(a) The board or any person may initiate a proceeding under this subchapter by filing with the board a complaint against a nurse. The complaint must be in writing and signed by the complainant.
(b) Except as otherwise provided by this section, the board or a person authorized by the board shall conduct each investigation. Each complaint against a nurse that requires a determination of nursing competency shall be reviewed by a board member, consultant, or employee with a nursing background the board considers sufficient.

(b-1) The board by rule shall provide for the appointment by the board of advanced practice registered nurses to act as expert reviewers and assist with complaints and investigations relating to alleged standard of care violations by advanced practice registered nurses.
(c) On the filing of a complaint, the board:
(1) may conduct a preliminary investigation into the identity of the nurse named or described in the complaint;
(2) shall make a timely and appropriate preliminary investigation of the complaint; and
(3) may issue a warning or reprimand to the nurse.
(d) After any preliminary investigation to determine the identity of the subject of the complaint, unless it would jeopardize an investigation, the board shall notify the nurse that a complaint has been filed and the nature of the complaint. If the investigation reveals probable cause to take further disciplinary action, the board shall either attempt an informal disposition of the complaint or file a formal charge against the nurse stating the provision of this chapter or board rule that is alleged to have been violated and a brief description of each act or omission that constitutes the violation.
(e) The board shall conduct an investigation of the complaint to determine:
(1) whether the nurse’s continued practice of nursing poses a risk of harm to clients or other persons; and
(2) whether probable cause exists that a nurse committed an act listed in § 301.452(b) or that violates other law.
(f) In making a determination under Subsection (e), the board shall review the evidence to determine the extent to which a deficiency in care by the registered nurse was the result of deficiencies in the registered nurse’s judgment, knowledge, training, or skill rather than other factors beyond the nurse’s control. A determination that a deficiency in care is attributable to a registered nurse must be based on the extent to which the registered nurse’s conduct was the result of a deficiency in the registered nurse’s judgment, knowledge, training, or skill.
(g) If the board determines after investigating a complaint under Subsection (e) that there is reason to believe that a nurse’s deficiency in care was the result of a factor beyond the nurse’s control, the board shall report that determination to the patient safety committee at the facility where the nurse’s deficiency in care occurred, or if the facility does not have a patient safety committee, to the chief nursing officer.
(h) Except as provided by Subsection (i), if the board determines under Subsection (e) that an act by an advanced practice registered nurse falls below an acceptable standard of care, the board shall refer the complaint for review by an expert reviewer appointed under Subsection (b-1) who practices in the same advanced practice role and population focus as the nurse who is the subject of the complaint.
(i) The board may not refer a complaint against an advanced practice registered nurse to an expert reviewer under Subsection (h) if the act alleged in the complaint is:
(1) within the scope of practice applicable to a nurse who is not an advanced practice registered nurse; or
(2) considered unprofessional conduct.