Journal- Legal Overview and Peer Review Process
YOU MUST ANSWER ALL 3 QUESTIONS ABOUT YOUR KEY POINT in document REFLECTIVE JOURNAL MODULE 2(ATTACHED*******) IN ORDER TO RECEIVE CREDIT (NO PARTIAL CREDIT). PLEASE COME UP WITH YOUR OWN KEY POINTS FOR EACH MODULE. attached 2 lectures for the class and provided links to all documents viewed for this module.http://www.bne.state.tx.us/faq_peer_review.asphttp://www.bon.texas.gov/rr_current/217-11.asphttp://www.bon.texas.gov/rr_current/217-12.asphttp://www.bne.state.tx.us/laws_and_rules_nursing_…http://www.bon.texas.gov/laws_and_rules_nursing_pr…
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Reflective Journal Module 2: Legal Overview and Peer Review Process: Identify 3 key
points from this module. Reflect on why each point is important, how it impacts on your work
experience or nursing practice, and how will you change your practice in the future based on
each key area.
Place Key
Point in
this
column:
Key Point
1:
Answer each question below with at least 4-6 well written sentences using critical
thinking.
1. Why it is important? at least 4-6 well written sentences using critical
thinking
2. How does it impact my work/nursing practice? at least 4-6 well written
sentences using critical thinking
3. How will I change my practice? at least 4-5 well written sentences using
critical thinking
Key Point
2
1. Why it is important? at least 4-6 well written sentences using critical
thinking
2.
How does it impact my work/nursing practice? at least 4-6 well written
sentences using critical thinking
3. How will I change my practice? at least 4-6 well written sentences using
critical thinking
Key Point
3
1. Why it is important? at least 4-6 well written sentences using critical
thinking
2. How does it impact my work/nursing practice? at least 4-6 well written
sentences using critical thinking
3. How will I change my practice? at least 4-5 well written sentences using
critical thinking
1
As the years went along and more and more nurses were peer reviewed in Texas and
other states in the Na?on, it became clear that a puni?ve approach was being taken
by licensing boards. The Ins?tute of Medicine-- a non--pro?t think--tank that exists to
study and in?uence the delivery of health care in the US-- called this puni?ve
approach the Bad Apple approach. The concept was that if we just pluck enough
bad apples [unsafe
prac??oners] out of the health care delivery system, then the system should be safe
for the pa?ents. But research didnt support this Bad Apple approach. The IOM
found, as a result of a study that it published in 1999/2000 en?tled To Err is
Human, that the healthcare system doesnt have a lot of unsafe prac??oners, but
that the system itself was unsafe or Sick. The system itself had many Failures.
Therefore, ever since the 2000 prin?ng of the To Err is Human study, there has
been supposed to have been an added emphasis on the systems shortcomings; in
other words, a systems
approach to unsafe pa?ent care, rather than the Bad Apple approach.
Nurses s?ll must take responsibility and accountability for their part in an incident.
But the system must take responsibility also. Though we s?ll have along way to go
before
Peer Review is viewed as non--puni?ve by many prac?cing nurses, we are making
headway toward a more fair process.
2
I want to discuss with you four of the basic concepts of Peer Review in Texas. Other
states may have these same basic concepts, or there may be some varia?on from
state--to-- state.
1st-- there is MANDATORY repor?ng. If you have a reasonable suspicion that a Nurse
is prac?cing unsafely and exposing a pa?ent to a signi?cant risk of harm, then you
must report that fellow Nurse. It isnt a guideline or
an ethical sugges?on, it is a legal mandate. Since the requirement to report is
MANDATORY and the mandate comes from your Nursing Prac?ce Act, then if you do
not report, you have violated the Prac?ce Act and the Board may inves?gate you for
failing to ensure pa?ent safety. The de?ni?on of what MUST be reported has
changed over the years, since 1987. For example, you dont have to report to the
Board, a Nurse whose ac?ons were a MINOR viola?on of the Prac?ce Act.
The 2nd concept is that the Nurse being inves?gated has the right of Con?den?ality.
This right belongs to the nurse and can be broken, without poten?al legal
consequences in only a few speci?c instances. A person can be sued in a civil court of
law for breach of con?den?ality. Again, Con?den?ality of the process is given to the
nurse under
inves?ga?on by the law. If you are the Nurse under inves?ga?on, you dont have to
tell anyone [with few excep?ons] that you are under inves?ga?on-- you do not have
to tell fellow employees, you do not have to tell future employers or even current
employers, that you are under inves?ga?on. It is an
3
1
If I had to choose only one Rule for Nurses to know, it would be Rule 217.11. This
Rule is divided into 4 parts. Part 1 is for all nurses--LVNs, RNs and Advanced Prac?ce
Nurses-- and delineates the Standards of Nursing Prac?ce by which ALL Nurses, no
ma?er their prac?ce site, must abide. It is in
this part of the Rule that the tremendous legal responsibility and accountability is
placed on you to: Know and conform to the Texas
Nursing Prac?ce Act and the board’s rules and regula?ons as well as all federal, state,
or local laws, rules or regula?ons a?ec?ng the nurse’s current area of nursing
prac?ce.
As you sit there today, can you state that you have met this mandate? It is in this part
of the Rule that Documenta?on is demanded and de?ned. It is in this part of the Rule
that the Board makes clear that you can MAKE for OTHERS or ACCEPT for YOURSELF
ONLY those assignments that take into considera?on client safety and that are
commensurate with the educa?onal prepara?on, experience, knowledge, and
physical and emo?onal ability of the Nurse to whom the assignments are made. You
can be
disciplined for making inappropriate
assignments and you can be disciplined for taking inappropriate assignments. I want
you to read, understand and know part 1 of 217.11. It is rich with guidance for the
prac?cing Nurse-- guidance as to what the
Board expects of you. Part 2 of 217.11 has to do with the scope of prac?ce for LVNs
2
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