Nursing Malpractice: What Proactive Measures Can A NAR|CRNA Implement To Shield Themselves From Legal Liability? With Maggie Ortiz, MSN, RN (Part 2)

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Legal issues in nursing, and nurse anesthesia practice, are more common than you might think- failing to protect yourself could have devastating consequences for your career. In this must-read follow-up to Part One, we’re diving deeper into the proactive steps you can take to shield yourself from legal liability as a CRNA or SRNA.

Our guest expert, Maggie Ortiz—a legal nurse consultant with Advocates for Nurses and a future attorney—shares real-life cases, expert advice, and actionable strategies to help you navigate the complexities of legal risks in anesthesia practice. Whether you’re working in a hospital, surgery center or elsewhere, understanding how to advocate for yourself, document properly, and recognize red flags in patient safety is critical.

In this episode, you’ll gain invaluable insights on recognizing unsafe situations, understanding professional liability insurance, and knowing your rights when legal action arises. You’ll also hear eye-opening stories about high-risk cases that nearly led to disaster—proving why standing your ground can literally save lives.

If you want to stay ahead of potential legal pitfalls and confidently protect your practice, you won’t want to miss this! Read on to equip yourself with the knowledge every anesthesia provider needs to safeguard their career.

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Understanding Legal Risks in Nursing and Anesthesia

Welcome back for Part Two of this podcast talking about some proactive measures you can implement in your current practice as an SRNA and CRNA that would shield you from legal liability. If you missed Part One, click here to read it first. 

We have expert Maggie Ortiz, who’s going to share with you her insider knowledge on being a paralegal nurse. She’s actually in the process of getting her legal degree. We had so much fun with this; I shared real life experiences that I have had as a CRNA. I also shared experiences that I have heard from other CRNAs, regarding legality issues that they have come up in practice. Maggie shares a lot of knowledge and wisdom on the proactive measures you can take to protect yourself as well as what you should do if something were to arise.

Let’s go ahead and get back into the show!

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I’ve worked at a surgery center and that was the reason why I didn’t stay there very long because it was incredibly aggravating to see all these things get missed with PAT. And I mean I don’t even, I could go on all day.

People in my course; I made surgical services a whole different one. People undervalue PAT. I said, “That needs to be me. That needs to be a jaded up old nurse who can ask the right questions.” You know what I mean? Then they go to anesthesia and even to the surgeon and say, “No, dude, you’re going to do this in the hospital. You’re not going to do this here.” PAT is so valuable. 

Pre-Admission Testing. That’s what that stands for. In case our listeners are wondering; typically it’s the first screening. However, as an anesthesia provider, you always do an additional screen, but I’ll tell you that doesn’t always stop hiccups.

Recognizing Unsafe Surgical Cases: When to Say No

Similar to that shoulder story that really resonated; I got put on a case, elective shoulder at a surgery center. This patient already had baseline 12 stents, and had an active MI six weeks prior. Cleared. Cleared by cardiology because he’s un-stentable. Why? Because there’s no place to stent! So he was cleared.

That cardiologist did not know this was going to be done at a surgery center. There’s no way.

Well, so I was like, “No, no, no, no, no.” We didn’t have any report on his echo. We didn’t have the troponins. We didn’t have anything other than he was cleared by cardiology because he was un-stentable, which is absolutely absurd.

Long story short, I refused to do the case; that was not looked at very highly and I had to actually call someone on-call to back me up. That was very upsetting to me, to have that happen knowing I was making the best educated, best decision for that patient. That was really hurtful and that was one of the many reasons why that was just not a place I could stay.

Jenny, you’re doing everything that I tell nurses to do. You just did textbook what I tell nurses to do; you don’t get pushed around. 

Call your backup. And that was me. I’m like, “You know what? If this is going to be the way it’s going to be, I’m going to play hardball here. I’m going to get someone who’s going to be on my side to back me with a physician background.”

And leave. Don’t stay somewhere unsafe.

Well, exactly. But that’s unfortunate. There’s other situations like a patient came in with a trigger finger release; he’s an AFib with RVR. Like, okay, I don’t care if it’s a trigger finger. I don’t care if it’s just going to take some lidocaine. You can do it locally. You’re not going to use anesthesia. And they’re like, “Oh no.” I’m like, “I’m not touching this patient.” So stuff like that.

Before we did a shoulder block, we typically would hook them up to the EKG back in the block room. Well, noticeable ST elevation, ruddy, big old nose, middle aged man, no complaints of chest pain whatsoever. We’re getting ready to do an Experal block, which is three days, right? A three day block. So, hold up, we’re not doing this. Let’s do an EKG first because we are not giving this guy a block who probably is having an active mi.

Long story short, pushback. Not going to go into it. Block done, EKG done in the ER. I mean, just stuff like that where it’s funny because I’ve had all these experiences so I’m like, there’s a wrong way and there’s a right way. Where I once worked, they call it the green dot, which means you’re good to go. You’ve seen anesthesia, you’ve seen the surgeon, whatever. All the checks, all the T’s and all the i’s are dotted and crossed. Well, that doesn’t always happen at certain facilities.

You have to be very proactive and make sure that they were actually seen by anesthesia. Because in the surgery center it’s about efficiency, right? They even time you, meaning you roll back in that door, as soon as they get in that door, you have six minutes to put them to sleep because you’re on the clock. And that I didn’t agree with either because this is safety, I don’t want to speed up this process. What if it’s a safety concern?

Anyways, long story short, they didn’t agree with me, but I could share stories all day where you have to be willing to say “No.” My second week there, I actually had to cancel a case after they made it back to the OR because I looked at the surgeon, I said, “This is a fire risk. This case needs to be canceled right now.”

What was the risk? Just briefly; again, your audience wants to know this.

Okay, I mean is it okay to share on the show? I’m not going to say names or anything like that, okay? So they made it through PAT. And I even remember sitting there, because I was new, we would look through these charts the day or two before, the week before the surgery. We as CRNAs would sit and look through these charts.

That’s totally acceptable. Just so we’re real clear, that is not a HIPAA violation because you’re working up a case; you’re making sure that they’re appropriate for anesthesia. So just for your listeners, I get asked this all the time, are you allowed to do that? Yes, you are because you’re working up the case. 

And it was a standard thing we would do and we would often catch things, cancel cases and things of that nature or ask more questions, right? So it was a screening tool and I remember, we brought it up to the whole team. We told them it doesn’t seem like we should do this.

This is a surgery center; the patient had a history of head, neck and throat cancer, radical neck, no hard palate, no hard palate prosthesis for a hard palate. Do you think you can mask a patient with no hard palate? What would this do to their sinuses? Does that directly connect to someone’s brain? I mean, really?

Nursing Malpractice: You have to be very proactive and make sure that your patient was actually seen by anesthesia prior to the procedure.

Anyways, long story short, I remember thinking, “I better not get assigned that case,” and yet they pushed it through. We all were like, “No, no, no, somehow don’t ask me.” But it got pushed through. I got assigned to that case and I’m like, “Really?” Long story short, it was a plastics procedure, because this person had radiation, so scarring galore. And I’m thinking, “Okay, this patient should be in awake fiber optic intubation, should never be done in a surgery center. We can’t even mask him if we wanted to because we blow air into his brain.” 

And on top of the complicating matters, at this particular facility, we had a hundred percent oxygen or nitrous. We had no air, no pipeline air. I mean, I think we could probably find it. I don’t know if we had an air tank, we had no air. It was either a hundred percent oxygen or nitrous. That was it. And they’re going to be boving on this guy’s face with a two LMA. 

Okay. So here we go. Here’s the fire risk folks.

I would’ve been one of your clients. I looked at the surgeon before anything started. I said, “This needs to be canceled right now.” And he just said, “Okay, done.” He didn’t argue with me at all. He just said okay. I explained to him why. I said, “This is why, this is incredibly high risk. We should not be doing this at all. A hundred percent. It should never have been passed.”

Tell us why. List out why.

Well, okay, so we couldn’t get a good seal on this LMA and we only had, again, a hundred percent oxygen, which is incredibly flammable. If you’re doing anything in the airway, you need to be having 30% or less oxygen period because it’s incredibly flammable. If they’re boving anywhere around, there’s oxygen spewing out of the patient’s mouth, it’s going to ignite a flame and catch the drapes on fire.

You’d have a huge mess, it would be a nightmare, a total disaster. Then on top of that, if something were to go wrong, if we were to lose that airway. How in the world are we going to secure that airway? We can’t even mask him. Masking saves lives if we can’t mask this guy because he has no hard palate…

Are you even able to crike him? Tell me about him. Can you even crike him with that?

With the scar tissue? And we had no ENT surgeon there. I mean, are you kidding me? No, I mean it would’ve been a struggle. It would’ve been a life altering event. I don’t know how to begin to describe how wrong this was, and I hope everyone listening can think through how scary this was for me to be like, “I can’t believe this is happening. What? It feels so wrong.”

And then the other thing, the language. What did you tell the doctor? So you’re in the room, walk through it; you’re not unprofessional. You’re not disrespectful. You are there, the surgeon is there and you’re doing what?

Avoiding Potential Legal Issues in Nursing: Calling for Backup & Due Diligence

So we got back in the room, even though I very much so should have just stopped it from even going back in the room. I was with the attending and we were both back in the room thinking, “How in the world is this going to work?” Trying to see if we can make this work. We’d already had them scheduled, blah, blah, blah, blah.

We were playing with having a propofol infusion and seeing if we could run nitrous. I mean, even though that’s not a good option either, it was just like, no, no, no. I essentially said, “We can’t get a good seal on that LMA; we are in a rock and a hard place if we lose that airway. And with that boving right around where that surgical field is, right around the airway, this is a super high fire risk. This is not safe. This patient is not maskable.”

So we were just explaining our thought process, thinking about the things that can go wrong. If we lose an airway, we’re toast. We could potentially do massive harm because we don’t have a way to even mask him to where we can get an airway established. He has a very small mouth opening. He’d be a very hard direct laryngoscopy. He’d be a very hard GlideScope intubation.

He’d need a fiber optic scope to intubate him, which we did have. But I mean, is this really necessary to be doing this at a surgery center? And I just looked at the surgeon. I said, “This needs to be scheduled at a hospital who can do an awake fiber optic intubation on him prior to you doing surgery.” And he just looked at me and said, “Okay, done. Case canceled.” And then it was done.

Was the patient on the table? Was the patient sedated? Was the patient cognizant? Were you guys having this conversation while the patient was present?

The patient was already asleep on the table, which was a mistake number one, we never should have put him to sleep.

Who gave, what did you give?

We put him asleep with propofol. Again, we kept him spontaneously breathing the whole time. We also kept trying different LMAs until we found one that we could get in his mouth that would seat kind of okay- which was a two for an adult male. A two is meant for someone between 20 and 30 kilos, a child. I just was like, the whole time, I knew it was wrong. 

How long had you been practicing?

I had been a CRNA for over five years now at that point. So that’s what I mean, this was my two weeks. When the shoulder came through, at that point I’d been there for, I don’t know, almost a year. And I was like, “No, no.” I think it’s one of those things where I wish I just would’ve said no from the very beginning, but there’s a lot of pressure that goes into it, so what would you do now? I’m not proud of that.

What would you do now? 

Oh my gosh. I would just say no. 

How about if you saw it on the schedule?

I mean you don’t always know as a CRNA, but yes if you see it on the schedule. We were doing the PAT portion when we were reviewing that chart. It should have been canceled then. But unfortunately it was me plus like four or five other CRNAs that were bringing this to people’s attention.

Nursing Malpractice: Digital charting has really opened up the ability to pre-look into your next case, which I always do.

We’re like “Red flag, red flag, red flag. Attending, attending, attending,” but all got bypassed. We got swept under even though we all felt it was wrong. We all tried to argue to cancel it. It got pushed. And this is the power of what the surgeons have over the attendings. That’s number one.

Not all CRNAs have that privilege of knowing what’s coming on the pipeline. You just show up and boom, there you go. Here’s your nightmare. And you’re like, “What?” But it’s your due diligence to thoroughly review the chart. And I will tell you, you don’t always have time to do that because it’s like you drop off a patient in PACU and then boom, the next patient’s going back to the OR. So you’re like, “Wait, about this next patient…” especially if there’s not digital charting.

Digital charting has really opened up the ability to pre-look into your next case, which I always do. But this place was paper charting still. I had no ability to review the chart prior to going to the pre-op. And I’m not joking you Maggie, when I say I had to review my patient’s airway as they were rolling down the hallway before they hit the OR because I had no other time to see them, I had just dropped off in PACU.

They already went to get my next patient; I’d have to meet them in the circle loop in the hallway and say, “Let me see.” I’d do my own airway assessment in the hallway on the way to the OR in the surgery center. And I’m like, “Whoa.” So I guess I’m poo-pooing surgery centers. I’m sure they’re not all like that. 

No, they’re not. We’re pointing out the possible risks that can happen in certain situations and then the language that you have to use. What I hear you’re saying is, you were using your chain of command.

You work in a place where the expectation, the norm is to kind of do what I call “cowboy anesthesia”. That’s what I call it. It’s like the wild wild west. What the heck are we doing? So I just caution you to trust your gut when you know something’s wrong, trust your gut and stick up for yourself. And frankly, if you find yourself doing that over and over again and people are giving you a hard time, then leave, get the heck out of dodge.

That’s ultimately what ended up happening with my story. I’d been practicing for over five years and it was the first time I ever felt so distraught going into work; I get emotional speaking about it. It was like, I love my job. I love what I do. I love being an anesthesia provider. And I still to this day, it’s the best thing I ever did, but holy cow. I mean it was very eye-opening and you just have to know how to trust your gut, speak up and be willing to say no.

And rely on one another. You know what I mean? This is why we develop relationships with one another, with another nurse anesthetist. A patient showed up to pre-op to have an upper in this rural area.; the patient comes in, a younger guy, hooking him up to the monitor. I’m doing the tasking, she’s doing the charting; patients with AFib, with RV for an elective upper and lower, young guy, right?

I was like, “Hey, do you have an irregular heart rhythm?” He said “No. But I’ve been feeling real bad. They had double prepped him. And so I looked at the pre-op nurse, I was like, “Hey, we need EKG.” She’s like, “We don’t have an order for an EKG.” I said, “We do.” It was actually a nurse anesthetist who was there. It was a smaller place.

So I went over, she of course loved me. I was like, “Here’s the EKG, we got an AFI with RV. What are your thoughts?” She was like, “Not a chance.” I was like, “I thought so.” So I went ahead, kept his line in, opened up his fluids, probably going to be suspending him over right on to the ER, right? That’s what we’re doing.

But to your point, from the PAT nurse to the pre-op nurse to even the OR nurse had a duty as well; that’s what people don’t realize, even to the nurse anesthetist who’s going to be probably hung dry. Because your education, training and knowledge is far different than mine as the pre-op nurse or whatever. And then the other thing that I’ve seen as well, that nurse anesthetists need to pay attention to when you’re just curb-siding, seeing their airway in the hallway, was that consent signed? I’ve seen it. I have.

I think that’s a good lesson to learn. Everyone should be paying attention to that. That’s when I said the green dot system didn’t always work. And that was my first experience; after talking to colleagues, I’m like, “Has this happened to you?” They’re like, “Yeah.”  I’m like, “How has this been happening? This is not okay. This should never be happening.”

So it’s not out of the realm of possibilities to bring a patient back to the OR who’s never been seen by anesthesia. Let me just put it out there. It’s not out of the realm of possibilities to have a patient on your table that you have never seen, that has not been seen by anesthesia. It has happened and it probably is always happening and it’s probably happening multiple times a day. So yes, please triple, triple, triple, triple check that the patient has been seeing prior to ever touching them.

I don’t care if you’re on the clock. Performance pressure is dangerous when it comes to anesthesia and it should never be the expectation, ever. And frankly, if it was whoever made that rule, if it was them on the operating table, would they want that rule? I just wonder, are we thinking about this clearly? I mean it’s so crazy you guys. Our medical system has gotten so gung-ho on profitability, profitability, that it sacrifices and bypasses safety. So you are that person to stand up and say, “No, this is not safe. We have to slow down and we have to do a thorough investigation.”

And don’t care who gets mad at you for it, it doesn’t matter. It’s funny, after that case that I refused to do where I called my reinforcements and got back up, guess what? I was thanked. I was thanked later. And I’m like, “Oh, well you’re welcome.” But it was disheartening to have it happen and I almost felt offended when they thanked me. That felt like a gut punch where I was like, “How dare you? I should not even be having to be thanked because it never should have been a disagreement.” That’s kind of how it felt to me. 

How irresponsible of the surgeon; why would they put you into that situation?

Don’t even get me started. It takes all kinds, but there are certain people who, I don’t know if they just don’t have a thought or a feeling for anybody else other than themselves, but that’s definitely what it seemed to be. Have you ever heard the joke of the orthopedic surgeon, “It’s a broken bone, I have to fix it.” It’s a broken bone. Well, they’re asystole.

Yes, I was going to mention that. I have seen that; I think that’s hilarious.

They don’t care. It’s a broken bone. I’ve got to fix it. It’s like that mentality of “I just got to pump out and make money.” And luckily that’s not honestly as common as I think people joke around about, but it does happen. You have to be that advocate; I love your name Advocates for Nurses. I mean, you have to advocate for yourself though too. And you have to advocate for your patient and what you know is right. I don’t care if you’re wrong.

Here’s another thing too- I think the reason why it hinders a lot of nurses from advocating is because they’re fearful of being wrong, then they’re fearful of being judged for being wrong and slowing down and delaying the process. I know that comes to mind in my own mind. What if I advocate or I say something and I end up being wrong and I look like a total doodoo head?

Who cares? That’s your own ego. You need to check that own ego. It does not matter at the end of the day, you’re just trying to be safe. And if it slowed down by 10, 15 minutes for patient safety, I’d rather be proved wrong. That’s another thing too, I got better about my later in my career; this is another example. I did a lot of thoracic cases. I did a lot of really big cases that were just cripply sick patients who had terrible baseline lung function.

But that being said, extubating those patients in the OR was incredibly difficult to do. And so I would always be like, “You know what? I’m going to get another opinion, another set of eyes. I need to get a second opinion because I don’t want to have to extubate and reintubate or potentially cause some harm.”

Frankly, what started happening was, I started earning more respect. I started being more trusted. But in the beginning, I remember feeling kind of bad about myself, not knowing if this is the right call and having to ask. So this is actually a strength of mine that I am asking because now it’s expanding my knowledge base; plus it’s allowing this relationship, this reciprocal trust between the surgeon and your attending to know that you are exercising competency.

And you know what they want? They want competent nurses. They want to know that you are competent. So kudos to you. And that should be one of the big takeaways. So back to my courses. You know one of my one a slide is check your ego at the door.

Oh, I love it. 

Check your ego at the door.

That’s the truth. It really causes a lot of patient harm and it feels bad afterwards too, because it’s such a simple thing to check. Well this has been amazing, Maggie. I would love for you to share some last tips with our audience on resources. Let’s just say, I mean gosh forbid, I’m knocking on all the wood and crossing all my fingers and toes, that you would never have anything happen.

The Role of Nurse Professional Liability Insurance in Protecting Your Career

But what’s really harmful is when something unexpectedly happens and you’re like, “What do I do next?” That would be what I would love to leave our listeners with as far as where they go to, who do they turn to, what do they ask? What kind of legal team do they need on their side if something, gosh forbid does happen?

There are two types of litigation. So as a nurse anesthetist, more likely than not, it’ll be a type of civil litigation. So it could be the lawyer from the hospital calling you to say, “Hey, you need to come on down. There’s been civil litigation, something has happened.” And so now that’s civil litigation. You as a nurse anesthetist, more often than not, and please correct me if I’m wrong, but you usually have professional liability insurance. Are you guys required to carry your own?

It depends; if you’re working as a 1099, you typically carry your own or through the National Association, the AANA. If you’re employed as a W2 employee, typically it’s included. However I will say, they will find every excuse under the bus to not cover you, so it’s never a bad idea to have a separate coverage.

So that’s what I was going to say. Then it comes down to a conflict of interest. If you’re the one who calls the wrongful death and it’s you in the hospital, who do you think they have a vested interest of representing, you or them? So just remember a conflict of interest. I would always be holding my own.

I tell LPNs, RNs, it doesn’t matter; especially you, yes, your organization, you are covered under respondent superior, but that’s the conflict of interest if it comes to you or them. So you should always have your own professional liability insurance regardless if you are a 1099 or you’re W2. So that’s my first takeaway.

And always ask them, “Do you underwrite for a nurse anesthetist?” Because what are you going to need if you are under a case? For them to pay for someone with your same or similar circumstance. And for you, that could be $450 to $900 for a nurse anesthetist to be giving their opinion in a written or verbal form about what you did or did not do. And if you don’t have professional liability insurance or if your company doesn’t underwrite for that, it’s out of network. It’s the same thing with medical insurance, right?

Legal Cases in Nursing: What Happens When Litigation Arises

If it’s out of network, then that’s on your dime, so you want to ask, “Do you underwrite for a nurse anesthetist?” Or, if you’re an RN, I don’t know what your audience is, so insert whatever your discipline is. Do you underwrite for an RN, LPN, MD, whatever it is; just more likely for LIPs. They normally do Licensed Independent Practitioners. It’s normally the RN and below that, they don’t always do that, but I would always make sure. So you should always pick up your own professional liability insurance; they’ll cover you for civil and for Board of Nursing.

Nursing Malpractice: You should always have your own professional liability insurance regardless if you are a 1099 or you’re W2.

So that’s the civil litigation. You need to make sure you’re talking to the legal team. You do have rights. I also wrote “Help I’m a Nurse and I’m being deposed.” I cannot help you nor talk to you if you’re in civil litigation. But I wrote that book; it’s a very short ebook. It’s just like 50 pages about what you should be doing. You should not be bringing up anything more. You only answer the question. Those types of things because civil litigation can cross over to the board of nursing, right? If there are deviations of the standard of care, the threshold of what you’re being looked at.

Are you referring to the legal team at the hospital that you would be talking to?

Yeah. So that would be considered the defense attorney for the organization that normally lives in risk management. They normally have legal nurse consultants. They normally have a lawyer. And so you’re not on the clock if you’re involved in a legal case and they’re like, “Hey, so just on your lunch break, come on Dan, and we need to talk.” No, hell no, no. Maybe on my day off when I can fully focus; what a legal case are you joking with me right now? No, no, no. I’m going to have to be fully focused.

Then if you open up the medical record, you ask for the petition number because that’s a HIPAA violation. You just don’t open up a medical record. “Hey Bob, lawyer Bob, what is that petition number?” And then you’re making a note and a medical record. “I’m here in legal with attorney Bob,” just something brief and the petition number, whatever.

Because when the other side looks at it, you’re going to be asked why you were in that medical record. And to your point, it’s a year from now, two years from now, do you remember? You don’t, but you’re going to say, “Oh, it looks like I was in legal and I was going over the case,” which you have a right to do.

I love that you said they’ll pull you from your typical day.

That’s the opening of my book. You’re just on the floor and legal calls you and you’re just like, “What the crap cakes?”

So ask to come in on a day off so you can dedicate a whole day.

But you’re clocking in, you’re clocking in because you were clocked in for that duty. So I’m going to need to clock in and get paid. It may be a different cost code. We all know, but I don’t care. But you got to figure it out. This happened in my normal workings. I wasn’t Sally Sue just in my everyday life. No, this in my normal job. So no, I will be clocking in. It might be under another cost center, but no, there’s litigation and I’m involved.

Now if, let’s just say you bounce someone out for five minutes or whatever, they had to go to the bathroom. You were not the primary provider, but your name is in the case. That’s way different than “They were the primary provider. There was a bad outcome.”

But you see what I mean? So you went down to legal, you saw, “Well, okay, I was there for five minutes. All right, I’m not really worried about it.” So then you see what your involvement is in that case because, if you were the primary provider and that patient has a bad outcome, I would be considering getting my own legal representation. But you have to take it very seriously.

And you’re saying don’t share anything, don’t even having discussions until you have your own representation.

Not necessarily. So I go down to legal and I find out that I am the primary provider. I can shut that down now and I can see I probably need to get my own legal representation. Versus- I did a blood sugar or I bounced you out for lunch. I’m not really worried about it. What questions do you have? I was here for five minutes and I didn’t deviate from the standard of care, so I’m not as worried about it. Does that make sense as I answer that question?

Board of Nursing is different, you get a complaint from a Board of Nursing, you get a letter that says on or about this date, this is what you did. It’s different from civil litigation. That’s a different lawyer. You’re still going to go to your professional liability insurance and you’re going to ask for a list of the administrative lawyers in the state. Then you’re going to call ideally a nurse attorney and me and I’m going to give you the education.

What’s going to alleviate your stress? It’s no different than when a patient gets diagnosed with diabetes, we don’t push them out in the world with a new diagnosis. I have 73 templates covering “What does it mean to be under investigation? What are agreed orders?” I meet you where you are in that process.

It’s going to be very overwhelming, and that’s going to be a very unnerving piece of it. This could be two to three years of your life and you can’t even begin to understand that this is not a fair nor just system. You can’t talk to just anyone and you have to get legal representation, especially as a nurse anesthetist.

Okay, thank you. And then your mention of making sure that if you open the chart, you have to get HIPAA approval or documentation.

I would, right? Because again, now you’re sitting in a courtroom and you’re being asked why you opened up that medical record. It is a HIPAA violation to do that. Now you were doing that, but do you remember that? You’re already unnerved. You’re in a setting that you’re not comfortable with. You’re on the stand or you’re being deposed and you’re being asked about things that are okay but you don’t remember.

And it is now the jury is the people at the Walmart, the Walgreens. Let’s all go back to the Johnny Depp case. I’m not here to talk about anything, but it’s theater. It’s a theater. You’re in a courtroom and the jury are not people who understand. All they hear is like, “You violated HIPAA.” Do you see what I mean? And so just make sure you’re dotting i’s crossing t’s, here’s the lawyer, the petition number.

This is so stressful already to think about, because the stress is there, so it’s like you’ll miss these steps already. Like what? Your mind’s already out of it. You’re not thinking rationally when they’re trying to talk to you. And I’m also going to leave this with one other share, and I am not proud of it. It was a learning experience. I take it as that.

Social Media, Cell Phones and Nursing: Avoiding Costly Legal Mistakes

During covid, everyone was sharing everything on social media. Well, you better believe people can easily get fired for doing that. I don’t know if people who do follow me now notice, I never ever post anything about me being in the operating room ever because that actually occurred, where I got in trouble for sharing something on social. It blew up my face, that occurred inside a hospital system.

I was told directly from their legal team, any picture, anything, we own it. So you have no right to share it on social media. We own that property and you have no right to share it.

And you know what they do to nurses? They could have reported you to a Board of Nursing and you would’ve been disciplined by a Board of Nursing and there would’ve been nothing that you could have said.

Correct. And the thing is, I think that’s happening more than we realize with how out of control it’s gotten on social media. So I just want to also exercise caution. Be very, very careful. I know a lot of it’s done in no harm, no foul, but it can bite you. So I just want to share; that was not a very proud moment. It was very upsetting to find out what occurred.

Nursing Malpractice: I never post anything about me being in the operating room ever because that actually occurred, where I got in trouble for sharing something from inside the hospital on social media.

Essentially what happened is someone took something that I had shared, they zoomed in, and I mean thank you cameras for being such high quality; they literally found a picture, zoomed all the way in and found something in the background that got me in trouble. It was something that I never, in my wildest dreams, thought someone would zoom all the way in, but people are cruel on the internet.

It was actually another nurse who did this to me, not from the anesthesia community. People are cruel if they want; I don’t know what it is, but people are just not nice. Luckily it was never escalated to the Board of Nursing, but it was enough of a scare and also got me in trouble with my employer. And so yeah, I knew better. I held myself completely accountable for it. Meaning, shame on you, Jenny. You should know better. And I walked away from it knowing more.

It was a lesson that stuck with me; now, as I try to share with all of the mentees I mentor, SRNAs who want to share their journey. Gosh dang it, be so careful. You don’t want to get removed from your program and all your hard work is worth nothing. So it’s not worth sharing. Do it in your car. That’s totally fine. You don’t need to be in the operating room. Just be so careful because it’s just not worth ruining your life over something so silly as a social media posts. Trust me.

And then just one last thing before we end, because with the advent of AI and using our phones, now you’re talking about two things. You’re on your phone and now you’re on the wifi and if you’re doing that stuff; because it’s not secure. Let’s look at home health nurses- now you’re on wifi and you’re documenting, and that wifi is not secure, but so you see, you’re on your phone, you have stuff on your phone, and now you’re on an unsecured wifi.

You see what I mean? This can get really tricky and I’ve seen this in legal cases, so you have to be really careful. I tell nurses as a rule, why are you on your phone? I don’t let doctors text me on my phone. I don’t let them call me on my phone. No, no, no, no. That’s discover. That is not legal. You will be disciplined.

Oh gosh. Well that’s terrifying to know because that’s a routine even where I work now, where they text you, “How’s the case going?” Nope, I’m not even joking. Well, because they don’t provide you phones. So it’s either that or they have these vaults I think they call them, which I don’t even know if they still have them anymore. I think they’re getting rid of them. I don’t know. But it’s very common practice.

A nurse who stood next to me in the cath lab, his wife got disciplined by the Board of Nursing. She worked for, I want to say was the American Heart. She didn’t have her phone locked down and stuff. She got reported and she wasn’t even sharing patient information. But you’re not allowed to use your personal device to do stuff. And I mean, what nurses don’t realize is that we have normalized this; so I tell nurses, “Don’t even get on your phone. Why are you on your phone? Stop it.”

Don’t even bring it in because now that is mine. It’s discoverable. Now you will be handing over that phone and the policy says you’re not supposed to be doing that. So now you’re deviating from your own policy within your organization and now you have no defense. It’s not standard of care, it’s not evidence-based science, it’s not research. The expert’s not going to say that. And now your own policy with that facility you deviated from, do you see what I mean? And they normalize this stuff. They allow it, it’s just not right.

Oh my gosh. Yeah. And unfortunately what I was going to add too is essentially they can search your phone, but again, you got to be careful with what they would find in there. Like you said, I think I’ve seen a lot of times, even with a student for example, they’re like, “But I was on the Vargo app looking up information. I was trying to read a text,” and I’m like, “From a distance, we don’t know that.”

And I always try to warn students, if a CRNA looks in a room and they just see you on your phone, they assume you’re doing something you shouldn’t be doing. Not looking up drugs or medications. It’s become common practice now to use apps on phone to look up the dosing and for example.

Your job, if they need you to have something, their requirement by law is to provide you with that. Obviously not a stethoscope, but if it’s required for your employment; you’re not bringing the monitor to hook up their EKG and stuff. So it’s the same situation. We just don’t realize that as a cath lab nurse, yes, there’s an iPhone that the person that’s making all the calls is using and we have pagers, right?

No, you can call the cath lab iPhone, the semi phone, and you can text on the semi phone. But you’re not calling me on my personal phone. You’re not texting me on my personal phone. No.

Oh gosh, yeah. But people routinely like texting you like, “Here’s my number. If you need anything, let me know because I’m going to step out of the room.” And that’s a common practice, which is really alarming to hear that that could be held against you. When they don’t provide you anything else, that feels like your only option. Okay, well, Maggie, I am sweating over here. 

I’m so sorry! I love my people.

You guys check out advocatesfornurses.com. Check out her documentation course, check out other her templates. I mean, Maggie’s a wealth of information and if you guys should ever, and hopefully not, but if you should ever need anything, please, Maggie is your girl. She’s wonderful.

As you can see, she has a huge heart; she cares for you and your practice and just generally for who you are and your happiness and your career fulfillment. So thank you Maggie, so much for being on the show. I appreciate you and I hope to have you on again because this was wonderful and I know it provided so much value. So thank you so much.

Thank you, thank you. And all the work you do, appreciate you.

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Well, that wraps up today’s show, future CRNA, part one, part two, done. I hope you gathered so much value from today’s show. I know it went in so many different directions. I had a lot of fun recording it. Maggie is so wonderful. Advocates for Nurses. Be sure to check out her site, check out her courses, check out of our legal templates. She is your girl.

If you need anything that has to do with Board of Nursing or any kind of civil suits, hopefully never. But she is someone you want to connect with and have in your back pocket, to know as far as a valuable resource in our community, it’s going to protect you and advocate for you as a nurse. So again, be sure to check out advocatesfornurses.com. She has a documentation course that I think should be a staple so you can learn how to protect yourself, especially with documentation.

That’s a step number one as far as making sure that you are protecting yourself legally as a nurse, as a CRNA, as a current nurse anesthesia resident. This is such a valuable show and I hope you enjoyed it and I appreciate you, rooting for you future CRNA. Thank you for tuning in and we’ll see you real soon. 

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