A complaint to the Texas Board of Nursing can put an RN, LVN or APRN license on the line long before any hearing takes place. In fiscal year 2015, the most recent year reviewed by the state's Sunset Advisory Commission, the board resolved more than 16,000 complaints, and about three in four ended in dismissal rather than discipline. A dismissal can reflect insufficient information, a lack of jurisdiction, or conduct that does not rise to a violation of the Nursing Practice Act. For the nurse named in a case, the license is the ability to practice and earn a living.
How a Complaint Reaches the Board
Anyone can file a complaint against a nurse, including a patient, a coworker, an employer, or a facility's nursing peer review committee. A complaint naming a specific nurse and describing conduct that could violate the Nursing Practice Act or a Board rule moves into an investigation. One that lacks identifying information or falls outside the Board's jurisdiction is closed without further action.
The Investigation Process
Once a case opens, the Board notifies the nurse of the allegations, unless doing so would jeopardize the investigation, and the nurse gets an opportunity to respond. Investigators gather evidence through records requests, witness interviews, and site visits. If a nurse or a third party will not produce records voluntarily, the Board can issue a subpoena to compel production or compel a witness to testify. Board rule requires staff to set an expected timeline for completing the investigation within 30 days of receiving the complaint, and to tell the parties if that timeline changes. A nurse under investigation may keep working until the Board issues an order affecting the license.
Facility Peer Review, Not a Board Proceeding
Many nurses assume peer review is a stage the Board refers a case to. It works the other way: nursing peer review takes place inside the hospital, nursing home, or agency that employs the nurse, separate from any Board complaint, and the Board itself does not conduct it. A facility's peer review committee decides whether a nurse's conduct must be reported and, if so, the committee submits a written report to the Board that includes a recommendation on whether the Board should take formal disciplinary action. The committee does not decide on disciplinary action itself; only the Board can impose a license sanction.
The Texas Board of Nursing does not conduct nursing peer review. That review happens inside the nurse's own workplace, before the Board ever opens a case.
Incident-based peer review carries its own due process timeline. The committee must meet between 21 and 45 calendar days after notifying the nurse, the nurse can review the evidence at least 15 calendar days before appearing, and the committee must complete its evaluation within 14 calendar days of the hearing and notify the nurse in writing within 10 calendar days, with 10 more calendar days for a written rebuttal.
Settlement, Hearings and Possible Outcomes
A case that moves past investigation toward discipline typically starts as an informal settlement. The Board sends a proposed agreed order setting out its findings and the sanction it seeks, and the matter can be resolved by stipulation, agreed settlement, agreed order, or dismissal; the executive director or a designee may hold an informal conference with the nurse before disposition. A nurse who disagrees, or cannot be reached, moves to formal charges, a written answer, and, absent a settlement, a hearing before an administrative law judge, who issues a proposal for decision; the Board may adopt it, or change a finding or order only for a stated legal reason.
Possible sanctions include remedial education, a fine, a warning, a reprimand, probation, suspension, or revocation, and a Board order becomes a permanent, public part of the nurse's licensure record, reported to the National Council of State Boards of Nursing and the National Practitioner Data Bank. NPDB Reports: Disputing and Adding a Statement covers how a nurse can challenge an inaccurate entry.
A Board sanction does not have to stand alone. Billing or diversion-related misconduct referred further can extend exposure to network termination from credentialing insurance networks, OIG exclusion from federal health care programs, or, after a criminal referral, a target letter from federal prosecutors.
Health Law Alliance has represented 2,500+ clients nationwide.
Why Early Legal Counsel Is Critical
It is critical that healthcare providers promptly retain experienced healthcare defense counsel upon receiving a subpoena, audit notice, investigative request, or other government inquiry. Early legal intervention can protect the provider's rights, support appropriate responses to government requests, avoid inadvertent admissions, preserve relevant defenses, and allow counsel to communicate with investigators on the provider's behalf. Delaying legal representation can significantly affect the outcome of a matter and expose the provider to unnecessary risk.
How Health Law Alliance Can Help
Health Law Alliance defends registered nurses, licensed vocational nurses, and advanced practice registered nurses in board investigations and peer review matters nationwide. If you have received notice of a complaint or a request from a peer review committee, contact Health Law Alliance's professional license defense lawyers for a free, confidential consultation before you respond to the Board or sit for an interview.
