Welcome to the Texas Board of Nursing

Frequently Asked Questions - Nursing Practice

Workplace and Employment — General Information

What is the BON Proposed Nursing Work Hours Position Statement?

At the October 2006 Texas Board of Nursing (Board or BON) meeting, the Board charged the Nursing Practice Advisory Committee (NPAC) to develop a position statement on nursing work hours and the impact of fatigue on patient safety.  Toggle Expand/Collapse Text

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Mandatory Overtime

Can an employer require a nurse to work longer than scheduled, or to work overtime?

The duty of every nurse is to provide safe patient care, and this duty supersedes any employment related requirements. Once a nurse assumes duty of a patient, the nurse has a regulatory responsibility to provide safe patient care in accordance with all applicable laws, rules and regulations.  Toggle Expand/Collapse Text

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Consecutive Shifts/Work Hours

How many consecutive hours or shifts can a nurse work?

The Texas Board of Nursing (Board or BON) licenses and regulates nurses in the State; the Board does not have purview over facility operations or most facility policies or procedures. As such, the Board does not have any jurisdiction over employment related matters including: work hours, scheduling, staffing, or extended work hours. The Board does, however, have applicable laws and rules that pertain to this topic as it relates to a nurse’s duty to patients. Board Rule 217.11 Standards of Nursing Practice, outlines the minimum standards for safe nursing practice at all levels of licensure, including the requirement that all nurses must implement measures to promote a safe environment for clients and others [§217.11(1)(B)] and 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 [§217.11(1)(T)].  Toggle Expand /Collapse Text

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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 (Board or BON) has no authority over staffing ratios, a workplace/employment matter; however, the Board does have applicable regulations that relate to a nurse’s duty to patients. The Texas Nursing Practice Act (NPA) and Board rules and regulations are written broadly so they can be applied by all nurses (LVNs, RNs, & APRNs) in any practice setting. Board Rule 217.11, Standards of Nursing Practice, provides the minimum standards nurses must meet in accepting any assignment, including situations involving inadequate staffing, specifically:  Toggle Expand/Collapse Text

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Floating to Unfamiliar Practice Settings

Nurses in my facility are often required to float from their home unit to other care units where they do not have clinical competence and/or clinical experience. What is the duty of the nurse when it comes to floating to different clinical units (i.e., adult, pediatric, ER, etc.)? Can a nurse invoke safe harbor? If so, how do nurses invoke safe harbor?

The Nursing Practice Act (NPA) and Board Rules are written broadly to apply to nursing practice in any setting.  Although the Board of Nursing (Board or BON) has no authority over workplace matters, such as floating or staffing ratios, nurse staffing was addressed in SB 476 during the 81st Texas Legislative Session in 2009.  As a result of the bill, new chapters (Chapters 257 and 258) were added to the Texas Health and Safety Code concerning “Nurse Staffing” and “Mandatory Overtime for Nurses Prohibited” respectively.

The changes created by SB 476 are applicable to you if you work in a hospital and, among other things, require hospitals to have a nurse staffing committee, policy, and plan to ensure that an adequate number and skill mix of nurses are available to meet the level of patient care needed.  Further, the staffing plan must include a method for adjusting the staffing plan for each patient care unit to provide staffing flexibility to meet patient needs and a contingency plan when patient care needs unexpectedly exceed direct patient care staff resources. Floating ...  Toggle Expand/Collapse Text

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When Does a Nurse's Duty to a Patient Begin and End?

Employment versus Licensure

There is no routine answer to the question, “When does the nurse’s duty to a patient begin?” A nurse's duty is not defined by any single event such as clocking in, or taking report. From a Board of Nursing standpoint, the focus is on the relationship and responsibility of the nurse to the patient(s), not to the nurse's employer or employment.  Toggle Expand/Collapse Text

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A Nurse's Duty Not Limited to Assignment:

All nurses, regardless of practice setting, position, title or role, are required to adhere to the NPA and other statutes, as well as the Board Rules. Two of the main rules that relate to nursing practice are Texas Administrative Code, Rule §217.11 Standards of Nursing Practice, and Texas Administrative Code, Rule §217.12 Unprofessional Conduct.  Toggle Expand/Collapse Text

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Decision Making for Determining Nursing Scope of Practice

Where can I find a list of tasks that LVNs and/or RNs can or cannot do in the State of Texas?

The Texas Nursing Practice Act (NPA) and Texas Board of Nursing (Board or BON) Rules are written broadly so they can apply to nursing practice in any setting. As such, the BON does not provide an all-purpose list of tasks that every nurse can perform, nor does the Board provide step-by-step procedures regarding how certain tasks are to be carried out by a nurse.  Toggle Expand/Collapse Text

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Nurses Have a Duty to Report Confidential Health Information

Do nurses have a duty to report confidential health information to administrators, law enforcement of to a patient's family?

Nurses have a duty to report patient information, including mental health information, to members of law enforcement, a patient's family and others when a patient is a serious danger to himself or others.  Toggle Expand/Collapse Text

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Nurse Admitted As Patient Under the Influence

I currently work in an ICU. I had an opportunity to care for a patient/nurse (who was a nurse at another facility) who overdosed. She was transferred, when stable, to a treatment center by court order. I was told we cannot report her to the board due to HIPAA. My question is, "How do we plan to handle this type of incident in the future?" "Will there be any specific changes made to address problems like this in the future?" I understand with the renewal of our license we must answer the question of treatment for use of "alcohol or any other drug." But if there is no report of her being in the hospital for treatment, due to HIPAA, it's possible that she may not answer the question truthfully. Can you please help with these questions. I appreciate your time.

Whether a nurse is admitted for an overdose of a substance, or admitted secondary to some type of accident related to being under the influence of any mind-altering substance, the answer would remain the same.  Toggle Expand/Collapse Text

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Initiation of CPR - A Nurse's Duty to Initiate

Is current CPR certification a licensure requirement for nurses?

No. The Texas Board of Nursing (Board or BON) does not require CPR certification for licensure renewal; however, employers may have specific requirements for maintaining current CPR status as a condition of employment.  Toggle Expand/Collapse Text

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Do all nurses have an obligation to initiate CPR for a client? Does the Texas Board of Nursing have rules that establish a nurse’s duty to initiate CPR?

Yes. All nurses have an obligation or duty to initiate CPR for clients who require resuscitative measures [Board Rule 217.11(1)(M)].  In all healthcare settings, nurses must initiate CPR immediately in the absence of a client’s do-not-resuscitate/out of hospital do-not-resuscitate order. A do-not-resuscitate/out of hospital do-not-resuscitate order is a medical order that must be given by a physician; and, in the absence thereof, it is generally outside the standards of nursing practice to determine that CPR will not be initiated. The initiation of CPR does not require a physician’s order in the absence of do-not-resuscitate/out of hospital do-not-resuscitate order.  Toggle Expand/Collapse Text

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What is the role of the licensed vocational nurse (LVN), registered nurse (RN), and advanced practice registered nurse (APRN) in initiating CPR in a witnessed arrest?

In the absence of a do-not-resuscitate/out of hospital do-not-resuscitate order from a physician, all nurses should initiate CPR immediately in a witnessed arrest, regardless of healthcare setting. CPR should continue and the physician should be notified of the client’s change in condition, to include the current life-saving interventions being provided to the client.

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Does the BON have a position statement that addresses the RN’s role in the management of an unwitnessed cardiac or respiratory arrest in a long-term care facility?

Yes, Position Statement 15.20, Registered Nurses in the Management of an Unwitnessed Arrest in a Resident in a Long-Term Care Facility. The purpose of this position statement is to provide recommendations and guidance to clarify issues for compassionate end-of-life care for residents residing in long-term care facilities only. This position statement is specific to long-term care facilities and is not to be construed as applicable to other healthcare settings in which nurses are employed.

In the case of an unwitnessed resident arrest without DNR orders in a long-term care facility, determination of the appropriateness of CPR initiation should be undertaken by the registered nurse through a resident assessment; and, interventions appropriate to the findings should be initiated.  After assessment of the resident is completed and appropriate interventions are implemented, documentation of the circumstances and the assessment of the resident in the medical record are required.

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Are nurses expected to perform CPR on clients with obvious clinical signs of irreversible death?

Board Rule 217.11(1)(A) requires all nurses to know and conform to the Texas Nursing Practice Act and Board rules and regulations as well as all federal, state, or local laws, rules or regulations affecting the nurses’ current area of nursing practice.  Additionally, nurses should know and follow their facility, agency or employer’s policies.

The American Heart Association recommends that all clients receive CPR immediately unless attempts at CPR would be futile, such as when clients exhibit obvious clinical signs of irreversible death. Obvious clinical signs of irreversible death include decapitation (separation of head from body), decomposition (putrefactive process; decay), dependent lividity (dark blue staining of the dependent surface of a cadaver, resulting from blood pooling and congestion), transection, or rigor mortis (body stiffness that occurs within two to four hours after death and may take 12 hours to fully develop).

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Does the Texas Board of Nursing have purview over the pronouncement of death?

No. The Board of Nursing does not have purview over physician practice, employment settings or the laws regulating the pronouncement of death in Texas. Additional information on Texas regulations regarding pronouncement of death may be found in the Texas Health and Safety Code Chapter 671.

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Is there a difference between the decision to initiate CPR and the decision to pronounce death?

Yes. The decision to initiate CPR for all nurses should be a spontaneous clinical decision and nursing intervention for a client in cardiac or respiratory arrest. Delay in initiating CPR can be critical to the outcome of CPR. CPR should not be delayed to review the client’s medical record or chart in search of physician orders for do-not-resuscitate/out of hospital do-not-resuscitate documentation. Employers and nurses should take a proactive approach to ensure that healthcare setting policies are in place to ascertain a physician’s order for resuscitative status upon admission.  Additionally, the care plan should be updated, as appropriate, if there are changes to the physician’s order concerning resuscitation status of the client.  Easy access to the most up-to-date physician’s order regarding resuscitation status is imperative.

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Can an RN or an APRN pronounce death?

Texas statutes, rules and regulations outside of the Board’s jurisdiction govern who can pronounce death, and only those legally authorized to pronounce death may do so (i.e., physician, justice of the peace). Texas regulations regarding pronouncement of death may be found in Texas Health and Safety Code Chapter 671 and Texas Administrative Code Chapter 193 (Texas Administrative Code, Title 22, Part 9, Chapter 193.18)  Toggle Expand/Collapse Text

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Can LVNs pronounce death or accept an order to pronounce death in Texas?

No. The Board of Nursing Position Statement 15.2 addresses the Role of the Licensed Vocational Nurse in the Pronouncement of Death. Licensed vocational nurses (LVNs) do not have the authority to legally determine death, diagnose death, or otherwise pronounce death in the State of Texas. Regardless of practice setting, the importance of initiating cardiopulmonary resuscitation (CPR) in cases where no clear Do Not Resuscitate (DNR) orders exist is imperative. The Board of Nursing (BON) has investigated cases involving the failure of a LVN to initiate CPR in the absence of a DNR order.

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What additional references are available should be considered when establishing policies and procedures for nursing staff in my facility?

In addition to the current American Heart Association Guidelines for CPR & Emergency Cardiovascular Care, the Board website (www.bon.texas.gov) may provide assistance and serve as a resource in developing policies and procedures to further support safe practice with regard to CPR. The Board recommends employers consider the following references when establishing policies and procedures in the healthcare setting:

Revised 2018

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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 seek out 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).

As a newly graduated LVN (or RN), I am interested in home health nursing.  Should I work in this environment as a new nurse? 

When you graduate from your vocational training program or your professional nursing program, you will likely be eligible for a temporary permit to practice as a Graduate Vocational Nurse (GVN) or Graduate Nurse (GN).  Board Rule 217.3 prohibits GVNs and GNs from working in "independent practice settings", which includes home health settings.  Toggle Expand/Collapse Text

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Practice of Nursing

I am answering the question on my licensure application: Have you used your nursing knowledge, skills and abilities within the past four (4) years? I'm not sure what this means, can I include volunteer positions or caring for a disabled family member? How does the Board of Nursing (BON) define "use of nursing knowledge, skills, and abilities”?

The practice of nursing requires specialized judgment and skill, which is based on knowledge and application of the principles of biological, physical, and social science as acquired by a completed course in an approved professional or vocational nursing program of study [NPA Section 301.002(2)&(5)]. The practice of nursing is not limited to the traditional roles, such as providing hands on, direct patient care, or teaching in a nursing program, or working as a nurse administrator. There are many more activities that nurses perform that comprise nursing practice, that are not in these traditional roles.  Toggle Expand/Collapse Text

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Practice Recommendations for Newly Licensed Nurses

Does the Board of Nursing (Board or BON) have any recommendations for newly licensed LVNs or RNs as they begin their nursing practice? 

The newly licensed nurse, as a novice practitioner, is inexperienced and not fully integrated into his/her nursing role and setting, thus undergoing a transitional phase into practice. Based on this belief, the Board provides the following guidance to newly licensed LVNs or RNs:  Toggle Expand/Collapse Text

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Regarding Position Statements 15.27, The LVN Scope of Practice and 15.28, The RN Scope of Practice

Position Statements 15.27 and 15.28 state that it is the LVN's responsibility to ensure appropriate supervision.  What is appropriate supervision?

As described in Position Statement 15.27, the LVN scope of practice is a directed scope of nursing practice and supervision of the LVN’s nursing practice is required by an appropriately licensed supervisor. Each LVN is required to ensure that he or she has the appropriate supervisor prior to accepting an assignment, a position, or employment. The Nursing Practice Act (NPA) and Board Rules define what supervisors are authorized to oversee the LVN’s nursing practice. Specifically, section 301.353 of the NPA states that "the practice of vocational nursing must be performed under the supervision of a registered nurse, physician, physician assistant, podiatrist, or dentist." Board Rule 217.11, subsection (2), which defines standards of nursing practice specific to LVNs, states that “the licensed vocational nurse practice is a directed scope of nursing practice under the supervision of a registered nurse, advanced practice registered nurse, physician's assistant, physician, podiatrist, or dentist”. Supervision is defined in the same rule referenced above as “the process of directing, guiding, and influencing the outcome of an individual's performance of an activity” [Board Rule 217.11 (2)]. The proximity of supervision is not defined in rule. Factors to consider when determining the degree and/or proximity of supervision are discussed in a FAQ on the BON’s website, LVNs “Supervision of Practice”;  Toggle Expand/Collapse Text

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Position Statements 15.27 and 15.28 state that LVNs are responsible for providing safe, compassionate, and focused nursing care to assigned patients with predictable health care needs. What does predictable health care needs mean?

The LVN in Texas provides nursing care to patients with healthcare needs that are predictable in nature, under the direction and supervision of an appropriately licensed supervisor. The term “predictable” describes health conditions that behave or occur in an expected way. A predictable health condition does not mean that the patient is always stable. Instead, predictable health conditions follow an expected range or pattern that allows the LVN, with his or her clinical supervisor, to anticipate and appropriately plan for the needs of patients. For example, it is appropriate for an LVN to care for a patient with a diagnosis of asthma. The disease process for asthma, while sometimes acute in nature, is predictable in that the symptoms can be recognized and anticipated. The LVN assists his or her clinical supervisor in the planning of nursing care in which the LVN implements appropriate aspects of nursing care to help stabilize the symptoms of asthma and prevent complications, while also helping to evaluate the patient’s response to nursing care. In addition, when complications arise or events occur that are outside the predicted range, the LVN must be able to recognize this change in condition and notify his or her clinical supervisor. This can be contrasted with the RN who may independently plan and implement nursing care while caring for patients with complex healthcare needs.

Helpful Resources:

August 2011
August 2017
Revised 2021

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LVNs Performing Initial Assessments

Can an LVN perform an “initial” assessment?

Although Board rules do not define initial assessments, Board Rule 217.11, Standards of Nursing Practice, addresses focused assessments performed by LVNs [Board Rule 217.11(2)(A)] and comprehensive assessments performed by RNs [Board Rule 217.11(3)(A)].  Toggle Expand/Collapse Text

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LVNs and Nursing Care Plans

Can an LVN initiate/develop the nursing care plan?

LVNs may not initiate care plans; however, they may contribute to the planning and implementation of the nursing care plan. Only the RN may develop the initial nursing care plan and make nursing diagnoses [Board Rule 217.11(3)(A)(ii) & (iii)].  Toggle Expand/Collapse Text

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LVNs Performing Triage/Telephonic Nursing/Being On-Call

Can an LVN perform "triage" duties (either telephone triage, such as for home health, or on-site triage, such as in an Emergency Room)?

Triage is defined as the sorting of patients and prioritizing of care based on the degree of urgency and complexity of patient conditions. Telephone triage is the practice of performing a verbal interview and making a telephonic assessment with regard to the health status of the caller. As the caller may not accurately describe symptoms and/or may not accurately perceive or communicate the urgency of the situation or condition prompting the call, nurses who perform these functions must have specific educational preparation, as the consequences of inadequate triage can be devastating.  Toggle Expand/Collapse Text

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Can an RN be "backup on-call" in case the LVN has questions?

It is not acceptable to have either an RN or advanced practice registered nurse (APRN) serving as "backup on-call" to assist an LVN who is also responding only telephonically to patients in need. As the LVN's formal education does not prepare the LVN to perform telephonic assessments, the LVN may not be able to determine what information is essential to obtain and then relay to an RN or APRN. In addition, if a patient’s situation is emergent, even if the RN or APRN subsequently call the patient back, the delay in securing emergent treatment may result in serious harm or patient death.

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Is the RN ultimately responsible?

Regardless of the number of years of practice experience, an LVN does not have the educational background equivalent to that of an RN and is not educated or trained to analyze and synthesize symptoms or otherwise conduct a comprehensive assessment telephonically with a patient. Additionally, if emergent action is needed and the LVN is unable to discern this need due to limited assessment abilities, intervention that may be necessary to save the patient's life could be delayed.
Even under supervision and direction, LVNs may not perform comprehensive nursing assessments. Likewise, RNs cannot assign an LVN to perform comprehensive nursing assessments under RN supervision with the intention that the RN will assume “ultimate responsibility”.  Each nurse has an independent duty and responsibility to follow the laws and rules applicable to their license [§217.11(1)(A)].  And, every nurse (LVN, RN or APRN) is responsible for making and/or accepting safe and appropriate assignments in accordance with Board Rule 217.11(1)(S) & (1)(T).

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"Medical Screening" in the ER

The Emergency Medical Treatment and Active Labor Act (EMTALA) is federal law and therefore not under the Board’s jurisdiction.  Though Board Staff cannot speak as experts on laws outside of the Board’s purview, in summary, EMTALA helps to ensure patients have access to emergency services regardless of their ability to pay for services.  Medicare-participating hospitals that offer emergency services are required to provide a “medical screening examination” (MSE) when a patient requests examination or treatment for an emergency medical condition, including active labor, to determine whether or not an emergency medical condition exists. A hospital is required to stabilize a patient if an emergency medical condition exists.  For more information, please visit https://www.cms.gov/Regulations-and-Guidance/Legislation/EMTALA/Toggle Expand/Collapse Text

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Other Practice Setting Examples (e.g., Call Centers, Physician's Offices, etc.)

The Board is aware that LVNs may also practice in "call centers" (such as a poison control center), physician's offices, or other similar settings. In settings where a physician is present, there may be a set of standardized guidelines approved by the physician to establish treatment priorities within the office environment under the supervision of the physician.  Such practice settings may be appropriate for a qualified LVN.  Please see Position Statement 15.5 (Nurses with Responsibility for Initiating Physician Standing Orders) for more information. In call centers, the LVN typically has access to computer systems that guide the LVN in asking specific symptom-driven, decision-tree questions that then dictate what action the LVN recommends to the caller.
Evaluation of the system utilized is recommended to assure (1) it is appropriate for the practice setting, (2) that it has an established, standardized and valid/reliable decision-making process (preferably determined outside of the institution/facility in which it is used), and (3) that the LVN has access to an appropriate supervisor for situations that might exceed the capabilities of any computer-based algorithm treatment model.

Summary

It is not the intent of the Board to preclude LVNs from practicing in settings where the LVN has sufficient guidance/support/supervision to promote both safe LVN practice as well as patient safety; however, the LVN should not practice in settings where he or she is required to perform comprehensive assessments, make independent treatment decisions or establish treatment priorities as described in this statement.
The BON cannot provide legal advice or counsel to nurses.  A nurse may wish to seek his or her own legal counsel for advice on the best course of action for her or himself. 
Additional Resources

Emergency Nurses Association (2017). Position Statement: Triage Qualifications and Competency. Retrieved from https://www.ena.org/docs/default-source/resource-library/practice-resources/position-statements/triagequalificationscompetency.pdf?sfvrsn=a0bbc268_8

Revised 2018

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LVNs "Supervision of Practice"

Describe what "supervision of practice" means in relation to an LVN functioning with a directed scope of practice “under the supervision of. . . .”

The Nursing Practice Act (NPA) and Board rules require licensed vocational nurse (LVN) practice to be performed under the supervision of a registered nurse (RN), advanced practice registered nurse (APRN), physician, physician assistant (PA), podiatrist, or dentist [NPA Section 301.353 & Board Rule 217.11 (2)]. These licensed supervisors are responsible for directing, guiding, and influencing the outcome of an LVN’s performance of an activity [Board Rule 217.11 (2)]. In sum, vocational nursing practice is a directed scope of practice that requires appropriate supervision.  Toggle Expand/Collapse Text

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Nurse's Role with the Emergency Medical Treatment & Labor Act: Performance of Medical Screening Exams

Background Information:

The Emergency Medical Treatment and Active Labor Act (EMTALA) is a federal law established in 1986 that requires hospitals or other acute care facilities who offer emergency services to provide a medical screening examination to each person presenting to the emergency department.  Toggle Expand/Collapse Text

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Can an RN Perform a Medical Screening Exam?

The EMTALA Interpretive Guidelines indicate that a facility may credential specific registered nurses to perform a Medical Screening Exam (MSE) and develop bylaws specifying which RN nursing staff are considered to be "qualified medical personnel" and under what circumstances a physician must be consulted and/or must physically come to the unit/facility. The MSE may be delegated by the physician to other qualified medical personnel according to the physician delegation rules found in the Texas Administrative Code, Chapter 193.  Toggle Expand/Collapse Text

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Can an LVN perform a Medical Screening Exam?

The Board believes that the performance of a Medical Screening Exam (MSE) is not within the scope of practice for an LVN, regardless of years of experience or post-licensure Continuing Nursing Education at the LVN level. As defined in Board Rule 217.11(2)(A) the scope of practice for an LVN includes the performance of a focused assessment and the determination of predictable healthcare needs of an individual client. Since a comprehensive nursing assessment would be necessary to conduct a MSE, the RN level of licensure would be required. Even if a physician wishes to delegate assessment of medical conditions and/or treatments to an LVN, the LVN is accountable for only accepting those assignments within his/her scope of practice as outlined in the NPA and in Board Rule 217.11, Standards of Nursing Practice.

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Is a medical screening exam the same as triage?

No, a Medical Screening Exam (MSE) is not the same as triage. The differentiation is discussed in depth under the EMTALA Interpretive Guidelines. Board staff cannot speak as experts on laws/rules outside the jurisdiction of the BON; therefore, Board staff suggest reviewing the guidelines.

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How do the NPA and Rules apply to RNs performing medical screening exams under EMTALA?

The definition of "professional nursing" found in Texas Occupation Code §301.002(2) of the Nursing Practice Act (NPA) states that the practice of professional nursing "does not include acts of medical diagnosis or prescription of therapeutic or corrective measures." This means an act must not require the RN to exercise independent medical judgment or make a medical diagnosis, as this is the practice of medicine, not nursing. Board Rule 217.11, Standards of Nursing Practice, contains the minimum standards of acceptable nursing practice. Some of the standards in Board Rule 217.11 that would apply to EMTALA medical screening exams performed by an RN include, but are not limited to, the requirements that an RN must:

  • (1)(A) know and conform to the NPA and Board rules as well as federal, state, or local laws affecting the nurse’s current area of practice;
  • (1)(B) maintain a safe environment for clients and others;
  • (1)(D) accurately and completely report and document: (i)-(vi);
  • (1)(M) institute appropriate nursing interventions that might be required to stabilize a client’s condition and/or prevent complications;
  • (1)(O) implement measures to prevent exposure to infectious pathogens and communicable conditions;
  • (1)(P) collaborate with the client, members of the health care team and, when appropriate, the client's significant other(s) in the interest of the client's health care;
  • (1)(T) accept only those nursing assignments that take into consideration patient safety and that are commensurate with one's own educational preparation, experience, knowledge and physical and emotional ability; and
  • (3)(A)(i) perform comprehensive nursing assessments regarding the health status of the client.

Regardless of practice setting, the nurse's duty to keep patients safe cannot be superseded by physician orders, facility policies, or administrative directives; see Position Statement 15.14, Duty of a Nurse in Any Practice Setting. Position Statement 15.11, Delegated Medical Acts contains additional information on physician delegation to nurses. To assist in determining if a task is within an individual nurse's scope of practice; nurses may utilize the Board's Scope of Practice Decision-Making Model (DMM).

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Can an Advanced Practice Registered Nurse Perform A Medical Screening Exam?

Advanced practice registered nurses (APRNs) are RNs who have completed a formalized education program, e.g., Master's or Post-Master's APRN curriculum, that enables them to engage in certain aspects of medical diagnosis and medical management within their advanced practice role and population focus. Advanced practice licensure is not sufficient on its own to qualify an APRN to perform all types of medical screening exams. The APRN would have to be licensed in an appropriate role and population focus, e.g., Acute Care Nurse Practitioner, Adult Nurse Practitioner, or Family Nurse Practitioner, for the evaluation of general medical conditions of adults. The appropriately licensed APRN should have a signed protocol or collaborative agreement with a physician, in accordance with Board rules, that specifically delegates medical aspects of care to the APRN.

Other sources of Information on EMTALA include:

Revised 2021

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Seasonal Influenza and other Vaccinations

What are the requirements for a nurse to give flu injections?

Although the laws regarding immunizations are not within the BON's authority, an Attorney General opinion in 1981 (MW-318) determined immunizations are preventative, thus no medical diagnosis is required or made when a person receives an immunization. Board staff recommends that a facility have standing physician delegation orders that guide the nurse when to give pneumococcal or influenza vaccines. Position Statement 15.5, Nurses with Responsibility for Initiating Physician Standing Orders, references the Texas Medical Board rules applicable to these types of orders, and provides guidance to nurses and employers on important components to include in standing delegation orders.

Board staff recommend review of documents located on our web site.  Some of the documents to consider for review are Rule 217.11 Standards of Nursing Practice, Registered Nurse Scope of Practice, LVN Scope of Practice and the Scope of Practice Decision-Making Model (DMM).

As the BON does not regulate specific practices or practice settings, you may wish to check with the Department of State Health Services [DSHS]. The number for the Immunizations Branch is  1-800-252-9152. The DSHS immunization web site is http://www.dshs.texas.gov/immunize/

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Can an RN delegate vaccination administration? 

Both the advanced practice registered nurse and the registered nurse delegate in the same manner – through the rules in Chapters 224 and 225. The Delegation Resource Packet contains access to the delegation rules in Chapters 224 and 225 as well as other resources related to delegation.

In general, vaccination administration would be prohibited from delegation by an RN to unlicensed assistive personnel (UAP). The delegation rules in Chapter 224 are more restrictive than the rules in Chapter 225. All medication administration and routes of medication administration are prohibited from delegation in the acute delegation rules with the exception of the medication aide permit holder. An RN cannot delegate the injectable route to a medication aide with the exception of insulin in compliance with Rule 224.9.

RNs may supervise UAPs performing tasks delegated by other licensed healthcare providers. In these situations, an RNs accountability is to verify the training of the UAP, verify the UAP can perform the task safely, and provide adequate supervision of the UAP. If the RN cannot verify all of these responsibilities, the RN must notify the delegating licensed healthcare provider that the UAP is not capable of performing the task (Rule 224.10 or 225.13)

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Does a nurse’s scope of practice change in a pandemic?

A nurse’s scope of practice is related to the nurse’s education, experience, knowledge, and physical and emotional ability. In addition, the practice setting of the nurse influences the nurse’s scope of practice through the policies and procedures as these reflect the regulations for the practice setting. Nurses follow the Nursing Practice Act (NPA) and Board Rules as well as any other laws, rules, or regulations affecting the nurse’s area of practice. The Scope of Practice Decision-Making Model (DMM) guides a nurse in making good judgments about the tasks or procedures a nurse chooses to perform. Nurses have a duty to promote safety for their patients. Position Statement 15.14, Duty of a Nurse in any Practice Setting further explains the responsibility of the nurse to advocate for patient safety.

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Can a nurse do a medical screening exam in the ER during a pandemic?

In the definition of nursing, found in the Nursing Practice Act section 301.002, medical diagnosis is excluded from the practice of nursing. If the purpose of a medical screening is to determine a medical diagnosis, this would be beyond the parameters of nursing practice. A nurse is required to implement measures to prevent exposure to infectious or communicable conditions [Rule 217.11 (1)(O)]. One way to accomplish this standard is to identify incoming patients who might be infectious and provide them with a separate waiting area so as not to expose others to communicable conditions. When a physician is delegating to a nurse, the nurse is expected to comply with the Standards of Nursing Practice just as if performing a nursing procedure. Position Statement 15.11, Delegated Medical Acts discusses physician delegation and the role of the nurse.

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Is it mandatory for a nurse to receive a flu vaccination?

Nurses are to implement measures to prevent patient exposure to infectious pathogens and communicable conditions as stated in Board Rule 217.11(1)(O).  Nurses may choose to receive a vaccination to prevent exposing patients to the flu and to protect them from possible infection.  A person may be contagious prior to developing symptoms with seasonal flu and thus may expose others to the disease. The following web sites have information on the seasonal influenza:

Revised 2018

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Role of the School Nurse With Unlicensed Diabetes Care Assistants (UDCAs)

What is the BON's recommendation regarding the role of the school nurse when working with UDCAs?

BON Position Statement 15.13, Role of LVNs and RNs in School Health, recommends that the school nurse be an registered nurse (RN) but does not absolutely preclude a licensed vocational nurse (LVN) with appropriate experience and supervision from practicing in a school health setting. However, the Texas Diabetes Council training guide for unlicensed diabetes care assistants (UDCAs) defines a school nurse in accordance with 19 Texas Administrative Code 153.1021(a)(17), as:

(17) School nurse--An educator employed to provide full-time nursing and health care services and who meets all the requirements to practice as a registered nurse (RN) pursuant to the Nursing Practice Act and the rules and regulations relating to professional nurse education, licensure, and practice, and who has been issued a license to practice professional nursing in Texas.

This particular section of the Texas Administrative Code is under the purview of the Texas Education Agency.  School nurses must be aware of and comply with not only the Board’s laws and rules, but also with all other related regulations to their area of practice [Board Rule 217.11(1)(A)].

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Can an LVN be a school nurse? Can an LVN train unlicensed diabetes care assistants (UDCAs) or serve in other roles (consultative relationship, administratively responsibility)?

The BON does not preclude LVNs from being employed in school settings; however, the BON regulates the nurse, not the setting, and has no jurisdiction over employment practices.  No matter the setting or job title, every nurse must comply with the NPA and Board rules as well as with all local, state or federal laws, rules or regulations affecting his/her area of practice [Board Rule 217.11(1)(A)].  In all cases, LVN practice is a directed scope of nursing practice under the supervision of a registered nurse, advanced practice registered nursed, physician assistant, physician, podiatrist, or dentist [Board Rule 217.11(2)].  The LVN participates in the planning of nursing care needs of patients and contributes to the development and implementation of nursing care plans for patients and their families with common health problems and well-defined health needs.  LVNs may teach from a developed education plan as well as contribute to its development.

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Who is responsible for determining which school employees will be trained as unlicensed diabetes care assistants (UDCAs) and who is responsible for training UDCAs in schools?

The regulations concerning training of UDCAs in Texas public schools are not within the BON's jurisdiction.  The school principal determines which school personnel are appropriate to be trained to assist with caring for students with diabetes if/when a nurse is not available. In schools that do not have a registered nurse, the principal assures that training is provided by a health care professional with expertise in diabetes care. Questions regarding training of UDCAs should be directed to the Texas Diabetes Texas Diabetes Council.  For complete information, see Texas Health & Safety Code Chapter 168.

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Can a healthcare provider with expertise in diabetic care be contracted to do all of the training for an individual school or a school district?

The training of UDCAs in Texas public schools is not within the BON's jurisdiction.

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A school nurse (RN) is assigned to 3 different elementary schools within one district and rotates between the schools. The schools’ principals assign who will be trained as unlicensed diabetes care assistants (UDCAs). The principals also assume administrative responsibility for these staff whether they are functioning within their job descriptions or in the "extra" role of UDCA. Working with the principals at all 3 schools, the school RN coordinates training of all UDCAs through another RN with expertise in all aspects of the care of children with diabetes. 

Given the situation described above, what is the role of the RN with the UDCAs from a BON standpoint?

According to Texas Health & Safety Code Chapter 168, if a school nurse is assigned to a campus, the school nurse shall coordinate the training of school employees acting as unlicensed diabetes care assistants.  Board Rule 217.11(1)(A) requires all nurses to comply with all laws, rules and regulations affecting their area of practice, not just those under the Board’s jurisdiction.

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How does the RN provide adequate communication and information to the UDCAs at each school related to the diabetic care needs of each child? What is the LVNs role?

Congruent with the diabetes management and treatment plan and the individualized health plan (IHP) for each child with diabetes, the RN can develop information sheets with emergency contact numbers, reportable conditions, and how to intervene in a number of possible emergency situations that could occur with each child.  Health and Safety Code, Chapter 168 and school policy mandate that this information be given to any school employee transporting a child or supervising a child during an off-campus activity.  The school principal and the school nurse, if a school nurse is assigned to the school, shall develop a student’s IHP in collaboration with the student’s parent or guardian and, to the extent practicable, the physician responsible for the student’s diabetes treatment and one or more of the student’s teachers (Health & Safety Code Chapter 168.003)

As for the LVN, Nursing Practice Act Section 301.002(5) defines the licensed vocational nurse (LVN) scope of practice as a directed scope of nursing practice and specifically states that LVNs participate in the development and modification of the nursing care plan, whereas the RN is responsible for the development of the nursing care plan. The LVN may assist with the development of the IHP but is not permitted to write it independently.

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Can the LVN develop the Individualized Health Plan (IHP)?   

 Texas Health and Safety Code §168.003  defines the IHP as a "coordinated plan of care" developed by the principal and the school nurse, if a school nurse is assigned to the school, in collaboration with the student’s parent/guardian and the student’s physician, if possible. Developing or initiating a student’s IHP is beyond the LVN scope of practice as defined by the BON in Rule 217.11(2)(A)(iii).  The LVN may assist with the development of the IHP but is not permitted to develop it independently.

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Texas Health and Safety Code §168.00 mandates schools to permit and encourage students' abilities to engage in self-care. Occasionally, used supplies, such as insulin syringes or blood-stained gauze, may not be disposed of properly, exposing other children to potentially hazardous bodily fluids/blood that could carry infectious pathogens.  Does Health and Safety Code §168.008 mandate that a child always be permitted to engage in the self-management of diabetes anywhere on the campus, regardless of the health threat posed on other students if a given student isn't capable of disposing of used supplies and cleaning the testing area in a responsible manner? Must a student who is not capable of, either by age, maturity or both, appropriately maintaining supplies and equipment (losing his/her glucometer, leaving used supplies where others could be exposed to blood, used sharps, etc.) be permitted to self-manage?

The Standards of Nursing Practice (Board Rule 217.11(1)(O)) require all nurses to prevent exposure of clients (students) to infectious pathogens and communicable conditions. The language in Health and Safety Code §168.008 prefaces the mandate to permit/encourage self-management with the phrase "in accordance with the student's individualized health plan...".

Based on maturity, intellectual understanding, or other factors, if a student with diabetes is unable to safely accomplish self-management, then the nurse should assure that this issue is addressed in discussions with the principal, parents, physician, and teacher(s) in revising the IHP as necessary to protect both the child with diabetes as well as others, including children, in the school setting. The IHP may require multiple revisions as the child's ability to engage in responsible self-management increases. The Texas School Health Program at the Department of State Health Services/Texas Health and Human Services may have additional information.

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Who is required to conduct the training of the unlicensed diabetes care assistants?

Texas Health and Safety Code Section 168.005(c) requires that a health care professional with expertise in the care of persons with diabetes or a school nurse provide the training.  The Texas Diabetes Council (TDC) is responsible for developing guidelines for training. The Guidelines for Training School Employees who are not Licensed Healthcare Professionals to implement House Bill 984 (79th Legislative Session) related to the Care of Elementary and Secondary School Students with Diabetes (Guidelines) include training curricula and links to websites (FAQs related to Implementing House Bill 984 and the Requirements in the Texas Health and Safety Code)

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Who will oversee that the evaluation of competency is acceptable?

The school nurse or the healthcare professional who conducts the training will determine if competence of clinical tasks is acceptable and safe.  If not, further training will need to be conducted OR the school principal will need to select additional staff to be trained (FAQs related to Implementing House Bill 984 and the Requirements in the Texas Health and Safety Code).

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Can a nurse train unlicensed diabetes care assistants (UDCAs), teachers, and other school personnel in the administration of glucagon?

While the BON has no jurisdiction over school district policies, nurses do have the obligation to promote a safe environment for students and staff [Board Rule 217.11(1)(B)] and to institute appropriate nursing interventions to stabilize a client's condition and prevent complications [Board Rule 217.11(1)(M)]. Glucagon is prescribed to thousands of students with diabetes. Both students and their parents or guardians are instructed by providers and pharmacists on administration of glucagon should a hypoglycemic reaction occur.

Chapter 224 of the Board’s rules concerns delegation and becomes applicable in the school setting when acute health conditions arise and patients become unstable or unpredictable, i.e., an emergency situation.  Board Rule 224.6General Criteria for Delegation, outlines the standards that must be met before an RN can delegate nursing tasks to unlicensed persons.  Even during an emergency situation in the school setting, the RN cannot delegate tasks that require unlicensed persons to exercise professional nursing judgment; but, the unlicensed person may take any action that a reasonable, prudent non-health care professional would take in an emergency situation.  This forms the basis for the Frequently Asked Question from the Board’s Delegation Resource Packet online entitled Medication or Procedures in an Emergency Situation.  Additionally,a series of algorithms that serve to provide delegation decision making guidance for RNs in the school setting along with BON Position Statement 15.13, Role of LVNs and RNs in School Health offer clarification.  Each nurse will need to exercise sound nursing judgment to decide when it is appropriate and safe to delegate in emergency situations, remembering the supervision requirements of delegation as well.

Additional Resources

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Off Label Use of Medication

May I administer a medication if the use is considered to be off label?

The Nursing Practice Act or NPA (Texas Occupations Code, Chapter 301) and Board Rules are written broadly so they can be applied by every nurse to all of the many different practice settings and specialty areas in nursing across Texas. The BON does not have a list of tasks that nurses can perform because each nurse has a different background, knowledge and level of competence. Determinations of a nurse's scope of practice are often complex and it is up to the individual nurse to utilize sound professional judgment in accepting any given assignment and/or performing any given procedure. Toggle Expand/Collapse Text

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When a nurse is considering giving a medication, there are resources available on the BON website under the Practice tab and by selecting Nursing Practice Information to assist the nurse in arriving at a decision based on the topic at hand.

One such resource is the Board’s  Scope of Practice Decision-Making Model (DMM) which is a step-by-step tool nurses practicing in Texas can use to determine if any given activity/intervention is within their individual scope of practice. The DMM is designed to be used in sequence, beginning at the top with question number one. In the model, nurses are asked reflective questions, and depending on how they answer, they are directed to continue through the model or stop. At any point, if a nurse reaches a Stop Sign, he/she should consider the activity or intervention in question beyond (or outside) his/her scope of practice. Keep in mind, the answer may not be the same for each nurse.  Toggle Expand/Collapse Text

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Nurses Performing Radiologic Procedures

Are there rules regarding nurses performing radiologic procedures?

Yes, Board Rule 217.14, Registered Nurses Performing Radiologic Procedures.  Toggle Expand/Collapse Text

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How does BON Rule 217.14 apply to LVNs?

Board Rule 217.14 only addresses RNs in the practice of performing radiologic procedures. The Nursing Practice Act and Board Rules and Regulations do not address LVNs performing radiologic procedures; therefore, an LVN would need to obtain the required license or permit necessary to perform radiologic procedures, such as, a medical radiologic technologist license (regulated by the Texas Medical Board). In such a case, the Board’s Position Statement 15.15, Board’s Jurisdiction Over a Nurse’s Practice in Any Role and Use of the Nursing Title, would be helpful for LVNs who obtain additional licensure, as the position statement reiterates that any licensed nurse in Texas is responsible to and accountable to adhere to both the NPA and Board Rules and Regulations, which have the force of law [§217.11(1)(A)].

Revised 2021

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RN Pronouncement of Death

Texas Senate Bill 823 (1991) amended Section 671.001 of the Texas Health and Safety Code and gave RNs, including APRNs, the legal authority to assess a patient/client and make a determination of death, unless the pronouncement is clearly prohibited under the Health and Safety Code (such as when artificial means of life support are in use). The bill specifically requires the RNs employing agency/facility to have written policies jointly developed and approved by the nursing and medical staff to direct the practice. Although APRNs may complete the medical certification of death for patients in limited instances, APRNs have no greater authority to pronounce death than RNs in Texas.

There was legislation some time ago that allowed nurses to pronounce death in long-term care and hospice facilities.  Can RNs and APRNs pronounce death in acute care facilities?

Texas laws and regulations regarding pronouncement of death may be found in Texas Health and Safety Code Chapters 671 and 193 respectively. Even though the Texas Board of Nursing (BON) does not have purview over the laws surrounding pronouncement of death and death records, because Board Rule 217.11(1)(A) requires all nurses to know and conform to the Texas Nursing Practice Act (NPA) and Board rules and regulations as well as, all federal, state, or local laws, rules or regulations affecting the nurses’ current area of nursing practice, all nurses should be aware of these relevant laws and rules concerning the topic.

Revised 2021

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Co-signature on Documentation

When a Graduate Nurse (GN) or Graduate Vocational Nurse (GVN) has completed all requirements for the nursing program attended, and has received permission to test from nursing boards, must the preceptor co-sign the nursing assessment, medication administration, and other records for patients assigned to the GN/GVN? 

In addition to obtaining approval to sit for the NCLEX, a student who has successfully completed a nursing program must also hold a current valid temporary permit from the Board to practice as a GN or GVN in the state of Texas.  Toggle Expand/Collapse Text

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Co-signature on LVN Actions/Documentation

Must an RN sign behind or "co-sign" nursing actions performed by an LVN?

In general, BON staff does not recommend a nurse co-sign anything unless he/she has directly witnessed an act (such as narcotic wastage) or has gone behind another nurse and personally performed the same assessment with the same findings.  Toggle Expand/Collapse Text

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Differentiating the Role of the Texas Board of Nursing from the Role of Professional Nursing Associations

What is the difference between the Texas Board of Nursing and professional nursing organizations?

Although the Texas Board of Nursing (BON or Board) and professional nursing associations are both involved in the arena of nursing, nursing associations serve a different purpose and provide different services to their nursing membership and the public.  Toggle Expand/Collapse Text

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Doctoral Degrees in Nursing and Using the Title “Doctor”

I am a nurse in Texas and recently graduated with a Doctor of Nursing Practice (DNP). Can I use the title “Doctor” when I work with patients and other healthcare providers?

One of the hallmarks of nursing is the approach to lifelong learning. As nurses earn advanced degrees, the number of nurses earning doctoral degrees is increasing....Toggle Expand/Collapse Text

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Cosmetic Procedures for LVNs

The Board receives questions frequently about whether cosmetic procedures are within the scope of practice for a licensed vocational nurse (LVN). Because each nurse has a different background, knowledge, and level of competence, the Board does not have an all-purpose list of tasks that every nurse can or cannot perform, and it is up to each individual nurse to use sound judgment when deciding whether or not to perform any particular procedure or act.

The following resources, however, are intended to provide you guidance in determining if cosmetic procedures are within your scope of practice.

What is the LVN scope of practice in regards to cosmetic procedures?

Vocational nursing is a directed scope of nursing practice, including the performance of an act that requires specialized judgment and skill, the proper performance of which is based on knowledge and application of the principles of biological, physical, and social science as acquired by a completed course in an approved school of vocational nursing. The term does not include acts of medical diagnosis or the prescription of therapeutic or corrective measures.  Toggle Expand/Collapse Text

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Cosmetic Procedures for RNs

The Board receives questions frequently about whether cosmetic procedures are within the scope of practice for a registered nurse (RN). Because each nurse has a different background, knowledge, and level of competence, the Board does not have an all-purpose list of tasks that every nurse can or cannot perform, and it is up to each individual nurse to use sound judgment when deciding whether or not to perform any particular procedure or act.

The following resources, however, are intended to provide you guidance in determining if cosmetic procedures are within your scope of practice.

What is the RN scope of practice in regards to cosmetic procedures?

Registered nursing, also known as professional nursing, is the performance of an act that requires substantial specialized judgment and skill, the proper performance of which is based on knowledge and application of the principles of biological, physical, and social science as acquired by a completed course in an approved school of professional nursing. The term does not include acts of medical diagnosis or the prescription of therapeutic or corrective measures.  Toggle Expand/Collapse Text

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APRN Scope of Practice

May a nurse practitioner who is educated to practice in a primary care population focus area (e.g., FNP or PNP) practice in a hospital?

The Nursing Practice Act and Board rules are written broadly to apply to all nurses, including advanced practice registered nurses (APRNs), across all practice settings.  Neither are prescriptive to specific tasks or services APRNs may perform or provide.  Likewise, they do not address specific practice settings for specific categories of APRNs. Scope of practice is not specific to a practice setting; rather, it is determined by the patient’s condition and patient care needs at the time services are provided. Board Rules 221.12 and 221.13 clarify that education is the foundation for determining APRN scope of practice.  

When making scope of practice determinations, it is important to consider the patient's condition and patient care needs. Primary care educated APRNs may provide care in the acute care setting for patients with similar patient care needs and diseases and conditions to those they diagnose and manage in the outpatient setting. For example, a family nurse practitioner may be part of a group practice in a specialty such as orthopedics or palliative care and required to round in an inpatient setting in collaboration with the delegating physician. There is nothing in the Nursing Practice Act or Board Rules that prohibits this practice provided management of the patient’s condition is within the scope of the APRN’s educational preparation. 

Although the Board grants APRN licensure titles that are consistent with the Consensus Model for APRN Regulation: Licensure, Accreditation, Certification, & Education, it is important to remember that there are APRNs who have been grand-parented under Board Rules. For example, an individual who is licensed as an adult nurse practitioner rather than an adult/gerontology nurse practitioner is still permitted to provide care to geriatric patients based on education in adult health. When reading the Consensus Model, it is important to bear in mind that it contemplates licensure and education based on an APRN role and a population focus. Nothing in the Consensus Model requires scope of practice be specific to a practice setting.

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Telehealth

What are the Texas Board of Nursing (BON) Rules and Regulations Relating to Telenursing/Telehealth?

Telenursing involves nursing practice via any electronic means such as telephone, satellite, or computer. Examples of telenursing practice may include (but are not limited to) teaching, consulting, triaging, advising, or providing direct services.

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. An indication that a position involves the practice of nursing can be found in the job description. If the position requires a person to hold a valid nursing license, then the job duties therein involve the practice of nursing.  When providing telehealth nursing services with patients residing within the geographical boundaries of Texas all nurses must practice in accordance with the Texas Nursing Practice Act and Board Rules. The practice of nursing via telenursing to patients in Texas should be no different than providing care to patients in an in person encounter. As such the minimum standards of nursing practice found in Board Rule 217.11, Standards of Nursing Practice, apply the same as in any other setting.

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 an online graduate (Master's Degree) nursing education program in Texas; or
  • An RN working for an insurance company in New York may assess ongoing home healthcare needs of a patient in Texas.

If a nurse from another state provides nursing services to a patient located in Texas, except as excluded in the Nursing Practice Act, Section 301.004Application of Chapter, the nurse must hold a valid Texas nursing license or a valid nursing license with multistate privileges in another Compact state in order to practice nursing in the State of Texas and/or with Texas residents.  A current map of the states belonging to the Enhanced Nurse Licensure Compact is located on the web page for the National Council of State Boards of Nursing https://www.ncsbn.org/nurse-licensure-compact.htm. Chapter 304 of the Texas Nursing Practice Act and Board Rule 220 contain the regulations applicable to the Enhanced Nurse Licensure Compact in Texas.

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 Texas or a valid nursing license with compact privileges in one of the compact states.  This is specified in the Nursing Practice Act, Section 301.4515 and Board Rule 217.10. This includes titles that apply to advanced practice registered nurses as defined in Board Rule 221.2 Authorization and Restriction to Use of Advanced Practice Titles. 

Additionally, nurses must identify themselves to patients through the display of their designations. Board Rule 217.10(b), Display of Designations, states that while interacting with the public in a nursing role, each licensed nurse shall wear a clearly legible insignia that: (A) displays the nurse's name, but the manner in which the name appears, in reference to use of first name and/or last name, is the nurse's preference in accordance with facility policy, if applicable; and (B) identifies the nurse as a registered nurse or vocational nurse according to licensure.

Similarly, Board Rule Board Rule 221.2(c) states when providing care to patients, the APRN shall wear and provide clear identification that includes the current APRN designation and licensure title being utilized by the APRN.

As the utilization of telenursing services increases, it remains important for nurses to communicate their name and licensure level to the public, when interacting in a nursing role via technology. Though an insignia may not always be visible through the use of technology, it is important for patients to know the nurse’s name (either by the nurse’s preference or in accordance with facility policy, if applicable) and the nurse’s level of licensure LVN, RN, or APRN.

LVNs and Telephonic Nursing 

The documents listed below provide detailed information on how the Texas BON views telephonic nursing in relation to LVN practice.  Board Rule 217.11(2)(A) limits the LVN scope, with regard to the nursing process, to "focused" assessments (not comprehensive).  Position Statement 15.27 provides a brief table of the basic educational preparation for LVNs compared to RNs. This document and the Frequently Asked Question entitled LVNs Performing Triage/Telephonic Nursing/Being On-Call (see below) explains 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.

LVNs Performing Triage/ Telephonic Nursing /Being On-Call — See:

Advanced Practice Registered Nurses (APRNs) and Telemedicine Medical Service Prescriptions

APRNs must be aware that a prescription issued as a result of a telemedicine medical service is determined to be valid by the same standards that would apply to an in-person setting where a prescription is issued. Board Rule 217.24 outlines valid prescriptions via telemedicine medical services.

Additional Resource Documents

Revised 2021

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For more information on these and other topics, use the search field at the top right corner of the page. Should you have further questions or are in need of clarification, please feel free to contact the Board.