Nursing Practice Act, Nursing Peer Review Act, & Nurse Licensure Compact

Texas Occupations Code and Rules Regulating the Practice of Nursing
Effective September, 2011

Agency Mission

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 this state is competent to practice safely. The Board fulfills its mission through the regulation of the practice of nursing and the approval of nursing educational programs. This mission, derived from the Nursing Practice Act, supersedes the interest of any individual, the nursing profession, or any special interest group.

Notice

The 81st Regular Session of the Texas Legislature passed four bills which amend the Nursing Practice Act (NPA).

House Bill (HB) 3961 enacts new requirements for physical and psychological evaluations related to fitness to practice and requires confidentiality of information collected for emergency relief work and certain health information provided for licensure. HB 3961 also authorizes a study by the Nursing Resource Center, at the Texas Department of State Health Services, evaluating competencies of clinical judgements and behaviors that professional nurses should possess at graduation of professional nursing programs.

House Bill 4353 allows the Board to issue a special license to a person already licensed to practice nursing in Mexico. The license will allow the person to practice nursing in a Texas hospital located in a county that borders Mexico. The person must have received a score of at least 475 on a Test of English as a Foreign Language (TOEFL) examination and a passing score on the English language version of the National Council Licensure Examination (NCLEX). The nurse must achieve a passing score of 560 on the TOEFL exam within a year of receiving the special license to continue practicing nursing in Texas. The provisions of HB 4353 expire September 1, 2013.

Senate Bill (SB) 476 amends the Nursing Practice Act by adding new Section 301.356 relating to Refusal of Mandatory Overtime. Following passage of SB 476, nurses working in a hospital may refuse to work mandatory overtime and refusing to work overtime “does not constitute patient abandonment.” SB 476 also amends the Texas Health and Safety Code by adding Chapters 257 and 258, which requires the governing body of a hospital to adopt, implement, and enforce a written official nurse services staffing policy that ensures that an adequate number and skill mix of nurses are available to meet the level of patient care needed. SB 476 also requires hospitals to establish nurse staffing committees as standing committees of the hospital. These committees must meet at least on a quarterly basis. The nurse staffing committee is required to develop and recommend a nurse staffing plan to the hospital’s governing body. The requirements for committee membership are specific and require the various types of nursing services provided by the hospital to be adequately represented on the committee. The Chief Nursing Officer (CNO) is a voting member of the committee and 60% of the committee must be RNs who spend at least 50% of their work time in direct patient care. RNs serving on the committee must be elected by their peers who provide direct patient care at least 50% of their work time. Committees are to meet during working hours and nurses are to be relieved of other duties in order to attend the meetings. Nurse staffing plans should be used as a component of the nurse staffing budget and nurses are encouraged to provide input to the nurse staffing committee without fearing retaliation from their employer.

Senate Bill 1415, which amends the Nursing Practice Act, requires the Board to study the feasibility of implementing a pilot program regarding the deferral of final disciplinary action no later than February 1, 2010. The pilot program would only apply to sanctions other than reprimand, denial, suspension or revocation of licensure for violations of the Nursing Practice Act.

Introduction

Welcome to the practice of nursing in the State of Texas. As you continue to practice as a nurse in Texas, it is your responsibility to be aware of changes to the law and the Board’s rules and regulations. Changes are reported in the Board’s quarterly newsletter mailed to all nurses licensed in Texas as well as posted on the BON web site. To assist you in being aware of these changes, the Board offers the following information and detailed table of contents.

Chapter 301 of the Texas Occupations Code (TOC) contains the Nursing Practice Act (NPA) which creates the BON and defines its responsibility for regulating nursing education, licensure and practice. Chapter 303 relates to Nursing Peer Review and Chapter 304 relates to the Nurse Licensure Compact. Chapter 305 introduces the Advanced Practice Registered Nurse Compact which will be implemented at a later date. These chapters of the TOC define nursing practice and give the Board the authority to make rules which implement and interpret the NPA. Licensees are required to comply with the NPA and the Board’s rules. The NPA and the Rules are amended from time to time. Only the Legislature can change the NPA, so statutory changes only occur every two years. The Board makes rule changes as needed to assist in the application of the NPA to evolving practice conditions and settings. It is necessary, therefore, that you keep up with the changes. You may obtain copies of this pamphlet at a nominal cost by writing to the Board’s office at 333 Guadalupe, Ste. 3-460, Austin, Texas 78701; calling 512/305-7400; or accessing our web page at www.bon.state.tx.us.

Any person practicing or offering to practice nursing in this state is required to have a license. Your license must be renewed every two years in order to continue practicing in Texas. Once licensed, you are authorized to use the title “RN” or “LVN” and are required to wear a name tag identifying yourself as a “RN” or “LVN” while providing patient care.

You must keep the Board informed of your current address at all times. To inform the Board of your address change or a name change, send written notice, clearly marked “change of address” or “name change” to the Board’s office within ten (10) days of the occurrence. Failure to do so can result in a lapse of your license and potential disciplinary action.

Nurses practicing in this state are expected to know and practice in compliance with chapters 301, 303, 304 and 305 of the TOC and with the Board’s Rules. Please refer to the following “Quick Reference” section, as well as the rules and excerpts printed in the back of this booklet. A complete set of the Board’s Rules and Regulations Relating to Nurse Education, Licensure and Practice can be found at our web site or purchased from the Board office.

Quick Reference

Sections of the Act:

Chapter 301 - Nurses

• Sec. 301.002(2) & (5).......... Definitions of Nursing.
• Sec. 301.004......................... Exceptions to the Nursing Practice Act.
• Sec. 301.161......................... Enforcement: BON authority to establish criminal investigations unit to investigate suspected criminal acts.
• Sec. 301.2511....................... Criminal History Record Information for License Applicants: Requirement to provide criminal history record as prerequisite for licensure.
• Sec. 301.262......................... Special License: Lower TOEFL scores accepted for Mexican nurses working in border counties.
• Sec. 301.301........................ Renewal: Procedure to renew your license every two years.
• Sec. 301.303........................ Continuing Competency: Describes the required types and number of hours of CE to keep your license current.
• Sec. 301.306........................ Forensic Evidence Collection Component in Continuing Education: Continuing education requirement relating to Forensic Evidence Collection.
• Sec. 301.351........................ Designations: Requirement to wear an insignia identifying yourself as a RN or LVN.
• Sec. 301.353........................ Nurse First Assistants: Describes requirements for recognition as “nurse first assistant.”
• Sec. 301.356........................ Refusal of Mandatory Overtime.
• Secs. 301.401-.402.............. Nurse Reporting: Duty to report colleagues who may expose others to risk of harm.
• Sec. 301.601........................ Anesthesia in Outpatient Setting.
• Sec. 303.003........................ Committee Membership: Requirements for peer review committee membership.
• Secs. 304.001-.010.............. Nurse Licensure Compact: Issuance and limitations of multistate licensure privilege for Texas nurses.

Discipline

• Sec. 301.452........................ Grounds for Disciplinary Action: Describes violations for which the Board should take action.
• Sec. 301.4521...................... Physical and Psychological Evaluation.
• Sec. 301.453........................ Disciplinary Authority of Board; Methods of Discipline.
• Sec. 301.4535...................... Required Suspension, Revocation, or Refusal of License for Certain Offenses: Describes bars and restrictions to nurse licensure due to certain criminal offenses.
• Sec. 301.455........................ Temporary License Suspension or Restriction.
• Sec. 301.4551...................... Temporary License Suspension for Drug or Alcohol Use.
• Sec. 301.458........................ Formal Charges; Discovery.
• Sec. 301.466........................ Confidentiality.
• Sec. 301.467........................ Reinstatement.
• Sec. 301.469........................ Notice of Final Action.
• Secs. 301.651-.57................ Corrective Action Proceedings: Imposition of corrective actions including fines, remedial education, or both.

Chapter 303 - Peer Review

• Sec. 303.001........................ Definition.
• Sec. 303.005........................ Request for Peer Review Committee Determination: Describes Safe Harbor Provisions.
• Sec. 303.006........................ Confidential Proceedings.
• Sec. 303.007........................ Disclosure of Information.
• Sec. 303.010........................ Immunity/Protection from Liability.

Chapter 304...................... Nurse Licensure Compact.

Chapter 305...................... Advanced Practice Registered Nurse Licensure Compact.

Six-Step Decision-Making Model for Determining Nursing Scope of Practice (Document) pdf
Six-Step Decision-Making Model for Determining Nursing Scope of Practice (Poster) pdf
This model is designed to assist the nurse in determining whether a particular activity is within the scope of nurse's practice.

TABLE OF CONTENTS

SUBTITLE E. REGULATION OF NURSING

CHAPTER 301. NURSES

SUBCHAPTER A. GENERAL PROVISIONS

• Sec. 301.001. SHORT TITLE
• Sec. 301.002. DEFINITIONS
• Sec. 301.003. APPLICATION OF SUNSET ACT
• Sec. 301.004. APPLICATION OF CHAPTER
• Sec. 301.005. REFERENCE IN OTHER LAW

SUBCHAPTER B. TEXAS BOARD OF NURSING

• Sec. 301.051. BOARD MEMBERSHIP
• Sec. 301.052. MEMBER ELIGIBILITY
• Sec. 301.053. MEMBERSHIP AND EMPLOYEE RESTRICTIONS
• Sec. 301.054. TERMS
• Sec. 301.055. GROUNDS FOR REMOVAL
• Sec. 301.056. PER DIEM; REIMBURSEMENT
• Sec. 301.057. OFFICERS
• Sec. 301.058. MEETINGS
• Sec. 301.059. TRAINING

SUBCHAPTER C. EXECUTIVE DIRECTOR

• Sec. 301.101. EXECUTIVE DIRECTOR
• Sec. 301.102. [REPEALED]
• Sec. 301.103. PUBLIC RECORDS; REGISTRY
• Sec. 301.104. PERSONNEL; EMPLOYMENT PRACTICE
• Sec. 301.105. DIVISION OF RESPONSIBILITIES
• Sec. 301.106. QUALIFICATIONS AND STANDARDS OF CONDUCT INFORMATION
• Sec. 301.107. CAREER LADDER PROGRAM; PERFORMANCE EVALUATIONS
• Sec. 301.108. EQUAL EMPLOYMENT OPPORTUNITY POLICY; REPORT

SUBCHAPTER D. GENERAL POWERS AND DUTIES OF BOARD

• Sec. 301.151. GENERAL RULEMAKING AUTHORITY
• Sec. 301.152. RULES REGARDING SPECIALIZED TRAINING
• Sec. 301.153. RULES REGARDING ADVERTISING AND COMPETITIVE BIDDING
• Sec. 301.154. RULES REGARDING DELEGATION OF CERTAIN MEDICAL ACTS
• Sec. 301.1545. RULES ON CONSEQUENCES OF CRIMINAL CONVICTION OR DEFERRED ADJUDICATION
• Sec. 301.155. FEES
• Sec. 301.156. GIFTS AND GRANTS
• Sec. 301.157. PROGRAMS OF STUDY AND APPROVAL
• Sec. 301.158. DISSEMINATION OF INFORMATION
• Sec. 301.1581. INFORMATION PROVIDED TO LICENSE HOLDERS
• Sec. 301.1582. POISON CONTROL CENTER INFORMATION
• Sec. 301.159. BOARD DUTIES REGARDING COMPLAINTS
• Sec. 301.1595. ADVISORY COMMITTEES
• Sec. 301.160. PILOT PROGRAMS
• Sec. 301.1605. PILOT PROGRAMS FOR INNOVATIVE APPLICATIONS
• Sec. 301.1606. PILOT PROGRAMS ON NURSE REPORTING SYSTEMS
• Sec. 301.161. ENFORCEMENT
• Sec. 301.1615. OBTAINING CRIMINAL HISTORY RECORD INFORMATION; HEARING
• Sec. 301.162. LEGAL COUNSEL
• Sec. 301.163. RECORD OF PROCEEDINGS; REPORT
• Sec. 301.164. ASSISTANCE OF PROSECUTOR
• Sec. 301.165. ANNUAL REPORT
• Sec. 301.166. USE OF TECHNOLOGY
• Sec. 301.167. NEGOTIATED RULEMAKING; ALTERNATIVE DISPUTE RESOLUTION

SUBCHAPTER E. PUBLIC INTEREST INFORMATION AND COMPLAINT PROCEDURES

• Sec. 301.201. PUBLIC INTEREST INFORMATION
• Sec. 301.202. COMPLAINTS
• Sec. 301.203. RECORDS AND ANALYSIS OF COMPLAINTS
• Sec. 301.204. GENERAL RULES, POLICIES, AND PROCEDURES REGARDING COMPLAINT INVESTIGATION AND DISPOSITION
• Sec. 301.205. PUBLIC PARTICIPATION
• Sec. 301.206. CONFIDENTIALITY OF INFORMATION COLLECTED FOR EMERGENCY RELIEF PROGRAMS
• Sec. 301.207. CONFIDENTIALITY OF INFORMATION PROVIDED FOR LICENSURE

SUBCHAPTER F. LICENSE REQUIREMENTS

• Sec. 301.251. LICENSE REQUIRED
• Sec. 301.2511. CRIMINAL HISTORY RECORD INFORMATION FOR LICENSE APPLICANTS
• Sec. 301.252. LICENSE APPLICATION
• Sec. 301.253. EXAMINATION
• Sec. 301.254. EXAMINATION RESULTS
• Sec. 301.255. REEXAMINATION
• Sec. 301.256. ISSUANCE OF LICENSE
• Sec. 301.257. DECLARATORY ORDER OF LICENSE ELIGIBILITY
• Sec. 301.258. TEMPORARY PERMIT
• Sec. 301.259. RECIPROCAL LICENSE BY ENDORSEMENT FOR CERTAIN FOREIGN APPLICANTS
• Sec. 301.260. TEMPORARY LICENSE BY ENDORSEMENT
• Sec. 301.261. INACTIVE STATUS
• Sec. 301.262. SPECIAL LICENSE

SUBCHAPTER G. LICENSE RENEWAL

• Sec. 301.301. LICENSE RENEWAL
• Sec. 301.3011. CRIMINAL HISTORY RECORD INFORMATION REQUIREMENT FOR RENEWAL
• Sec. 301.302. RENEWAL OF EXPIRED LICENSE BY OUT-OF-STATE PRACTITIONER
• Sec. 301.303. CONTINUING COMPETENCY
• Sec. 301.304. CONTINUING EDUCATION IN TICK-BORNE DISEASES
• Sec. 301.305. BIOTERRORISM RESPONSE COMPONENT IN CONTINUING EDUCATION [EXPIRED]
• Sec. 301.306. FORENSIC EVIDENCE COLLECTION COMPONENT IN CONTINUING EDUCATION

SUBCHAPTER H. PRACTICE BY LICENSE HOLDER

• Sec. 301.351. DESIGNATIONS
• Sec. 301.352. PROTECTION FOR REFUSAL TO ENGAGE IN CERTAIN CONDUCT
• Sec. 301.353. SUPERVISION OF VOCATIONAL NURSE
• Sec. 301.354. NURSE FIRST ASSISTANTS; ASSISTING AT SURGERY BY OTHER NURSES
• Sec. 301.355. POLICIES APPLICABLE TO NURSES EMPLOYED BY MEDICAL AND DENTAL UNITS
• Sec. 301.356. REFUSAL OF MANDATORY OVERTIME

SUBCHAPTER I. REPORTING VIOLATIONS AND PATIENT CARE CONCERNS

• Sec. 301.401. DEFINITIONS
• Sec. 301.4011. GOOD FAITH REPORT BY NURSE
• Sec. 301.402. MANDATORY REPORT BY NURSE
• Sec. 301.4025. OPTIONAL REPORT BY NURSE
• Sec. 301.403. DUTY OF PEER REVIEW COMMITTEE TO REPORT
• Sec. 301.404. DUTY OF NURSING EDUCATIONAL PROGRAM TO REPORT
• Sec. 301.405. DUTY OF PERSON EMPLOYING NURSE TO REPORT
• Sec. 301.406. DUTY OF CERTAIN PROFESSIONAL ASSOCIATIONS AND ORGANIZATIONS TO REPORT
• Sec. 301.407. DUTY OF STATE AGENCY TO REPORT
• Sec. 301.408. DUTY OF LIABILITY INSURER TO REPORT
• Sec. 301.409. DUTY OF PROSECUTING ATTORNEY TO REPORT
• Sec. 301.410. REPORT REGARDING IMPAIRMENT BY CHEMICAL DEPENDENCY, MENTAL ILLNESS, OR DIMINISHED MENTAL CAPACITY
• Sec. 301.4105. BOARD RESPONSIBILITY FOLLOWING REPORT
• Sec. 301.4106. PEER ASSISTANCE PROGRAMS
• Sec. 301.411. EFFECT OF FAILURE TO REPORT
• Sec. 301.412. REPORTING IMMUNITY
• Sec. 301.413. RETALIATORY ACTION
• Sec. 301.414. NOTICE AND REVIEW OF REPORT
• Sec. 301.415. REBUTTAL STATEMENT
• Sec. 301.416. INVESTIGATION
• Sec. 301.417. CONFIDENTIALITY REQUIREMENTS; DISCLOSURE OF INFORMATION
• Sec. 301.418. DISCLOSURE OF CHARGES OR DISCIPLINARY ACTION
• Sec. 301.419. GENERAL PROVISIONS REGARDING DUTY TO REPORT; MINOR INCIDENTS

SUBCHAPTER J. PROHIBITED PRACTICES AND DISCIPLINARY ACTIONS

• Sec. 301.451. CERTAIN PROHIBITED PRACTICES
• Sec. 301.4515. USE OF CERTAIN NURSING TITLES
• Sec. 301.452. GROUNDS FOR DISCIPLINARY ACTION
• Sec. 301.4521. PHYSICAL AND PSYCHOLOGICAL EVALUATION
• Sec. 301.453. DISCIPLINARY AUTHORITY OF BOARD; METHODS OF DISCIPLINE
• Sec. 301.4531. SCHEDULE OF SANCTIONS
• Sec. 301.4535. REQUIRED SUSPENSION, REVOCATION, OR REFUSAL OF LICENSE FOR CERTAIN OFFENSES
• Sec. 301.454. NOTICE AND HEARING
• Sec. 301.455. TEMPORARY LICENSE SUSPENSION OR RESTRICTION
• Sec. 301.4551. TEMPORARY LICENSE SUSPENSION FOR DRUG OR ALCOHOL USE
• Sec. 301.456. EVIDENCE
• Sec. 301.457. COMPLAINT AND INVESTIGATION
• Sec. 301.458. INITIATION OF FORMAL CHARGES; DISCOVERY
• Sec. 301.459. FORMAL HEARING
• Sec. 301.460. ACCESS TO INFORMATION
• Sec. 301.461. ASSESSMENT OF COSTS
• Sec. 301.462. VOLUNTARY SURRENDER OF LICENSE
• Sec. 301.463. AGREED DISPOSITION
• Sec. 301.464. INFORMAL PROCEEDINGS
• Sec. 301.465. SUBPOENAS; REQUEST FOR INFORMATION
• Sec. 301.466. CONFIDENTIALITY
• Sec. 301.467. REINSTATEMENT
• Sec. 301.468. PROBATION
• Sec. 301.469. NOTICE OF FINAL ACTION
• Sec. 301.470. REFUND
• Sec. 301.471. EMERGENCY CEASE AND DESIST ORDER

SUBCHAPTER K. ADMINISTRATIVE PENALTY

• Sec. 301.501. IMPOSITION OF PENALTY
• Sec. 301.502. AMOUNT OF PENALTY
• Sec. 301.503. REPORT AND NOTICE OF VIOLATION AND PENALTY
• Sec. 301.504. PENALTY TO BE PAID OR HEARING REQUESTED
• Sec. 301.505. HEARING
• Sec. 301.506. DECISION BY BOARD
• Sec. 301.507. OPTIONS FOLLOWING DECISION: PAY OR APPEAL
• Sec. 301.508. COLLECTION OF PENALTY
• Sec. 301.509. DETERMINATION BY COURT
• Sec. 301.510. REMITTANCE OF PENALTY AND INTEREST
• Sec. 301.511. ADMINISTRATIVE PROCEDURE

SUBCHAPTER L. OTHER PENALTIES AND ENFORCEMENT PROVISIONS

• Sec. 301.551. INJUNCTION
• Sec. 301.552. MONITORING OF LICENSE HOLDER
• Sec. 301.553. CIVIL PENALTY
• Sec. 301.554. CRIMINAL PENALTY
• Sec. 301.555. APPEAL

SUBCHAPTER M. ANESTHESIA IN OUTPATIENT SETTING

• Sec. 301.601. DEFINITION
• Sec. 301.602. RULES
• Sec. 301.603. APPLICABILITY
• Sec. 301.604. REGISTRATION REQUIRED
• Sec. 301.605. COMPLIANCE WITH RULES
• Sec. 301.606. INSPECTIONS
• Sec. 301.607. REQUESTS FOR INSPECTION AND ADVISORY OPINION

SUBCHAPTER N. CORRECTIVE ACTION PROCEEDING

• Sec. 301.651. DEFINITION
• Sec. 301.652. IMPOSITION OF CORRECTIVE ACTION
• Sec. 301.653. REPORT AND NOTICE OF VIOLATION AND CORRECTIVE ACTION
• Sec. 301.654. RESPONSE
• Sec. 301.655. ACTION FOLLOWING RESPONSE
• Sec. 301.656. REPORT TO BOARD
• Sec. 301.657. EFFECT ON ACCEPTANCE OF CORRECTIVE ACTION

CHAPTER 303. NURSING PEER REVIEW

• Sec. 303.001. DEFINITIONS
• Sec. 303.0015. REQUIRED ESTABLISHMENT OF NURSING PEER REVIEW COMMITTEE
• Sec. 303.002. GENERAL PROVISIONS REGARDING PEER REVIEW
• Sec. 303.003. COMMITTEE MEMBERSHIP
• Sec. 303.004. PEER REVIEW BY TWO ENTITIES
• Sec. 303.005. REQUEST FOR PEER REVIEW COMMITTEE DETERMINATION
• Sec. 303.006. CONFIDENTIALITY OF PEER REVIEW PROCEEDINGS
• Sec. 303.007. DISCLOSURE OF INFORMATION
• Sec. 303.0075. SHARING OF INFORMATION
• Sec. 303.008. REBUTTAL STATEMENT
• Sec. 303.009. RETALIATORY ACTIONS
• Sec. 303.010. CIVIL LIABILITY
• Sec. 303.011. EVALUATION BY COMMITTEE
• Sec. 303.012. ERROR CLASSIFICATION SYSTEM

CHAPTER 304. NURSE LICENSURE COMPACT

• Sec. 304.001. NURSE LICENSURE COMPACT
• Art. 1 Findings and Declaration of Purpose
• Art. 2 Definitions
• Art. 3 General Provisions and Jurisdiction
• Art. 4 Application for License in a Party State
• Art. 5 Adverse Actions
• Art. 6 Additional Authorities of Party State Nurse Licensing Board
• Art. 7 Coordinated Licensure Information System
• Art. 8 Compact Administration and Exchange of Information
• Art. 9 Immunity
• Art. 10 Effective Date, Withdrawal, and Amendment
• Art. 11 Construction and Severability
• Sec. 304.002. ADMINISTRATION OF COMPACT
• Sec. 304.003. RULES
• Sec. 304.004. GENERAL PROVISIONS
• Sec. 304.005. ENFORCEMENT
• Sec. 304.006. INFORMATION MAINTAINED UNDER COMPACT
• Sec. 304.007. ACCESS TO PRACTICE-RELATED INFORMATION
• Sec. 304.008. DISCLOSURE OF PERSONAL INFORMATION
• Sec. 304.009. WITHDRAWAL FROM COMPACT

CHAPTER 305. NCSBN ADVANCED PRACTICE REGISTERED NURSE COMPACT

[Expired December 31, 2011]