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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!!