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A BILL TO BE ENTITLED
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AN ACT
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relating to nursing peer review and the regulation of the practice |
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of nursing. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 301.002, Occupations Code, is amended by |
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adding Subdivisions (1-a) and (1-b) to read as follows: |
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(1-a) "Chief nursing officer" means the registered |
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nurse who is administratively responsible for the nursing services |
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at a facility. |
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(1-b) "Patient safety committee" has the meaning |
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assigned by Section 303.001. |
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SECTION 2. Section 301.303(b), Occupations Code, is amended |
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to read as follows: |
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(b) The board may not require participation in more than a |
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total of 20 hours of continuing education in a two-year licensing |
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period [and may not require that more than 10 hours of the
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continuing education consist of classroom instruction in approved
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programs. The remaining hours of continuing education may consist
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of any combination of:
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[(1)classroom instruction;
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[(2)institutional-based instruction; or
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[(3)individualized study]. |
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SECTION 3. The heading to Subchapter I, Chapter 301, |
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Occupations Code, is amended to read as follows: |
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SUBCHAPTER I. REPORTING VIOLATIONS AND PATIENT CARE CONCERNS [DUTY
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TO REPORT VIOLATION] |
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SECTION 4. Section 301.401, Occupations Code, is amended to |
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read as follows: |
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Sec. 301.401. DEFINITIONS [GROUNDS FOR REPORTING
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NURSE]. In this subchapter: |
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(1) "Conduct subject to reporting" means conduct by a |
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nurse that: |
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(A) violates this chapter or a board rule and |
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contributed to the death or serious injury of a patient; |
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(B) causes a person to suspect that the nurse's |
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practice is impaired by chemical dependency or drug or alcohol |
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abuse; |
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(C) constitutes abuse, exploitation, or fraud, |
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violates professional boundaries, or is an intentional or knowing |
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act of significant unprofessional conduct; or |
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(D) indicates that the nurse lacks knowledge, |
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skill, judgment, or conscientiousness to such an extent that the |
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nurse's continued practice of nursing could reasonably be expected |
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to pose a risk of harm to a patient or another person, regardless of |
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whether the conduct consists of a single incident or a pattern of |
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behavior. |
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(2) "Minor incident" means conduct by a nurse that |
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does not indicate that the nurse's continued practice poses a risk |
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of harm to a patient or another person. |
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(3) "Nursing educational program" means an |
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educational program approved by the board that may lead to an |
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initial license as a registered nurse or vocational nurse. |
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(4) "Nursing student" means an individual who is |
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enrolled in a nursing educational program [(a) Except as provided
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by Subsection (b), the following are grounds for reporting a nurse
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under Section 301.402, 301.403, 301.405, or 301.407:
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[(1) likely exposure by the nurse of a patient or other
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person to an unnecessary risk of harm;
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[(2)unprofessional conduct by the nurse;
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[(3) failure by the nurse to adequately care for a
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patient;
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[(4) failure by the nurse to conform to the minimum
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standards of acceptable nursing practice; or
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[(5) impairment or likely impairment of the nurse's
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practice by chemical dependency]. |
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[(b) Subsection (a) does not apply to a minor incident, as
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defined by Section 301.419, if the incident is not required to be
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reported under a rule adopted under Section 301.419.] |
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SECTION 5. Sections 301.402(b) and (e), Occupations Code, |
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are amended to read as follows: |
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(b) A nurse shall report to the board in the manner |
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prescribed under Subsection (d) if the nurse has reasonable cause |
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to suspect that: |
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(1) another nurse has engaged in conduct subject to |
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reporting [is subject to a ground for reporting under Section
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301.401]; or |
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(2) the ability of a nursing student to perform the |
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services of the nursing profession would be, or would reasonably be |
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expected to be, impaired by chemical dependency. |
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(e) Instead of reporting to the board under Subsection (b), |
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a [A] nurse may make a report required under: |
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(1) Subsection (b)(1) to a nursing peer review |
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committee under Chapter 303; or |
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(2) Subsection (b)(2) to the nursing educational |
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program in which the student is enrolled [instead of reporting to
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the board]. |
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SECTION 6. Section 301.403, Occupations Code, is amended to |
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read as follows: |
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Sec. 301.403. DUTY OF PEER REVIEW COMMITTEE TO REPORT. (a) |
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Except as provided by Subsection (b), a [A] nursing peer review |
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committee operating under Chapter 303 that determines that a nurse |
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has engaged in conduct subject to reporting [has a ground for
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reporting a nurse under Section 301.401] shall file with the board a |
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written, signed report that includes: |
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(1) the identity of the nurse; |
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(2) a description of any corrective action taken |
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against the nurse; |
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(3) a recommendation [statement] whether the [nursing
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peer review committee recommends that the] board should take formal |
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disciplinary action against the nurse and the basis for the |
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recommendation; |
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(4) a description of the conduct subject to [ground
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for] reporting; |
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(5) the extent to which any deficiency in care |
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provided by the reported nurse was the result of a factor beyond the |
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nurse's control [rather than a deficiency in the nurse's judgment,
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knowledge, training, or skill]; and |
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(6) any additional information the board requires. |
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(b) A report under Subsection (a) is not required if: |
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(1) the nursing peer review committee determines that |
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the reported conduct was a minor incident that is not required to be |
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reported under board rule; or |
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(2) the nurse has been reported to the board for the |
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conduct under Section 301.405. |
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SECTION 7. Section 301.404, Occupations Code, is amended to |
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read as follows: |
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Sec. 301.404. DUTY OF NURSING EDUCATIONAL PROGRAM TO |
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REPORT. [(a) In this section, "nursing educational program" and
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"nursing student" have the meanings assigned by Section 301.402(a).
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[(b)] A nursing educational program that has reasonable |
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cause to suspect that the ability of a nursing student to perform |
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the services of the nursing profession would be, or would |
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reasonably be expected to be, impaired by chemical dependency shall |
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file with the board a written, signed report that includes the |
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identity of the student and any additional information the board |
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requires. |
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SECTION 8. Sections 301.405(b), (c), and (e), Occupations |
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Code, are amended to read as follows: |
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(b) A person that terminates, suspends for more than seven |
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days, or takes other substantive disciplinary action, as defined by |
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the board, against a nurse, or a substantially equivalent action |
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against a nurse who is a staffing agency nurse, because the nurse |
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engaged in conduct subject to reporting [a ground under Section
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301.401 exists to report the nurse] shall report in writing to the |
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board: |
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(1) the identity of the nurse; |
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(2) the conduct subject to reporting that resulted in |
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[ground that preceded] the termination, suspension, or other |
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substantive disciplinary action or substantially equivalent |
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action; and |
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(3) any additional information the board requires. |
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(c) If a person who makes a report required under Subsection |
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(b) is required under Section 303.0015 to establish a nursing peer |
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review committee, the person shall submit a copy of the report to |
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the nursing peer review committee. The nursing peer review |
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committee shall review the conduct to determine if any deficiency |
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in care by the reported nurse was the result of a factor beyond the |
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nurse's control. A nursing peer review committee that determines |
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that there is reason to believe that the nurse's deficiency in care |
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was the result of a factor beyond the nurse's control shall report |
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the conduct to the patient safety committee at the facility where |
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the reported conduct occurred, or if the facility does not have a |
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patient safety committee, to the chief nursing officer [Except as
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provided by Subsection (g), each person subject to this section
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that regularly employs, hires, or otherwise contracts for the
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services of 10 or more nurses shall develop a written plan for
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identifying and reporting a nurse under Section 301.401(a). The
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plan must provide for the review of the nurse and the incident by a
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nursing peer review committee established and operated under
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Chapter 303. Review by the committee is only advisory, but is
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required, even if the nurse is voluntarily or involuntarily
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terminated]. |
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(e) The requirement under Subsection (c) that a nursing peer |
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review committee review the nurse and the incident does not subject |
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a person's administrative decision to discipline a nurse to the |
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peer review process [or prevent a person from taking disciplinary
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action before review by the peer review committee is conducted]. |
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SECTION 9. Section 301.407(b), Occupations Code, is amended |
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to read as follows: |
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(b) Unless expressly prohibited by state or federal law, a |
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state agency that has reason to believe that a nurse has engaged in |
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conduct subject to reporting [a ground for reporting a nurse exists
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under Section 301.401] shall report the nurse in writing to the |
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board or to a nursing peer review committee under Chapter 303 [the
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identity of that nurse]. |
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SECTION 10. Section 301.457, Occupations Code, is amended |
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by adding Subsection (g) to read as follows: |
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(g) If the board determines after investigating a complaint |
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under Subsection (e) that there is reason to believe that a nurse's |
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deficiency in care was the result of a factor beyond the nurse's |
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control, the board shall report that determination to the patient |
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safety committee at the facility where the nurse's deficiency in |
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care occurred, or if the facility does not have a patient safety |
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committee, to the chief nursing officer. |
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SECTION 11. Section 303.001, Occupations Code, is amended |
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by adding Subdivision (4-a) to read as follows: |
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(4-a) "Patient safety committee" means a committee |
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established by an association, school, agency, or other |
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organization to address issues relating to patient safety, |
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including: |
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(A) the entity's medical staff; or |
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(B) a committee that performs the functions |
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required of a hospital under Subchapter H, Chapter 241, Health and |
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Safety Code. |
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SECTION 12. Chapter 303, Occupations Code, is amended by |
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adding Section 303.0015 to read as follows: |
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Sec. 303.0015. REQUIRED ESTABLISHMENT OF NURSING PEER |
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REVIEW COMMITTEE. (a) A person shall establish a nursing peer |
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review committee to conduct nursing peer review under this chapter |
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and Chapter 301: |
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(1) for vocational nurses, if the person regularly |
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employs, hires, or contracts for the services of 10 or more nurses; |
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and |
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(2) for professional nurses, if the person regularly |
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employs, hires, or contracts for the services of 10 or more nurses, |
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at least five of whom are registered nurses. |
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(b) A person required to establish a nursing peer review |
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committee under this section may contract with another entity to |
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conduct the peer review for the person. |
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SECTION 13. Section 303.005(b), Occupations Code, is |
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amended to read as follows: |
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(b) If a person who is required to establish a nursing peer |
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review committee under Section 303.0015 [regularly employs, hires,
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or otherwise contracts for the services of at least 10 nurses] |
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requests a nurse [one of those nurses] to engage in conduct that the |
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nurse believes violates a nurse's duty to a patient, the nurse may |
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request, on a form developed or approved by the board, a |
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determination by a nursing peer review committee under this chapter |
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of whether the conduct violates a nurse's duty to a patient. |
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SECTION 14. Chapter 303, Occupations Code, is amended by |
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adding Section 303.0075 to read as follows: |
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Sec. 303.0075. SHARING OF INFORMATION. (a) A nursing peer |
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review committee and a patient safety committee established by the |
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same entity may share information. |
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(b) The requirement to maintain the confidentiality of |
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information obtained by a nursing peer review committee or patient |
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safety committee applies to information shared under Subsection |
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(a). A committee that receives information from another committee |
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under this section owes the same duty of confidentiality regarding |
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the information as the committee that provided the information. |
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(c) A committee that receives information may not disclose |
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the information to another person and shall forward any request to |
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disclose the information to the committee that provided the |
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information. |
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SECTION 15. Section 303.011, Occupations Code, is amended |
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to read as follows: |
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Sec. 303.011. EVALUATION BY COMMITTEE. (a) In evaluating |
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a nurse's conduct, the nursing peer review committee shall review |
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the evidence to determine the extent to which a deficiency in care |
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by the nurse was the result of deficiencies in the nurse's judgment, |
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knowledge, training, or skill rather than other factors beyond the |
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nurse's control. A determination that a deficiency in care is |
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attributable to a nurse must be based on the extent to which the |
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nurse's conduct was the result of a deficiency in the nurse's |
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judgment, knowledge, training, or skill. |
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(b) The nursing peer review committee shall report a |
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deficiency in care that the committee determines was the result of a |
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factor beyond the nurse's control to a patient safety committee for |
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evaluation. The patient safety committee shall evaluate the |
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influence of the factors on the conduct of the nurse being evaluated |
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and on the practice of other nurses within the entity that |
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established the committee. The committee shall report its findings |
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to the nursing peer review committee. |
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SECTION 16. The following sections of the Occupations Code |
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are repealed: |
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(1) Section 301.303(d); |
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(2) Section 301.352(e); |
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(3) Section 301.402(a); |
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(4) Sections 301.405(d), (f), (g), and (h); |
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(5) Section 301.419(a); and |
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(6) Section 303.005(h). |
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SECTION 17. (a) Except as provided by Subsection (b) of |
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this section, the changes in law made by this Act apply only to |
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conduct that occurs on or after the effective date of this Act. |
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Conduct that occurs before the effective date of this Act is |
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governed by the law in effect when the conduct occurs, and the |
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former law is continued in effect for that purpose. |
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(b) The change in law made by this Act by the amendment of |
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Section 301.303(b), Occupations Code, applies only to an |
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application for renewal of a license issued under Chapter 301, |
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Occupations Code, that is submitted on or after the effective date |
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of this Act. An application for renewal submitted before the |
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effective date of this Act is governed by the law in effect when the |
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application is submitted, and the former law is continued in effect |
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for that purpose. |
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SECTION 18. This Act takes effect immediately if it |
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receives a vote of two-thirds of all the members elected to each |
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house, as provided by Section 39, Article III, Texas Constitution. |
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If this Act does not receive the vote necessary for immediate |
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effect, this Act takes effect September 1, 2007. |