Question: Our civilian hospital has entered into an agreement to train various military personnel in our facility, i.e.: Navy Corpsmen, Airmen, etc. While military personnel are allowed to administer oral, subcutaneous, and intramuscular medications, insert intravenous catheters and administer IV fluids in their job descriptions when they are caring for military personnel on military installations or in combat situations, are we allowed to train them in these tasks in our hospital during their clinical rotations?
Answer: The Texas Board of Nursing (BON) values the service of our military personnel and honors their commitment to our Nation. In the interest of fulfilling its mission to protect the health, safety, and welfare of the people of Texas through the regulation of nurses, the Board of Nursing (BON), through the Nursing Practice Act (NPA) and Board Rules, emphasizes the nurse’s responsibility and duty to the patient to provide safe, effective nursing care.
When considering this question regarding the civilian nurse’s role in training or supervising military personnel in civilian hospitals, the Board Rules in Chapter 224, Delegation of Nursing Tasks by Registered Professional Nurses to Unlicensed Personnel for Clients with Acute Conditions or in Acute Care Environments, will guide RNs as to their responsibilities and nursing actions. Military personnel, i.e.: Navy Corpsmen, Airmen, etc, are considered Unlicensed Assistive Personnel (UAPs); therefore, RNs may delegate certain tasks associated with the military training according to the Board Rules in Chapter 224. There are many tasks that would be prohibited from RN Delegation in acute care settings or to patients experiencing acute conditions. In addition to the Board Rules in Chapter 224, RNs must consider the licensing regulations established by the Department of State Health Services, the facilities policies and procedures and the agreement between the facility and the military when deciding what tasks can be delegated to the unlicensed military personnel.
If your facility has a medical director who is overseeing the military training, remember that physicians have a broader delegatory authority than RNs. The RN still has an important role in this situation. According to Board Rule 224.10, the RN must verify the training to ensure the UAP can properly perform the delegated task and provide adequate supervision. The RN must be vigilant and intervene if he or she determines the UAP is not capable of performing the task safely as well as notifying the delegating practitioner.
Question: I am aware of the Texas Nursing Practice Act (NPA) and the Rules and Regulations that discuss delegation of tasks to non-licensed personnel. Are we allowed to delegate these tasks to the military personnel In the course of their training?
Answer: There are tasks that can be delegated to UAPs in an acute setting such as a hospital. Nurses should be familiar with the Board Rules in Chapter 224 in their entirety; however, Board Rule 224.8, Discretionary Delegation Tasks in particular specifies the tasks that RNs are: 1) commonly permitted to delegate, 2) discretionary tasks that can be delegated in certain situations and 3) tasks that are prohibited from delegation. For example, medication administration including including IV administration of fluids are tasks prohibited from delegation in acute settings such as hospitals. The insertion of Intravenous (IV) Catheters is a sterile procedure that falls within the category of discretionary delegation tasks and requires RNs to use specific criteria listed in Board Rule 224.8(b) when determining whether it is appropriate to delegate this type of task.
The RN must use his or her judgment when deciding whether to delegate tasks to UAPs. The RN retains the accountability and assumes the responsibility for the proper performance of the tasks that he or she delegates to UAPs. The RN must determine if tasks are correctly performed and the RN must provide adequate and ongoing supervision. The supervision criteria are outlined in Board Rule 224.7. The RN as the coordinator of care must always be mindful of their duty to provide for patient safety when delegating tasks to UAPs.
While the Texas Board of Nursing does not have purview in certain employment situations, BON staff recommends nurses have a clear understanding of their employer’s agreement with the military as to the nurse’s role in training military personnel. For example, will military faculty be present and providing direct supervision and instruction to their students (the UAPs), or will civilian nurses have this role? If you determine that nurses in your facility will be supervising and training the UAPs, BON staff recommends that polices and procedure be developed in order to provide guidance to the nursing staff to ensure the safety of their patients.
Question: Will military personnel be able to function in the same role as the nursing students training in our hospital?
Answer: No, they are considered unlicensed assistive personnel. Nursing students enrolled in Texas approved nursing education programs are exempt from the NPA and the Delegation Rules when performing the practice of nursing as a part of their clinical rotations. The law provides for nursing students to have the opportunity to learn the role of the nurse under the supervision of their faculty. However, the military personnel are considered UAPs and the RN must delegate tasks according to Chapter 224.
Question: Can military nurses practice and train in our civilian hospital working with civilian patients?
Answer: Nurses working in Texas must be licensed in Texas or have a compact license that permits them to work in compact states. For nurses wishing to endorse into Texas, please refer to information on the BON’s website, www.bon.texas.gov under "Verification and Licensing", then "Online Endorsement Application".
- The Texas Nursing Practice Act (NPA) http://www.bon.state.tx.us/nursinglaw/npa.html
- Rule 224, Delegation of Nursing Tasks by Registered Professional Nurses to Unlicensed Personnel for Clients with Acute Conditions or in Acute Care Environments, http://info.sos.state.tx.us/pls/pub/readtac$ext.ViewTAC?tac_view=4&ti=22&pt=11&ch=224&rl=Y
- Rule 217. 11(1)(B) http://info.sos.state.tx.us/pls/pub/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=22&pt=11&ch=217&rl=11
- Position Statement 15.14, Duty of a Nurse in Any Setting http://www.bon.state.tx.us/practice/position.html#15.14
- Position Statement 15.11, Delegated Medical Acts http://www.bon.state.tx.us/practice/position.html#15.11
- Delegation Resource Packet http://www.bon.state.tx.us/practice/delegationresources.html
- The Texas Medical Board (TMB), Chapter 193 http://info.sos.state.tx.us/pls/pub/readtac$ext.ViewTAC?tac_view=4&ti=22&pt=9&ch=193&rl=Y
- The Department of State Health Services (DSHS) http://www.dshs.state.tx.us/
- Online Endorsement Application http://www.bon.state.tx.us/olv/endorsement.html