Discussion #1: Nurse Practice Act and Rules and Regulations in Texas Board of Nursing
This section sets the precedence upon which the Texas Board of Nursing can take disciplinary action against an individual for reasons that have been proven beyond doubt that they would in one way, or another compromise the delivery of service. This section identifies all prohibited practices within the health care settings for all nurses. Among the issues, it identifies include the use of fraudulent documents or those obtained unlawfully by anyone serving within the workforce. The section also identifies the use of a license that has been revoked or suspended as a prohibited practice (Texas Board of Nursing, 2011). This section offers me an insight into my personal responsibility to ensure that all my service documents and licenses are obtained legally and always up to date with the regulations of service.
In this section there is a list of activities identified as grounds for disciplinary. The section identifies the set of reasons upon which the TBN can revoke or suspend a license for a practicing nurse. Among the issues, the Board identifies as those that can lead to such action being taken include the use of fraudulent and unlawfully obtained licenses. A reported conviction for felony or misdemeanor, being on call or duty while under the influence of alcohol, confirmed case of lack of fitness to continue in practice as well as failure to provide required care to the patient from other violations that can lead to revoking or suspension of license (Texas Nurses' Association, 2012). To me this is a critical section of the Nurse Practicing act as it stipulates the ethical guidelines that should guide a nurse in practice. With a vast knowledge about the actions that can lead to revoking or suspension of the license I am in a position to ensure that my credentials are not compromised by my own failure to remain responsible.
This section of the nursing practice act discusses the formation of the Peer Review Committee’. The Peer review Committee is a body that conducts the evaluation of a nurse’s service delivery in terms of accuracy, complaints lodge against the mode of service delivery of a nurse and the merits of the complaints. This body according to the Act is a mandatory requirement in any health care setting where there are more than ten nurses. At any time, the committee should comprise of not less than three quarters of the members being nurses. The role of the members is to gauge the service delivery of each of their peers within service delivery across the specified metrics of observation. The report from the committee can be used to advance professional action on the individual nurse (Texas Board of Nursing, 2011). This section is useful to me as it offers me an insight into my role within the committee at any time I am selected as part of the committee as well as understanding my obligation during service to other colleagues within the station where I work.
This section discusses the civil liability of a nurse as reported by the Peer Review Committee. The section discusses the cause of action in reaction to malice as reported by the committee against an individual, an institution, health agency or nursing facility. This section also discusses that the an individual, an institution, health agency or nursing facility who submits the records or information to report a malice is not liable to civil action or retaliatory action as a result of their participation in reporting the act (Texas Board of Nursing, 2011). This section informs me of my obligation to nay Peer Review Committee even in the event that I am not a member of that particular committee. By stipulating the conditions upon which I can report a malice without fear of intimidation or civil action, the section gives me the belief to continue being responsible even beyond my line if duty.
Discussion #2: Peer Review and Safe Harbor
I happened to have an interview with a nurse manager at one of the health facilities in relation to the Peer Review and Safe Harbor. In her response, the manager who has worked within the facility for the past four years indicated that while the Peer Review and Safe Harbor has is a useful element in the nursing practice, it optimization in practice has dwindled over the years. I then inquired from her whether she has taken any measures within the facility she is stationed to see to it that the Peer Review and Safe Harbor is effective. In her response, she was categorical that the Peer Review and Safe Harbor is an activity that cannot be implemented singlehandedly by the authorities. In her view, he said that she has done her part as a nurse manager to ensure that the nurses are aware of the existence of such a provision but cannot practically have the nurses utilize this provision. The safe harbor and peer review are utilized where the nurse is not sure if the implications that may follow their own acceptance or rejection of the assignment (Texas Board of Nursing, 2011). A safe harbor is a formal submission which can later be determined by a written report from the peer review committee. The nurse manager was of the opinion that she always informs the nurse of the need to request for Safe harbor any time she assigned a task to the nurse. However, she says that, during her time at the facility, she has only received less than five safe harbor requests.
In another interview, I inquired from a worker within the same facility whether they have at any time during their time in service requested for safe harbor/peer review. In her response, she said that while she has heard of it and understand the provision clearly but has never considered utilizing it. I then went ahead to inquire whether she considers the safe harbor/peer review within the work environment. In her response, she said that it is a crucial provision but the complexity and technicality involved once the safe harbor has been requested by a nurse are some of the hurdles that make the workers shy away from using the provision.
Within this facility, the peer review committee is compromised of a total of ten members chosen from within the workforce. The total nurse workforce comprises of 34 members. At any time of request, the members are composed of at least two LVNs, and the rest of the team can be made up of RNs and APNs. The request for Safe harbor begins with the submission of a “Comprehensive Request for Nursing Safe Harbor Peer Review”; this is considered as invoking the provision. The nurse is then supposed to fill the form and present it to the nurse manager who upon receipt acknowledges the submission of the form. The nurse manager then presents the form to the chair of the Peer Review Committee. Upon sitting, the Committee through its chair submits the report to the Chief Nursing Administrator, upon which the CNA decides on the best course of action. The CNA then returns back the forms with his or her own recommendation upon assessment of the Peer review Committee.
The Safe Harbor and Peer Review provision has impacted the nursing profession in a number of ways. In a positive way, it has enabled the nurse to remain resilient in their delivery of service and to take no compromise in quality of care (Texas Nurses' Association, 2012). This has been necessitated by the need to remain accountable. Negatively, the provision has caused conflict between nurse and their colleagues as well as with their employers especially in the case of an incident-based peer review. The nurses under peer review feel under threat professionally and may not be able to deliver effectively as would be in a normal environment (Willmann, & Texas Nurses Association, 2006). However, it is clear that despite these challenges the safe harbor and peer review provisions have had an amazing impact on the level of responsibility witnessed within the nursing workforce.
Texas Center for Quality & Patient Safety. (2011). Nursing Peer Review. Retrieved from http://www.texashospitalquality.org/White%20Paper%20Final.pdf
Texas Nurses' Association (2012). ABCs of nursing peer review, 2010: A reference guide for implementing nursing peer review. Austin, Tx.: Texas Nurses Association.
Willmann, J. H., & Texas Nurses Association (2006). Annotated guide LVN to the Texas Nursing Practice Act: Including Nursing Practice Act, nursing peer review law, BNE rules & position statements, [and] other nursing-related laws & rules. Austin, TX: Texas Nurses Association.
Texas Board of Nursing (September 2011). Nursing Practice Act. Retrieved 28/03/2014 from http://www.bon.state.tx.us/nursinglaw/npacontents.html