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Discipline & Complaints - What Happens When a Complaint Gets Filed

Investigatory & Disciplinary Process

General Overview of the Disciplinary Process
Investigatory & Disciplinary Process Flow Chart

A streaming video, Board of Nursing Complaint Process: Investigation to Resolution, has been developed by the National Council State Boards of Nursing (NCSBN) 2010 Disciplinary Resource Committee and produced by NCSBN. The video is intended for information purposes for nurses facing disciplinary action and provides a high level overview on the topics:

  • The Board of Nursing investigation process;
  • Due process rights;
  • Formal and informal administrative hearings; and
  • Types of resolutions.

Texas Board of Nursing Overview:

More than 16,000 complaints per year are typically received by the Texas Board of Nursing (BON or Board). However, not all complaints result in an investigation or disciplinary action by the Board. Many of the complaints received by the Board contain insufficient information about the nurses identity, are out of the Board's jurisdiction, are considered "minor incidents" or are about issues that, even if proven, would not constitute violations of the Nursing Practice Act (NPA). In all cases, the identity of the complainant is kept confidential.

Investigatory Process:

The BON provides due process to nurses by notifying them of the investigation and the allegations, unless doing so would jeopardize the investigation, and nurses are given an opportunity to respond to the alleged conduct and to show compliance with the Nursing Practice Act (NPA). During the course of the investigation, relevant evidence is obtained and witnesses are contacted. While the majority of most investigations is conducted through the mail and over the phone, on-site investigations are occasionally conducted also.

After relevant evidence has been obtained, the investigations team reviews the evidence in order to determine whether or not a violation of the NPA occurred. Based on the review of the evidence, some cases are closed, and, depending upon the specific type of closure, the complaint and all evidence will either be expunged immediately from the nurse’s file or expunged after being retained for a specific period of time according to the Board’s retention policies. Closed cases in which the file has been retained may be reopened if additional information, evidence, or complaints are received before the file has been expunged.

Cases in which the evidence indicates that a sanction against the nurse is needed in order to protect the public will result in an Order of the Board and will include both the sanction and any requirements placed on the nurse for retention of his/her license. Possible sanctions include remedial education, fine, warning, reprimand, suspension, probation, and revocation. Most Board Orders are public information and, except for deferred disciplinary orders that have been successfully completed, are permanent designations in the licensure records of the nurse.

An investigation typically takes five (5) to twelve (12) months to complete, depending on the circumstances. While numerous factors beyond the control of Board staff and the nurse under investigation affect complaint resolution time, case resolution time is diligently monitored and internal processes are routinely reviewed and often improved to ensure complaints are resolved as quickly as possible. Both the complainant and the nurse being investigated are notified periodically of the status of each investigation, and unless instructed otherwise, all complainants are notified of the final outcomes of investigations.

Informal Settlement Processes:

Informal settlement processes typically begin with nurses being offered proposed agreed orders containing the investigative findings, conclusions of law, sanction, and stipulated requirements necessary to ensure that the nurse is safe to practice.

When nurses agree with the contents of the proposed agreed order, they sign their order before a notary and return it to the Board’s office. Agreed orders are then scheduled for review and ratification by the Board each month. Although the majority of agreed orders reviewed by the Board are accepted and ratified, the Board may alternatively vote to modify or reject any order with which they disagree.

If nurses do not agree with their proposed orders, they may submit specific suggested revisions to the proposed orders in writing for the Board’s consideration. If any of the submitted revisions are accepted, new proposed agreed orders incorporating the accepted revisions will typically be sent.

In some cases, and at the Board’s discretion, nurses may be invited to attend informal settlement conferences, often scheduled a month or more in advance, at the Board’s offices in Austin, Texas. Informal conferences are conducted by the Executive Director, or his/her designee, and are attended by the Director of Enforcement, one of the Board’s attorneys, and the assigned investigator, as well as other Board staff. During each conference, the nurse and Board staff dialogue regarding the evidence, possible violations, and acceptable settlement. At the conclusion of the majority of conferences, nurses are informed of the panel’s recommended disposition of their case. When the panel determines action is warranted to protect the public, new proposed agreed orders are mailed to nurses. As with other proposed agreed orders, nurses may sign their order before a notary and return it or they may submit specific suggested revisions to the proposed orders in writing for the Board’s consideration.

When orders are ratified, they become final Board orders and the terms become effective. A copy of each final Board order is mailed to the nurse and to the last known employer, and complainants are notified of the outcome. Most disciplinary actions taken by the Board are public information and become a permanent part of the licensure record. Disciplinary actions are printed in the Board’s quarterly newsletter and are also reported to the National Council of State Boards of Nursing, Inc., and the National Practitioner Data Bank (NPDB).

Formal Settlement Processes:

When nurses and the Board are unable to reach agreements for informal settlement, or if the Board is unable to make contact with nurses during investigations, the Board files formal charges, which require nurses to file answers to the charges in writing. When required answers to formal charges are not filed, cases may proceed toward revocation of the license(s) by default.

If answers to the formal charges are filed, negotiations may continue toward agreed settlements while formal, public disciplinary hearings before an Administrative Law Judge (ALJ) are being scheduled. When cases do not reach agreed settlements, they proceed to hearings at which Board staff present evidence and nurses present their side of the case. After each hearing, the ALJ submits a proposal for decision (PFD) to the Board, and each PFD contains the Judge’s findings of fact and conclusions of law. The Board reviews and acts on each PFD by imposing appropriate penalties or by closing the case with no action.

 

Should you have further questions or are in need of clarification, please feel free to contact the Board.