Understanding Board Orders from the Texas Board of Nursing

When a licensed nurse in Texas faces disciplinary proceedings, they often enter an agreement with the Texas Board of Nursing (the BON) to settle the matter, or they become subject to a ruling by the Board following an administrative hearing. In either case, whether the nurse agrees to, or the Board imposes some discipline on the nurse, it comes in the form of a Board Order. Therefore, nurses need to be aware of the typical content of Board Orders and the repercussions that can arise from failure to follow them. 

An experienced nursing license defense lawyer can represent your interests in any disciplinary proceedings before the Board. We can also explain your options and work to achieve a reasonable solution with the licensing board to resolve your pending disciplinary action.

General Structure of Board Orders

Board Orders typically contain the following sections:

  • Introduction – This section identifies the Board and the nurse and provides the legal basis for the Order.
  • Findings of Fact – This section describes the nurse’s education, licensure information, and work experience. It then explains the incident(s) that violated the Nursing Practice Act (NPA). 
  • Conclusions of Law – This section references the NPA and Board Rules that apply to the incident(s) outlined in the Findings of Fact section. 
  • Terms of the Order – This section outlines the requirements you must complete to satisfy and clear the Board Order. 
  • Respondent’s Certification Page – This is the page where the nurse must sign indicating agreement with the terms and conditions of the Board Order.
  • The Board’s Ratification Page – This is the page that the Executive Director of the Board signs to ratify the Order and gives the effective date of the Board Order. The Order’s effective date is important because it is used to calculate due dates for certain requirements in the Order.

Requirements of Board Orders

Board Orders contain specific requirements that nurses must complete as part of their disciplinary proceedings. These requirements help improve nursing practice and ensure safe patient care. In addition, all Board Orders require you to submit any changes to your name and/or address to the Board within ten calendar days. 

The specific requirements of Board Orders vary from one case to the next, depending on the type of violation involved and the sanctions that the parties have agreed upon or that the Board has issued. However, some requirements are common to most Board Orders.

Remedial Education Course(s)

A Board Order may require you to complete one or more remedial education courses, typically within one year of the Order’s effective date. However, an Order may specify that the nurse completes some courses within a shorter time limit, such as within 60 days of the Order’s effective date. All courses listed on the Board’s compliance resource page have been preapproved. Therefore, if you receive CNE hours from completing courses due to a Board Order, those hours will not count toward your required CNE hours for license renewal.

Common courses for many Orders include a course on Texas nursing jurisprudence and ethics and “Sharpening Critical Thinking Skills.” The Board may also order you to complete other specific courses. For instance, if the nurse violated a rule regarding patient records, the Board might order the nurse to complete a course on nursing documentation. Upon completion of required courses, the nurse must ensure the instructor provides the Board with a Verification of Course Completion form

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Monetary Fines and Monitoring Fees

A Board Order may require you to pay a monetary fine or monitoring fees within a certain number of days from the Order’s effective date. You must pay the full fine or fees directly to the Board via cashier’s check or U.S. money order, along with the appropriate Board Order Billing Form

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Employment Requirements 

A Board Order may require you to complete certain employment requirements, which differ according to whether you are an RN, LVN, or APRN. For instance, if you are an RN, a Board Order may require you to:

  • work as a nurse in the state of Texas;
  • providing direct patient care;
  • in a clinical healthcare setting; and
  • for at least 64 hours per month.

Additionally, periods of unemployment and/or non-nursing employment do not count toward completing your Order. Some Board Orders may have additional employment restrictions during the first year of employment, such as no nights or rotating shifts, no overtime, no critical care, or no administration of controlled substances. 

Notification of Employment

You must notify all your current nursing employers when your Order becomes effective and provide them with a copy within five calendar days of receiving it. You also must provide the Order to future nursing employers before accepting a new position. All current nursing employers must submit the Board’s Notification of Employment form within ten calendar days of the date that you receive the final Order. New employers must submit the form within five calendar days of you starting a new nursing position. 

Supervised Practice Requirements

Your Board Order may require you to be supervised for the duration of the Order. There are four different types of supervised practice requirements to which you may be subject:

  • Direct Supervision – You must have another nurse on the same regularly assigned, identified, and predetermined unit supervising your practice, who is at your same or greater level of practice, and who is immediately available to assist and intervene if needed. You cannot be employed by a staffing agency, nurse registry, hospice agency, or home health agency. You also cannot be self-employed, contract for services, or have more than one nursing employer.
  • Indirect Supervision – You must have another nurse on the facility’s premises supervising your practice who is readily available to you and who is at your same or greater level of practice but not a subordinate. You must work on the same regularly assigned, identified, and predetermined unit. As with direct supervision, you cannot be employed by a staffing agency, nurse registry, hospice agency, or home health agency. You also cannot be self-employed, contract for services, or have more than one nursing employer.
  • Incident Reporting – You must immediately submit to the Board any incident, counseling, variance, unusual occurrence, medication or other error reports, and investigative documentation regarding your practice as a nurse.
  • Monitored Practice – A Registered Nurse (RN) Consultant, approved by the Board, must monitor your practice. This type of practice can apply to home health or hospice practice, and you may not have more than one nursing employer. You must submit a list of three potential RN Consultants within ten calendar days of employment, including their names, license number(s), education, and work experience. The Board will notify you of their choice, and the RN Consultant must begin monitoring your practice within 30 calendar days of approval. As part of that monitoring, the RN Consultant must:
    • Identify and document:
      • Individualized goals and objectives for you;
      • Resources to be utilized; and
      • Methods to be used to determine the successful completion of the monitoring period relative to the violation(s) identified in your Order.
    • Meet with you at least twice monthly for at least one hour, more frequently, or longer if the RN Consultant deems it necessary.

If documentation and/or physical assessments are a goal or objective, you must perform and document assessments for actual patients. 

A Board Order may contain more than one type of supervised practice. For instance, you might be subject to direct supervision for a certain period, followed by indirect supervision for a certain period. Likewise, you might be subject to one type of supervision for a particular employer and position but a different type of supervision for future employers. 

Nursing Performance Evaluations / Reports

A Board Order may require you to submit a Nursing Performance Evaluation or Report to be submitted to the Board at the end of every quarter. For example, if you are under direct supervision, indirect supervision, or incident reporting, your supervisor must submit the evaluation or report to the Board. Likewise, your RN Consultant must submit the evaluation or report to the Board if you are under monitored practice. The Board will mail these documents to you about a month before their due dates. 

Drug and Alcohol-Related Requirements

Your Board Order may require you to comply with specific drug and alcohol-related requirements, including the following:

  • Abstinence from alcohol (and all products containing alcohol), nalbuphine, propofol, and all controlled substances unless legitimately prescribed, in which case you must notify the Board in writing and provide documentation from your healthcare provider within ten calendar days of the date of the prescription; 
  • Pain management/substance use disorder evaluation by a Board approved evaluator if you are required to take a prescription for controlled substances for two weeks or longer;
  • Daily call-ins to determine if you are subject to random drug screening by urinalysis through the Board’s screening provider at your cost while working as a nurse that day, the frequency of which will be determined by your Order and which will decrease over time; and
  • Attend at least two weekly support groups, at least one of which must address substance abuse, and provide quarterly documentation to the Board of your attendance.

Therapy Requirements

A Board Order may require you to participate in therapy with a professional counselor with credentials approved by the Board. In addition, the therapist must provide written reports to the Board about your progress, rehabilitation, and capability to safely practice nursing. Therapy typically must continue for at least three months, but the Board may require it to continue longer depending on the therapist’s recommendations. 

Probation Reports

Your probation officer typically must submit quarterly written reports to the Board concerning your compliance with the terms of your court-ordered probation until you are released from probation. 

Consequences for Failing to Comply with a Board Order

If you fail to comply with a Board Order, the consequences can be severe. The Board can open a noncompliance investigation, leading to delays in clearing the discipline from your license. You also could be subject to further disciplinary proceedings, including revocation of your nursing license. 

Get Assistance Defending Your Nursing License Today 

Be sure to get legal assistance if you are facing 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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