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Nursing Practice Act, Nursing Peer Review Act, & Nurse Licensure Compact

Texas Occupations Code and Rules Regulating the Practice of Nursing
Effective September, 2011

Preface

Agency Mission

The mission of the Texas Board of Nursing (BON or Board) is to protect and promote the welfare of the people of Texas by ensuring that each person holding a license as a nurse in this state is competent to practice safely. The Board fulfills its mission through the regulation of the practice of nursing and the approval of nursing educational programs. This mission, derived from the Nursing Practice Act, supersedes the interest of any individual, the nursing profession, or any special interest group.

Notice

The 81st Regular Session of the Texas Legislature passed four bills which amend the Nursing Practice Act (NPA).

House Bill (HB) 3961 enacts new requirements for physical and psychological evaluations related to fitness to practice and requires confidentiality of information collected for emergency relief work and certain health information provided for licensure. HB 3961 also authorizes a study by the Nursing Resource Center, at the Texas Department of State Health Services, evaluating competencies of clinical judgements and behaviors that professional nurses should possess at graduation of professional nursing programs.

House Bill 4353 allows the Board to issue a special license to a person already licensed to practice nursing in Mexico. The license will allow the person to practice nursing in a Texas hospital located in a county that borders Mexico. The person must have received a score of at least 475 on a Test of English as a Foreign Language (TOEFL) examination and a passing score on the English language version of the National Council Licensure Examination (NCLEX). The nurse must achieve a passing score of 560 on the TOEFL exam within a year of receiving the special license to continue practicing nursing in Texas. The provisions of HB 4353 expire September 1, 2013.

Senate Bill (SB) 476 amends the Nursing Practice Act by adding new Section 301.356 relating to Refusal of Mandatory Overtime. Following passage of SB 476, nurses working in a hospital may refuse to work mandatory overtime and refusing to work overtime, "does not constitute patient abandonment." SB 476 also amends the Texas Health and Safety Code by adding Chapters 257 and 258, which requires the governing body of a hospital to adopt, implement, and enforce a written official nurse services staffing policy that ensures that an adequate number and skill mix of nurses are available to meet the level of patient care needed. SB 476 also requires hospitals to establish nurse staffing committees as standing committees of the hospital. These committees must meet at least on a quarterly basis. The nurse staffing committee is required to develop and recommend a nurse staffing plan to the hospital's governing body. The requirements for committee membership are specific and require the various types of nursing services provided by the hospital to be adequately represented on the committee. The Chief Nursing Officer (CNO) is a voting member of the committee and 60% of the committee must be RNs who spend at least 50% of their work time in direct patient care. RNs serving on the committee must be elected by their peers who provide direct patient care at least 50% of their work time. Committees are to meet during working hours and nurses are to be relieved of other duties in order to attend the meetings. Nurse staffing plans should be used as a component of the nurse staffing budget and nurses are encouraged to provide input to the nurse staffing committee without fearing retaliation from their employer.

Senate Bill 1415, which amends the Nursing Practice Act, requires the Board to study the feasibility of implementing a pilot program regarding the deferral of final disciplinary action no later than February 1, 2010. The pilot program would only apply to sanctions other than reprimand, denial, suspension or revocation of licensure for violations of the Nursing Practice Act.

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Introduction

Welcome to the practice of nursing in the State of Texas. As you continue to practice as a nurse in Texas, it is your responsibility to be aware of changes to the law and the Board's rules and regulations. Changes are reported in the Board's quarterly newsletter mailed to all nurses licensed in Texas as well as posted on the BON web site. To assist you in being aware of these changes, the Board offers the following information and detailed table of contents.

Chapter 301 of the Texas Occupations Code (TOC) contains the Nursing Practice Act (NPA) which creates the BON and defines its responsibility for regulating nursing education, licensure and practice. Chapter 303 relates to Nursing Peer Review and Chapter 304 relates to the Nurse Licensure Compact. Chapter 305 introduces the Advanced Practice Registered Nurse Compact which will be implemented at a later date. These chapters of the TOC define nursing practice and give the Board the authority to make rules which implement and interpret the NPA. Licensees are required to comply with the NPA and the Board's rules. The NPA and the Rules are amended from time to time. Only the Legislature can change the NPA, so statutory changes only occur every two years. The Board makes rule changes as needed to assist in the application of the NPA to evolving practice conditions and settings. It is necessary, therefore, that you keep up with the changes. You may obtain copies of this pamphlet at a nominal cost by writing to the Board's office at 333 Guadalupe, Ste. 3-460, Austin, Texas 78701; calling 512/305-7400; or accessing our web page at www.bon.state.tx.us.

Any person practicing or offering to practice nursing in this state is required to have a license. Your license must be renewed every two years in order to continue practicing in Texas. Once licensed, you are authorized to use the title "RN" or "LVN" and are required to wear a name tag identifying yourself as a "RN" or "LVN" while providing patient care.

You must keep the Board informed of your current address at all times. To inform the Board of your address change or a name change, send written notice, clearly marked "change of address" or "name change" to the Board's office within ten (10) days of the occurrence. Failure to do so can result in a lapse of your license and potential disciplinary action.

Nurses practicing in this state are expected to know and practice in compliance with chapters 301, 303, 304 and 305 of the TOC and with the Board's Rules. Please refer to the following "Quick Reference" section, as well as the rules and excerpts printed in the back of this booklet. A complete set of the Board's Rules and Regulations Relating to Nurse Education, Licensure and Practice can be found here Board's Rules and Regulations PDF graphic icon or purchased from the Board office.

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Quick Reference to Sections of the Act

Chapter 301 — Nurses

  • Sec. 301.2511Criminal History Record Information for License Applicants: Requirement to
    provide criminal history record as prerequisite for licensure
  • Sec. 301.262Special License: Lower TOEFL scores accepted for Mexican nurses working in border counties
  • Sec. 301.301Renewal: Procedure to renew your license every two years
  • Sec. 301.303Continuing Competency: Describes the required types and number of hours of CNE
    to keep your license current
  • Sec. 301.306Forensic Evidence Collection Component in Continuing Education: Continuing education
    requirement relating to Forensic Evidence Collection
  • Sec. 301.351Designations: Requirement to wear an insignia identifying yourself as a RN or LVN
  • Sec. 301.353Nurse First Assistants: Describes requirements for recognition as "nurse first assistant"
  • Sec. 301.356Refusal of Mandatory Overtime
  • Sec. 301.401–.402Nurse Reporting: Duty to report colleagues who may expose others to risk of harm
  • Sec. 301.601Anesthesia in Outpatient Setting
  • Sec. 303.003Committee Membership: Requirements for peer review committee membership
  • Sec. 304.001–.010Nurse Licensure Compact: Issuance and limitations of multistate licensure
    privilege for Texas nurses

Chapter 301 — Discipline

  • Sec. 301.452Grounds for Disciplinary Action: Describes violations for which the Board
    should take action
  • Sec. 301.4521Physical and Psychological Evaluation
  • Sec. 301.453Disciplinary Authority of Board; Methods of Discipline
  • Sec. 301.4535Required Suspension, Revocation, or Refusal of License for Certain Offenses:
    Describes bars and restrictions to nurse licensure due to certain criminal offenses

Chapter 303 — Peer Review

Chapter 304 — Nurse Licensure Compact

  • Sec. 304.001–.010Nurse Licensure Compact: Issuance and limitations of multistate licensure
    privilege for Texas nurses

Chapter 305 — Advanced Practice Registered Nurse Licensure Compact

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Six-Step Decision-Making Model for Determining Nursing Scope of Practice

This model is designed to assist the nurse in determining whether a particular activity is within the scope of nurse's practice.
Six-Step Decision-Making Model for Determining Nursing Scope of Practice PDF PDF graphic icon
Six-Step Decision-Making Model for Determining Nursing Scope of Practice Poster PDF PDF graphic icon

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Table of Contents

SUBTITLE E. REGULATION OF NURSING

CHAPTER 301. NURSES

SUBCHAPTER A. GENERAL PROVISIONS

SUBCHAPTER B. TEXAS BOARD OF NURSING

SUBCHAPTER C. EXECUTIVE DIRECTOR

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SUBCHAPTER D. GENERAL POWERS AND DUTIES OF BOARD

SUBCHAPTER E. PUBLIC INTEREST INFORMATION AND COMPLAINT PROCEDURES

SUBCHAPTER F. LICENSE REQUIREMENTS

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SUBCHAPTER G. LICENSE RENEWAL

SUBCHAPTER H. PRACTICE BY LICENSE HOLDER

SUBCHAPTER I. REPORTING VIOLATIONS AND PATIENT CARE CONCERNS

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SUBCHAPTER J. PROHIBITED PRACTICES AND DISCIPLINARY ACTIONS

SUBCHAPTER K. ADMINISTRATIVE PENALTY

SUBCHAPTER L. OTHER PENALTIES AND ENFORCEMENT PROVISIONS

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SUBCHAPTER M. ANESTHESIA IN OUTPATIENT SETTING

SUBCHAPTER N. CORRECTIVE ACTION PROCEEDING

CHAPTER 303. NURSING PEER REVIEW

CHAPTER 304. NURSE LICENSURE COMPACT

CHAPTER 305. NCSBN ADVANCED PRACTICE REGISTERED NURSE COMPACT

[Expired December 31, 2011]

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