TX: Jurisprudence and Ethics for Nurses
Texas Board of Nursing (BON) Rules
In the preface to Texas Board of Nursing Rules and Regulations relating to Nurse Education, Licensure and Practice, the Board makes its role and responsibilities clear: The Nursing Practice Act of Texas provides for the creation of a Board of Nursing (Board) empowered with the responsibility and legal authority for ensuring competent practitioners of nursing. The Board fulfills this responsibility by licensing qualified practitioners, controlling the practice of nursing in the interest of society by licensure, by investigation of violations of the Act, by initiating appropriate legal action when necessary, and by establishing minimum standards for educational programs in nursing. Without legal regulation of nursing practices, the public has no assurance that the nurses who provide nursing care as a part of the total healthcare plan are qualified to do so.
It is the responsibility of the Board to establish standards for nursing education in the State of Texas. The Board shall approve such nursing education programs that meet its requirements, and shall deny or withdraw approval from schools of nursing and educational programs which fail to meet the prescribed course of study or other standards. The intent of the approval process is to improve the educational programs and stimulate continuous self-study, evaluation, innovation, and appropriate changes within the programs. The Board provides guidance to nursing programs so that a high quality education for the preparation of practitioners is ensured (BON, 2013a).
- Chapter 211, General Provisions
- Chapter 213, Practice and Procedure
- Chapter 214, Vocational Nursing Education
- Chapter 215, Professional Nursing Education
- Chapter 216, Continuing Competency
- Chapter 217, Licensure, Peer Assistance and Practice
- Chapter 219, Advanced Practice Nurse Education
- Chapter 220, Nurse Licensure Compact
- Chapter 221, Advanced Practice Nurses
- Chapter 222, Advanced Practice Registered Nurses with Prescriptive Authority
- Chapter 223, Fees
- Chapter 224, Delegation Of Nursing Tasks By Registered Professional Nurses to Unlicensed Personnel for Clients with Acute Conditions or in Acute Care Environments
- Chapter 225, RN Delegation to Unlicensed Personnel and Tasks Not Requiring Delegation in Independent Living Environments for Clients with Stable and Predictable Conditions
- Chapter 226, Patient Safety Pilot Programs on Nurse Reporting Systems
- Chapter 227, Pilot Programs for Innovative Applications to Vocational and Professional Nursing Education
- Chapter 228, Pain Management
Rule 217.11* Standards of Nursing Practice
The Texas Board of Nursing is responsible for regulating the practice of nursing within the State of Texas for Vocational Nurses, Registered Nurses, and Registered Nurses with advanced practice authorization. The standards of practice establish a minimum acceptable level of nursing practice in any setting for each level of nursing licensure or advanced practice authorization. Failure to meet these standards may result in action against the nurse’s license even if no actual patient injury resulted.
- Standards Applicable to All Nurses. All vocational nurses, registered nurses and registered nurses with advanced practice authorization shall:
- Know and conform to the Texas Nursing Practice Act and the board’s rules and regulations as well as all federal, state, or local laws, rules or regulations affecting the nurse’s current area of nursing practice;
- Implement measures to promote a safe environment for clients and others;
- Know the rationale for and the effects of medications and treatments and shall correctly administer the same;
- Accurately and completely report and document:
- the client’s status including signs and symptoms;
- nursing care rendered;
- physician, dentist or podiatrist orders;
- administration of medications and treatments;
- client response(s); and
- contacts with other health care team members concerning significant events regarding client’s status;
- Respect the client’s right to privacy by protecting confidential information unless required or allowed by law to disclose the information;
- Promote and participate in education and counseling to a client(s) and, where applicable, the family/significant other(s) based on health needs;
- Obtain instruction and supervision as necessary when implementing nursing procedures or practices;
- Make a reasonable effort to obtain orientation/training for competency when encountering new equipment and technology or unfamiliar care situations;
- Notify the appropriate supervisor when leaving a nursing assignment;
- Know, recognize, and maintain professional boundaries of the nurse-client relationship;
- Comply with mandatory reporting requirements of Texas Occupations Code Chapter 301 (Nursing Practice Act), Subchapter I, which include reporting a nurse:
- who violates the Nursing Practice Act or a board rule and contributed to the death or serious injury of a patient;
- whose conduct causes a person to suspect that the nurse’s practice is impaired by chemical dependency or drug or alcohol abuse;
- whose actions constitute abuse, exploitation, fraud, or a violation of professional boundaries; or
- whose actions indicate that the nurse lacks knowledge, skill, judgment, or conscientiousness to such an extent that the nurse’s continued practice of nursing could reasonably be expected to pose a risk of harm to a patient or another person, regardless of whether the conduct consists of a single incident or a pattern of behavior.
- except for minor incidents (Texas Occupations Code §§301.401(2), 301.419, 22 TAC §217.16), peer review (Texas Occupations Code §§301.403, 303.007, 22 TAC §217.19), or peer assistance if no practice violation (Texas Occupations Code §301.410) as stated in the Nursing Practice Act and Board rules (22 TAC Chapter 217).
- Provide, without discrimination, nursing services regardless of the age, disability, economic status, gender, national origin, race, religion, health problems, or sexual orientation of the client served;
- Institute appropriate nursing interventions that might be required to stabilize a client’s condition and/or prevent complications;
- Clarify any order or treatment regimen that the nurse has reason to believe is inaccurate, non-efficacious or contraindicated by consulting with the appropriate licensed practitioner and notifying the ordering practitioner when the nurse makes the decision not to administer the medication or treatment;
- Implement measures to prevent exposure to infectious pathogens and communicable conditions;
- Collaborate with the client, members of the health care team and, when appropriate, the client’s significant other(s) in the interest of the client’s health care;
- Consult with, utilize, and make referrals to appropriate community agencies and health care resources to provide continuity of care; 106
- Be responsible for one’s own continuing competence in nursing practice and individual professional growth;
- Make assignments to others that take into consideration client safety and that are commensurate with the educational preparation, experience, knowledge, and physical and emotional ability of the person to whom the assignments are made;
- Accept only those nursing assignments that take into consideration client safety and that are commensurate with the nurse’s educational preparation, experience, knowledge, and physical and emotional ability;
- Supervise nursing care provided by others for whom the nurse is professionally responsible; and
- Ensure the verification of current Texas licensure or other Compact State licensure privilege and credentials of personnel for whom the nurse is administratively responsible, when acting in the role of nurse administrator.
- Standards Specific to Vocational Nurses. The licensed vocational nurse practice is a directed scope of nursing practice under the supervision of a registered nurse, advanced practice registered nurse, physician’s assistant, physician, podiatrist, or dentist. Supervision is the process of directing, guiding, and influencing the outcome of an individual’s performance of an activity. The licensed vocational nurse shall assist in the determination of predictable healthcare needs of clients within healthcare settings and:
- Shall utilize a systematic approach to provide individualized, goal-directed nursing care by:
- collecting data and performing focused nursing assessments;
- participating in the planning of nursing care needs for clients;
- participating in the development and modification of the comprehensive nursing care plan for assigned clients;
- implementing appropriate aspects of care within the LVN’s scope of practice; and
- assisting in the evaluation of the client’s responses to nursing interventions and the identification of client needs;
- Shall assign specific tasks, activities and functions to unlicensed personnel commensurate with the educational preparation, experience, knowledge, and physical and emotional ability of the person to whom the assignments are made and shall maintain appropriate supervision of unlicensed personnel.
- May perform other acts that require education and training as prescribed by board rules and policies, commensurate with the licensed vocational nurse’s experience, continuing education, and demonstrated licensed vocational nurse competencies.
- Standards Specific to Registered Nurses. The registered nurse shall assist in the determination of healthcare needs of clients and shall:
- Utilize a systematic approach to provide individualized, goal-directed, nursing care by:
- performing comprehensive nursing assessments regarding the health status of the client;
- making nursing diagnoses that serve as the basis for the strategy of care;
- developing a plan of care based on the assessment and nursing diagnosis;
- implementing nursing care; and
- evaluating the client’s responses to nursing interventions;
- Delegate tasks to unlicensed personnel in compliance with Chapter 224 of this title, relating to clients with acute conditions or in acute are environments, and Chapter 225 of this title, relating to independent living environments for clients with stable and predictable conditions.
- Standards Specific to Registered Nurses with Advanced Practice Authorization. Standards for a specific role and specialty of advanced practice nurse supersede standards for registered nurses where conflict between the standards, if any, exist. In addition to paragraphs (1) and (3) of this subsection, a registered nurse who holds authorization to practice as an advanced practice nurse (APN) shall:
- Practice in an advanced nursing practice role and specialty in accordance with authorization granted under Board Rule Chapter 221 of this title (relating to practicing in an APN role; 22 TAC Chapter 221) and standards set out in that chapter.
- Prescribe medications in accordance with prescriptive authority granted under Board Rule Chapter 222 of this title (relating to APNs prescribing; 22 TAC Chapter 222) and standards set out in that chapter and in compliance with state and federal laws and regulations relating to prescription of dangerous drugs and controlled substances.
*The provisions of this §217.11 adopted to be effective September 28, 2004, 29 TexReg 9192; amended to be effective November 15, 2007, 32 TexReg 8165.
In addition, the Board has adopted position statements and interpretive guidelines that are intended to clarify §217.11 or address specific practice-related issues. These can be found on the Board’s website in the “Nursing Practice” section (BON, 2013a).
Other parts of Rule 217 as well as other rules—eg, Rule 216—Continuing Competency, or Rule 220—Nursing Licensure Compact—apply to all nurses, while some of the rules may apply only to Registered Nurses or Licensed Vocational Nurses or Advanced Practice Nurses, or to nurses working only in specific practice settings or with specific job duties. It is your responsibility to familiarize yourself with all applicable rules and to consult BON Position Statements and other supplementary material whenever necessary. This material can be obtained from the Board of Nursing and on its website.