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Frequently Asked Questions - Nursing Practice

Workplace and Employment — General Information

What is the BON Proposed Nursing Work Hours Position Statement?

BON Proposed Nursing Work Hours Position Statement. The Texas Board of Nursing's (BON) Nursing Practice Advisory Committee (NPAC) initiated an online survey concerning nursing work hours which was conducted on the BON web site. The survey was developed in response to research...Toggle Expand/Collapse Text

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Mandatory Overtime/Consecutive Shifts

Can an employer require a nurse to work longer than scheduled, or to work overtime? How many consecutive hours or shifts can a nurse work?

The Texas Board of Nursing (BON) does not have authority over work-place issues, such as schedules or number of hours worked, either consecutively, in a given time period or "on-call". In 2009, during the 81st Legislative Session, SB 476 made changes to the Nursing Practice Act (NPA) and the Health & Safety Code. SB 476 applies to hospitals and nurses working in hospital settings only....Toggle Expand/Collapse Text

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Staffing Ratios

Is there a law regarding how many patients (nurse: patient ratio) a nurse can be assigned to care for in Texas?

The Texas Board of Nursing (BON) has no authority over workplace or employment issues, such as staffing ratios. The Nursing Practice Act (NPA) and Board Rules and Regulations are written broadly to apply to nursing practice in any setting. In particular, you should familiarize yourself...Toggle Expand/Collapse Text

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Floating to Unfamiliar Practice Settings

I am a Neonatal ICU RN and work at a very large hospital. I have not cared for adults or worked in other clinical practice settings for over 4 years. What are my rights when it comes to floating to different clinical units, adults, pediatric, ER, etc.? The census in my department has been very low for a while and, many times, the extra nurses that are scheduled are floated to the Pediatric units and now, Adult units. I did this once last year and had a really bad experience, and I left fearing for my license. I have heard that I could call Safe Harbor, but many people, including myself, don't know much about it. Please help!

The Nursing Practice Act (NPA) and Board rules are written broadly to apply to nursing practice in any setting. The Board of Nursing (BON) has no authority over workplace policies, such as floating or staffing ratios. Nurses are required to "know and conform" with the NPA and...Toggle Expand/Collapse Text

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When Does a Nurse's Duty to a Patient Begin and End?

Employment versus Licensure

A nurse's duty to his or her patient(s) is a frequent topic of e-mails and phone calls to Board of Nursing (BON) staff. A nurse's duty is not defined by any single event such as clocking in, or taking report. From a BON standpoint, the focus is on the relationship and responsibility of the nurse to the patient(s), not to the nurse's employer or employment....Toggle Expand/Collapse Text

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Safe Harbor Peer Review

What is a Safe Harbor Peer Review?

Request for Peer Review Committee Determination or Safe Harbor applies to all nurses when the nurse believes an assignment may place patients at risk of harm, thus violating the nurse's duty to the patient. Safe Harbor provides a means by which a nurse protects his or her nursing...Toggle Expand/Collapse Text

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A Nurse's Duty Not Limited to Assignment:

All nurses, regardless of practice setting, position, title or role, are required to adhere to the NPA and other statutes, as well as the Board Rules. Two of the main rules that relate to nursing practice are Texas Administrative Code, Rule §217.11 Standards of Nursing Practice,...Toggle Expand/Collapse Text

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List of Tasks a Nurse Can/Cannot Perform

Where can I find a list of tasks that LVNs and/or RNs can or cannot do in the State of Texas?

The Nursing Practice Act (NPA) and Board Rules are written broadly so that they can apply to nursing practice in any setting. As such, the BON does not provide lists of tasks or step-by-step procedures of how they are to be carried out by the nurse. It is up to the individual nurse,...Toggle Expand/Collapse Text

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Nurses Have a Duty to Report Confidential Health Information

Do nurses have a duty to report confidential health information to administrators, law enforcement of to a patient's family?

In January 2013, the U.S. Department of Health and Human Services - Office for Civil Rights issued clarification regarding the Health Insurance Portability and Accountability Act (HIPAA) titled, Message to Our Nation's Health Care Providers. The message can be found at http://www.hhs.gov/ocr/office/lettertonationhcp.pdf....Toggle Expand/Collapse Text

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Nurse Admitted As Patient Under the Influence

I currently work in an ICU. I had an opportunity to care for a patient/nurse (who was a nurse at another facility) who overdosed. She was transferred, when stable, to a treatment center by court order. I was told we cannot report her to the board due to HIPAA. My question is, "How do we plan to handle this type of incident in the future?" "Will there be any specific changes made to address problems like this in the future?" I understand with the renewal of our license we must answer the question of treatment for use of "alcohol or any other drug." But if there is no report of her being in the hospital for treatment, due to HIPAA, it's possible that she may not answer the question truthfully. Can you please help with these questions. I appreciate your time.

Whether a nurse is admitted for an overdose of a substance, or admitted secondary to some type of accident related to being under the influence of any mind-altering substance, the answer would remain the same....Toggle Expand/Collapse Text

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Initiation of CPR - A Nurse's Duty to Initiate

Is current CPR certification a licensure requirement for nurses?

No. The Texas Board of Nursing (Board or BON) does not require CPR for licensure renewal; however, employers may have specific requirements for maintaining current CPR status as a condition of employment. Nurses should use their professional judgment when...Toggle Expand/Collapse Text

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Do all nurses have an obligation to initiate CPR for a client? Does the Texas Board of Nursing have rules that establish a nurse’s duty to initiate CPR?

Yes. All nurses have an obligation or duty to initiate CPR for clients who require resuscitative measures. The decision to initiate CPR can “preserve life, restore health, relieve suffering, limit disability, and respect the individual’s decisions, rights, and privacy.” In all...Toggle Expand/Collapse Text

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What is the role of the licensed vocational nurse (LVN), registered nurse (RN), and advanced practice registered nurse (APRN) in initiating CPR in a witnessed arrest?

In the absence of a do-not-resuscitate/out of hospital do-not-resuscitate order from a physician, all nurses should initiate CPR immediately in a witnessed arrest, regardless of healthcare setting. CPR should continue and the physician should be notified of the client’s change in condition to include current life-saving interventions being provided to the client.

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Does the BON have a position statement that addresses the RN’s role in the management of an unwitnessed cardiac or respiratory arrest in a long-term care facility?

Yes, Position Statement 15.20, Registered Nurses in the Management of an Unwitnessed Arrest in a Resident in a Long-Term Care Facility. The purpose of this position statement is to provide recommendations and guidance to clarify issues for compassionate end-of-life care...Toggle Expand/Collapse Text

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Are nurses expected to perform CPR on clients with obvious clinical signs of irreversible death?

Nurses should know and follow their facility, agency or employer’s policies in advance of establishing a nurse-patient relationship....Toggle Expand/Collapse Text

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Does the Texas Board of Nursing have purview over the pronouncement of death?

No. The Board of Nursing does not have purview over physician practice, employer policies, or the laws regulating the pronouncement of death in Texas. Additional information on Texas regulations regarding pronouncement of death may be found in the Texas Health and Safety Code Chapter 671 and Texas Administrative Code Chapter 193 (22 TAC, §193.9).

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Is there a difference between the decision to initiate CPR and the decision to pronounce death? Can an RN or an APRN pronounce death?

Yes. The decision to initiate CPR for all nurses should be a spontaneous clinical decision and nursing intervention for a client in cardiac or respiratory arrest. Delay in initiating CPR can be critical to the outcome of CPR. CPR should not be delayed to review the client’s medical record...Toggle Expand/Collapse Text

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Can LVNs pronounce death or accept an order to pronounce death in Texas?

No. The Board of Nursing Position Statement 15.2 addresses the Role of The Licensed Vocational Nurse in the Pronouncement of Death. LVNs have a directed scope of practice under the supervision of RNs, APRNs, PAs, Physicians, Dentists, and Podiatrists. LVNs conduct focused...Toggle Expand/Collapse Text

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What additional references are available should be considered when establishing policies and procedures for nursing staff in my facility?

In addition to the current American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, the Board website (www.bon.texas.gov) may provide assistance and serve as a resource in developing policies and procedures to further support safe practice with regard to CPR. The Board recommends employers consider the following references when establishing policies and procedures in the healthcare setting....Toggle Expand/Collapse Text

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GNs, GVNs, and Newly Licensed Nurses Practicing in Home Health Settings

I will be graduating from a vocational nurse training program in a few months, and am beginning to scope out my employment options once I graduate. I am attracted to the area of home health nursing, and I wondered if LVNs can work in home health settings? (Note: The same answer applies to graduates of registered nurse training programs).

First, when you graduate from your vocational training program, you will likely be eligible for a temporary permit to practice as a Graduate Vocational Nurse (GVN). Board Rule §217.3 prohibits GVNs (as well as Graduate Nurses [GNs] who complete registered nurse training) from working in "independent practice settings," which includes home health settings, regardless of if the GN or GVN is under direct supervision....Toggle Expand/Collapse Text

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Practice Recommendations for Newly Licensed Nurses

Does the Board of Nursing (BON) have any recommendations for newly licensed LVNs or RNs as they begin their nursing practice?

The newly licensed nurse is in a transitional process and as a novice practitioner, the new LVN or RN is inexperienced and not fully integrated into his/her nursing role and setting. Based on this belief, the Board provides the following guidance to newly licensed LVNs or RNs:...Toggle Expand/Collapse Text


Regarding Position Statements 15.27, The LVN Scope of Practice and 15.28, The RN Scope of Practice

I am an LVN and read in Position Statements 15.27 and 15.28 that it is the LVN's responsibility to ensure that he or she has an appropriate Clinical Supervisor. Who can be my clinical supervisor?

Each LVN is required to ensure that he or she has the appropriate supervisor prior to accepting an assignment, a position, or employment. The Nursing Practice Act (NPA) Section 301.353...Toggle Expand/Collapse Text

In Position Statements 15.27 and 15.28, I read that LVNs are responsible for providing safe, compassionate, and focused nursing care to assigned patients with predictable health care needs. What does predictable mean in this statement?

The LVN in Texas provides nursing care to patients with health care needs that are predictable in nature, under the direction and supervision of a registered nurse, advanced practice registered nurse, physician, physician assistant, podiatrist, or dentist. The term...Toggle Expand/Collapse Text

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LVNs Performing Initial Assessments

Can an LVN perform an “initial” assessment?

The answer depends on many factors, as with most practice questions. Board Rule 217.11, Standards of Nursing Practice, refers to focused assessments performed by LVNs [Board Rule 217.11(2)(A)] and comprehensive assessments performed by RNs...Toggle Expand/Collapse Text

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LVNs and Nursing Care Plans

Can an LVN initiate/develop the nursing care plan?

Staff recommends you review Board Rule 217.11, Standards of Nursing Practice, as well as Position Statement 15.27, The LVN Scope of Practice. Board Rule 217.11(2)(A)(ii) and (iii) clarifies that LVNs may not initiate care plans; however, they should contribute to the planning and...Toggle Expand/Collapse Text

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LVNs Performing Triage/Telephonic Nursing/Being On-Call

Can LVNs in any practice setting be "on-call" to deal with after-hours issues called in by patients, families, or facility staff? Can an LVN perform "triage" duties (either telephone triage such as for home health or on-site such as an Emergency Room)? Finally, can an RN be on "back-up on-call" in case the LVN has questions? Can the RN be the one ultimately responsible [with the LVN relaying his/her assessment (telephonic or actual assessment)] to the RN?

Triage is commonly defined as the sorting of patients and prioritizing of care based on the degree of urgency and complexity of patient conditions. Telephone triage is the practice of...Toggle Expand/Collapse Text

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LVNs On-Call/Telephone Triage in Independent Living Environments

LVNs and RNs have been disciplined in the past for not making prudent judgments with regard to taking appropriate and timely action to safeguard patients in an independent...Toggle Expand/Collapse Text

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"Medical Screening" in the ER

The question of an LVN performing "triage" in an emergency room (ER) setting also raises another question—is the LVN being asked to perform a "medical screening" examination? This...Toggle Expand/Collapse Text

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Other Practice-Setting Examples (Physician's Office, Call Center)

The Board is aware that LVNs may also practice in "call centers" (such as a poison control center), physician's offices, or other similar settings. In settings where a physician(s) is/are...Toggle Expand/Collapse Text

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Summary

It is not the intent of the Board to preclude LVNs from practicing in settings where the LVN has sufficient guidance/support/supervision to promote both safe LVN practice...Toggle Expand/Collapse Text

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LVNs "Supervision of Practice"

Describe what "supervision of practice" means in relation to an LVN functioning with a directed scope of practice “under the supervision of. . . .”

The LVN’s scope of practice requires that his or her nursing practice be directed by an appropriately licensed supervisor, e.g. registered nurse, advanced practice registered nurse, physician,...Toggle Expand/Collapse Text

Revised August 2013

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Nurse's Role with the Emergency Medical Treatment & Labor Act: Performance of Medical Screening Exams

Background Information:

The Emergency Medical Treatment and Active Labor Act (EMTALA) is a federal law established in 1986 that requires hospitals or other acute care facilities who offer emergency services to provide a medical screening examination to each person presenting to the emergency department....Toggle Expand/Collapse Text

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Can an RN Perform A Medical Screening Exam?

The EMTALA guidelines and frequently asked questions (FAQs) indicate that a facility may credential specific registered nurses and develop bylaws specifying which RN nursing staff is considered to be "qualified medical personnel" and under what circumstances a...Toggle Expand/Collapse Text

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Can an LVN perform a medical screening exam?

The board believes that the performance of a medical screening exam is not within the scope of practice for an LVN, regardless of years of experience or post-licensure continuing nursing education at the LVN level. As defined in §217.11(2)(A) the scope of practice for an LVN is limited...Toggle Expand/Collapse Text

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Is a medical screening exam the same as triage?

No, a medical screening exam is not the same as triage. The differentiation is discussed in depth under the Interpretive Guidelines for Enforcement for 42CFR §489.24 on the EMTALA...Toggle Expand/Collapse Text

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How do the NPA and Rules apply to RNs performing medical screening exams under EMTALA?

The definition of "professional nursing" in Texas Occupation Code §301.002(2) of the Nursing Practice Act (NPA) states that the practice of professional nursing "does not include acts of medical diagnosis or prescription of therapeutic or corrective measures." This means an act must not require the RN to exercise independent medical judgment or medical diagnosis, as this is the practice of medicine, not nursing....Toggle Expand/Collapse Text

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Can an Advanced Practice Registered Nurse Perform A Medical Screening Exam?

Advanced practice registered nurses (APRNs) are RNs who have completed a formalized education program, e.g., Master's or Post-Master's APRN curriculum that enables them to engage in certain aspects of medical diagnosis and medical management within their advanced practice...Toggle Expand/Collapse Text


2009 H1N1 Influenza, Seasonal Influenza, and Pneumococcal Vaccinations

What are the requirements for a nurse to give flu injections?

The laws regarding immunizations are not within the BON's authority. With regard to vaccines of any kind, an Attorney General opinion in 1981 (MW-318) determined that...Toggle Expand/Collapse Text

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Can an RN delegate vaccination administration?

Both the advanced practice registered nurse and the registered nurse delegate in the same manner – through the rules in Chapters 224 and 225. The Delegation Resource Packet contains access to the delegation rules in Chapters 224 and 225 as well as other resources related to delegation....Toggle Expand/Collapse Text

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Does a nurse’s scope of practice change in a pandemic?

A nurse’s scope of practice is related to the nurse’s education, experience, knowledge, and physical and emotional ability. In addition, the practice setting of the nurse influences the...Toggle Expand/Collapse Text

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Can a nurse do a medical screening exam in the ER during a pandemic?

In the definition of nursing, found in the Nursing Practice Act section 301.002, medical diagnosis is excluded from the practice of nursing. If the purpose of a medical screening is...Toggle Expand/Collapse Text

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Is it mandatory for a nurse to receive a flu vaccination (either the seasonal flu vaccination or the 2009 H1N1 influenza vaccination?

Nurses may choose to receive a vaccination to prevent exposing patients to the flu and to protect themselves from possible infection. A person may be contagious prior to...Toggle Expand/Collapse Text


Role of the School Nurse With Unlicensed Diabetes Care Assistants (UDCAs) (HB984)

What is the BON' recommendation?

BON Position Statement 15.13, Role of LVNs and RNs as School Nurses, recommends that the school nurse be an RN, but does not absolutely preclude an LVN with appropriate...Toggle Expand/Collapse Text

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Can an LVN be a school nurse? Can an LVN train Unlicensed Diabetes Care Assistants (UDCAs) or serve in other roles (consultative relationship, administratively responsible)?

As you have already noted, the BON does not preclude LVNs from being employed in school settings; however, the BON has no jurisdiction over employment practices or facility policies. If you primarily utilize one or more LVNs in a specific school or school district, BON Staff recommends you contact the Texas Diabetes Council/Program at www.dshs.state.tx.us/diabetes/ or 512-458-7111.

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Who is responsible for determining which school employees will be trained as Unlicensed Diabetes Care Assistants (UDCAs)?

Neither the training of Unlicensed Diabetes Care Assistants in Texas public schools nor the implementation of HB 984 is within the BON's jurisdiction. According to the...Toggle Expand/Collapse Text

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As the school nurse assigned to one school, must I be responsible for training the Unlicensed Diabetes Care Assistants (UDCAs) in my own school? Can a healthcare provider with expertise in diabetic care be contracted to do all of the training for an individual school or a school district?

This is not within the jurisdiction of the BON to determine. The training guide developed by the Texas Diabetes Council defines who can be a healthcare provider for...Toggle Expand/Collapse Text

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a) As a school nurse assigned to 3 different elementary schools within one district, I rotate between the schools. The principals at my schools assign who will be trained as Unlicensed Diabetes Care Assistants (UDCAs). The principals also assume administrative responsibility for these staff whether they are functioning within their job descriptions or in the "extra" role of UDCA. Working with the principals at all 3 schools, I have coordinated training of all UDCAs through another RN with expertise in all aspects of the care of children with diabetes.

Given my situation (as described), what is my role with the Unlicensed Diabetes Care Assistants (UDCAs) from a BON standpoint?

Based on your description above, you have a "consultative" relationship with the UDCAs at each of your schools.

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b) Since I will have only a consultative relationship with the Unlicensed Diabetes Care Assistants (UDCAs) at each campus, I am concerned about how to provide adequate communication and information to the UDCAs at each school related to the diabetic care needs of each child.

Congruent with the Diabetes Management and Treatment Plan (DMTP) and the Individualized Health Plan (IHP) for each child with diabetes, I have developed information sheets with emergency contact numbers, reportable conditions, and how to intervene in a number of possible emergency situations that could occur with each child. I know that HB984 and school policy mandate that this information be given to any school employee transporting a child or supervising a child during an off-campus activity. My question is—Can I provide this same information to the Unlicensed Diabetes Care Assistants (UDCAs) for students at their respective schools? Is this a violation of HIPAA or FERPA to share this information with the UDCAs?

While you are not responsible for training or assessing ongoing competency of each UDCA in the situation you describe (above), you are responsible to assure the safety of each...Toggle Expand/Collapse Text

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I understand that HB984 (Section 168.008) mandates schools to permit and encourage students' abilities to engage in self-care. However, we have had issues on our campus in the past where used supplies, such as insulin syringes or blood-stained gauze, were not disposed of properly, exposing other children to potentially hazardous bodily fluids/blood that could carry HIV or Hepatitis. One of our school employees felt that HB984 mandated that a child always be permitted to engage in the self-management of diabetes anywhere on the campus, regardless of the health threat posed on other students if a given student isn't capable of disposing of used supplies and cleaning the testing area in a responsible manner.

Must we allow a student who is not capable, either by age, maturity or both, of appropriately maintaining supplies and equipment (not losing his/her glucometer, leaving used supplies where others could be exposed to blood, used sharps, etc) to self-manage?

The Standards of Nursing Practice (Rule 217.11) require all nurses to prevent exposure of clients (students) to infectious pathogens and communicable conditions. The language in...Toggle Expand/Collapse Text

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Does the LVN have to report signs and symptoms or changes in the student's health status to the school nurse (RN)?

First, LVNs are licensed nurses, so do not confuse RN "delegation" to an unlicensed person with an RN who may be supervising assignments being carried out by LVNs. LVNs and RNs are responsible for the assignments that they make or accept, and for complying with the NPA and Rules as outlined in Rule 217.11, Standards of Nursing Practice....Toggle Expand/Collapse Text

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Can the LVN develop the Individualized Health Plan (IHP)?

No. This would be in violation of HB984, Health and Safety Code §168.003 that defines the IHP as a "coordinated plan of care" developed by the principal and the school nurse (RN) in collaboration with the student’s parent/guardian and the student’s physician, if possible. Developing or initiating a student’s IHP would also be beyond the LVN’s scope of practice as defined by the BON in Rule 217.11(2)(A).

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What if the principal refuses to act on a school nurse’s report that the Unlicensed Diabetes Care Assistant (UDCA) is unable or unwilling to carry out applicable duties?

The BON has no jurisdiction over employment issues; however, the nurse should consider reporting up the chain of command, or if necessary, reporting to the Texas Education Agency (TEA), http://www.tea.state.tx.us/. The nurse always has a duty to provide a safe...Toggle Expand/Collapse Text

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Is it within the RN’s scope of practice to train the Unlicensed Diabetes Care Assistant (UDCA)?

Though all RNs receive both knowledge and skills training in care of clients with diabetes across the life span, this does not necessarily mean that every RN is capable of effectively training a UDCA. What is within the scope of practice for one RN may not be within the scope of practice for another. See articles on the BON web page under Scope of Practice for specific guidance on how each RN can determine what is within his/her individual scope of practice.

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If I only train the Unlicensed Diabetes Care Assistant (UDCA), am I responsible if they make a mistake?

No. "Training" is not "delegation."

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How do I know my role(s) in relation to Unlicensed Diabetes Care Assistants (UDCAs)?

Read through the bullet points in the "Quick Cards." If you are still not certain, try collaborating with other school nurses through relationships or through professional nursing organizations such as the Texas School Nurse Organization at http://www.texasschoolnurses.org/.

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How often should the nurse that trained the Unlicensed Diabetes Care Assistants (UDCAs) do a re-check on their knowledge and skills?

This is a school policy question; the BON has no jurisdiction over the UDCAs or school policies.

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Can a nurse train Unlicensed Diabetes Care Assistants (UDCAs), teachers, and other school personnel in the administration of glucagon?

While the BON has no jurisdiction over school district policies, nurses do have the obligation to promote a safe environment for students and staff [Rule 217.11(1) (B)] and to...Toggle Expand/Collapse Text

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Other Resources

Acknowledgments

The BON wishes to thank Anita Wheeler, BSN, RN, Texas School Health Network Administrator and School Nurse Consultant at the Texas Department of State Health Services, and Susan Young, MSN, RN, Nurse Consultant for the Diabetes Program at the Texas Department of State Health Services, for their assistance in the development of this document.


Off Label Use of Ketamine for Pain Management by a Nurse

The mission of the Texas Board of Nursing (BON or Board) 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 Nursing Practice Act or NPA (Texas Occupations Code, Chapter 301) and Board Rules are written broadly so they can be applied by every nurse to all of the many different practice settings and specialty areas in nursing across Texas. The BON does not have a list of tasks that nurses can perform because each nurse has a different background, knowledge and level of competence. Determinations of a nurse's scope of practice are often complex and it is up to the individual nurse to utilize sound professional judgment in accepting any given assignment and/or performing any given procedure.

Ketamine is a schedule three controlled substance1 that has been approved by the U. S. Food and Drug Administration (FDA) as an anesthetic agent2 and has been in use for a relatively long period of time. Ketamine is being used in additional ways for which FDA approval...Toggle Expand/Collapse Text

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Nurses Performing Radiologic Procedures

I am a registered nurse in the State of Texas. I have accepted a job working in an orthopedic surgeon's office where my duties will include performing X-rays. I think there is a rule about RNs doing X-rays but I cannot find it. Do I need to attend a special certification course? Are there different requirements for hospitals, urgent care centers, or other types of practice settings?

BON Rule 217.14, Registered Nurses Performing Radiologic Procedures is the Texas Board Nursing (Board or BON) rule applicable to your question. According to this rule, if a registered nurse (RN) is employed in a practice setting that is not a Medicare-approved provider or...Toggle Expand/Collapse Text

How does BON Rule 217.14 apply to LVNs?

BON Rule 217.14 only addresses the RN. Chapter 601 of the Texas Occupations Code, 25 Texas Administrative Code, Part 1, Chapter 140, Subchapter J, as well as the Nursing Practice Act and Board Rules and Regulations do not address the LVN performing radiological procedures. Therefore, the LVN would be required to become a certified radiologic technologist/technician in order to perform X-rays.

Revised February 2013

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RN Pronouncement of Death

Pronouncement of death articles published in the RN Update

"Legislation Allows RNs to Pronounce Death," in RN Update, February, 1992....Toggle Expand/Collapse Text

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I work in the critical care unit of a hospital. I am aware that there was legislation some time ago that allowed nurses to pronounce death in long-term care and hospice facilities, but the nurses on my unit are being asked to pronounce death. Is this allowed, or am I jeopardizing my license?

During the 1991 Legislative Session, registered nurses were given the legal authority to determine and pronounce a person dead in situations not involving artificial life support, if permitted by written policies of a licensed health care facility, institution, or entity providing services...Toggle Expand/Collapse Text

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BON Rules and Regulations Relating to Telenursing/Telehealth

What are the Texas Board of Nursing (BON) Rules and Regulations Relating to Telenursing/Telehealth?

Telenursing involves nursing practice via electronic means such as telephone, satellite, or computer. Examples of telenursing practice may include teaching, consulting, triaging, advising, or providing direct services, to name but a few....Toggle Expand/Collapse Text

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Using Nursing Titles Applies to Telephonic Nursing Practice

Any title that would lead a member of the public to believe that a person is licensed as a nurse is prohibited from use unless the person indeed holds a valid nursing license either in...Toggle Expand/Collapse Text

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Designated Agent

Nurses can act as a physician's "designated agent" to relay prescriptions to a pharmacy. This law is not within the purview of the BON, but is located in the Pharmacy Act (Tx Occ. Code, Subtitle J, Section 551.003(14) and defines who can be a "designated agent" for a physician. This law...Toggle Expand/Collapse Text

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LVNs and Telephonic Nursing

The documents listed below provide detailed information on how the Texas BON views telephonic nursing in relation to LVN practice. Rule 217.11(2)(A) limits LVN scope with regard to...Toggle Expand/Collapse Text

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LVNs Performing Triage/ Telephonic Nursing /Being On-Call — See:

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Additional Resource Documents

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Texas TERCAP© Pilot Project

What is TERCAP©?

In an effort to promote safe nursing practice, the National Council of State Boards of Nursing (NCSBN), worked with its member boards to initiate the TERCAP© (Taxonomy of Error, Root Cause Analysis and Practice Responsibility) Adverse Error Reporting System. The TERCAP©...Toggle Expand/Collapse Text

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What is the Texas TERCAP© Pilot Project?

In 2011, the 82nd Texas Legislature passed SB 193 allowing the Board to adopt an error classification system, such as the TERCAP©, for utilization by nursing peer review committees....Toggle Expand/Collapse Text

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How can my hospital become a part of the Texas TERCAP© Pilot Project?

A call or invitation has been sent to hospital-based employers to participate in the Texas TERCAP© Pilot whereas they would utilize the TERCAP© instrument for reviewing all nursing peer (example letter). A signed contract is necessary and must be on file with the Texas Board of Nursing in order to participate in the Texas TERCAP© Pilot Project. The contract is located here....Toggle Expand/Collapse Text

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What information from the nursing peer review process will be shared in the Texas TERCAP© Pilot Project?

The NCSBN TERCAP Adverse Error Event Reporting System is currently used as a tool for collecting information about practice breakdown data from disciplinary cases within Boards...Toggle Expand/Collapse Text

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Our hospital is interested in the Texas TERCAP© Pilot Project. We are concerned about the confidentiality of information that may be collected and evaluated as a result of the pilot. What mechanisms are available to ensure our hospital's information is protected?

The information entered and collected in the database will be de-identified and anonymous. Consistent with Section 303.012-(c), the Board of Nursing will maintain confidentiality of information...Toggle Expand/Collapse Text

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How long will the Texas TERCAP© Pilot be conducted?

The Texas TERCAP© Pilot Project will begin in August 2012 and continue through August 2014.

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What if we only want to use the TERCAP© instrument but do not want to participate in the Pilot Project

Hospital employers and nursing peer review committees wishing to utilize the TERCAP© instrument as a template for conducting nursing peer review proceedings must have submitted a completed and signed contract in order to participate in the Texas TERCAP© Pilot Project. The TERCAP© instrument is the property of the National Council of State Boards of Nursing. Therefore, only hospitals participating in the TERCAP© Pilot Project will be able to utilize the TERCAP© instrument for nursing peer review.

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Forensic Evidence Collection

Could the BON require more than just two (2) hours of CNE? (Suggest maybe 2 hours the first year, an additional 2 hours the second year, etc).

Nursing Practice Act (NPA) 301.306 and Rule 216.3(5) - January 2006

Given the multitude of practice settings and procedures nurses may perform, requiring prescriptive training requirements for every task or procedure a nurse may be able to perform would be a never-ending task. Proposed Rule language [22 Texas Administrative Code §216.3(5)]...Toggle Expand/Collapse Text

There is no explanation of "service-approved evidence collection kit and protocol." Is there a standard for an "evidence collection kit"?

The statutes for evidence collection and documentation are contained in laws outside the jurisdiction of the BON. The terminology "service-approved evidence collection kit and protocol" is taken directly from section 420.031 of the Government Code. The statutes in Chapter 420 may be viewed...Toggle Expand/Collapse Text

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The documentation requirements do not list everything that should be documented regarding forensic evidence (such as in a sexual assault case).

The Board has long maintained the position that nursing professional organizations and/or regulatory entities that focus on a specialty area of practice are far better resources for determining appropriate standards of care for a given specialty area of nursing. An extensive list of prescriptive...Toggle Expand/Collapse Text

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Many aspects of forensics exist, and not all are related to sexual assault. The California Board of Nurse Examiners allows their nurses to obtain CEUs related to all types of Forensics. In the Emergency Department, gunshot wounds, motor vehicle accidents, and assaults are classified under forensics. Is the Texas forensic CEU requirement only related to sexual assault evidence collection?

No, proposed Rule 216.3(5) does not limit appropriate CNE to only sexual assault evidence collection. Nursing laws can and do vary from state-to-state. The Texas Legislature passes laws (Texas Occupations Code chapters 301, 303, & 304) that establish the requirements for nursing...Toggle Expand/Collapse Text

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The American Forensic Nurses Association offers an online SANE (Sexual Assault Nurse Examiner) evidence collection course. It is a 4 hour CEU course on Basic Evidence Collection related to what is required when performing sexual assault forensic examinations. Will this meet Texas requirements?

Provided a CNE offering covers the topics listed in the proposed Rule 216.3(5)(D), it should meet Texas requirements for CNE. For specifics on what qualifies as CNE, see Rule 216 in its entirety....Toggle Expand/Collapse Text

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Do we really want someone who "floats" to an Emergency Department (ED) without established/documented duration, frequency, history, competency, etc. collecting this evidence?

The language passed by the Texas Legislature in SB39 states that the forensic continuing nursing education requirement applies to a "license holder who is employed to work in an emergency room..." A review of the bill analysis reveals that the concern of the original bill was that sexual assault victims...Toggle Expand/Collapse Text

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Forensic Evidence Collection CNE

Effective September 1, 2005, the NPA was amended, adding the CNE requirement: Forensic Evidence Collection in Continuing Education. This targeted CNE requirement applies to all nurses practicing in emergency department (ED) settings as either their home unit, floating, contracted,...Toggle Expand/Collapse Text

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Co-signature on Documentation

When a Graduate Nurse(GN) or Graduate Vocational Nurse (GVN) has completed all requirements for the nursing program attended, and has received permission to test for nursing boards, must the preceptor co-sign the nursing assessment, medication administration, and other records for patients assigned to the GN/GVN?

Besides obtaining approval to sit for the NCLEX, a student who has successfully completed a nursing program must also hold a current valid temporary permit from the Board to practice as a GN or GVN in the state of Texas. Assuming the graduate has this, he/she may not practice in an...Toggle Expand/Collapse Text

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Co-signature on LVN Actions/Documentation

Must an RN sign behind or "co-sign" nursing actions performed by an LVN?

In general, BON staff does not recommend a nurse co-sign anything unless he/she has directly witnessed an act ( such as narcotic wastage) or has gone behind another nurse and personally performed the same assessment with the same findings. As discussed above, each...Toggle Expand/Collapse Text

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