Episode 1: Nurse Advocacy

This transcript was generated automatically. Its accuracy may vary.

Cara Lunsford

Oh, hey, nurses. Welcome to the Nurse Dot podcast. Giving nurses validation, resources and hope. One episode at a time. So today on Nurse Dot podcast.

Maggie Ortiz

You know what? I'm not called a nursing. I'm called a nurses. I am called to make change. If a nurse is under investigation by the Board of Nursing. I help them and their legal team. Because nurses, they just don't understand the process. You don't think that that's going to ever be you? And then it is.

Cara Lunsford

Joining us today, Maggie Ortiz. A dynamic force in health care advocacy in a world where nurses are constantly feeling the pressure of a strained health care system. Maggie, a nurse by profession and advocate by choice, tirelessly champions for nurses rights and is committed to bettering the world of nursing. I'm your host, Kara Lunsford, registered nurse and VP of community at Nurse Icon.

Oh, how are you? Maggie Ortiz.

Maggie Ortiz

I'm good. I'm good.

Cara Lunsford

I'm excited to introduce you to the nurse podcast audience. We had the opportunity to meet a little while back. I was really blown away by the work that you're doing, how you're helping nurses, the advocacy that you're doing for them. Nurses are patient advocates, as we know, so it's important that we have advocates for us. So I wanted to just take a second and have you tell us just a little bit about yourself.

You know, how long have you been a nurse? And maybe you just quickly, how you got into this profession of just advocacy for nurses.

Maggie Ortiz

Sure. So I've been a nurse for 23 years. I spent the majority of my career as an associate degree nurse. And I think that that's important to pause because there's, you know, it's not always the end all, be all to have a master's degree. I did go on to get my master's because I was being tired, being told no.

And everyone who was a nurse who's got an associate's degree knows that journey. I made the bridge. I did AT&T medicine, I did a leadership degree, and I don't even know why I'm never going to be in leadership. But I chose to write my thesis in procedural situation. I was working primarily in the cath lab, the procedural areas, and I felt like we were being mis utilized as our end and not anesthesia wasn't involved enough.

And I felt like it was putting once again a nurse in a place where it wasn't safe. So during that time, I also was at the border nursing. I had been practicing for about 15 years, ICU, er pre-op like you and I are cath lab travel local had just kind of done everything but labor and delivery by choice.

And then what I would call traditional operating room. I've done a lot of procedural but not traditional and I'm not an owner. And so I crossed over to the Board of Nursing. I was an investigator. I applied, got the position. I left a freestanding emergency room because everyone knows I was just tired of it, was there for about six months and became obviously very intimate with the rules and regulations.

I had a badge and I was just not feeling like nurses were getting a due process. And that kind of changed me. I then I only stayed about six months. I left and I went and stood in front of my representative, sort of reaching out to the governor and just asking questions like, Who oversees the Board of nursing?

No one. No one oversees the Board of Nursing. And I'm like, Wait, what? Wait, wait, wait, wait, wait, wait. Pause. I was like, No, I mean, but I was not real. And then I started just like, diving into administrative law, what that really meant, because that's what we fall under when you get handed that license and you're not taught this enough, you're now practicing under administrative law all along with civil and criminal.

And oh, by the way, which is not stress enough either. And then I started working with I crossed over to civil. So I was on LinkedIn. A legal nurse consultant reached out to me and said, Hey, I have a case. And I don't remember if it was like ICU E.R. when you look at it. So just using my investigator training and what I already know as a nurse, I just looked at a case because you only come at it as unbiased and there's always a family and a patient tie to that.

So I never took anything that was, you know, I couldn't give an opinion on the nurses conduct. And sometimes the nurses did nothing wrong. And I was more than happy, again, unbiased to explain that to the attorney. Then I crossed over into administrative exper where if a nurse is under investigation by the Board of Nursing, I help them and their legal team.

And that's the space that I'm in right now because nurses just don't know what they don't know. And I call them the one percenters, and still it's too late. So I just dropped a lot there, but I wasn't called to nursing. I got pregnant at a young age. I left home, I was going to join the military and they're like, Oh yeah, sign right here, your child away.

And I was like, Negative. I started Community college. My grandmother was in the ICU at the Cleveland Clinic and my cousin was a nice nurse there and I was like, No, this is what I'm going to do. I'm going to be a nurse. So I went to the ICU and then still not feeling like I was like called I wasn't like five or six with a stethoscope.

My mom wasn't a nurse. Family of 100 of nurses. It wasn't until I was at the border nursing and I saw that that I said, You know what? I'm not called a nursing. I'm called a nurses. I am call to make change.

Cara Lunsford

I love.

Maggie Ortiz

That. I know what that means. But when a nurse calls me and she's sleeping in her car, you know, like I can't charge her for that. Like, what do you need? You know, how can I help you? Because most times they just don't understand the process. The nurse will reach out and they've had allegations I've been holding on to for six months.

We're like, Yeah, the border and reach back out to me. I said, I'm not obligated to. And now you've been formally charge. But sometimes it's just the lack of education because when you're in nursing school were briefly told about this entity or the rules or regulations, you're drowning care plans and medical terminology, and that's not going to be you because you're not, quote unquote, a criminal.

You're not going to quote unquote, ever do anything wrong. So you don't really dwell here. You don't think that that's going to ever be you. And then it is.

Cara Lunsford

Yep. And I think, like, that's why it's so important. And you clearly were put on a path to do this because you put yourself into all kinds of nursing situations. So you weren't just in med surge or you weren't just in ICU or you weren't just in the E.R. you really took it upon yourself to become very knowledgeable.

Aside from O.R. in L.A. with a lot of areas of nursing, which I think first and foremost, kudos to you for just like getting up and leaving and and discovering and being curious about other departments, because I'm sure that you lean in on that information a lot.

Maggie Ortiz

Yes. Yes. I hate to interrupt my. Yes, yes, yes, yes. And let's just pause here. You know, like you're stating, leave your comfort zone nurses, get out. Leave or don't stay in one place. Or you could stay in the same hospital. Absolutely. Don't leave that facility over to go to another unit float. You know, as long as you get the proper training, I tell nurses float, but make sure you're going to that unit and you're getting whatever you need.

That may be three months, right? Because again, you're really crossing over. If I'm going to labor delivery, I'm get my three months. If I'm going from ICU to step down or to, you know, I might not need that long. I'm having to learn to manage more patients. So maybe in the med surge because now I'm managing five or six patients, I might need that full three months because I'm going to have to throttle back my critical care.

I'm doing all these crazy assessments to just a broader. But that's something I have to be taught maybe how to do.

Cara Lunsford

Yeah. And so I'm going to kind of piggyback on what you said for a second about how you don't have to leave your institution. You can start branching out, learning new areas, new specialty is within your organization, and then at some point that's going to give you that's going to make you feel empowered and kind of courageous to make those bigger moves, which might be too another area outside of the hospital, maybe where you want to explore home health or hospice or you want to explore a whole other area of nursing and that kind of baby step into those smaller discomforts.

You know, embracing those different discomforts allows you to make those bigger moves where you can leave your institution altogether and go and explore something else. And I think the really important thing that I'd like to add to that is what I learned is that other institutions have different rules, different policies, different procedures, and suddenly and this is what travel nurses benefit from, they start to move around and go, Oh, you know what?

It's not a one size fits all. I learned pretty quickly if a patient was discharged from this hospital over here, they might be discharged with 300 units of heparin in their port. Cath, you know, and that's what they used to lock. And then another patient gets discharged from a different hospital and suddenly it's 500 units when you only stay in one establishment for too long, you start to think that your way is the right way.

And that's not necessarily the best, in my opinion. Personally, I think that, like, it's much better to understand that, hey, you know, 300 units of heparin is fine for a board of Cath. 500 units of heparin is also fine for a port. Guess they both work and they're both okay and they're both safe. And because then it allows someone like you who has all of that experience to be able to go and look at scenarios and go, Yeah, you know what?

That person do anything wrong because you're more informed.

Maggie Ortiz

Because I saw the the CAT scan 500 different ways and evidence based science because again, the rural hospital does not have the same resources as the big university. They don't. But that doesn't mean the level of care cannot be the same. It's just you may not have the $500,000 piece of equipment as opposed to something that's maybe refurbished, but then you're relying on your skills.

What you know what? And again, it's your eyes, ears and whatever it is, because that's a good nurse. You're not relying on what the monitors saying, stop it. You're looking at the patient. And that's why I teach nurses all the time. I mean, you know, you have a noninvasive pressure on a patient that's decompensating. That's a tool because what you need is a line and you get the material on.

You're basically just turning that is not going up or down because that's what your biggest worry is. But you need to be able to rely on that. And then that just makes you more confident as a nurse that just make sure builds your nerve soul and then you can you go somewhere else, you get exposed to something else and you've said, you know, I want to do that.

And then that's where work life balance comes in. Your I was in the cath lab and one of the nurses, my kids, and she didn't want to leave the lab. And I was like, you know, the clinic kind of job. Open it. Let me show you. She was missing out on the things that she wanted. Are taking our daughter just, you know, her kids in school picking at the soccer game.

Because when you're look at working in the cath lab, you have to be 30 minutes away from the hospital and you're not you can't you're not doing anything else. So it's I was like, go somewhere else. Go take care of your work life balance, because that's not the end of the day. Your that's your job. It's not your life.

So figure it out for yourself. Future nurse role and then figure out your life. Because nursing is so vast, you want to work remotely. There's something out there you want to work. There's, like I said, home health. There's something out there. You want to be in the hospital 100% on and what fits you. That's but again, we are amazing people.

Cara Lunsford

Yeah, I think that we're very capable people, so we tend to take on more than sometimes we should.

Maggie Ortiz

Yes.

Cara Lunsford

And stretch ourselves a little too thin. I like to say sometimes, like just because you can doesn't mean you should, because there's a lot of things I can do. I'm a pretty capable human being. I've put myself in a variety of situations, everything from bedside to management to building a company, selling a company. So there's a lot that I know and and can do.

Does it mean that I want to do it every day, all day, all three of those things or four of those things all the time? No, I don't. Right. So I think it's really important to take a second to evaluate like what you were saying, what matters most to you, where do you get your joy? What fills you up?

Because you're going to make better, safer decisions for yourself. And hopefully you're not going to get into a bad situation. But that being said, there's only so much we can do to try and practice professional boundaries and all of that so that we can try to keep ourselves out of bad situations. But then there's stuff that's like outside of our control, that's policies that are at the hospital level, and then there's staffing ratios and acuity based staffing and all of that.

We can practice our professional boundaries like we can say, No, I can't take that patient. We also have to remember that like these nurses, this is their livelihood and it's hard to say no, maybe there's no other hospital near you. Maybe you live in some rural area where there's one hospital that's within driving distance of your home and there's not a whole lot of opportunity for you as a nurse.

So that's tough. Like that's a tough situation. What would you say to nurses that are in those situations where it's really hard to practice those professional boundaries and not risk losing their whole career?

Maggie Ortiz

Right. And there it is. Is is unfortunate. We are a place where people, like everyone knows we're down to these other nurses. Michel Christian I have stood in front of three different courts, or maybe the civil one. They just wrote a check, but they got their ankle bracelet off on the 1st of December. So that unfortunately is the worst case scenario for us right now, because you cannot stand in front of the Board of Nursing and say, they told me absolutely not.

And my state 1514 is a position statement that was passed in 1983 that literally I'm going to quote says that I have a duty to the patient that supersedes the hospital policy or physician order. So we have to unite. We have to collaborate. So you're walking into a unit and I always say you're going to be respectful. You have to know the rules and the regulations, and you're going to have to put things on your purview.

Like if you see the schedule is out and you know that there's not enough nurses, don't wait till that day or I take some responsibility. Right now, we're just in a sensitive place. I'm going to my leadership and I've done before. I was on call with someone I didn't know who was. I'm not going to stand next to someone at 2:00 in the morning and not understand what their modality is and what they do in their experience, which turned out to be they had never taken cath lab call and we had to make arrangements.

But you see how I didn't wait till that day, but I went in a respectful manner and again I went to this person again and just said, This is not about you, right? It's about the person on the other end of this. Because if you don't even know what a STEMI is, you can't stand next to us at 2:00 in the morning.

So looking at the schedule. Okay, so I see on Thursday we only have two nurses and we need seven. So open that up with leadership saying What are we doing? Because that could take time to get another like someone inside the facility. Maybe someone flows down to your unit, try to be part of the solution. Maybe you have to reach out to a local agency.

Maybe there's been a PR nurse that you know, Hey, what do you think about working these days or whatever you got to be part of the solution. That being said, they're still trying to force you into an unsafe assignment. If you're in states like Texas and New Mexico, you got to find a safe harbor. If you're union violating a ADA, which is except despite objection, I don't come from union.

So some of these words I don't know, Ada, but it doesn't protect you from the border. Nursing the ADA was something else that's driven by the union, by the hospital. Association has nothing to do with the Board of Nursing. I tell nurses they need to understand that the definition of medical malpractice is knowingly and willingly taking on an unsafe assignment.

That's not defendable. And they're going to call a work nurse like myself, right? Who's going to be slinging around policy and quoting peer reviewed articles. I'm not telling you. That's right. But there's a plaintiff and a defense side to every single case, criminal and administrative. And we have to unite. We have to stand together. Maybe that means union people have their opinions about unions is do I know, am I big on union?

I don't know. But what came first? The child labor, The child labor laws. We're just in a place where I don't know the hospitals. We already know these organizations don't have money, and we just know that means that we are the low man on the totem pole and it directly affects us. I stand in front of my representatives.

I stand in front of the public Health Committee. You can't make complaints. And then you're doing what? And it doesn't have to be anything. That's crazy. Your you're a mom, you're single mom. You're just trying to manage. This is a 15 minute email to your representative. This is nothing that's crazy. You know, Twitter or Facebook, whatever it is.

This is a phone call. This isn't something that's crazy connecting maybe with one of your nurses associations, because, again, if they're already trying to push for some legislation and you don't have time, donate to them so that they're pushing for violence bills or staffing ratios. Look at Oregon. Look at Oregon. Just did. I mean, that was done by nurses.

But if we don't unite and stand and not ask for what's ours are going to be given it. It was nurses who took it their right and asked for it is verbal in my state now you can say it verbally and at the end of your ship you just have to fill out that paperwork. But that was literally done by the Texas Nurses Association.

Cara Lunsford

So where do you think this? Because I always say, like if I wasn't a nurse, I probably would have studied sociology because I think people are fascinating and how we tend to behave and how we will be reactive and how we will have a victim perspective of things. This happened to me and also for me just personally, I've started looking at just changing simple verbiage from this happened to me to this happened for me and just changing that one word, like just catching myself in the moment where I say, All right, instead of saying like this happened to me, when you change the perspective of it and you say this happened for me, that means

that that's an opportunity, that you had an opportunity to learn from something, to make different decisions in the future, and that it's really just more about opportunity. And so I'm always constantly trying to think of ways and new ways to communicate that with nurses about, look, just think about what you're doing. Think about how you could be more empowered instead of going, Oh, you know, I go to work and all of this stuff happens to me.

And they gave me this terrible assignment and they did this and they did that. And it's like, okay, well, this might be true that all of these things happened, but what role did you play or what role did you not play in this? And when you're talking to nurses, like how do you level set with them in that way where that maybe they come to you and they feel super victimized?

What is your what's your message to them? How do you start that conversation?

Maggie Ortiz

So first, to empower them to like start with the Nurse Practice act. We walk through whatever is happening and then I'm like, Well, let's look at the policy. Have you pulled up a policy? Have you sat down with your leadership? Because sometimes even nonverbals like take a folder of that open and have the nurse have some policies out.

Because if you're saying, for example, that this assignment is not fair, well, what does that mean? You know, I mean, don't be vague. You know, let me pull up like Oregon and California have like a staffing that's based on research. So if you're going to use something to talk about, maybe like a staffing group have a tool that is a tool that that's researched, right?

It's passing the law in two states, right? So that's a guide. So I tell them, introduce yourself, because not only that, that empowers you. You know, if they're asking you to take like an unsafe assignment to 17, 11, you know, s and T for me. So you're asking me to violate that. So I help them because again, if just like you said, if you carry the victim and that's the purview that you're going to be doing everything through and you have to change that lens and power yourself.

Because if you're sitting in front of them, because oftentimes leaders don't know as well and not being disrespectful, but oftentimes we even see a nurse who's been in practice for like two or three years, and then you see them as managers and you're director and you're like, how how you have what? You've been here for 5 minutes. That's not even real.

So oftentimes educating them about, you know, what's out there. But I think that empowering yourself and then if you need to leave that job, you need to leave the job. You know, Laurie Brown, she's a nurse, an orange A.D., I mean, in her book, she talks about that, you know, she's dealing with who the nurses that have been reported to the Board of Nursing and are under investigation.

So she sees has been real clear. There are some consistencies. Right. If you're at a place and they're writing you up and you feel like it's retaliatory, you know, sometimes you're not going to be a better environment. And just like we talked about, maybe it's just not that unit, you know, traditionally and I came from the ICU, so I totally feel it liberating, talking about this, but I can sometimes be the mean girl unit, right?

So go somewhere else. Maybe you just don't get there or go somewhere else. So start empowering yourself with some tools. And just like you said, move out of the victim role. Sometimes it is a little work and if you have been wrongfully terminated, then going through those channels, there's, you know, the National Relations Labor Board. If there was a violation, there was a violation.

You know, make sure that you have the employee handbook and what that means. But just making sure that you're empowering yourself and always be respectful. You're a professional, you know what I mean? I'm big on upholding the integrity of our profession. I have no problems whistling around some code and stuff, but I'm showing up trying to make resolutions.

I don't pull that stuff in until I get pushed or I don't do that. That's not respectful.

Cara Lunsford

I love that because I really think we have to lead. And I had this conversation yesterday when I was interviewing somebody for the podcast, and I was talking about how shame is rarely ever, if ever, a useful tool. Correct. So shaming your administration, shaming your managers, shaming anybody into doing what you want them to do or making the changes you want them to make, rarely, if ever, is going to work in your favor.

And it really just doesn't serve the greater good. It's like education. Empower yourself through education and assume positive intent. Assume that the person just doesn't know. Let's start there. I mean, if you've educated them and you've told them and now you know that they know and they're still choosing to make certain decisions, then too, what you're saying is leave.

Maggie Ortiz

Yes. If you can take it up the chain of command, depending on what it is, but then you know what kind of environment you could possibly make. And as a nurse, you, for the most part, have other opportunities. And if you truly want to stay within that organization and I'm not always telling you this, it's fair, right? You and I both know I'm 23 years in.

I'm not always telling you this stuff is fair. It's just reality. So dig in. I'm. I'm you. Sometimes you just have to make the most of what your environment is. Read the room as I like to say, Read the room here. If you know that if you take that up the chain of command, you're just going to be retaliating by your manager.

You need to do some self-reflection. Is it worth it? Or, you know, I want to go to labor and delivery or I would like to try out the emergency room and maybe I do this now. I don't burn this bridge because she's not going to let me go or he's not going to let me go. I'm just going to gracefully, you know, transition in to somewhere else, reach out to another manager, start picking up a maybe a shift or two down there and just say, hey.

And then now they see where you are and then you just transition over. But you have to be professional. You have to way too many options of the nurse, Way too many.

Cara Lunsford

Yep. You have to be smart and strategic about how you do things. And so sometimes when you're working to move somewhere in your life and you want to elevate in your career, you know that burning that bridge is not necessarily the right thing to do. You're like, okay, I'm going to strategically, I'm going to play this game. I always tell people, I'm like, you know what?

If you want to learn how to read people and be very strategic, go learn how to play poker. Because I'm a poker player and there is plenty of times where I have used strategy poker face. I've read that person and I've played that person to my advantage so that I can move to another area where I know that I'm going to be more well suited.

You can call that whatever you want to call it, manipulation, you know, whatever it is.

Maggie Ortiz

And this is a game. This isn't a short game.

Cara Lunsford

No, but you have to. I'd like to. What you said is read the room, right? No, people read people and then know how to leverage those relationships to your benefit so that you can do the work you were put here to do. You know, it's not like you're leveraging or manipulating so that you can go out and steal and pillage and, you know, do something horrible.

You're leveraging and and strategically being very strategic so that you can go and be the best contributor to health care that you can be. And so I think that that's really important information that you just shared and.

Maggie Ortiz

That it's investing in you because you and I know and maybe some listeners don't don't know, statistics show that the first year 30% of nurses walk away from nursing, walk away from their degree, second year up to 60% walk away from their degree, like never work in nursing again, not go to another unit. Not so don't. If you rarely know this, then start setting yourself into positions where that's not going to be.

You. We know burnout is real moral fatigue. And you know, there are a lot of words out there being slung around and post code and we know what's happening to our people. So if you're starting to recognize that there's nothing wrong with saying, you know what, I need to move to a different area, I need to do something else.

You know, I'm teaching my nurses how to transition over to legal nursing because that's like the other question I get asked all the time. I'm like, there's a litany of things that you can do and you don't even have to pay for it. I went to the border nursing and I was trained as an investigator and they paid me to go.

And then that crossed over into where I am. And a decade later I'm not doing what I was doing initially. So just know, especially if you've been in nursing for over five years, ten years, start looking around, you're magical. You can do things honestly, any time you learn some legal stuff as a nurse, it's you're protecting your license.

And I'm huge on that. Once you learn some legal stuff or you read the case, you're like, Oh, oh, and it does. It just changes you. It changes you for sure.

Cara Lunsford

What is one of the things that you think nurses and it could be new nurses, it could be seasoned nurses. What's the one thing that you see nurses do all the time that puts their license at risk, that they just have no idea that they're doing.

Maggie Ortiz

Consent patients.

Cara Lunsford

Consent patients?

Maggie Ortiz

It's not within your scope of practice. I read from nurses in the law, you know, Nancy Bryant wrote that book, and that's one that I talk about. You're not providing informed consent, are you? You are not, because that means that you're talking about diagnoses and the treatment plan and even consenting for blood. I'm like, you're not consenting a patient for blood because that's tied to a diagnoses that you're not talking to the patient about.

The physician has gone in and provided them with informed consent for the blood transfusion. Then you're coming in and witnessing it, which the housekeeper can do. Other people can do like a fine, a procedural sedation nurse. The physician comes in and talks about write your case, say the cath lab. I'm in the cath lab. I'm doing the conscious sedation.

He comes in, tells you about the procedure. You're going to get Twilight, whatever it is. Then I can come back in and have you fill out your the box for conscious sedation. I'm the one administering it. I'm the one who has the additional education under the physician who has those privileges. But physicians still gave the informed consent as the provider.

I'm just going over there with you and then you're witnessing your signature and that is it.

Cara Lunsford

So this is where nurses are working outside their scope of practice.

Maggie Ortiz

And I'm not talking about frequently. Often, often, and I've seen this as a travel nurse. I went to interventional radiology where none of those nurses had worked, any other departments had worked other departments, I'm sorry, had never worked. Interventional radiology outside of just their right. And this we've talked about this, right. We just talked about this. So they didn't realize that they were not supposed to be consenting patients for these procedures who had never seen the interventional radiologist.

They had seen their hematologist or whomever had sent them for the consulting services to have the procedure that the interventional radiologist was going to perform. And the nurses were coming over to prep. And I was like, Oh, not me. That's not within our scope of practice in any state. You're not allowed to do that. And they had pains and I was like, No, you asked the P.A. to come over and discuss the procedure that the interventional radiologist is going to do.

Then I walk in, Hey, you know, tell me your first and last name some identifiers for the consent. Do you have any questions about the doctor said, are you comfortable? You know, I even hand the patient the consent form and if they want to read every single line. Absolutely. You know what I mean? That's their right, you know.

Do you have any questions about that? We look at the wrist, you know, where they're supposed to initial and then I'm witnessing their signature. The dates on that is all if they have questions as a heart. Stop. Let me go get the provider. Sir. Ma'am, unless it's something basic. How long is the procedure? Now? I can talk about that kind of stuff, but it's very specific to the procedure or the outcome or that.

That's not my lane. No, no, no, no, no. And I've seen in civil cases and now it's up on the big screen and I've seen this. And then the nurses asked in a deposition, who consented? The patient. Oh, man. Filled out wrong and didn't even have the right procedure on it. Now it's on the big screen. Oh.

Cara Lunsford

God, it's just so painful.

Maggie Ortiz

It is.

Cara Lunsford

I think about blood transfusions. How often? That's probably a major one. That's like an easy because the nurse is the one administering it.

Maggie Ortiz

Correct.

Cara Lunsford

So I think it's very cloudy right there. Kind of like one. The one giving it. It's like it makes total sense when there's a surgeon or there's someone else who's administering or doing the actual procedure. You're like, Well, clearly I can't consent that person there. I'm not even the one doing it. But when you're actually the one administering blood products, But they haven't been explained why they're getting blood products.

Maggie Ortiz

And they're just what's the diagnosis tied to? It's just like you're not prescribing a medication, you're administering it, and you can talk about the side effects, but you're not the one writing for the physician. Is writing the order for the blood transfusion and the indication for that. And even some people don't think about as well because like, if it changes because like, if the consent form is good for 30 days, see the indication changes.

Really the provider needs to go back in and discuss why you're getting this new. You know, that's like cutting hairs, but it is the responsibility of the provider to go in because again, this is a poor example. They almost come to mind. It's a trauma. You need blood for a different reason than say, your and you also have cancer that's causing you anemia and you're in the hospital for like 30 days, you know, under 30 days.

Now you need a blood transfusion related to your cancer. A truly is a different consent form because the indication is different, correct? Yeah.

Cara Lunsford

I mean, I'm going to give like a hypothetical right now because this is not this is not anything that has cancer.

Maggie Ortiz

Yeah, I know. But I need legal advice. Yeah. So.

Cara Lunsford

Yeah, we can't give you.

Maggie Ortiz

I'm just a nurse.

Cara Lunsford

You're not just a nurse. Not just a nurse, but the hypothetical I'm going to put out there. The reason why I'm putting this out there is because I want nurses who are listening to this to see themselves in a very real situation. Because I think a lot of times we're like, Oh, I would never do that. Really? Really?

You'd never do that because.

Maggie Ortiz

Don't judge other people.

Cara Lunsford

Right? Because imagine this situation, right? Like, imagine and I'm going to just say like a pediatric oncology, because that's my area of expertise. So let's just say you're a pediatric oncology nurse and you have a patient that needs a blood transfusion. They have like their hemoglobin super low. Let's say it's like under seven, right? Let's just say that it's under seven and they need to get chemo later that day or no, let's say that they need to get radiation.

They can't get radiation as their hemoglobin is above ten. And so you're pressed for time. You're thinking like, I got to get this blood transfusion done. They have radiation at this time. If I don't get the hemoglobin up, they're going to miss the radiation. It's Friday. That means that they're not going to have it's not open until Monday.

So not going to be able to do it until Monday. There's somebody in the room, looks like an adult and you're like, I just need you to sign this blood transfusion consent. I need to get, you know, the hemoglobin A patients going to radiation. You get the person in there to sign it. The doctors, not they're not involved in this conversation.

And you find out later that the patient is actually a Jehovah's Witness and that the family now is like saying, I never consented to that. I would never have allowed my child to get blood products. I would have said, you know, that they needed to wait or get procreate or they would need something else. But I would never have agreed to this.

And that's something that if the doctor had been one consenting, that may not have been missed. But I would say that this is a very real life scenario where you can get caught up in the things you need to do and the things that you think that patient needs and that what's best for them. And it can cloud your judgment and you could find yourself one of those situations.

Maggie Ortiz

That sounds like a very legitimate situation and it's not defendable and the hospital would probably have to sign a check. Now, imagine the worst case scenario. And, you know, that's what I tell nurses as well, because again, it's nurses are out me that patient died. And now do you think that that physician is going to stand next to you?

You think the hospital is going to stand next to you? You took the liberty on your own and that's what they're going to say. Do I know that 100%? But let's just say 5050, you have a 50% chance that they're going to stand next to you, which probably not, and a 50% chance that they're not. Now, you get reported to the Board of Nursing that's not defendable.

That's, you know, and then wrongful death. And the other thing that I tell nurses now, you'll do your restitution, you'll pay your fine. Now I want you to look at the family. They're not going to put that down. They're not. Yeah. And that we can't have that. So sometimes we do have to take a second step back, paused, and then just making sure that you are doing again.

You and I both know I've worked in the emergency room. I worked on the E.R., the cath lab. You can get caught up into things. And that's why I like stop the line, Time out. All of these things were put into place, and that's why we're all oftentimes a little negligent cutting corners. Right. But that that's when there's a huge swing, like being mindfully negligent and then grossly negligent in that you just that willful wanton, which is what makes it gross negligence.

Cara Lunsford

Give an example of what mindful negligence looks like and gross negligence. So just get get I mean, give like an example because I think people who are listening to this, they're like, I don't know, did I do that?

Maggie Ortiz

Like cutting a corner? Like you said, we cut corners and we can send patients and you don't realize. So consulting a patient for blood, that's what I consider, you know, you don't even really think about it and then it's too late and then the patient has a bad outcome. And it is. It's just like.

Cara Lunsford

You feel like you're justified, like mindful negligence would be.

Maggie Ortiz

Culture would be. We always take a patient off the monitor, go to radiology, and there was not an order. You know, we always start IVs on the right arm. And even though the patient has, you know, a fistula, we always it's sometimes it's, you know, when you get caught up in culture, there's no scanner down in radiology. So we didn't scan the medication, you know what I mean?

Even though that's a policy at the hospital, you know, we overrode the medication, even though the policy says but the patient needed the medication. So we all get caught up into that. But you're not in a unit. The E.R. and the PACU. I have access to everything. When I'm in an inpatient unit, I do not have access to everything.

When you're an inpatient unit, the policy says you're not supposed to be overriding drugs.

Cara Lunsford

And isn't this where I feel like bullying gets in? Right? If you stand up and you say, Look, that's outside my scope of practice, I'm not doing that. You know, that doesn't seem right. How come you guys are doing it this way? Like, you know, this woman's had a mastectomy. I can't do their blood pressure on the on the left side.

They had a mastectomy on the left side, you know, something like that. And then other colleagues are like, oh, God, you know, like, I just go with it. We've all been doing this for years. Everybody does it this way. Nothing bad has happened. You're never going to get anything done if you just keep questioning everything and so people start to get quiet.

Maggie Ortiz

Oh, I didn't come this way. I too have been subjected to all of that. I mean, I refuse in a respectful manner to sedate a patient for a case that the patient, again, I wrote, I led with. I wrote a tool for to discriminate anesthesia versus nurse. Today, she lit up like five of them. It was not appropriate and it was for a battery change for a pacemaker.

Oftentimes most doctors would just use local. It wasn't worth the risk of giving her an oversight. And one of them she had an allergy to. So I went to the provider in a respectful manner. But my case, because, again, I don't often work with this provider he comes to the lab, gave them some words. He wouldn't assess the patient and he came back and he was like, How about Benadryl or Phenergan?

And I said something I couldn't reverse. I said, Probably not a good idea. And then he got like closer to my face and said that he was going to ask another nurse to sedate the patient. Absolutely. So then I picked up the phone. I called the manager. That was our chain of command, because in certain areas or runner who would be concerned, like the chart was a, there's nothing wrong with that.

But telling that person about sedation, that's not. Then I went to the next in my chain of command, which was the manager. His wife actually was an anesthesiologist. So he obviously had some insight, but he was interim manager and he used to call the anesthesia. I'll just call whoever was on call. Happen to be the head of anesthesia who loves me.

I was like hanging, doing these amazing dreams. And he was like, where are you at? And so he came on down to the lab and him and the physician literally started screaming and yelling. They go to the back. But I removed myself from that and I did not sedate that patient. So it's not always easy. And I get ostracized by my own people.

I'm animated I'm activated. And then when they see or I've heard that nurses come to me because now they're under investigation, some of them now have changed their perspective. But even the doctors, I've told them real clear, I'm not going to do one say stop. You're involving all of us in litigation. All of us. I'm not I'm not doing it, you know, even to the extent of we're going to put a patient on the table who didn't I didn't know if they could lay flat our tables or this small.

And there have been civil cases where patients have fallen off tables. So myself on the tech one upstairs. And so I just took it one more step. I was going to be sedating the patient, so I took it upon myself, went upstairs. I was like, Hey, how are you? You know, I'm one of the nurses from downstairs. You're going to have this procedure done.

You're not going to be able to sedate John. This is what we're going to be able to do and just kind of assess before I ever brought that patient down to the unit. So it's not always easy. And then I went to the doc and I was like, We're not bringing this guy down. He can't lay flat all the words.

And then that's where you're part of the solution. And then sometimes you're going to be bumped up against and then you're going to have to make the decision what you do. You know, I'm not going to tell you. You're not going to be retaliated against for me. I would have filed safe Harbor. They were going to push me to do something.

I already utilized that tool, which would have enacted peer review, which involves the CNO.

Cara Lunsford

So explain Safe Harbor. Safe Harbor a little bit.

Maggie Ortiz

Sure. So it is a peer review process that's in place in Texas and New Mexico. And it basically says that you're going to say, take on the extra patient or you're going to do this assignment that you don't feel is safe and you're going to explain why. And then it's supposed to act like a peer review process within the organization to evaluate it, to look at it, and then hopefully to develop a new process that can be sent to the Board of Nursing and use.

Because imagine that there was a bad outcome and now you're standing in front of the Board of Nursing, but you're saying, Hey, I was asking for some help.

Cara Lunsford

And is that something that happens like at that moment, like it's 7:00 in the morning and you've got the.

Maggie Ortiz

Ship, the CNO is involved and there's a process that's put in place. Every hospital that has more than eight nurses has to have a policy in place. I don't have it memorized. I don't have. But it is if you in Texas or New Mexico, you can look up safe harbor and your facility has a policy and will tell you exactly what you need to do.

So it was passed verbally in the state of Texas and I believe was related to the doctor death case, the neurosurgeon. There was, an O.R. nurse that was scrubbed in because, again, we're magical and do lots of things. She also scrubbed. She couldn't break scrub. It felt like it's all on the news. Right. We've seen this that they were doing.

He would do an say stop, was trying to voice her opinion. Safe harbor was this long paperwork that you have to fill out. Well, she couldn't do that at the time. And she was worried about her license. So went to the Nurses Association and then so they went to legislator, got it, passed the words verbally you can say on file and safe harbor.

And then at the end your shift, you fill out the paperwork because it can be very lengthy, because it's asking you like, what did you do? What was unsafe? I mean, the questions are very are lengthy to help to figure out what's going on, to hopefully resolve it within the organization.

Cara Lunsford

That's fascinating. And it's only in two states.

Maggie Ortiz

Right. But any state can have it. And I tell nurses, you know, because I get asked this as well, if you don't go to your nurses association or you don't go to your representatives and say, you know, maybe it's the public health committee, we you know, Texas and New Mexico has this, why reinvent the wheel? Print that right on out of your folder and just say, we want this pass in our state and what needs to happen?

All my representatives know who I am. The public Health Committee knows who I am. Every time there's an opportunity to testify, I'm at the Capitol. I was the only bedside nurse, a couple of months ago. I mean, am I getting paid to do that? Absolutely not. But sometimes it's putting in the hard work and maybe it's not you, because I tell nurses, I'll put your name on an Excel document.

You can't show up. You're raising kids are doing what you need to do, but it can't just be me. I need to add your name and maybe you just get one person and then you add your name on. But if they don't know we're out here, nothing's going to change.

Cara Lunsford

Right? The thing I'm going to say before we finish this is that if you haven't done so already, I really hope that you have written like the Advocacy for Dummies book, because if you haven't, that's.

Maggie Ortiz

A good idea.

Cara Lunsford

You should. I just really think, look, I mean, nurses have like pocket guides, right? We have medication pocket guides and maybe it's not like written form, maybe it's in an app or something like that. I'm just giving you a new business in case you didn't already have one. A new product line for your business. Like, you know, when I think about like, what we use as nurses and there's all kinds of apps and things like that, but you have just such an incredible amount of information.

And I feel like for a lot of nurses, it can feel so overwhelming. And it's just tell me, like, how do I thumb to that section? How do I click? And I.

Maggie Ortiz

Can.

Cara Lunsford

You know, I'm feeling this now, I need to go to this section.

Maggie Ortiz

We'll start with I tell nurses from the very beginning, start with and go to Cornell Law. You don't even have to go to your state. Go to unprofessional conduct standards of practice and grounds for discipline. This is a ten minute read. I promise. I promise you. And I think I am going to get those on like little badge things because that's really like a ten minute read.

Why do you care how a school got accredited? You don't.

Cara Lunsford

Well, that's exactly it. It is like a thing on your badge. It is a QR code. It is something where you have collected this information for people, where it's this very simple kind of how to guide. Like, I'm feeling this, here's what I am struggling with. I need to go to my manager about this. You know, here's some of the things that you should be thinking about.

Here are some of the things that you should be reading, because I always say, like for nurses right now, it sounds like I say this to me all the time. I'm like, Just do this. And then like, but it's literally like asking them to pick up like a grain of salt on their fingertip is too much to ask.

They're just like, I, I am. I'm here, I've got nothing. So it's like you have to, like, literally.

Maggie Ortiz

Just.

Cara Lunsford

Spoon feed it and make it as easy as humanly possible for a nurse to go, Here's what's happening. Here's what I should know. I just think that you have so much information to share. And I was thinking, Oh my God, I could do an entirely another hour with you because I'm like, Oh, I have this. I want to ask this question.

So you know what? She needs to make it how to guide.

Maggie Ortiz

Exactly. But actually that's a good because I do oftentimes and if I don't have the answer for then I want to get you to someone that can, because that's that's just how I am. So is workman's comp related? I don't have this knowledge, but here I know someone who does this.

Cara Lunsford

Well, that's a list of referrals. So you have a whole section just for referrals. I'm helping you with your business plan. You are.

Maggie Ortiz

I do feel called to just because, again, oftentimes nurses, you just feel overwhelmed and it is. And then you add now that they're under investigation, it's like getting cancer diagnosed and then it's so overwhelming so that I have dumbed down. Now I do have a PDF form that I do send to a nurse. And even if a nurse, you know, has already been working with an attorney and rolls up on me a year and a half later, I mean, they'll read this and start calling.

They're like, Well, where were you like a year ago? I'm like, Been here? Well, all.

Cara Lunsford

Those little things that you could put behind your badge.

Maggie Ortiz

Absolutely.

Cara Lunsford

Little, little pins with QR codes on them. Yeah, the pins are great. I mean, nurses use pins all the time, so Create a pin. I think this has been just so incredibly inspiring. And I just love how much you just have such a depth and breadth of knowledge. And what comes with it is just so much respect. Because what you've done, you have walked the walk okay, So that is what enables you to be able to really show up and share all of this information and keep these nurses safe and empower them.

And the minute I talked to you, I was like, Oh my gosh, I have got to get her on the podcast. She's just amazing. This is not going to be the last time I have you on the podcast. I know because I have like three other questions that I want to ask you, but I just want to thank you so much for sharing the last hour with me.

Maggie Ortiz

Thank you, man.

Cara Lunsford

Respect, Matt. Respect.

Maggie Ortiz

Stay strong, sister.

Cara Lunsford

Stay strong. Stay strong. We'll see each other again soon.

Maggie Ortiz

Yes, we will. By Day care.

Cara Lunsford

If you are a nurse or a nursing student who enjoyed this episode, don't forget to join us on the nurse dot com app where you can find the discussion group, a place where we dissect each episode in detail and delve deeper into today's topics. Nurse Dot is a nurse dot com original podcast series, production music and sound editing by Dawn Lunsford, Production Coordination by Rhea Wade, Additional editing by John Wells.

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