Licensed Certified Registered Nurse Anesthetists (CRNAs) are essential for healthcare in Texas. More than 4,200 licensed CRNAs in the state are the “sole anesthesia providers for over three million of Texas' rural population in 66 counties.” They also provide more than half the anesthesia in the state. CRNAs are valued in the medical community and Texas at large, and we give them a great deal of trust. As a CRNA, you've also invested many years in education, professional training, and building a practice. An allegation of misconduct to the Texas Board of Nursing can jeopardize all that. If you're facing an investigation or a disciplinary matter, you need the Professional License Defense Team from the Lento Law Firm to protect your rights and career. Call 888.535.3686 or contact us online to schedule a consultation as soon as possible.
Licensing for CRNAs in Texas
There are more than 4,200 licensed CRNAs in Texas. The Board of Nursing is responsible for licensing registered nurses and CRNAs, establishing and enforcing professional standards, and the Texas Nursing Practice Act for all nurses in the profession. Applicants for CRNA licensing in Texas must first be licensed registered nurses. To become a registered nurse in Texas, you must:
- Apply to take the NCLEX-RN,
- Submit a $75 application fee,
- Pass a criminal background check,
- Get a passing score on the nursing jurisprudence exam, and
- Submit an affidavit verifying your graduation from an accredited nursing program.
You will need a Bachelor of Science or an associate degree in nursing to sit for the NCLEX.
CRNAs in Texas are licensed as Advanced Practice Registered Nurses (APRNs). There are four categories of APRNs in Texas: clinical nurse specialists, nurse anesthetists, nurse midwives, and nurse practitioners. To obtain an APRN in Texas, you must have a graduate-level degree in nursing, either a master's or doctorate. You must also:
- Obtain certification through the American Association of Nurse Anesthetists Council on Certification,
- Graduate from an approved anesthesia education program,
- Complete the certification exam, and
- Comply with all continuing education requirements for recertification every two years.
There are five nurse anesthetist programs in Texas, including:
- Armey Center Program for Anesthesia Nursing,
- Baylor College of Medicine, Graduate Program in Nurse Anesthesia,
- Texas Christian University School of Nurse Anesthesia,
- Texas Wesleyan University, Graduate School of Nurse Anesthesia, and
- Cizik School of Nursing at the University of Texas Health Science Center Houston
It takes seven to eight years of clinical hours and coursework for a student nurse anesthetist to complete a master's or doctoral degree in nurse anesthesia. CRNA students must complete clinical hours before entering a graduate program.
Professional Standards for CRNAs in Texas
All nurses in Texas must comply with the Standards of Nursing Practice set by the Texas Board of Nursing. Texas's nursing standards “establish a minimum acceptable level of nursing practice for any setting for each level of nursing licensure or advanced practice authorization.” If you fail to meet these standards, even if no patient is harmed, you could face disciplinary action against your license.
In Texas, all RNs and CRNAs can face disciplinary action for:
- Unsafe practice,
- Unlawful practice,
- Failure of a chief administrative nurse to follow standards, guidelines, and regulations in oversight and services,
- Exceeding your scope of practice,
- Conduct that can endanger a patient's life, health, or safety,
- Inability to practice safely because of illness, alcohol, drugs, or a mental or physical condition,
- Misconduct,
- Failure to pay child support payments,
- Diverting drugs or attempting to do so,
- Dismissal from a peer assistance program for noncompliance,
- Other drug-related conduct, including using controlled substances or alcohol while on duty and a positive drug screen, and
- Leaving a nursing assignment without notifying the appropriate person.
Misconduct that can result in Texas disciplinary actions for CRNAs include:
- Falsifying reports, client documents, and agency records,
- Failing to cooperate with a BON investigation,
- Causing or allowing emotional, physical, or verbal abuse or injury to a patient or the public,
- Failing to report abuse or injury to an employer or the licensing board,
- Violating professional boundaries, including having a “physical, sexual, emotional or financial exploitation” of a patient or their significant other,
- Engaging in a physical relationship with a patient, including touching a patient in a sexual manner or offering sexual favors,
- Violent or threatening behavior at work,
- Taking anything of value from a patient, employer, or anyone else when related to the practice of nursing,
- Providing false information “in connection with the practice of nursing,”
- Providing false, misleading, or incomplete answers in a licensing or employment matter, or
- Offering, soliciting, or giving a referral fee to a third party for client referrals.
Under the Texas Administrative Code, the BON may decide not to act for a “minor incident” or error. A minor incident is “conduct by a nurse that may be a violation of the Texas Nursing Practice Act or a Board rule but does not indicate the nurse's continued practice poses a risk of harm to a patient or another person.”
You can also face disciplinary action for criminal convictions, whether related to your profession or not. You must report the following to the Texas BON:
- “Any felony conviction,
- Misdemeanor convictions, except Class C misdemeanor traffic tickets,
- A DWI conviction,
- Any no-contest, nolo contendere, or guilty plea,
- Court-ordered confinements, including any prison or jail sentence,
- Court-order probation or supervision,
- Any deferred adjudication,
- Any criminal charges or citations, or
- A court-martial or military judgment or punishment.
- Failure to do so can result in suspension or revocation of your nursing license.”
The Disciplinary Process for CRNAs in Texas
The Texas Board of Nursing (BON) receives more than 16,000 complaints about nurses each year. Many of these complaints are outside the board's jurisdiction or don't contain enough information to identify a nurse. But when a complaint is legitimate and within the board's purview, it will proceed through the investigative process.
- CRNA Investigations in Texas When the BON receives a complaint, it will notify you of the allegations against you and the investigation unless informing you would jeopardize it. You will be able to respond and show how you complied with the Nursing Practice Act (NPA). During the investigation, the BON investigator may contact the complainant and interview with your colleagues, supervisor, and other witnesses. They may also ask you to provide written responses to questions about the allegations or potential evidence. Most of the investigation may happen in writing or via mail, but the BON investigator may also make in-person visits or phone calls. After gathering all the relevant evidence, the investigating team will determine whether you have violated the Nursing Practice Act. If not, they may close the case. Sometimes, they automatically expunge the complaint and evidence from your file after a mandatory waiting period. Investigations typically take five to 12 months, depending on the case's complexity. The board will update you and the complainant periodically about the status of the investigation. Many nurses facing investigation are convinced they can clear up a misunderstanding by simply explaining the context or circumstances to an investigator. This may be true in some cases. However, it's essential to remember that any information you give them may be used against you later in a disciplinary proceeding. That's why you should contact the Professional License Defense Team at the Lento Law Firm as soon as possible after you hear about a complaint or investigation against you with the BON.
- Informal Licensing Settlements in Texas After the investigation, the team will complete a written report with their “investigative findings, conclusions of law, sanction, and stipulated requirements necessary to ensure” that it is safe for you to practice. If the investigation team determines there was a violation of the NPA and a sanction is needed to protect the public, they will issue an order including the sanction and any limitations placed on your license. If you agree with the proposed order, you will sign it before a notary and return it to the BON. The BON will then review and ratify the order at its next monthly meeting. They may decide to reject or modify an order as well. If you disagree with the proposed order, you can submit your suggested revisions to the BON. If the board accepts them, they will send a revised order. In some cases, the BON may invite you to a settlement conference at the board's offices in Austin, Texas. The conference is an informal process conducted by the executive director with the director of enforcement, a board attorney, the investigator, and additional BON staff. During the conference, you'll discuss the allegations against you, the evidence, any possible violations of the NPA, and proposed settlements. After the conference, the panel will inform you of their recommended decision before issuing an order.
- Formal Licensing Settlements If the informal settlement process fails or the board doesn't hear from you during the investigation process, they will formally charge you. When you receive formal charges, you must file answers in writing. If you don't respond, the board will move to enter a default judgment against you and possibly revoke your license.
- Formal Hearings for CRNAs in Texas Once you answer formal charges with your lawyer, a public disciplinary hearing before an administrative law judge (ALJ) will be scheduled. The BON will present its evidence at the hearing, and you can present your defense. Each party can call witnesses and issue subpoenas. After the hearing, the ALJ will submit a proposed decision with findings of fact and conclusions of law. The BON then reviews the proposal, imposes the appropriate penalty, or closes the case. If you disagree with the decision, you can request a rehearing with the BON within 25 days of the final decision. Even after the board files formal charges against you, it's possible to continue negotiating an agreed settlement. If you and the board come to an agreement before your formal hearing, the parties will cancel the public hearing. However, having an experienced Lento Law Firm Professional License Defense Team is essential to ensuring your case has the best possible resolution.
Appealing a CRNA License Disciplinary Action in Texas
Under Texas's Administrative Procedure Act, you can appeal any final decision of an agency after you've exhausted all your administrative remedies. That means you can still appeal a Board of Nursing decision after a formal hearing before an administrative law judge once the BON has overruled your request for a rehearing.
You must file your appeal in the District Court within 30 days of the BON's final decision. While the court cannot review your case de novo, it can reverse or remand the BON order if there isn't “substantial evidence” supporting the decision. “Substantial evidence” means there was enough evidence present that a reasonable person could reach the same decision. However, the court must rely solely on the record created in the BON hearing and the ALJ's decision. The court won't typically accept new evidence. You may have a good chance on appeal if the BON's order contradicts the factual findings of the ALJ. If the court overturns the BON's order, it can remand the decision to the BON for future action. The court can also issue a temporary injunction preventing the BON's order from going into effect during your appeal process.
You Need a Skilled License Defense Team
If you're facing a Board of Nursing license investigation, hearing, or appeal, the consequences can affect your entire professional career. If you don't mount an aggressive defense, you could face public censure, license suspension, or lose your license to practice as a CRNA or a registered nurse. That's why you need the experienced Professional License Defense Team standing up for you during the BON disciplinary process. The Lento Law Firm can help you mount an effective defense, negotiate with the BON, and protect your rights during the entire process. Call 888.535.3686 or contact us online to schedule your consultation and find out how we can help.
