BON Process For Evaluation Of A Complaint: Step By Step

When someone files a complaint with the Texas Board of Nursing (BON), there’s a multi-step process that the board follows, one that ensures that the complaint is addressed appropriately and that the nurse is given due process.

Below is a step-by-step, general explanation of the process that the board follows, and what’s required of the nurse.

Receipt Of A Complaint
All complaints about a nurse must be in writing and signed by the complainant (whose identity remains confidential throughout the process). Anyone can file a complaint – patients, family members, employees, employers, healthcare providers, and others.

Initial Review Of A Complaint
Once the nursing board receives a complaint, it’s reviewed by the board. If the initial review determines that there hasn’t been a violation of the Nursing Practice Act (NPA) or Board Rules and Regulations, that’s the end of it. And many complaints end this way, often because the alleged facts aren’t within the Board’s jurisdiction or the allegation doesn’t relate to nursing care.

Notification Of Investigation
If the nursing board does determine that there might have been a violation, the board opens an investigation and notifies the nurse of the allegations. Once notified of the investigation, the nurse usually has 30 days from the date on the notice to respond in writing to address the alleged conduct, show compliance with the NPA, provide information regarding any mitigating circumstances, and provide an updated resume with work history.

Investigation Of The Complaint
The investigation process varies, according to the nature of the complaint, but it typically involves: collecting additional information, and reviewing relevant documents.

Case Review
Once all of the information has been gathered and compiled, the board reviews it to determine if there’s enough evidence to prove that the nurse violated the NPA or Board Rules and Regulations. Based on the review of the evidence, some cases might be dismissed or closed at this point.

Proposed Order Agreement
If, however, the nursing board believes that there has been a violation, the board often, but not always, will offer the nurse a Proposed Agreed Order that includes investigative findings and stipulated requirements. Possible disciplinary sanctions include: a fine, remedial education, warning, reprimand, suspension, probation, and/or license revocation.

If the nurse agrees to the Proposed Agreed Order, the nurse signs it, and it’s sent  to the board to be reviewed and ratified.

Revisions To The Proposed Agreed Order
If the nurse doesn’t agree with the Proposed Agreed  Order, the nurse can suggest amendments or revisions for the board to consider. If any of the nurse’s submitted amendments or revisions are accepted, the board will then send the nurse a new Proposed Agreed Order.

Informal Settlement Conferences
At the nursing board’s discretion, the nurse might be invited to attend an informal settlement conference. During the settlement conference, the nurse (and an attorney, if the nurse has representation) meets with BON representatives to discuss the allegations and potential disciplinary actions. The goal is to reach a mutually acceptable agreement, without having to proceed to a hearing. Typically, at the end of the informal settlement conference, the nurse is informed of the panel’s recommended disposition of the case.

Formal Charges
If the nurse and the board can’t come to an agreement with an Agreed Order or informal settlement conference, (or if the Board hasn’t been able to get a response from the nurse during the investigation), the Board often files formal charges. Formal charges are public.

With formal charges, the nurse is required to submit an answer to the charges, in writing, to the board.

Mediation
Mediation may be the next step – a chance for the nurse (and the nurse’s attorney) to negotiate with the board’s representatives for an agreed upon settlement.

Formal Hearings
If the mediation process isn’t successful, a disciplinary hearing is scheduled with an independent Administrative Law Judge (ALJ), at the State Office of Administrative Hearings. During the hearing, the board and the nurse (and an attorney, if the nurse has representation) can present evidence, call and cross examine witnesses, and present their case before the ALJ. It’s important to note that the board has the burden of proof and must establish a violation of the Nurse Practice Act or Board Rules and Regulations by a “preponderance of the evidence.”

Final Orders
After the hearing, the ALJ reviews the evidence and testimony and submits a Proposal For Decision (PFD) to the board. The PFD includes findings of fact and recommendations for action. The BON then reviews this proposal and makes a final decision on disciplinary action, if any.

Appeal Process
If the nurse disagrees with the ALJ’s decision or the Board’s disciplinary orders, the nurse has the right to appeal the decision to a court.

Disciplinary Orders
Disciplinary orders aren’t final until they’re approved by the nursing board (which reviews and approves orders monthly). Once approved, the order takes effect immediately.

Disciplinary actions are required to be reported to the National Council of State Boards of Nursing (NCSBN) and the National Practitioners Data Bank. They’re also required to be published in the BON’s quarterly bulletin. Additionally, copies of the final order are sent to the nurse and the nurse’s last known employer.

Most nursing board orders are public information and become a permanent part of the nurse’s licensure record, even after all terms of the order are met.

We Can Help – An Attorney On Your Side
Clearly, the process of having a complaint filed against you and being investigated by the board of nursing can be a drawn-out, traumatic, and potentially life-changing experience. You don’t need to go it alone – we can help you every step of the way and, potentially, help change the outcome.

Kevin Keaney is an experienced nurses attorney, and he’s a member of The American Association Of Nurse Attorneys. Prior to becoming an attorney, Kevin earned his BSN from the University of Texas at Austin School of Nursing and practiced as a registered nurse.

For more information about the complaint evaluation process, or to schedule a free consultation with a nurses attorney, please call (512) 829-5619. Note that the free consultation is ONLY for professional licensing matters.