McCullum Legal Nurse Consulting

02/24/2025

Officially triple board-certified: CEN, CPEN, and now TCRN!

My head hurts, but I'm absolutely thrilled with this accomplishment.

02/13/2025

Officially double board-certified!

I took and passed my Certified Pediatric Emergency Nurse examination today, making me one of less than 5,600 nurses with this elite certification.

Thank you, BOARD OF CERTIFICATION FOR EMERGENCY NURSING (BCEN®), Bill Light, and Pam Bartley BSN, RN, CEN, TCRN, CCRN, CFRN, CTRN, CPE

12/27/2024

I'm on Calendly now!

Let's cut out about 3 emails and go straight to scheduling that phone call: https://calendly.com/mccullumlegal/introductory-phone-call

10/16/2024

I'll be sharing some thoughts on Friday at the BASF Paralegal Conference. Come check it out if you're local!

We are now just a couple of days away from the 2024 Paralegal Conference, a full day in-person conference filled with opportunities to network and learn!…

10/04/2024

Triage nurses, did you know you actually influence providers' decision-making?

There's an interesting cognitive bias called triage cueing. Triage cueing, also termed patient cueing, is a cognitive bias that occurs when a provider's diagnostic decisions are influenced by the triage category the patient was initially placed in. This can happen at many points in the healthcare system, including when patients self-triage, when a referring physician selects a specialist, or when an emergency department triage nurse diagnoses a patient.

Triage cueing can lead to a variety of errors, including:

Diagnosis momentum: The tendency for a particular diagnosis to become established, even when other evidence suggests otherwise,

Representativeness restraint: Not considering a diagnosis because the patient's presentation is not "classic" enough, &

Inheriting someone else's thought process: Accepting a misdiagnosis from the triage nurse.

It is therefore supremely important that triage nurses are objective, follow the triage algorithm, and obtain a good history from the patient to avoid mistriaging.

Anyone have a good example of triage cueing in action?

08/28/2024

Implicit bias is not overt racism, homophobia, or sexism. It's a subtle, unconscious, automatic reaction, and it may actually contradict one's stated beliefs and values.

Implicit bias is insidious, nebulous, and requires thorough self-awareness to mitigate. It's the precursor to explicit bias, which is why self-awareness and being open and frank about oneself is so important.

Need a medical example?

Explicit bias: stating Hispanics can't tolerate pain because they are very vocal about it.

Implicit bias: ordering smaller doses of pain medication for the Hispanic population despite severely high stated pain scores compared to similar pain scores from the white population.

Bias is scary, and people don't want to believe they hold bias. My presentations on bias make some people defensive or uncomfortable, and that's the point.

What are some examples of implicit bias you've seen?

08/12/2024

I see a lot of fall risk assessments.

But I don't see a lot of interventions documented.

As an attorney-client just mentioned last week, "if it wasn't documented, it didn't happen."

While there may be exceptions to that rule, fall prevention interventions are one of what I call an always-chart event, especially in high-risk patients.

Always. Chart.

08/08/2024

Medical record entry: patient stated chest pain is a 10/10 and, "I feel like I'm dying."

Those are scare quotes. Scare quotes are quotation marks used around a word or phrase when they are not required, thereby eliciting doubts or disbelief towards the statement in quotations.

There's no need to document using scare quotes. Keep it clean, neutral, and fact-based.

08/07/2024

I see a lot of posts by nurses wanting to leave the bedside. It seems like the goal of so many nurses, the ephemeral hands-off nurse job while raking in the cash.

That's not my goal.

I like being a testifying expert, but I also like being a nurse. Emergency nursing takes a special breed, and it suits me well. Besides not being built for a desk job and liking the adrenaline, I enjoy seeing how healthcare evolves through the years and what impact I can make, whether that's a personal change, a change in my department, or a regional/nationwide change. I use that knowledge to write publications and speak in webinars and conferences.

My dad once said, "you're not just a nurse." But I am. I'm the full package, a nurse who is here for the entire experience, a nurse who has a seat at many tables. I write, I consult with attorneys, I testify, I speak at conferences, and then I clean up vomit or hold a hand.

I'm a nurse.

08/06/2024

I got asked on a consultation call recently if nurses can advocate for certain tests to be ordered, like imaging scans. After all, nurses can't order tests, so can they request orders? Should they?

Absolutely.

Nurses are highly educated and have honed their training in their respective disciplines. If a nurse feels strongly that a certain test or medication should be ordered for the safety or wellbeing of the patient, they should certainly speak with the provider about it.

Most of the time, the providers either have a reasonable rationale for not ordering it (waiting on a consult) or they simply order it when asked (the amount of providers who forgot to place an order is astonishing).

But occasionally, there is a disagreement.

At this point, the chain of command 🔗 factors in.

The chain of command is a step or ladder escalation process that directs employees how to consult and report with figures of authority. It is designed to eliminate confusion or having to decide which authority figure to go to when proceeding with a task. It's used in organizations such as the military, police departments, and civil organizations like hospitals.

Every facility with this process should have the chain of command organization chart available to their employees. My facility had it posted in the nursing stations and bathrooms, for example.

Utilizing the chain of command appropriately can assist in ensuring the best care for patients.

Have you ever utilized the chain of command?

08/05/2024

The actual text may not be saved into the medical record...
.. but the audit trail will show if a secure message was sent at the time stated it was sent.

08/04/2024

It's mildly intriguing how many attorneys will respond back to my weekend communications within a few hours.