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Nursing Practice Act — Chapter 301

Subchapter A. General Provisions

Sec. 301.001. Short Title.

This chapter may be cited as the Nursing Practice Act.

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Sec. 301.002. Definitions.

In this chapter:

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Sec. 301.003. Application of Sunset Act.

The Texas Board of Nursing is subject to Chapter 325, Government Code (Texas Sunset Act). Unless continued in existence as provided by that chapter, the board is abolished September 1, 2017.

Sec. 301.004. Application of Chapter.

(a) This chapter does not apply to:

(b) This chapter does not authorize the practice of medicine as defined by Chapter 151.

Sec. 301.005. Reference in Other Law.

A reference in any other law to the former Board of Nurse Examiners means the Texas Board of Nursing.

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Subchapter B. Texas Board of Nursing

Sec. 301.051. Board Membership.

(a) The Texas Board of Nursing consists of 13 members appointed by the governor with the advice and consent of the senate as follows:

(b) Appointments to the Board shall be made without regard to the race, color, disability, sex, religion, age, or national origin of the appointee.

Sec. 301.052. Member Eligibility.

(a) A person is not eligible for appointment as 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.

(b) A person is not eligible for appointment as a public member of the board if the person or the person's spouse:

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Sec. 301.053. Membership and Employee Restrictions.

(a) In this section, "Texas Trade Association" means a cooperative and voluntarily joined statewide association of business or professional competitors in this state designed to assist its members and its industry or profession in dealing with mutual business or professional problems and in promoting their common interest.

(b) A person may not be a member of the board and may not be a board employee employed in a "bona fide executive, administrative, or professional capacity," as that phrase is used for the purposes of establishing an exemption to the overtime provisions of the federal Fair Labor Standards Act of 1938 (29 U.S.C. Section 201 et seq.), if:

(c) A person may not be a member of the board or act as the general counsel to the board if the person is required to register as a lobbyist under Chapter 305, Government Code, because of the person's activities for compensation on behalf of a profession related to the board's operation.

Sec. 301.054. Terms.

Members of the board serve staggered six-year terms, with the terms of as near to one-third of the members as possible expiring on January 31 of each odd-numbered year.

Sec. 301.055. Grounds for Removal.

(a) It is a ground for removal from the Board that a member:

(b) The validity of an action of the board is not affected by the fact that the action is taken when a ground for removal of a board member exists.

(c) If the executive director has knowledge that a potential ground for removal exists, the executive director shall notify the presiding officer of the Board of the potential ground. The presiding officer shall then notify the governor and the attorney general that a potential ground for removal exists. If the potential ground for removal involves the presiding officer, the executive director shall notify the next highest ranking officer of the board, who shall then notify the governor and the attorney general that a potential ground for removal exists.

(d) [Repealed by Acts 2007, 80th Leg., R.S., Ch. 889, § 74(1), eff. September 1, 2007.]

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Sec. 301.056. Per Diem; Reimbursement.

(a) Each board member is entitled to receive a per diem as set by the General Appropriations Act for each day the member engages in the business of the Board.

(b) A board member is entitled to reimbursement for travel expenses incurred while conducting board business, including expenses for transportation, meals, and lodging, as provided by the General Appropriations Act.

Sec. 301.057. Officers.

(a) The Governor shall designate a member of the Board as presiding officer to serve in that capacity at the pleasure of the governor.

(b) The Board shall elect other officers from its members.

Sec. 301.058. Meetings.

The presiding officer shall call a special Board meeting on the written request of at least two board members.

Sec. 301.059. Training.

(a) A person who is appointed to and qualifies for office as a member of the board may not vote, deliberate, or be counted in attendance at a meeting of the board until the person completes a training program that complies with this section.

(b) The training program must provide the person with information regarding:

(c) A person appointed to the board is entitled to reimbursement, as provided by the General Appropriations Act, for the travel expenses incurred in attending the training program regardless of whether the attendance at the program occurs before or after the person qualifies for office.

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Subchapter C. Executive Director and Personnel

Sec. 301.101. Executive Director.

(a) The Board shall employ an executive director. The Executive Director may not be a member of the Board.

(b) Under the direction of the Board, the Executive Director shall perform the duties required by this chapter or designated by the Board.

Sec. 301.103. Public Records; Registry.

(a) The Executive Director shall keep:

(b) Information maintained under this section is open to public inspection at all times.

Sec. 301.104. Personnel; Employment Practices.

The Board shall employ persons as necessary to carry on the work of the Board.

Sec. 301.105. Division of Responsibilities.

(a) The Board shall develop and implement policies that clearly define the respective responsibilities of the Board and the staff of the Board.

(b) The Board shall determine the salaries and compensation to be paid to employees and persons retained by the Board.

Sec. 301.106. Qualifications and Standards of Conduct Information.

The Board shall provide, as often as necessary, to its members and employees information regarding their:

Sec. 301.107. Career Ladder Program; Performance Evaluations.

(a) The Executive Director or the Executive Director's designee shall develop an intra-agency career ladder program. The program must require intra-agency posting of all non-entry level positions concurrently with any public posting.

(b) The Executive Director or the Executive Director's designee shall develop a system of annual performance evaluations based on measurable job tasks. All merit pay for Board employees must be based on the system established under this subsection.

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Sec. 301.108. Equal Employment Opportunity Policy; Report.

(a) The Executive Director or the Executive Director's designee shall prepare and maintain a written policy statement to ensure implementation of an equal employment opportunity program under which all personnel transactions are made without regard to race, color, disability, sex, religion, age, or national origin. The policy statement must include:

(b) A policy statement prepared under Subsection (a) must:

(c) The Governor shall deliver a biennial report to the Legislature based on the information received under Subsection (b). The report may be made separately or as part of other biennial reports to the legislature.

Subchapter D. General Powers and Duties of Board

Sec. 301.151. General Rulemaking Authority.

The Board may adopt and enforce rules consistent with this chapter and necessary to:

Sec. 301.152. Rules Regarding Specialized Training.

(a) In this section, "advanced practice nurse" means a registered nurse approved by the Board to practice as an advanced practice nurse on the basis of completion of an advanced educational program. The term includes a nurse practitioner, nurse midwife, nurse anesthetist, and clinical nurse specialist. The term is synonymous with "advanced nurse practitioner."

(b) The Board shall adopt rules to:

(c) At a minimum, the rules adopted under Subsection (b)(3) must:

(d) The signature of an advanced practice nurse attesting to the provision of a legally authorized service by the advanced practice nurse satisfies any documentation requirement for that service established by a state agency.

Sec. 301.1525. Nurse First Assistants.

[Repealed by Acts 2005 (H.B. 1718), 79th Leg., eff. Sept. 1, 2005. Replaced by Sec. 301.353]

Sec. 301.1526. Certain Nurses Directly Assisting in Surgery.

[Repealed by Acts 2005 (H.B. 1718), 79th Leg., eff. Sept. 1, 2005. Replaced by Sec. 301.353]

Sec. 301.1527. Certain Nurses Directly Assisting in Surgery in Small Hospitals.

[Repealed by Acts 2005 (H.B. 1718), 79th Leg., eff. Sept. 1, 2005. Replaced by Sec. 301.353]

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Sec. 301.153. Rules Regarding Advertising and Competitive Bidding.

(a) The Board may not adopt rules restricting advertising or competitive bidding by a person except to prohibit false, misleading, or deceptive practices by the person.

(b) The Board may not include in its rules to prohibit false, misleading, or deceptive practices by a person regulated by the board a rule that:

Sec. 301.154. Rules Regarding Delegation of Certain Medical Acts.

(a) The Board may recommend to the Texas State Board of Medical Examiners the adoption of rules relating to the delegation by physicians of medical acts to registered nurses and vocational nurses licensed by the Board. In making a recommendation, the Board may distinguish between nurses on the basis of special training and education.

(b) A recommendation under Subsection (a) shall be treated in the same manner as a petition for the adoption of a rule by an interested party under Chapter 2001, Government Code.

(c) The Board in recommending a rule and the Texas State Board of Medical Examiners in acting on a recommended rule shall, to the extent allowable under state and federal statutes, rules, and regulations, act to enable the state to obtain its fair share of the federal funds available for the delivery of health care in this state.

Sec. 301.1545. Rules on Consequences of Criminal Conviction or Deferred Adjudication.

(a) The board shall adopt rules and guidelines necessary to comply with Chapter 53, except to the extent the requirements of this subtitle are stricter than the requirements of that chapter.

(b) In its rules under this section, the board shall list the offenses for which a conviction would constitute grounds for the board to take action under Section 53.021 or for which placement on deferred adjudication community supervision would constitute grounds for the board to take action under this chapter.

Sec. 301.155. Fees.

(a) The Board by rule shall establish fees in amounts reasonable and necessary to cover the costs of administering this chapter. The Board may not set a fee that existed on September 1, 1993, in an amount less than the amount of that fee on that date.

(b) The Board may adopt a fee in an amount necessary for a periodic newsletter to produce and disseminate to license holders the information required under Section 301.158.

(c) The board shall assess a surcharge of not less than $3.00 or more than $5.00 for a registered nurse and a surcharge of not less than $2.00 or more than $3.00 for a vocational nurse to the fee established by the board under Subsection (a) for a license holder to renew a license under this chapter. The board may use nine cents of the registered nurse surcharge and six cents of the vocational nurse surcharge to cover the administrative costs of collecting and depositing the surcharge. The board quarterly shall transmit the remainder of each surcharge to the Department of State Health Services to be used only to implement the nursing resource section under Section 105.002, Health and Safety Code. The board is not required to collect the surcharge if the board determines the funds collected are not appropriated for the purpose of funding the nursing resource section.

[Amended by Acts 2009 (H.B. 3961), 81st Leg., eff. June 19, 2009]

Sec. 301.156. Gifts and Grants.

The Board may receive gifts, grants, or other funds or assets.

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Sec. 301.157. Programs of Study and Approval.

(a) The board shall prescribe three programs of study to prepare a person to receive an initial license as a registered nurse under this chapter as follows:

(a-1) A diploma program of study in this state that leads to an initial license as a registered nurse under this chapter and that is completed on or after December 31, 2014, must entitle a student to receive a degree on the student's successful completion of a degree program of a public or private institution of higher education accredited by an agency recognized by the Texas Higher Education Coordinating Board.

(b) The board shall:

(b-1) The board may not require accreditation of the governing institution of a school of nursing. The board shall accept the requirements established by the Texas Higher Education Coordinating Board for accrediting the governing institution of a school of nursing. The governing institution of a professional nursing school, not including a diploma program, must be accredited by an agency recognized by the Texas Higher Education Coordinating Board or hold a certificate of authority from the Texas Higher Education Coordinating Board under provisions leading to accreditation of the institution in due course.

(c) A program approved to prepare registered nurses may not be less than two academic years or more than four calendar years.

(d) A person may not be certified as a graduate of any school of nursing or educational program unless the person has completed the requirements of the prescribed course of study, including clinical practice, of a school of nursing or educational program that:

(d-1) A school of nursing or educational program is considered approved by the board and, except as provided by Subsection (d-7), is exempt from board rules that require ongoing approval if the school or program:

(d-2) A school of nursing or educational program that fails to meet or maintain an acceptable pass rate on applicable licensing examinations under this chapter is subject to review by the board. The board may assist the school or program in its effort to achieve compliance with the board's standards.

(d-3) A school or program from which approval has been withdrawn under this section may reapply for approval.

(d-4) The board may recognize and accept as approved under this section a school of nursing or educational program operated in another state and approved by a state board of nursing or other regulatory body of that state. The board shall develop policies to ensure that the other state's standards are substantially equivalent to the board's standards.

(d-5) The board shall streamline the process for initially approving a school of nursing or educational program under this section by identifying and eliminating tasks performed by the board that duplicate or overlap tasks performed by the Texas Higher Education Coordinating Board or the Texas Workforce Commission.

(d-6) The board, in cooperation with the Texas Higher Education Coordinating Board and the Texas Workforce Commission, shall establish guidelines for the initial approval of schools of nursing or educational programs. The guidelines must:

(d-7) A school of nursing or educational program approved under Subsection (d-1) shall:

(d-8) For purposes of Subsection (d-4), a nursing program is considered to meet standards substantially equivalent to the board's standards if the program:

(d-9) A graduate of a clinical competency assessment program operated in another state and approved by a state board of nursing or other regulatory body of another state is eligible to apply for an initial license under this chapter if:

(d-10) In this section, the terms "clinical competency assessment program" and "supervised clinical learning experiences program" have the meanings assigned by Section 105.008, Health and Safety Code.

(d-11) Subsections (d-8), (d-9), (d-10), and (d-11) expire December 31, 2017. As part of the first review conducted under Section 301.003 after September 1, 2009, the Sunset Advisory Commission shall:

(e) The Board shall give each person, including an organization, affected by an order or decision of the board under this section reasonable notice of not less than 20 days and an opportunity to appear and be heard regarding the order or decision. The Board shall hear each protest or complaint from a person affected by a rule or decision regarding:

(f) Not later than the 30th day after the date an order is entered and approved by the Board, a person is entitled to bring an action against the Board in a district court of Travis County to have the rule or order vacated or modified, if that person:

(g) An appeal under this section shall be tried de novo as if it were an appeal from a justice court to a county court.

(h) The Board, in collaboration with the nursing educators, the Texas Higher Education Coordinating Board, and the Texas Health Care Policy Council, shall implement, monitor, and evaluate a plan for the creation of innovative nursing education models that promote increased enrollment in this state's nursing programs.

[Amended by Acts 2009 (H.B. 3961), 81st Leg., eff. June 19, 2009. Subsections (d-8), (d-9), (d-10), and (d-11) added by Acts 2009 (H.B. 3961), 81st Leg., eff. June 19, 2009.]

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Sec. 301.158. Dissemination of Information.

The Board shall disseminate, at least twice a year and at other times the Board determines necessary, information that is of significant interest to nurses and employers of nurses in this state, including summaries of final disciplinary action taken against nurses by the Board since its last dissemination of information.

Sec. 301.1581. Information Provided to License Holders.

At least once each biennium, the Board shall provide to license holders information on:

Sec. 301.1582. Poison Control Center Information.

The Board shall provide to license holders information regarding the services provided by poison control centers.

Sec. 301.159. Board Duties Regarding Complaints.

(a) The board by rule shall:

(b) The Board shall provide reasonable assistance to a person who wishes to file a complaint with the Board.

Sec. 301.1595. Advisory Committees.

(a) The board may appoint advisory committees to perform the advisory functions assigned by the board.

(b) An advisory committee shall provide independent expertise on board functions and policies, but may not be involved in setting board policy.

(c) The board shall adopt rules regarding the purpose, structure, and use of advisory committees, including rules on:

(d) A board member may not serve as a member of an advisory committee, but may serve as a liaison between an advisory committee and the board. A board member liaison that attends advisory committee meetings may attend only as an observer and not as a participant. A board member liaison is not required to attend advisory committee meetings. The role of a board member liaison is limited to clarifying the Board's charge and intent to the advisory committee.

(e) To the extent of any conflict with Chapter 2110, Government Code, this section and Board rules adopted under this section control.

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Sec. 301.160. Pilot Programs.

(a) In this section:

(b) The Board may develop pilot programs to evaluate the effectiveness of mechanisms, including proactive nursing peer review and targeted continuing nursing education, for maintenance of the clinical competency of a nurse in the nurse's area of practice and the understanding by nurses of the laws, including regulations, governing the practice of nursing.

(c) A pilot program under Subsection (b) must be designed to test the effectiveness of a variety of mechanisms in a variety of practice settings.

(d) The Board may approve a pilot program under Subsection (b) that is to be conducted by a person other than the board.

(e) The Board may spend funds to develop or fund a pilot program and may contract with, make grants to, or make other arrangements with an agency, professional association, institution, individual, or other person to implement this section.

(i) Except as provided by this subsection, in developing or approving a pilot program under this section the Board may exempt the program from rules adopted under this chapter. Subchapter I and Chapter 303 apply to pilot programs, except that Sections 303.002(e), 303.003, and 303.008(b) do not apply to a pilot program using proactive peer review. The Board may establish alternative criteria for nursing peer review committees conducting proactive peer review.

(j) The Board shall issue an annual report regarding any pilot programs developed or approved and a status report on those programs, including preliminary or final findings concerning their effectiveness. The Board shall mail the report to statewide associations of nurses and nurse educators and employers of nurses that request a copy.

[Amended by Acts 2009 (H.B. 3961), 81st Leg., eff. June 19, 2009. Subsections (f), (g) and (h) repealed by Acts 2007 (H.B. 2426), 80th Leg., eff. Sept. 1, 2007]

Sec. 301.1605. Pilot Programs for Innovative Applications.

(a) The Board may approve and adopt rules regarding pilot programs for innovative applications in the practice and regulation of nursing.

(b) The Board shall specify the procedures to be followed in applying for approval of a pilot program. The Board may condition approval of a program on compliance with this section and rules adopted under this section.

(c) In approving a pilot program, the Board may grant the program an exception to the mandatory reporting requirements of Sections 301.401-301.409 or to a rule adopted under this chapter or Chapter 303 that relates to the practice of nursing, including education and reporting requirements for nurses. The Board may not grant an exception to:

[Amended by Acts 2009 (H.B. 3961), 81st Leg., eff. June 19, 2009]

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Sec. 301.1606. Pilot Programs on Nurse Reporting Systems.

(a) The Board may solicit proposals for pilot programs designed to evaluate the efficacy and effect on protection of the public of reporting systems designed to encourage identification of system errors.

(b) The Board may grant a pilot program approved under this section an exception to the mandatory reporting requirements of Sections 301.401-301.409 or to a rule adopted under this chapter or Chapter 303 that relates to the practice of nursing, including education and reporting requirements for nurses. If the board grants an exception, the board may require that the program:

(c) The Board may require that the entity conducting a pilot program under this section reimburse the board for the cost of monitoring and evaluating the pilot program.

(d) The Board may contract with a third party to perform the monitoring and evaluation.

(e) The Board may limit the number of pilot programs that it approves under this section.

[Amended by Acts 2009 (H.B. 3961), 81st Leg., eff. June 19, 2009]

Sec. 301.1607. Pilot Program on Deferral of Final Disciplinary Action.

(a) In this section, "deferred disciplinary action" means a final disciplinary action against a person licensed or regulated under this chapter that is deferred by the board as provided by this section.

(b) Not later than February 1, 2010, the board shall determine the feasibility of conducting a pilot program designed to evaluate the efficacy and effect on the public's protection of board deferral of disciplinary action against a person licensed or regulated under this chapter in cases in which the board proposes to impose a sanction other than a reprimand or a denial, suspension, or revocation of a license. If the board determines the pilot program is feasible, the board shall develop and implement the pilot program not later than February 1, 2011. The pilot program must conclude not later than January 1, 2014.

(c) The pilot program may not include cases in which the board proposes to issue a reprimand or to deny, suspend, or revoke a license.

(d) During the time the pilot program is implemented and for any action or complaint for which the board proposes to impose a sanction other than a reprimand or a denial, suspension, or revocation of a license, the board may:

(e) Except as otherwise provided by this subsection, a deferred disciplinary action by the board under the pilot program is not confidential and is subject to disclosure in accordance with Chapter 552, Government Code. If the person successfully meets the conditions imposed by the board in deferring final disciplinary action and the board dismisses the action or complaint, the deferred disciplinary action of the board is confidential to the same extent as a complaint filed under Section 301.466.

(f) The board may treat a deferred disciplinary action taken against a nurse under this section as a prior disciplinary action against the nurse when considering the imposition of a sanction for a subsequent violation of this chapter or a rule or order adopted under this chapter.

(g) The board may contract with a third party to evaluate the pilot program established under this section.

(h) The board shall appoint an advisory committee to assist the board in overseeing the pilot program and its evaluation. The committee must include representatives of public advocacy organizations.

(i) This section expires September 1, 2014.

[Added by Acts 2009 (S.B. 1415), 81st Leg., eff. Sept. 1, 2009]

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Sec. 301.161. Enforcement.

(a) The Board shall aid in the enforcement of this chapter.

(b) The Board may:

(c) The Attorney General shall provide legal assistance necessary to enforce this chapter. This subsection does not relieve a local prosecuting officer of any duty under the law.

(d) The Board may establish a criminal investigations unit to investigate suspected criminal acts relating to the practice of nursing as authorized by this chapter.

(e) The Board may assist federal, state, or local law enforcement agencies in the investigation and prosecution of crimes related to the practice of nursing.

Sec. 301.1615. Obtaining Criminal History Record Information; Hearing.

(a) In addition to the information to which the board is entitled under Section 411.125, Government Code, the Board may request and receive criminal history record information from the Federal Bureau of Investigation as provided by Section 411.087, Government Code.

(b) Criminal history record information received by the Board may be used only by the board and is privileged. The information may not be disclosed to any person other than:

(c) If, on the basis of criminal history record information obtained by the Board, the board proposes to deny an application for a license, refuse to renew a license, or suspend or revoke a license or temporary permit, the applicant or license holder is entitled to a hearing under Section 301.454.

Sec. 301.162. Legal Counsel.

The Board may retain legal counsel to represent the Board if first:

Sec. 301.163. Record of Proceedings; Report.

The Board shall keep a record of its proceedings under this chapter and make an annual report to the Governor.

Sec. 301.164. Assistance of Prosecutor.

A board member may present to a prosecuting officer a complaint relating to a violation of this chapter. The Board, through its members, officers, counsel, or agents, shall assist in the trial of a case involving an alleged violation of this chapter, subject to the control of the prosecuting officers.

Sec. 301.165. Annual Report.

[Repealed by Acts 2011 (S.B. 1179), 82nd Leg., eff. June 17, 2011]

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Sec. 301.166. Use of Technology.

The board shall implement a policy requiring the board to use appropriate technological solutions to improve the board's ability to perform its functions. The policy must ensure that the public is able to interact with the board on the Internet.

Sec. 301.167. Negotiated Rulemaking; Alternative Dispute Resolution.

(a) The board shall develop and implement a policy to encourage the use of:

(b) The Board's procedures relating to alternative dispute resolution must conform, to the extent possible, to any model guidelines issued by the State Office of Administrative Hearings for the use of alternative dispute resolution by state agencies.

(c) The Board shall designate a trained person to:

Subchapter E. Public Interest Information and Complaint Procedures

Sec. 301.201. Public Interest Information.

(a) The Board shall prepare information of public interest describing the functions of the Board and the procedures by which complaints are filed with and resolved by the Board.

(b) The Board shall make the information available to the public and appropriate state agencies.

Sec. 301.202. Complaints.

(a) The board by rule shall establish methods by which consumers and service recipients are notified of the name, mailing address, and telephone number of the Board for the purpose of directing complaints to the board. The Board may provide for that notice:

(b) [Repealed by Acts 2009.]

(c) The Board shall list with its regular telephone number any toll-free telephone number established under other state law that may be called to present a complaint about a health professional.

[Subsection (b) repealed by Acts 2009 (H.B. 3961), 80th Leg., eff. June 19, 2009]

Sec. 301.203. Records and Analysis of Complaints.

(a) The Board shall maintain a system to promptly and efficiently act on complaints filed with the board. The board shall maintain information about:

(b) The Board shall make information available describing its procedures for complaint investigation and resolution.

(c) The Board shall periodically notify the parties to the complaint of the status of the complaint until final disposition unless notice would jeopardize an undercover investigation.

(d) The Board shall develop a method for analyzing the sources and types of complaints and violations and establish categories for the complaints and violations. The Board shall use the analysis to focus its information and education efforts on specific problem areas identified through the analysis.

(e) The Board shall analyze complaints filed with the Board to identify any trends or issues related to certain violations, including:

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Sec. 301.204. General Rules, Policies, and Procedures Regarding Complaint Investigation and Disposition.

(a) The Board shall adopt rules, policies, and procedures concerning the investigation of a complaint filed with the Board. The rules, policies, or procedures adopted under this subsection must:

(b) The Board shall:

(c) The Board shall notify the parties of the projected time requirements for pursuing the complaint.

(d) The Board shall notify the parties to the complaint of any change in the schedule not later than the seventh day after the date the change is made.

(e) The Executive director of the Board shall notify the Board of a complaint that is unresolved after the time prescribed by the Board for resolving the complaint so that the Board may take necessary action on the complaint.

(f) At each public meeting of the board, the executive director shall report to the Board each complaint dismissed under Subsection (a)(6) since the Board's last public meeting.

Sec. 301.205. Public Participation.

(a) The Board shall develop and implement policies that provide the public with a reasonable opportunity to appear before the Board and to speak on any issue under the Board's jurisdiction.

(b) The Board shall prepare and maintain a written plan that describes how a person who does not speak English can be provided reasonable access to the Board's programs.

Sec. 301.206. Confidentiality of Information Collected for Emergency Relief Programs.

(a) In this section, "emergency relief program" means a program operated or sponsored by the federal government, the state, or a nonprofit organization to provide nurses to assist in providing health care to victims or potential victims of a disaster or state or local emergency.

(b) A nurse's personal contact information, including e-mail addresses, telephone numbers, and fax numbers, collected by the board for use by an emergency relief program is:

[Added by Acts 2009 (H.B. 3961), 80th Leg., eff. June 19, 2009]

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Sec. 301.207. Confidentiality of Information Provided for Licensure.

The following information that a person submits to the board for a petition for a declaratory order of eligibility for a license or for an application for an initial license or a license renewal under this chapter is confidential to the same extent information collected on a nurse as part of an investigation of a complaint is confidential under Section 301.466:

[Added by Acts 2009 (H.B. 3961), 81st Leg., eff. June 19, 2009. Amended by Acts 2011 (S.B. 193), 82nd Leg., eff. Sept. 1, 2011]

Subchapter F. License Requirements

Sec. 301.251. License Required.

(a) A person may not practice or offer to practice professional nursing or vocational nursing in this state unless the person is licensed as provided by this chapter.

(b) Unless the person holds a license under this chapter, a person may not use, in connection with the person's name:

(c) This section does not apply to a person entitled to practice nursing in this state under Chapter 304.

(d) unless the person holds a license under this chapter, a person may not use, in connection with the person's name:

Sec. 301.2511. Criminal History Record Information for License Applicants.

(a) An applicant for a registered nurse license must submit to the Board, in addition to satisfying the other requirements of this subchapter, a complete and legible set of fingerprints, on a form prescribed by the Board, for the purpose of obtaining criminal history record information from the Department of Public Safety and the Federal Bureau of Investigation.

(b) The Board may deny a license to an applicant who does not comply with the requirement of Subsection (a). Issuance of a license by the Board is conditioned on the Board obtaining the applicant's criminal history record information under this section.

(c)The Board by rule may develop a system for initiating the process of obtaining criminal history record information for applicants for a license under this chapter by requiring persons who enroll or plan to enroll in an educational program that prepares a person for a license as a registered nurse to submit to the Board a set of fingerprints that meets the requirements of Subsection (a). The Board may require payment of a fee by a person who is required to submit a set of fingerprints under this subsection.

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Sec. 301.252. License Application.

(a) Each applicant for a registered nurse license or a vocational nurse license must submit to the Board a sworn application that demonstrates the applicant's qualifications under this chapter, accompanied by evidence that the applicant:

(a-1) The jurisprudence examination shall be conducted on the licensing requirements under this chapter and board rules and other laws, rules, or regulations applicable to the nursing profession in this state. The board shall adopt rules for the jurisprudence examination under Subsection (a)(3) regarding:

(b) The board may waive the requirement of Subsection (a)(2) for a vocational nurse applicant if the applicant provides satisfactory sworn evidence that the applicant has completed an acceptable level of education in:

(c) The board by rule shall determine acceptable levels of education under Subsection (b).

[Amended by Acts 2007 (H.B. 2426), 80th Leg., eff. Sept. 1, 2007. The requirement to pass a jurisprudence examination, as amended by this Act, applies only to an individual who applies for a license as a nurse on or after September 1, 2008.]

Sec. 301.253. Examination.

(a) Except as provided by Section 301.452, an applicant is entitled to take the examination prescribed by the Board if:

(b) Each examination administered under this section must be prepared by a national testing service or the board. The board shall ensure that the examination is administered in various cities throughout the state.

(c) The examination shall be designed to determine the fitness of the applicant to practice professional nursing or vocational nursing.

(c-1) The board shall:

(d) The Board shall determine the criteria that determine a passing score on the examination. The criteria may not exceed those required by the majority of the states.

(e) A written examination prepared, approved, or offered by the Board, including a standardized national examination, must be validated by an independent testing professional.

(f) The board shall develop a written refund policy regarding examination fees that:

(g) The board may recommend to a national testing service selected by the board to offer examinations under this section the board's written policy for refunding an examination fee for an applicant who:

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Sec. 301.254. Examination Results.

(a) The Board shall notify each examinee of the results of the examination not later than the 30th day after the date the examination is administered. If an examination is graded or reviewed by a national testing service, the Board shall notify each examinee of the results of the examination not later than the 14th day after the date the Board receives the results from the testing service.

(b) If the notice of the examination results graded or reviewed by a national testing service will be delayed for longer than 90 days after the examination date, the Board shall notify each examinee of the reason for the delay before the 90th day.

(c) If requested in writing by a person who fails an examination, the Board shall provide to the person an analysis of the person's performance on the examination.

Sec. 301.255. Reexamination.

The Board by rule shall establish conditions under which an applicant who fails an examination may retake the examination. For an applicant who fails the examination two or more times, the Board may:

Sec. 301.256. Issuance of License.

If the results of an examination taken under Section 301.253 or 301.255 satisfy the criteria established by the Board under that section, the Board shall issue to the applicant a license to practice professional nursing or vocational nursing in this state. The license must be signed by the Board's Presiding Officer and the Executive Director and attested by the Board's Seal.

Sec. 301.257. Declaratory Order of License Eligibility.

(a) A person may petition the board for a declaratory order as to the person's eligibility for a license under this chapter if the person as reason to believe that the person is ineligible for the license and:

(b) The petition must state the basis for the person's potential ineligibility.

(c) The Board has the same powers to investigate the petition and the person's eligibility that it has to investigate a person applying for a license.

(d) The petitioner or the Board may amend the petition to include additional grounds for potential ineligibility at any time before a final determination is made.

(e)If the Board determines that a ground for ineligibility does not exist, instead of issuing an order, the Board shall notify the petitioner in writing of the Board's determination on each ground of potential ineligibility. If the Board proposes to find that the petitioner is ineligible for a license, the petitioner is entitled to a hearing before the State Office of Administrative Hearings.

(f) The Board's order must set out each basis for potential ineligibility and the Board's determination as to eligibility. In the absence of new evidence known to but not disclosed by the petitioner or not reasonably available to the Board at the time the order is issued, the Board's ruling on the petition determines the person's eligibility with respect to the grounds for potential ineligibility set out in the written notice or order.

(g) The Board may require an individual accepted for enrollment or enrolled in an educational program preparing a student for initial licensure as a registered nurse or vocational nurse to submit information to the Board to permit the Board to determine whether the person is aware of the conditions that may disqualify the person from licensure as a registered nurse or vocational nurse on graduation and of the person's right to petition the Board for a declaratory order under this section. Instead of requiring the person to submit the information, the Board may require the educational program to collect and submit the information on each person accepted for enrollment or enrolled in the program.

(h) The information required under Subsection (g) must be submitted in a form approved by the Board.

(i) If, as a result of information provided under Subsection (g), the Board determines that a person may not be eligible for a license on graduation, the Board shall notify the educational program of its determination.

[Amended by Acts 2009 (H.B. 3961), 80th Leg., eff. June 19, 2009]

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Sec. 301.258. Temporary Permit.

(a) Pending the results of a licensing examination, the Board may issue to an applicant who is a graduate of an approved educational program a permit to practice professional nursing under the direct supervision of a registered nurse or to practice vocational nursing under the direct supervision of a registered nurse or vocational nurse.

(b) The Board may not issue a permit under this section to an applicant who has previously failed an examination administered by the Board or another state.

(c) A permit issued under Subsection (a) expires on the date of receipt of:

(d) The Board may issue a temporary permit to practice professional nursing or vocational nursing for the limited purpose of allowing a nurse to satisfy a requirement imposed by the Board necessary for:

(e) A permit issued under Subsection (d) expires on the earlier of:

(f) A person who holds a temporary permit issued under this section is considered to be a licensed registered nurse or vocational nurse for all purposes except to the extent of any stipulation or limitation on practice imposed by the Board as a condition of issuing the permit.

Sec. 301.259. Reciprocal License by Endorsement for Certain Foreign Applicants.

On payment of a fee established by the Board, the Board may issue a license to practice as a registered nurse or vocational nurse in this state by endorsement without examination to an applicant who holds a registration certificate as a registered nurse or vocational nurse, as applicable, issued by a territory or possession of the United States or a foreign country if the Board determines that the issuing agency of the territory or possession of the United States or foreign country required in its examination the same general degree of fitness required by this state.

Sec. 301.260. Temporary License by Endorsement.

(a) An applicant for a license under this chapter who is licensed as a registered nurse or vocational nurse by another state may qualify for a temporary license by endorsement to practice as a registered nurse or vocational nurse, as applicable, by submitting to the Board:

(b) A holder of a temporary license under this section is entitled to receive a permanent license if the applicant:

(c) The Board shall grant or deny an application for a permanent license not later than the 180th day after the date the Board receives all required forms or information. The Board may extend that deadline to allow for the receipt and tabulation of examination results.

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Sec. 301.261. Inactive Status.

(a) The Board may place on inactive status the license of a person under this chapter who is not actively engaged in the practice of professional nursing or vocational nursing if the person submits a written request to the Board in the form and manner determined by the board. The inactive status begins on the expiration date of the person's license.

(b) The Board shall maintain a list of each person whose license is on inactive status.

(c) A person whose license is on inactive status may not perform any professional nursing or vocational nursing service or work.

(d) The Board shall remove a person's license from inactive status if the person:

(e) The board by rule shall permit a person whose license is on inactive status and who was in good standing with the board on the date the license became inactive to use, as applicable, the title "Registered Nurse Retired," "R.N. Retired," "Licensed Vocational Nurse Retired," "Vocational Nurse Retired," "L.V.N. Retired," or "V.N. Retired" or another appropriate title approved by the board.

[Subsection (e) amended by Acts 2011 (S.B. 193), 82nd Leg., eff. Sept. 1, 2011]

Sec. 301.262. Special License.

(a) The board may issue a license under this section to a person licensed to practice nursing in Mexico if the person:

(b) A license issued under this section is valid for one year and may not be renewed. A person who holds or has held a license issued under this section may apply for another type of license under this chapter.

(c) A person who holds a license issued under this section may practice nursing only as an employee of a hospital located in a county that borders Mexico.

(d) A person who holds a license issued under this section is not entitled to a multistate licensing privilege to practice under the Nurse Licensure Compact under Chapter 304.

(e) This section expires September 1, 2013.

[Added by Acts 2009 (H.B. 4353), 81st Leg., eff. Sept. 1, 2009]

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Subchapter G. License Renewal

Sec. 301.301. License Renewal.

(a) The Board by rule may adopt a system under which licenses expire on various dates during the year.

(b) A person may renew an unexpired license issued under this chapter on payment to the Board of the required renewal fee before the expiration date of the license, payment to the board of any costs assessed under Section 301.461, and compliance with any other renewal requirements adopted by the Board. A person whose license has expired may not engage in activities that require a license until the license has been renewed.

(c) A person whose license has been expired for 90 days or less may renew the license by paying to the Board the required renewal fee and a late fee in the amount considered appropriate by the board to encourage timely renewal.

(c-1) A person whose license has been expired for more than 90 days but less than one year may renew the license by paying to the Board all unpaid renewal fees and a late fee that is equal to twice the amount of a late fee under Subsection (c).

(d) The Board by rule shall set a length of time beyond which an expired license may not be renewed. The Board by rule may establish additional requirements that apply to the renewal of a license that has been expired for more than one year but less than the time limit set by the Board beyond which a license may not be renewed. The person may obtain a new license by submitting to reexamination and complying with the requirements and procedures for obtaining an original license.

(e) At least 30 days before the expiration of the person's license, the Board shall send written notice of the impending license expiration to the person at the person's last known address according to the records of the Board.

(f) A registered nurse who practices professional nursing or a vocational nurse who practices vocational nursing after the expiration of the nurse's license is an illegal practitioner whose license may be revoked or suspended.

Sec. 301.3011. Criminal History Record Information Requirement for Renewal.

(a) The Board may require that an applicant for renewal of an unexpired license submit to the board, in addition to satisfying any other requirements for license renewal, a complete and legible set of fingerprints, on a form prescribed by the board, for the purpose of obtaining criminal history record information from the Department of Public Safety and the Federal Bureau of Investigation.

(b) The Board may refuse to renew the license of a person who does not comply with the requirement of Subsection (a). Renewal of a license by the board is conditioned on the Board obtaining the person's criminal history record information under this section.

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Sec. 301.302. Renewal of Expired License by Out-of-State Practitioner.

(a) A person who was licensed to practice professional nursing or vocational nursing in this state, moved to another state, and is currently licensed and has been in practice in the other state for the two years preceding application may obtain a new license without examination.

(b) The person must pay to the Board a fee that is equal to the amount of the initial fee for the license and the renewal fee.

Sec. 301.303. Continuing Competency.

(a) The Board may recognize, prepare, or implement continuing competency programs for license holders under this chapter and may require participation in continuing competency programs as a condition of renewal of a license. The programs may allow a license holder to demonstrate competency through various methods, including:

(b) The Board may not require participation in more than a total of 20 hours of continuing education in a two-year licensing period.

(c) If the Board requires participation in continuing education programs as a condition of license renewal, the Board by rule shall establish a system for the approval of programs and providers of continuing education.

(d) [Repealed by Acts 2007.]

(e) The Board may adopt other rules as necessary to implement this section.

(f) The Board may assess each program and provider under this section a fee in an amount that is reasonable and necessary to defray the costs incurred in approving programs and providers.

(g) The Board by rule may establish guidelines for targeted continuing education required under this chapter. The rules adopted under this subsection must address:

[Subsection (d) repealed by Acts 2007 (S.B. 993), 80th Leg., eff. Sept. 1, 2007]

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Sec. 301.304. Continuing Education in Tick-Borne Diseases

(a) As part of the continuing education requirements under Section 301.303, a license holder whose practice includes the treatment of tick-borne diseases shall be encouraged to participate, during each two-year licensing period, in continuing education relating to the treatment of tick-borne diseases.

(b) The board shall adopt rules to identify the license holders who are encouraged to complete continuing education under Subsection (a) and establish the content of that continuing education. In adopting rules, the board shall seek input from affected parties and review relevant courses, including courses that have been approved in other states. Rules adopted under this section must provide that continuing education courses representing an appropriate spectrum of relevant medical clinical treatment relating to tick-borne diseases qualify as approved continuing education courses for license renewal.

(c) If relevant, the board shall consider a license holder's participation in a continuing education course approved under Subsection (b) if:

(d) The board may adopt other rules to implement this section, including rules under Section 301.303(c) for the approval of education programs and providers.

[Added by Acts 2011 (H.B. 2975, S.B. 1360), 82nd Leg., eff. Sept. 1, 2011]

Sec. 301.305. Bioterrorism Response Component in Continuing Education.

[Expired Sept. 1, 2007]

Sec. 301.306. Forensic Evidence Collection Component in Continuing Education.

(a) As part of continuing education requirements under Section 301.303, a license holder who is employed to work in an emergency room setting and who is required under Board rules to comply with this section shall complete at least two hours of continuing education relating to forensic evidence collection not later than:

(b) The continuing education required under Subsection (a) must be part of a program approved under Section 301.303(c).

(c) The Board shall adopt rules to identify the license holders who are required to complete continuing education under Subsection (a) and to establish the content of that continuing education. The Board may adopt other rules to implement this section, including rules under Section 301.303(c) for the approval of education programs and providers.

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Subchapter H. Practice by License Holder

Sec. 301.351. Designations.

(a) A person who holds a license as a registered nurse under this chapter:

(b) A person who holds a license as a vocational nurse under this chapter:

(c) While interacting with the public in a nursing role, each nurse shall wear a clearly legible insignia identifying the nurse as a registered or vocational nurse. The insignia may not contain information other than:

(d) The Board may adopt rules establishing specifications for the insignia.

Sec. 301.352. Protection for Refusal to Engage in Certain Conduct.

(a) A person may not suspend, terminate, or otherwise discipline, discriminate against, or retaliate against:

(a-1) A nurse may refuse to engage in an act or omission relating to patient care that would constitute grounds for reporting the nurse to the Board under Subchapter I, that constitutes a minor incident, or that violates this chapter or a board rule if the nurse notifies the person at the time of the refusal that the reason for refusing is that the act or omission:

(b) An act by a person under Subsection (a) does not constitute a violation of this section if a nursing peer review committee under Chapter 303 determines:

(c) A nurse's rights under this section may not be nullified by a contract.

(d) An appropriate licensing agency may take action against a person who violates this section.

(e) [Repealed by Acts 2007]

(f) A violation of this section is subject to Section 301.413.

[Subsection (e) deleted by Acts 2007 (S.B. 993), 80th Leg., eff. Sept. 1, 2007. Subsection (a) amended by Acts 2011 (S.B. 192), 82nd Leg., eff. Sept. 1, 2011. Subsection (b) amended by Acts 2011 (S.B. 193), 82nd Leg., eff. Sept. 1, 2011]

Sec. 301.353. Supervision of Vocational Nurse.

The practice of vocational nursing must be performed under the supervision of a registered nurse, physician, physician assistant, podiatrist, or dentist.

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Sec. 301.354. Nurse First Assistants; Assisting at Surgery by Other Nurses.

(a) In this section, "nurse first assistant" means a registered nurse who:

(b) Unless the person is a nurse first assistant, the person may not use:

(c) A health maintenance organization or an insurer, including an insurer offering a preferred provider benefit plan, may not, by contract or any other method, require a physician to use the services of a nurse first assistant.

(d) A nurse who is not a nurse first assistant may assist a physician, podiatrist, or dentist in the performance of surgery if the nurse:

(e) A patient or third-party insurer may not be billed separately for the services performed by a nurse described by Subsection (d).

Sec. 301.355. Policies Applicable to Nurses Employed by Medical and Dental Units.

[Repealed by Acts 2011 (S.B. 193), 82nd Leg., eff. Sept. 1, 2011]

Sec. 301.356. Refusal of Mandatory Overtime.

The refusal by a nurse to work mandatory overtime as authorized by Chapter 258, Health and Safety Code, does not constitute patient abandonment or neglect.

[Added by Acts 2009 (S.B. 476), 81st Leg., eff. Sept. 1, 2009]

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Subchapter I. Reporting Violations and Patient Care Concerns

Sec. 301.401. Definitions.

In this subchapter:

[Amended by Acts 2009 (H.B. 3961), 81st Leg., eff. June 19, 2009]

Sec. 301.4011. Good Faith Report by Nurse.

In this subchapter, a report is considered to be made in good faith if:

[Added by Acts 2011 (S.B. 192), 82nd Leg., eff. Sept. 1, 2011]

Sec. 301.402. Mandatory Report by Nurse.

(a) [Repealed by Acts 2007]

(b) A nurse shall report to the Board in the manner prescribed under Subsection (d) if the nurse has reasonable cause to suspect that:

(c) [Repealed by Acts 2007]

(d) A report by a nurse under Subsection (b) must:

(e) Instead of reporting to the Board under Subsection (b), a nurse may make a report required under:

(f) A person may not suspend or terminate the employment of, or otherwise discipline, discriminate against, or retaliate against, a person who:

(g) A violation of Subsection (f) is subject to Section 301.413.

[Subsections (a) and (c) repealed by Acts 2007 (S.B. 993), 80th Leg., eff. Sept. 1, 2007. Subsection (f) amended and Subsection (g) added by Acts 2011 (S.B. 192), 82nd Leg., eff. Sept. 1, 2011]

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Sec. 301.4025. Optional Report by Nurse.

(a) In a written, signed report to the appropriate licensing board or accrediting body, a nurse may report a licensed health care practitioner, agency, or facility that the nurse has reasonable cause to believe has exposed a patient to substantial risk of harm as a result of failing to provide patient care that conforms to:

(b) A nurse may report to the nurse's employer or another entity at which the nurse is authorized to practice any situation that the nurse has reasonable cause to believe exposes a patient to substantial risk of harm as a result of a failure to provide patient care that conforms to minimum standards of acceptable and prevailing professional practice or to statutory, regulatory, or accreditation standards. For purposes of this subsection, an employer or entity includes an employee or agent of the employer or entity.

(c) A person may not suspend or terminate the employment of, or otherwise discipline, discriminate against, or retaliate against, a person who:

(d) A violation of Subsection (c) is subject to Section 301.413.

[Subsection (c) amended and Subsection (d) added by Acts 2011 (S.B. 192), 82nd Leg., eff. Sept. 1, 2011]

Sec. 301.403. Duty of Peer Review Committee to Report.

(a) Except as provided by Subsection (b), a nursing peer review committee operating under Chapter 303 that determines that a nurse has engaged in conduct subject to reporting shall file with the Board a written, signed report that includes:

(b) A report under Subsection (a) is not required if:

Sec. 301.404. Duty of Nursing Educational Program to Report.

A nursing educational program that has reasonable cause to suspect that the ability of a nursing student to perform the services of the nursing profession would be, or would reasonably be expected to be, impaired by chemical dependency shall file with the Board a written, signed report that includes the identity of the student and any additional information the Board requires.

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Sec. 301.405. Duty of Person Employing Nurse to Report.

(a) This section applies only to a person who employs, hires, or contracts for the services of a nurse,including:

(b) A person that terminates, suspends for more than seven days, or takes other substantive disciplinary action, as defined by the Board, against a nurse, or a substantially equivalent action against a nurse who is a staffing agency nurse, because the nurse engaged in conduct subject to reporting shall report in writing to the board:

(c) If a person who makes a report required under Subsection (b) is required under Section 303.0015 to establish a nursing peer review committee, the person shall submit a copy of the report to the nursing peer review committee. The nursing peer review committee shall review the conduct to determine if any deficiency in care by the reported nurse was the result of a factor beyond the nurse's control. A nursing peer review committee that determines that there is reason to believe that the nurse's deficiency in care was the result of a factor beyond the nurse's control shall report the conduct to the patient safety committee at the facility where the reported conduct occurred, or if the facility does not have a patient safety committee, to the chief nursing officer.

(d) [Repealed by Acts 2007]

(e) The requirement under Subsection (c) that a nursing peer review committee review the nurse and the incident does not subject a person's administrative decision to discipline a nurse to the peer review process.

(f) [Repealed by Acts 2007]

(g) [Repealed by Acts 2007]

(h) [Repealed by Acts 2007]

[Subsections (d), (f), (g), and (h) repealed by Acts 2007 (S.B. 993), 80th Leg., eff. Sept. 1, 2007]

Sec. 301.406. Duty of Certain Professional Associations and Organizations to Report.

A professional association of nurses or an organization that conducts a certification or accreditation program for nurses and that expels, decertifies, or takes any other substantive disciplinary action, as defined by the Board, against a nurse as a result of the nurse's failure to conform to the minimum standards of acceptable nursing practice shall report in writing to the Board the identity of the nurse and any additional information the Board requires.

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Sec. 301.407. Duty of State Agency to Report.

(a) This section applies only to a state agency that:

(b) Unless expressly prohibited by state or federal law, a state agency that has reason to believe that a nurse has engaged in conduct subject to reporting shall report the nurse in writing to the Board or to a nursing peer review committee under Chapter 303.

Sec. 301.408. Duty of Liability Insurer to Report.

(a) Each insurer that provides to a nurse liability insurance that covers claims arising from providing or failing to provide nursing care shall submit to the Board the report or data required by this section at the time prescribed.

(b) The report or data must be provided for:

(c) Not later than the 30th day after the date the insurer receives a complaint subject to Subsection (b), the insurer shall provide to the Board:

(d) Not later than the 30th day after the date of a judgment, dismissal, or settlement of a suit involving an insured nurse or settlement of a claim on behalf of the nurse without the filing of a lawsuit, the insurer shall provide to the Board information regarding the date of the judgment, dismissal, or settlement and, if appropriate:

(e) A nurse shall report the information required to be reported under this section if the nurse is named as a defendant in a claim arising from providing or failing to provide nursing care and the nurse:

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Sec. 301.409. Duty of Prosecuting Attorney to Report.

(a) The attorney representing the state shall cause the clerk of the court of record in which the conviction, adjudication, or finding is entered to prepare and forward to the Board a certified true and correct abstract of the court record of the case not later than the 30th day after the date:

(b) A prosecuting attorney shall comply with Subsection (a) even if the conviction, adjudication, or finding is entered, withheld, or appealed under the laws of this state.

(c) The abstract required under Subsection (a) must include:

(d) The board shall prepare the form of the abstract and distribute a copy to each district attorney and county attorney in this state with appropriate instructions for preparation and filing.

Sec. 301.410. Report Regarding Impairment by Chemical Dependency, Mental Illness, or Diminished Mental Capacity.

(a) A person who is required to report a nurse under this subchapter because the nurse is impaired or suspected of being impaired by chemical dependency or mental illness may report to a peer assistance program approved by the Board under Chapter 467, Health and Safety Code, instead of reporting to the Board or requesting review by a nursing peer review committee.

(b) A person who is required to report a nurse under this subchapter because the nurse is impaired or suspected of being impaired by chemical dependency or diminished mental capacity must report to the board if the person believes that an impaired nurse committed a practice violation.

Sec. 301.4105. Board Responsibility Following Report.

The board shall determine whether a nurse violated this chapter or a rule adopted under this chapter for any case reported to the board in which the nurse's ability to perform the practice of nursing was impaired or suspected of being impaired by chemical dependency or diminished mental capacity and in which the nurse is suspected of committing a practice violation. The board, in deciding whether to take disciplinary action against the nurse for a violation of this chapter or board rules, shall balance the need to protect the public and the need to ensure the impaired nurse seeks treatment.

Sec. 301.4106. Peer Assistance Programs.

The board by rule shall develop guidelines to:

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Sec. 301.411. Effect of Failure to Report.

(a) A person is not liable in a civil action for failure to file a report required by this subchapter.

(b) The appropriate state licensing agency may take action against a person regulated by the agency for a failure to report as required by this subchapter.

Sec. 301.412. Reporting Immunity.

A person who in good faith makes a report required or authorized under this subchapter, or a person who advises a nurse of the nurse's right or obligation to report under this subchapter:

[Amended by Acts 2011 (S.B. 192), 82nd Leg., eff. Sept. 1, 2011]

Sec. 301.413. Retaliatory Action.

(a) A person may file a counterclaim in a pending action or prove a cause of action in a subsequent suit to recover defense costs, including reasonable attorney's fees and actual and punitive damages, if:

(b) A person may not suspend, terminate, or otherwise discipline, discriminate against, or retaliate against a person who:

(b-1) A person suspected of violating Subsection (b) may be reported to the appropriate licensing agency and, notwithstanding any other provision, that agency may impose an administrative penalty not to exceed $25,000 against the person if the agency finds a violation of Subsection (b). An administrative penalty imposed under this subsection is in addition to other penalties the agency is authorized to impose and is subject to the procedural requirements applicable to the appropriate licensing agency.

(c) A person who reports under this subchapter, refuses to engage in conduct as authorized by Section 301.352, or requests a nursing peer review committee determination under Section 303.005, or a person who advises a nurse of the nurse's right to report under this subchapter, refuse to engage in conduct as authorized by Section 301.352, or request a nursing peer review committee determination under Section 303.005, has a cause of action against a person who violates Subsection (b), and may recover:

(d) In addition to the amount recovered under Subsection (c), a person whose employment is suspended or terminated in violation of this section is entitled to:

(e) A person who brings an action under this section has the burden of proof. It is a rebuttable presumption that the person was suspended, terminated, or otherwise disciplined, discriminated against, or retaliated against for reporting under this subchapter, for refusing to engage in conduct as authorized by Section 301.352, for requesting a peer review committee determination under Section 303.005, or for providing advice to a person regarding reporting under this subchapter, refusing to engage in conduct as authorized by Section 301.352, or requesting a peer review committee determination under Section 303.005 if:

(f) An action under this section may be brought in a district court of the county in which:

[Amended by Acts 2009 (S.B.476), 81st Leg., eff. Sept. 1, 2009. Subsections (a), (b), (c), and (e) amended and Subsection (b-1) added by Acts 2011 (S.B. 192), 82nd Leg., eff. Sept. 1, 2011.]

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Sec. 301.414. Notice and Review of Report.

(a) The Board shall notify each nurse who is reported to the board under Section 301.402, 301.403, 301.405, 301.406, 301.407, 301.408, or 301.409 of the filing of the report unless the notification would jeopardize an active investigation.

(b) The nurse or the nurse's authorized representative is entitled on request to review any report submitted to the Board under a section specified under Subsection (a) unless doing so would jeopardize an active investigation. The Board may not reveal the identity of the person making or signing the report.

Sec. 301.415. Rebuttal Statement.

(a) A nurse who is entitled to receive notice under Section 301.414 or the authorized representative of the nurse may file with the Board a statement of reasonable length containing the nurse's rebuttal of any information in the report to the Board.

(b) The statement made under Subsection (a) must accompany the part of the report being rebutted.

(c) In investigating the report, the board shall:

Sec. 301.416. Investigation.

(a) Except as provided by Subsections (b) and (c), a report under this subchapter shall be treated as a complaint under Section 301.457.

(b) If the Board determines that the reported conduct does not indicate that the continued practice of nursing by the nurse poses a risk of harm to a client or other person, the Board, with the written consent of the nurse and the person making the report, may elect not to proceed with an investigation or to file formal charges. The Board shall:

(c) The Board is not required to investigate a report filed by an insurer under Section 301.408, but shall:

Sec. 301.417. Confidentiality Requirements; Disclosure of Information.

(a) A report required or authorized under this subchapter and the identity of the person making the report are confidential and may not be disclosed except as provided by this section and Section 301.414.

(b) The Board may disclose the information to the same extent that the board may disclose information relating to a complaint under Section 301.466.

(c) [Repealed by Acts 2005]

(d) In addition to the other authorizations of this section, the information may be disclosed in:

[Subsection (c) repealed by Acts 2005 (S.B. 1000), Section 18, 79th Leg., eff. May 20, 2005]

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Sec. 301.418. Disclosure of Charges or Disciplinary Action.

(a) This subchapter does not prevent disclosure under Section 301.466 of formal charges filed by the Board or a final disciplinary action taken by the board as a result, in whole or in part, of submission of a report under this subchapter.

(b) A report or information submitted as required or authorized by this subchapter arising out of the provision or failure to provide nursing services may not be made available in a liability action for:

(c) A person is not prevented from taking disciplinary action against a nurse by:

Sec. 301.419. General Provisions Regarding Duty to Report; Minor Incidents.

(a) [Repealed by Acts 2007]

(b) The Board shall adopt rules governing reporting required under this subchapter to minimize:

(c) If the Board determines that a report submitted under this subchapter is without merit, the board shall expunge the report from the nurse's file.

(d) The Board shall inform, in the manner the board determines appropriate, nurses, facilities, agencies, and other persons of their duty to report under this subchapter.

(e) The reporting required under this subchapter does not constitute state action on behalf of the person reporting.

(f) The duty to report or any other requirement of this subchapter may not be nullified by a contract.

[Subsection (a) repealed by Acts 2007 (S.B. 993), 80th Leg., eff. Sept. 1, 2007]

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Subchapter J. Prohibited Practices and Disciplinary Actions

Sec. 301.451. Certain Prohibited Practices.

A person may not:

Sec. 301.4515. Use of Certain Nursing Titles.

Unless the person is practicing under the delegated authority of a registered nurse or is otherwise authorized by state or federal law, a person may not use, in connection with the person's name:

Sec. 301.452. Grounds for Disciplinary Action.

(a) In this section, "intemperate use" includes practicing nursing or being on duty or on call while under the influence of alcohol or drugs.

(b) A person is subject to denial of a license or to disciplinary action under this subchapter for:

(c) The Board may refuse to admit a person to a licensing examination for a ground described under Subsection (b).

(d) The Board by rule shall establish guidelines to ensure that any arrest information, in particular information on arrests in which criminal action was not proven or charges were not filed or adjudicated, that is received by the board under this section is used consistently, fairly, and only to the extent the underlying conduct relates to the practice of nursing.

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Sec. 301.4521. Physical and Psychological Evaluation.

(a) In this section:

(b) The board may require a nurse or applicant to submit to an evaluation only if the board has probable cause to believe that the nurse or applicant is unable to practice nursing with reasonable skill and safety to patients because of:

(c) A demand for an evaluation under Subsection (b) must be in writing and state:

(d) If the nurse or applicant refuses to submit to the evaluation, the board shall schedule a hearing on the issue of probable cause to be conducted by the State Office of Administrative Hearings. The nurse or applicant must be notified of the hearing by personal service or certified mail. The hearing is limited to the issue of whether the board had probable cause to require an evaluation. The nurse or applicant may present testimony and other evidence at the hearing to show why the nurse or applicant should not be required to submit to the evaluation. The board has the burden of proving that probable cause exists. At the conclusion of the hearing, the hearing officer shall enter an order requiring the nurse or applicant to submit to the evaluation or an order rescinding the board's demand for an evaluation. The order may not be vacated or modified under Section 2001.058, Government Code.

(e) If a nurse or applicant refuses to submit to an evaluation after an order requiring the evaluation is entered under Subsection (d), the board may:

(f) The board may request a nurse or applicant to consent to an evaluation by a practitioner approved by the board for a reason other than a reason listed in Subsection (b). A request for an evaluation under this subsection must be in writing and state:

(g) If a nurse or applicant refuses to consent to an evaluation under Subsection (f), the nurse or applicant may not introduce an evaluation into evidence at a hearing to determine the nurse's or applicant's right to be issued or retain a nursing license unless the nurse or applicant:

(h) The board shall establish by rule the qualifications for a licensed practitioner to conduct an evaluation under this section. The board shall maintain a list of qualified practitioners. The board may solicit qualified practitioners located throughout the state to be on the list.

(i) A nurse or applicant shall pay the costs of an evaluation conducted under this section.

(j) The results of an evaluation under this section are:

(k) If the board determines there is insufficient evidence to bring action against a person based on the results of any evaluation under this section, the evaluation must be expunged from the board's records.

(l) The board shall adopt guidelines for requiring or requesting a nurse or applicant to submit to an evaluation under this section.

(m) The authority granted to the board under this section is in addition to the board's authority to make licensing decisions under this chapter.

[Added by Acts 2009 (H.B. 3961), 81st Leg., eff. June 19, 2009. [Subsection (j) amended by Acts 2011 (S.B. 193), 82nd Leg., eff. Sept. 1, 2011]

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Sec. 301.453. Disciplinary Authority of Board; Methods of Discipline.

(a) If the Board determines that a person has committed an act listed in Section 301.452(b), the Board shall enter an order imposing one or more of the following:

(b) In addition to or instead of an action under Subsection (a), the Board, by order, may require the person to:

(c) The Board may probate any penalty imposed on a nurse and may accept the voluntary surrender of a license. The Board may not reinstate a surrendered license unless it determines that the person is competent to resume practice.

(d) If the Board suspends, revokes, or accepts surrender of a license, the Board may impose conditions for reinstatement that the person must satisfy before the Board may issue an unrestricted license.

[Amended by Acts 2009 (H.B. 3961), 81st Leg., eff. June 19, 2009]

Sec. 301.4531. Schedule of Sanctions.

(a) The Board by rule shall adopt a schedule of the disciplinary sanctions that the Board may impose under this chapter. In adopting the schedule of sanctions, the Board shall ensure that the severity of the sanction imposed is appropriate to the type of violation or conduct that is the basis for disciplinary action.

(b) In determining the appropriate disciplinary action, including the amount of any administrative penalty to assess, the Board shall consider:

(c) In the case of a person described by:

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Sec. 301.4535. Required Suspension, Revocation, or Refusal of License for Certain Offenses.

(a) The board shall suspend a nurse's license or refuse to issue a license to an applicant on proof that the nurse or applicant has been initially convicted of:

(a-1) An applicant or nurse who is refused an initial license or renewal of a license or whose license is suspended under Subsection (a) is not eligible for a probationary, stipulated, or otherwise encumbered license unless the board establishes by rule criteria that would permit the issuance or renewal of the license.

(b) On final conviction or a plea of guilty or nolo contendere for an offense listed in Subsection (a), the board, as appropriate, may not issue a license to an applicant, shall refuse to renew a license, or shall revoke a license.

(c)A person is not eligible for an initial license or for reinstatement or endorsement of a license to practice nursing in this state before the fifth anniversary of the date the person successfully completed and was dismissed from community supervision or parole for an offense described by Subsection (a).

[NOTE: Section 301.4535, Occupations Code, applies only to a person who is initially convicted of an offense or placed on deferred adjudication after a plea of guilty or nolo contendere for an offense on or after September 1, 2005. A person initially convicted of an offense or placed on deferred adjudication before that date is governed by the law in effect on the date the conviction or plea occurred, and the former law is continued in effect for that purpose. Amended by Acts 2009 (H.B. 3961), 81st Leg., eff. June 19, 2009]

Sec. 301.454. Notice and Hearing.

(a) Except in the case of a temporary suspension authorized under Section 301.455 or an action taken in accordance with an agreement between the Board and a license holder, the Board may not initiate a disciplinary action relating to a license unless:

(b) If an informal meeting is held, a board member, staff member, or board representative who attends the meeting is considered to have participated in the hearing of the case for the purposes of ex parte communications under Section 2001.061, Government Code.

(c) A person is entitled to a hearing conducted by the State Office of Administrative Hearings if the Board proposes to:

(d) The State Office of Administrative Hearings shall use the schedule of sanctions adopted by the Board for any sanction imposed as the result of a hearing conducted by that office.

(e) Notwithstanding Subsection (a), a person is not entitled to a hearing on a refusal to renew a license if the person:

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Sec. 301.455. Temporary License Suspension or Restriction.

(a) The license of a nurse shall be temporarily suspended or restricted on a determination by a majority of the Board or a three-member committee of board members designated by the Board that, from the evidence or information presented, the continued practice of the nurse would constitute a continuing and imminent threat to the public welfare.

(b) A license may be temporarily suspended or restricted under this section without notice or hearing on the complaint if:

(c) The State Office of Administrative Hearings shall hold a preliminary hearing not later than the 17th day after the date of the temporary suspension or restriction to determine whether probable cause exists that a continuing and imminent threat to the public welfare exists. The probable cause hearing shall be conducted as a de novo hearing.

(d) A final hearing on the matter shall be held not later than the 61st day after the date of the temporary suspension or restriction.

[Subsection (c) amended by Acts 2011 (S.B. 193), 82nd Leg., eff. Sept. 1, 2011]

Sec. 301.4551. Temporary License Suspension for Drug or Alcohol Use.

(a) The board shall temporarily suspend the license of a nurse as provided by Section 301.455 if the nurse is under a board order prohibiting the use of alcohol or a drug or requiring the nurse to participate in a peer assistance program, and the nurse:

(b) For the purposes of Section 301.455(c), proof of the elements required for the board to suspend a license under this section is proof that probable cause of a continuing and imminent threat to the public welfare exists.

[Added by Acts 2009 (H.B. 3961), 81st Leg., eff. June 19, 2009. Amended by Acts 2011 (S.B. 193), 82nd Leg., eff. Sept. 1, 2011.]

Sec. 301.456. Evidence.

A certified copy of the order of the denial, suspension, or revocation or other action under Section 301.452(b)(8) is conclusive evidence of that action.

Sec. 301.457. Complaint and Investigation.

(a) The Board or any person may initiate a proceeding under this subchapter by filing with the Board a complaint against a nurse. The complaint must be in writing and signed by the complainant.

(b) Except as otherwise provided by this section, the Board or a person authorized by the board shall conduct each investigation. Each complaint against a nurse that requires a determination of nursing competency shall be reviewed by a board member, consultant, or employee with a nursing background the Board considers sufficient.

(c) On the filing of a complaint, the board:

(d) After any preliminary investigation to determine the identity of the subject of the complaint, unless it would jeopardize an investigation, the Board shall notify the nurse that a complaint has been filed and the nature of the complaint. If the investigation reveals probable cause to take further disciplinary action, the Board shall either attempt an informal disposition of the complaint or file a formal charge against the nurse stating the provision of this chapter or board rule that is alleged to have been violated and a brief description of each act or omission that constitutes the violation.

(e) The Board shall conduct an investigation of the complaint to determine:

(f) In making a determination under Subsection (e), the board shall review the evidence to determine the extent to which a deficiency in care by the registered nurse was the result of deficiencies in the registered nurse's judgment, knowledge, training, or skill rather than other factors beyond the nurse's control. A determination that a deficiency in care is attributable to a registered nurse must be based on the extent to which the registered nurse's conduct was the result of a deficiency in the registered nurse's judgment, knowledge, training, or skill.

(g) If the board determines after investigating a complaint under Subsection (e) that there is reason to believe that a nurse's deficiency in care was the result of a factor beyond the nurse's control, the board shall report that determination to the patient safety committee at the facility where the nurse's deficiency in care occurred, or if the facility does not have a patient safety committee, to the chief nursing officer.

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Sec. 301.458. Initiation of Formal Charges; Discovery.

(a) Unless there is an agreed disposition of the complaint under Section 301.463, and if probable cause is found under Section 301.457(e)(2), the Board or the Board's Authorized Representative shall initiate proceedings by filing formal charges against the nurse.

(b) A formal charge must:

(c) A copy of the formal charge shall be served on the nurse or the nurse's counsel of record.

(d) The Board shall adopt reasonable rules to promote discovery by each party to a contested case.

Sec. 301.459. Formal Hearing.

(a) The Board by rule shall adopt procedures under Chapter 2001, Government Code, governing formal disposition of a contested case. The State Office of Administrative Hearings shall conduct a formal hearing.

(b) In any hearing under this section, a nurse is entitled to appear in person or by counsel.

Sec. 301.460. Access to Information.

(a) Except for good cause shown for delay and subject to any other privilege or restriction set forth by statute, rule, or legal precedent, the Board shall, not later than the 30th day after the date the board receives a written request from a license holder who is the subject of a formal charge filed under Section 301.458 or from the license holder's counsel of record, provide the license holder with access to:

(b) The Board is not required to provide:

(c) The provision of information under Subsection (a) does not constitute a waiver of privilege or confidentiality under this chapter or other applicable law.

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Sec. 301.461. Assessment of Costs.

The Board may assess a person who is found to have violated this chapter the administrative costs of conducting a hearing to determine the violation.

Sec. 301.462. Voluntary Surrender of License.

The Board may revoke a nurse's license without formal charges, notice, or opportunity of hearing if the nurse voluntarily surrenders the nurse's license to the Board and executes a sworn statement that the nurse does not desire to be licensed.

Sec. 301.463. Agreed Disposition.

(a) Unless precluded by this chapter or other law, the Board may dispose of a complaint by:

(b) An agreed disposition of a complaint is considered to be a disciplinary order for purposes of reporting under this chapter and an administrative hearing and proceeding by a state or federal regulatory agency regarding the practice of nursing.

(c) An agreed order is a public record.

(d) In civil or criminal litigation an agreed disposition is a settlement agreement under Rule 408, Texas Rules of Evidence.

Sec. 301.464. Informal Proceedings.

(a) The Board by rule shall adopt procedures governing:

(b) Rules adopted under this section must:

Sec. 301.465. Subpoenas; Request for Information.

(a) The Board may request issuance of a subpoena to be served in any manner authorized by law, including personal service by a board investigator and service by certified mail.

(b) Each person shall respond promptly and fully to a request for information by the board or to a subpoena issued by the Board. A request or subpoena may not be refused, denied, or resisted unless the request or subpoena calls for information within the attorney-client privilege. No other privilege applies to a board proceeding.

(c) The Board may pay a reasonable fee for photocopies subpoenaed at the Board's request. The amount paid may not exceed the amount the Board charges for copies of its records.

(d) The Board shall protect, to the extent possible, the identity of each patient named in information received by the Board.

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Sec. 301.466. Confidentiality.

(a) A complaint and investigation concerning a nurse under this subchapter and all information and material compiled by the board in connection with the complaint and investigation are:

(b) Notwithstanding Subsection (a), information regarding a complaint and an investigation may be disclosed to:

(c) The filing of formal charges against a nurse by the Board, the nature of those charges, disciplinary proceedings of the board, and final disciplinary actions, including warnings and reprimands, by the Board are not confidential and are subject to disclosure in accordance with Chapter 552, Government Code.

Sec. 301.467. Reinstatement.

(a) On application, the Board may reinstate a license to practice nursing to a person whose license has been revoked, suspended, or surrendered.

(b) An application to reinstate a revoked license:

(c) If the Board denies an application for reinstatement, it may set a reasonable waiting period before the applicant may reapply for reinstatement.

Sec. 301.468. Probation.

(a) The Board may determine that an order denying a license application or suspending a license be probated. A person subject to a probation order shall conform to each condition the Board sets as the terms of probation, including a condition:

(b) At the time the probation is granted, the Board shall establish the term of the probationary period.

(c) At any time while the person remains subject to the probation order, the Board may hold a hearing and rescind the probation and enforce the Board's original action in denying or suspending the license. The hearing shall be called by the presiding officer of the Board, who shall issue a notice to be served on the person or the person's counsel not later than the 20th day before the date scheduled for the hearing that:

(d) Notice under Subsection (c) is sufficient if sent by registered or certified mail to the affected person at the person's most recent address as shown in the Board's records.

(e) A hearing under this section is limited to a determination of whether the person violated the terms of the probation order under Subsection (a) and whether the board should:

(f) If one of the conditions of probation is the prohibition of using alcohol or a drug or participation in a peer assistance program, violation of that condition is established by:

[Amended by Acts 2009 (H.B. 3961), 81st Leg., eff. June 19, 2009]

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Sec. 301.469. Notice of Final Action.

If the Board takes a final disciplinary action, including a warning or reprimand, against a nurse under this subchapter, the Board shall immediately send a copy of the Board's final order to the nurse and to the last known employer of the nurse.

Sec. 301.470. Refund.

(a) Subject to Subsection (b), the board may order a license holder to pay a refund to a consumer as provided in an agreement resulting from an informal settlement conference instead of or in addition to imposing an administrative penalty under this chapter.

(b) The amount of a refund ordered as provided in an agreement resulting from an informal settlement conference may not exceed the amount the consumer paid to a nurse for a service regulated by this chapter or the actual amount stolen or defrauded from a patient by the nurse. The board may not require payment of other damages or estimate harm in a refund order.

Sec. 301.471. Emergency Cease and Desist Order.

(a) If it appears to the board that a person who is not licensed under this chapter is violating this chapter, a rule adopted under this chapter, or another state statute or rule relating to the practice of professional nursing or vocational nursing and the board determines that the unauthorized activity constitutes a clear, imminent, or continuing threat to the public health and safety, the board may:

(b) An order issued under Subsection (a) must:

(c) Unless the person against whom the emergency cease and desist order is directed requests a board hearing in writing before the 11th day after the date it is served on the person, the order is final and nonappealable as to that person. A request for a board hearing must:

(d) On receiving a request for a hearing, the board shall serve notice of the time and place of the hearing by personal delivery or registered or certified mail, return receipt requested. The hearing must be held not later than the 10th day after the date the board receives the request for a hearing unless the parties agree to a later hearing date. A hearing under this subsection is subject to Chapter 2001, Government Code.

(e) After the hearing, the board shall affirm, modify, or set aside wholly or partly the emergency cease and desist order. An order affirming or modifying the emergency cease and desist order is immediately final for purposes of enforcement and appeal.

(f) An order under this section continues in effect unless the order is stayed by the board. The board may impose any condition before granting a stay of the order.

(g) The board may release to the public a final cease and desist order issued under this section or information regarding the existence of the order if the board determines that the release would enhance the effective enforcement of the order or will serve the public interest.

(h) A violation of an order issued under this section constitutes grounds for imposing an administrative penalty under this chapter.

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Subchapter K. Administrative Penalty

Sec. 301.501. Imposition of Penalty.

The Board may impose an administrative penalty on a person licensed or regulated under this chapter who violates this chapter or a rule or order adopted under this chapter.

Sec. 301.502. Amount of Penalty.

(a) The amount of the administrative penalty may not exceed $5,000 for each violation. Each day a violation continues or occurs is a separate violation for purposes of imposing a penalty.

(b) The amount of the penalty shall be based on:

Sec. 301.503. Report and Notice of Violation and Penalty.

(a) If the Executive Director determines that a violation has occurred, the Executive Director may issue to the Board a report stating:

(b) Not later than the 14th day after the date the report is issued, the Executive Director shall give written notice of the report to the person on whom the penalty may be imposed. The notice may be given by certified mail. The notice must:

Sec. 301.504. Penalty to be Paid or Hearing Requested.

(a) Not later than the 20th day after the date the person receives the notice, the person may:

(b) If the person accepts the Executive Director's determination and recommended penalty, the board by order shall approve the determination and impose the recommended penalty.

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Sec. 301.505. Hearing.

(a) If the person requests a hearing or fails to respond in a timely manner to the notice, the Executive Director shall set a hearing and give notice of the hearing to the person.

(b) An administrative law judge of the State Office of Administrative Hearings shall hold the hearing.

(c) The administrative law judge shall make findings of fact and conclusions of law and promptly issue to the board a proposal for decision as to the occurrence of the violation and the amount of any proposed administrative penalty.

Sec. 301.506. Decision by Board.

(a) Based on the findings of fact, conclusions of law, and proposal for decision, the Board by order may:

(b) The notice of the Board's order given to the person under Chapter 2001, Government Code, must include a statement of the right of the person to judicial review of the order.

Sec. 301.507. Options Following Decision: Pay or Appeal.

(a) Not later than the 30th day after the date the Board's order becomes final, the person shall:

(b) Within the 30-day period, a person who acts under Subsection (a)(3) may:

(c) If the Executive Director receives a copy of an affidavit under Subsection (b)(2), the Executive Director may file with the court a contest to the affidavit not later than the fifth day after the date the copy is received.

(d) The court shall hold a hearing on the facts alleged in the affidavit as soon as practicable and shall stay the enforcement of the penalty on finding that the alleged facts are true. The person who files an affidavit has the burden of proving that the person is financially unable to pay the penalty and to give a supersedeas bond.

Sec. 301.508. Collection of Penalty.

If the person does not pay the penalty and the enforcement of the penalty is not stayed, the executive director may refer the matter to the Attorney General for collection of the penalty.

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Sec. 301.509. Determination by Court.

(a) If a court sustains the determination that a violation occurred, the court may uphold or reduce the amount of the administrative penalty and order the person to pay the full or reduced penalty.

(b) If the court does not sustain the determination that a violation occurred, the court shall order that a penalty is not owed.

Sec. 301.510. Remittance of Penalty and Interest.

(a) If after judicial review, the administrative penalty is reduced or not imposed by the court, the court shall, after the judgment becomes final:

(b) The interest paid under Subsection (a)(1) is the rate charged on loans to depository institutions by the New York Federal Reserve Bank. The interest shall be paid for the period beginning on the date the penalty is paid and ending on the date the penalty is remitted.

Sec. 301.511. Administrative Procedure.

A proceeding under this subchapter is subject to Chapter 2001, Government Code.

Subchapter L. Other Penalties and Enforcement Provisions

Sec. 301.551. Injunction.

(a) In addition to any other action authorized by law, the Board may institute an action in its name to enjoin a violation of this chapter or a board rule.

(b) To obtain an injunction under this section, it is not necessary to allege or prove that:

(c) Notwithstanding Subsection (b), in a proceeding for an injunction under Subsection (a), the defendant may assert and prove as a complete defense to the action that the Board's actions or proceedings were:

(d) Either party to an action under Subsection (a) may appeal. The Board is not required to give an appeal bond in a cause arising under this section.

Sec. 301.552. Monitoring of License Holder.

The Board by rule shall develop a system for monitoring the compliance of license holders with the requirements of this chapter. Rules adopted under this section must include procedures to:

Sec. 301.553. Civil Penalty.

(a) A person who violates Section 301.451 or Section 301.251 is liable to the state for a civil penalty not to exceed $1,000 a day.

(b) The civil penalty may be collected in a suit initiated by the Board.

Sec. 301.554. Criminal Penalty.

(a) A person commits an offense if the person violates Section 301.451 or Section 301.251.

(b) An offense under Subsection (a) is a Class A misdemeanor, except that if it is shown on the trial of the offense that the defendant has been previously convicted under Subsection (a), the offense is a felony of the third degree.

(c) Each day of violation constitutes a separate offense.

(d) On final conviction of an offense under Subsection (a), the defendant forfeits all rights and privileges conferred by a license issued under this chapter.

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Sec. 301.555. Appeal.

(a) A person against whom the Board has taken adverse action under this chapter may appeal to a district court in the county of the person's residence or in Travis County.

(b) The Board's decision may not be enjoined or stayed except on application to the district court after notice to the Board.

Subchapter M. Anesthesia in Outpatient Setting

Sec. 301.601. Definition.

In this subchapter, "outpatient setting" means a facility, clinic, center, office, or other setting that is not part of a licensed hospital or a licensed ambulatory surgical center.

Sec. 301.602. Rules.

(a) The Board by rule shall establish minimum standards for anesthesia services provided in an outpatient setting by a person licensed by the Board.

(b) The rules adopted under this section must be designed to protect the health, safety, and welfare of the public and must include requirements relating to:

(c) The Board shall cooperate with the Texas State Board of Medical Examiners in the adopting rules under this subchapter to eliminate, to the extent possible, conflicts between the rules adopted by each board.

Sec. 301.603. Applicability.

Rules adopted by the board under Section 301.602 do not apply to:

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Sec. 301.604. Registration Required.

(a) The Board shall require each certified registered nurse anesthetist who provides anesthesia services in an outpatient setting to register biennially by applying to the Board on a form prescribed by the board and paying to the Board a fee in an amount established by the Board.

(b) The Board shall coordinate the registration required under this section with the license renewal requirements of Subchapter G so that the times of registration, payment, notice, and imposition of penalties for late payment are similar and provide a minimal administrative burden for the Board and certified registered nurse anesthetists.

Sec. 301.605. Compliance With Rules.

(a) A certified registered nurse anesthetist providing anesthesia services in an outpatient setting shall comply with the rules adopted by the Board under Section 301.602.

(b) The Board may require a certified registered nurse anesthetist to submit and comply with a corrective action plan to remedy or address any current or potential deficiencies with the nurse anesthetist's provision of anesthesia in an outpatient setting in accordance with this chapter or board rule.

Sec. 301.606. Inspections.

(a) The Board may conduct inspections to enforce this subchapter, including inspections of the equipment owned or leased by a certified registered nurse anesthetist and of documents of a certified registered nurse anesthetist's practice that relate to providing anesthesia in an outpatient setting. The Board may contract with another state agency or qualified person to conduct these inspections.

(b) Unless it would jeopardize an ongoing investigation, the Board must provide notice at least five business days before the date of conducting an on-site inspection under this section.

(c) This section does not require the Board to make an on-site inspection of an outpatient setting in which a certified registered nurse anesthetist provides anesthesia.

Sec. 301.607. Requests for Inspection and Advisory Opinion.

(a) The Board may consider a request by a certified registered nurse anesthetist for an inspection of equipment owned or leased by the nurse anesthetist and of documents of the nurse anesthetist's practice that relate to the provision of anesthesia in an outpatient setting. The Board, on payment of a fee set by the board, may conduct the requested inspection and issue an advisory opinion.

(b) An advisory opinion issued by the Board under this section is not binding on the board. Except as provided by Subsection (c), the board may take any action under this chapter relating to the situation addressed by the advisory opinion as the board considers appropriate.

(c) A certified registered nurse anesthetist who requests and relies on a board advisory opinion may use the opinion as mitigating evidence in an action or proceeding by the Board to impose an administrative penalty or to assess a fine under this chapter. On receipt of proof of reliance on an advisory opinion, the Board shall consider the reliance and mitigate imposition of an administrative penalty or assessment of a fine accordingly.

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Subchapter N. Corrective Action Proceeding

[Added by Acts 2009 (H.B. 3961), 81st Leg., eff. June 19, 2009]

Sec. 301.651. Definition.

In this subchapter, "corrective action" means a fine or remedial education imposed under Section 301.652.

[Added by Acts 2009 (H.B. 3961), 81st Leg., eff. June 19, 2009]

Sec. 301.652. Imposition of Corrective Action.

(a) The board may impose a corrective action on a person licensed or regulated under this chapter who violates this chapter or a rule or order adopted under this chapter. The corrective action:

(b) The board by rule shall adopt guidelines for the types of violations for which a corrective action may be imposed.

[Added by Acts 2009 (H.B. 3961), 81st Leg., eff. June 19, 2009]

Sec. 301.653. Report and Notice of Violation and Corrective Action.

If the executive director determines that a person has committed a violation for which a corrective action may be imposed under the guidelines adopted under Section 301.652(b), the executive director may give written notice of the determination and recommendation for corrective action to the person subject to the corrective action. The notice may be given by certified mail. The notice must:

[Added by Acts 2009 (H.B. 3961), 81st Leg., eff. June 19, 2009]

Sec. 301.654. Response.

Not later than the 20th day after the date the person receives the notice under Section 301.653, the person may:

[Added by Acts 2009 (H.B. 3961), 81st Leg., eff. June 19, 2009]

Sec. 301.655. Action Following Response.

(a) If the person accepts the executive director's determination and satisfies the recommended corrective action, the case is closed.

(b) If the person does not accept the executive director's determination and recommended corrective action as originally proposed or as modified by the board or fails to respond in a timely manner to the executive director's notice as provided by Section 301.654, the executive director shall:

[Added by Acts 2009 (H.B. 3961), 81st Leg., eff. June 19, 2009]

Sec. 301.656. Report to Board.

The executive director shall report periodically to the board on the corrective actions imposed under this subchapter, including:

[Added by Acts 2009 (H.B. 3961), 81st Leg., eff. June 19, 2009]

Sec. 301.657. Effect on Acceptance of Corrective Action.

(a) Except to the extent provided by this section, a person's acceptance of a corrective action under this subchapter does not constitute an admission of a violation but does constitute a plea of nolo contendere.

(b) The board may treat a person's acceptance of corrective action as an admission of a violation if the board imposes a sanction on the person for a subsequent violation of this chapter or a rule or order adopted under this chapter.

[Added by Acts 2009 (H.B. 3961), 81st Leg., eff. June 19, 2009]

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