The Texas Board of Nurse Examiners is responsible for regulating the practice of nursing within the State of Texas for Vocational Nurses, Registered Nurses, and Registered Nurses with advanced practice authorization. The standards of practice establish a minimum acceptable level of nursing practice in any setting for each level of nursing licensure or advanced practice authorization. Failure to meet these standards may result in action against the nurse's license even if no actual patient injury resulted.

1. (1) Standards Applicable to All Nurses. All vocational nurses, registered nurses and registered nurses with advanced practice authorization shall:

   1. (A) Know and conform to the Texas Nursing Practice Act and the board's rules and regulations as well as all federal, state, or local laws, rules or regulations affecting the nurse's current area of nursing practice;
   2. (B) Implement measures to promote a safe environment for clients and others;
   3. (C) Know the rationale for and the effects of medications and treatments and shall correctly administer the same;

   4. (D) Accurately and completely report and document:

      1. (i) the client's status including signs and symptoms;
      2. (ii) nursing care rendered;
      3. (iii) physician, dentist or podiatrist orders;
      4. (iv) administration of medications and treatments;
      5. (v) client response(s); and
      6. (vi) contacts with other health care team members concerning significant events regarding client's status;
   5. (E) Respect the client's right to privacy by protecting confidential information unless required or allowed by law to disclose the information;
   6. (F) Promote and participate in education and counseling to a client(s) and, where applicable, the family/significant other(s) based on health needs;
   7. (G) Obtain instruction and supervision as necessary when implementing nursing procedures or practices;
   8. (H) Make a reasonable effort to obtain orientation/training for competency when encountering new equipment and technology or unfamiliar care situations;
   9. (I) Notify the appropriate supervisor when leaving a nursing assignment;
   10. (J) Know, recognize, and maintain professional boundaries of the nurse-client relationship;

   11. (K) Comply with mandatory reporting requirements of Texas Occupations Code ch. 301, Subchapter I, which include:

       1. (i) unnecessary or likely exposure by the nurse of a client or other person to a risk of harm;
       2. (ii) unprofessional conduct by a nurse;
       3. (iii) failure by a nurse to adequately care for a client;
       4. (iv) failure by a nurse to conform to the minimum standards of acceptable nursing practice;
       5. (v) impairment or likely impairment of a nurse's practice by chemical dependency; or
       6. (vi) exclusions for minor incidents (Tex. Occ. Code §301.419, 22 TAC §217.16), peer review (Tex. Occ. Code §§301.403, 303.007, 22 TAC §217.19), or peer assistance (Tex. Occ. Code §301.410) as stated in the Nursing Practice Act and Board rules (22 TAC ch. 217).
   12. (L) Provide, without discrimination, nursing services regardless of the age, disability, economic status, gender, national origin, race, religion, health problems, or sexual orientation of the client served;
   13. (M) Institute appropriate nursing interventions that might be required to stabilize a client's condition and/or prevent complications;
   14. (N) Clarify any order or treatment regimen that the nurse has reason to believe is inaccurate, non-efficacious or contraindicated by consulting with the appropriate licensed practitioner and notifying the ordering practitioner when the nurse makes the decision not to administer the medication or treatment;
   15. (O) Implement measures to prevent exposure to infectious pathogens and communicable conditions;
   16. (P) Collaborate with the client, members of the health care team and, when appropriate, the client's significant other(s) in the interest of the client's health care;
   17. (Q) Consult with, utilize, and make referrals to appropriate community agencies and health care resources to provide continuity of care;
   18. (R) Be responsible for one's own continuing competence in nursing practice and individual professional growth;
   19. (S) Make assignments to others that take into consideration client safety and that are commensurate with the educational preparation, experience, knowledge, and physical and emotional ability of the person to whom the assignments are made;
   20. (T) Accept only those nursing assignments that take into consideration client safety and that are commensurate with the nurse's educational preparation, experience, knowledge, and physical and emotional ability;
   21. (U) Supervise nursing care provided by others for whom the nurse is professionally responsible; and
   22. (V) Ensure the verification of current Texas licensure or other Compact State licensure privilege and credentials of personnel for whom the nurse is administratively responsible, when acting in the role of nurse administrator.

2. (2) Standards Specific to Vocational Nurses. The licensed vocational nurse practice is a directed scope of nursing practice under the supervision of a registered nurse, advanced practice registered nurse, physician's assistant, physician, podiatrist, or dentist. Supervision is the process of directing, guiding, and influencing the outcome of an individual's performance of an activity. The licensed vocational nurse shall assist in the determination of predictable healthcare needs of clients within healthcare settings and:

   1. (A) Shall utilize a systematic approach to provide individualized, goal-directed nursing care by:

      1. (i) collecting data and performing focused nursing assessments;
      2. (ii) participating in the planning of nursing care needs for clients;
      3. (iii) participating in the development and modification of the comprehensive nursing care plan for assigned clients;
      4. (iv) implementing appropriate aspects of care within the LVN's scope of practice; and
      5. (v) assisting in the evaluation of the client's responses to nursing interventions and the identification of client needs;
   2. (B) Shall assign specific tasks, activities and functions to unlicensed personnel commensurate with the educational preparation, experience, knowledge, and physical and emotional ability of the person to whom the assignments are made and shall maintain appropriate supervision of unlicensed personnel.
   3. (C) May perform other acts that require education and training as prescribed by board rules and policies, commensurate with the licensed vocational nurse's experience, continuing education, and demonstrated licensed vocational nurse competencies.

3. (3) Standards Specific to Registered Nurses. The registered nurse shall assist in the determination of healthcare needs of clients and shall:

   1. (A) Utilize a systematic approach to provide individualized, goal-directed, nursing care by:

      1. (i) performing comprehensive nursing assessments regarding the health status of the client;
      2. (ii) making nursing diagnoses that serve as the basis for the strategy of care;
      3. (iii) developing a plan of care based on the assessment and nursing diagnosis;
      4. (iv) implementing nursing care; and
      5. (v) evaluating the client's responses to nursing interventions;
   2. (B) Delegate tasks to unlicensed personnel in compliance with 22 Tex. Admin. Code chapter 224, relating to clients with acute conditions or in acute are environments, and chapter 225, relating to independent living environments for clients with stable and predictable conditions.

4. (4) Standards Specific to Registered Nurses with Advanced Practice Authorization. Standards for a specific role and specialty of advanced practice nurse supersede standards for registered nurses where conflict between the standards, if any, exist. In addition to paragraphs (1) and (3) above, a registered nurse who holds authorization to practice as an advanced practice nurse (APN) shall:

   1. (A) Practice in an advanced nursing practice role and specialty in accordance with authorization granted under Board Rule 221 (relating to practicing in an APN role; 22 TAC ch. 221) and standards set out in that Rule.
   2. (B) Prescribe medications in accordance with prescriptive authority granted under Board Rule 222 (relating to APNs prescribing; 22 TAC ch. 222) and standards set out in that Rule and in compliance with state and federal laws and regulations relating to prescription of dangerous drugs and controlled substances.

Source Note:The provisions of this §217.11 adopted to be effective September 28, 2004, 29 TexReg 9192.