After one of my patients suffered a bad medication reaction, I was brought before my hospital's nursing peer review board. I had struggled to manage two difficult ICU patients that night. My charting had been lacking, to put it mildly.
The nursing peer review process is simply that, review by your nursing peers. I was required to appear and explain my actions. After hearing my testimony, the board would vote to decide if it was a minor issue or needed to be reported to the Texas Board of Nurse Examiners (BNE). If reported to the board, an official investigation would be completed. If negligence or malpractice was apparent, the board may revoke, suspend or restrict the my license.
I had done the best I could for my patients that night, my documentation didn't reflect that. I was embarrassed. I was scared- scared of my bully of a nurse manager, scared of what might happen, scared of losing my nursing license.
After the initial shock had worn off, I took council from my friends. Some had been nurse managers, another was a nurse and attorney. The concensus seemed to be that as there had been no harm (patient was discharged with no deficits), nothing serious was likely to happen to me or my license.
My nurse-attorney friend, Cecelia, had participated in many peer reviews.
"Write out a statement of what happened. Acknowledge what you feel you did wrong and explain what was going on. State what you should have done differently and what you have learned. It might be a good idea if you took a course in documentation. It will appear as though you are working to improve. Consider calling anyone who helped you that night as a witness. Also, when you appear before the board, your attitude and demeanor count for a lot. Don't get defensive. Also, don't change your story."
I did just that, taking a twenty four credit hour documentation course. I completed a statement which Cecelia edited. One the other nurses on duty that night, Byron, agreed to speak on my behalf. He was sympathetic.
"You got a sh---y assignment that night. Nobody could really help you. We were all drowning ourselves. I honestly don't think you did anything wrong. I've seen your work. You're good."
The day of the hearing, with it's overwhelming dread, came. Perhaps the most terrifying was the feeling of being completely alone, without a friend or advocate, trying to defend my livelihood. Byron was there, but he was seated outside until his testimony was required.
It all passed as a blur. My nurse manager, B, appeared and was asked why she had submitted this incident for peer review. She mentioned the issue in question and second incident where I had forgotten to complete a drug waste. She kept repeating herself, seeming oddly defensive.
The unit manager, L, testified. Her clothing appeared wrinkled, her hair oily and unkempt. She starting talking about a completely different patient until the board chairman corrected her.
The nurse I had given morning report to spoke. M was basically neutral. She had witnessed the reaction.
The chart was reviewed thoroughly. The patient had not revealed to the admitting nurse all his home medications. A progress note from his internist informed us he took a large dose of another medication on a regular basis. A high tolerance of this type of drug may have contributed to the reaction.
Byron spoke. He had cared for the patient in question before and after the incident. His testimony helped to paint a picture of what I dealt with that night, why I had done what I had. It fit with my statements.
The witnesses and I were dismissed as the board prepared to deliberate.
I was told the results that afternoon. The board had decided this was a "minor incident", it would not be reported further.
A few weeks later, I saw one of the members of the review board. We chatted about the event.
"There was a lot of tension in that room. It's normally not like that." She said. "You did very well. You held yourself together and defended your practice. Basically the only thing that it came down to was that you didn't chart like you should have."
I knew it then. I wanted to be a lawyer. That was 2008. I had put that aside to do what was practical: something that could be worked around a future husband and children. I loved being a nurse and I find work as a nurse practitioner challenging and rewarding. However, the desire to pursue a legal education was still with me.
It was now 2014 and I was 35. Was I going to spend my entire life waiting for Mr. Right to appear? Besides, if he every does show, wouldn't the right relationship encompass my dreams and goals?
My mother had always been opposed to me pursuing a medical or law degree. Neither fit her version of a proper wife and mother. Was I going to live life for my mom? Or was this my life?
I confided my desires to Noel.
"Hey! I think you'd be awesome. It's your life. I'm glad you're finally making it about you!"
"What about my debt?"
"There's always loans."
"I don't want anymore debt. Plus, I'll be almost 40 by the time I'm admitted to the Texas Bar. I have to consider retirement"
"Well. What options do you have?
I fell silent thinking.
"My GI Bill will cover 40%, provided I go to a state school. Texas A&M bought Texas Wesleyan School of Law. I could apply to go part time.
"Ok, there's a big chunk"
"That still leaves around $60,000."
"Are you going to let that stop you? I think you're smart enough to find a way." He was right. There had to be another way around the mountain.
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