Episode 13 - Maggie Ortiz - Nurse Advocacy: Creating Due Process for Nurses who are otherwise Unrepresented and lost in the Legal System!

Thank you for joining me for another episode of the Nursing Strategies for Success podcast with this week's guest, Maggie Ortiz. Maggie is a registered nurse and has been in critical care for 22 years. She holds a master's in nursing leadership and administration.

Maggie has worked in a small community hospital, level 1 trauma, ICU, ER, PACU, IR, and cath lab as a staff nurse, local agency nurse, and traveler.

Maggie has been an expert witness for medical malpractice and administrative law for over the last 5 years. During her short stay as an investigator, things came to light about the lack of due process extended to nurses and drove her passion to advocate for nurses. So let's welcome Maggie to the show. Welcome to the Nursing Strategies for Success podcast, brought to you by The Nurse Speak, a show where we rally some of our nation's greatest nurse leaders educators, experts, and advocates to tackle some of our greatest challenges that the nursing profession faces. My name is Damion Jenkins, and I'm your host for this show. So sit back, relax, and get ready to learn that nurses can do anything.

Okay, Maggie, thank you so much for being on the Nursing Strategies for Success podcast. Why don't you take a moment to introduce yourself to the listeners? Let them know a little bit about who you are, where you started your nursing career, and where you are today.

Absolutely. So I've been a nurse for 22 years, primarily critical care, ICU, ER, pre-op, PACU, endo. Interventional radiology and cardiology. Spent the last 6 years in the cath lab, really enjoyed that. I have been an expert witness for civil law and for administrative law. I did spend a short period of time at the Texas Board of Nursing, which has now driven me to be where I am currently as a nurse advocate. So I try and advocate for nurses that are under investigation, by their Board of Nursing. And then I go to the Capitol to try and make change so that if a nurse is under investigation, they get due process.

Wow. So, wow. So not only have you done so much in your nursing career that I heard over the course of 22 years, but now you advocate for nurses. And I've heard of nurse advocates, but usually it's the other way around. We're advocating for patients and things like that, but you're actually advocating for nurses who aren't getting their due process. So that's very interesting, and I really want to pick your brain a lot about that. So, um, first of all, thank you for your service because that's incredible. I know that I've watched colleagues get kind of drug through the legal process when there have been mistakes or accidents that happened, whether it was their fault or not. And many of them lost their jobs and even had, you know, suspensions on their licenses to be found not guilty or have nothing to do with it later. And during that time, no one seemed to be in their court, which is very interesting. So, well, here we are. This is the Nursing Strategies for Success podcast, and we always talk about what are some of the challenges that faces our profession. Is this the challenge that you want to talk about? Is this what you're working towards finding a solution for?

Yes, yes. Once I identified it, when I was at the Board of Nursing, and I was there a short period of time, but I was hearing things in the culture was, they're all guilty, don't read their response, criminal investigators investigating practice cases that it— I just could not be a part of it. I stayed for about 6 months and then I did take on this challenge. So I've made change in my own state. Like, there's a way to complain about the Texas Nursing Board to the nursing board. I work with some activists and representatives to make that happen. Their lead counsel investigates them, so we would like to take that away from them. But so that is the— my challenge. That is my nursing challenge. Not only I feel like that's my responsibility to take on, but once I tell my people aka the audience, but it's the nurses out there, right? Your turn. It's, it's time for you to come and join. It's time for us to hold our representatives accountable, and I'm more than happy to help you do that and/or be the one to stand there to ask for that.

Yeah, so let me, let me make sure I heard you correct. You said that there's a way to complain about the board to the board. Meaning the board ultimately makes the decisions anyhow. So how does that work?

Yeah, so there's no way to— if you've got a complaint from the Board of Nursing and you feel like you're being retaliated against, who will you tell?

No one.

There's no one, right?

Correct. So a third-party entity like an ombudsman. So I helped write a bill for an ombudsman. So that's like a fix. That's the challenge. So I feel like that's what I've found. Is that an ombudsman. Do I know that that's the answer? No, I don't. But it would be a third-party entity not funded by the Board of Nursing that you could ask to say, hey, I feel like I'm being retaliated against, will you look at my case? And then they look at it, they would have the ability to challenge that, to then reach out to the Board of Nursing and say, no, we have experts who are contradicting the allegations that you're making against the nurse, and here's why. Right, but that doesn't exist anywhere.

Wow. So there's no actual process for that. And so this is the challenge that you've identified. And so you've set out to do quite a few things. I know you and I talked before, um, and you were sharing some of those things, and I would love for you to share that with the audience. You know, once you identified this and you decided you wanted to kind of step into the role as an advocate for nurses who are facing allegations to support them through the process, where did you start? How did you start that process? And, you know, where are you now in that process? And what kind of help do you need? Because I'm sure there's plenty of people listening who are interested and maybe seeing how they could also be a part of this solution.

Sure. So I came out and started walking around talking a little bit about my concerns. Someone who had sanctions on her license reached out to me. We started collaborating and just started with like going to the Capitol. And then I met some other activists were there who were nurses. She was not a nurse, so I hooked up with her. And so she started like exposing me to the Capitol because it's— it can be intimidating, like who you need to speak to, like even just geographically how you even get around that building can be intimidating. So she helped me, exposed me to that, and even like how to write a bill, how you can come down to the Capitol and vote, how you can testify. So she exposed me to that, and so that kind of started my journey. I was like, you know what, We need to have a way to make a complaint about the nursing board to the nursing board. So I sat in my representative's office, anyone who would listen to me, and it was on the aisle that I don't sit on that actually helped me, right? It was myself, this Darlene Nelson, another nurse, and then an activist. And we just— they called in the executive director for the Texas Board of Nursing and asked her, what process do you have in place? She couldn't come up with an answer, obviously. So then she had to create a process that they now investigate themselves, which I don't think is fair. Their lead counsel does. But it's a process. It's something that's in place. So then just going down to the Capitol, I just decided that I didn't know what it was going to look like. And I started taking suggestions from some other activists. And then we still work on stuff today. Like, I'm still trying to get the ombudsman pushed. I mean, this is like— I'm— 4 years out now, 5 years out. We wrote due process clauses. There are federal bills like Nurses Take DC are trying to get passed, like the HR 3185, the safe staffing. So I now reach out to other activists who are doing different stuff to try to get ideas, like how do you get something passed? You know, how do you write a petition? Because those are things that I don't always know how to do. So aligning myself with people who are activists nationally, which I think is very important. And then I'll take any help. If you're in your state and you want to— I'm trying to get advocates from every state. It doesn't matter what state it is. So you can stand in front of your representative and say, my board doesn't have any oversight and this is affecting nurses. 1,500 in my state are reported annually, right? A portion of those may not even go back to the bedside. So it is a problem, right? So we use stats and I can help you do the research to when we stand in front of your representative. I helped an organization in Arizona, a state that I'm not even in, right? They wanted help, and I said, let's identify who are the nurses who hold office, and that's where we start, right? And so we got someone— again, you tell her you're a nurse, right? You want to talk to her, and she did. She took our call, right? But it just takes that. I email my representatives every week. So I don't have the answer, but I'm more than willing for nurses to help come and join me. Nurses in Texas, because again, there are 400,000 of us in this state. Even if I could put your name on an Excel document, so when I am standing in front of whomever, I can say, sir, ma'am, I have 12 people in your district.

Yeah, well, I think that is, um, super important. We all know, all of us who have an inkling of experience in the nursing profession here in this country know that there's a tremendous amount of, um, pull from entities that are outside of nursing. And then when it does come back to kind of nursing organizations who kind of govern nursing practice, there is no oversight for those organizations. Where are they getting, you know, their information from? Who's telling them what to do? And again, when you have these nurses who aren't being represented appropriately, who aren't being supported When we do ask for these organizations to support us, they usually are wiping their hands clean of any of the stress or drama because they're in a position where they don't have to. And to align with my mission, which is really to help get nurses in the profession and help them stay in the profession so that we can really make good forward progress on the nursing shortage, this right here is also a big contributing factor to the nursing shortage. Because not only, like you mentioned, we're losing nurses— a good portion of them who go before the courts never make it back to the bedside, never make it back to the profession. But there are a lot of people—

yeah, the PTSD that they have. Oh my gosh.

But a lot of people are afraid to even stay in nursing because they know someone who went through this and got thrown under the bus. With zero representation. And despite how they were blowing the whistle and they were doing their best to bring to the attention of everyone that there's safety issues, they still wound up getting the short end of the stick. And that's not fair to nurses who put everything on the line to help other individuals, the most trusted profession out of all of them. And yet whenever there's some kind of issue, it's always the nurse's fault and it's always the nurse who winds up suffering the consequences. So I think the work that you're doing is great, and you mentioned you don't have the answer, but I think you do have the answer. I think you know exactly what you need to be doing, and you need to continue to rally the troops and get those advocates in all of the states so that you guys can unify and come together and do these, you know, this, this great work with changing the laws so that we can have these protections in place. And I think partnering with groups like Nurses Take DC and other big advocacy groups like that is very important. And I hope that you have a lot of allies in that group because they've gotten pretty big and they're doing some great things as well.

I agree. I mean, they dumb it down even like you can go and they can show you how to even look at a policy up if you want to see if someone in your state is supporting a policy. I mean, they do great work, videos. Reporting state staffing issues. So we all do like a different piece, right? And so us all collaborating and coming together because we are the largest workforce in the nation and it's time that we have a seat at the table. The other thing is getting nurses into office is another thing. I'm really about that. Like, you want to run for office, please call me. I will help you. Let's get you there. Because again, we need to have a seat at the table. They're making decisions about our workforce and we're not sitting there. No, no, no, no.

Yeah, absolutely. There's so many different ways in to finding solution, and we all know that representation is so important. This has been historical from women's rights to people of color, you know, immigrants, so on and so forth, right? So we know that representation matters, and we do have to get nurses at the table to make those decisions. We need them in the C-suites, we need them in, you know, local government and federal government. We need nurses everywhere. And just the last 5 or 10 years or so, we started seeing nurses, you know, get into some of those elected positions. But we need more, we definitely need more. So do you have any tips or strategies that you want to offer to the listeners right now that can help them kind of take this, that resonate. It should resonate with every nurse. If there's a single nurse out there that this doesn't resonate with, you might be in the wrong profession.

It's—

say that like you don't care about what's happening to your colleagues, and nursing is such a team effort, albeit the bullying and albeit, you know, the cattiness that happens and all of those things that make our jobs difficult sometimes. Truly, when the fire starts, we come We get the work done. It's always in the best interest of our patients and our peers. We can do this. So if you don't feel like this is an issue for you, I would challenge you to reflect on that deeply and, and come to terms with the fact that we're all involved. So what strategy do you have to offer if someone wanted to get started to be more of an advocate like yourself or maybe even, um, take up advocacy in their local areas?

So I always tell nurses, or anyone who represents me, like Google that, type in your stuff, and then you have your representatives. Start with them, right? They'll— it'll normally link you to— most of them have a page where you can just— they really dumb it down. You put in your first name, your lot, and just tell them, I'm a nurse in your district, What are you doing for me? I want to actually talk to you. Normally it'll be their chief of staff that will reach back out to you and just say, and if you know of a bill that you want passed, like, you know, H.R. 31685, and your representative is not a co-sponsor, ask them why. Ask them why. Why aren't you co-sponsoring this? Because you sure can. And if you need help doing that or you don't understand why, I'm here to let you know. Call me. I will not be voting for you. Don't underestimate that ability. I do that every week. Copy and paste that in a Word document. Don't reinvent the wheel. You know what I mean? It doesn't have to be a lot of your time. I'm talking about 15 minutes a week, really. I mean, I tweet them, I Instagram— everyone, all these people are on Twitter. The last thing that they don't want you to do is call them out on Twitter, right? So just start there. Who represents me?

Okay, great. So once they do get in touch with the representatives, right, then— and you said, you know, make notice of any bills that they're aware of. Um, so my ask for you is, do you have a one-stop shop that nurses can go to to get this information, like a web page, a landing page, anything like that?

I do have a website, and that's actually a good point. I will make actually a blog because I do have one that talks about, you know, going to the Capitol and stuff. But I'll even put one in there like, you know, I'm a nurse in your state, and I'll put in the language that you could copy and paste. Absolutely. Um, so I'm an advocate for nurses. Yeah. Because again, I'll make it as easy as possible, right? And then have them, you know, reach back out to you, or even like an email, or even that they know that you're on their radar, right? And maybe they don't get back to you, but they now know that, okay, you and 12 other people are going to reach back out to them. They're not going to forget that, right?

And then actually follow through on that, right? So this is where the advocacy piece comes in. Just like us nurses, when we're, when we're really trying to elicit that positive change for our patients, we keep circling back. We don't just do our due diligence, address it once, and then forget about it. No, we got to keep coming back to it. So, you know, I would say put it on your calendar, mark off some time, block off some time once a week so that you're doing that, so that you are reaching out to your representatives on the local level, the state level, and the federal level, and really just constantly put in their ear that these are issues, we want answers, we want solutions. And if they have none, then they need to listen to nurses for them.

And if you're a baller like me, you can go down to the Capitol and just stand in their office. And actually, that's my house and not theirs. And I remind them of that.

So I love that. That is our house and not theirs.

You're a visitor, my friend. I voted you there. You're not staying.

So that is music to my ears. That is music to my ears.

You live in the Capitol? Go! I live in Austin, so I'll go down there, right? When they were— everyone screaming on the 12th, I was on the steps screaming on my Capitol as well with the rest of the nurses, reminding them that this is our house.

Right, that is music to my ears. And I also want to remind everyone that that goes for the same thing for any kind of, um, position of power. This is managers, this is charge nurses, this is CNOs, DONs, CFOs. Presidents, right? You're all chosen to be there by other people. And those other people, if you don't represent them well or don't perform to the standard that everyone is expecting you to, you are replaceable, and we can move on to someone who will fulfill the role. And there's no reason why— reportable.

I want people—

and reportable.

There is, under the Nurse Practice Act in every state, If you choose to be a CNO or you choose to be a leader, you're taking on additional NPE rules and regulations that don't apply to me when I clock in as a staff nurse. So remember that. And I tell people, report their conduct, because if they're not creating a safe environment, you know what that's affecting? Patient safety, which is apportable to what? The Board of Nursing. If they're asking you to float to environment that you don't have the education, knowledge, and training, and even under the disaster clause under your Board of Nursing, it clearly says that if you don't have that education, knowledge, and training, and I'm quoting that, you're not allowed to be in that unit as a primary caretaker. Quote the Board of Nursing and use that against them and ask them, are you asking me to violate the NPA? I'm just asking you, right?

Are you asking me to violate the Nurse Practice Act? Those words must send shivers down directors' spines when they hear that. I'm sure they don't. I probably would be like, did you just say that to me? But Guess what? I've been the person to say the same thing. I've been in your shoes, and sometimes you have to pull those cards. Sometimes you have to say, wait, whoa, whoa, I understand that we need to make money. It's a business. I understand that I have to show up, do my work, be professional, prudent, do my due diligence, yada yada, right?

Keep the peace.

I get it. But there's a certain time where I'm not going to do what you want me to do. Because it is going to violate the laws, the rules, the regulations, my moral compass or ethics. And at that point, I have to make a decision. And I know—

yeah, because if your conduct gets reported to the Board of Nursing— and let me say this again— if you do not file safe harbor and/or ADO, which in some states the Board of Nursing will have to look at the conduct. And let me repeat that again: if you file safe harbor, the board does not look at the conduct because you said, hey, And if someone reports it, they're going to come back and say you filed safe harbor, we're not looking at this conduct. If you do not file safe harbor, the Board of Nursing has to look at the conduct and most likely will sanction your conduct.

So can you just explain for the listeners, for those who might not understand, what does safe harbor mean?

Sure. So it's a form of peer review. There's two types of peer review: incident peer review process and safe harbor peer review, where the nurse is saying I'm calling safe harbor because I came to work, for example, and I'm being floated to labor and delivery and I'm an ICU cath lab nurse, right? And they're asking me to take an assignment, not task. I file safe harbor because they have one nurse and there's 12 laboring moms, right? So I say I'm going to file safe harbor, I'll take care of patients, but anything that happens to them is on you guys and not me because I'm not educated to be in this unit. Right, or you're asked to take 12 patients when you should only have 4 because, you know, 5 people have COVID. So you come to work and you say, I'm going to accept assignment, I'm filing safe harbor before you take report on these patients. And then a peer review process is initiated. It's paperwork that's put out by the Board of Nursing. If you have more than 8 nurses in the state of Texas, you have to have a peer review process. It is in the Nurse Practice Act. That creates a peer review process that your leaders should not be on. It should be your peers that are gonna review your conduct. It's only 5 to 8 and has to be more RNs to LVNs that look at the conduct, whatever it is, and decide, does this rise to the level of reporting to the Board of Nursing and/or should there be conduct? You know, was this conduct, you know, culturally driven? You know, let's look at the process. Did the nurse do something wrong? So that's safe harbor, and some states call it ADO. I believe it to be a very similar process. You're saying, I'm going to take care of patients, but for whatever reason, you're, you're worried about your livelihood and being reported to the Board of Nursing.

Okay, and does every state have that kind of process in place?

Texas and New Mexico are the only states that have safe harbor. Texas is the only one that has verbal safe harbor. And then there are a couple states on the East Coast that have ADO.

Okay, so just a handful of states in the whole United States, guys, for those listening, have a process that allows nurses to say, whoa, whoa, whoa, this isn't safe. I know you need the work done, I want to help, but I don't want to be liable because this is stretching me beyond my capacity for safe practice. And they have protections for that., but just a handful of states. So right here is where is a, I think, a great starting point that every board of nursing needs to develop a process like that so that their nurses can be protected against the money-hungry hospitals and healthcare organizations who refuse to pay the staff what they deserve and put in place the incentives that other organizations spend quadruple the amount of money on to recruit their staff who do less impactful work. So it's really time to start paying nurses what they deserve and give them the services that they need to protect them. So I think that's a great place to start.

Think about that young lady, that LVN, Christina, and I'm— I can't remember her last name. She's the LPN that was in that long-term care facility. She had 32 patients. The one. So imagine if she came in and said, I'm going to take care of these people, but I'm going to file safe harbor. This may not— she may not even be in the situation where she's got a bracelet around her ankle right now, right?

I mean, losing her license, right? Not being able to be a nurse anymore.

Correct. But even— I want not just safe harbor, there should be just peer review in general, like Texas does. Because again, You leaders should have to use that before it rises to the level of the Board of Nursing. Now, if a nurse injects air, does something, then of course, yes, you should go right to the Board of Nursing. But if it's something that maybe 5 nurses have done, do a peer review process. As long as it's less than 5 minor instances, the, the Board of Nursing in Texas says then that falls within the ability to call for peer review. It alleviates the organization, literally in the language of the policy, in the position statement, it says it alleviates the, the organization's responsibility to report to the Board of Nursing if they utilize the nurse— the peer review process appropriately, right? So peer review are two things that every nurse should be pushing for in their state. I agree.

Yeah, I think that's incredible place to start. So look, Maggie, um, what's your website where people can find you so they can learn more? They'll be looking for that blog article you just promised everyone, so make sure you get that posted. Um, and then I can always update the show notes of this episode to include all of the ways to get in touch with you and links to those articles. So where can they find you?

Advocates for Nurses— it's either number 4 or F-O-R. I have a landing page website I just got up, so please reach out to me and I will put that blog on there with you know, just copy and paste out of there and send it to your representatives. And any nurse that wants to do some advocacy work or needs help, please reach out to me. I do have a Facebook group for nurses, you know, who've been touched or been reported. So, um, come on down, love to have you.

Awesome. So Advocates for Nurses, is that at .com? Yes, yes, absolutely, fornurses.com. What's the name of your Facebook group?

Advocates for Nurses. I don't get crazy. What's my email address? Advocates for Nurses at gmail.com.

Perfect. And then do you have like Twitter and LinkedIn and all that?

All the same handle.

And then Maggie, um, Ortiz at— on LinkedIn, right?

Yes. Yep. And I think that I have my Advocates linked to there as well.

All right, perfect. So you hear that, guys? Lots of ways to get in touch with Maggie. Maggie, I want to thank you so much for being on the Nursing Strategies for Success podcast today. I really enjoyed our conversation. I learned a thing or two, and I'm really excited about how I can start reaching out to my representatives to see if we can get some of these issues addressed sooner than later. Thank you so much for being on the show, and I can't wait to collaborate with you soon. Have a good day.

Take care.

Bye.

And that concludes episode 13 of season 2 of the Nursing Shadowcast. Strategies for Success podcast with this week's guest Maggie Ortiz. We hope that everything that we shared for you in today's podcast will help you protect yourself and advocate for nurses to find due process. We need your help. If you would like to connect with Maggie, all of the ways to connect with her will be in the show notes of this episode. And as always, if you have any questions about anything we covered, please go to thenursespeak.com/contact and get in touch with me. I would love to have a conversation with you. So until next episode, take care, be well, and remember that nurses can do anything.