Telenursing involves nursing practice via electronic means such as telephone, satellite, or computer. Examples of telenursing practice may include teaching, consulting, triaging, advising or providing direct services, to name but a few.
All of these actions constitute the practice of nursing, even when there is no face-to-face or physical contact with a person or patient. If a job description requires a person to hold a valid nursing license, then the job duties therein involve the practice of nursing. This means a nurse must comply with the Texas Nursing Practice Act and Board Rules in the exercise of his/her practice of nursing. Rule 217.11, Standards of Nursing Practice, is the primary rule applied to nursing practice in any setting. This rule and additional documents that provide guidance for nurse's on determining their individual scope of practice are located in the Nursing Practice section of the BON web page http://www.bon.texas.gov under the sub- heading "Scope of Practice."
Telenursing may also involve practicing nursing across state lines. For example:
- A nurse working in an emergency hotline center in Virginia may provide advice to clients in Texas;
- A nursing faculty professor from Arizona may teach nurses enrolled in a graduate (Master's Degree) program in Texas via the internet; or
- An RN working for an insurance company in New York may assess ongoing home healthcare needs with a man in Texas relating to injuries the man sustained in an accident 6 weeks ago.
If a nurse from another state provides nursing to a resident of Texas, except as excluded in the Nursing Practice Act, Section 301.004, Application of Chapter, the nurse must hold a valid Texas nursing license or a valid nursing license in another Compact state in order to practice nursing in the State of Texas and/or with Texas residents. The most current list of states belonging to the Nurse Licensure Compact is located on the web page for the National Council of State Boards of Nursing www.ncsbn.org/nlc.htm. Chapter 304 of the Texas Nursing Practice Act and Rule 220 contain the regulations applicable to the Nurse Licensure Compact in Texas.
{Note: There is no implementation date at this time for Chapter 305 NCSBN Advanced Practice Registered Nurse Compact}
Using Nursing Titles Applies to Telephonic Nursing Practice
Any title that would lead a member of the public to believe that a person is licensed as a nurse is prohibited from use unless the person indeed holds a valid nursing license either in the Texas or in one of the compact states. This is specified in the Nursing Practice Act, Section 301.4515 and Rule 217.10. This includes titles that apply to advanced practice nurses as defined in rule 221.2 Authorization and Restriction to Use of Advanced Practice Titles.Both the Nursing Practice Act and board Rules may be viewed in their entirety on the BON web page at http://www.bon.texas.gov under the Nursing Laws and Rules link.
Designated Agent
Nurses can act as a physician's "designated agent" to relay prescriptions to a pharmacy. This law is not within the purview of the BON, but is located in the Pharmacy Act (Tx Occ. Code, Subtitle J, Section 551.003(14) and defines who can be a "designated agent" for a physician. This law does state that the designated agent is "an individual" designated by the physician---ie, it does not have to be a licensed person who relays orders from the MD (such as in the MD office). The law also permits a nurse in a facility setting to relay prescription information to a pharmacy. BON staff cannot speak as experts on laws outside of the board's authority. For more information on this law, contact the Texas State Board of Pharmacy at (512)305-8000 or mailto:rxlaw@tsbp.state.tx.us or home web page http://www.tsbp.state.tx.us/
LVNs and Telephonic Nursing
The documents listed below provide detailed information on how the Texas BON views telephonic nursing in relation to LVN practice. Rule 217.11(2)(A) limits LVN scope with regard to nursing process to "focused" assessments (not comprehensive). The Interpretive Guideline for LVN Practice Under Rule 217.11 provides a brief table of the basic educational preparation for LVNs compared to RNs. This document and the LVN FAQ about LVNS Performing Telenursing/Triage/Being On-call explain that whether telephonic or in person, triaging a client requires the ability to perform a comprehensive assessment, which is beyond the scope of practice for a LVN. Use of decision support tools (such as computerized triage and treatment algorithms) with access to physician or RN supervisors may provide adequate guidance in prescribed settings to permit safe practice of the LVN.
FAQ: LVNs Performing Triage/ Telephonic Nursing /Being On-Call:
http://www.bon.state.tx.us/practice/faq- LVNperformingtriage.html
LVN Supervision of Practice http://www.bon.state.tx.us/practice/faq-lvnspractice.html
Interpretive Guideline for LVN Scope of Practice ttp://www.bon.state.tx.us/practice/lvn-guide.html
Additional Resource Documents
Patient Safety with Verbal Orders: July 2007 BON Bulletin, page 14 http://www.bon.state.tx.us/about/pdfs/july07.pdf
BON Position Statements www.bon.state.tx.us/practice/position.html