|
| A) | 1890. | ||
| B) | 1909. | ||
| C) | 1955. | ||
| D) | 2007. |
Nursing practice acts have a long history in the United States, with the first standards being enacted in the early 1900s [1]. In 1907, nineteen nurses from around the state formed the Texas Graduate Nurses' Association in Fort Worth. These women had a collective interest in establishing standards for the delivery of nursing care and creating a nursing board [1]. Using recent Colorado legislation as a model, the Graduate Nurses' Association advocated for nursing legislation in Texas. The Nurses Registration Act of 1909 (an early version of the Nursing Practice Act) passed the Texas Legislature, and thus the Board of Nurse Examiners, which became the Board of Nursing in 2007, was created [1].
| A) | Chapter 301 | ||
| B) | Chapter 303 | ||
| C) | Chapter 304 | ||
| D) | Chapter 305 |
The Texas Nursing Practice Act has undergone extensive revision and amendment since 1909 [1,2]. Legislated to safeguard the public, its purpose is to ensure that minimum safety requirements are met by every nurse practicing in the state. The Nursing Practice Act (i.e., Chapter 301 of the Texas Occupations Code) includes laws and rules regulating nursing education, licensure, and practice [2]. Chapter 301 establishes the Texas Board of Nursing as an authority to adopt rules, develop standards for nursing programs, and discipline nurses who violate regulations [2]. Nurses who fall below the Board's required minimum competency; who present a danger to patients, coworkers, or others; or who fail to comply with all Board of Nursing rules will be prohibited from working in the state.
| A) | The Position Statements are a collection of guidelines designed to help nurses position patients for different procedures. | ||
| B) | The Position Statements are a set of additional laws passed by the Texas Board of Nursing and are required reading for all nurses in Texas. | ||
| C) | The Position Statements are not technically laws, but provide guidance regarding patient safety, scope of practice, and other important issues. | ||
| D) | All of the above |
In addition to Chapter 301 (the Nursing Practice Act), the Board of Nursing stipulates that Texas nurses are required to be familiar with Chapter 303 (Nursing Peer Review) and Chapter 304 (the Nurse Licensure Compact) [2]. Several chapters of the Texas Administrative Code, which is a collection of all state agency rules, also pertain to nursing education, licensure, practice, and discipline. Together, these laws and rules form the basis for the legal practice of nursing and the regulation of nursing by the State of Texas. Although they are not technically laws, the Texas Board of Nursing Position Statements provide guidance regarding patient safety, scope of practice, and other important issues; the Board strongly encourages that nurses read all Position Statements, or at the very least, the Summary of Position Statements [3]. Texas nurses should also be familiar with the principles of nursing ethics and have a firm understanding of professional boundaries [3].
| A) | Participating in the development and modification of the nursing care plan | ||
| B) | Medical diagnosis and the prescription of therapeutic or corrective measures | ||
| C) | Collecting data and performing focused nursing assessments of the health status of an individual | ||
| D) | Assisting in the evaluation of an individual's response to a nursing intervention and the identification of an individual's needs |
According to the Texas Nursing Practice Act, the practice of vocational nursing is defined as a "directed scope of nursing practice, including the performance of an act that requires specialized judgment and skill, the proper performance of which is based on knowledge and application of the principles of biologic, physical, and social science as acquired by a completed course in an approved school of vocational nursing. The term does not include acts of medical diagnosis or the prescription of therapeutic or corrective measures." Vocational nursing involves [2]:
Collecting data and performing focused nursing assessments of the health status of an individual
Participating in the planning of the nursing care needs of an individual
Participating in the development and modification of the nursing care plan
Participating in health teaching and counseling to promote, attain, and maintain the optimum health level of an individual
Assisting in the evaluation of an individual's response to a nursing intervention and the identification of an individual's needs
Engaging in other acts that require education and training, as prescribed by Board rules and policies, commensurate with the nurse's experience, continuing education, and demonstrated competency
| A) | A professional nurse is not allowed to supervise other nurses. | ||
| B) | A professional nurse is responsible for developing a patient's treatment plan. | ||
| C) | Developing a patient's nursing care plan is within a professional nurse's scope of practice. | ||
| D) | A professional nurse is not accountable for the outcome of a task delegated by a physician. |
The practice of professional nursing is defined as "the performance of an act that requires substantial specialized judgment and skill, the proper performance of which is based on knowledge and application of the principles of biologic, physical, and social science as acquired by a completed course in an approved school of professional nursing. The term does not include acts of medical diagnosis or the prescription of therapeutic or corrective measures." Professional nursing involves [2]:
Observation, assessment, intervention, evaluation, rehabilitation, care and counsel, or health teachings of a person who is ill, injured, infirm, or experiencing a change in normal health processes
Administration of a medication or treatment as ordered by a physician, podiatrist, or dentist
Maintenance of health or prevention of illness
Performance of an act delegated by a physician
The development of the nursing care plan
Supervision or teaching of nursing
Administration, supervision, and evaluation of nursing practices, policies, and procedures
Requesting, receiving, signing for, and distribution of prescription drug samples to patients at practices at which an APRN is authorized to sign prescription drug orders
| A) | A nurse whose actions constitute abuse, exploitation, fraud, or a violation of professional boundaries | ||
| B) | A nurse whose conduct causes a person to suspect that the nurse's practice is impaired by chemical dependency or drug or alcohol abuse | ||
| C) | A nurse whose actions indicate that the nurse lacks knowledge, skill, judgment, or conscientious- ness to such an extent that the nurse's continued practice of nursing could reasonably be expected to pose a risk of harm to a patient or another person, regardless of whether the conduct consists of a single incident or a pattern of behavior | ||
| D) | All of the above |
In addition to the Nursing Practice Act, there are several chapters of the Texas Administrative Code (i.e., Chapters 211–228) that contain rules pertinent to nursing. Texas Administrative Code Rule 217.11 (Standards of Nursing Practice) contains the minimum acceptable standards for all licensed nurses. It states that the Board of Nursing is responsible for regulating the practice of nursing within the State of Texas for LVNs, RNs, and APRNs, and that action against the nurse's license may result from a failure to meet the minimum acceptable level of practice, even if no patient injury results from a nurse's actions or inactions [10]. All nurses practicing in Texas must meet the minimum acceptable standards specified in Rule 217.11, which includes requirements to [10]:
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
Implement measures to promote a safe environment for clients and others
Know the rationale for and the effects of medications and treatments and correctly administer the same
Accurately and completely report and document: the client's status, including signs and symptoms; nursing care rendered; physician, dentist, or podiatrist orders; administration of medications and treatments; client response(s); and contacts with other healthcare team members concerning significant events regarding client's status
Respect the client's right to privacy by protecting confidential information unless required or allowed by law to disclose the information
Promote and participate in education and counseling to a client(s) and, where applicable, the family/significant other(s) based on health needs
Obtain instruction and supervision as necessary when implementing nursing procedures or practices
Make a reasonable effort to obtain orientation/training for competency when encountering new equipment and technology or unfamiliar care situations
Notify the appropriate supervisor when leaving a nursing assignment
Know, recognize, and maintain professional boundaries of the nurse-client relationship
Comply with mandatory reporting requirements of Texas Occupations Code Chapter 301 (Nursing Practice Act), Subchapter I, which include reporting a nurse: who violates the Nursing Practice Act or a Board rule (except for minor incidents as stated in the Nursing Practice Act and Board rules) and contributed to the death or serious injury of a patient; whose conduct causes a person to suspect that the nurse's practice is impaired by chemical dependency or drug or alcohol abuse; whose actions constitute abuse, exploitation, fraud, or a violation of professional boundaries; or whose actions indicate that the nurse lacks knowledge, skill, judgment, or conscientiousness to such an extent that the nurse's continued practice of nursing could reasonably be expected to pose a risk of harm to a patient or another person, regardless of whether the conduct consists of a single incident or a pattern of behavior
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
Institute appropriate nursing interventions that might be required to stabilize a client's condition and/or prevent complications
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 decision is made not to administer the medication or treatment
Implement measures to prevent exposure to infectious pathogens and communicable conditions
Collaborate with the client, members of the healthcare team and, when appropriate, the client's significant other(s) in the interest of the client's health care
Consult with, utilize, and make referrals to appropriate community agencies and health care resources to provide continuity of care
Be responsible for one's own continuing competence in nursing practice and individual professional growth
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
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
Supervise nursing care provided by others for whom the nurse is professionally responsible
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.
| A) | order is believed to be inaccurate. | ||
| B) | nurse has too much experience with performing the task. | ||
| C) | patient has different religious beliefs than the nursing staff. | ||
| D) | patient speaks an unfamiliar language and has limited English proficiency. |
In addition to the Nursing Practice Act, there are several chapters of the Texas Administrative Code (i.e., Chapters 211–228) that contain rules pertinent to nursing. Texas Administrative Code Rule 217.11 (Standards of Nursing Practice) contains the minimum acceptable standards for all licensed nurses. It states that the Board of Nursing is responsible for regulating the practice of nursing within the State of Texas for LVNs, RNs, and APRNs, and that action against the nurse's license may result from a failure to meet the minimum acceptable level of practice, even if no patient injury results from a nurse's actions or inactions [10]. All nurses practicing in Texas must meet the minimum acceptable standards specified in Rule 217.11, which includes requirements to [10]:
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
Implement measures to promote a safe environment for clients and others
Know the rationale for and the effects of medications and treatments and correctly administer the same
Accurately and completely report and document: the client's status, including signs and symptoms; nursing care rendered; physician, dentist, or podiatrist orders; administration of medications and treatments; client response(s); and contacts with other healthcare team members concerning significant events regarding client's status
Respect the client's right to privacy by protecting confidential information unless required or allowed by law to disclose the information
Promote and participate in education and counseling to a client(s) and, where applicable, the family/significant other(s) based on health needs
Obtain instruction and supervision as necessary when implementing nursing procedures or practices
Make a reasonable effort to obtain orientation/training for competency when encountering new equipment and technology or unfamiliar care situations
Notify the appropriate supervisor when leaving a nursing assignment
Know, recognize, and maintain professional boundaries of the nurse-client relationship
Comply with mandatory reporting requirements of Texas Occupations Code Chapter 301 (Nursing Practice Act), Subchapter I, which include reporting a nurse: who violates the Nursing Practice Act or a Board rule (except for minor incidents as stated in the Nursing Practice Act and Board rules) and contributed to the death or serious injury of a patient; whose conduct causes a person to suspect that the nurse's practice is impaired by chemical dependency or drug or alcohol abuse; whose actions constitute abuse, exploitation, fraud, or a violation of professional boundaries; or whose actions indicate that the nurse lacks knowledge, skill, judgment, or conscientiousness to such an extent that the nurse's continued practice of nursing could reasonably be expected to pose a risk of harm to a patient or another person, regardless of whether the conduct consists of a single incident or a pattern of behavior
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
Institute appropriate nursing interventions that might be required to stabilize a client's condition and/or prevent complications
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 decision is made not to administer the medication or treatment
Implement measures to prevent exposure to infectious pathogens and communicable conditions
Collaborate with the client, members of the healthcare team and, when appropriate, the client's significant other(s) in the interest of the client's health care
Consult with, utilize, and make referrals to appropriate community agencies and health care resources to provide continuity of care
Be responsible for one's own continuing competence in nursing practice and individual professional growth
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
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
Supervise nursing care provided by others for whom the nurse is professionally responsible
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.
| A) | Veracity | ||
| B) | Causation | ||
| C) | Beneficence | ||
| D) | Competence |
Major ethical issues that may arise in the practice of nursing are related to the provision of patient-centered care, advocacy, delegation, self-care, and supporting colleagues and the profession [11]. Ethical concepts central to patient-centered care include advocacy, confidentiality, privacy, self-determination, and the dignity and worth of all persons. Ethical concepts central to nursing practice include accountability (i.e., accepting responsibility for one's action or inaction), beneficence (i.e., the duty to do good), competence (i.e., only performing duties within one's scope of practice, acquiring new skills and education), nonmaleficence (i.e., the duty to do no harm), veracity (i.e., truthfulness), and social reform (e.g., advocating for patients and groups). Additionally, as a nurse gains experience in his or her field and specialty, the ethic of teaching comes into play. This can simply involve helping an inexperienced nurse grow by passing along knowledge, or can involve more specific leadership, supervisory, or teaching roles.
| A) | Proper management of client records | ||
| B) | Carefully and repeatedly conforming to generally accepted nursing standards in applicable practice settings | ||
| C) | Failing to supervise the performance of tasks by any individual working pursuant to the nurse's delegation or assignment | ||
| D) | Accepting the assignment of nursing functions or a prescribed health function when the acceptance of the assignment could be reasonably expected to result in safe and effective client care |
The State of Texas defines unprofessional conduct, in Texas Administrative Code Rule 217.12, as "unprofessional or dishonorable behaviors of a nurse that the Board believes are likely to deceive, defraud, or injure clients or the public" [17]. These behaviors include but are not limited to [17]:
Unsafe practice, including, but not limited to:
Carelessly failing, repeatedly failing, or exhibiting an inability to perform vocational, registered, or advanced practice nursing in conformity with the standards of minimum acceptable level of nursing practice set out in Rule 217.11
Carelessly or repeatedly failing to conform to generally accepted nursing standards in applicable practice settings
Improper management of client records
Delegating or assigning nursing functions or a prescribed health function when the delegation or assignment could reasonably be expected to result in unsafe or ineffective client care
Accepting the assignment of nursing functions or a prescribed health function when the acceptance of the assignment could be reasonably expected to result in unsafe or ineffective client care
Failing to supervise the performance of tasks by any individual working pursuant to the nurse's delegation or assignment
Failure of a clinical nursing instructor to adequately supervise or to assure adequate supervision of student experiences
Failure of a chief administrative nurse to follow appropriate and recognized standards and guidelines in providing oversight of the nursing organization and nursing services for which the nurse is administratively responsible
Failure to practice within a modified scope of practice or with the required accommodations, as specified by the Board in granting a coded license or any stipulated agreement with the Board
Careless or repetitive conduct that may endanger a client's life, health, or safety (whether or not actual injury to a client is established)
Inability to practice safely, as defined by demonstration of actual or potential inability to practice nursing with reasonable skill and safety to clients by reason of illness; use of alcohol, drugs, chemicals, or any other mood-altering substances; or as a result of any mental or physical condition
Misconduct, including, but not limited to:
Falsifying reports, client documentation, agency records, or other documents
Failing to cooperate with a lawful investigation conducted by the Board
Causing or permitting physical, emotional, or verbal abuse or injury or neglect to the client or the public, or failing to report same to the employer, appropriate legal authority, and/or licensing board
Violating professional boundaries of the nurse/client relationship, including but not limited to physical, sexual, emotional, or financial exploitation of the client or the client's significant other(s)
Engaging in sexual conduct with a client, touching a client in a sexual manner, requesting or offering sexual favors, or language or behavior suggestive of the same
Threatening or violent behavior in the workplace
Misappropriating, in connection with the practice of nursing, anything of value or benefit, including, but not limited to, any property (real or personal) of the client, employer, or any other person or entity; or failing to take precautions to prevent such misappropriation
Providing information that was false, deceptive, or misleading in connection with the practice of nursing
Failing to answer specific questions or providing false or misleading answers that would have affected the decision to license, employ, certify, or otherwise utilize a nurse
Offering, giving, soliciting, or receiving or agreeing to receive (directly or indirectly) any fee or other consideration to or from a third party for the referral of a client in connection with the performance of professional services
Failure to pay child support payments as required by the Texas Family Code§232.001
Diversion or attempts to divert drugs or controlled substances
Dismissal from a Board-approved peer assistance program for noncompliance and referral by that program to the Board
Other drug-related actions or conduct including, but not limited to:
Use of any controlled substance or any drug (prescribed or unprescribed), device, or alcoholic beverages while on duty or on call and to the extent that such use may impair the nurse's ability to safely conduct to the public the practice authorized by the nurse's license
Falsification of or making incorrect, inconsistent, or unintelligible entries in any agency, client, or other record pertaining to drugs or controlled substances
Failing to follow the policy and procedure in place for the wastage of medications at the facility where the nurse was employed or working at the time of the incident(s)
A positive drug screen for which there is no lawful prescription
Obtaining or attempting to obtain or deliver medication(s) through means of misrepresentation, fraud, forgery, deception, and/or subterfuge
Unlawful practice, including, but not limited to:
Knowingly aiding, assisting, advising, or allowing an unlicensed person to engage in the unlawful practice of vocational, registered, or advanced practice nursing
Violating an order of the Board; carelessly or repetitively violating a state or federal law relating to the practice of vocational, registered, or advanced practice nursing; or violating a state or federal narcotics or controlled substance law
Knowingly aiding, assisting, advising, or allowing a nurse under Board order to violate the conditions set forth in the order
Failing to report violations of the Nursing Practice Act and/or the Board's rules and regulations
Leaving a nursing assignment (including a supervisory assignment) without notifying the appropriate personnel
| A) | Touching a client in a nonsexual or nonthreatening way as part of a nursing task | ||
| B) | Notifying an employer that another employee is misappropriating medical supplies | ||
| C) | Providing information that was accurate and true in connection with the practice of nursing | ||
| D) | Causing or permitting physical, emotional, or verbal abuse or injury or neglect to the client or the public, or failing to report same to the employer, appropriate legal authority, and/or licensing board |
The State of Texas defines unprofessional conduct, in Texas Administrative Code Rule 217.12, as "unprofessional or dishonorable behaviors of a nurse that the Board believes are likely to deceive, defraud, or injure clients or the public" [17]. These behaviors include but are not limited to [17]:
Unsafe practice, including, but not limited to:
Carelessly failing, repeatedly failing, or exhibiting an inability to perform vocational, registered, or advanced practice nursing in conformity with the standards of minimum acceptable level of nursing practice set out in Rule 217.11
Carelessly or repeatedly failing to conform to generally accepted nursing standards in applicable practice settings
Improper management of client records
Delegating or assigning nursing functions or a prescribed health function when the delegation or assignment could reasonably be expected to result in unsafe or ineffective client care
Accepting the assignment of nursing functions or a prescribed health function when the acceptance of the assignment could be reasonably expected to result in unsafe or ineffective client care
Failing to supervise the performance of tasks by any individual working pursuant to the nurse's delegation or assignment
Failure of a clinical nursing instructor to adequately supervise or to assure adequate supervision of student experiences
Failure of a chief administrative nurse to follow appropriate and recognized standards and guidelines in providing oversight of the nursing organization and nursing services for which the nurse is administratively responsible
Failure to practice within a modified scope of practice or with the required accommodations, as specified by the Board in granting a coded license or any stipulated agreement with the Board
Careless or repetitive conduct that may endanger a client's life, health, or safety (whether or not actual injury to a client is established)
Inability to practice safely, as defined by demonstration of actual or potential inability to practice nursing with reasonable skill and safety to clients by reason of illness; use of alcohol, drugs, chemicals, or any other mood-altering substances; or as a result of any mental or physical condition
Misconduct, including, but not limited to:
Falsifying reports, client documentation, agency records, or other documents
Failing to cooperate with a lawful investigation conducted by the Board
Causing or permitting physical, emotional, or verbal abuse or injury or neglect to the client or the public, or failing to report same to the employer, appropriate legal authority, and/or licensing board
Violating professional boundaries of the nurse/client relationship, including but not limited to physical, sexual, emotional, or financial exploitation of the client or the client's significant other(s)
Engaging in sexual conduct with a client, touching a client in a sexual manner, requesting or offering sexual favors, or language or behavior suggestive of the same
Threatening or violent behavior in the workplace
Misappropriating, in connection with the practice of nursing, anything of value or benefit, including, but not limited to, any property (real or personal) of the client, employer, or any other person or entity; or failing to take precautions to prevent such misappropriation
Providing information that was false, deceptive, or misleading in connection with the practice of nursing
Failing to answer specific questions or providing false or misleading answers that would have affected the decision to license, employ, certify, or otherwise utilize a nurse
Offering, giving, soliciting, or receiving or agreeing to receive (directly or indirectly) any fee or other consideration to or from a third party for the referral of a client in connection with the performance of professional services
Failure to pay child support payments as required by the Texas Family Code§232.001
Diversion or attempts to divert drugs or controlled substances
Dismissal from a Board-approved peer assistance program for noncompliance and referral by that program to the Board
Other drug-related actions or conduct including, but not limited to:
Use of any controlled substance or any drug (prescribed or unprescribed), device, or alcoholic beverages while on duty or on call and to the extent that such use may impair the nurse's ability to safely conduct to the public the practice authorized by the nurse's license
Falsification of or making incorrect, inconsistent, or unintelligible entries in any agency, client, or other record pertaining to drugs or controlled substances
Failing to follow the policy and procedure in place for the wastage of medications at the facility where the nurse was employed or working at the time of the incident(s)
A positive drug screen for which there is no lawful prescription
Obtaining or attempting to obtain or deliver medication(s) through means of misrepresentation, fraud, forgery, deception, and/or subterfuge
Unlawful practice, including, but not limited to:
Knowingly aiding, assisting, advising, or allowing an unlicensed person to engage in the unlawful practice of vocational, registered, or advanced practice nursing
Violating an order of the Board; carelessly or repetitively violating a state or federal law relating to the practice of vocational, registered, or advanced practice nursing; or violating a state or federal narcotics or controlled substance law
Knowingly aiding, assisting, advising, or allowing a nurse under Board order to violate the conditions set forth in the order
Failing to report violations of the Nursing Practice Act and/or the Board's rules and regulations
Leaving a nursing assignment (including a supervisory assignment) without notifying the appropriate personnel