Peer review is an important part of any profession that requires a high degree of competence. If a nurse’s conduct or actions are questioned, they may be subjected to an incident-based peer review (IBPR), the outcome of which will be reported to the Texas Board of Nursing (BON). An IBPR is initiated by an agency, facility, school, association or any other entity that uses the services of the nurse who is to be peer-reviewed.
Purpose of IBPR and the Role of the IBPR Committee
The purpose of an IBPR is to determine whether a nurse should be reported to the Texas Board of Nursing (BON) for professional misconduct or licensure violations based on one or more such events. It is not done to determine issues related to employment. An employer may take disciplinary action against a nurse employee before, after and regardless of the status of a peer review.
In case a report to the BON has already been made (or is already required to be made), the role of the review committee will be to investigate whether external factors caused the error or situation leading to the report, and to report the findings of the review to the entity’s patient safety committee, or to the nursing administrator if such a committee doesn’t exist.
Due Process Requirements
IBPR cannot be done randomly and without giving prior notice to the nurse who is being peer-reviewed. At the minimum, the following due process requirements must be fulfilled:
- The nurse must be notified of the date of the peer review hearing, which should not be earlier than 21 days and not later than 45 days after the notice has been issued.
- She/he must be made fully aware of the policies, procedures, and plan of the peer review, including the details of the charges against her/him and the contact address of the person who will receive her/his response.
- She/he should be given the opportunity to go through the documents relating to the review 15 days or more ahead of the date fixed for the hearing.
- During the meeting, she/he should be allowed to make an opening statement, ask and answer questions, and submit a statement in writing to clarify her/his position.
- She/he should be allowed to present her/his witnesses, question them freely, and attend the meeting when the evidence or testimony is being presented. A copy of the list of witnesses should be provided to her/him 48 hours or more before the hearing.
- The evaluation must be completed within 14 days after the hearing, and the nurse must be provided with a written notification of the outcome of the hearing within ten calendar days from that date.
- After she/he receives the notification of the outcome, she/he should be given ten days to submit a rebuttal in writing if she/he so wishes.
What does the IBPR Committee’s report to the Texas BON include?
If an IBPR Committee determines that a nurse engaged in conduct that deserves to be reported to the Texas BON, they must submit a written report that includes the following:
- The nurse’s identity.
- A description of the nurse’s conduct that led to the review.
- A description of the corrective actions taken, if any.
- A description of whether the nurse’s deficiency in care was impacted by external factors beyond their control.
- A recommendation regarding whether formal disciplinary action should be taken against the nurse by the BON.
- Additional information required by the BON.
The IBPR committee has no authority to enforce their decisions, and employers are not required to follow the recommendations of the IBPR. However, employers can and may choose to utilize the outcome of the review to bolster their case for or against a nurse on their payroll whose conduct or actions have been questioned.
If a nurse resigns voluntarily, or is terminated or is suspended for seven days or more for reasons related to nursing care, then her/his employer must submit a written report identifying her/him and describing the events or incidents that led to the resignation, termination or suspension to the Texas BON.
Even after a report has been made (or is required to be made) by the employer, the review committee is still required to carry out a hearing to find out if external factors impacted the nurse’s conduct and then report their findings to the concerned authority.
Peer Review for Temporary or Contract Nurses
Temporary or contract nurses are also subject to IBPR. The review is initiated by either the facility that uses their services or by the compensating agency, or both. There is much more to IBPR for nurses than can be covered in this short article. It is best to hire a skilled and experienced health attorney if you are involved in any peer review processes.