The Texas Board of Nursing (TBON) regulates and monitors licensed nurses. If TBON determines that you have violated a rule or law that governs the nursing profession, you could face sanctions that are extremely damaging to your license and career. However, in some cases, your employer may be able to handle a situation internally using a nursing peer review committee. A nursing license defense attorney can help you navigate the nursing peer review committee or disciplinary proceedings and work to salvage your license and career.
What is a Nursing Peer Review Committee?
Tex. Occ. Code § 303.001(4) defines a nursing peer review committee as: “a committee established under the authority of the governing body of a national, state, or local nursing association, a school of nursing, the nursing staff of a hospital, a health science center, a nursing home, home health agency, temporary nursing service, or other health care facility, or state agency or political subdivision to conduct peer review. The committee includes an employee or agent of the committee, including an assistant, an investigator, an intervenor, an attorney, and any other person who serves the committee in any capacity.”
What is the Makeup of a Nursing Peer Review Committee?
A nursing peer review committee must consist of at least 75% nurses. If the peer review involves vocational nursing, to the extent feasible, the committee must include vocational nurses, and only vocational and registered nurses may be voting members. If peer review involves professional nursing, registered nurses must make up at least two-thirds of its members, and only registered nurses may be voting members.
To the extent feasible, the committee should contain at least one nurse familiar with the nursing practice area in which the nurse being reviewed practices. The committee also may not contain people with administrative authority for personnel decisions directly relating to the nurse.
What is the Purpose of a Nursing Peer Review Committee?
Nursing peer review refers to “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” under Tex. Occ. Code §303.001(5).
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Employers use the peer review process to decide whether to make a report to the Texas Board of Nursing (BON) or report findings to an entity’s patient safety committee or nursing administrator, as appropriate, where a BON report has already occurred.
When is an Employer Required to Establish a Nursing Peer Review Committee?
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Tex. Occ. Code § 303.0015 requires an employer to establish a nursing peer review committee or contract with another entity to provide peer review services in the following situations:
- In the case of vocational nurses, if the person regularly employs, hires, or contracts for the services of eight or more nurses; or
- In the case of professional nurses, if the person regularly employs, hires, or contracts for the services of eight or more nurses, at least four of whom are registered nurses.
What are the Two Types of Nursing Peer Review?
The two types of nursing peer review can apply to the practice of an LVN, RN, or APRN and include:
- Incident-Based Nursing Peer Review (IBNPR) – This review determines whether a single event or a series (up to five minor incidents within a year) events rise to the level of a BON report or constitute a minor event appropriate for remediation. In addition, this review includes whether external factors beyond the nurse’s control contributed to any deficiency in the nurse’s actions. The review also considers whether to report the incident to the entity’s patient safety committee.
- Safe Harbor Nursing Peer Review (SHNPR) – This type of review can protect a nurse from employer retaliation, discipline, discrimination, and license sanction. SHNPR can protect a nurse who makes a good faith request to review an assignment or conduct that someone has asked the nurse to perform and that the nurse believes that the assignment could violate the Nursing Practice Act (NPA) or BON rules.
Are Nursing Peer Review Committees Confidential?
All nursing peer review committee meetings are confidential. All communications between committee members, agents, employees, and participants in those committee proceedings are confidential. Likewise, anyone who attends nursing review peer committee meetings may not disclose or be required to disclose any information about the committee proceedings.
Due to this confidentiality, information concerning committee proceedings is neither subject to subpoena nor discovery in legal proceedings. It is not admissible as evidence in any court or administrative proceedings, including nursing liability lawsuits that arise from the provision or failure to provide nursing services.
Can the Nursing Peer Review Committee Disclose Information to Any Entity?
The peer review committee shall disclose information only to the following entities:
- a licensing agency of any state;
- a law enforcement agency investigating a criminal matter;
- the association, school, agency, facility, or other organization under whose authority the committee is established;
- another nursing peer review committee;
- a peer assistance program approved by the board under Chapter 467, Health and Safety Code;
- an appropriate state or federal agency or accrediting organization that accredits a health care facility or school of nursing or surveys a facility for quality of care; or
- a person engaged in bona fide research if all information identifying a specific individual is deleted.
Is a Nurse Entitled to Any Due Process Rights During Nursing Peer Review?
A nurse is entitled to due process rights during the nursing peer review process, including prior notice of a peer review hearing by certified mail at the last known address the facility has for the nurse. The nurse must receive notice of the hearing date no earlier than 21 days and no later than 45 days after issuance of the notice. The nurse also must receive:
- A description of the event to be evaluated in detail;
- Contact information for the person to receive the nurse’s response;
- A copy of the entity’s nursing peer review plan, policies, and procedures;
- At least 15 days to review any related documents before the hearing;
- The right to make opening and closing statements, ask and answer questions of the committee, and submit a written statement articulating their position;
- The right to present witnesses, question witnesses, and attend the meeting where evidence or witnesses are being presented;
- Receive a list of all witnesses at least 48 hours before the hearing;
- A completed review within 14 days of the hearing;
- Written notification of the outcome of the hearing within ten days from the date of the completed review; and
- The option to submit a written rebuttal statement within ten days of receiving notification of the hearing outcome.
Can an Employer Still Take Disciplinary Action Against a Nurse Regardless of the Outcome of the Nursing Peer Review Process?
An employer can take any disciplinary action against the nurse it chooses, regardless of the outcome of the nursing peer review committee. However, a nursing peer review committee can be instrumental in helping employers determine the best course of action in a case involving alleged nurse misconduct, including whether to report a nurse to the BON.
Get Legal Advice and Work to Renew Your Nursing License
A Bertolino LLP nursing license defense lawyer can evaluate your situation and determine the best strategy to renew your license successfully. We also can protect your license should you face a complaint or disciplinary proceedings due to misconduct allegations. Call us today at (512) 515-9518 or get more information about us online.
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