The Texas Board of Nursing (BON) licenses, regulates, and disciplines nurses per the Texas Nursing Practice Act (NPA) and Board Rules. Therefore, serious NPA and Board Rules violations can lead to disciplinary action against your nursing license. However, not every minor violation can or should result in disciplinary action, and BON discourages the reporting of conduct by nurses that constitute only “minor incidents.” With that said, committing a minor violation still may lead to complaints to the BON or a nursing peer review committee.
You are potentially subject to discipline when your actions lead to a complaint, whether from a minor incident or not. As a result, you should consult a Texas nurse license defense lawyer for advice about handling your situation. We can provide you with the guidance you need to approach the complaint, help you distinguish between minor and major incidents, and minimize the adverse effects of the complaint on your career.
Defining a Minor Incident Under the NPA
A “minor incident,” “minor error,” or “minor violation of the NPA or Board rule” under 22 Tex. Admin. Code §217.16 is “ conduct by a nurse that may be a violation of the Texas Nursing Practice Act or a Board rule but does not indicate the nurse’s continued practice poses a risk of harm to a patient or another person.” As outlined in this section of the Code, BON assumes that reporting minor incidents to BON is unnecessary when sufficient mechanisms are in place in the practice setting to identify, address, and remediate nursing practice errors. These errors may relate to a nurse’s knowledge, skill, judgment, training, professional responsibility, or patient advocacy but do not include employment-related issues unrelated to the nursing practice, such as time, attendance, and dress code violations.
This Code section details the analysis that one must utilize to determine whether a violation is a minor incident, which is highly fact specific. This analysis involves consideration of various factors, including the nurse’s conduct, the factors beyond a nurse’s control, and the relationship between the two that influenced or impacted the nursing practice breakdown. BON also publishes a helpful flow chart that outlines the evaluation of whether an incident is “minor.”
Deficits in the Nurse’s Knowledge, Judgment, Skills, Professional Responsibility or Patient Advocacy
First, one must determine whether one or more deficits in a nurse’s knowledge, judgment, skills, professional responsibility, or patient advocacy contributed to the incident. If the nurse displayed no such deficits, then the incident may not reach the level of a minor incident.
On the other hand, if the nurse’s practice has one or more deficits that contributed to the error, one must determine whether remediation will address the identified deficit. If so, a remediation plan may be adequate to address the deficit.
Suppose a remediation plan is inadequate to address the deficit. In that case, the error is NOT a minor incident, and the nurse must be reported to the nursing peer review committee or, in settings with no such peer review, the BON. Likewise, if a remediation plan is adequate, but the nurse fails to complete the required remediation, the nurse must be reported to the nursing peer review committee or, in the absence of peer review, the BON.
Factors Beyond the Nurse’s Control
One also must evaluate the presence of factors beyond the nurse’s control for their contribution to the incident. Any such factors must be reported to the patient safety committee or, in the absence of such a committee, the chief nursing officer of the nurse’s practice setting.
The Relationship Between Factors Beyond the Nurse’s Control and the Nurse’s Contribution to the Incident
If one identifies factors beyond the nurse’s control present in the incident, one must evaluate whether the error would have occurred without such factors. If not, the incident may not rise to the level of a minor incident. However, factors beyond the nurse’s control do not automatically exclude the possibility that the error would have occurred without such factors. If one identifies any deficits in the nurse’s actions, one must address those deficits. Addressing these deficits is necessary even when factors beyond the nurse’s control contribute to the error.
Frequency of Minor Incidents
Suppose a nurse engages in multiple minor incidents. In that case, one must evaluate whether they indicate a pattern of practice that demonstrates the nurse’s continued practice poses a risk of harm. If so, multiple minor incidents may be grounds for reporting to BON.
Generally, if a nurse commits five minor incidents within 12 months, the nurse must be reported to the peer review committee. If no such peer review exists in the practice setting, then reporting to BON must occur.
Mandatory Reporting of Conduct that Goes Beyond Minor Incidents
Some types of conduct automatically fall within the definition of a minor incident and are subject to mandatory reporting. This conduct includes the following:
- conduct that ignores a substantial risk that exposed a patient or other person to significant physical, emotional, or financial harm or the potential for such harm;
- conduct that violated the Texas Nursing Practice Act or a Board rule and contributed to a patient’s death or serious injury.
- a practice-related violation involving impairment or suspected impairment because of chemical dependency, intemperate use, misuse, or abuse of drugs or alcohol, mental illness, or diminished mental capacity;
- a violation of Board Rule 217.12 with actions that constitute abuse, exploitation, fraud, or a violation of professional boundaries; or
- actions that indicate the nurse lacks knowledge, skill, judgment, or conscientiousness to such an extent that the nurse’s continued practice of nursing could reasonably be expected to pose a risk of harm to a patient or another person, regardless of whether the conduct consists of a single incident or a pattern of behavior.
Get Help Protecting Your Nursing License Today
Facing a complaint concerning your nursing license may significantly affect your career and your ability to support yourself. However, in some circumstances, you can avoid disciplinary proceedings altogether. Contact the nursing license defense attorneys at Bertolino LLP, so that we can investigate your case. You can call our office at (512) 515-9518 or visit us online to get more information about the services we can offer you.
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