I’ve been teaching Board of Nursing (BON) stipulation/remedial courses for several years. It is rewarding and I love seeing nurses reactions to information that will help them become or remain safe, knowledgeable  practitioners.

I begin each class by asking the nurse what they hope to get out of the day’s class. I make it clear that getting the certificate at the end of the day  is not a sufficient response. It sometimes leads to very interesting discussions. Responses range from I don’t know to stating they want a clearer understanding of the reason they ‘got in trouble with the BON.’

Select Responses

During the discussion some responses indicate that a jurisprudence, ethics, or legal issues course was not taught in their nursing program. Some admit that such a course was taught but they did not recognize the significance of it.

Some state they should not be in the class because nothing was done to the other person – usually referring to another discipline; or that nothing happened to the patient. Some nurses even say that it had nothing to do with patient care. The Board of nursing is accountable and responsible for nurses practice in the state. When other disciplines are indicated in the reportable incident, the board of nursing must know their boundaries. They have no authority for members of other disciplines. 

Nurses often state that they believed their employer would protect them if they did as they are told. 

I didn’t know – nobody told me is another common response. 

Some feel that the board does not care about nurses and they just rubber-stamp whatever is presented to them.

The Challenge

The challenge I face is to provide appropriate and sufficient information so the nurse will leave the class with a better understanding of nursing jurisprudence and ethics and the role and responsibility of the individual nurse for their practice. It is also important for the nurse to understand protection of their license is his or her responsibility.

During the class it becomes necessary to refer the nurse to the NPA and to board rules and regulations. For many they have no idea how these documents apply to them or their practice. Using these documents along with position statements and other relevant documents sheds light on the nurse’s obligation and responsibility to protect their license.

Often nurses are surprised to learn that all the information needed to protect their license is available to them on the BON website and in the quarterly newsletter. They state they are surprised to learn that the BON holds them responsible for knowing the laws, rules and regulations, and changes pertaining to their area of practice. 

Impact of Board Orders

Even though most have taken the online course “Understanding the Requirements of Board Orders”, they still do not appreciate the full effect of Board stipulations or have an understanding of the impact of the Board order on their license and practice. It becomes a challenge to help them gain some understanding. During the course, we utilize many of the Board’s  documents and resources to clarify and provide examples. It also lends some insight into the process of decision-making by the Board.

Other key messages to take away include: 

1. The BON’s mission is to protect and promote the welfare of the public. So nurses need to get rid of the notion that the BON is their for their protection. The BON is responsible for interpreting the law, which is the Texas Nursing Practice Act. They do this by writing rules and regulations. In addition to the rules the board understands that not all issues of concern to the nurse as it relates to protection of the public is codified in the law. For this reason the board writes position statements so nurses will understand the board’s position on these subjects. 
2. There are other laws pertinent to nursing besides the Nursing Practice Act that impact the nurse and her/his practice. They are the Nurse Peer Review Law which addresses both incident based peer review process and the safe harbor peer review process. 
3. The e-enhanced Nurse Compact Licensure Law lays the foundation and the process for nurses holding a license in a compact state but wishes to seek employment in other states. The important point here is that the Compact license is voluntary and not every state has joined. It is therefore imperative that the nurse know the member states and fully understand the circumstances of  employment in the selected state. There is information on the Board website as well as a link to the National Council of State Boards of Nursing’s website for more information.

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Dierdre D. Rockeymoore APRNCNS, PMHCNS-BC, CLC is a certified advanced practice registered nurse who is also certified as a life coach. As the primary nurse planner and president of Ames Heigh, LLC, she develops and presents continuing professional development education courses as an approved provider. She is approved by the Texas Board of Nursing to teach stipulation and remedial courses. Dierdre has many years of experience as a clinician, nurse therapist, life coach focusing on life-balance issues, manager, and leader in nursing. She sits on boards and contributes to her community. She lives in San Antonio, Texas and holds membership in multiple professional, community, and civic organizations.