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TITLE 22EXAMINING BOARDS
PART 11TEXAS BOARD OF NURSING
CHAPTER 213PRACTICE AND PROCEDURE
RULE §213.33Factors Considered for Imposition of Penalties/Sanctions

(a) The Board and the State Office of Administrative Hearings (SOAH) shall utilize the Disciplinary Matrix set forth in subsection (b) of this section in all disciplinary and eligibility matters.

(b) The Disciplinary Matrix is as follows:

Attached Graphic

(c) The Board and SOAH shall consider the following factors in conjunction with the Disciplinary Matrix when determining the appropriate penalty/sanction in disciplinary and eligibility matters. The mitigating and aggravating factors specified in the Matrix are in addition to the factors listed in this subsection. Further, the presence of mitigating factors in a particular case does not constitute a requirement of dismissal of a violation of the Nursing Practice Act (NPA) and/or Board rules. If multiple violations of the NPA and/or Board rules are present in a single case, the most severe sanction recommended by the Matrix for any one of the individual offenses should be considered by the Board and SOAH pursuant to Tex. Occ. Code §301.4531. The following factors shall be analyzed in determining the tier and sanction level of the Disciplinary Matrix for a particular violation or multiple violations of the NPA and Board rules:

  (1) evidence of actual or potential harm to patients, clients, or the public;

  (2) evidence of a lack of truthfulness or trustworthiness;

  (3) evidence of misrepresentation(s) of knowledge, education, experience, credentials, or skills which would lead a member of the public, an employer, a member of the health-care team, or a patient to rely on the fact(s) misrepresented where such reliance could be unsafe;

  (4) evidence of practice history;

  (5) evidence of present fitness to practice;

  (6) whether the person has been subject to previous disciplinary action by the Board or any other health care licensing agency in Texas or another jurisdiction and, if so, the history of compliance with those actions;

  (7) the length of time the person has practiced;

  (8) the actual damages, physical, economic, or otherwise, resulting from the violation;

  (9) the deterrent effect of the penalty imposed;

  (10) attempts by the person to correct or stop the violation;

  (11) any mitigating or aggravating circumstances, including those specified in the Disciplinary Matrix;

  (12) the extent to which system dynamics in the practice setting contributed to the problem;

  (13) whether the person is being disciplined for multiple violations of the NPA or its derivative rules and orders;

  (14) the seriousness of the violation;

  (15) the threat to public safety;

  (16) evidence of good professional character as set forth and required by §213.27 of this chapter (relating to Good Professional Character);

  (17) participation in a continuing education course described in §216.3(f) of this title (relating to Requirements) completed not more than two years before the start of the Board's investigation, if the nurse is being investigated by the Board regarding the nurse's selection of clinical care for the treatment of tick-borne diseases; and

  (18) any other matter that justice may require.

(d) Each specific act or instance of conduct may be treated as a separate violation.

(e) The Board may, upon the finding of a violation, enter an order imposing one or more of the following disciplinary actions, with or without probationary stipulations:

  (1) Denial of temporary permit or licensure (including renewal, reinstatement/reactivation, or the return to direct patient care from a limited license);

  (2) Approval of temporary permit or licensure (including renewal, reinstatement/reactivation, or the return to direct patient care from a limited license), with one or more reasonable probationary stipulations as a condition of issuance, renewal, or reinstatement/reactivation. Additionally, the Board may determine, in accordance with §301.468 of the NPA, that an order denying a license application/petition, license renewal, license reinstatement/reactivation, or temporary permit be probated. Reasonable probationary stipulations may include, but are not limited to:

    (A) submit to care, supervision, counseling, or treatment by a health provider designated by the Board as a condition for the issuance, renewal, or reinstatement/reactivation of the license or temporary permit or the return to direct patient care from a limited license;

    (B) submit to an evaluation as outlined in subsections (k) and (l) of this section and/or pursuant to the Occupations Code §301.4521;

    (C) participate in a program of education or counseling prescribed by the Board;

    (D) limit specific nursing activities and/or practice settings and/or require periodic Board review;

    (E) practice for a specified period under the direction of a registered nurse or vocational nurse designated by the Board;

    (F) abstain from unauthorized use of drugs and alcohol to be verified by random drug testing conducted through urinalysis; or

    (G) perform public service which the Board considers appropriate;

  (3) Issuance of a Warning. The issuance of a Warning shall include reasonable probationary stipulations which may include, but are not limited to, one or more of the following:

    (A) submit to care, supervision, counseling, or treatment by a health provider designated by the Board;

    (B) submit to an evaluation as outlined in subsections (k) and (l) of this section and/or pursuant to the Occupations Code §301.4521;

    (C) participate in a program of education or counseling prescribed by the Board;

    (D) limit specific nursing activities and/or practice settings and/or require periodic Board review;

    (E) practice for a specified period of at least one year under the direction of a registered nurse or vocational nurse designated by the Board;

    (F) abstain from unauthorized use of drugs and alcohol to be verified by random drug testing conducted through urinalysis; or

    (G) perform public service which the Board considers appropriate;

  (4) Issuance of a Reprimand. The issuance of a Reprimand shall include reasonable probationary stipulations which may include, but are not limited to, one or more of the following:

    (A) submit to care, supervision, counseling, or treatment by a health provider designated by the Board;

    (B) submit to an evaluation as outlined in subsections (k) and (l) of this section and/or pursuant to the Occupations Code §301.4521;

    (C) participate in a program of education or counseling prescribed by the Board;

    (D) limit specific nursing activities and/or practice settings and/or require periodic Board review;

    (E) practice for a specified period of at least two years under the direction of a registered nurse or vocational nurse designated by the Board;

    (F) abstain from unauthorized use of drugs and alcohol to be verified by random drug testing conducted through urinalysis; or

    (G) perform public service which the Board considers appropriate;

  (5) Limitation or restriction of the person's license or permit, including limits on specific nursing activities and/or practice settings and/or periodic Board review;

  (6) Suspension of the person's license or permit. The Board may determine that the order of suspension be enforced and active for a specific period and/or probated with reasonable probationary stipulations as a condition for lifting or staying the order of suspension. Reasonable probationary stipulations may include, but are not limited to, one or more of the following:

    (A) submit to care, supervision, counseling, or treatment by a health provider designated by the Board;

    (B) submit to an evaluation as outlined in subsections (k) and (l) of this section and/or pursuant to the Occupations Code §301.4521;

    (C) participate in a program of education or counseling prescribed by the Board;

    (D) limit specific nursing activities and/or practice settings and/or require periodic Board review;

    (E) practice for a specified period of not less than two years under the direction of a registered nurse or vocational nurse designated by the Board;

    (F) abstain from unauthorized use of drugs and alcohol to be verified by random drug testing conducted through urinalysis; or

Cont'd...

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