Texas Board of Nursing


Texas Board of Nursing

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I have successfully represented LVN's, RN's and APN's before the TBN from the investigation phase to State Office of Administrative Hearings proceedings.

I am familiar with the process the TBN uses in all phases of a case and the individuals involved in implementing that process on behalf of the TBN.

My philosophy is to treat those who work with and for the TBN with as much dignity and respect as my clients deserve, no more and no less.

I vigorously represent my nurse clients before the board. I clearly understand that his or her livelihood and profession are on the line. I am adamantly aware of nursing professionals too frequently find themselves subjected to being a circumstantial "fall guy" in systems created with focus on the dollar rather than on patient care.

Disciplinary sanctions

Results can range from dismissal to Sanction Level I (Remedial Education with possible fine), more severe Sanction Level II to Emergency Suspension and subsequent revocation of a nursing license.

Texas Board of Nursing Disciplinary Process

The mission of the Texas Board of Nursing is to protect and promote the welfare of the people of Texas by ensuring that each person holding a license as a nurse in this state is competent to practice safely. The Board fulfills its mission through the regulation of the practice of nursing and the approval of nursing educational programs. This mission, derived from the Nursing Practice Act, supersedes the interest of any individual, the nursing profession, or any special interest group.

Notice of Investigation

The Texas Board of Nursing provides "due process" to the nurse by notifying him/her of the investigation and the allegations, unless doing so would jeopardize the Board's investigation. The nurse is afforded the opportunity to respond to the allegations made against him/her and to show compliance with the Nursing Practice Act for retention of the license.

Your expedient action to respond to a Notice of Investigation by the Texas Board of Nursing is vital. Early involvement by legal representation is a crucial element to a successful outcome. You have the right to self-respond to a Notice of Investigation. However, without professional guidance your well intentioned response can lead to additional allegations against you, in addition to loss of personal and work time. The complaint process is time sensitive. Should you ignore the inquiry letter and fail to respond, it will initiate an investigation.

Complaint Investigation

The investigator then obtains necessary evidence and interviews witnesses. Most of this process is conducted through the mail and over the phone. Occasionally, investigators make on site visits. Once all necessary evidence has been obtained to either substantiate or refute the allegations, the investigations team reviews the evidence in order to determine whether or not probable cause exists. The team then decides whether to close or settle the case.

If the case is closed, the complaint and all evidence is expunged from the nurse's file, unless it is closed “without prejudice” (Definition: Without Predjuice - When a case is dismissed but the Board is allowed to bring a new actions on the same claim).

All evidence is kept on file in cases closed without prejudice for up to 2 years and destroyed if no additional information or complaints are received about the nurse during this time period. If the team determines that a settlement is needed to resolve the case, the case will be settled either formally or informally.

Informal Conference

This process typically begins with the nurse and his/her counsel of record attending an informal conference at the Board's office in Austin, which is usually scheduled several months in advance. This process is used by the majority of nurse's in cases where substantial evidence exists to prove one or more violations of the Nursing Practice Act. In attendance at the conference are Executive Director, or her designee, Director of Investigations, legal counsel for the Board, the assigned investigator and the nurse and his/her counsel of record, if applicable.

During the conference, all evidence is presented and reviewed and questions are asked of the nurse by those in attendance. The nurse and his/her counsel is also provided the opportunity to respond to the allegations, to ask questions and to provide any additional information that he/she feels is appropriate. Having an attorney with Board experience and knowing what is likely to be asked is critical in preparing you for this conference. At the conclusion of the conference, the nurse is informed of the recommended disposition of his/her case.

If the panel determines that the nurse should be disciplined, the Board will generate a proposed agreed order and mail the document to the nurse or his/her counsel of record. The order contains findings of fact, conclusions of law and agreed sanctions. Typical sanctions and penalties include warning, reprimand, imposition of fines, completion of remedial education, supervision and restrictions on the license for finite periods of time. The Board may also revoke or suspend the license.

If the nurse agrees with the contents of the proposed order, the nurse and his/her counsel of record signs the order before a notary and returns it to the Board's office The proposed order is then scheduled for review by the full Board or by the Eligibility and Disciplinary committee of the Board at their next meeting. The Board may choose to ratify the order as is, suggest modification, or reject it. The order is usually ratified on initial review by the Board. When the order is ratified, it then becomes a final order of the Board and the terms of the order are in effect.

A copy of the final order of the Board is mailed to the nurse or his/her counsel of record, if applicable, to the last known employer and to the complainant. Disciplinary action is printed in the next Texas Board of Nursing quarterly newsletter and is entered into the National Council of State Boards of Nursing Disciplinary Data Bank. All disciplinary actions taken by the Board are public information and become a permanent part of the nurses licensure record.

Formal Conference

If the nurse does not wish to sign the proposed agreed order or if the Board is unable to make contact with the nurse during the investigation, the Board will file formal charges based on the allegations. A public disciplinary hearing before an Administrative Law Judge is scheduled several months in advance. This is the "nurse's day in court".

The Board's staff present the evidence against the nurse and the nurse, who may have legal counsel, is provided the opportunity to present his/her side of the case. Clearly, experienced counsel is essential in this courtroom setting no less than a surgeon in the operating room. The Administrative Law Judge renders a Proposal For Decision (see TOC rules below), which contains findings of fact and conclusions of law, and submits this proposal to the Board.

Based on the findings of fact, conclusions of law and the Proposal For Decision, the Board may find that a violation has occurred and impose a penalty or may find that no violation occurred and close the case with no action.

Texas Occupational Code Sec. 301.505 Proposal for Decision 

  1. If the person requests a hearing, or fails to respond in a timely manner to the notice, the executive director shall set a hearing and give notice of the hearing to the person.
  2. An administrative law judge of the State Office of Administrative Hearings shall hold the hearing.
  3. The administrative law judge shall make findings of fact and conclusions of law and promptly issue to the board a proposal for decision as to the occurrence of the violation and the amount of any proposed administrative penalty. Acts 1999, 76th Leg., ch. 388, Sec. 1, eff. Sept. 1, 1999. Sec. 301.506

Decision by Board

  1. Based on the findings of fact, conclusions of law, and proposal for decision, the board by order may:
    • Find that a violation occurred and impose an administrative penalty; or
    • Find that a violation did not occur.

Remember - Early Attorney Involvement is Key

Early involvement by an attorney experienced with TBN process will most often improve the chances of a successful conclusion for the nurse.

Legal Fees

I know and understand full well nurses work hard and are not in the profession to get rich. I also understand that in a working family every dollar counts.

But not being wealthy does not mean a nurse can do without legal representation, especially before the TBN.

Your livelihood may be at stake. To that end, I work with you and your circumstances so that you can continue to provide for yourself and your family while affording top experienced legal representation familiar with the TBN.

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Austin, Texas Professional License Defense Attorney Oscar San Miguel represents clients who are located in Austin, Houston, Dallas, San Antonio, El Paso, Fort Worth, Arlington, Amarillo, Lubbock, Brownsville, Laredo, Harlingen, McAllen, Round Rock, Longview, Travis County, Harris County, Dallas County, Tarrant County, Bexar County, Fort Bend County, Montgomery County, Cameron County, Nueces County, El Paso County, Potter County, Lubbock County, Grayson County, Collin County and throughout Texas.
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