PEER REVIEW AND DISCIPLINE RELATED TO NURSING PRACTICE
[This section is taken from Texas Occupations Code, Ch. 303, Nursing Peer Review, and Texas Occupations Code, Ch. 301, Nurses.]
The Texas BON “has the authority and power to regulate nursing practice utilizing the language stipulated in the Nurse Practice Act. It is also the responsibility of the BON to protect (Texas) citizens’ health, safety, and welfare against substandard nursing care.” The Texas Board of Nursing protects the public’s health and welfare by overseeing and ensuring the safe practice of nursing. It regulates and oversees nursing practice by enforcing the nursing laws of Texas (Boehning & Haddad, 2022).
Violations of Texas laws related to nursing (TAC Title 22, Part 11, and TOC Chapters 301–305) are serious and may result in complaints being filed and in discipline by the Board of Nursing. Violations of nursing laws and rules can result in written warnings, public reprimands, fines, limitations or restrictions on the person’s license, citations, denial, revocation, or suspension of licenses.
Nursing Peer Review
Peer review means the evaluation of nursing services, the qualifications of a nurse, the quality of patient care rendered by a nurse, the merits of a complaint concerning a nurse or nursing care, and a determination or recommendation regarding a complaint.
Peer review includes:
- The evaluation of the accuracy of a nursing assessment and observation and the appropriateness and quality of the care rendered by a nurse
- A report made to a nursing peer review committee concerning an activity under the committee’s review authority
- A report made by a nursing peer review committee to another committee or to the Board as permitted or required by law
- Implementation of a duty of a nursing peer review committee by a member, an agent, or an employee of the committee
- The provision of information, advice, and assistance to nurses and other persons relating to:
- The rights and obligations of and protections for nurses who raise care concerns or report under Chapter 301 or other state or federal law
- The rights and obligations of and protections for nurses who request nursing peer review under this chapter
- Nursing practice and patient care concerns
- The resolution of workplace and practice questions relating to nursing and patient care
(TX BON, 2019a)
There two distinct types of nursing peer review, the incident-based nursing peer review and safe harbor nursing peer review:
- Incident-based nursing peer review is conducted to find out if a nurse’s singular or repetitive action needs to be reported to the Board or if it can be disciplined by the facility.
- Safe harbor nursing peer review is when a nurse makes a request in good faith for nursing peer review for a task the nurse has been asked to do that the nurse believes could be a violation of the NPA or Board rules. Nurses who request safe harbor nursing peer review are protected from discipline and discrimination for making the request and may engage in the requested conduct pending the peer review.
(TX BON, 2022; TX BON, 2019a)
Grounds for Disciplinary Action
Violations of Texas law that are grounds for disciplinary action include, but are not limited to:
- Violation of the Texas Nursing Practice Act, a rule or regulation not inconsistent with the Act, or an order issued under the Act
- Fraud or deceit in procuring or attempting to procure a license to practice professional nursing or vocational nursing
- Conviction for, or placement on deferred adjudication community supervision or deferred disposition for, a felony or a misdemeanor involving moral turpitude
- Conduct that results in the revocation of probation imposed because of conviction for a felony or for a misdemeanor involving moral turpitude
- Use of a nursing license, diploma, or permit, or the transcript of such a document, that has been fraudulently purchased, issued, counterfeited, or materially altered
- Impersonating or acting as a proxy for another person in the licensing examination required under Sections 301.253 or 301.255
- Directly or indirectly aiding or abetting an unlicensed person in connection with the unauthorized practice of nursing
- Revocation, suspension, or denial of, or any other action relating to, the person’s license or privilege to practice nursing in another jurisdiction or under federal law
- Intemperate use of alcohol or drugs that the Board determines endangers or could endanger a patient
- Unprofessional or dishonorable conduct that, in the Board’s opinion, is likely to deceive, defraud, or injure a patient or the public
- Adjudication of mental incompetency
- Lack of fitness to practice because of a mental or physical health condition that could result in injury to a patient or the public
- Failure to care adequately for a patient or to conform to the minimum standards of acceptable nursing practice in a manner that, in the Board’s opinion, exposes a patient or other person unnecessarily to risk of harm
Required Suspension, Revocation, or Refusal of a License
The Board shall suspend a nurse’s license or refuse to issue a license to an applicant on proof that the nurse or applicant has been initially convicted of:
- Murder, capital murder, or manslaughter
- Kidnapping or unlawful restraint
- Sexual assault
- Aggravated sexual assault
- Continuous sexual abuse of a young child or children or indecency with a child
- Aggravated assault
- Intentionally, knowingly, or recklessly injuring a child, elderly individual, or disabled individual
- Intentionally, knowingly, or recklessly abandoning or endangering a child
- Aiding suicide
- An offense involving a violation of certain court orders or conditions of bond punished as a felony
- An agreement to abduct a child from custody
- The sale or purchase of a child
- Robbery
- Aggravated robbery
- An offense for which a defendant is required to register as a sex offender
- An offense under the law of another state, federal law, or the Uniform Code of Military Justice that contains elements that are substantially similar to the elements of an offense listed above