Nurses in the State of Texas may interrupt their practice or change their primary area of practice for a variety of reasons. The impact that a change of practice area or lack of continuity in practice may have on the competence of the nurse is of concern to the Texas Board of Nursing, as either situation may affect the nurse's ability to provide safe and effective nursing care that complies with the Nursing Practice Act (NPA) and Board Rules. A nurse who has not practiced and is re-entering the work force after a period of four or more years may not be current in his/her knowledge base of new drugs, current therapies, and/or changes in technology. A nurse who is transitioning into a practice setting that differs greatly from the nurse's previous experience may also lack the necessary knowledge to immediately assume responsibility for patient care. In 1994, a study conducted by the Board and Lamar University identified that nurses who fit into one of the above two categories were at highest risk for committing practice errors that resulted in Board discipline against the nurse's license. The Board, therefore, believes it is essential that during the transitional period, either back into practice or into a new practice area, that the nurse seek and receive appropriate orientation, direction, supervision, consultation and collaboration from nurses who possess current skills and knowledge of the particular practice environment.
Rule 217.11, Standards of Nursing Practice, requires that when assignments are made, both the charge nurse and the staff nurse take into consideration client safety, as well as the educational preparation, knowledge, skills, and physical and emotional abilities of the individual licensed nurse to whom a given assignment is being made.
Applicable standards in Rule 217.11 include (but are not limited to):
(1)(B): Implement measures to promote a safe environment for clients and others;
(1)(G): Obtain instruction and supervision as necessary when implementing nursing procedures or practices;
(1)(H): Make a reasonable effort to obtain orientation/training for competency when encountering new equipment and technology or unfamiliar care situations;
(1)(T): 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.
Guidance for the Nurse:
The Board recommends that a nurse returning to the work force after a period of four or more years or changing his/her primary area of practice consider the following recommendations:
- Direct supervision should be continued for a period mutually determined by the nurse and his/her supervisor/nurse preceptor. Competence to perform safely and independently should be one of the determining factors. Direct supervision means an experienced nurse (minimum 2 years experience) is immediately available on site to coordinate, direct and observe at firsthand another individual for whom the nurse is responsible.
- The nurse should be permitted to perform any function that falls within the scope of nursing practice for which he/she has received educational preparation and has demonstrated minimal competency.
- The nurse who is returning to the work force or transitioning to a new primary practice area should neither act as charge nurse nor hold any similar position for a period of at least six months, unless a lesser time period is agreed upon by the nurse and his/her supervisor based upon documented competency of the nurse.
- Staff nurses should be willing to supervise, collaborate with, and/or mentor nurses returning to work or changing their practice area or role.
Guidance for Employers:
In order to promote a successful transition of the nurse into the new practice setting, it is recommended that the employer:
- Establish policies and procedures for incorporating the transitioning nurse into specific roles and staffing patterns;
- Develop preceptors who are willing to assume the role of direct supervisor and mentor for transitioning nurses;
- Assign a consistent preceptor who is willing to supervise and offer ongoing constructive evaluation of the skills, judgment and knowledge of the transitioning nurse. Alignment with Board Rule 217.11, Standards of Nursing Practice, as well as any practice-specific national nursing care standards is recommended to promote practice that meets at least the minimally safe level required. Length and depth of orientation should be individualized to meet the needs of the transitioning nurse within a reasonable time period established by the employer; and
- Evaluate each nurse on an ongoing basis, (not to exceed six months in accordance with §217.3), in order to determine the competence of the nurse to perform at a minimally safe level commensurate with the nurse's licensure.
The following nurses who have completed a formal educational program that includes a clinical practicum are excluded from these guidelines when entering into advanced practice in their newly-educated and authorized advanced role and specialty:
- Clinical Nurse Specialists;
- Nurse Practitioners;
- Nurse Anesthetists; and
- Nurse Midwives.
The Board provides these guidelines to assist employers and nurses to safely integrate into the current role and functions of licensed vocational or professional nursing as applicable.
- 22 Texas Administrative Code, §217.11
- A.Green et al. (1994). Disciplined Professional Nurses in the State of Texas.
- A.Green et al. (1995). "Are you at risk for disciplinary action?" American Journal of Nursing. 95(7), 37-41.