The Most Aggressive Board

The Star-Telegram has written an article about the Texas Board of Nursing. The article states that "The board is perhaps the most aggressive healthcare regulator in Texas, taking patient safety to heart." I have represented nurses before the Board for over 10 years and before that I interacted with the Board while I worked at the Texas Medical Board, so I have seen the Board change over the years. What I have seen is that the Board has become much more conservative and much more punitive.

Complaints against nurses that used to be dismissed if the nurse could show knowledge of the incident and remediation of the issue. For several years now, those same types of complaints have resulted in increasingly harsher actions by the Board. Whenever the public sees the number of disciplinary orders increasing, they assume that the public is being protected. That is an illusion. Public Safety and high numbers do not go hand in hand. To obtain those numbers, many good nurses that were forced to choose between violating the Nurse Practice Act and caring for their patients are finding themselves under disciplinary sanctions. Yes, they violated the law, but the reality of nursing practice (too many very sick patients and too few nurses) is the cause of the violation, not the competency of the nurse.

I have always believed that all regulatory Boards need to focus on true public safety issues, which means discipline of those licensees that are truly a threat: incompetent without remediation potential, addicts that are not in recovery (although I do believe there needs to be a non-disciplinary, non-public method of monitoring all addicts), and those missing core ethical boundaries. SB 993/HB 2158 seems to be a step in that direction. this legislation defines what conduct by a nurse is subject to reporting. The requirements for reporting are:
1. Violating the law AND contributing to the death or SERIOUS injury of a patient;
2. Substance abuse impairment;
3. Intentional or knowing abuse, exploitation or fraud, violation of boundaries;
4. Incompetency where the nurse's continued practice could harm a patient.

This legislation should stop all the minor reporting of documentation issues and simple medication errors that are not due to incompetency. Perhaps this legislation will slow the reporting of nurses for minor, non-public safety issues and the Board can focus on those nurses that require monitoring by the Board to ensure public safety.