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.

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.

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

The other posted dates for the Nursing Jurisprudence course by the Board (the formal title is “Texas Board of Nursing: Protecting Your Patients and Your Practice”, the course is only one day and is offered on two consecutive days):

• June 23/24, 2010 – Arlington, Texas
  
• August 18/19, 2010 – Houston, Texas

Sec. 301.4551. Temporary License Suspension for Drug or Alcohol Use.

The board shall temporarily suspend the license of a nurse as provided by Section 301.455 if the nurse is under a board order prohibiting the use of alcohol or a drug or requiring the nurse to participate in a peer assistance program, and the nurse:

(1) tests positive for alcohol or a prohibited drug;

(2) refuses to comply with a board order to submit to a drug or alcohol test; or

(3) fails to participate in the peer assistance program and the program issues a letter of dismissal and referral to the board for noncompliance.

[Added by Acts 2009 (H.B. 3961), 81st Leg., eff. June 19, 2009]

 (1) The mid-level providers can obtain there own certification with the DEA and DPS.  Their individual certification number must appear on their prescription pad and they are required to have a supervisor relationship with a licensed physician.  This person is viewed as a “sponsor.”

 (2) There must be a standing protocol for the mid-level provider to prescribe using the physician’s prescription pad for the listed symptoms and only prescribe medications that are listed in the protocol for the symptoms. 

 The parties meet to discuss creating a field on the Texas Medical Board’s Physician Profile that will list all of the mid-level providers under the physician’s sponsorship who have prescriptive authority.

 The Texas Medical Board’s Standing Delegation Committee voted to create a sub-committee with the Physician Assistant Board and the Nursing Board to look into the guidelines for supervising physicians over PA’s and APN’s who have prescriptive authority under the physician’s supervision.   Their goal is to have everyone on the same page as to what the rules are and the risks involved in prescriptive delegation.

 My Take: First, physicians and mid-levels need to be sure they are in full compliance with current level and the correct paper work is in the Board denoting the supervisor relationship.  Second, look for the rules to be changed in the future.  If you have three boards get together, I can assure you the rules will change.  Given the current regulatory climate, I suspect that rules will tighten-up.  I just hope that before the Boards publish any rule changes, they talk and meet with “stake holders” in this area as any changes to mid-level prescriptive authority will have significant affect over thousands of providers.  Please continue to monitor this blog for changes.