Archives for December 2010

Restrictions on Using Nursing Titles in Arizona

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Arizona law regulates who can use various nursing titles within the state.   The use of these titles by individuals who do not hold a current and valid license can result in a finding of unprofessional conduct by the Arizona Board of Nursing and may result in disciplinary action.  Below is a general discussion about the restrictions on using certain nursing titles in Arizona.

Registered Nurses

Only an individual who holds a current and valid license to practice registered nursing in Arizona or in a state that participates in the Nursing License Compact may use the title nurse, registered nurse, professional nurse or use the abbreviation R.N. within the state.

Licensed Practical Nurse

Only an individual who holds a current and valid license to practice practical nursing in Arizona or in a state that participates in the Nursing License Compact may use the title nurse, licensed practical nurse, practical nurse or use the abbreviation L.P.N. within the state.

Nurse Practitioner

Only a person who holds a current and valid certificate to practice as a registered nurse practitioner in Arizona may use the title nurse practitioner, registered nurse practitioner or nurse midwife within the state.  A person who is certified as a registered nurse practitioner in Arizona must indicate by title or initials the specialty area of certification.

Retired Nurses

A retired nurse is prohibited from practicing nursing, but may use the title registered nurse-retired, RN-retired, licensed practical nurse-retired or LPN-retired if applicable.

It is important to know the various titles that a nurse may hold in Arizona in order to avoid possible disciplinary action.  If you have a question about nursing law in Arizona contact Attorney Robert Chelle.

Advertisement Restrictions for Arizona Health Professionals

Under Arizona law an advertisement for health care services by a health care professional that includes their name must identify the title and type of license they hold.  Arizona recognizes the following as health professionals (this list does not include all health professionals):

  • Acupuncturists
  • Athletic Trainers
  • Behavioral Health Professionals
  • Chiropractors
  • Dentists
  • Occupational Therapists
  • Optometrists
  • Pharmacists
  • Physical Therapists
  • Physicians
  • Podiatrists
  • Psychologists
  • Radiologic Technologists
  • Veterinarians

An advertisement under this particular section of Arizona law includes (A.R.S. 32-3213):

“billboards, brochures, pamphlets, radio and television scripts, electronic media, printed telephone directories, telephone and direct mail solicitations and any other means of promotion intended to directly or indirectly induce any person to enter into an agreement for services with the health professional.”

Any health professional that violates this advertisement restriction will have committed an act of unprofessional conduct and will be subject to discipline from their respective governing board.  So, be careful when advertising and make certain that you identify the title and type of license or certification that you hold.

If you have a question about whether a health professional advertisement violates Arizona law contact Attorney Robert Chelle.

Arizona Nurse Licensure Compact (NLC) Reporting Rules

Currently, Arizona is a participating state in the Nurse Licensure Compact (“NLC”).  The NLC in an interstate agreement between participating states that authorizes Licensed Practical Nurses (“LPN”) and Registered Nurses (“RN”) licensed and residing in a participating state to practice in other states that follow the NLC without having to obtain an additional license in that state.  Under the NLC the nurse is subject to each state’s practice laws and disciplinary proceedings while practicing in that state.

A nurse holding a license and residing in a state that follows the NLC is free to practice in other states that follow the NLC, except when their practice is limited or restricted in their home state.

The states currently participating in the NLC  are as follows:  Arizona, Arkansas, Colorado, Delaware,  Idaho, Iowa, Kentucky, Maine, Maryland, Mississippi, Missouri, Nebraska, New Hampshire, New Mexico, North Carolina, North Dakota, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, and Wisconsin.

Arizona law states that any nurse who wishes to practice in Arizona pursuant to the NLC must notify the board if their nursing license has been denied, suspended or revoked in another jurisdiction within the past five years.  Additionally, any felony conviction where the nurse did not receive an absolute discharge from the sentence at least five years before the date that the person applies to practice in Arizona pursuant to the NLC must be reported as well.  The Arizona Board of Nursing will find that any nurse who fails to report these issues prior to practicing in the state has committed an act of unprofessional conduct and will be subject to discipline.

So, it is important that any nurse who wishes to practice in Arizona pursuant to the NLC, even for a single day, notify the Board of past transgressions or risk discipline.  As always, it is much better to report problems at the beginning instead of dealing with a disciplinary act at the end.

If you have a question about the Nurse Licensure Act contact Arizona Attorney Robert Chelle.

Arizona Board of Nursing Regulatory Journal Discipline Reports

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The Arizona Board of Nursing publishes a report (Report) of all disciplinary action regarding certified nursing assistants (CNA), registered nurses (RN) and licensed practical nurses (LPN) in the Arizona State Board of Nursing Quarterly Regulatory Journal (Journal). The Report not only lists currently licensed or certified nurses, but any applicants that have been denied certification or licensure.

The Report lists in detail the:
1. Effective date of the disciplinary action
2. Nurse’s name
3. Certificate number
4. Discipline taken
5. Nature of the violation

The discipline taken can range from:
1. Revocation
2. Civil penalties
3. Denial of certification/licensure
4. Decree of censure
5. Voluntary surrender
6. Probation
7. Stayed revocation with probation

Besides having your name published for all to see, the detailed listing of the nature of the violation should cause any nurse concern. Patient abuse, criminal convictions, disruptive conduct, and sexual misconduct are just a few of the possible violations listed by the Board.

If a nurse would like to keep their name out of the Journal they have two options. First, obviously, is to not commit a violation. The second option is to avoid disciplinary action after the Board has initiated an investigation. The Board will initiate an investigation after a complaint is received, on its own accord during the certification and licensure process or if the Board has received information about a possible violation. Once the Board has started an investigation the nurse will receive a notice of action and will have the opportunity to respond to the Board (usually within 30 days). Most nurses wait until it is too late to retain an attorney, but I cannot stress how important it is to seek counsel prior to submitting your response to an inquiry from the Board.

A strong response can put you in the best possible position to avoid discipline and hopefully keep your name out of the Journal.  If you have a question about disciplinary action from the Arizona Board of Nursing contact Attorney Robert Chelle.

Reporting Criminal Charges to the Arizona Board of Nursing

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Arizona law holds that any nurse who has been charged with a misdemeanor involving conduct that may affect patient safety must notify the Arizona Board of Nursing (“Board”) in writing within 10 business days after the charge is filed.  Being charged with a crime means that a police officer has issued an arrest or citation and has sent copies of their report to the prosecutor’s office for review.    Failure to report the criminal charge within 10 business days will result in an act of unprofessional conduct and the Board may impose a fine in addition to disciplinary action.

Arizona has released a list of misdemeanor offenses that have been determined to affect patient safety and are required to be reported to the Board.  A licensee or applicant to the Arizona Board of Nursing must report the following charges involving (this is not an all-inclusive list, for the full list click here):

  • Assault
  • Cruelty to animals
  • Disorderly conduct
  • Driving or boating under the influence
  • Drug offenses
  • Issuing a bad check
  • Sexual offenses
  • Theft

There are literally hundreds of crimes that must be reported to the Board if a nurse has been charged.  Most licensed professionals would rather conceal the charge than self-report, however, if the Board does find out, not only will the professional face discipline if ultimately convicted of the charge, but they will also receive discipline for concealing the charge as well.  Remember, a charge is not a conviction and it is better to reveal the charge at the beginning rather than face a sanction from the Board for failure to disclose.

If you have failed to report a criminal charge or face discipline from the Arizona Board of Nursing contact Chelle Law.

Arizona Board of Nursing Administrative Violations

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Arizona law holds that a licensed nurse may be sanctioned by the Arizona Board of Nursing (“Board”) with an administrative penalty should they:

1.    Fail to timely renew a nursing license or nurse assistant certificate while continuing to practice nursing or engage in activities or duties related to nursing.

2.    Fail to notify the board in writing within thirty days after a change in address.

The law allows the Board to fine a nurse up to $1000.00 for a violation of the actions listed above, however, a fine of that amount is highly unlikely.  For failure to notify the Board of a change of address a nurse would likely receive a warning or nominal fine.

The Board has specifically defined the penalty amounts for practicing without a license assuming the nurse did not intend to deceive the Board by not renewing in a timely manner.

For RN/LPN’s the fines range from $100-500.00.  However, the Board will refer the nurse’s employer to the Arizona Department of Health Services (“DHS”) if the nurse is more than two months late in renewing their license.  Obviously, no employer likes to be referred to the DHS, so a nurse must be careful that they aren’t sanctioned by their employer as well.

For CNA’s the fines range from $25-75.00.  As with RN/LPN’s the Board will refer the nurse’s employer to the DHS if the nurse is more than two months late in renewing their license.

So, Arizona nurses must be careful and renew their licenses on time!  Failure to do so could not only open them up to administrative fines, but could also put their employer in jeopardy as well.

If you have any questions about Arizona Board of Nursing Administrative violations contact Arizona Attorney Robert Chelle.

Production Based (wRVU) Physician Employment Contracts

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*If you need a RVU based employment contract reviewed contact Attorney Robert Chelle*

This will be the first part of a series discussing what a physician should look for in a production based physician employment agreement. Many physicians believe an RVU based contract will generally decrease their compensation; however, many physicians can increase their overall compensation under an RVU based contract. This first part will introduce the concept of work relative value units (wRVU).

It seems every five to ten years hospitals vacillate on whether to employ physicians because the costs associated with employing a physician are considerable. Those costs include office space, staff, supplies, equipment, malpractice insurance, CME reimbursement, in addition to the physician’s salary. The hospital’s motive behind employing physicians is to capture the downstream revenue generated by the physician’s practice. For instance, an employed physician is expected to use hospital services (labs, imaging, rehab, etc.) and other employed specialists when referring patients in need of continued care. The revenue collected from these “in-house” referrals is expected to more than cover the cost associated with employing the physician.

However, when a hospital employs a physician who doesn’t see enough patients or generate enough downstream revenue to cover the costs of their practice the hospital can lose an enormous amount of money. Therefore, hospitals have begun to use productivity based employment agreements with employed physicians to ensure that the physician is financially incented to see more patients. A physician who sees more patients not only bills more from an increase in patient encounters, but also creates more downstream revenue.

What is a wRVU?

In my opinion, the most effective productivity based employment model uses the wRVU to determine the compensation of the physician. The wRVU combines the relative level of time, skill, training and intensity to provide a given service (determined through a CPT code) and it places a numeric value for each CPT code billed by the physician. For example, a family practice physician sees a new patient and codes a 99202 for the encounter. Let’s say the wRVU for a 99202 is 1.70 and a family practitioner receives $36.00 per wRVU. Thus, the doctor would generate $61.20 per 99202. Hospitals that use wRVU based employment contracts use a physician’s total wRVU’s generated for a specific period of time to determine how much the physician is compensated.

I advise hospitals to use a combination of base salary and incentives (bonuses) based on wRVU. However, it is ultimately all based on wRVU’s generated because the base compensation is determined from the physician’s wRVU total from the previous year.

If you are a physician entering into an RVU based contract it is imperative that you understand the intricacies of the contract structure in order to maximize your compensation. My next post will review how a RVU based contract can ultimately be more lucrative for a physician than the traditional models.

If you have a question about RVU based employment contracts contact Attorney Robert Chelle.