The Role of Nursing Peer Review Committees in Texas

Determining whether to report a licensed nurse to the Texas Board of Nursing (BON) for professional misconduct or other violations can be difficult and highly fact-specific. Hospitals, nursing homes, and other medical facilities must report violations in certain situations but may be able to handle some violations internally if they choose. 

An experienced nursing license defense lawyer can assist you through the nursing peer review committee process and any BON disciplinary proceedings that ensue. We can explain the full range of options available and work with you to reach a reasonable resolution with the BON in your pending disciplinary action.

The Function of a Nursing Peer Review Committee

Although a nursing peer review committee helps an employer decide whether to report a nurse to the BON, an employer can still take any disciplinary action against the nurse it chooses, regardless of the outcome of the nursing peer review committee. The only function of the peer review process is to decide whether to make a BON report or report findings to an entity’s patient safety committee or nursing administrator, as appropriate, where a BON report has already occurred. Nonetheless, a nursing peer review committee can be instrumental in helping employers determine the best course of action in a case involving alleged nurse misconduct.  

Under Tex. Occ. Code § 303.0015, a person must establish a nursing peer review committee or contract with another entity to provide peer review services in the following circumstances:

  • For vocational nurses, if the person regularly employs, hires, or contracts for the services of eight or more nurses; or
  • For 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.

The Make-Up of 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.

At least 75% of the members of nursing peer review committees must be nurses. Furthermore, to the extent it is feasible, nursing peer review committees must be composed as follows:

  • When conducting a peer review involving vocational nursing, the committee must include vocational nurses and only vocational and registered nurses may be voting members;
  • When conducting a peer review involving professional nursing, the committee must have members consisting of at least two-thirds professional nurses, and only registered nurses may be voting members; and
  • The committee should contain at least one nurse familiar with the nursing practice area in which the nurse being reviewed practices. 

How Nursing Peer Review Works

Nursing peer review occurs under Tex. Occ. Code § 303.001(5) when there is an “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.”

A nurse may request a nursing peer review if they believe they are being requested to engage in conduct violating their duty to a patient. A duty to a patient means “conduct required by standards of practice or professional conduct adopted by the board for nurses.” They can request a nursing peer review on an appropriate form or by an oral request to their supervisor, who must prepare a written record of the request. 

A nurse who, in good faith, makes a nursing peer review request may not be subject to discipline, discrimination, suspension, or termination of employment for making the request. If the nurse refuses to engage in the requested conduct pending peer review, the employer must consider the determination of the peer review committee in deciding whether to discipline the nurse. However, the decision of the peer review committee is not binding if a nurse administrator has a good faith belief that the peer review committee’s decision was incorrect. On the other hand, the BON may not discipline the nurse for engaging in the requested conduct pending peer review.

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Nursing Peer Review Committees and Confidentiality

All nursing peer review committee meetings are confidential. Members, agents, and employees of nursing review peer committees and participants in those committee proceedings may not disclose any communications or records of the proceedings. Likewise, attendees of nursing review peer committee meetings may not disclose or be required to disclose any information concerning said proceedings. 

As a result, all information concerning the committee is not subject to subpoena or discovery in legal proceedings. It is not admissible as evidence in any judicial or administrative proceeding or any nursing liability lawsuit arising from the provision of or failure to provide nursing services. For instance, suppose the committee determines that the nurse’s conduct should not be reported to the BON. In that case, the committee members may only report the nurse to the BON if the committee member has knowledge of the nurse’s conduct independently of peer review or believes that the committee made its determination in bad faith. 

The only entities the peer review committee shall disclose information to are licensing authorities of any state and law enforcement agencies investigating criminal matters. They also may disclose information 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;  
  • a person engaged in bona fide research if all information that identifies a specific individual is deleted; or
  • a patient safety committee established by the same entity that established the peer review committee.

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Get Assistance Defending Your Nursing License Today 

Do not hesitate to get legal assistance if facing a nursing peer review committee or disciplinary action against your nursing license. Contact a Texas nursing license defense attorney immediately if you receive or anticipate receiving notice of disciplinary proceedings.

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