Board of Nursing Investigative and Disciplinary Process

The Texas Board of Nursing’s Enforcement Division responds to an average of 15,000 complaints regarding Nursing practice violations annually. Nurses in Texas are subject to discipline by the Board of Nursing by way of the submission of a formal complaint that may generally allege that the nurse has violated the Nursing Practice Act. The complaint may be brought by patients, or patient family members, co-workers, physicians, or current or former employers of the nursing professional.

Additionally, the Board may also independently conduct an investigation when it receives information that indicates that a nurse has withheld or omitted information related to her initial license application, or license renewal. This board inquiry mainly concerns the nurse’s character and honesty, although mitigating circumstances are taken into account when the nurse’s response to the allegations are reviewed by the boards investigative team.

Once the complaint is received by the Board’s Enforcement Division, it is formally reviewed by an assigned investigator, who may be a registered nurse, criminal justice trained investigator, or both.  Upon completion of the complaint review, the investigator may choose the following options;

1) Close the case without further action.

2) Refer the Case to TPAPN, if substance misuse is suspected, or signs and symptoms of mental/psychological illness are apparent to the degree that nursing practice is impaired.

If the nurse’s case is determined to be the result of chemical dependency or other mental health impairment, the investigator will require the nurse being investigated to have a formal evaluation by a licensed chemical dependency counselor, or psychiatrist. If, at this time the evaluation reveals that the nurse has chemical dependency or an identified mental health impairment, the recommendation for enrollment in TPAPN will be made. The nurse may elect to forego this recommendation, and the investigation will continue, or elect to participate in TPAPN.

The Texas Peer Assistance Program serves as a liaison between the impaired nurse, and the board of nursing. The liaison function of TPAPN is to divert the nurse from being subject to formal discipline by the Board, enlist the nurse in intensive rehabilitation efforts, and monitor the nurse, while she continues with nursing practice.

TPAPN participation includes individualized counseling and therapy, random urine drug screening, attendance of community support groups, peer support groups, after-care, and monthly reporting. In some cases, a nurse may not be able to return to work until she has completed a recommended course of intensive rehab or therapy. Once such provision is satisfied by the participating nurse, she may return to work, with case by case restrictions, which include work hour limitations, and confidential, employer disclosure of participation in TPAPN.

Facing the decision of whether to participate in TPAPN is voluntary. However, the advantages and disadvantages of participating should be discussed with Clay before making this critical commitment.

For more information about the Texas Peer Assistance Program, visit

3) Open a formal investigation.

If the Board’s Enforcement Divsion decides to proceed with investigation of the allegations, the nurse will then receive a formal notice via certfied mail. This notice will set out the allegations, as described by the person or entity that brought the allegations to the board’s attention.

This letter asks for a response by the nurse to the allegations as set out in the notice within thirty days. This is when it is critical that you contact Clay to schedule an initial consult by phone, web conference, or face to face meeting.

Failing to respond the allegations within the prescribed thirty days may result in default, and the investigator may then bring formal charges against the nurse on behalf of the board.

Once hired, Clay will formally request the evidence that the enforcement division has in its possession that forms the substance of the allegations. This the exercise of your rights to due process under the Nursing Practice Act. Clay’s staff will also contact witnesses, or others based upon the facts or circumstances surrounding the specific allegations.

Clay will then compile a detailed response to the allegations based upon the provided record, any helpful information that the nurse client provides, and matters that are subject to the Nursing Practice Act, other provisions of State Law, or well-established legal defenses that may justify, mitigate, or excuse the nurses conduct.

The board investigator will then decide whether to

a) close the case,

b) refer the case to TPAPN, based upon information developed in the investigation,

c) hold an informal conference to resolve the allegations, or

d) file formal charges against the Nurse with the Texas Board of Nursing.

4) Refer the case to a different State Administrative Regulatory Agency

In some instances, allegations against a nurse may implicate other state regulatory agency investigation. Depending on the nature of the allegations, the underlying Nursing Practice allegations may be temporarily suspended if the nurse becomes subject to additional agency scrutiny.

More commonly, this may occur if there is evidence of a financial crime, such as medicaid fraud, or a nurse’s participation in a conspiracy with other health care professionals and/or administrators.

The remaining steps in the investigative process will determine whether the board will close the investigation, or take formal disciplinary action, ranging from remedial education to revocation, or surrender of the nurse’s professional license.

As a Registered Nurse, and an Attorney, Clay has the unique, combined skills to decipher complicated medical records, nursing documentation, and the provisions of the Nursing Practice Act. As your nursing peer, Clay has first hand experience with the demands placed on the profession from the point of view of hospital administration, patient family members, and unreasonable physicians.

Call Clay Now, and get the advocacy you deserve to defend your license, and continue your Nursing practice.