Anticipating the Future, Maintaining Your License•

Texas Occupations CodeChapter 301

Chapter 301 - Law that establishes & empowers

Many different occupations are governed by this code. Provides direction to the BON (Board of

Nursing) ,and other such Boards, about requirements

Nurse Practice Act

BON Rules and Regulations Provides more detail on how the requirements

of the Occupations Code are to be carried out

Texas Administrative Code

Provides more detail on how the requirements of the Occupations Code are to be carried out.

Appointment of members, meetings, proceedings, investigations, disciplinary actions, etc.

Texas Administrative CodeTITLE 22 EXAMINING BOARDS

PART 11 Texas BOARD OF NURSING ChaptersCHAPTER 211 GENERAL PROVISIONS CHAPTER 213 PRACTICE AND PROCEDURE CHAPTER 214 VOCATIONAL NURSING EDUCATION CHAPTER 215 PROFESSIONAL NURSING EDUCATION CHAPTER 216 CONTINUING EDUCATION CHAPTER 217 LICENSURE, PEER ASSISTANCE AND PRACTICE CHAPTER 219 ADVANCED NURSE PRACTITIONER PROGRAM CHAPTER 220 NURSE LICENSURE COMPACT CHAPTER 221 ADVANCED PRACTICE NURSES CHAPTER 222 ADVANCED PRACTICE NURSES WITH PRESCRIPTIVE AUTHORITY CHAPTER 223 FEES CHAPTER 224 DELEGATION OF NURSING TASKS BY REGISTERED PROFESSIONAL NURSES TO UNLICENSED PERSONNEL FOR CLIENTS WITH ACUTE CONDITIONS OR IN ACUTE CARE ENVIRONMENTS CHAPTER 225 RN DELEGATION TO UNLICENSED PERSONNEL AND TASKS NOT REQUIRING DELEGATION IN INDEPENDENT LIVING ENVIRONMENTS FOR CLIENTS WITH STABLE AND PREDICTABLE CONDITIONS CHAPTER 226 PATIENT SAFETY PILOT PROGRAMS ON NURSE REPORTING SYSTEMS CHAPTER 227 PILOT PROGRAMS FOR INNOVATIVE APPLICATIONS TO PROFESSIONAL NURSING EDUCATION

Texas Administrative CodeTITLE 22 EXAMINING BOARDSPART 11 Texas Board of Nursing CHAPTER 211 GENERAL PROVISIONS

RULE §211.1 IntroductionName. Decision-making board appointed by Governor (Texas Occupations Code).

(b) Location. Austin, Texas

(c) Legal Authority. Chapters 301, 303 and 304 - Texas Occupations Code.

(d) Composition. Persons appointed by Governor with Senate approval. (Source Note: The provisions of this §211.1 adopted to be effective March 31, 2002, 27 TexReg 2236; amended to be effective May 17, 2004, 29 TexReg 4884

Texas Administrative CodeGENERAL PROVISIONSRULE §211.3 Organization and Structure

(b) Terms of office for Board members. Six years in length with staggered terms.Members may be reappointed by the Governor.

(c) Eligibility. Board member eligibility is governed by the Texas Occupations Code §§301.052 and 301.053.

(d) Compensation. Per diem as provided by law for each day that the member engages in the business of the board Travel expenses

Source Note: The provisions of this §211.3 adopted to be effective March 31, 2002, 27 TexReg 2236; amended to be effective May 17, 2004, 29 TexReg 4884

TEXAS OCCUPATIONS CODE AND STATUTES REGULATING

THE  PRACTICE OF NURSINGAs Amended September, 2005

AGENCY MISSION

The mission of the Texas Board of Nursing is to protect and promote the welfare of the people of Texas by ensuring that each person holding a license as a nurse in the State of Texas is competent to practice safely.

This mission, derived from the Nursing Practice Act, supersedes the interest of any individual, the nursing profession, or any special interest group.

BON

Primary function is to protect the public Defines the scope of practice for RN and LVN Law and Rules differ from state to state

What activities by BON protect public?

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Contacting the Texas Board of Nursing Location of Board’s office:

333 Guadalupe, Ste. 3-460

Austin, Texas 78701

Telephone:

512/305-7400Web page:

www.bne.state.tx.us.

Protecting the People of Texas

Nurse Licensure CompactChapter 304 NPA

Agreement among states to mutually recognize each others’ licenses

Texas among first to adopt

Premise: current licensure requirements essentially the same from state to state

Does not interfere with each state defining scope of practice

Only defines requirements to hold license

Nurse Licensure Compact Administrators

Updated October 2007

Definitions

Party states – states who have adopted the compact

Home state license – where you permanently reside

Remote state – where you practice using multistate privilege (must be a party state)

Compact RequirementsNurse mustMaintain home state licenseAdhere to state practice laws of state in which

patient is located at the time care is providedUse multistate privilege only in party statesHold home state license in only one party

state at a time. If nurse changes permanent residence to another party state, he/she must relinquish previous state license, apply for and meet requirements of new home state

Practicing in a Non-Party State

To practice in a state that is not part of the Compact, the nurse must obtain license from the non-party state

May concurrently hold a home state license and a license to practice in a non-party state

If you live in a non-party state, you must obtain a non-resident Texas license in order to practice in Texas

Impact of ModelCompact created a shared information system - includes licensing and disciplinary action for each nurseGives public more choice in qualified nurses Protects public health and safetyMore mobile workforce for employersAllows nurses to be more mobileProvides for new forms of practice Online practice Telephone practice

Peer Review

Nursing Peer ReviewChapter 303

A process mandated by BON more than 15 years ago, updated in 80th legislative session.

Provides mechanism for nurse’s actions to be reviewed by peers

In place for RN’s and LVN’s

Any facility that regularly employs 10 or more RN’s and/or LVN’s must have a Peer Review Committee

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Incident-Based Nursing Peer ReviewEvaluation of Nursing services Qualifications of a nurse Quality of care provided Merits of a complaint about a nurse Recommendations about a complaint

Nurse under review given written notice to attend with info about complaintFact finding process, analysis studying events that occurred - due process as right to question witnesses and confidentialityClimate of collegial problem solvingNot a legal proceeding but can have lawyer/peerIf fault is found nurse is subject to Reporting Requirements

Grounds for Reporting (Duty to Patient)

Employers of 10 or more licensed nurses must have a peer review committee Unnecessary or likely exposure by nurse of patient or

other person to risk/harm; Unprofessional conduct by nurse – see rule 217.12 Failure by nurse to adequately care for patient Failure by nurse to conform to minimum standards of

acceptable professional practice – see detail in 217.11

Impairment or likely impairment of nurse’s practice by chemical dependency

The Nurse’s Duty to Report

Licensed care giver, agency, or facility Exposing a patient to substantial risk of harm due to lack of minimum standard of nursing care

Another nurse Impairment, lack of minimum standard of care,

unprofessional conduct, or unnecessary exposure of pt. to risk for harm

Nursing student Chemical impairment Ability to perform professional service within

reasonable expectations

Reporting

Report must be written/signed

Include identity of nurse or student, and any other information required by BON

Nurse may make report to employer of nurse, or to nursing school of student

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Peer Review Committee

If nurse reports to employer, Peer Review Committee will review case, and if committee finds “cause” they are required to report to BON. Identity of the nurse Any corrective action taken against the nurse Recommendation re: Board action Any additional information required by the BON

Peer Review Proceedings are confidential!

“Minor” IncidentsConduct that does not indicate that continuing practice of nursing by the involved nurse poses a risk of harm to client Potential risk of harm is very low Incident is singular Nurse exhibits a conscientious and accountable

approach to his/her practice Nurse has knowledge and skill to practice safely

5 minor incidents in any consecutive 12 month period must be reported to Peer Review Committee (rule 217.16 d)

If no Peer Review Committee is available, the incident must be reported to BON

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Peer Assistance Rule 217.13

Required by law

Identifies, assists, and monitors professional colleagues experiencing mental health, alcohol or drug problems that are likely to be job impairing so they may return to safe practice.

BON contracts TNA to provide this service

TPAPNTexas Peer Assistance Program for NursesVoluntaryConfidentialAvailable for substance abuse/dependency,

anxiety disorders, major depression, schizophrenia, schizoaffective

and bipolar disorders.Self or employer referral

Safe Harbor Peer Review

Safe Harbor Peer Review

Protects nurses asked to engage in conduct which they believe violates duty to patient“Duty to Patient” – means conduct including administrative decisions directly affecting a nurse’s ability to comply with that duty required by: Standards of practice Professional conduct adopted by the Board in

Section 303.005 (a)

Required by facilities employing/contracting at least 10 nurses

ProtectionsIf nurse requests a

Safe Harbor Peer Review: May not be disciplined/discriminated against for making

request May engage in requested conduct pending the peer

review – (that is- continue working) Is not subject to reporting requirement just covered May not be disciplined by board for engaging in that

conduct while the peer review is pending

Requesting Safe HarborMust be done in good faith

Must notify supervisor making the assignment that he/she is invoking safe harbor

Use form on BON web site Include all info. on required form

If used to question a medical order Medical staff/director will make a determination

Nurse invoking Safe Harbor will get a copy of Peer Review Committee’s determination and the administrator’s review

Other

If used to question a physician order, the medical staff or medical director will make a determination

Nurse invoking Safe Harbor responsible for keeping a copy – will get a copy of peer review committee’s determination and administrator’s review

Applying for your License http://www.ncsbn.org/

www.pearsonvue.com/nclex Forms, all info is on BON website.See the checklist at end of application Application by NCLEX-RN Examination form

completed and $200.00 Two FBI fingerprint cards $139.00 fee to BON Affidavit of Graduation from Nursing Program 2x2 passport photo; signature, date taken Registration for NCLEX-RN Exam

Assuring CompetenceNCLEX–RN exam = assurance of knowledge base, decision-making competence

Graduation from an accredited school = assurance of psychomotor/technical, legal/ethical, interpersonal, decision-making skills. Evaluation criteria used by school is related to the

“Standards of Nursing Practice” and “Unprofessional Conduct “ in the BON Rules and Regulations

NCLEX and Success

Web sites in syllabus/ModuleTake Review course or purchase NCLEX book to: help practice with NCLEX type questions, identify areas of needs practice at least 2500 ?’s get 85% correct before taking boards!!

Close correlation of grades within program and lev4 exam results and “pass” on the NCLEX. If one exam score is low, remediate!HESI – if score is below 85% - remediate

Taking the NCLEX

Type of Testing

CAT – Computer Adaptive TestingIdentifies 95% chance of safe practice Various types of questions

Pictures, fill in the blank, multiple answer, etc. Don’t make wild guesses to finish items Each test is different

Computer selects items for candidate’s skill level Level of question based on answer to previous question Different questions each time applicant tests

Contains some items that are not graded Instructions, sample items, and breaks are included in

testing time period allowed

www.pearsonvue.com/nclex

Test Plan4 major categories of client needs Safe and effective care environment

Management of careSafety and Infection Control

Health Promotion and Maintenance Psychosocial Integrity Physiologic Integrity

Basic Care and ComfortPharmacological and parenteral therapiesReduction of risk potentialPhysiological Adaptation

Processes

Integrated into every categoryNursing ProcessCaring – interaction of nurse and client;

collaborative environmentCommunication and documentationTeaching/learning

Across life span in a variety of settingsSome questions will apply knowledge from 2 different areas

TipsStudy, practice! Plan You can now test in AUSTIN, TX Schedule carefully- $50.00 to reschedule Sleep, eat, take precautions so you can stay calm!

Master test-taking strategies Read carefully 1-2 minutes/question Think through carefully Remember your ABC’s Do not read into the question Remember Nurse Practice Act: what can LVN’s and CNA’s

do Remember ‘textbook’ patient and ‘Utopia’ hospital

(in ‘a perfect world’ scenarios) Use your breaks to rest!pearsonvue.com/nclex

What to Expect/Prepare

• Arrive 30 minutes early, if you are more than 30 late test will need to be rescheduled and fee paid again

• Come alone no children/family/friends waiting or calling

• No hats, scarves, coats, calculators, pencils, etc. permitted in testing area

• Bring – Authorization to Test (ATT) form – needed to schedule testing session –

Name same as on ID– Valid non-expired Photo ID with your signature

• Finger print, photo, & signature will be taken on admission to test

What to Expect

May take up to 6 hours to complete test – raise hand when done, do not get upMust us computer calculator75-265 questions- 15 unscoredNumber of questions does not predict pass/fail– 75 high pass/fail as computer determines trends

Must answer each item to continue on through test – after hitting ENTER, you may not go back

What to Expect

Results come from BON – approx 21 days – or pay $8 to check score in 48 hours

Retest every 50 days for 4 years in TXSection 301.255 (Reexaminations)Texas Occupations Code- BON may

require additional education requirements of deny testing

Texas Nursing Jurisprudence Exam (NJE)

Effective Sept. 08, all persons applying to take NCLEX must first pass the NJE

Details re exam are still being finalized…per BON

Access BON Bulletin information

Guidelines for New Grad Employment

GN Verification Letter from BON (issued after graduation and completion of application for licensure and examination processes and fees complete) and NCLEX testing date setNo outstanding eligibility issues75 day time period specified on GN Verification letter, OR results of first NCLEXIf first NCLEX exam is failed, practice as GN must stop – no longer eligible. Must know and comply with Nurse Practice Act, and Rules and Regulations

Temporary Authorization to Practice

GN must work under the direct supervision of an RN (physically available, on same unit)

GN shall not be placed in a charge or supervisory position, no independent settings

GN’s permitted to perform any function that falls within scope of nursing practice for which they have received educational preparation and have demonstrated minimal competency

After Being LicensedDirect supervision should be continued for 6 months, or less if agreed upon by new grad and supervising RN. Competence to work independently should be mutually determined and be demonstrated and supported by documentationNewly licensed nurse should not act as charge or be in supervisory position for 6 months – or less with same criteria as above

THESE GUIDELINES PROTECT YOU!!

The 1-2-3s of CE- Continuing Competency (301.303 TOC)

•Required completion of targeted cont ed. programs•Professional portfolio including certifications•Twenty (20) clock contact hours (or 2 Continuing Education Units-CEUs) required every 2 years coinciding with nurse’s license renewal.

•A Continuing Education Unit (CEU) equals 10 contact hours•CE hours must be earned within the two-year period immediately preceding the license renewal, beginning with the first day after the renewal month until the last day of subsequent renewal.

Acceptable CE coursesProgram must be approved by an approved credentialing agency recognized such as American Association of Critical-Care Nurses; Education and Service (NAPNES) Other State Boards of Nursing

Academic courses are approved – proved within framework that that leads to an academic degree in nursing or relevant nursing practice., Self-Paced/Online CE Programs are acceptable for CE credit if approved by approved credentialing program.

Activities Not Acceptable for CE Credit Basic CPR; In-service programs that provide specific information about the work

setting's philosophy, procedures; On-the-job training and equipment demonstration; Refresher courses designed to update knowledge ETC.;

First Time Renewal

A nurse newly licensed in Texas either by examination or by endorsing from another state is exempt from continuing education requirement for first licensure renewal.A nurse's initial license may be valid for a period ranging from six (6) to 29 months, depending on the Licensee's birth date.Following first license renewal, nurse must meet CE requirements for subsequent biannual renewal periods.

Entry into Practice1965 ANA paper recommended Baccalaureate DegreeOne of most contentious issues in nursing50 years of debateSame licensing exam

2000 ANA reaffirmed it’s recommendation Public Health Nursing usually requires BSNSpecialist positions may require masters degree

Differentiated Practice

Structured nursing roles based on:EducationExperienceCompetence

Education based – different prep = different roles

Assessment based – all facets, competency focused

Differentiated Practice Models

Numerous studies and projects have worked on this issue over the last 20 yearsRoles delineated according to educational

preparation: correlating compensation has not been widely used

Competency modelsSome incorporate ANA’s standards of care

with “levels of practice”; novice to expert. RN I to RN V

Can be linked to job descriptions and evaluation

Regulatory Agencies

BON

Certification- standards of a government agency and AccreditationMedicare/Medicaid

Accreditation – non-governmentJCAHOCHAP – Community Health Accreditation

Program

Advisory GroupsProvide expert advice to organizations, governmentExamplesSecretary of Health, Congress – National

Advisory Council on Nurse Education and Practice

Workforce diversity goals – increase recruitment, retention and graduation of minority students; promote minority nurse leadership; develop practice environments that promote diversity; prepare nurses to provide culturally competent care

JCAHO – Nursing Advisory Council

Legislation

Texas LegislatureHas addressed nursing shortages in pastHepatitis C continuing education

requirementCurrent proposal to increase Hepatitis C

requirement to 2 contact hours per renewal period: Nursing groups opposing this.

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ANA

Advocates for Nursing

Defines standards of practice for RNGeneralSpecialty

Provides avenue for nursing to be involved in decision making at national level

Texas Nurses Association

Mission: Promoting excellence through leadership,

advocacy and innovation.

Advocate for nursing with the legislature

Continuing Ed

Current information on legal issues, interpretation of legal, BON

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Go out there and give them health!!