While the Texas Board of Nursing (Board) receives more than 16,000 complaints a year, not all of them lead to the Board taking any investigation or disciplinary action. This is because many complaints the Board receives contains insufficient information about the nurse, are considered ‘minor incidents’, aren’t in the Board’s jurisdiction or sometimes certain issues even if proven, don’t violate the Nursing Practice Act (NPA).
The Board usually notifies the nurse about the investigation and allegations unless doing so will jeopardize the investigation. Nurses also have a chance to respond to allegations and show compliance with the Nursing Practice Act. Collecting relevant evidence and contacting witnesses is part of the investigation. While most of the investigation is happens over the mail and phone, at times, on-site investigations also take place. When collecting relevant evidence, the investigative team reviews all evidence to determine if any violation of the NPA has occurred. It’s after this review the board closes some cases.
Depending on the type of closure the Board decides on, the complaint and all relevant evidence may be immediately expunged from the nurse’s file. The board may also retain all information for a specific period of time. If the Board receives additional information, complaints or evidence before expunging the file the case will be reopened. If the evidence proves a sanction must be produced against the nurse to protect the public, an Order of the Board is the next step. When a nurse receives an Order of the Board it requires a sanction and other stipulations be put on the nurse to retain his or her license.
Possible sanctions include:
- A fine
- Remedial education
- Revocation of their license
While most Board Orders are public information and permanent designations in the nurse’s licensure records there are exceptions. Exceptions include successfully completed deferred disciplinary orders.
Depending on the circumstances of the complaint, an investigation is takes anywhere between five to twelve months to complete. Various factors beyond the control of Board staff and the nurse under investigation can affect the complaint’s resolution time. Despite these factors, the board regularly monitors case resolution and internal processes. They also work to improve upon all processes to ensure complaints are resolved as quickly as possible.
Throughout the process both the nurse under investigation, as well as the complainant are periodically notified of the status of said investigation. Unless instructed otherwise, all complainants are also notified of the investigation’s final outcomes.
An informal settlement begins with offering the nurse proposed agreed orders. These orders include investigative findings, the sanction, law conclusions and stipulated requirements. The purpose of this is to ensure the nurse is safe to practice.
Nurses who agree with the proposed agreed order’s contents sign and return it to the Board’s office before a notary. Agreed orders then go for review and ratification by the Board every month. While the Texas Board of Nursing accepts and ratifies many of the agreed orders, it’s important to note if the board disagrees with the orders they may modify or reject them.
Nurses who don’t agree with their proposed orders can submit specific written suggested revisions for the Board to consider. If the board accepts the submitted revisions, they will send new agreed orders.
Informal settlement conference
Sometimes, nurses can receive invites to attend an informal settlement conference that happen at the Board’s discretion. The Board holds these conferences a month or more in advance at their offices in Austin, Texas. The Executive Director or his/her designee conducts informal conferences. Attendees also include one of the Board’s attorneys, the Director of Enforcement, the investigator and other Board staff.
The nurse and Board staff speak about the possible violations, evidence and acceptable settlement during each conference. At the end of most of the conferences, the nurse receives the panel’s recommended case disposition.
Should the panel determine they need to protect the public, they will send new proposed agreed orders to the nurse. Like other proposed agreed orders, the nurse can sign their orders before a notary and return it. They also have the option to submit suggested written revisions to be made to the proposed orders for the Board’s consideration.
Once the Board ratifies orders they become final and its terms are effective. A copy of the final Board order is sent to the nurse as well as their last employer. Complainants also receive notifications about the outcome. Generally, the Board’s disciplinary action is public information and a permanent part of the licensure record. Disciplinary action can also be found in the Board’s quarterly newsletter as well as in the National Practitioner Data Bank and the National Council of State Boards of Nursing.
Formal settlement process
When the Board and nurse cannot reach an agreement for an informal settlement or if the Board cannot contact the nurse during the investigation the Board will file formal charges. At this point the nurse must file written answers to the charges. If there is a failure to file answers for formal charges, it may lead to the revocation of the nurse’s license by default.
If the nurse files answers, negotiations toward agreed settlements continue. During this time a formal public disciplinary hearing before the Administrative Law Judge (ALJ) is scheduled. Cases which do not reach agreed settlements proceed to hearings where the Board staff presents evidence while the nurses present their side of the case.
The ALJ submits a proposal for decision (PFD) after each hearing to the board where each PFD contains the Judge’s findings of fact and law conclusions. The Board then reviews and acts on each PFD by either imposing the appropriate penalties or by closing the case without any action.
Have Questions About Texas Board of Nursing Investigations?
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