Texas Nursing Jurisprudence

and Documentation

for School Nurses

Copyright 2009, 2018 Taralynn R. Mackay

All Rights Reserved

The author/speaker has provided the material contained within as information regarding current laws, regulations, and issues affecting health care. Obviously, this

material cannot address all laws and regulations that may impact all aspects of health care and please note that such laws and regulations are constantly changing.

This material should not be used as a substitute for legal counseling and should not be considered as legal advice or a legal opinion. This material is not intended to

take the place of legal or professional advice or services and a reader should obtain independent legal advice before undertaking any activity that may be within the

scope of any law or regulation discussed in these materials.

Lawyer At Work

• Disclaimer

The opinions expressed are mine.

My opinions may not reflect those of McDonald,

Mackay. Porter & Weitz, LLP

My opinions may not reflect those of

the sponsor of this talk

I am very honest and brutal with the truth

Taralynn R. Mackay, RN, JD

McDonald, Mackay, Porter & Weitz, LLP Austin, Texas

mailing address:PO Box 1137Elgin, TX 78621

512-281-5999512-281-9559 fax

www.nursingattorney.com

Navigating the Board

Nurse Practice Act

Rules and Regulations

Position Statements and

Guidelines

The Nursing BoardNurse’s responsibility

– How many CUE hours the nurse has,

when to renew

– Address Changes/Name Changes –

inform the BON within 30 days

– Must know the Nurse Practice Act and

Board Rules

– Must be familiar with the Board

statements and guidelines

– The Board has help (flow charts) for

determining scope of practice and for

delegation

Nursing Complaints by Year

6673

8812

10485

13365

16890

15823

16631

19363

14595

13837

16308

15420

0 5000 10000 15000 20000 25000

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017

Number of Disciplinary Orders

0 1000 2000 3000 4000 5000

2009

2010

2011

2012

2013

2014

2015

2016

2017

Number of SOAH Hearings Filed

0 100 200 300 400 500

2010

2011

2012

2013

2014

2015

2016

2017

2018

**These numbers are based on records kept in Electronic Case

Filings at the State Office of Administrative Hearings

Nursing Board Investigation Myths

– Only bad nurses get reported

– I will lose my license

– The Board is out to get me

– The Board will understand my side We were UNDERSTAFFED at the time

I was SICK that day

I am a NEW NURSE

– I cannot admit I was wrong

– The student was not harmed so nothing will happen

– If I ignore the Board nothing will happen

– I need to wait for the Board to tell me what to do

– There is a Statute of Limitation for the Board

Implications on the License

• Restrictions on Nursing

• Public Knowledge

• Employment

• Databank

• Other state licenses

• Background License Reporting companies

Criminal Offenses

BIG CHANGE in 2017: Now not

everything affects your nursing license

Medication Errors

Never, Never, Never,

EVER

FAIL TO PERFORM THE 5/6/7* RIGHTS OF

MEDICATION ADMINISTRATION

*whichever your P&P states

DANGER-Medication Issues Impacting School Nurses

• Do Not borrow from one student to give to another

• Do Not use meds left over from previous year

• Do not administer meds without physician order and written parental consent

• Make sure ordered meds are not expired (do medication inventory)

• Document medication administration immediately, DO NOT WAIT

Failure to Document the Care

Means

Failure to Provide the Care

AND if you did not provide the care,

you are negligent and in violation of

the NPA

School Documentation Basics• IHP – for students with health conditions that require

ongoing health services during school day. – Only an RN can develop, but others can give info in

formulating the IHP. – Should be reviewed and updated annually.

• ECP-must have if student has a condition that could potentially result in emergency

• When documenting consider who may see the record under FERPA and document only what is required and in the appropriate location

• Document in the EMR and not in handwritten notes• Document timely or risk falling behind

Confidentiality Basics• Watch out for innocent confidentiality breaches• Student health records should have locked access• When giving out ANY info consider if you have proper

releases/consents• There MUST be a legitimate educational interest for other school

staff to look at student health records– Can only review some of the student’s health info – School staff, other than the nurse, accessing health info must log in

with their name, title, date and what their legitimate interest is in seeing the health info

• FERPA- you CANNOT release “personally identifiable student information” without prior written consent (parent, guardian, or student who is at least 18 and not a dependent according to Income tax purposes)

• HIPAA compliant form: Should have parents sign an annual permission form to share medical information

Social Media

• Do Not post anything that involves students or work

• Even if the posting does not identify a particular student, Do Not Post (the Board has no tolerance for Social Media posting)

Boundary Violations

• Schools are more susceptible to breaches of confidentiality and boundary violations

• Inappropriate relationships– Dating

– Friendship

– A family member is also off limits

• For Interactions, ask whose needs are being met to determine possible boundary crossing?

• Gifts, Loans

Malpractice Lawsuits and Board InvestigationsDifferences between Administrative & Civil Law

Administrative

• Nursing Board

• Affects your license

• Investigation, Complaint, Regulatory

• Administrative Law Attorney with experience before nursing boards

Civil

• Court

• Affects your money

• Malpractice, Negligence

• Malpractice Defense Attorney

Malpractice Insurance

• It is recommended that all nurses who have any contact with patients have malpractice insurance

• The main reason is the number of complaints against nurses is high and most insurance covers professional license defense (check to be sure).

• There are many myths that keep nurses from getting insurance but they are just myths

Peer Review

• New rules in 2018, now requires PR if the school employs 8 or more nurses (instead of 10 with prior statue)

• Incident based PR (§217.19)

• Minor Incidents

• Safe Harbor PR (§217.20)– Must be filed prior to proceeding with nursing act

– Must be in writing

– The actual form is not required but the minimum info must be present

– Can do quick request initially but more details must be provided before leaving work

Impairment

• TPAPN-Texas Peer Assistance Program for Nurses

• For nurses with mental illness, addiction or substance abuse issues

• It is better to self-report to TPAPN than have a Board Order

• Note the change in the question on renewal form for mental illnesses—asks if the illness has impaired the nurse’s work or school