1) informs licensees, applicants, petitioners, and the public about the Board’s requirements and procedures regarding physical and psychological evaluations under the Nursing Practice Act (the Occupations Code Chapter 301).

Amendments to §216.1 (relating to Definitions)

Amendments to  §216.3 (relating to Requirements)

Continuing education needs to be in the Nurse’s practice area, as this has shown to improve practice rather than taking courses in general nursing.

amendments to §217.6 (relating to Failure to Renew License)

 §217.9 (relating to Inactive Status)

(i)                  clarify existing requirements on reactivation of an expired (delinquent) or inactive nursing license;

(ii)                 specify the new requirements that apply to reactivation of an expired (delinquent) or inactive nursing license;

(iii)                provide additional guidance regarding the content requirements of a refresher course, extensive orientation to the practice of nursing, and nursing program of study (refresher course/s);

(iv)               ensure consistency among the requirements of §217.6 and §217.9; and

(v)                 prevent individuals with serious and potentially disqualifying histories from renewing delinquent licenses until the Board has had a full opportunity to investigate and take appropriate action.

This is a change from what we have always thought–that since the questions are meant to disclose unknown situations or occurrences, an investigation by the BON does not need to be disclosed to the BON.   But the Board wants to make sure there are no areas of confusion and they want everything disclosed to them even if the nurse thinks the Board knows about an issue, the nurse should disclose it.  The only exception is when the nurse receives a letter from the Board informing the nurse he/she no longer has to disclose a specific listed occurrence (Hint-Make sure you keep this letter forever in case it becomes an issue later on).

Don’t forget to disclose pending charges for criminal incidents as well as needing to disclose deferred adjudications, pleas of nolo contendere, or no contest.  These questions continue to trip up nurses.   Above all, read the questions carefully EACH time you renew.  Questions change and a failure to answer truthfully will result in a BON investigation.  Also, don’t wait until the last few weeks to renew.   A nurse can renew up to 60 days prior to the end of the renewal period–early is better.

When ratios were first discussed, I thought the law would be loosely written so that hospitals could “meet” the law, but there would be no visible improvement for nurses or patients.  That seems to be the case with Texas’ staffing law; I just don’t see any improvement and still receive multiple complaints from nurses that are being forced to work under unsafe staffing numbers and when they refuse the unsafe assignments they are charged with abandonment.   The article notes that other states are considering ratios.  Perhaps Texas will also consider changes to the law to protect nurses and patients, but history does not support this.  Nurses need to be politically active and join associations that promote nursing and fight for nursing laws; just complaining will do no good, nurses must take action and support the associations that work on legislative issues on behalf of nursing in Texas.  National organizations/associations will not focus on individual state issues so be sure to check into any association/organization you are thinking of joining to see what their legislative mandates/agendas are.

There are so many pitfalls associated with the questions posed on the Board’ s renewal/application paperwork, that it is prudent to speak to an attorney who has experience working with the Texas Board of Nursing before you complete the questions.

Recently, I have received several inquiries regarding “setting aside board orders.”  This cannot be done and this is misinformation.  While criminal incidents can sometimes be expunged or sealed, administrative actions currently cannot be removed from one’s license.  Once a disciplinary action occurs, the history remains even once the “probation” is complete.

Update: Wednesday, February 10

Andrews Courthouse – On the stand this morning, the nurse’s defense attorney Cook continued the cross-examination of Sheriff Robert Roberts of Winkler County. Defense wanted to know: what was confidential about the nurses’ complaint? That’s still unclear.

Update: 5:45 p.m., Wednesday

Court has recessed after what was day 3 of the Winkler RN trial. Judge Rex denied an earlier defense attorney’s motion for a directed verdict. The defense started presenting its case this afternoon and called a number of character witnesses for Anne Mitchell. Trial resumes tomorrow morning. Closing arguments might be heard at day’s end.

Thursday, February 11

The State and the Defense have put on their cases and rested. This morning, Anne’s attorney has finished her defense.

The State had to prove five elements to prove Anne misused official information: 1) Anne was a public servant (all public employees are), 2) she had access to information because of her employment, 3) that information not public, 4) Anne used the information with the intent to harm another, 5) the information was used for a nongovernmental purpose. The State’s evidence focused on the last two elements because the prosecutor told the jury that those were the two most in dispute. The State’s main evidence consisted of several witnesses who testified about two to three occasions on which they heard Anne make statements such as “Dr. Arafiles will be gone in a year” “he is not a doctor” “he is a witch doctor.” There was also testimony of an ongoing conflict between Anne and Dr. Arafiles. She had refused to sign off on his original credentialing because hospital bylaws required physicians to have unrestricted license. The State also focused on the need to follow the chain of command. In cross examination, Anne’s attorney was able to get in good information about substandard care by Dr. Arafiles on cases Anne reported to Texas Medical Board (TMB). The Defense showed that most of the witnesses who testified about Anne’s motives had only been contacted within the past couple of weeks and not before Anne was indicted.

On Wednesday, Anne’s attorneys began her defense and called several witnesses to testify. The first was a nurse practitioner who had worked at the Winkler County Rural Health Clinic and left because of her concerns that issues relating to the care provided by Dr. Arafiles had not been addressed. She had also filed a complaint against Dr. Arafiles with the TMB at the same time as Anne and Vicki (all worked together). The NP testified that she has subsequently filed a second complaint. She testified that Anne was motivated only by her concern for patients. The second witness was an LVN, who testified about her concerns regarding Dr. Arafiles’ work at the clinic. She also left because of those concerns and the stress they were causing her. The Defense called the Winkler County judge (not the trial judge) testified that she knew Anne and Anne had discussed her concerns about Dr. Arafiles. The judge said Anne’s motive was patient concern. Lolly Lockhart, RN, testified as an expert witness on a nurse’s duty. Dr. Pham, Chief of Staff at Winkler County Memorial Hospital, testified about concerns about Dr. Arafiles’ care. He also testified that Anne was concerned about patient care and that Anne is a good nurse.

Thursday morning, the defense called a medical expert, who testified that he had reviewed the five cases cited in the complaint to TMB and found substandard care. The Defense has rested. Next, the charge will be read to the jury, the Prosecution and Defense will give their closing arguments, and the jury will begin deliberation.

The case is no less perplexing as to why Anne was indicted. All witnesses (even the State’s) have agreed nurses have a duty to report unsafe care.

Personal take: That this case has even gotten this far is unbelievable and the only hope is that the jury is fair and unbiased. It sounds like the defense teams for both nurses have been working hard in establishing that the nurses were concerned about patient care.

1.  Make sure you have malpractice insurance so that you have the financial resources to go to a hearing if you do not agree with the BON’s decision in your case.

2. When looking for a job, ask everyone you know for help in finding a job.  It tends to be easier to get a job if someone is on the “inside” vouching for you and your skills.  There are also employers out there that understand that most nurses with a Board Order are not “bad” nurses; that the nurse just made a mistake, or was overworked/understaffed, or had a disease relapse etc.  These employers recognize that most nurses that have had a Board Order become extremely cautious nurses and become definite assets to the facility.

3. Make sure that you have an experienced and BON knowledgeable attorney assist you with your case before the BON so that you get the best outcome possible.

4. You must present a professional appearance (this includes your resume, your social networking site pages, and any application you complete).

5. Contact your state senators and representatives and ask them to make some changes for the next legislative session in 2011.  Some areas that need changes: expand the corrective action provisions to apply to minor practice violations, allow non-public orders for mental health issues and substance abuse (these are diseases, so why allow the publicity?), allow deferred adjudications to be just that and not be considered a conviction by the BON, and change the language in the NPA from shall to may to allow the BON leeway to make determinations based on mitigating factors.   As 2010 progresses, I will probably think of more…

I also have more info here:  http://nursinglaw.blogspot.com/2009/07/how-to-explain-past-board-orders-to.html