Health Policy Legal Aspects Module 3 Reflection

Health Policy Legal Aspects Module 3 Reflection Assignment

Overview: Peer Review In the Module 3 Reflection Assignment, you will reflect upon what you have learned about Peer Review Committee processes and Texas Board of Nursing rules as you consider the actions of fictitious nurses and committee members in scenarios. REMEMBER, YOU ARE USING THE TEXAS BOARD OF NURSING RULES, NOT THE STATE YOU LIVE IN. Please use the link provided in the assignment for the Texas BON Rule 217.16. ALSO, THERE ARE 2 PARTS TO THIS ASSIGNMENT.

PLEASE MAKE SURE YOU COMPLETE BOTH PARTS. Refer to your course readings and lectures as you complete the assignment.

Paper For Above instruction

The following academic paper addresses the core elements of the assignment: analyzing peer review processes, applying specific Texas Board of Nursing rules, and reflecting critically on clinical scenarios involving nurses' practice and violations.

Introduction

The integrity of nursing practice and ensuring patient safety are paramount concerns within healthcare. The Texas Board of Nursing (BON) establishes regulations such as Rule 217.16 and Rule 217.19 that guide peer review procedures and incident reporting mechanisms. This paper critically examines two hypothetical scenarios—one involving minor incident reporting and another related to incident-based peer review—to demonstrate appropriate application of these rules. Reflecting on these scenarios enhances understanding of how nurses and committees navigate legal and ethical responsibilities, safeguarding patient welfare while respecting due process.

Part 1: Application of Rule 217.16(h) - Minor Incidents

Scenario Overview: Nurse A administered immunizations using an expired hepatitis B vaccine vial. Although she took responsibility when informed, the question arises whether this act warrants reporting to the BON as a minor incident or a reportable one under Rule 217.16(h).

Analysis: Texas BON Rule 217.16 outlines criteria distinguishing minor incidents from reportable events. In this context, the five essential criteria include:

  • 1. Conduct that ignores a substantial risk of physical, emotional, or financial harm—or potential for such harm—being exposed to a patient or person.
  • 2. Conduct that violates the Texas Nursing Practice Act or Board rules and results in death or serious injury.
  • 3. Practice-related violations involving impairment or suspected impairment due to chemical dependency, misuse of substances, or mental health concerns.
  • 4. Violations of professional boundaries, including abuse, exploitation, or fraud under Rule 217.12.
  • 5. Actions revealing a lack of knowledge, skill, judgment, or conscientiousness so severe that continued practice could reasonably be expected to pose harm.

Application: Regarding Nurse A’s administration of an expired vaccine, the critical criteria are as follows:

Criterion 1: The use of an expired vaccine could potentially expose patients to a risk of harm, constituting conduct ignoring a substantial risk. The vaccine's efficacy and safety might be compromised, leading to possible adverse effects. This aligns with the first criterion, warranting reporting due to the potential for harm.

Criterion 2: Since there was no report of death or serious injury directly linked to this incident, this criterion does not fully apply here.

Criterion 3: The nurse was not impaired by substances or mental health issues; thus, this criterion is not met.

Criterion 4: There was no evidence of professional boundary violations—no abuse or exploitation involved.

Criterion 5: The act suggests possible a deficiency in clinical judgment, but it does not definitively indicate a lack of knowledge or skill to the extent of risking ongoing practice. Therefore, this criterion is less applicable.

Decision and Reflection: Based on the above analysis, Nurse A’s conduct falls under the first criterion as conduct that ignores a substantial risk of harm, making it a reportable incident. Therefore, Nurse A should be reported to the BON to ensure proper oversight and prevent recurrence. Although the vaccine was still stored properly, the expired status signifies a lapse in protocol that could compromise patient safety. The nurse demonstrated accountability by acknowledging the mistake; however, the incident's potential harm justifies formal reporting.

Part 2: Incident-Based Peer Review Violations under Rule 217.19

Scenario Overview: A nurse is informally notified that a peer review will occur due to alleged medication errors and reports made to the Texas Department of State Health Services. The nurse witnesses her manager and chairperson discussing her performance and impending suspension, suggesting bias and potential misconduct in the review process.

Analysis: Texas BON Rule 217.19 details procedures for incident-based peer review, emphasizing fairness, confidentiality, and due process. The violations observed include:

  • 1. Subsection 217.19(a): Failing to ensure a fair and unbiased review—The manager and chairperson's remarks suggest prejudgment and bias, violating due process rights.
  • 2. Subsection 217.19(b): Lack of confidentiality—Predicting a suspension and discussing the review publicly without proper procedures breaches confidentiality principles.
  • 3. Subsection 217.19(c): Failure to provide written notice—The scenario indicates the nurse was not given formal notice of the review process, infringing upon her rights.
  • 4. Subsection 217.19(d): No evidence of objective review—The discussion indicates assumptions rather than objective evaluation of the nurse’s conduct, violating adversarial and fair review standards.

The violations collectively undermine the integrity of the peer review process, compromising the nurse’s right to fair treatment and due process. Such procedural lapses could lead to unjust sanctions and legal repercussions, emphasizing the importance of strict adherence to rule 217.19.

Conclusion

Applying the Texas BON rules, including 217.16 and 217.19, requires careful analysis of incidents and review procedures to uphold ethical standards and protect patient safety. The assessment of Nurse A's expired vaccine incident highlights the importance of recognizing potentially harmful conduct that warrants reporting. Simultaneously, evaluating the peer review scenario underscores the necessity of fairness and adherence to protocols in disciplinary actions. Overall, these scenarios illuminate the critical role of regulatory rules in guiding nursing practice and peer review, balancing accountability with due process.

References

  • Texas Board of Nursing. (2023). Rule 217.16: Minor Incidents. Retrieved from https://www.bon.texas.gov
  • Texas Board of Nursing. (2023). Rule 217.19: Incident-Based Peer Review. Retrieved from https://www.bon.texas.gov
  • State of Texas. (2023). Occupations Code §301.401(2). Nursing Practice Act.
  • Giddens, J. (2017). Legal implications of nursing practice. Elsevier.
  • Lamb, R., & Kasper, M. (2019). Legal and ethical issues in nursing. Jones & Bartlett Learning.
  • American Nurses Association. (2021). Nursing: Scope and standards of practice. ANA.
  • Code of Federal Regulations. (2022). Part 42: Medical and Professional Practice Standards.
  • Green, A., & Carper, A. (2020). Patient safety and legal considerations in nursing. Springer Publishing.
  • Sullivan, E. J., & Decker, P. J. (2020). Legal and ethical issues in nursing: Practice matters. Saunders.
  • Hood, L. (2018). The importance of due process in nursing peer review. Journal of Nursing Law, 23(4), 165-172.

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