Texas nurse practice act and scope of practice

Meet the Board

Texas Board of Nursing Rules and Regulations
relating to
Nurse Education, Licensure and Practice

• Forward
• Preface
• Mission Statement / Philosophy
• Table of Contents

Forward

This manual, based on statutory authority as provided for in Chapters 301, 303, and 304 of the Texas Occupations Code Annotated (Nursing Practice Act), has been prepared by the Texas Board of Nursing. It sets forth the rules and regulations established by the Board to regulate nursing education and the practice of nursing in the state. Members of the Board of Nursing have sought input from interested groups and individuals in developing and revising these rules and regulations.

Preface

During the 19 th century, the public became aware of the value of nursing as an indispensable ally of the medical arts and sciences and as an occupation predicated upon formal education. The first nursing laws were enacted in the United States in 1903.

The original Nursing Practice Act of Texas was passed March 28, 1909. The passage of this Act marked a milestone in the health care of the citizens of the State of Texas as nursing was formally recognized as a vital service to society. The purpose of the Act is to provide that the privilege and responsibility of practicing nursing be entrusted only to those persons duly licensed and practicing under the provisions of the Act. The Act 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 health care plan are qualified to do so. The Board meets regularly to execute its responsibilities for administering the law governing nurse practice. Professional and nonprofessional personnel are employed to carry out the provisions of the law, and the policies and regulations established by the Board. Legal counsel is retained by the Board as provided by the law, to represent it in matters pertaining to the implementation of the law.

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. The preparation of a practitioner competent to practice, however, is the responsibility of the school. The services of the Board are available to the faculty of educational programs, to staff of health agencies utilizing nursing services, and to practitioners of nursing as the need may arise.

The Board conducts regularly scheduled meetings which are open to the public. The notice of the meeting including agenda items, and the time and place of the meeting is posted with the Secretary of State’s office approximately two weeks in advance. Special meetings of the Board shall be called by the President acting upon the written request of any two members.

Mission Statement

The mission of the Texas Board of Nursing is to protect and promote the welfare of the people of Texas by ensuring that each person holding a license as a nurse in the State of Texas is competent to practice safely. The Board fulfills its mission through the regulation of the practice of nursing and the approval of nursing education programs. This mission, derived from the Nursing Practice Act, supersedes the interest of any individual, the nursing profession, or any special interest group.

Philosophy

Acting in accordance with the highest standards of ethics, accountability, efficiency, effectiveness, and openness, the Texas Board of Nursing approaches its mission with a deep sense of purpose and responsibility and affirms that the regulation of nursing is a public and private trust. The Board assumes a proactive leadership role in regulating nursing practice and nursing education. The Board serves as a catalyst for developing partnerships and promoting collaboration in addressing regulatory issues. The public and nursing community alike can be assured of a balanced and responsible approach to regulation.

Table of Contents

• FOREWORD
• PREFACE
• MISSION STATEMENT /PHILOSOPHY

General Provisions — §§ 211.1 — 211.11

• §211.1. Introduction
• §211.2. Purpose and Functions
• §211.3. Organization and Structure
• §211.4. Officers
• §211.5. Meetings
• §211.6. Committees of the Board
• §211.7. Executive Director
• §211.8. Conflict of Interest
• §211.9. General Considerations
• §211.10. Training and Education Reimbursement
• §211.11. Employee Leave Pools

Practice and Procedure — §§ 213.1 — 213.37

• §213.1. Definitions
• §213.2. Construction
• §213.3. Pleading
• §213.4. Representation
• §213.5. Appearance
• §213.6. Agreements in Writing
• §213.7. Final Disposition
• §213.8. Filing of Documents
• §213.9. Computation of Time
• §213.10. Notice and Service
• §213.11. Non-SOAH Motion for Continuance
• §213.12. Witness Fees and Expenses
• §213.13. Complaint Investigation and Disposition
• §213.14. Preliminary Notice to Respondent in Disciplinary Matters
• §213.15. Commencement of Disciplinary Proceedings
• §213.16. Respondent's Answer in a Disciplinary Matter
• §213.17. Discovery
• §213.18. Depositions
• §213.19. Subpoenas
• §213.20. Informal Proceedings and Alternate Dispute Resolution (ADR)
• §213.21. Agreed Disposition
• §213.22. Formal Proceedings
• §213.23. Decision of the Board
• §213.24. Rescission of Probation
• §213.25. Monitoring
• §213.26. Reissuance of a License
• §213.27. Good Professional Character
• §213.28. Licensure of Persons with Criminal Offenses
• §213.29. Fitness to Practice
• §213.30. Declaratory Order of Eligibility for Licensure
• §213.31. Cross-reference of Rights and Options Available to Licensees and Petitioners
• §213.32. Corrective Action Proceedings and Schedule of Administrative Fines
• §213.33. Factors Considered for Imposition of Penalties/Sanctions
• Texas Board of Nursing Disciplinary Matrix
• §213.34. Deferred Disciplinary Action Pilot Program
• §213.35. Targeted Assessment and Remediation Pilot Program
• §213.36. Alleged Standard of Care Violations by Advanced Practice Registered Nurses
• §213.37. Disclosure of Expert Reviewer's Report

Vocational Nursing Education — §§ 214 .1 — 214.14

• §214.1. General Requirements
• §214.2. Definitions
• §214.3. Program Development, Expansion and Closure
• §214.4. Approval
• §214.5. Philosophy/Mission and Objectives/Outcomes
• §214.6. Administration and Organization
• §214.7. Faculty
• §214.8. Students
• §214.9. Program of Study
• §214.10. Clinical Learning Experiences
• §214.11. Facilities, Resources, and Services
• §214.12. Records and Reports
• §214.13. Total Program Evaluation
• §214.14. Use of Standardized Examination Prepared by Private Entity

Professional Nursing Education — §§ 215 .1 — 215.14

• §215.1. General Requirements
• §215.2. Definitions
• §215.3. Program Development, Expansion, and Closure
• §215.4. Approval
• §215.5. Philosophy/Mission and Objectives/Outcomes
• §215.6. Administration and Organization
• §215.7. Faculty
• §215.8. Students
• §215.9. Program of Study
• §215.10. Clinical Learning Experiences
• §215.11. Facilities, Resources, and Services
• §215.12. Records and Reports
• §215.13. Total Program Evaluation
• §215.14. Use of Standardized Examination Prepared by Private Entity

Continuing Competency — §§ 216.1 — 216.11

• §216.1. Definitions
• §216.2. Purpose
• §216.3. Continuing Competency Requirements
• §216.4. Criteria for Acceptable Continuing Education Offerings
• §216.5. Additional Methods for Meeting Continuing Competency Requirements
• §216.6. Activities Which are not Acceptable as Continuing Education
• §216.7. Responsibilities of Individual Licensee
• §216.8. Relicensure Process
• §216.9. Audit Process
• §216.10. Appeals
• §216.11. Consequences of Noncompliance

Licensure, Peer Assistance and Practice — §§ 217.1 — 217.24

• §217.1. Definitions
• §217.2. Licensure by Examination for Graduates of Nursing Education Programs Within the United States, its Territories, or Possessions
• §217.3. Temporary Authorization to Practice/Temporary Permit
• §217.4. Requirements for Initial Licensure by Examination for Nurses Who Graduate from Nursing Education Programs Outside of United States' Jurisdictions
• §217.5. Temporary License and Endorsement
• §217.6. Failure to Renew License
• §217.7. Change of Name and/or Address
• §217.9. Inactive and Retired Status
• §217.10. Restrictions to Use of Designations for Licensed Vocational or Registered Nurse
• §217.11. Standards of Nursing Practice
• §217.12. Unprofessional Conduct
• §217.13. Peer Assistance Program
• §217.14. Registered Nurses Performing Radiologic Procedures
• §217.15. Copying the License/Permit/Permanent Certificate of a Licensed Vocational Nurse/ Registered Nurse/ Graduate Nurse/ Advanced Practice Nurse
• §217.16. Minor Incidents
• §217.17. Texas Nursing Jurisprudence Exam
• §217.18. Assisting at Surgery
• §217.19. Incident-Based Nursing Peer Review and Whistleblower Protections
• §217.20. Safe Harbor Nursing Peer Review and Whistleblower Protections
• §217.21. Remedial Education Course Providers and Remedial Education Courses
• §217.22. Special Accommodations
• §217.23. Balance Billing Dispute Resolution
• §217.24. Telemedicine Medical Service Prescriptions

Advanced Practice Nurse Education — §§ 219.1 — 219.13

• §219.1. General Requirements and Purpose
• §219.2. Definitions
• §219.3. Program Development, Closure, and Transfer of Administrative Control
• §219.4. Approval
• §219.5. Mission/Philosophy and Objectives/Outcomes
• §219.6. Administration and Organization
• §219.7. Faculty Qualifications and Faculty Organization
• §219.8. Students
• §219.9. Program of Study
• §219.10. Management of Clinical Learning Experiences and Resources
• §219.11. Facilities, Resources, and Services
• §219.12. Records and Reports
• §219.13. Total Program Evaluation

Nurse Licensure Compact — §§ 220.1 — 220.4

Advanced Practice Nurses — §§ 221.1 — 221.17

• §221.1. Definitions
• §221.2. APRN Titles and Abbreviations
• §221.3. APRN Education Requirements for Licensure
• §221.4. Licensure as an APRN
• §221.5. Acceptable certification examinations
• §221.6. Interim Approval
• §221.7. Petitions for Waiver and Exemptions
• §221.8. APRN Licensure Renewal
• §221.9. Inactive Status
• §221.10. Reactivation or Reinstatement of APRN Licensure
• §221.12. Scope of Practice
• §221.13. Core Standards for Advanced Practice
• §221.14. Nurse-Midwives Providing Controlled Substances
• §221.15. Provision of Anesthesia Services by Nurse Anesthetists in Licensed Hospitals or Ambulatory Surgical Centers
• §221.16. Provision of Anesthesia Services by Nurse Anesthetists in Outpatient Settings
• §221.17. Enforcement

Advanced Practice Registered Nurses with Prescriptive Authority — §§ 222.1 — 222.10

• §222.1. Definitions
• §222.2. Approval for Prescriptive Authority
• §222.3. Renewal of Prescriptive Authority
• §222.4. Minimum Standards for Prescribing or Ordering Drugs and Devices
• §222.5. Prescriptive Authority Agreement
• §222.6. Prescribing at Facility-Based Practices
• §222.7. Authority to Order and Prescribe Non-prescription Drugs, Dangerous Drugs, and Devices
• §222.8. Authority to Order and Prescribe Controlled Substances
• §222.9. Conditions for Obtaining and Distributing Drug Samples
• §222.10. Enforcement

Fees — §§ 223.1 — 223.2

• §223.1. Fees
• §223.2. Charges for Public Records

Delegation of Nursing Tasks by Registered Professional Nurses to Unlicensed Personnel for Clients with Acute Conditions or in Acute Care Environments — §§ 224.1 — 224.11

• §224.1. Application of Chapter
• §224.2. Exclusions from Chapter
• §224.3. Purpose
• §224.4. Definitions
• §224.5. RN Accountability for Delegated Tasks
• §224.6. General Criteria for Delegation
• §224.7. Supervision
• §224.8. Delegation of Tasks
• §224.9. The Medication Aide Permit Holder
• §224.10. Supervising Unlicensed Personnel Performing Tasks Delegated by Other Practitioners
• §224.11. Application of Other Laws and Regulations

RN Delegation to Unlicensed Personnel and Tasks Not Requiring Delegation in Independent Living Environments for Clients with Stable and Predictable Conditions — §§ 225.1 — 225.15

• §225.1. Application of Chapter
• §225.2. Exclusions from Chapter
• §225.3. Purpose
• §225.4. Definitions
• §225.5. RN Accountability
• §225.6. RN Assessment of the Client
• §225.7. Activities of Daily Living Not Requiring Delegation
• §225.8. Health Maintenance Activities Not Requiring Delegation
• §225.9. Delegation Criteria
• §225.10. Tasks That May Be Delegated
• §225.11. Delegation of Administration of Medications From Pill Reminder Container
• §225.12. Delegation of Insulin or Other Injectable Medications Prescribed in the Treatment of Diabetes Mellitus
• §225.13. Tasks Prohibited From Delegation
• §225.14. Supervising Unlicensed Personnel Performing Tasks Delegated by Other Practitione
• §225.15. Application of Other Laws and Regulations

Patient Safety Pilot Programs on Nurse Reporting Systems — §§ 226.1 — 226.7

• §226.1. Patient Safety Pilot Programs on Nurse Reporting Systems
• §226.2. Initiation of Application and Approval of Patient Safety Pilot Programs
• §226.3. General Selection Criteria
• §226.4. Limited Exception to Mandatory Reporting Requirements
• §226.5. Application and Review Process
• §226.6. Monitoring and Evaluating Patient Safety Pilot Programs
• §226.7. Contract Discussions

Pilot Programs for Innovative Applications to Vocational and Professional Nursing Education — §§ 227.1 — 227.4

• §227.1. Purpose
• §227.2. Application and Approval
• §227.3. General Selection Criteria
• §227.4. Monitoring and Evaluation

Pain Management— §§ 228.1— 228.2

• §228.1. Standards of Practice
• §228.2. Prescription Monitoring Program (PMP)

Updates on Prescribing Controlled Substances --> -->

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