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FAQ - 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 with the main rule applied to nursing practice, Rule 217.11, Standards of Nursing Practice. This rule provides the minimum standards nurses must meet in accepting any assignment, including floating, working short staffed and other practice situations.

During the 2009, 81st Legislative Session, SB 476 was enacted and changed the Health and Safety Code. If you practice in a hospital, you may wish to contact the Department of State Health Services (DSHS) - Health Facility Program at 1-888-973-0022 or http://www.dshs.state.tx.us/hfp/default.shtm about the regulations for the official nurse staffing policies and plans that took effect on September 1, 2009.

You may also wish to contact various nursing specialty organizations, such as the Texas Nurses Association at 512-452-0645 or www.texasnurses.org. While the Board cannot address employment issues, specialty nursing organizations exist to serve their members and may be able to provide you with additional guidance. The Texas Hospital Association at www.tha.org or 512-465-1000 has developed a Nurse Staffing Law Toolkit that may provide nurses and hospitals with additional resource information.

If you believe, you are being asked to accept an assignment that would cause you to violate the NPA or rules, especially any of the standards of practice in Rule 217.11, you may wish to review the NPA Section 301.352 Protection for Refusal to Engage in Certain Conduct. If your facility or employer routinely utilizes at least 10 nurses, 5 of which are RNs, you may wish to consider invoking Safe Harbor. While the BON does not have authority over workplace issues, such as determining nurse: patient ratios, there are protections in both the NPA and the Safe Harbor Rule 217.20 for a nurse who declares Safe Harbor in good faith. If adverse employment action was taken against a nurse, then the nurse may choose to seek private legal counsel. Rule 217.20 (e) outlines the requirements the nurse must meet in order to secure the protections, what the protections are, and where they are listed in the Texas Occupations Code, Section 303.005.

Revised October 2009