The Texas BON has two types of disciplinary peer review:
Incident-based Peer review Rule 217.19
Safe Harbor Peer Review Rule 217.20
Peer review means the evaluation of professional nursing services, the qualification of professional nurses, the quality of patient care rendered by professional nurses, the merits of complaints concerning professional nurses and professional nursing care, and determinations or recommendations regarding complaints.
NPA Rule §303.001(5) Rule §217.19(a)(14).
The peer-review process is a fact finding mission to analyze and study the events, make recommendations and report findings to the Director of Nursing and the Board of Nurse Examiners Rule 217.19 (a)(14). All proceedings of a nursing peer review committee are confidential (unless information sent to BNE) and all communications made to a nursing peer review committee are privileged (Texas BON https://www.bon.texas.gov/faq_peer_review.asp)
Reporting
Every Licensed Nurse is obligated to report Unsafe Nursing Practice which the nurse reasonably suspects has exposed, or is likely to expose, a patient unnecessarily to risk of harm resulting from failure to provide patient care conforming to minimum standards of acceptable and prevailing professional practice.
Under BON Rule §217.19(b), reporting a nurse to a nursing peer review committee satisfies the duty of the nurse to report to the BON
Behavior Requiring Reporting
Duty of the Nursing Peer Review Committee when submitting a written, signed report is to:
Once the BON has made a decision, recommendations are made.
Recommendations can include suspension or revocation of licensure, remedial education to fill knowledge gaps, and additional skills training for skill deficiency.
Other recommendations can be related to Process change/improvement, Policy change, Evidence-based practice, or developing/ improving a culture of safety.
Safe Harbor Nursing Peer Review and Whistleblower Protections Rule 217.20
https://www.bon.texas.gov/rr_current/217-20.asp
What is safe harbor? [Tex. Occ. Code §303.005(b) and (e); Tex. Admin. Code §217.20(a)(15)]
Safe harbor is a nursing peer review process that a nurse may initiate when asked to engage in an assignment or conduct that the nurse believes, in good faith, would potentially result in a violation of the Nursing Practice Act (NPA) or Board rules. When invoked in good faith, safe harbor protects a nurse from employer retaliation, suspension, termination, discipline, discrimination, and from licensure sanction by the Board of Nursing (“BON” or “Board”).
Safe harbor must be invoked before engaging in the conduct or assignment for which nursing peer review is requested and may be invoked at any time during the work period when the initial assignment changes.
Examples of safe harbor situations include clinical assignments related to patients' staffing and/or acuity when the nurse believes patient harm may result [Tex. Admin. Code §217.11(1)(B) and (T)], and can involve a request to engage in unprofessional or illegal conduct, such as falsifying medical record documents.
Safe harbor also allows for a nurse to request that a determination be made on the medical reasonableness of a physician’s order [Tex. Occ. Code §303.005(e)]. There is a separate form for requesting a determination regarding the Medical Reasonableness of a Physician’s Order. (Safe Harbor Peer review FAQ https://www.bon.texas.gov/faq_peer_review.asp#t2)
References:
Texas Board of Nursing Safe Harbor Peer review FAQ https://www.bon.texas.gov/faq_peer_review.asp#t2)
Safe Harbor Nursing Peer Review and Whistleblower Protections Rule 217.20
https://www.bon.texas.gov/rr_current/217-20.asp