At the July 18, 2025 meeting the Texas Board of Nursing's Assistant Director of Enforcement, Danielle Green, gave a detailed, informational presentation on how complaints are handled from intake through final disposition.

Green said the agency is complaint‑driven and that as of the meeting date the enforcement division had received 15,293 complaints in the fiscal year to date. Complaints come from external reporters (employers, patients and family members, required reporters) and internal eligibility checks (licensure disclosures, criminal background checks). Intake requires a written complaint and the board encourages use of its online complaints portal; submissions by mail, fax or email are also accepted.

Green described the investigatory steps: initial review to determine whether the complaint alleges conduct within the Nurse Practice Act (Texas Occupations Code Chapter 301) and whether there is sufficient information to initiate an investigation; issuance of notice to the respondent unless notice would jeopardize the investigation; subpoenas for records; witness interviews; and, where appropriate, expert review or evaluations (for example, chemical dependency evaluations). Tony (a staff investigator who participated in the presentation) gave a law‑enforcement example in which investigators do not give pre‑notice when advance notice would allow a subject to destroy evidence or close operations (the example described a 'pill mill' scenario involving coordinated illicit prescribing).

Green said the enforcement division has five investigative teams comprising 30 investigators: six eligibility staff, nine nurse investigators, 15 criminal justice investigators and five supervisors. She also said the agency was granted seven additional FTEs and that the division plans to add another team this fall.

Green reviewed outcomes and monitoring: during the previous fiscal year 1,496 licenses were sanctioned; the vast majority (she said, more than 99% by category) of licensees do not have current discipline. Common post‑investigation actions include agreed orders presented for board ratification, remedial education, monitoring through the Board's compliance unit (drug screens, employer forms, check‑ins), and — if parties do not agree to a proposed order — filing formal charges and, if necessary, administrative hearings at the State Office of Administrative Hearings (SOAH). Green stressed that investigations rely on evidence and that a complaint alone does not establish a violation.

The presentation also explained that certain investigative steps are confidential; formal charges and hearings are public and will be reflected on a nurse's licensure record. Green and staff answered board members' questions about complaint sufficiency, evidence gathering, agency cooperation with outside audits and employer investigations, and how the office handles potentially retaliatory or false complaints.