A nursing peer review committee aims to determine if an entity (such as a hospital or nursing home) should report an incident involving a nurse to the Texas Board of Nursing (BON) for professional misconduct or licensure violations. An employer can take disciplinary action against a nurse regardless of the outcome of the peer review. The peer review process exclusively deals with BON reports, or where a BON report already has occurred, with reporting findings to the entity’s patient safety committee or nursing administrator, as applicable.
Defining Nursing Peer Review Committees and Reviews
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, health science center, 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.
A nursing peer review committee must consist of members of at least ¾ nurses. To the extent feasible, the committee must contain:
- LVNs when reviewing the practice of an LVN, and only LVNs and RNs may vote
- RNs as 2/3 of its members when reviewing the practice of an RN, and only RNs may vote
- At least one nurse who has a working familiarity with the area of nursing practice as the nurse being reviewed
The committees also may not contain persons with administrative authority for personnel decisions directly relating to the nurse.
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.”
Confidentiality and Nursing Peer Review Committees
All proceedings are confidential, and all communications made to the committee are privileged. All information discussed in or provided to the committee is not subject to subpoena or discovery or admissible as evidence in any judicial or administrative proceeding. The only entities to which the committee must divulge this information are:
- A licensing authority of any state, or
- A law enforcement agency investigating a criminal matter
Additionally, the committee may disclose the information to:
- An employer of the nurse,
- Another nursing peer review committee,
- A peer assistance program approved by the BON,
- An appropriate state or federal agency, or accrediting organization that accredits health care facilities or schools of nursing, or
- a person engaged in bona fide research, if all information that identifies a specific individual is deleted
Types of Nursing Peer Review
There are two distinct types of nursing peer review, which can apply to the practice of an LVN, RN, or APRN:
- Incident-based nursing peer review (IBNPR) – This type of review determines whether a single event or a series (up to five minor incidents within a year) events rise to the level of a BON report or constitute a minor event that is appropriate for remediation. In addition, this review includes whether external factors beyond the nurse’s control contributed to any deficiency in the nurse’s actions.
- Safe harbor nursing peer review (SHNPR) – This type of review can protect a nurse from employer retaliation, discipline, discrimination, and license sanction when a nurse makes a good faith request to review an assignment or conduct that someone has asked the nurse to perform. The nurse can invoke this type of review when the nurse believes that the assignment could violate the Act or BON rules.
Due Process Rights in Nursing Peer Review
A nurse is entitled to due process rights during the nursing peer review process, including prior notice of a peer review hearing. The nurse must receive notice of the date of the hearing no earlier than 21 days and no later than 45 days after issuance of the notice. The nurse also must receive:
- All policies, procedures, and plans of the peer review process
- The details of the charges against them
- The contact address of the person who will receive their response
- At least 15 days to review the documents before the hearing
- The right to make an opening statement, ask and answer questions, and submit a written statement to clarify their position
- The right to present witnesses, question witnesses, and attend the meeting where evidence or witnesses are being presented
- Receive a list of all witnesses at least 48 hours before the hearing
- A completed evaluation within 14 days of the hearing
- Written notification of the outcome of the hearing within ten days from the date of the completed evaluation
- Ten days after receiving notification of the outcome of the hearing to submit an optional rebuttal in writing
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