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BON two (2) principal responsibilities

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Regulation of the practice of nursing Approval of nursing education programs

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Board of Nursing Mission/Purpose

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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 purpose supersedes the interest of any individual, the nursing profession, or any special interest group).

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BON Purpose and Functions

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Establish standards of nursing practice and regulate the practice of professional and vocational nursing Interpret the Nursing Practice Act and the Rules and Regulations Relating to Nurse Education, Licensure and Practice to nurses Receive complaints and investigate possible violations Discipline violators

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BON Purpose and Functions

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Examine and license qualified applicants to practice professional and vocational nursing Grant licensure by endorsement to vocational and registered nurses Recommend to legislature appropriate changes in the Nursing Practice Act to ensure that the act is current

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The Board serves the people of Texas through

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assuring licensed nurses meet minimum standards of safe practice.

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Board of Nursing

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Responsible to the public No jurisdiction in facility policies Prohibited from lobbying legislature

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Professional Organizations

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Responsible to their members Serve interests of RNs and LVNs Lobby legislature and Governor

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When Does a Nurse's Duty to a Patient Begin?

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It is not defined by any single event such as clocking in, or taking report. From a BON standpoint, the focus is on the relationship and responsibility of the nurse to the patient(s), not to the nurse's employer or employment.

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Licensure

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

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Minimum Information Required on a name badge The insignia may not contain information other than:

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The registered or vocational nurse designation The nurse name, certifications, academic degrees, or practice position Name of the employing facility or agency A picture of the nurse Any other information authorized by the board

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Temporary GN permit

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is not renewable and is valid for 75 days from the date of eligibility. Once NCLEX is taken and if a no pass GN permit is void.

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The Texas BON is the primary source verification for nurse licensure,

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and the BON web site should be used to verify that a nurse is eligible to practice in Texas.

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Licensure Renewal Requirement

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Twenty contact hours of continuing education within the two years immediately preceding renewal of registration are required, and paying the current licensure fee. (New Rule) Continuing Education (CE) contact hours are no longer by "Type", has be to approved by a credentialing agency. Audits after 10/31/08 must comply with the new rule **The length of the program shall be at least one hour (50 consecutive minutes) in length.

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An applicant for initial licensure by examination shall pass the NCLEX-PN or NCLEX-RN

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within four years of completion of requirements for graduation.

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Renewal period—

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Two-year period determined by the licensee's birth month and year. Specific time frame for renewal may vary from six months to 29 months as determined by board policies.

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Licensure Renewal CEUs ( unacceptable)

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Basic Life Support (BLS) or cardiopulmonary resuscitation (CPR) courses. Inservice programs. Nursing refresher courses. Orientation programs Courses which focus upon self-improvement, changes in attitude, self-therapy, self-awareness, weight loss, and yoga.

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Licensure Renewal CEUs ( unacceptable)

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Economic courses for financial gain, e.g., investments, retirement, preparing resumes, and techniques for job interview. Courses which focus on personal appearance in nursing

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Mandatory Licensure---

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Requires that all person who are compensated as a member of the licensed profession obtain licensure prior to practicing actions of the profession.

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Nurses in Armed services or nurses employed by Federal Agencies must

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hold a current State license, but not necessarily from the State in which they are currently employed or assigned.

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Reciprocity---

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An agreement by 2 or more States granting recognition to licensure by other State BON. They only must apply and pay required fees.

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the Nurse Licensure Compact

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Once residency is established and declared within a compact state, the license, if clear of discipline, will become a compact license and can be used to work in all other compact states.

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Nurse Licensure Compact (BNE Rule 220.2) As of July 1, 2005, no applicant for initial licensure will be issued a license granting a multistate privilege to practice unless the applicant first

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obtains a passing score on the applicable NCLEX examination or its predecessor examination used for licensure.

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Nurse Licensure Compact (BNE Rule 220.2) A nurse changing primary state of residence, from one party state to another party state, may continue to practice under the former home state license and multistate licensure privilege during the processing of the nurse's licensure application in the new home state for a period not to exceed

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thirty days.

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Nurse Licensure Compact (BNE Rule 220.2) If a decision is made by the new home state denying licensure,

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the new home state shall notify the former home state within **ten business days ** and the former home state may take action in accordance with that state's laws and rules. The former home state license shall no longer be valid upon the issuance of a new home state license.

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Endorsement---

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A concept which allows a state to grant licensure to an already licensed nurse from another state if the two states' qualifications and licensure requirements are comparable. Usually, the state granting endorsement requires that a similar licensure examination exists in both states. This means of granting licensure is distinguished from reciprocity in that no prior agreement exists between the two individual states.

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Reciprocity----

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Is an agreement by two or more states granting recognition to licensure by other state boards of nursing. For reciprocity, the licensing requirements of the involved states must be equivalent. Such a provision allows licensed nurses to be granted additional licensure merely by application and payment of required fees. The concept of reciprocity also allows states with similar disciplinary actions to revoke a license in a state based on revocation in a sister state.

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Changing from State to State From non-compact to compact:

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You must apply for licensure by endorsement in the new state of residency. Your individual state license issued by the non-compact state is not affected and will remain active if you maintain licensure and if so provided by the laws of the nonparty state.

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Changing from State to State From compact to non-compact:

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You must apply for licensure by endorsement in the new state of residency. Your compact license is changed to a single-state license valid only in that state. You must notify the board of nursing that you have moved out of state. ***A change of address, or name must be reported to the BON within 10 days***

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Moving from State to State From one compact state to another:

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**You can practice on the former residency license for up to 30 days.** You will be required to: Apply for licensure by endorsement (It is recommended that nurses apply 1-2 months in advance of a move.) Pay any applicable fees Complete a declaration of primary state of residency in the new home state You will be issued a new multistate license and the former is inactivated. You must notify the board of nursing in the former residency state that you have moved out of state. Proof of residency may be required

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Nursing Ethics §213.28. Licensure of Persons with Criminal Offenses.

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The nurse has access to personal information about all aspects of a person's life, resources and relationships. Therefore, criminal behavior whether violent or non-violent, directed against persons, property or public order and decency is considered by the Board as highly relevant to an individual's fitness to practice nursing.

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Criminal conduct that relate to and affect the practice of nursing:

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offenses against the person offenses against property, e.g., robbery, burglary and theft, etc offenses involving fraud or deception offenses involving lying and falsification offenses involving the delivery, possession, manufacture, or use of, or dispensing or prescribing a controlled substance, dangerous drug, or mood-altering substance

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Excessive Self-Disclosure -

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The nurse discusses personal problems, feelings of sexual attraction or aspects of his or her intimate life with the client.

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Secretive Behavior -

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The nurse keeps secrets with the client and / or becomes guarded or defensive when someone questions their interaction.

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"Super Nurse" Behavior -

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The nurse believes that he or she is immune from fostering a non-therapeutic relationship and that only he or she understands and can meet the client's needs.

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Nursing Practice Registered Nurses: Included but not limited to:

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Perform comprehensive nursing assessments Make Nursing Diagnoses Develop a plan of care Implement nursing care Evaluate the client's responses to nursing interventions Delegate tasks to unlicensed personnel

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Negligence---

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Conduct lacking in due care (ex. Not stocking the crash cart, a fall by an elderly patient who is being cared for by a sitter).

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Malpractice—

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Addresses the professional standard of care as well as the professional status of the caregiver. (To be liable for malpractice, the person must be a professional

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Elements of malpractice/Negligence

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Duty owed the patient Breach of the duty owed the patient Foreseeability Causation— Injury- Damages-

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Good Samaritan Laws are enacted to allow

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health care personnel and citizens trained in first aid to deliver needed medical care without unnecessary fear of incurring criminal and civil liability.

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Only when a person renders grossly negligent or willful and wanton negligent care is

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the health care provider not protected by the Good Samaritan immunity These acts vary from state to state

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Scope of Practice--Determining Nursing Scope of Practice (Six Step decision-making Model) Question 1

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Is the activity consistent with the Nursing Practice Act, Rules and regulations and Board Positions Statements?

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Scope of Practice--Determining Nursing Scope of Practice (Six Step decision-making Model) Question 2

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Is the activity appropriately authorized by valid order and in accordance with established policies and procedures?

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Scope of Practice--Determining Nursing Scope of Practice (Six Step decision-making Model) Question 3

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Is the act supported by either research reported nursing and health-related literature or in scope of practice statements by national nursing organizations?

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Scope of Practice--Determining Nursing Scope of Practice (Six Step decision-making Model) Question 4

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Do you possess the required knowledge and have you demonstrated the competency required to carry out this activity Safely?

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Scope of Practice--Determining Nursing Scope of Practice (Six Step decision-making Model) Question 5

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Would a reasonable and prudent nurse perform this activity in this setting?

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Scope of Practice--Determining Nursing Scope of Practice (Six Step decision-making Model) Question 6

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Are you prepared to assume accountability for the provision of safe care and the outcome of the care rendered?

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Scope of Practice--Determining Nursing Scope of Practice (Six Step decision-making Model)

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If you cannot answer yes to all 6 questions, it's not in your scope of practice and you shouldn't do it.

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217.11 standards of practice and 217.12 Unprofessional Conduct

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Provides baseline for safe and effective care Establishes minimal acceptable level Identifies unprofessional behaviors

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217.11 standards of practice -Standard (1) A KNOW rules & laws

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Know and conform to NPA, Rules and other law affecting current area of practice Know laws for your specific practice area Violating laws outside of BON usually violates something in Rules

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217.11 standards of practice -Standard (1) B Safe Environment

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Violation of any other standard=actual or potential violation of this standard Duty cannot be diminished by physician order or facility policy

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217.11 standards of practice -Standard (1) T Accept Assignments

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Each nurse is individually accountable for accepting a given assignment Safe Harbor situation impact BON's determination regarding action on the nurse's license

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217.11 standards of practice -Standard (1) S Making Assignments

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1. Must have educational preparation, experience, knowledge and ability to perform assignment safely. 2. Applies to LVNs and RNs who make assignments to others.

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217.11 standards of practice -Standard (1) K Mandatory Reporting; Identify those having a mandatory reporting requirement:

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A Nurse Educational Program Peer-Review Committee Employer Professional Organizations State Agency Liability Insurer Prosecuting Attorney ***Actual harm need not occur, risk of harm related to wrong actions or lack of action by a nurse may be sufficient to warrant reporting the nurse.

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