N3375 Health Policy & Legal AspectsModule 3: Reflection Assignment – Peer Review
Submit by 2359 (CT) Saturday of Module 3.
Name:
Date:
Overview: Peer Review
In the Module 3 Reflection Assignment, you will reflect upon what you have learned about the
Minor Incident Rule and Peer Review Committee processes as you consider the actions of
fictitious nurses and committee members in scenarios. REMEMBER, YOU ARE USING THE
TEXAS BOARD OF NURSING RULES, NOT THE STATE YOU LIVE IN. Please use the link
provided in the assignment for the Texas BON Rule 217.16.
Refer to your course readings and lectures as you complete the assignment.
Performance Objectives:
• Differentiate between the the Minor Incident Rule (217.16 a) vs. a Reportable Incident
(217.16 h)
• Describe the due process protections (Rule 217.19) for a nurse who is peer-reviewed.
Rubric
Task
Accomplished
Proficient
Part 1
Applying Rule 217.16 Minor vs.
Reportable Incident
Correct conclusion with
4 professionally written
sentences
demonstrating critical
thinking (35 points)
Correct conclusion with
2 professionally written
sentences
demonstrating critical
thinking (25 points)
35 points
Correct conclusion with
3 professionally written
sentences
demonstrating critical
thinking (30 points)
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Needs Improvement
Incorrect conclusion OR 1
sentence (15 points)
Does not answer question
(0 points)
N3375 Health Policy & Legal Aspects
Part 2
Applying IBPR Rule 217.19 a (2)
Bad Faith
35 points
Response includes 4
professionally written
sentences
demonstrating critical
thinking (35 points)
Response includes 2
professionally written
sentences
demonstrating critical
thinking (25 points)
Response includes 3
professionally written
sentences
demonstrating critical
thinking (30 points)
Part 3
Multiple Choice questions
4 correct answers (20
points)
10 points
Does not answer question
(0 points)
3 correct answers (15
points)
1 correct answer (5 points)
0 correct answers (0 points)
2 correct answers (10
points)
20 points
Professional Writing
1 sentence (15 points)
Assignment is written
clearly without any
grammatical or spelling
errors.
(10 points)
Assignment contains 13 grammatical or
spelling errors.
Assignment contains 4 or greater
grammatical or spelling errors.
(0 points)
(5 points)
Part 1: Applying Rule 217.16
Let’s review what deems a Minor Incident (217.16 a) vs. a Reportable incident- (217.16 h)A minor incident is- 217.16(a)- nurses’ actions may be a violation of a board rule, but does not
indicate the nurses continued practice poses a risk of harm to a patient or another person.
A reportable incident is- 217.16(h)- conduct that falls outside of the definition of a minor
incident and must be reported to a PRC or BON.
Let’s come up with an easy way to remember what is a minor incident- in case you are ever in
this situation, whether this happens to you or you are participating on a peer review committee
evaluating a fellow nurse’s actions. Think about the word “harp.”
•
•
•
•
H- no significant Harm
A- nurse must take Accountability
R- easily Remediated
P- no Pattern of this behavior
However, these minor incidents still must be documented, tracked and remedied. The nurse must
be reported to the nursing peer review committee if a nurse commits five (5) minor incidents
within a 12-month period.
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N3375 Health Policy & Legal Aspects
Look at this case study scenario below.
“Nurse Karen is caring for a newly admitted 67-year-old male patient with infectious
endocarditis due to a bacterial infection of his prosthetic heart valve. After blood cultures come
back positive for staphylococcus aureus, IV Vancomycin is ordered. He tells Nurse Karen and
the doctor that the last time he got this medication, he experienced hives and hot, itchy skin but
he was not allergic to it. The doctor ordered the medication to be infused slowly as to avoid Red
Man Syndrome (500 mg IV bag at a rate of two hours as opposed to the standard one
hour). Karen sets the IV pump incorrectly, and the infusion is given within a 30-minute
period. She calls the doctor and immediately gives 50 mg diphenhydramine and ranitidine 50
mg via IV with orders. The patient experienced mild flushing, but the episode resolved within 20
minutes. Karen is a well-seasoned nurse with over 20 years of experience and no prior history
of incidents. She took immediate responsibility for this error when meeting with the unit
manager. Karen will now need another RN to witness and sign when she administers IV
medication for the next 60 days. Karen agrees to this plan.”
Using the Texas BON Rule 217.16, review (a) a Minor Incident vs. (h) a reportable incident.
This information can be found at
https://www.bon.texas.gov/rr_current/217-16.asp.html.
Based on your assessment of the criteria, was this a Minor Incident or reportable event? Why or
Why not? Please write four (4) professionally written sentences with examples from the Rule to
support your thoughts for full credit.
Minor or Reportable?
Why? Or Why not? Include examples from the Rule.
Part 2: Applying Rule 217.19 Incident-Based Peer Review
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N3375 Health Policy & Legal Aspects
First, review your learning about incident-based peer review. The purpose of an IBPR is to
determine whether a nurse should be reported to the Texas Board of Nursing (BON) for
professional misconduct or licensure violations based on one or more such events.
Please use the link provided at https://www.bon.texas.gov/rr_current/217-19.asp.html
to review. Apply the information to this case study”Nurse Sam is charting at the nurse’s station where there are co-workers, physicians and a unit
secretary gathered. Sam and the nurse manager have not been seeing eye to eye lately (verbal
altercations both in the halls and in the cafeteria recently). The nurse manager approaches Sam
and loudly states, “I am glad you are here. Just to let you know, the Incident Based Peer Review
Committee is meeting tomorrow, and we are investigating your recent questionable behavior. I
know you have made many recent medication errors and safety violations noted by the Patient
Safety Committee. I also heard you are dating that patient who was in Room 256B last month. I
thought you would want to know this was happening, you could be in big trouble and probably
fired. I don’t have anything official to give you, but you better find a lawyer, although I doubt
you can with this short notice.”
How did this nurse manager violate the IBPR? Refer to the Rule listed below and
discuss in the text box.
Rule 217.19 a (2) Bad Faith- knowingly or recklessly acting without the supported of
reasonable or legal basis, misrepresenting the facts surrounding the facts under review, acting out
of malice or personal animosity towards the nurse, acting from a conflict of interest, or
knowingly or recklessly denying due process. How did this nurse manager violate the IBPR
based on this rule? Please write four (4) professionally written sentences with examples from the
Rule to support your thoughts for full credit.
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Part 3: Multiple Choice Questions
Answer the following multiple-choice questions according to the Module 3 readings and
lectures. They are worth 5 points each, there is only 1 correct answer.
1). According to Clevette and colleagues, examples of unsafe, common disciplinary actions
reviewed by boards of nursing include all of the following EXCEPTa). Destruction or alteration of patient records, including fraudulent charting and/or signatures
and/or replacement of records with intent to mislead or deceive.
b). Physical patient abuse, such as when a nurse hits, strikes, or performs similar physical acts of
aggression involving patient contact.
c). Practicing beyond the authorized scope, such as administering medications without a
physician’s order.
d). Failure to implement safeguards to ensure patient confidentiality and integrity of patients
protected health information, violating HIPPA.
2). Rule 217.19 in Texas, Incident Based Nursing Peer Review and Whistleblower Protections
provides to the nurse being peer reviewed EXCEPTa). Minimum protection
b). Minimum due process
c). Minimum legal representation
d). Minimum rights afforded to nurse
3). If a nurse does not agree to the discipline set due to a complaint made against this nurse, after
reviewing the proposed agreed order, they can request aa). Informal conference
b). Formal conference
c). Informal hearing
d). Formal hearing
4). Common nursing remedial education courses required if a nurse is being disciplined area). medication refresher, ethics, geriatric care, nursing jurisprudence, care coordination.
b). ethics course, care coordination, documentation, medication refresher.
c). physical assessment refresher, critical thinking, documentation, medication refresher, geriatric
care.
d). nursing jurisprudence, documentation, ethics, medication refresher, physical assessment
refresher and critical thinking.
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N3375 Health Policy & Legal Aspects
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