the allegations:

• The nurse was the primary nurse for this client for over one year. She saw this client in question 1 x a day/ 7 days a week to begin with and thereafter she saw her 2 x a day/ 7 days a week when another nurse was fired from this same agency for complaining multiple times to the Administrator/CEO about the poor quality of care provided by some newly hired nurses.

• At this time a new Manager was hired by this agency. She came in and re-scheduled nurses, transferred patients to other nurses and changed patients’ primary nurses. This new Managers scheduled nurses so that more than one nurse would go out to see patients weekly. As many as 4 different nurses a week would see the client in question with these new schedule changes. This nurses visits to this client and to others were cut down for no apparent or vocalized reason. A different nurse at this agency reported overhearing that this new Manager wanted to get rid of the nurses that the Administrator/CEO hired and replace them with her own nurses and/or friends she knew. This has been evident since this Manager started, nurses’ hours were cut, some nurses left because of limited hours, some being fired and others resigning and this new manager hiring her friends who worked with her before.

• Needless to say this created a lot of confusion and anxiety for the client in question and other the clients, because they were use to the continuity of care they were receiving. Now, with no continuity of care, this client became increasingly anxious about her schedule. To decrease the anxiety on visits this nurse would would put a copy of this clients schedule out for her, so she would know who was coming and when. This nurses clients were an 80 old, a disabled client and a bed-bound client, and the client in question. They reported to her that they didn’t like having a lot of different people in their home, and were uncomfortable with different nurses performing invasive procedures. These clients expressed not only their disappointment to this nurse but also to this agency many times. This nurse received a copy of her personnel file upon her request and only found the concerns about the schedule from this one client in question in her file and none of the other complaints from other clients were documented in her file or anywhere else within the agency for that matter.

• Continuing with the story. The client in question reported to this nurse that she missed her when I was not scheduled for visits. This nurse told her that she should get use to the other nurses because I may be leaving this agency soon to do her own thing. This client said, “What do you mean?” The nurse told her that she was investigating starting her own business. She did agree the other nurses were nice and she liked them. This was just an innocent conversation between the client in question and this nurse. Thereafter when this nurse was scheduled to see the client in question, this client continued to express missing her. She then said, “If you start your own business I would like to be your patient”. This nurse told her that she had a long way to go before she could take on patients. This client said, “Contact my lawyers at XYZ”. This nurse told her that she couldn’t do that. This client must have initiated a call to one of her contacts who then contacted this nurse. The nurse was unaware of this until she got the call from this clients’ trust administrator at the law firm. However, she have never spoken to this clients’ lawyer/s to this day.

• She never solicited any clients of this agency. She was contacted by the clients’ in question trust administrator because the client expressed interest in being transferred once this nurses future business was operational.
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• As far as this nurses business, at this time she has a business name and licenses. She has a way to go before she will be operational, and/or have the ability to take on clients. This nurse reiterated this to the clients’ in question trust administrator when she contacted her.

• This nurse never told the client in question while she was employed with this agency as stated in the complaint filed that she would take this client out to dinner and failed to take her. In fact the opposite is true. This nurse told the client in question, after her “termination” with this agency, that they would get together for dinner because the client was worried that she was off the schedule. And in fact, she did take this client out to dinner on a date that they had mutually agreed upon, which was after her employment with this agency. It was just a friendly dinner get together because the client in question missed her former nurse.

• This nurse also filed a complaint with her former agency regarding care a patient received from this agency was receiving as well as a complaint about another nurse who lied to her and who put the client in the middle of the dispute. She also filed a complaint regarding harassment behavior from the Manager at this agency who had a personality conflict with her. These complaints this nurse filed were never addressed or followed up with as per this companies policy to address all complaints filed. It was ignored.

• This nurse has been a since 1993 and have never had one complaint filed about her. She was employed at this agency that filed a complaint against her only as a part-time registered nurse performing home care visits for clients. At her time of employment with this agency she was and currently still is employed full time as a registered nurse elsewhere. She also never had any complaints or questions regarding her work, her ethics and her performance review at this agency was EXCELLENT.

• On the day of her dismissal at this ageney this client in question called this nurse and told her what she told this agency about this nurse staring her own business and was very upset and anxious. She stated, “I hope I didn’t get you in trouble.” “Laura kept asking me questions about you and I told her.” The client said, “I hope you don’t think I have a huge mouth”. This nurse reassured this client that she did not get her in trouble and not to worry about it. This clients’ anxiety was relieved with this response. This client in question still does not know that this nurse was dismissed from this agency. In my opinion pumping this patient about this nurse and starting her own business could have put her at risk of harm as noted by the anxiety in her voice the day of the phone call. They could have called the nurse directly instead of pressuring her to answer further questions. It wasn’t even a nurse asking the questions to this client, it was an office worker. This worker should have directed the call to the Administrator who is a nurse.

• This nurse has asked other nurses at this company if they were aware of this so-called solicitation policy and they have replied, “NO”.

Now after talking to a nurse investigator at the Board of Nursing this nurse was told that this agency was provided a copy of a non solicitation agreement from this agency. It's not signed, it's not part of the handbook it is just a typed up document with no signature and was placed behind the page the nurse signed stating that she received the employee handbook and understood the policies and procedures of this agency. No other nurse still employed or not employed has this policy or signed one. This agency just typed up a document and submitted it to the Board of Nursing! Isn't that fraud?

It has also come to this nurses attention that the nurse investigator at the Board is a friend and former co-worker of the Manager at this agency. She called this nurse and was somewhat rude telling her that she crossed boundaries by taking a former client out to dinner. This nurse investigator told this nurse that that you must not ever enter into a friendship with any former client you once cared for and it’s against nursing boundaries to do so, even after a nurse-client’s professional relationship has ended. Now I've searched high and low for such a boundary violation and have found nothing to state such a thing...especially after a professional relationship has ended. In fact this nurse truly believed at the time, that taking her former client out to dinner was therapeutic to her current client's emotional state - missing her and being anxious about her not being on the schedule when she was really just terminated...

Should this nurse have this investigator nurse taken off the case? There seems to be a conflict of interest where she worked with the manager at this agency before?

Also should this nurse file a complaint or get a lawyer regarding this agency frauduantly submitting a policy that never existed and saying it did...

[lya]

OMG! I tried, I really tried. I just could not read this epistle.

From what I gleaned, it appears the nurse solicted patients for her own business and otherwise acted in an unprofessional manner (troublemaker with a capital T).

I would have fired her and sued her for the loss of any patients/income that she derived from her soliciting actions.

The RN's license is in jeopardy. A requirement to complete a Board approved Ethics class is in order.

[blakem]

I can tell you didn't read the post in its entirety. First off this nurse never solicitated a client. She told a client she was thinking of starting her own business in a casual conversation. This client contacted her lawyers who then contacted this nurse because of this client's wishes to go with her. The nurse told this client she couldn't contact her lawyers when this client told her if she left to start her own business that she wanted to go with her! A client has a legal right to transfer care if they wish. There was never a non-solicitation agreement or policy at this agency either so even if this nurse DID solicit a client she was not in violation of any policy/agreement. She didn't pursue this client. It was this client who pursed this nurse by contacting her lawyers and then someone at this law firm contacted this nurse FIRST.

Nurses have come to this agency to work and have taken patients from other agencies with them to this agency for personal gain......this CEO at this agency is famous for saying that, "I have a new nurse manager starting and they are going to bring an entire building of patients with them from their old company." These are her ethics. It's okay for her to take clients from other agencies, but it's not okay for a nurse to go forward with a client's wishes if they are the ones who contacted their lawyers to transfer care????

[lya]

An RN is held to a code of ethics as is every other profession, something the RN to whom you refer is apparently oblivious. I suspect the RN in trouble is you; and you (or she) are in trouble with the Board.

My advice is to stop being argumentative and humbly ask to participate in any corrective measure the Board feels would benefit you, or the RN in this story.

I stand by my initial reply.

[blakem]

I'm not a nurse it's a friend I'm writing about. Anyways she just contacted a lawyer that is a specialist with these types of issues and he told her that the agency is actually in a lot of trouble for fraudently submitting information, that she did absolutely nothing wrong or in violation of nursing ethics or boundaries, and didn't solicitate any client - this client's lawyers contacted her first. This lawyer said she has a major civil lawsuit she can file against this agency for submitting false and inaccurate information and also against the Board of Nurses for putting an investigator on the case that use to work with this agency - major conflict of interest.....anyways thanks for your thoughts on this matter even though they are wrong.

[ecmst12]

The lawyer she is paying for is telling her (to some extent) what she wants to hear. But it is good that he will help her defend herself against the board complaint. I hope they are successful.

Most of the information you put in your first post is totally irrelevent to your question and just confused the matter.

[alishalove]

Wow. You did post a lot of information, but it is helpful. It seems clear that your nurse friend did not solicit this client, but it was the client's wish to go with your friend once her business was operational. As far as I know that is part of M.G.L. c. 111, § 70E (Patients’ or Residents’ Rights). So what is the big deal? It seems this agency that filed a complaint is acting in a retaliatory manner by filing a complaint and only for personal gain because they don't want to loose this paying client. That is a violation of the Standards of Nursing. Last time I checked a patient can transfer care to whomever they want.

I believe that you can't cross boundaries even with former patients. This is interesting though because you state that the patient missed your friend, and was anxious because she was no longer employed/on the schedule, so her former nurse took her out to dinner. If she ignored the patient or didn't take her out to dinner wouldn't that be neglect or abandonment and cause harm versus taking her out to dinner? Seems like your friend took the lesser of evil to me and viewed this as beneficial and therapeutic to her and it was. How could this be viewed as breaking boundaries? It seems your friend was looking at this patient ethically vs. looking at the standards of practice and as a human being with dignity and self worth. Is anyone knowledgeable about nursing boundaries?

If the nurse investigator with the Board of Nursing is a former colleague of the Manager at the agency that filed the complaint against your nurse friend I would think she would have to take herself off the case and this would be a Conflict of Interest. Maybe she doesn't know this Manager well though or she does and is friends with this Manager? Whose to say or know. Have your friend call the Board and have a new nurse investigator assigned to the case. I would.

Seems to that this agency falsified information by submitting a Non-Solicitation policy to the Board that didn't exist and is trying to make it look like one did exist. I would think this could get this Administrator at this agency is BIG trouble. It's good that you have other nurses that will testify that one doesn't exists. You should file a complaint with the Board against this agency.