Your Nurse Lawyer, Irnise Williams, Esq.

My guest this week, Irnise Williams, has been a nurse for 16 years. Starting with her eye on medical school, she opted for nursing school, fell in love, and never looked back. Because if you’re looking back, you can’t look forward, and forward was the direction Irnise wanted to go.
She could have advanced her degree by becoming a Nurse practitioner or a CRNA, two popular paths over a decade ago.  Instead, she attended Howard University School of Law, became a lawyer, and established her law firm.
She is now in a unique position. As a healthcare and regulatory compliance lawyer with a nursing background, she has a deeper understanding of healthcare practices and patient care.
With this knowledge, she helps healthcare providers and organizations navigate federal and state regulations, as well as advising small businesses and educating nurses.
As a Top Voice on LinkedIn and a strong Instagram presence as Your Nurse Lawyer, she frequently tackles controversial topics such as documentation, AI, and affecting social change through changing health policy.
I’m so thankful to Tiffany Gibson for recommending her bestie Irnise as a guest on my podcast. Irnise has elevated nurses everywhere by using her law degree to amplify the voices of our profession.
In the five-minute snippet: I’m a big fan of the Golden Rule. For Irnise's bio, visit my website (link below).
Irnise F. Williams, Esq
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Transcript

[00:00] Michelle: My guest this week, Irnise Williams has been a nurse for 16 years. Starting with her eye on medical school, she opted for nursing school, fell in love, and never looked back. Because if you're looking back, you can't look forward, and forward was the direction Irnise wanted to go. She could have advanced her degree by becoming a nurse practitioner or a CRNA, two very popular paths over a decade ago. Instead, she attended Howard University School of Law, became a lawyer, and established her law firm. She is now in a unique position.  As a healthcare and regulatory compliance lawyer with a nursing background, she has a deeper understanding of healthcare practices and patient care. With this knowledge, she helps healthcare providers and organizations navigate federal and state regulations, as well as advising small businesses and educating nurses. As a Top Voice on LinkedIn and a strong Instagram presence as Your Nurse Lawyer, she frequently tackles controversial topics such as documentation, AI, and affecting social change through changing health policy. I'm so thankful to Tiffany Gibson for recommending her bestie Irnise as a guest on my podcast because Irnise has elevated nurses everywhere by using her law degree to amplify the voices of our profession. In the five-minute snippet, I'm a big fan of the golden rule.  Well, good morning, Irnise. Welcome to the podcast.

[01:59] Irnise: Thank you. Thank you so much for having me.

[02:03] Michelle: Well, it's my pleasure. I started following you a while ago on LinkedIn and then Instagram, and then I interviewed your friend, your bestie, Tiffany Gibson.

[02:16] Irnise: She's so good.

[02:17] Michelle: Yeah, she was amazing, and she recommended you as a guest on this podcast. So thank you so much for coming on, because you have a lot to say.

[02:29] Irnise: A lot. That's all I do is talk. Right? Lots of conversation.

[02:35] Michelle: I love it. Yes. Okay, well, why don't you just start by telling us your story?

[02:41] Irnise: Yeah. So, I've been a nurse for 16 years. I just was counting recently, and for a decade, I've also been a lawyer. I started my career as a nurse going into a traditional BSN program. It took me five instead of four years, but it was a great experience to just expose me to, you know, the collegiate level. Right. Not just nursing, but just college in general. I think I learned a lot about the challenges of nursing while in nursing school because a lot of my classmates were coming from the military or other programs or just transitioning from, you know, other countries is just a huge challenge. And I was, of course, living in my little blissful world, like, oh, everyone just applies and goes, and that's really not the truth. And so, you know, again, being in college exposes you to so many different aspects of life that you never thought or considered. And I knew that I wanted to work in healthcare. I thought I wanted to be a physician, but I wanted to start with nursing and fell in love with nursing. Knew that I wasn't going to go to medical school, but I wanted to advance my degree. I wanted to get another degree, and advance my education. A lot of people were going to nurse practitioner school at that time, and CRNA programs were just starting to grow. Like, we knew there were some, like, older CRNA's who had been around for a long time, but actual, like, full-fledged programs that were bringing in dozens of students were just starting off. And I started my career in the OR, and I knew I didn't want to do that. And so I kind of started to look at what other options there were for people who wanted to help but work in healthcare. Still have some insight and all of that. And so I decided law school was better than getting a public health degree. And, you know, I applied and got in. People always ask, like, oh, what should I do? And I'm just like, I really just fly by the seat of my pants, which isn't always a good thing. Like, for college. I applied to one school, and I said, if I don't get in, then I'll just, like, go to plan B. Didn't necessarily have a plan B, but, you know, it kind of worked out. Law school, I applied to a couple of different programs, but again, I kind of was just, like, throwing it to the wind, not knowing what would happen. And I got into my first choice, which was Howard University, where I also went to undergrad. And going in, you know, again, I was the only nurse in the program. There were, there was a physician who was ahead of me and a few other people who had some healthcare experience and backgrounds, but it was a new world. I didn't have a lot of support for people to tell me how to transition from being a nurse to becoming a lawyer. And then again, I was exposed to landlord-tenant laws and housing issues and the criminal justice system and things that I never even considered as big of an issue as healthcare, because healthcare was my world and the only world I knew, I'm like, if you don't have healthcare, you don't have anything. But it's like, no, if you don't have housing, if you don't have a stable job. If you don't have quality transportation, all of those things impact your health as well. And so we focus only on healthcare. We kind of lose people because now we're talking about, you know, determinants of health. But we weren't talking about that 15 years ago in a way that it was holistic. We were talking about it, but in silos, everybody had their own thoughts about it. And so over the last decade, I've just tried to find my way. I've had a lot of challenges, really trying to find opportunities that allowed me to be both the nurse and use my nursing background and experience and also the legal mind that I've kind of honed and, you know, worked on over the past decade. I can tell people, like, when people ask me, like, oh, should a nurse become a lawyer? I always am cautious about encouraging people to do it because people have a hard time seeing nurses other than being a nurse. Like, they don't get it. They don't understand it. And it's because they don't understand what we do. They only assume that we pass medications and we, you know, change patients and things like that, which, that is a part of the work that we do, that is a part of the care that we provide. But we are so much more, especially in this growing technology era. You know, when I first became a nurse, we were still using paper charting. And quickly, when we transitioned from paper charting to EMR's, there wasn't, there wasn't a lot of time. Like, it wasn't like they gave us a year to figure it out. It was like, oh, today you're paper charting, tomorrow there's EMR. Here's one or two trainings. Figure it out. And I'm like, what other profession gets thrown into not only caring for people's lives but also figuring out an electronic medical record that no one has ever used before? And so I say all that to say that, you know, people look at my, my story or my life and they think like, oh, you just did whatever. And I'm like, no, there's a lot of challenges that have come with being who I am, not because it's me, but because people don't look deeper into who people really are, right? Like, they don't look deeper into what nurses do. They just say, if you're a nurse, this is all you do. And they accept those assumptions without opening their mind or being open to listen. So, yeah, that's what I've been doing for the past decade. I now have my own law practice where I do regulatory and compliance help small businesses and educate nurses. But again, that kind of came out of not being able to find an opportunity that would allow me to use both my nursing skills and my legal background.

[08:02] Michelle: Wow, that's a lot. Yeah. Yeah. That's amazing. You know, there were so many things that you said there that I just. I was like, yep. You saw me shaking my head and like, yep, yep, yep. Man, you're one of the OG nurses, then. Paper charting. Yeah. And you are absolutely right.

[08:21] Irnise: Yeah.

[08:22] Michelle: It was like, okay, here goes the paper. Here comes the computer. And, you know, even back then, it's like computers weren't really, like, people weren't computer savvy, so it was just so difficult. And I think when people look at you and they see your success and it's. It's easy to say that, you know, that came easy, but they don't know your story until you tell it, right?

[08:48] Irnise: Yeah.

[08:49] Michelle: Yeah. So thank you so much for sharing that. Well, let's see. I have some questions for you. Okay. You know, one of the things that when you were talking about, you know, people don't know what nurses do, and. So true. And. Or they put them in a box and they say, nurses just do this.

[09:09] Irnise: Yeah.

[09:10] Michelle: And I think nurses do that to themselves as well. And I think that we're trying to break out of that. But what was the pull with going into law for you?

[09:26] Irnise: Yeah. So I think the way that healthcare is taught and discussed again, is in a silo. It's like if you are a clinician, that is all you are, and that's all that you can do. But everything that we do is heavily regulated. Everything that, every decision that we make, how we provide insurance, and who we provide insurance to is all based on the law, whether that's local, whether that's state, whether that's federal. And it impacts us in a way where by the time that we get the decision, it's too late. We can't even change or fix or amend it. And so when I was still. I mean, I was still only a nurse for about two or three years when I started looking into law school, and I met a PhD prepared. He was a principal at the time, an educator who was very young and healthy, but he had just lost his job. So he lost his job, he lost his insurance, but he wasn't feeling well. Went to a free clinic because he didn't have any insurance. And they treated him so poorly, and they told him that he was a diabetic, and they were just shaming him for having this diagnosis and not knowing. But how else do people get diagnosed unless they have the symptoms, they show up, and they get the help that they need? So he decided he was never going to go back. Got a small little nick on his leg that grew and grew and grew that wasn't treated because he didn't have insurance. His blood sugars were out of control, which led to an amputation in his thirties. And I've told this story so many times that I'm like, one day this person's going to hear me tell this story and be like, it's me. But it shook me to my core because I'm like, one, how can healthcare providers who work in a role to help people who are uninsured treat you badly because you're uninsured? Like, that's not your fault? And then two, to make you feel so low and disempowered from being and taking care of yourself that you. You miss out on the symptoms, that your, your disease process is getting worse, that leads to an amputation like that, to me, blew my mind because then what comes after that? The healing and being out of work. At that time, he had got a new job he was leading in another school, but of course, he had to take time off. And all of the things that come, I'm like, all could have been prevented by people just treating someone with just a little bit of respect. But the fact that even health insurance is tied to someone's job is still problematic, right? If you're changing jobs or changing careers or you go through a layoff, the fact that there are very few opportunities for you to have some type of safety net is very scary. And that is what made me feel like, okay, I can't sit here and help from the healthcare perspective because it's already too late. Right. The decisions have already been made that if you don't have a job, then you don't qualify for health insurance, and that's it. And so the Affordable Care Act was coming out. There were a lot of charged conversations and feelings about that and about all that was coming from there. But I thought that it was going to be an opportunity for us to open the conversation about what is being lost in the process without covering people appropriately. And, you know, politics is politics. And so some of that was lost. But I felt that if I got ahead of it if I could be on the other side, then it would be easier for me to be able to remind people that one, nurses have a lot of expertise and experience to weigh in on these conversations because we are with the people, we're with the community, we're with the patients, but also for us to be aware that people are making decisions for us and we need to speak up. We need to be looking out for these situations. We need to be aware of what's going on. I just posted on LinkedIn about the Maryland legislators trying to take away the role of the Board of Nursing executive from it to be a nurse. They think that it shouldn't be a nurse, it doesn't have to be a nurse because according to some study, nurses don't have the leadership experience to lead an organization. And it's like, how can you make that type of decision? So when I tweeted out to the legislator saying, why would you say that? She was like, well, they can. If they choose to, they can. And I'm like, why would that even be a choice? That should be a mandate that this role has to be filled by a nurse, whatever those other requirements are. Maryland has 82,000 nurses. You can't tell me you can't find a master's prepared, educated nurse, who has leadership experience. That's absurd. And so those are the things and the conversations that we have to jump into and speak up for and make sure that people aren't just going to make decisions without first allowing us to at least have a conversation. So there were hearings on it. It's been pushed back to 2025. But that's a problem. And that's scary that this nonnurse, nonclinician is making a decision for the nursing board and for 82,000 nurses without asking us our opinion.

[14:26] Michelle: Yeah, I'm shocked. I'm really shocked. You can see that. I was like, what? This is crazy. And, you know, I think some of the best nurses, I think some of the best lawyers are nurses. You know, I interviewed Kwamane Liddell, and he's a JD who saw this injustice just like you did in the patient community as an ER nurse. And he saw these people coming in with high blood pressure and diabetes and all these really heavy diagnoses and sending him home with dietary instructions, and it's like, they can't even get food. They don't have heat. So he was like, I am powerless, almost powerless as a nurse to affect change unless I get a law degree. And I just love that, that there's, that there's those of you in this world that think like that, that see social change as something that you can do, that you have the power to do. And now you have the background because you have the nursing background to know, you know, how to do it. That's amazing.

[15:50] Irnise: Yeah, yeah, it's definitely, you know, good for us to start to be able to support each other as well. Right. Because when you have a, Everybody needs a lawyer, but it's different when you have a nurse who's a lawyer, as a nurse, to at least reach out to and say, hey, I have a question. Where should I go next? So it matters?

[16:07] Michelle: Yeah, absolutely. And, you know, as I was preparing to talk to you, I was thinking, you know, I really have no frame of reference. I've never worked with a nurse lawyer, and I have a family full of nurses and several lawyers, but no nurse lawyers. Right. So those conversations around the dinner table, you know, they, they were nonexistent because we were either nurses or lawyers, but we never blended the two. So I think that's really cool. Well, who are your clients Irnise?

[16:40] Irnise: So most of my clients are healthcare and healthcare tech companies that are growing and trying to diversify the way that healthcare is being done in the community. So a lot of value-based care companies, companies that are just trying to approach healthcare from a more futuristic perspective. I worked with hundreds of small practitioners who were just trying to get started. They're, you know, new to practice and they just want to make sure that their business is in compliance. And so a lot of nurse practitioners, nurses and physicians who are, you know, detaching themselves from traditional healthcare and trying to find new ways to care for people within their own community. And then there are a lot of people in between, therapists and nursing associations and organizations who have been able to provide training to and offer education and information. And so, yeah, these last three years have been a growing experience on how diverse healthcare is and that a lot of people are looking for someone who understands both sides. They don't want just a lawyer because what they find is that lawyers don't understand their role, their scope, their abilities. And then, of course, you know, you need someone who has that nursing or clinic clinical background to be able to advise on the licensing side because they don't want to risk, you're now risking your license and your business. So it's just a whole different world. So it's been good to see that there's a huge need out there in the conversations that have come from the opportunities of people leaving their traditional jobs to start their own businesses.

[18:16] Michelle: Do you work with individual nurses at all? Like, do nurses come to you for help with, you know, how to protect their license or anything like that?

[18:26] Irnise: Yes, I do a lot of consultations for people who have questions specifically about how to protect their license, I re-released my course on documentation to avoid litigation to specifically address some of those major concerns that come up a lot. I feel like maybe they come up a lot on units, but on social media, they're like these hot topics of should I write this or should I not? Or, and I mean, have led to very big arguments and disagreements about what's right and what's wrong. Wrong with. And I think what I find is that people who have never done paper charting feel that the EMR is, is God. And I don't mean to say like that, but they're like, well, the EMR has this or the, and I'm like, the EMR is not the standard of care for healthcare practitioners. It was what was built by the engineer. Like, it was created by a company that felt that this was what was needed or for them trying to interpret a regulation and figure out how they can pull that information in that doesn't go like, that's not who governs us. And we have to figure out how to find ourselves and our voice within that system to make sure that we're effectively documenting. And so that's a huge challenge. I think that when you're, you are tech-savvy. That's the, what, what's being lost, right? Is the fact that people feel that, that the EMR should guide them and what should be done, versus us. Right? We know that. We tell you what needs to be done. Like, that's our role.

[19:59] Michelle: Exactly. And let's talk about that. Because there was this recent social media post on Instagram and it created a lot of, a lot of buzz, right? And so it was about nurses charting no orders received, you know, calling the doctor or the provider for some reason, and charting no orders received. And, you know, a lot of, I was reading through the comments because I'm always there for the comments. I'm like, let the comment floodgates open because people are not afraid to share their opinions. And, you know, a lot of nurses were saying, you know, this is how I was taught. And I was one of those nurses that was saying, you know, I was taught in nursing school back in the eighties to chart, you know, either orders received or no orders received. And so why do you think that this particular post got so much feedback and, and, and just, yeah, give us some context on it?

[21:12] Irnise: So the original post was from a resident who was called by a nurse about a situation, like maybe in the evening. She didn't put a lot of context or details. And so she responded, give me a few minutes. Let me review the chart. The nurse documents no new orders received. And she felt that was passive-aggressive. And so I went into her comments, and they were in shambles. I mean, nurses were just going off about, like, who are you to tell me what to document? And, no, I'm not being passive-aggressive. And I've been a nurse for this long, and this is what we are supposed to do to protect ourselves. And I'm here to CYA and cover myself, and you figure out how to cut, like. And I'm just like, when did we not, you know, when did we forget that we were on the same team, that we were working together, especially a resident? Now, sometimes I get it. I mean, people can feel how they feel about, you know, attendings and the relationships that they have with them, but, like, you definitely have to give the resident some grace because they may be on this, their first week on this service, or they may be covering every unit in the hospital because no one else is there. So the reality that someone is going to give you an order over the phone immediately or say that they are going to give you an order so you would document yes or no to me isn't fair, right? And it makes it seem as if they didn't do something and something needed to be done because every phone call doesn't lead to an order. If I'm calling because the chart says to call if the blood pressure falls below 160, right? I call and say, hey, we're at 159, we're trending down. Is there anything you want me to do? And they may say, okay, call me back in an hour, or you, you know, I'll check in the chart, or I'll be up to see them. There wasn't an order that was needed for that, right? Based on the order set. And I think the other issue is what I see, especially from, like, labor and delivery in the emergency department, is that because there aren't providers who are clinicians who are on staff all the time, like, they're away, right? Especially OB-GYNs, things like that. They're not always there is that they have to call for everything instead of there being an order set or decision tree on what should be done, because you shouldn't stop the care to call. And if the fact that some of y'all aren't calling because you're afraid and some people are calling. There's a huge discrepancy in the continuity of care, the type of care that is being provided, and the critical thinking that is going on behind them. So I think people always assumed that when I make statements like this it's about right or wrong or black and white. And for me, it's about the critical thinking and the conversations that are happening on the back end. If I trust that the physician that I called or the nurse practitioner or the PA is going to either come and see the patient or they're going to follow up with me in the appropriate amount of time or do what I think needs to be done, I don't need to write something because I know they're going to. They're coming. I know that they're going to come write a note right behind me in ten minutes, an hour, however long, because I trust them. Right? And I think that's where what I think is missing. The context of the relationship should be so strong between you and who you're working with that you already know what their next step is, whether it's an order, whether it's no order, whether they're coming to see the patient, or whatever the case may be. And so the, one of the, I didn't, I've talked about this example before, but I didn't talk about it in this context. But one chart that I was reviewing for a big med-mal case where a family wanted to sue hospital was a patient who had had surgery and was transferred from the chair to the bed, and they were fine. And then somehow when they were transferred to get up, they, they fell. But it was an assisted fall. There were two nurses who were present. They didn't fall hard and they like, fell like on the nurse's shoe. So it was kind of, you know, a little bit of a cushion, right? It wasn't like hitting the ground immediately. Protocol was followed. They, you know, notified the physician. They, you know, got a CT, got a CT. Like whatever they needed to do was done. The documentation was so succinct, so clear, so concise, you couldn't infer anything. So I don't know if the physician came in an hour because the nurse said it took an hour for the patient, and the physician to come or that they just documented in an hour. All I know is the physician came and the orders were eventually put in. I don't know if there was a delay from when the patient was, you know, fell and it maybe take, took 2 hours for them to get taken down to CT because the nurse had other patients. Why? Because none of that was in the chart. So I could not infer anything from anything that was said because it was concise. And it was only from the nurse's perspective. And then whatever the physician and the PA and the resident and everyone else decided, it was from their perspective and that was it. There was nothing in between. And I was like, there's no way we can take this to court. And they didn't. And so now we're saving not only nurses, but everyone else who was involved in that patient's care from being sued, from being scrutinized, and from having to go through the pressure and the stress of being sued, which people don't take into consideration. Like a lawsuit isn't just a lawsuit, it is an emotional roller coaster and it's very traumatizing for every person who's involved. And then it also shows the family like nobody's perfect. And the expectation of perfection is not reality. The expectation is that we're going to care for your family the best way we can, which means that things happen. But when things happen, we're going to do the best that we can and we're going to communicate and effectively take care of your family member. That's the standard. But what happens is everyone puts in these little notes that then attorneys pull out. Then once the attorney pulls out that note, they can now request other documentation that may have been protected if those notes weren't in there and put the whole story together. So they can now request emails. They can now request, you know, messages that may have been sent in the chart and put the full picture together, for now, you then to turn around and ask for $5 million, $30 million, how much ever to settle this case because nobody really wants to go to court because that's going to 4X the cost. So I know that it feels like this 90 second video is giving so much information, but it's not. It's really just answering one specific scenario or specific question, but the context of what happens after that is so much greater. And I just don't think that everybody takes into consideration.

[27:50] Michelle: Yeah, there were so many themes going on there. It was like, you know, the us against them. And I think that's really prevalent in healthcare in certain hierarchies and the CYA aspect of it. And, you know, the thing that I was thinking about was, you know, you're in real-time. So if you're in the EMR and you're charting, you know, no orders received. At 10:00 the provider, they put orders in remotely, right, so they could rethink what went on with the conversation. And at 1005 they could put in an order. But you just said no orders were received, so it just muddies the water, you know, tremendously. 

[28:36] Irnise: I wanted to add that when you said it muddies the water, like, because if the nurse doesn't follow the order within a reasonable amount of time, then it also looks bad.

[28:46] Michelle: Yeah, exactly. And, you know, I think there needs to be regular updates for nurses on documentation. Like, I don't know, maybe at the yearly, you know, all these institutions have their yearly stuff where they pile all the crap on you that you have to take and it doesn't change, you know, kind of all the time. And so we really need regular updates on that. So I'm glad that you, you have a whole course on documentation, is that correct?

[29:24] Irnise: Yep, I have a whole course on documentation. The original course was created specifically for providers, but then a lot of nurses were like, well, nobody taught me how to document. I'm like, okay, so I created the documentation course for that. And then I also have one that's more, goes more into malpractice for physicians, PA's and NP's to be able to understand how to navigate that because for them it's somewhat inevitable. And I've heard some very bad stories of people just assuming if I agree to be a part of this, that if I didn't do anything wrong I won't be held responsible, which isn't always true. And so I think there are just some challenges that are not discussed about malpractice cases that I began to highlight. And that was kind of my passion a couple of years ago to really get out and let providers know, like, you have to fight on the front end to get out of this because you don't even, you don't even want your name attached once it gets past a certain point and how to navigate that. So, yeah, those things are out and available.

[30:20] Michelle: Wow, that's very cool. Okay, can you share an example of a particularly challenging case that you worked on and, and kind of how you navigated it?

[30:32] Irnise: Yes. When I worked in-house at a hospital, while I was in law school, because I was the nurse in the lawyer, they were like, this is perfect. Like here, let's dump all of this on you because you can navigate it a lot faster. And some of the things that I saw that I think were extremely difficult and one that I think I've reviewed before like kind of publicly and it wasn't my personal case, but it's always the labor and delivery cases where there's a delay in a decision or there's a provider who decides to use forceps or whatever the decision. And so now we're dealing with dystocia. We're dealing with whatever has happened because of that. And I think the challenge there is, like, everyone's trying to make the right decision in a very short amount of time. And some of the things that are said and communicated, whether it's someone who says, I don't want to have a c section or I want to wait a little bit longer or, you know, I think I can do this. Is it documented for anybody else to be able to defend themselves? And so I think, you know, this wasn't a case that I personally worked on, but one that I did a lot of research in. And I was talking to labor and delivery nurses where a young girl was having a baby and they told her that the baby wasn't viable. So she was just waiting to have the baby, you know, naturally. And then the baby is delivered and the baby is alive. And of course, this baby did, she didn't have oxygen. They weren't being monitored like all of these things. And so now she has a lifetime of disabilities. And this mother is saying, well, nobody told me that there was an option that this baby was alive because if that was the case, then I would have chosen the C-section. But they told me that the baby wasn't alive. So I just chose to have the baby. Now why would I have a C-section? And so there was a conversation of, like, was she educated enough to make the right decision? And did everybody really know that the baby, like, wasn't viable? And so it's heartbreaking because now you have a 16-17 year old taking care of a child who would have been okay if they were properly cared for in a hospital, who at that time was experiencing, experiencing the largest lawsuit ever in the entire nation. They appealed it, and I'm not sure where they are in the appeal. It's been a couple of years, and I'm sure they're extremely behind with appeals. But it was heartbreaking because for everybody who was involved, like, I'm not saying anybody made a right or wrong decision, but it was such a complicated thing. But what was missing was that they educated the patient on her options. They said that she chose this, but there was no documentation that they educated her on her options. And because she was so young, they should have also educated someone else. Like, yes, as, as a 16-year-old, once you're pregnant, you can make your own decision. But because she was so young, they felt that someone else also should have been in the room to be educated, to ensure she understood her decisions and she was making the right decision for herself and her baby. And so, yeah, it was hard. It was hard to read. I think another big one that comes up is her name was Kira, and she was a second-time mom. She was having her baby. Everything went fine. She had a c-section, and she was in the recovery area in postpartum, and she was complaining of a lot of different symptoms, like, she wasn't feeling well. Something didn't feel right. There was blood in her urine. And her husband at the time was like, hey, you know, something is wrong. They kept asking the nurse to call the doctor, and the doctor was not responding, wasn't calling them back, had an attitude, and kept saying, she's fine, she's fine. By the time someone did come to see her, she had so much bleeding in her belly. By the time they opened up her belly, she crashed, she passed away. And so I've seen her stories across the media. Her mother-in-law is a famous judge, and there are some other ways that, you know, I've seen her story recently here in Atlanta, and it's heartbreaking because she was communicating. She was speaking up. The family was present and speaking up. We failed on that. And I think, you know, there was a huge loss of trust in that community. It happened in California. And that, because that physician never came back and said anything. He never apologized. He never addressed, you know, the issues of people calling him and him not responding, like, all of that, and continues to practice. Right. And so now this mother has lost her life. Thankfully, the baby was born and healthy, and now this father is a single father caring for these children, and that's heartbreaking. Right. And I think those are the cases that always, like, shake me the most, because I'm like, we had a role in doing something. And sometimes the conversations and the comments hat bother me the most are, like, this fear of, like, being able to speak up for yourself or for your patient. Like, I don't care what some. If someone's going to tell me I'm stupid or they think I shouldn't be calling, that's not my problem. My problem is making sure that I'm confident in the decisions that I'm making because ultimately I'm going to be responsible, whether it's just me, emotionally responsible or responsible, you know, legally as well. So.

[35:59] Michelle: Yeah, well, those are heartbreaking cases. And, you know, as a longtime NICU nurse and you know, going to deliveries and man L&D is just, it's a hotbed for litigation, right? And potential litigation. And, you know, I think it's. It's definitely hard for me. I would say it's hard for new nurses to speak up because, you know, I can identify with that as a new nurse. I was, you know if you're working with these different personalities, physicians and other providers, and they yell at you or they seem upset with you because you called again, and I definitely remember as a new nurse, feeling intimidated, like, I don't want to call because I'm going to get yelled at or whatever. Well, that quickly left with some years behind me and where I didn't care and other nurses coming to me and saying, how did you do that? Like, he's this person. Such an asshole. And now we have, we have ways to address those things, thankfully. So I don't see it so much anymore. But, yeah, that's. It's very sad to see that level of disaster. And it could have totally been avoided.

[37:29] Irnise: Yeah, yeah, yeah.

[37:32] Michelle: Okay, let's see. Let's talk about data privacy. So I saw that on your website, and many healthcare institutions have been hacked in the recent past. What's your opinion on it? Are our systems, like, so outdated that they're just really vulnerable? And how do you address this with clients that want to have good, you know, data privacy?

[38:00] Irnise: Yeah. So I think that there used to be a time where it was difficult to hack into systems because everything was, like, computer-based. So if you can't get access to the computer, you can't get access to the information. But now that everything is cloud-based, right? Everything is being uploaded into some figurative cloud, which is really just an external server. Outside of where you are, there are people who are figuring out that instead of breaking into your hospital and stealing computers, they're now breaking into these servers to steal the information. And I think hackers have realized that I can hack a bank or I can hack all of these different companies, and I'm only going to get so much information. But if I hack a healthcare practice or a hospital, I am not only getting all of their personal information, but I'm also getting other information that I can then utilize to steal even more stuff from them. Right. And so. Or to gain their trust in order for me to send out a spam that to diabetic patients to say, oh, if you want to get access to a free, you know, machine, here's you. Here you go. And they click that. And now I can access all their personal information. And so that has been the shift. It used to be that hackers just wanted to get into very popular systems that had a ton of information, but they realized how limited that information was. And so now that. That they've transitioned to mostly. And so just not mostly, but just a lot of healthcare practices. The fact that almost every person in this country has probably been exposed in some way is just unbelievable, because there was a time where it'd be like, oh, 100,000 people over here, and 100 now it's like a million people, and it just has grown exponentially. Right, so the black market also grew when the Bitcoin exchange grew. So that is just a different way to exchange money on blockchain, which means that we don't have access to it. We can't see it, and it's not connected to any bank, bank, or system. It is such a secretive way to share money in the black market. And so now that that is also happening, people have found that to be a way of life and business, like criminal activity is always going to happen. But criminals want to find more discreet ways to commit crimes so they can continue to grow their criminal enterprise, whatever that means for them. And so I think our mindset has always been that these are just bad people doing bad things, not understanding that these are entities who are essentially created just like a business, that up a lot like a business, and supporting all types of activities across the world. And so now that we as an industry, you know, cybersecurity specialists and lawyers who work in data privacy have really accepted the fact that we can no longer just sit here and wait for someone to hack us, we now have to, one, educate on the foundational level. So a lot of what I do is educate on the foundational level, making sure the healthcare practitioners understand the basics of data privacy, which is every computer you have should have a password on it. Every computer you have should have a VPN on it, which essentially just scrambles your location and makes it a little bit more difficult for people to hack into your system. If you have any type of clinical information, it shouldn't be on your home computer. It should be in a system that has a lot of protection. So if you're using EMR, you shouldn't be downloading things on your computer. Everything should be in the EMR. I tell people things like text messaging. You're texting someone that is not secure, that information can be stolen unless it's on an encrypted system. And so just teaching people the basic ways that they can protect themselves and that they can protect their businesses and their patients from being hacked because when a hospital is hacked, it is terrible. There's a terrible experience, what is happening with change healthcare and all these things, but they have insurance money, federal backing to help them figure it out. Most small healthcare practices don't. And some hospitals, even major hospitals, have had to close because they've been hacked. And so when I talk about data privacy, a lot of the vulnerabilities that we create ourselves, sharing passwords, not having a complex password, not locking our computers, not reporting if something has been stolen, does lead to other breaches where people get access to healthcare information. And if we can nip some of those smaller incidents in the bud, then we can focus on some of the bigger incidents that are happening and figure out how we can combat that as well. So the changing healthcare, which essentially is how a lot of healthcare practices get paid, that's the system that they use to submit their billing to then get paid by CMS that was hacked because someone used AI to call over the phone and say, I need to reset my password. So the person who had that password didn't follow protocol because that wasn't even, that should have never been an option. Right. The password should have only been reset by sending a confirmed email to the person. And, you know, text messaging, you know, two-factor authentication, all of those things were in place. The fact that this person changed that. That password over the phone, which then led to the whole system being hacked and shut down, shows how vulnerable we are without education. And this is someone who works in cybersecurity or the IT department, per se. And so the reminder, it's crazy, right?

[43:30] Michelle: Crazy.

[43:31] Irnise: I don't even know if they could be held criminally liable because, I mean, the. The damage and the ripple effect that has been going on for about three or four months.

[43:41] Michelle: Yeah. It's just, it's. There's so much press on it. And you would think that because there's so much press on it these companies, these institutions, would really want to beef up their security systems. And I was. I interviewed Taofiki Gafar-Schaner last year. And he was, you know, an informatics nurse and talking about the vulnerabilities of the systems. And, you know, we were teasing, but I was telling him that my password was actually 14 digits long. And he said that's great. You know, you need to have, like, a passphrase where it's not so easily hacked. And I remember when we were still doing paper charting and we had these big, huge bins that were locked, and the paper was going to be shredded. And the big thing in our hospital was somebody had broken the lock on that bin and taken all those papers. And that was like a big hack of paper charting. So that was back in the day. So it's still going on, you know.

[44:49] Irnise: And, like, people don't understand. It's just become more sophisticated. It has just become a little bit different. But they still get ahold of paper, anything paper, if they can, right? There are just so many different ways for people to hack into systems in order to get access to protected health information. And it's our role to just try to combat it as much as possible. One of the conversations that happened at a healthcare tech conference that I went to recently was like, when do we just start going after the bad actors, right? Instead of waiting to be hacked, we should be going after people who are doing the hacking. So even if it's a failed attempt, we should be investigating who these people are so that we can arrest them and shut them down. But the hardest part is how complex and intricately they have now become that you don't even know who's really running it. Even if you find the individuals who may have attempted the hack, there are so many other people behind them and above them, that it's going to be difficult to do. And so that is the new conversation. It's like, okay, we're. We know that we may get hacked. We're going to get hacked. What are our other options to then go after the hackers before they hack us? And I think there haven't been enough conversations or answers to that just yet, but it's definitely coming.

[46:04] Michelle: Well, we certainly need some answers on that. Okay. One of my upcoming guests is disabled. She's wheelchair-bound, and she frequently enters places like doctor's offices, clinics, and hospitals that are not ADA-compliant. And I want to know, how is this still happening in 2024? And is this something that you would help clients with?

[46:33] Irnise: Yeah, so I don't do ADA work or, you know, defense work or lawsuits, but there are a lot of people out there who do. Who will sue for a failure, for ADA compliance? I think the biggest issue is the enforcement. There hasn't been consistent enforcement on every level in someone who has been assigned to be the enforcer on the local and state level of federal laws. And I think that's some of the hardest things with federal laws and why some people think that the state should handle it. Because if the state creates it. They also have to create a role for people to follow and enforce it. But if the federal, federal government creates it, the enforceability does become hard because there's no funding that comes from that or for that to be enforced. And that's what I've seen the most. Right. I think airlines are just now potentially on the verge of being penalized in a major way for their inability and their lack of following transport, transportation laws and federal laws for ADA compliant being hit with immediate fines. Like immediate. And I think that is what makes them wake up and say, okay, we have to now do right, because for so long, you've been breaking people's wheelchairs. You're not giving people adequate access to federally governed options to travel, yet you're taking their money, and that's not acceptable. And so I think there has been a lot of awareness, which I don't think was happening before. I think that people who are part of the disability community are in their own world trying to advocate for themselves. But I think the rest of us are just as angry. Like, it's not fair that someone who's using a wheelchair has to be forced to potentially think or feel that their wheelchair, their main form of transportation, is going to be broken when they land. Why is that even an option? I don't even have that as an issue, and it angers me. And every time I see it, I'm tweeting the secretary of transportation, like, what are you going to do about this? This is a problem. Like, pull up. Like, what are we, what are we doing? Because I shouldn't have to hear this from other people so often. Like, it's not like it's happening once in a blue moon. It's happening every single, I just saw a post before I came on about an airline that took apart people's wheelchairs, took the wheels off of the chair, or maybe ten or twelve people who were traveling together, and now they're all trying to figure out whose wheels are whose, and it costs and delays and all these other things, and it's just like immediate fine, like, immediately. This needs to be fined and dealt with to avoid this from happening because they have to also fly home. So, you know, disability rights is a huge industry in healthcare, and there are lawyers who are out there who know the ins and outs of the ADA and who are enforcing it and suing behind it and trying to get policies changed to ensure that people have access for it, whether it's going through a door to the post office or going to a clinic where they have accessible beds so that you can actually be properly assessed and seen without there being, you know, some of the challenges that people are facing.

[49:51] Michelle: Yeah, it's infuriating just listening to one person, her telling me her story of on a weekly basis of encountering medical institutions that are not ADA compliant, and it's really sad. Okay. If you hadn't gone into law, do you think there's another field or specialty that you would have gone into or that you want to go into?

[50:17] Irnise: I wish that I had gotten my master's in business administration, so my MBA. I had an option to go into the MBA program to get a JD-MBA, but I was so done with school, I was like, I gotta get out of here. And I should have just stayed. But getting my MBA, I think, would have been really empowering, because, again, the healthcare business is such a big part of everything that we do, and you need someone at the table who has the experience. My friend, who is a nurse who has her MBA, has been in executive leadership for a really long time, and it's impactful, and she's very impactful in creating systems and changes that need to be done. She was like, there's no way that we're going to run a clinic, and this is how it looks because she's a clinician, but because she has that MBA, she's sitting at the table with the right people who are saying, okay, no problem, we're going to listen to you because you have this experience. So I definitely would have just gone straight into the business side of things versus, you know, trying to do the law, but also kind of do the business stuff as well.

[51:18] Michelle: There's still time, Irnise.

[51:21] Irnise: Not a dollar in my pocket that anyone would ever give me. I've maxed out on my student loans. If someone. I would definitely, definitely consider a few years to get an MBA.

[51:33] Michelle: Yeah, I see so many nurses doing that, and the masters in healthcare administration. And, you know, those. Those nurses are really. affecting policy change. Right. And that's very, very cool. Okay. What advice do you have for nurses who are contemplating going into law?

[51:56] Irnise: Yes, I think that you want to be open-minded, because I think people think that the only thing that you can do is do medical malpractice or policy work. There are so many aspects of healthcare in the law, whether it's working at an EMR company, doing their in-house work, working for big pharma or a medical device company, that there are so many options and opportunities. And I think that, again, when you don't have anyone who's ever walked that road before and you're trying to figure it out, it's taken. I didn't even know that some of these jobs, you know, existed until the last few years when more postings on LinkedIn have kind of come up. And so if you're interested, make sure that you're exploring all of the different options that are out there so that you can tailor your education and your internships and your experiences towards that so that when you graduate, you can find the opportunity that kind of fits your goals.

[52:49] Michelle: That's great advice. And law sounds a lot like nursing. Like, there's so many different avenues that you can go. So that's great. Well, as we get ready to close here, I'm going to ask you the same question that I asked your bestie, Tiffany Gibson. Is there someone you recommend as a guest on this podcast?

[53:11] Irnise: Yes. Have you ever had ebbtheNP? She's a nurse practitioner who does locum travel, and her story is very interesting about how she's integrated travel into her. Her world and how she's helped nurse practitioners who have worked as nurses for so long to just expand their mind and their mindsets. I think she's an awesome person to consider.

[53:31] Michelle: Okay, awesome. Thank you so much for that. Okay, well, where can we find you?

[53:36] Irnise: Yes. So I am Your Nurse Lawyer on all social media platforms, I mainly focus on Instagram and LinkedIn. I am actually, once this comes out, I may have a YouTube video up, but I'm relaunching, and investing more time into my YouTube because I think those 90 seconds lead to so much drama because I don't have the time to give the context. And so I want to do a little bit more long-form video about these subjects so that people have the information that they need. And so I'm really, really excited about that. And, yeah, I'm always on Instagram. That's really where I'm at most of the time.

[54:09] Michelle: Do you have somebody manage your social media or do you do it all yourself?

[54:14] Irnise: I've tried and I end up just doing all myself because people ask very niche questions that usually I can say, yay, I can help you, or here. Here's where you can go. So I do everything myself right now.

[54:24] Michelle: Wow, that's amazing. That's a lot because I'm just trying to keep up with the whole social media thing. I'm just trying to increase my posts from twice a week to three times a week. And I'm having trouble doing that. So bravo to you. That's amazing.

[54:40] Irnise: Thank you.

[54:42] Michelle: Wow. Irnise, thank you so much for coming on today and sharing all of your knowledge and expertise as a nurse lawyer with my audience today. I've really enjoyed talking with you.

[54:52] Irnise: Oh, I have done the same. Thank you so much for having me. I can't wait till this comes out.

[54:57] Michelle: You're gonna love it, and they're gonna love you. And we're ready for the five-minute snippet at the end. This is just five minutes of fun. So are you ready?

[55:07] Irnise: Yeah.

[55:08] Michelle: Okay, let me get my questions. All right. If you were a fruit, what fruit would you be? And why a pineapple?

[55:22] Irnise: Because not perfectly beautiful on the outside, but the inside is so sweet, just like me.

[55:30] Michelle: I love it. And isn't the sign of, like, welcoming?

[55:34] Irnise: Yes.

[55:35] Michelle: Love it. Okay. Favorite way to unwind. 

[55:41] Irnise: Working out. I feel like that's the only way I can focus. I tried a million other things, but once I get into a good workout, there's nothing else that matters.

[55:49] Michelle: I love that. You know, I've met so many people that workouts are really central for their mental health and physical health, and God did not grant me that. Why God? Okay, good for you. Okay. Do you have a favorite famous legal case ruling or trial?

[56:17] Irnise: I think the biggest case that kind of got me interested in law as well happened at Hopkins with a patient. It was a huge case, and I feel like it was the. What? To Err is Human? I was just looking at it.

[56:34] Michelle: To error is human. Oh, yeah. The IHI. Yeah.

[56:41] Irnise: Yep. And so I think that was one of the cases where I was like, what? Where that lawyer, I ended up meeting him, but, like, hearing his story. When I worked at the hospital in my career, they used to play that video all the time and hurt and listen to the mom and her experience and how nobody was listening to her. And it really, really changed kind of my insight on how I practice as a clinician.

[57:02] Michelle: So powerful. Yes. If aliens landed on earth tomorrow and offered to take you with them, would you go?

[57:09] Irnise: Oh, my God. Yeah.

[57:11] Michelle: Please take me to see what's out there. Right?

[57:15] Irnise: Yeah.

[57:16] Michelle: Favorite genre of music?

[57:20] Irnise: I think it definitely depends on the mood. I'm an R&B, hip hop type of girl, but it depends on the mood. Sometimes I need some jazz. Sometimes I need some gospel to keep me together so I won't lose it all. So I like all types of music. You know, I used to live in Texas, so I used to love it. I  feel like sometimes when you live in certain places, you fall in love with the music of that place. And so when I lived in Texas, you couldn't tell me that I wasn't a country girl. I was, yeah, definitely.

[57:46] Michelle: I love it. I love it. Okay. What three things would you want to bring with you if you were stranded on a desert island?

[57:56] Irnise: Sunscreen. I would say a pail so that I can get water and a nice bathing suit. Right. I probably need some stuff to survive, but.

[58:15] Michelle: Okay, what's your favorite color, and how does it make you feel?

[58:20] Irnise: Purple. And it makes me feel regal. I think it's like royalty. No matter if I have it on my sneakers or an outfit, it's just regal.

[58:31] Michelle: Okay. If you could go back in time and give yourself one piece of advice, what would it be?

[58:38] Irnise: It would be to think bigger. I think that even though I have had a very successful life, I think that I narrowed my opportunities by not thinking bigger. And so just to be a little bit more open and think bigger about what the future could hold.

[58:54] Michelle: That's a great message. Listen up out there, everybody. Think bigger. Okay. What's a belief or a value that you hold dear?

[59:04] Irnise: I believe that you should treat everybody with love and respect, no matter who they are, or where they're from. And I think I really, really learned that being a nurse, because people fall on hard times, or people can be very rich and wealthy and not very nice, but you still have to kind of treat everyone with the same love and respect, and it definitely heals in a different way.

[59:25] Michelle: I think that's a perfect way to end the five-minute snippet.

[59:29] Irnise: Yay. Thank you.

[59:31] Michelle: Awesome. Thank you so much, Irnise. I love it. Have a great rest of your day.

[59:37] Irnise: Thank you so much. It was so nice to meet you again. Take care.