Journal- Legal Overview and Peer Review Process
Journal- Legal Overview and Peer Review Process
Reflective Journal Module 2: Legal Overview and Peer Review Process: Identify 3 key points from this module. Reflect
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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-‐profit think-‐tank that exists to study and influence 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 didn’t 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 doesn’t 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 system’s 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 significant risk of harm, then you must report that fellow Nurse. It isn’t 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 defini�on of what MUST be reported has changed over the years, since 1987. For example, you don’t 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 Confiden�ality. This right belongs to the nurse and can be broken, without poten�al legal consequences in only a few specific instances. A person can be sued in a civil court of law for breach of confiden�ality. Again, Confiden�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 don’t 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-‐LVN’s, RN’s 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 affec�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 defined. 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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