Angela Purcell, a nurse making a difference, has helped save patients’ sight and taught others how as part of the Flying Eye Hospital.
Purcell didn’t start her career expecting to help save people’s eyesight around the globe. In fact, she didn’t even start working as a nurse until an amazing experience changed her life permanently.
Purcell, now an RN with an Ophthalmic Nurse diploma and the Associate Director of Nursing for Orbis International’sFlying Eye Hospital, began her career as a legal secretary.
“When I was unexpectedly hospitalized, my life and career path changed forever. During that brief experience as a patient, I was inspired by the nurses around me. Good nursing depends on discipline, keen observation, and sound clinical skills. Those attributes attracted me to the profession,” recalls Purcell. “It was then I decided to start my training to become a nurse. I knew it was the right decision as I thought about the lives I could change by helping to improve the well-being of others.”
Purcell attended nursing school at Cambridge University Hospital in England, earning her RN degree in 1985. Her first job out of nursing school was working as part of intensive care teams at a cardiovascular heart and lung specialty hospital. “After a few years in this high-intensity specialty, I moved to specialize in eyes and earned my diploma in ophthalmic nursing,” she says.
During her ophthalmic studies, Purcell attended a conference where she heard an Orbis representative talk about their work. “I was captivated. I promised myself that I would join their Voluntary Faculty, a global force of more than 400 medical experts who share their skills with local eye care teams around the world,” says Purcell.
And beginning in 2012, she did just that. She began working as a volunteer faculty scrub nurse, and a few months later, she was offered a permanent position as Orbis’s Head Nurse with the Flying Eye Hospital Team.
Eyes in the Skies
According to Purcell, the Flying Eye Hospital is a fully accredited ophthalmic teaching hospital on board a plane. It travels to locations that don’t have access to quality eye care, and the staff trains eye care teams–ophthalmologists, nurses, anesthesiologists, and biomedical engineers–on how to deliver the same care in their community.
“Training is at the heart of everything Orbis does and everything I do in my daily role. I provide in-person, hands-on training to local nurse teams in infection control and emergency preparedness during training programs. I work with them on the plane and in the partner hospital,” explains Purcell. “During training programs, we care for children and adults with a wide variety of eye diseases, including cataracts, glaucoma, strabismus, and other conditions that can cause vision loss or blindness.”
Globally, she says, 1.1 billion people live with vision loss–90% of which is avoidable.
“The work I do is fighting to decrease this statistic,” says Purcell.
During the pandemic, when she couldn’t teach people in person, Purcell began teaching on Cybersight, the Orbis telemedicine and e-learning platform. Even when in-person programming returned, Purcell continued to teach online. “I found that virtual training is a great way to reach everyone,” she says. “It’s a fabulous complementary tool to every nurse’s training.”
Another crucial part of Purcell’s job is that she plays an important role in ensuring that the standards to obtain accreditation for the Flying Eye Hospital from the American Association of Accreditation for Ambulatory Surgery, are met and adhered to.
“In my role, I also ensure [that] Orbis employees are benefiting and growing, which, in turn, benefits my occupational development,” says Purcell.
Miracles Happen
One of Purcell’s greatest rewards in her job is hearing some of the patients’ stories. She shared this one:
“One of my favorite stories in my nursing career happened in April 2018 when I went to Trujillo, Peru, with the Flying Eye Hospital for a three-week training program. I worked with a volunteer nurse to care for patients before and after their surgeries. While she was preparing a patient for surgery–a young man of about 25 years old–I spoke to his mother. To my surprise, this was the second time her son had been a patient at the Flying Eye Hospital.
Twenty years ago, her son had surgery on his eye on the plane as a small child. She said she was so grateful and surprised the plane was back in Peru when her son needed urgent surgery. He had just had an accident and injured the same eye that had been operated on as a child. His mother proudly showed me pictures from the day of her son’s first surgery on the plane.
“As I looked at the pictures of the little boy and the nurse caring for him, I realized this was the same nurse preparing him for surgery again, so many years later. The nurse remembered him as a child, and the nurse, the patient, and the mother had a sweet, sentimental reunion. For me, as a witness to this fascinating story, I will always remember how it made me realize that miracles do happen in our ‘hospital with wings.’”
Purcell says she’s realized how well her job fits her skill sets. “I am great at networking and communicating with people from different cultures. Working with a global organization allowed me to collaborate, innovate, meet targets, help others, and challenge myself. Some of the highlights of my current role working at the Flying Eye Hospital have enabled me to meet quite famous individuals, including Cindy Crawford, HRH Duchess of Wessex, many heads of state, and the list goes on,” she says.
But there are many other reasons why she loves the work she does. “I love my Flying Eye Hospital team. We are like a family. We are a small, multi-cultural, close-knit team that supports one another and encourages progression and collaboration. We all share the same vision and are dedicated to fighting avoidable vision loss together,” says Purcell. “I am inspired by the people around me and how rewarding it is to see the results of our work.”
According to “The 2022 Nurse Practitioner Professional Liability Exposure Claim Report: 5th Edition,” claims again nurse practitioners (NPs) are rising.
To find out what this means and what NPs can do about it, Daily Nurse interviewed Georgia Reiner, MS, CPHRM, Risk Analyst, Nurses Service Organization (NSO).
What follows is our interview, edited for length and clarity.
According to the Claim Report, you found that aging services against NPs are up. What did they increase from and to? Why do you think this is happening? Why are more NPs being sued?
NSO’s & CNA’s report entitled, The 2022 Nurse Practitioner Professional Liability Exposure Claim Report: 5th Edition, revealed that aging services claims increased from 17.2 percent of the total distribution in the 2017 dataset to 20.3 percent of the total distribution in the 2022 dataset. Specifically, allegations against nurse practitioners (NPs) that occurred most often in the aging services setting included improper or untimely management of a pressure injury and improper prescribing/management of anticoagulants and controlled medications. Three main factors may drive the increase in these claims:
The number of older Americans is increasing.
There is a shortage of primary care physicians.
The number of NPs in the workforce is increasing.
One of the realities of life is that our medical needs increase as we age. And the number of older Americans is steadily growing. According to the Administration on Aging, in 2020, the population of 65 and older numbered 55.7 million. It is projected to grow to more than 80 million by 2040. Many older Americans receive care from aging services facilities across the United States. There are currently about 14 million people receiving some form of long-term care services. That number is expected to double by 2050, according to the U.S. Centers for Medicare and Medicaid Services.
However, aging service facilities need more staffing to meet regulatory and quality of care standards. In addition, risk factors for older adults include increased physical health problems/conditions, side effects from medications, loss of mobility, and social isolation, which may lead to depression. These factors can contribute to an NP’s liability risks as NPs are responsible for diagnosis, medication management, and timely treatment and care.
Injuries the patient or resident sustained can result in allegations against the NP for negligent care.
This increase in claims may also be attributed partly to the overall rise of NPs in the workforce coupled with the expansion of NPs working in underserved specialties, such as aging services, and the steady decline of primary care physicians. In December 2019, the American Association of Nurse Practitioners (AANP) reported that 290,000 NPs were licensed to practice in the United States. In November 2022, the AANP reported that the number of NPs in the workforce had increased to 355,000.
Lastly, experts have warned that a shortage of primary care physicians could lead to challenges in accessing care. According to The Association of American Medical Colleges, by 2030, we will face a physician shortage of 40,000 and 100,000 doctors. As a result, an increasingly common solution is staffing more NPs at offices, clinics, hospitals, and aging services facilities, encouraging patients to receive care from NPs instead of physicians.
Why have malpractice claims – in terms of the amount of money awarded – been increasing?
According to NSO’s & CNA’s new NP report, the average total incurred of professional liability claims in the 2022 dataset ($332,137) increased more than 10.5 percent compared to the 2017 dataset ($300,506). In addition, the findings suggest a continued shift towards larger claim settlements. For example, claims that resolved for over $500,000 represented 21.5 percent of all claims in the 2022 dataset, compared to 13 percent in the 2012 dataset.
The increasing severity of claim costs can be attributed, at least in part, to social inflation, which is the growth of liability/litigation risks and costs. This rate of growth is more rapid than what could be explained by just inflation by itself. Several potential drivers of this growth rate include:
More sophisticated plaintiff attorney litigation strategies.
Tort reform rollbacks.
Litigation funding.
Other large jury verdicts across the country.
Another possible driver of social inflation is the liability associated with the increasing complexity of patient needs. For example, meeting the needs of high-acuity patients can involve many surgical, restorative, and diagnostic procedures, which can incur significant expenses. And with rising healthcare costs in general, it then follows that it requires more significant verdicts to make plaintiffs whole for their losses.
What were the nursing specialties that you found to have the highest exposures? Why do you think they are sued the most?
NSO and CNA’s Nurse Practitioner Claim Report revealed that in the 2022 dataset, 66 percent of all claims involved NPs specializing in family and adult-gerontology primary care. Family and adult-gerontology primary care have consistently represented the majority of NP claims across 2012, 2017, and 2022 claim report datasets. Most of these claims occurred in the office of an NP or physician, with many involving allegations related to diagnosis and medication prescribing. These specialties likely account for most claims because, according to the AANP, 79.2 percent of licensed NPs in the U.S. are certified in family and adult-gerontology primary care.
What can NPs do to protect themselves from malpractice claims? Please explain.
Below are some proactive concepts and behaviors that NPs can include in their customary nursing practice:
Practice within the requirements of your state nurse practice act, in compliance with organizational policies and procedures, and within the standard of care.
Maintain basic clinical and specialty competencies by proactively obtaining the professional information, education, and training needed to remain current regarding nursing techniques, clinical practice, medications, biologics, and equipment.
Document your patient care assessments, observations, communications, and actions in an objective, timely, accurate, complete, and appropriate manner.
To help improve the diagnostic process, consider the potential unintended consequences of pursuing a specific diagnosis:
Are factors present that do not align with the diagnosis?
Are there symptoms that are inconsistent with the current diagnosis?
Why are these symptoms not indicative of another diagnosis?
Are there elements that can’t be explained?
Is there a condition with similar symptoms to consider?
If a patient is uninsured or unable to afford necessary diagnostic and consultative procedures, refer them to appropriate organizations or social agencies for financial assistance, payment counseling, and/or free or low-cost alternatives, and document these actions.
Remind patients to seek emergency treatment if a condition worsens, and document this action.
If necessary, utilize the chain of command, risk management, or legal department regarding patient care or practice issues.
Maintain files that can be helpful for your character, such as letters of recommendation, performance evaluations, and continuing education certificates.
Most people are hardworking and often pretty good folks, and then there are the others like those caught up in a scheme uncovered in January where several people allegedly faked diplomas and transcripts and sold them to nurses—many of whom had allegedly used them to sit for their licensing and work as nurses.
The thought that this could happen is absolutely horrific.
Daily Nurse interviewed Jennifer Flynn, CPHRM, Risk Manager, Nurses Service Organization (NSO), to learn how it could affect nurses who have done nothing wrong and how they could protect themselves in the future.
What follows is our interview, edited for length and clarity.
What was the scheme for nurses who haven’t heard about the scandal? Why were people doing this? How could they pass the national nursing board exam if they didn’t have diplomas/credentials?
Earlier this year, the Justice Department announced it had uncovered a scheme involving the sale of more than 7,600 fake diplomas and transcripts from several now-shuttered nursing schools in Florida. These alleged actions allowed individuals who aspired to become nurses to bypass the courses and clinical work required to sit for the National Council Licensure Examination (NCLEX). Since then, 25 individuals have been charged for their involvement in the fraud scheme.
The alleged scheme sold fake and fraudulent nursing degree diplomas and transcripts from accredited Florida-based nursing schools to those wishing to seek licensure as Registered Nurses (RNs) and Licensed Practical/Vocational Nurses (LPN/LVNs).
The individuals who allegedly acquired the fake nursing credentials used them to qualify to sit for the NCLEX. If they successfully passed the exam, they became eligible to obtain licensure in various states to work as an RN or an LPN/LVN. According to a representative from the HHS Office of the Inspector General, about 2,800 people— or 37 percent of those who bought fake documents — passed the test. Many individuals who passed the NCLEX and obtained licensure could then secure employment in the healthcare field.
State Boards of Nursing (SBONs) from Delaware, New York, New Jersey, Texas, and Florida, have launched their investigations into individuals tied to the scheme.
However, attorneys representing nurses now linked to the scheme said that not all students attending those Florida nursing schools purchased fraudulent documents. An attorney representing several affected nurses in New York has stated that many affected nurses are immigrants who assert that they attended classes and may also have completed training or education to become nurses in their home countries before coming to the U.S.
Additionally, according to The National Council of State Boards of Nursing, many individuals who allegedly paid for the fraudulent documents had experience working in healthcare as certified nursing assistants or other positions, which may help explain how so many were able to pass the NCLEX.
Licensing boards are investigating nurses who graduated from the schools allegedly involved in the scheme. If nurses received their diplomas/credentials ethically, why must they protect themselves? As in defending themselves?
Yes, nursing students who attended the identified Florida schools are worried about their careers. In some cases, the SBONs sent letters to licensees who attended those schools allegedly tied to the scheme and their employers, asking them to submit proper documentation or surrender their licenses. In New York state alone, the SBON identified more than 900 nurses asking them to prove their credentials are legitimate or surrender their licenses.
There are potential liability issues on both the employer and individual sides. Depending on the unique facts of the case, and state law, healthcare facilities that employed these nurses could face medical malpractice actions from patients who these individuals treated. Further, they could face allegations of improper hiring practices as they employed improperly credentialled providers. Healthcare employers must verify a nurse’s competence in performing essential functions — and are vicariously liable for anything that happens under their facility name.
For individual nurses, if a patient injury occurred during treatment, the patient could bring a claim against them related to professional negligence. The patients cared for by one of these nurses could claim the care they received was negligent because the nurse was not properly licensed. Again, these cases would depend on the patient’s allegations of injury, the unique facts of the case, and state law.
Why would they need lawyers if they haven’t done anything wrong?
Any nurse who receives a letter from the SBON should have an attorney to help them defend themselves against allegations or complaints against their license. The SBONs’ missions are to protect the public, and they have the authority to enact sanctions that range from fines up to and including more severe actions such as license probation, surrender, or revocation
When a complaint is made against a nurse to the SBON, nurses must be equipped with the resources to defend themselves adequately. Being unprepared may represent the difference between a nurse retaining or losing their license. Therefore, NSO’s policies include license defense protection which reimburses insured nurses up to the applicable limit for their defense of disciplinary charges and other covered expenses arising out of a covered incident if a complaint is brought against you before a state licensing board.
What can nurses do to protect themselves in the future? Aren’t they covered under their employers’ insurance? If not, why not?
According to the National Practitioner Data Bank, nursing professionals were more than 43 times more likely to have an adverse licensing action reported to the NPDB than a medical malpractice payment in 2022.*
Further, an SBON complaint can be filed against a nurse by anyone–for example, a patient, a patient’s family member, a colleague, or an employer. You may or may not know the identity of your accuser, and the complaint may be filed anonymously.
Nurses should ask their employers about the coverage afforded to them as an employee to identify if there are any gaps in coverage. If employers do not cover you for complaints made against your license to the SBON, they may wish to purchase professional liability insurance that includes coverage for license protection and safeguards nurses against licensing board complaints.
*Division of Practitioner Data Bank, Bureau of Health Workforce, Health Resources and Services Administration. Generated March 31, 2021, using the Data Analysis Tool at https://www.npdb.hrsa.gov/analysistool.
Data source: National Practitioner Data Bank (2022): Registered Nurse and Practical Nurse State Licensure/Certification Adverse Action and Medical Malpractice Reports (January 1, 2022 – December 31, 2022).
What most surprised you about this scheme?
As of today, from what I read about these cases, the SBON is not differentiating nurses who did attend these schools while they were accredited from those nurses who purchased fraudulent documents. The notices/letter sent to nurses by their SBON asking them to prove their credentials are legitimate were given very short response times to engage with an attorney, review the allegations, gather the required documents, and still meet this compliance deadline, which may raise questions about due process and their ability to be heard in these cases.
Besides working in an ER, Monique Davis, RN, BSN, has a side gig as a real estate investor specializing in land flipping and spec builds. (She also has another side gig as a family crisis coach, specializing in troubled teenagers, but we’ll save that one for another column.)
Davis took the time to answer our questions about her business. What follows is our interview, edited for length and clarity.
Why did you start flipping real estate/land as a side gig? When did you start it, and how did you go about it?
I started investing in real estate in 2018 with my first rental purchase, then followed that with purchasing my first Airbnb. When I learned about land investing, I hired a coach to teach me how to scale my real estate investing business in 2019. I could buy cheap properties and flip them for a significant profit. I did that repeatedly, and I kept taking the profits and buying more properties until I had enough money to buy a piece of land to build on.
From there, I built and sold spec houses (this stands for speculative houses and means that it’s a new house that someone has constructed, assuming it will sell for a profit). I recently sold my last spec house and am focused on land that I bought to build a venue and cabins on.
What exactly do you do with flipping real estate/land? How often do you do it?
When I am flipping land, it’s pretty basic. I buy them well under market price and then re-list them at market price—same concept with flipping houses.
When I look at a house flip, I am looking at how much work is needed, the cost, and the holding costs. Then, I use that to determine the amount that I can purchase. I don’t typically flip houses. I prefer to build from the ground up or flip land. We build 1-2 homes per year at this point. Although I have sold 45+ properties since 2019, I continuously evaluate, buy, or sell land.
Did you have previous entrepreneurial experience? Or did you learn on the go? Did establishing your side gig take a lot of time or money?
I was self-employed from the time I was 18 until I became a nurse at 36. I had never owned a business, though.
Becoming a business owner was a “learn on the go” experience for me and continues to be. Every time I take on something new in real estate, I learn on the go. I studied for two years before making my first purchase, and I felt like, as a single mom, it took all my savings to buy just one house. So I borrowed money from my dad to pay a coach to teach me how to scale. I was determined to make back the money I borrowed within 30 days of coaching.
Within 30 days of coaching, I could pay my dad back for coaching and had made a profit. The first property I purchased was $350.00, so the initial investment for land flipping was more the cost of the coach than the land itself.
What did you enjoy most about your side gig?
I love real estate. Everywhere I go, I look at real estate. Sitting on the couch, I cruise the internet looking at real estate. I love that I can do it from wherever I am at any time.
I love land flipping because it requires low effort. Spec building is a ton of fun to me. Watching a piece of dirt become someone’s dream home is super rewarding. I design every house with love, and my partner is the most detail-oriented person and takes a ton of pride in building a wonderful home for new owners.
Besides working in an ER, Monique Davis, RN, BSN, has a side gig as a real estate investor specializing in land flipping and spec builds.
What are some of the challenges?
The only challenge with land flipping is finding land that makes sense to purchase.
There are always many challenges that come with “ground-up” builds. You deal with many moving parts from beginning to end–permits and inspections to subcontractors and materials. I have learned so much from the ground-up construction. It is very rewarding but can also be highly stressful.
What are the biggest rewards of having your side gig?
Freedom. I can do that business from anywhere I am. I also travel more than I did before. I like to go and see new potential investment areas.
What would you say to someone who was considering getting into flipping real estate/land?
Real estate investing seems sexy and can be, but it is also a lot of work and commitment. I suggest studying the different types of real estate investing that interest you and then hiring a coach to teach you what they know to get you there faster.
Anything else that is important for readers to know?
While I love real estate investing, my passion is working with families on their healing journey. Real estate investing gives me the freedom and time to do what I am passionate about. Money is always good if you can use it to make an impact.
Have you ever wondered what it’s like to work as a vascular access nurse and what this job offers? Here are the basics that you need to know.
Rebecca Myers, MSN, RN, VA-BC, NPD-BC, is a Vascular Access Nurse (aka PICC nurse). Her hospital experience includes critical care, education, and vascular access.
Rebecca Myers, MSN, RN, VA-BC, NPD-BC
How did you get interested in being a vascular access nurse? What drew you to it? How long have you been doing it?
I started my nursing career in ICU and was always interested in learning new skills. In 2011, there was an opportunity to join an all-ICU RN PICC team. We trained with a seasoned team from a sister hospital. We rotated as the PICC nurse for the hospital and outpatients for a week at a time and worked in ICU the rest of the time. In addition, we placed lines for our hospital patients and outpatients needing long-term IV therapy.
Now, I am a full-time vascular access nurse.
Explain what a vascular access nurse does. What types of patients do you serve? What do you provide for them?
As a vascular access nurse, I consult to determine the best vascular access for a patient. I work in an inpatient setting and provide ultrasound-guided peripheral IVS, midlines, and peripherally inserted central catheters (PICCs) to patients requiring IV therapy.
I educate nurses about vascular access, choosing the best option for a patient, and advocating for a patient’s vein preservation and health. In addition, I educate patients about their access and what to expect before and after the procedure and answer any questions.
Did you need to get additional education for this position? Please explain.
Yes. There is an educational component required before any hands-on training. The classroom portion is an 8-hour course with successful completion needed before moving on to simulated hands-on training.
Once competence is achieved with simulated insertion techniques, we trained with a seasoned partner at a sister hospital. The requirements are to place a minimum of 10 lines successfully under supervision before moving into placing lines independently.
My hospital system uses a uniform approach for all vascular access nurses. We use Infusion Therapy Standards of Practice to guide our practice and incorporate Michigan Appropriateness Guideline for Intravenous Catheters (MAGIC) to aid in choosing the right line for each patient.
What do you like most about working as a vascular access nurse?
I love participating with patients, nurses, and physicians. I love being an expert in my field and having the knowledge and experience to help a patient through a procedure that has uncomfortable moments.
My master’s degree is in education, so I also love the education part of my position. There is an element of autonomy to my position that is professionally satisfying. I have been a nurse for more than 15 years and enjoy using my experience in this way.
What are your biggest challenges as a vascular access nurse?
Challenges change with time. When I started, the challenge was consistency and gaining the staff’s trust. I have now been at my current hospital for over four years. There is always an element of education that needs to be ongoing. Nurses and physicians are changing, and keeping the information readily available is key.
I send out a newsletter about 4x a year with summary tables for MAGIC, reminders, updates, and clickable links for more information. The more everyone knows, the better for all of our patients. The biggest challenge is to keep the communication flowing and fresh.
What are your greatest rewards as one?
The greatest reward of being a vascular access nurse is when a patient says I did a good job. Or family tells me they can see that I am experienced and trust me.
Anytime I can do something that makes a positive difference is the best reward.
Is there anything else that is important for our readers to know?
I want readers to know it is never too late…for anything! I became a nurse after my children were adults. It is the most satisfying and enriching thing in the world. It took me a minute, but I found my tribe in nursing. So whatever your dream is, go after it!
Nursing provides so many varied opportunities! It is still a great field. If you are feeling overwhelmed at the bedside, try something else.
