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FAQ - 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).

A: 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.
B: Once you receive confirmation from the BON that you have passed your NCLEX-PN (or NCLEX-RN) licensure exam, you will be entitled to hold yourself out as a Licensed Vocational Nurse (LVN) or Licensed Registered Nurse (RN) as applicable, with all of the privileges and responsibilities that go along with each license. Though the Board cannot prevent a newly licensed LVN or RN from practicing in a home health environment, the Board strongly discourages newly licensed nurses from accepting employment in any independent living environment setting until the new nurse achieves twelve (12) to eighteen (18) months of nursing experience in an acute health care setting (such as a hospital).
The Board believes that the newly licensed nurse (LVN or RN) needs adequate time to apply newly learned nursing knowledge and clinical skills, as well as time to develop clinical judgment and decision-making skills. Further, the Board believes that this process occurs most effectively in a structured health care environment where resources and supervision are immediately available to the new nurse. Once licensed, you are required to “know and comply with” the Nursing Practice Act (NPA) and Board Rules, as the content of each has the force of law with regard to nursing practice in Texas. The NPA and rules may be viewed in their entirety on this site.
The main rule applied to nursing practice is Rule 217.11 Standards of Nursing Practice. Two of the main standards that apply to practice issues require the nurse to always maintain client safety [standard (1)(B)] and to accept only those assignments that are commensurate with the nurse’s education, licensure, experience, and abilities [standard (1)(T)]. If a newly-licensed nurse decides to work in home health, and is subsequently reported to the Board for possible violations of the Board Rules, the nurse would likely be asked to explain his/her rationale for accepting employment in a home health setting, particularly when the Board expressly cautions new nurses regarding doing this very thing.