Each state, including Texas, has its own version of the Nursing Practice Act (NPA). If you're a licensed nurse, you probably are already very aware of the role that the NPA plays in regulating the nursing profession in general and your work as a licensed nurse in particular. Texas's NPA covers a wide range of topics, including the composition and duties of the Texas Board of Nursing, testing and licensing requirements for the different types of nursing licenses issued by the state, continuing education requirements for licensed nurses, disciplinary standards and procedures, and more. In particular, the NPA provides guidance on the types of care that licensed nurses are expected to provide, as well as what they are prohibited from doing.
Having a good understanding of what the Texas NPA expects from you as a nurse and what it prohibits can help you avoid being accused of violating the NPA and facing disciplinary sanctions that can jeopardize your license. If you are facing a disciplinary investigation or proceeding, or if you have questions about what the Texas NPA expects of you in a particular situation, the Lento Law Firm's Professional License Defense Team is here to help. Call us today at 888.535.3686 or use our contact form to schedule a confidential consultation with an experienced attorney.
What is the Nursing Practice Act?
The Texas Nursing Practice Act includes statutes that can be found in Chapter 301 of the Texas Occupations Code, as well as rules and regulations found in Title 22, Part 11 of the Texas Administrative Code. For the most part, these statutes, rules, and regulations are administered by the Texas Board of Nursing (BON). In addition to its licensing functions, the BON issues rules relating to the practice of nursing regulates nursing education in the state, investigates complaints made against licensed nurses, and disciplines nurses found to have committed misconduct. The NPA is made up of more than 150 statutory sections and almost 200 regulatory rules which together cover many, many aspects of nursing practice for the various types of nursing licenses issued by the Texas BON.
The Texas BON's website includes many resources that nurses can use to help explain what the NPA requires under various circumstances. This includes information on a number of aspects of nursing practice, advanced practice registered nurse nursing practice, the scope of practice for licensed vocational nurses, registered nurses, and advanced practice registered nurses, more than 30 BON “Position Statements” on various topics, and more. The wealth of information available through the BON website can make it a challenge to find exactly the information you may need if you have a question that relates to what your responsibilities are as a nurse in a particular situation or if you've been notified that a misconduct complaint has been made against you. The Lento Law Firm's Professional License Defense Team can help you in these situations.
What Does the Texas Nursing Practice Act Authorize Licensed Nurses to Do?
The Texas Nursing Practice Act provides guidelines for the kinds of care and standards that registered nurses are expected to provide. Because nursing is a skilled profession, the NPA doesn't attempt to cover every conceivable health care situation in detail. Indeed, the NPA recognizes that “professional nursing” requires “substantial specialized judgment and skill.” It notes that the “proper performance” of professional nursing is based on “knowledge and application of the principles of biological, physical, and social science” as taught by an approved nursing school. Professional nurses at all levels are expected to be able to:
- “Know and conform” to Texas's NPA, including the BON's rules and regulations.
- Take steps to “promote a safe environment” for patients.
- Accurately and completely maintain patient care records.
- Maintain the confidentiality of patient information except as allowed or required by law.
- When encountering new equipment or technology in a patient care situation, “make a reasonable effort” to become competent with it before using it for patient care.
- When implementing nursing procedures or practices, obtain instruction or supervision as necessary.
- When leaving a nursing assignment, notify their supervisor.
- Be aware of and maintain professional boundaries in the relationship between nurse and patient.
- Comply with the Texas NPA's mandatory reporting requirements as they relate to reporting misconduct by another nurse.
- Do not discriminate against any patient based on their “age, disability, economic status, gender, national origin, race, religion, health problems, or sexual orientation.”
- Take appropriate steps to prevent exposure to “infectious pathogens and communicable conditions.”
- Intervene as necessary to help stabilize a patient's condition or prevent complications.
- Clarify an order or treatment regimen when there are legitimate questions about its accuracy or effectiveness by consulting with the “appropriate licensed practitioner.”
- Notify the practitioner who ordered medication or treatment when the nurse makes a decision not to administerit.
What Does the Texas Nursing Practice Act Authorize Registered Nurses to Do?
Registered nurses are expected to observe the standards described above. In addition, they are also expected to be able to:
- Use a “systemic approach” to delivering patient care that includes:
- Performing “comprehensive nursing assessments”
- Making nursing diagnoses that can be used to develop care strategies for the patient
- Developing a nursing care plan for the patient
- Implementing appropriate nursing care
- Evaluating the patient's responses to the care
- Observe, assess, intervene, evaluate, rehabilitate, care for counsel, and educate patients who are “ill, injured, infirm, or experiencing a change in normal health processes.”
- Maintain health or prevent illness.
- Where permitted by their license, correctly administer medication or treatments as ordered by a physician, podiatrist, or dentist and know the “rationale for and the effects of” the administered medication.
- As appropriate based on their license and position, supervise others working with the nurse in connection with providing health care.
- Administer, supervise, and evaluate “nursing practices, policies, and procedures.”
- Supervise the nursing care provided by others for whom the nurse is responsible.
What does the Texas Nursing Practice Act Authorize Advance Practice Registered Nurses to Do?
Advanced practice registered nurses in Texas include nurse practitioners, nurse-midwives, nurse anesthetists, and clinical nurse specialists. An advanced practice registered nurse (APRN) must complete a separate course of study approved by the Texas BON directed towards the nurse's particular specialty and must be separately licensed as an APRN by the Texas BON.
In addition to the requirements that all professional nurses and registered nurses must meet, APRNs are expected to be able to
- Practice as an APRN in accordance with their particular license specialty.
- Act “independently and/or in collaboration with the health team” in connection with observing, assessing, diagnosing, intervening, evaluating, rehabilitating, caring and counseling, and teaching patients.
- Promote and maintain patient health and prevent patient illness.
- Prescribe medications as authorized by the BON when appropriate.
- Where authorized, request, receive, sign for, and distribute prescription drug samples to patients.
- When the APRN is a nurse-midwife, administer certain controlled substances as appropriate “during intra-partum or immediate post-partum care,” provided a physician has delegated authority to do so to the nurse-midwife and other requirements are met.
- When the APRN is a nurse anesthetist, select, obtain, and administer drugs pursuant to a physician's order for anesthesia or an anesthesia-related service.
What Does the Texas Nursing Practice Act Authorize Vocational Nurses to Do?
The Texas BON also regulates the licensing and practice of vocational nurses, who, in most other states, are known as licensed practical nurses. Vocational nurses must be supervised by a registered nurse, advanced practice registered nurse, physician assistant, physician, dentist, or podiatrist. The responsibilities of a vocational nurse are more limited than those of a registered nurse, though obviously still extremely important in the context of patient care.
In addition to the requirements that apply to all professional nurses listed above, vocational nurses are expected to be able to:
- Collect data and perform “focused nursing assessments” of a patient's health status.
- Participate in planning the care needs of a patient.
- Participate in the creation and modification of a patient's nursing care plan.
- Help to evaluate a patient's response to “nursing intervention,” and to identify the patient's needs.
- Participate in teaching and counseling a patient to “promote, attain, and maintain” the patient's “optimum health level.”
- Assign care tasks to unlicensed personnel consistent with their education, experience, knowledge, and ability and supervise them.
If you are a licensed vocational nurse in Texas facing discipline from the BON, the Lento Law Firm's Professional License Defense Team is ready to help you protect your license and your future.
Texas BON Continuing Education Requirements
In addition to the initial licensing requirements each type of nurse must meet, all nurses have an obligation to take a minimum number of continuing education courses that have been approved by the BON. The requirements vary depending on the type of nursing license the nurse holds. A nurse who fails to meet the continuing education requirements or who falsely says that they have done so can be disciplined by the BON.
What Does the Texas Nursing Practice Act Prohibit Nurses from Doing?
One of the functions of the Texas BON is to take disciplinary action against nurses who commit misconduct that violates the NPA's statutes or rules. The misconduct that the Texas BON will discipline nurses for includes the following:
- Making false records relating to patient care.
- Failing to cooperate with a BON misconduct investigation
- Abusing or neglecting patients – physically, emotionally, or verbally.
- Failing to report patient abuse to their employer, law enforcement, or the BON.
- Violating professional boundaries between the nurse and patient, including engaging in sexual contact with a patient, emotionally exploiting a patient, or taking financial advantage of a patient (or significant others of the patient).
- Threatening violence in the workplace.
- Stealing from patients or their workplace.
- Providing false or deceptive information in connection with their nursing practice.
- Providing false, deceptive, or incomplete information in connection with their nursing license or employment.
- Accepting payment from any third party in exchange for referring a patient to the party for health care services.
- Failing to pay child support as required by Texas law.
- Diverting drugs or attempting to do so.
- Being dismissed for noncompliance from a BON-approved “peer assistance program.”
- Use of drugs, controlled substances, or alcohol while working, or working while impaired by any of these.
- Leaving a nursing assignment without notifying the appropriate personnel or providing for the continued care of a patient.
- Violating an order from the BON or helping another nurse to do so.
- Helping anyone to unlawfully practice nursing.
- Failing to report NPA or BON rule violations to the BON.
- For registered nurses who perform radiologic procedures, failing to act within the scope of the NPA and BON rules, complete an approved training program in connection with those procedures, or follow the Medical Radiological Technologist Certification Act and any applicable rules of the Texas Medical Board.
If you are facing a misconduct complaint based on an alleged violation of these or any other statutes, rules, or requirements of the Texas NPA or BON, you need the help of an experienced professional license defense attorney. Your nursing license is the key to your career and your livelihood, and when it is placed at risk by a misconduct complaint, it makes sense to have an attorney who understands the Texas NPA and the BON's rules and procedures on your team to defend you.
The Lento Law Firm's Professional License Defense Team Can Help
It can be very upsetting as well as enormously distracting to learn that someone has filed a misconduct complaint against you with the Texas BON. If that has happened to you, the Lento Law Firm's Professional License Defense Team can help. Our attorneys have years of experience helping licensed nurses and other healthcare professionals in Texas and across the US protect their licenses and their futures in the face of disciplinary investigations or proceedings.
We will make sure you meet the deadlines for a nursing misconduct case and that you meet your obligation to cooperate with the BON's investigation so that you can't be accused of violating that requirement. We will also communicate regularly with the BON and, in appropriate circumstances, will negotiate with the BON on your behalf to resolve the matter in the best way for you. And when necessary, we will vigorously defend you in the BON disciplinary hearing.
You've worked very hard to earn your nursing license. When that license is threatened by a misconduct allegation, call the Lento Law Firm's Professional License Defense Team at 888.535.3686 or use our contact form to schedule a confidential consultation with one of our experienced attorneys. Let us help you protect your license, your career, and your future!
