Contact Hours: 2
This educational activity is credited for 2 contact hours at completion of the activity.
To provide healthcare professionals with an overview of the Nurse Practice Act and Texas Board of Nursing rules for nursing practice, and ethical considerations.
Contact Hour Designation
This online independent study activity is credited for 2 contact hours.
The Nursing Practice Act was codified as Chapter 301 of the Texas Occupations Code, which created laws for professional nurses and practice standards. The state of Texas recognized professional nursing after the NPA was passed, and soon afterward the Texas Board of Nursing was established. The board defines the requirements in education, licensure, and practice of nurses. This course provides an overview of the Nurse Practice Act and Texas Board of Nursing rules for nursing practice, and ethical considerations.
Upon completion of the independent study, the learner will be able to:
- Describe the Nurse Practice Act
- Describe the functions of the Texas Board of Nursing
- Review requirements for nursing licensure in the state of Texas
- Identify prohibitive nursing practices
- Understand mandatory reporting requirements
This activity has been planned and implemented in accordance with the policies of FastCEForLess.com.
Fast CE For Less, Inc and its authors have no disclosures. There is no commercial support.
|Nurse Practice Act (NPA)||The nurse practice act defines the authority, power, and composition of the Texas Board and sets the scope of practice and responsibilities for nurses|
|Texas Nurse Association (TNA)||A statewide membership-based professional association of licensed nurses|
|Texas Occupations Code 301||A provision of law that outlines health professions and regulation of nursing|
|Nurse||A person trained to care for the sick or infirm|
|Texas Board of Nursing||The accrediting board responsible for the licensure, regulation, and monitoring of the nurses in the state of Texas.|
|Licensed Vocational Nurse||A graduate of school of vocational nursing whose qualifications have been examined by a state board of nursing and who has been legally authorized to practice as a licensed vocational nurse.|
|Registered Nurse||A graduate of a school of nursing whose qualifications have been examined by a state board of nursing and who has been legally authorized to practice as a registered nurse.|
|Advanced Practice Nurse||A registered nurse who has education beyond the basic nursing education and certified by a nationally recognized professional organization in a nursing specialty, or meeting other criteria established by the Texas Board of Nursing.|
Prior to the early 1800s, nursing practice laws were nonexhistent.2 Nurses often worked in hospitals without proper guidance and were not licensed or registered.2 Because training and educational experiences varied between states, the need for organized training of professional nurses became apparent in all states, including Texas.2
In 1907, the Texas Graduate Nurses’ Association (now the Texas Nurse Association) was formed to improve the practice and education of nurses.3 The organization proposed a bill to the Texas Legislature to create a state registration for nurses, which was passed in 1909 and created the Board of Nurse Examiners for the State of Texas.3
As a result of the creation of the Board of Nurse Examiners, nursing school standards greatly improved.3 Eight-hour school days were introduced, along with 3-year nursing courses.3 The Texas Nurses Association also helped create the first Nursing Practice Act (NPA) and added nursing practice definitions, peer preview, whistle-blower protection, and more to the NPA.3
The Nursing Practice Act (NPA, passed in March 1909, has been revised and amended multiple times, reflecting the changes in nursing.2 The Texas Board of Nursing (BON), formerly called the Board of Nurse Examiners, is responsible for licensing, regulating, and monitoring the status of licensed registered and licensed vocational nurses.4
The Nursing Practice Act was codified as Chapter 301 of the Texas Occupations Code, which created laws for professional nurses and practice standards.2 The state of Texas recognized professional nursing after the NPA was passed, and soon afterward the Texas Board of Nursing was established. The board defines the requirements in education, licensure, and practice of nurses.2
The Texas Board of Nursing consists of thirteen members appointed by the governor with the advice and consent of the Senate.1 All members are appointed without regard for race, disability, gender, color, sex, religion, or national origin.1
The members consist of the following groups1:
- Six nurse members include one advanced practice nurse, two registered nurses, and three vocational nurses that are not members of the nurse faculty.
- Three members are nurse faculty members of schools of nursing. All three are different based on the degree program their school of nursing offers. For instance, one member’s school of nursing offers a baccalaureate degree program, the second member’s school of nursing offers an associate degree program, and the last is a faculty member of a school of nursing at an institution of higher education.
- Four members represent the public.
There are certain rules for appointing members to the board of nursing. For instance, a person is not eligible for the role of a registered nurse or vocational nurse member of the board unless the person has practiced nursing in the role for which the member was appointed for at least three of the five years preceding the date of appointment.1
Moreover, a person is not eligible for the role of the public member of the board of nursing if the person or the person’s spouse is1:
- Certified, licensed, or registered by an occupational regulatory agency in the healthcare field.
- Directly or indirectly owns or controls 10% of a business entity or organization that provides health care services, sells, and manufactures health care equipment, and receives money or tangible goods, services, or funds from the board.
- Participates or is employed by a business entity or organization that provides health care services, sells, and manufactures health care equipment, and receives money from the board.
The board is responsible for establishing and reinforcing rules to regulate the practice of professional and vocational nurses, establish standards of professional conduct for license holders, and determine whether an act is in line with the current nursing practice.1
In subchapter D, General Powers and Duties of Board, section 301.152 consists of rules regarding specialized training, which can be summarized as follows:
- The board has the power to license a registered nurse as an advanced practice registered nurse.1 This term includes a nurse practitioner, clinical nurse specialist, nurse midwife, and nurse anesthetist.1 According to the board, a registered nurse is licensed as an advanced practice registered nurse upon completion of an advanced educational program.1
- The board also establishes specialized training or education, including pharmacology for advanced practice registered nurses to prescribe or order a drug or device as delegated by a physician under Section 157.0512 or 157.054 and a system as well for issuing a prescription authorization number to an advanced practice registered nurse.1
- The board is also responsible for renewing any license or approval granted to any advanced practice registered nurse.1
For the above rules, the candidate must complete pharmacology and related pathophysiology education for initial approval and continue education in clinical pharmacology and related pathophysiology in addition to any continuing education otherwise required under Section 301.303.1
License Requirements and Renewal
To get licensed as a registered nurse, the applicant must submit the following documents to the board: a complete and legible set of fingerprints to obtain criminal history record information from the Department of Public Safety and the Federal Bureau of Investigation.1
The applicant for a registered nurse license or a vocational nurse license also must submit a sworn application that demonstrates their qualifications, such as completion of a professional or vocational nursing education program, professional character related to nursing practice, and passing the nursing examination approved by the board.1
The nursing examination is conducted on the licensing requirements, board rules, and other laws, rules, and regulations regarding the nursing profession followed in Texas.1 The board is responsible for adopting the rules for the nursing examination regarding the examination development, applicable fees, administration, reexamination, grading procedures, and result notice.1
For license renewal, the board has adopted a system under which licenses will expire during various dates of the year.1 Moreover, a person with an expired license is not allowed to participate in activities that require a license until it has been renewed.1 Following are the different scenarios of license renewal1:
- A person whose license has not expired can renew it before the expiration date by submitting the renewal fee to the board and complying with other license renewal requirements.
- A person whose license has expired for 90 days or less can renew it by submitting the renewal fee and late fee to the board.
- A person whose license has expired for more than 90 days but less than a year can renew it by paying all the unpaid renewal fees and a late fee that is twice the amount of a late fee for the above applicant.
- A person can obtain a new license by submitting to reexamination and complying with the requirements and procedures for obtaining an original license.
The board has developed a system and set a time limit, after which the license will not be renewed.1 The board is also responsible for sending a written notice to the individual 30 days before their license expiration date.1
Moreover, a registered nurse who practices professional nursing after
the expiration of the nurse’s license is an illegal practitioner whose license may be revoked or suspended by the board.1
The board prepares, organizes, or implements continuing competency programs for license holders, making it a condition for license renewal.1 The programs help nurses demonstrate their competency by completing continuing education programs or having a professional portfolio, including certifications.1 The board also decides the nurses, time required to complete, course type, fee, and frequency for continuing competency education.1
Each licensed candidate must understand and comply with the Nursing Practice Act (NPA) and the board’s rules and regulations.5 Among them, the standards of nursing practice and unprofessional conduct need to be reviewed in their entirety.5
The standards of nursing practice are developed to establish the minimum level of nursing practice in any setting for each level of nursing licensure or advanced practice authorization.2,6 Failure to comply with these standards may result in the nurse’s license being terminated even if no patient injury occurred.2,6
The standards applicable to all nurses, i.e., vocational nurses, registered nurses, and registered nurses with advanced practice authorization, are as follows:2,6
The Texas Occupations Code Chapter 301 (Nursing Practice Act), Subchapter I, consists of mandatory reporting requirements that include reporting a nurse:
Licensed vocational nursing practice is directed under the supervision of a registered nurse, advanced practice registered nurse, physician’s assistant, physician, podiatrist, or dentist.6 Standard nursing practices for vocational nurses include determining healthcare needs within a healthcare setting and:2,6
- Nurses must develop a systematic approach that provides individualized and purposeful nursing care by:
- Data collection and performing focused nursing assessment,
- Participate and plan nursing care needs for the patient
- Participate in the development and modification of comprehensive care plans for assigned patients.
- Based on the licensed vocational registered nurse’s scope of practice, implement appropriate aspects of care.
- Evaluate patients’ responses to nursing interventions and identify the patient’s needs.
- Nurses should assign specific tasks, activities, and functions to unlicensed personnel at a level with the educational preparation, experience, knowledge, and physical and emotional ability of the person to whom the assignments are made and maintain appropriate supervision of unlicensed personnel.
- Nurses may perform acts that require continuing education and training. This is often prescribed by the board of nursing and should be at the level with the licensed vocational nurse’s experience, continuing education, and demonstrated licensed vocational nurse competencies.
Standards of nursing specific to registered nurses include2,6:
- Nurses need to develop a systematic approach that provides individualized and purposeful nursing care by:
- Perform comprehensive nursing assessments regarding the patient’s health status.
- Make diagnoses that will serve as the basis of patient care plans and strategies.
- Develop a care plan based on nursing assessment and diagnosis.
- Implement nursing care
- Evaluate nursing interventions based on the patient’s responses.
- Delegate tasks to unlicensed personnel relating to patients with acute conditions or in acute care environments and independent living environments for patients with stable and predictable conditions.
The standards of nursing specific for a registered nurse with advanced practice certification can supersede the standards of other nurses if a conflict of standards occurs. For such nurses, the standards are as follows:2,6
- Practice in an advanced nursing practice role and specialty following the authorization granted under Board Rule Chapter 221 and standards set out in that chapter.
Prescribe medications following the prescriptive authority granted under Board Rule Chapter 222 of this title and standards set out in that chapter and in compliance with state and federal laws and regulations relating to the prescription of dangerous drugs and controlled substances.
The following are mandatory reports that nurses should make to the Board of Nursing (BON)1:
- Any report made to the board must be written and signed and should include the identity of the nurse or student or additional information required by the board.
- Nurses should report if they suspect a nursing student’s ability to perform the nursing profession’s services would be, or would be expected to be, impaired by chemical dependency.
- A nurse can also report to the peer review committee or the nursing educational program under which the student is enrolled.
- A person may not suspend or terminate employment, discipline, discriminate, or retaliate against a person who reports in good faith or advises a nurse of the nurse’s right to report.
Following are the optional reports made by nurses to the board or related authority that a licensed healthcare practitioner, agency, or facility that a nurse has exposed a patient to a substantial risk because of failing to provide patient care that conforms to1:
- For a report made regarding a practitioner, minimum standards of acceptable and prevailing professional practice, or statutory, regulatory, or accreditation standards, for a report made regarding an agency or facility.
The peer review committee is also responsible for reporting a nurse that has engaged in conduct subject to the Board.1 The written and signed report should include the nurse’s identity, a description of the action taken against the nurse, a recommendation for the action taken by the board, the description of the conduct subject to reporting, the extent of the violation, and any other additional information the board requires.1
Board Responsibilities Regarding Report
After a report is received, the board needs to determine whether a nurse violated a rule that affected their ability to perform the practice of nursing because of impaired functionality by chemical dependency or diminished mental capacity and in which the nurse was suspected of committing a practice violation.1 The board needs to be careful and strike a balance that protects the public and ensures the impaired nurse receives treatment.1
The board is responsible for creating guidelines to outline the roles and responsibilities of the board and a peer assistance program established or approved by the board under Chapter 467, Health and Safety Code.1 The board also created an outline for the process of a peer assistance program and establish requirements for the completion of a program demanded by the board.1 The board also establishes a clear procedure based on meaningful performance goals for evaluating the success of a peer assistance program.1
Certain prohibited practices, as outlined by the BON, include1:
- A person cannot sell, obtain, or fraudulently furnish a nursing diploma, license, renewal license, or record.
- A person cannot practice nursing under a license, diploma, or record fraudulently obtained, signed, or issued under unlawful and false representation.
- A person cannot assist another person in selling, obtaining, or fraudulently furnishing a nursing diploma, license, renewal license, or record.
The board is required to impose a penalty on a person licensed or regulated who violates the rules and regulations.1 The amount of penalty should not exceed $5,000 for each violation and the amount of the penalty is based on the seriousness of the violation, including the nature and extent of the prohibited acts and the potential hazard created to the health, safety, or economic welfare of the public.1
The penalty amount is also depended on the economic harm to the property or environment, the history of previous violations, the amount necessary to deter a future violation, the efforts made to correct the violation, and any other matter that justice may require, including litigation, incarceration, license suspension, and revocation of nursing licens.1
A nursing peer review committee is a committee established under the authority of1:
- Governing body of a national, state, or local nursing association
- A school of nursing
- The nursing staff of a hospital, health science center, nursing home, home health agency, temporary nursing service, other health care facility, a state agency, or political subdivision for the purpose of conducting peer review
A peer review committee is created to evaluate the qualifications of a nurse, nursing services, quality of patient care provided, the merits of a complaint concerning a nurse or nursing care, and a determination or recommendation regarding a complaint.1
The establishment of a nursing peer review committee is required if a person regularly employs, hires, or contracts for the services of eight or more vocational nurses or if a person regularly employs, hires, or contracts for the services of eight or more nurses, at least four of whom are registered nurses, for professional nurses.1
The members of a peer review committee should have nurses as three-fourths of its members.1 For a peer review committee that involves the practice of vocational nurses, it should mostly include vocational nurses as members or may have only registered nurses and vocational nurses as voting members.1 Moreover, a peer review that involves the practice of professional nursing must have registered nurses as two-thirds of its members and may have only registered nurses as voting members.1
A nursing peer review committee is responsible for disclosing written, or oral communications made to the committee and the records and proceedings of the committee, on request, to a licensing authority of any state or a law enforcement agency investigating a criminal matter.1 However, a peer review committee is responsible for disclosing written or oral communications to another peer review committee, a licensing agency of the state, or a person engaged in research.1
The Texas nursing law is a complete code of conduct for nurses, including the principles of nursing ethics and boundaries. The American Nurses Association Code of Ethics states that “The nurse’s primary commitment is to the patient, whether an individual, family, group, community, or population.” Certain situations may offer challenges to nurses, including conflicts of interest, collaborative situations, and issues of professional boundaries.2
As nursing is one of the most widely respected and trusted professions, nurses should be knowledgeable regarding professional boundaries and vigilant in their observation of those boundaries.2 The professional boundaries are also a code of conduct for an ideal patient-nurse relationship and prevents under and over-involvement.2 The National Council of State Boards of Nursing defines professional boundaries as “the spaces between the nurse’s power and the client’s vulnerability.”2
Nurses have a professional responsibility to know and understand their own boundaries as well as rules and laws applicable in the state of Texas.2 When questions arise, the nurse should contact the Texas Board of Nursing at (512) 305-7400.
- 22 Tex. Admin. Code § 217.11 – Standards of nursing practice. (n.d.). LII / Legal Information Institute. https://www.law.cornell.edu/regulations/texas/22-Tex-Admin-Code-SS-217-11
- Laws & rules – Rule changes. (n.d.). Welcome to the Texas Board of Nursing Website. https://www.bon.texas.gov/laws_and_rules_rule_changes.asp.html
- Texas Board of Nursing – History. (n.d.). Welcome to the Texas Board of Nursing Website. https://bon.texas.gov/history.asp.html
- Texas Board of Nursing – Laws & rules – Rules & regulations. (n.d.). Welcome to the Texas Board of Nursing Website. https://bon.texas.gov/laws_and_rules_rules_and_regulations.asp.html
- Texas Board of Nursing – Practice – Guidelines. (n.d.). Welcome to the Texas Board of Nursing Website.
- Texasnurses.org. (n.d.). texasnurses.org. https://www.texasnurses.org/page/AboutTNA