TBON Peer Review

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The Texas Board of Nursing Rules and Regulations (TBON), the Texas Nurse Practice Act (NPA) and the Texas Occupations Code (TOC) guide nursing practice by defining nursing actions and mandating that nurses perform their jobs appropriately. The TBON utilizes the NPA and TOC to review cases with which there are questions regarding the scope of practice and delegation of duties. Of the two cases to be reviewed the first involves a nursing task, administration of blood products and Foley catheter insertion that was delegated incorrectly. The improper delegation of duties by a MD to a paramedic and the RN’s responsibility will be evaluated according to the Texas Nurse Practice Act, the Texas Board of Nursing Rules and Regulations and standards for blood transfusion. The second case will explore the peer review process by evaluating a case involving a RN working in a clinic.

Jane is a RN who has been sent to peer review for unprofessional behavior and practicing outside her scope of practice. She was reported to be completing full medical exams including pap smears and bilateral breast exams. Jane and a physician had an agreement for at least the past 18 months where the MD was signing off on the charts as if he had seen the patients. According TOC § 303.001 (5)(A-D) Peer review is as “the evaluation of nursing services, qualifications, quality of patient care, and the merits of a complaint concerning a nurse.” The process is one of fact finding, analysis and studying events by nurses focused on obtaining relevant information about an event. As defined by TBON § 217 unprofessional conduct and unsafe practice also applies to the management of client records; failure to practice within a modified scope of practice or with the required accommodations, as specified by the board in granting a coded license or any stipulated agreement with the board. A Nursing Peer Review Committee (PRC) is defined in § 303.001 of the TOC as a committee that is established in order to...
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