Nursing Jurisprudence and Ethics for Texas Nurses

Transcription

1 Nursing Jurisprudence and Ethics for Texas Nurses Contact Hours: 2 hours First Published: March 31, 2017 This course expires on: March 31, 2019 This course complies with the guidelines set forth by the Texas Board of Nursing. COURSE OBJECTIVES Upon completion of this course, the nurse will be able to: 1. Describe the legislative purpose for the Nurse Practice Act. 2. Verbalize specific laws and rules related to the practice of nursing in Texas. 3. Discuss the general requirements for continuing licensure in the State of Texas. 5. Differentiate between ethical and legal practice.

2 Nurses are the main foundation when building a healthcare system that wishes to ensure optimal care for patients. It is with the due diligence and care from a professionally trained nursing staff, practicing within the boundaries of the outlined standards of nursing practice, that complete recovery and health can be ascertained for the masses. The nursing profession requires acute observation, training, and continuous practice for success, and the Texas Board of Nursing has set forth standards of nursing practice that are to be expected to be followed by all Registered Nurses and Licensed Practical Nurses practicing in the state. Jurisprudence The philosophy or science of law and to a body of law. Ethics The moral principles that oversee an individual s behavior or the performance of a task or activity. How the Texas Board of Nursing (BON) Defines Jurisprudence and Ethics Jurisprudence It refers to the philosophy and rules that direct the Law and Rules governing the Board of Nursing in Texas. The Texas Board of Nursing s guiding philosophy is to promote and protect the interests and welfare of the residents of Texas by ensuring that each individual carrying a nursing license in the state of Texas is competent and knowledgeable to practice safely. Ethics It refers to the fundamental moral values, commitments and duties of nurses in the medical field. The Code of Ethics for Nurses expresses these essential moral values, commitments, and duties. The Role of the Texas Board of Nursing The state of Texas recognized the Texas Board of Nursing as professional and regulatory authority presiding over the licensing, monitoring, and regulating the status of several licenses nurses in Texas on March 8, The Responsibilities and Services of BON The Board of Nurses (BON) is tasked with the following responsibilities A) Licensing qualified nurses B) Enforcing rules and regulations C) Investigating violations of the Nursing Practice Act (NPA) D) Initiating appropriate legal action when required E) Establishing minimum standards and requirements for educational nursing programs

3 EDUCATION EDGE! Everything written in green throughout this course is information you will need to The History of Jurisprudence and Ethics The role to care for the injured or the ill and assist in childbirth fell on women. As early as the 1820s, women in Texas performed medical care, nursing residents through injuries and illnesses. Even though they received a lot of practice, they received no recognition or training. Three sisters belonging to the Incarnate Word Convent in France visited Galveston to establish St. Mary s Infirmary in At the height of the yellow fever epidemic, the hospital received several patients. The year 1869 saw several sisters leaving their covenant to establish a hospital in San Antonio. The same sisters would open schools years later (Tschirch & Crowder, 2010). In 1890, the first nursing school in Texas was established in Galveston at the John Sealy Hospital, becoming a permanent branch of the University of Texas Medical Branch in Before, nursing schools depended on medical schools and hospitals to finance them. Gradually, the responsibilities of nurses began to grow and included: Caring for patients in operating rooms and hospital wards Assisting doctors in surgeries performed at home Obtaining and possessing knowledge to understand illnesses of patients in order to provide them with effective treatments Evaluating and developing nursing care requirements Providing post and pre-operation care Examining and overseeing intravenous infusions and medication administration Taking pulses, patient samples, blood pressures, and temperatures Writing records Supervising junior staff Organizing workloads Tutoring student nurses Offering emotional support to patients and their relatives

4 World War II saw hospitals hiring more graduate nurses. Several states began to put nurse practice and nursing registration acts into law, except for Texas. Nurses began to push for regulations and improvements and in 1907 they formed the Graduate Nurses Association of Texas (TGNA) now called the Texas Nurses Association (TNA). In 1909, they influenced the state s legislature to pass a nurse registration and practice law. However, the law failed to provide any method for accrediting and inspecting nursing schools. They helped pass a law, permitting an educational secretary to visit nursing schools and prepare a report yearly in 1923 (Brown, 2010). The present-day Texas Nurses Association is the largest and oldest nursing association in Texas. They are a membershipbased association of licensed nurses. Although the nurses practice in different types of settings, they share the common principle of advancing excellence in nursing (TNA, nd). In 1909, the Nursing Practice Act (NPA) was passed into law. Since then, the TNA have revised, changed, and updated it several times throughout the years to reflect the changes in nursing practice and healthcare (BON, 2013). Presently, the TNA approves about 260,000 licensed Registered Nurses and about 98,000 Licensed Vocational Nurses and approves 98 programs for licensed vocational nurses and 114 education courses for registered nurses (BON, 2013). Introduction to Chapter 301 of the Texas Occupations Code: The Nursing Practice Act Chapter 301 of the Texas Occupations Code (TOC) discusses the Nursing Practice Act (NPA). Chapter 301 contains the Nursing Practice Act created by the Board of Nursing (BON), a regulatory body responsible for regulating and modifying nursing education, licensure, and practice. Chapter 301 of the Texas Occupations Code defines nursing practices and provides the TOC the authority to create policies, which implement and interpret the Nursing Practice Act. The policies change over time. The Texas Nurses Association is the only regulatory body with the authority to change the Nursing Practice Act. Therefore, statutory modifications only happen every two years. The Board creates policies to better assist in the application of the Nursing Practice Act to accommodate the continuously changing practice settings and conditions. For people in the nursing profession, it is important to stay upto-date with the latest policies NPA implements. Therefore, it is important to understand Chapter 301 of the Texas Occupations Code.

5 General Provisions Terms Board Chief Nursing Officer Patient Safety Committee Nurse Nursing Vocational Nursing Professional Nursing Definitions The Texas Board of Nursing A registered nurse responsible for overseeing the nursing services at a facility A committee created by a school, association, health care facility, agency, or another organization to address issues related to patient safety It is the requirement of a person to obtain a license under Chapter 301 to practice vocational or professional nursing Refers to vocational or professional nursing A division of nursing practice, which includes the conducting of an act that needs specific judgment and skill and accurate knowledge and the application of the ethics of physical, biological, and social science obtained from a vocational course at a recognized institution The application of an act that needs extensive and specific skill and judgment and accurate knowledge and the application of the ethics of physical, biological, and social science obtained from a vocational course at a recognized institution Collects data and performs nursing assessments of a person s health status Participates in the organization of a person s nursing care needs Participates in the creation and adjustments of the nursing care plan Participates in the education and counseling to encourage, accomplish, and sustain optimal health levels Assists in the assessment of a person s response to a nursing involvement and the classification of a person s requirements Interacts in other acts that need education and training, as instructed under the rules and policies of the board, appropriate with the nurse s experience, ongoing education, and demonstrated capability Involves the examination, assessment, involvement, evaluation, treatment, care and counsel, or health education of an injured or an ill person Participates in the preservation of health or deterrence of an illness Administers medication or treatment ordered by a podiatrist, physician, or dentist Supervises or teaches nursing Administers, supervises, and evaluates nursing policies, practices, and procedures Requests, receives, signs for, and distributes prescription drug samples to patients at facilities where the presence of an advanced practice registered nurse is required Performs an act at the request of a physician Develops a nursing care plan Vocational and professional nurses cannot diagnose a patient with a medical illness, provide a prescription drug, or recommend remedial measures.

6 Chapter 301 Does Not Apply to Nursing care a friend provides to a person Nursing care a person provides to a person during natural disasters, as stated in the State Emergency Management Plan, If the person providing the care does not hold the person out as a nurse unless the person is licensed in another state (Texas Disaster Act of 1975) Nursing care where treatment is prayer or spiritual based A person performs an application under the supervision of an individual licensed and recognized by the Texas Medical Board A person licensed and recognized by another state agency performs an act if the statute authorizes the person under which they are licensed to perform the act except that the person has a license under Chapter 301 and the performed act is within the nursing practices, the board can consider taking against the person based on the act they performed Nursing practice that is supplementary to a nursing course a student enrolls in at an approved nursing institution and leads to them obtaining a license A person licensed to practice in another state that is present in Texas on a non-routine basis for duration of not more than 72 hours can offer care to a person being transported into, out of, or through Texas, offer nursing consulting services, and visit or give a continuing nursing education program Texas Board of Nursing Board Membership: The governor appoints members to the Texas Board of Nursing with counsel and approval of the state senate Board Membership The Texas Board of Nursing consists of 13 members as follows: (1) Six Nurse Members, Including: (A) one advanced practice nurse; (B) two registered nurses who are not advanced practice nurses or members of a nurse faculty; and (C) three vocational nurses who are not members of a nurse faculty; (2) Three Members Who Are Nurse Faculty Members of Schools of Nursing: (A) one of whom is a nurse faculty member of a school of nursing offering a baccalaureate degree program in preparing registered nurses; (B) one of whom is a nurse faculty member of a school of nursing offering an associate degree program in preparing registered nurses; and (C) one of whom is a nurse faculty member of a school of nursing at an institution of higher education preparing vocational nurses; and (3) Four Members Who Represent the Public. Appointments to the Texas Board of Nursing will be made without regard to race, religion, color, gender, age, disability, and the nationality of the considered person

7 Member Eligibility An individual is ineligible for appointment as a vocational nurse member or a registered nurse of the Texas Board of Nursing unless they have experience as a nurse for which the member was selected for at least three of the five years prior to the appointment date An individual is ineligible for appointment as a public member of the Texas Board of Nursing if they or their spouse: Is registered, licensed, or certified by an occupational regulatory agency in the health care field Is worked for or partakes in the administration of a business entity or another business that: Offers heath care services Manufacturers, distributes, or sell health care supplies or equipment Is controlled by or obtains funding from the Texas Board of Nursing Controls or owns, either directly or indirectly, an interest of over 10% in a business entity or association that: Offers heath care services Manufacturers, distributes, or sell health care supplies or equipment Is controlled by or obtains funding from the Texas Board of Nursing Utilizes or obtains a considerable amount of services, tangible goods, or funds from the Texas Board of Nursing, besides reimbursement or compensation sanctioned by law for attendance, board membership, or expenses Membership and Employee Restrictions Texas Trade Association stands for a cooperative and voluntarily joined statewide association of professional competitors and businesses in Texas. They help members, industry, and professionals in dealing with problems, mutual business interests, and promotion of common goals. Terms An individual cannot be a member of the Texas Board of Nursing and cannot be employed by the board in any administrative, professional, and executive position if The individual cannot be a board member or operate as the general counsel to the Texas Board of Nursing if they are required to list as a lobbyist (Chapter 305, Government Code) because of their activities to earn compensation on behalf of a profession associated to the board s function Board members serve six-year terms with the terms of members expiring on January 31 of every odd year. Officers The individual or their spouse is an employee, officer, or a paid consultant working for a Texas Trade Association in the health care field Training Program for Board Members Must Include the Following The governor selects a board member to become a presiding officer. The board selects other officers from its members. The legislation that formed the board The board s function, budget, and rules Recent formal audit Law requirements of open meetings, administrative procedure, public information, and conflicts of interest Ethics and policies of the board or the Texas Ethics Commission

8 Training An appointed person with the qualifications to become a board member cannot vote, deliberate, or be counted in attendance at a board meeting until they complete a training program. Nursing License Requirements It is illegal for a person to practice nursing without a license or imply they have a license using abbreviations or titles such as Registered Nurse, Professional Nurse, Licensed Vocational Nurse, Vocational Nurse Graduate Nurse, Licensed Practical Nurse, and Practical Nurse. Criminal History Record A person must submit their fingerprints to allow the board to obtain their criminal history record information, if any, from the Department of Public Safety and the Federal Bureau of Investigation. The criminal background check can take 45 days, depending on how extensive the review (Nursing Licensure, 2016). License Application A person applying for a vocational nurse license or a registered nurse license must submit the following applications (Bon, 2013): A non-refundable fee of $186 High school graduation or G.E.D. certificate Proof of completing a nursing program from an approved registered nursing, practical nursing or vocational nursing school with a minimum score of C in all courses Applicants who graduated from an international nursing program will need to submit a Credential Evaluation Service (CES) Full Education report from the Commission on Graduates of Foreign Nursing Schools, the International Research Foundation, Inc., or the Educational Records Evaluation Service, Inc. confirming the completion of an applicant s nursing program Jurisprudence Rules the Texas Board of Nursing Adopts The creation of the exam, either prepared by the board or the national testing service Applicable fees The administration of the exam Reexamination process Grading method Results of Exam Examination The NCLEX exam is design to determine how qualified the person is to practice vocational nursing or registered nursing The Texas Board of Nursing adopts guidelines and policies detailing the procedures for the testing procedure, which includes test admission, administration, and national exam requirements

9 % of People Passed The Texas Board of Nursing posts on their official internet site the policies referencing the testing process established by the national organization chosen by the board to oversee the exam The Texas Board of Nursing is responsible for determining the criteria of a passing score on the exam (the criteria of the exam should not surpass those required by most of the states in the country) An independent testing professional must approve a standardized national written exam offered or approved by the Texas Board of Nursing History of NCLEX Exam National Council Licensure Examination (NCLEX) followed by two abbreviations, Practical Nurse (PN) or Registered Nurse (RN), is used to distinguish between the two types of test takers. All graduates in nursing are required to take the exam. The exam ensures the competency of each nurse to practice nursing safely. Computerized Adaptive Testing (CAT) is the method used to conduct the exam. This ensures that no exam is the same. The National Council of State Boards of Nursing (NCSBN) is responsible for producing the test. The NCSBN surveys the licensed nurses in order to update the requirements for the NCLEX and to ensure it remains relevant to the current practices of nursing (NCLEX-PN Exam, n.d.). The Texas Board of Nursing provides a written refund policy for the Independent Testing Service to Consider: Applicants need to provide a notice of their inability to take the exam ahead of the exam s scheduled time Applicants may receive a refund if an emergency occurs The NCLEX exam contains anywhere from 85 to 205 questions with the average number of questions being 112. Applicants are given 5 hours to complete the exam. NCLEX Passing Rate Passing Rate (NSCB, n.d.)

10 The NCLEX Tests Applicants on the Following Areas: Safety and Infection Control Safe Effective Care Environment Reduction of Risk Potential Psychosocial Integrity Physiological Integrity Physiological Adaptation Pharmacological and Parenteral Therapies Management of Care Health Promotion and Maintenance Basic Care and Comfort Examination Results The Texas Board of Nursing is required to release the results of the exam no later than the 30th day after the scheduled date of the exam If the Independent National Testing Service is grading and reviewing the exam, the Texas Board of Nursing must notify each applicant of the results of the exam no later than the 14th day after the scheduled date of the exam Nursing Jurisprudence Examination (NJE) Applicants must pass the nursing jurisprudence exam before being authorized to take the NCLEX exam The exam contains 50 questions and applicants are required to answer 38 questions out of 50 correctly in order to earn the passing score of 75% Instructions to take the Nursing Jurisprudence Examination Submit an exam application with the Texas Board of Nursing Takes fifteen business days Prepare for the exam by viewing the Board Rules and Regulations and Nursing Practice Act (NPA) Practice for the exam by taking the online jurisprudence prep course on the Texas s Board of Nursing site After fifteen business days, log on to complete and submit the online nursing jurisprudence exam It is a two-hour exam If a person s attempt to take the exam is unsuccessful due to them not passing the exam or the system locking up, they are permitted to retake the exam after 24 hours In the event that the Independent National Testing Service delays the results or reviews for more than 90 days after the scheduled date of the exam, it is the responsibility of the Nursing Board of Texas to notify each applicant of the delay prior to the 90th day If an applicant fails the exam, the Texas Board of Nursing will provide them with an analysis of their results of the exam Re-examination The Texas Board of Nursing established conditioned which a person who failed the exam may retake it Applicants who fail the exam two or more than two times, the Texas Board of Nursing may require the person to fulfill extra educational requirements or deny them the opportunity to retake the exam

11 Issuance of License If the results of the exam fulfill the criteria set by the Texas Board of Nursing, the board will issue a license to the person to practice nursing professionally in Texas The Texas Board of Nursing s presiding officer and the executive director will sign the license and the board s seal will attest it Declaratory Order of License Eligibility A petition for Declaratory Order of license eligibility is an official admission to the Texas Board of Nursing of the applicant s ineligibility to take the NCLEX exam once they complete an approved nursing program. The Declaratory Order procedure allows the Texas Board of Nursing to make a decision related to an applicant s eligibility for a nursing license before they enroll or complete a nursing program. To avoid a delay in the Declaratory Order procedure, applicants need to follow all the directions carefully and complete the entire application. The Texas Board of Nursing will not review an order until the applicant meets all the established requirements and pays the fees. A petitioner indicates a person who: A) Is enrolled or planning to enroll in a nursing program that prepares them to obtain their nursing licensure as either a registered nurse or a vocational nurse B) Seeks nursing licensure by endorsement pursuant for a temporary license C) Seeks nursing licensure by exam pursuant by taking a nursing program within the United States A person who believes the Texas Board of Nursing may find them ineligible for a nursing license has the right to petition the board to begin a Declaratory Order process to decide their eligibility A person needs to submit a petition on applications the Texas Board of Nursing provides, which includes: A) The person s statement indicates the reason or reasons and the grounds of possible ineligibility B) If criminal conduct or conviction or both is the reason for the person s possible ineligibility, they must provide all court documents related to their charge such as proof of completion, probation records, court judgments, indictments, and orders of deferred adjunction, with their application C) If mental disability or illness is the reason for the person s possible ineligibility, they must provide proof of an evaluation that meets the requirements of the Texas Nursing Board as well as proof of any treatments they sought D) If chemical dependency is the reason for the person s possible ineligibility, they must provide proof of an evaluation that meets the requirements of the Texas Nursing Board and submit documents such as after care, treatment, and attendance at support groups E) They need to provide them with a non-refundable fee Once the Texas Board of Nursing has all the required information and documents in their possession, they will conduct an investigation to conclude the eligibility of the person

12 The applicant or the Texas Board of Nursing has the right to revise the petition to add additional reasons for possible ineligibility at any time in the process, but before the board makes a final decision on the matter If a person seeking licensure through endorsement pursuant is a practicing registered nurse or vocational nurse and disciplinary action against them has been taken or permitted to yield in place of disciplinary action in that jurisdiction, the following provisions will decide if they are eligible for a nursing license: A) Provide a certified copy of the order or the ruling of the disciplinary action from the jurisdiction is sufficient to establish a proof of the issue mentioned in the order or ruling and a final decision in the jurisdiction that the person has committed professional misconduct is definite of the professional misconduct assumed in the ruling or judgment B) A person who has had disciplinary action taken against them in any jurisdiction or who resigned in place of disciplinary action is said not to exhibit proper professional conduct and before. Therefore, declaring them as ineligible to obtain licensure through endorsement during the duration of discipline enforced by a jurisdiction. In the event of revocation or resignation in place of disciplinary action, until the person has filed a declaratory order for a return in the jurisdiction and received a final decision on the order If criminal activity or a prior conviction is the reason for their possible ineligibility, the following conditions will govern their eligibility: A) The conviction, the order of deferred settlement, and the guilty plea is definite proof of the person s guilt B) Evidence suggesting that a probation order or conviction of a felony with or without guilt has been either reversed or set aside, the person may then be entitled to another hearing before the Texas Board of Nursing to conclude whether, missing the record of definite proof of guilt, the person exhibits proper professional fitness and behavior In the event, the Executive Director of the Texas Nursing Board finds the person ineligible to apply for licensure may have a hearing before the State Office of Administrative Hearings (SOAH). The Executive Director will be responsible for setting a hearing and notifying the person about the scheduled date. The hearing and the decision must be conducted in agreement with the Formal Proceedings and policies of SOAH. If a conflict arises, the SOAH s policies will prevail The Texas Board of Nursing issues a final order after the result of the appeal occurs in a proposal for decision from SOAH. The board s final order needs to establish every ground for possible ineligibility and the board s reason as to eligibility. If the declaratory order is denied, the person is not allowed to file another one through examination or endorsement until three years from the date of the board s decision on the matter. If the person does not file an appeal for a formal hearing at SOAH after a proposal letter to deny their eligibility by the board s Eligibility and Disciplinary Committee or the Executive Director, they may file a declaratory order or seek licensure through examination or endorsement The Disciplinary Matrix establishes the penalties a person receives when determining the eligibility of a person. The SOAH and the Executive Director when making a decision utilize the Disciplinary Matrix (Bon, 2016). Comprises of exploitation, fraud, or violation of professional boundaries Signifies that the nurse lacks the skills, judgment, and knowledge to continue practicing as a nurse and if they continue practicing, it can place the patient at risk despite of whether their behavior consists of a single, multiple, or a pattern of incidents

13 Guide to Check Licensure Eligibility Answer the Following Questions 1. Have you been convicted of a misdemeanor? 2. Have you been convicted of a felony? 3. Have you pled not guilty or no contest? 4. Have you received deferred settlement? 5. Have you been placed on court-ordered probation or community service, regardless of the judgment? 6. Have you been sentenced to go to prison or court-ordered incarceration? 7. Have you been granted a diversion before trial? 8. Have you been arrested or do you have any awaiting criminal charges? 9. Have you been charged or cited with a law violation? 10. Have you been the subject of martial dispute, the Article 15 violation, or have received any type of punishment, military judgment, or action? Class C Misdemeanor for Traffic Violations are Excluded (Licensure Eligibility, 2016) Sealed and Expunged Offenses Sealed or expunged arrests, offenses, tickets, or citations do not require disclosure. However, it is the applicant s responsibility to ensure their past offenses are sealed or expunged. Applicants are advised to submit a copy of their court order, stating their records are in fact sealed or expunged. Failure to disclose an offense that is not sealed or expunged results in a disciplinary fine and raises questions about a person s ethics and moral behavior. Government Code Chapter 411 of the Texas Nursing Board Cost of License Renewal (biennium) License renewal costs $60 for registered nurses and $40 for licensed vocational nurses. According to Chapter 411, the Texas Nursing Board is permitted access to the criminal record of an applicant who may have not revealed a criminal matter due to a non-disclosure agreement. In the event the Texas Board of Nursing discovers a criminal issue that requires further action, as it raises concerns about a person s character, they will ask you questions regarding the nature of the crime and if it is still an ongoing matter under investigation. Mental illnesses and past addictions are also included in Chapter 411. Reporting Violations and Patient Care Concerns The Texas Board of Nursing will hold a nurse in violation of this chapter if they display a conduct that: Lead to an injury or death of a patient

14 Caused a person to deduce that a drug or alcohol dependency is responsible for their impaired judgment Requirements for Licensure Renewal The Texas Board of Nursing requires nurses to renew their licenses after every two years. The board requires nurses to provide them with their present home address and name and notify them. If a name change or a change of address occurs, nurses must send in a notice marked name change or change of address to the board within ten days of it happening. Failure to notify the board can result in possible disciplinary action or delay in license renewal. Continuing Nursing Education (CNE) Requirements for License Renewal Continuing Education ensures nurses stay current with the changing industry practices, increase their professional capability, study about new treatment routines and technology, and revise and renew their clinical skills. In nursing, continuing education includes courses and programs established to promote and improve knowledge, progress skills, and develop attitudes for the improvement of nursing practices. Another way to increase competency is to take nursing certification courses. The Texas Board of Nursing requires nurses to complete 20 contact hours of CNE within two years prior to renewing their nursing license. Nurses can also demonstrate the accomplishment, maintenance, and renewal of a nationally recognized nursing certificate in the area of their expertise to fulfill their CNE requirement. Nurses licensed through an examination within a biennium are excused from the CNE requirement for that biennium. The Type of Courses Nursing License Holders Must Complete The following courses are part their CNE requirements: Two contact hours in Nursing Ethics and Jurisprudence prior to the end of each third two-year licensing period One time course for 2 contact hours in Forensic Evidence Compilation for nurses working in an emergency room setting 2 contact hours every 2 years in Care for Geriatric or Older Adult Population if practice includes care of this patient group The APRN who holds prescriptive authority must complete, in addition to the above requirements, at least five additional contact hours of continuing education in pharmacotherapeutics and Material related to treatment of Tick- Borne Illnesses, if applicable to practice area. In every licensure cycle after January 1, 2015, the APRN who holds prescriptive authority and prescribes controlled substances must complete, in addition to the requirements of this subsection, at least three additional contact hours of continuing education related to prescribing controlled substances. Nurses are responsible for documenting their CNE activities. They need to document attendance by keeping attendance record certificates, contact hour certificates, and academic transcripts. They need to submit copies of their CNE activities to the Texas Board of Nursing. Nurses need to maintain their records for license renewal for three successive periods or six years.

15 Expired Nursing License Individuals with an expired nursing license are prohibited by law to engage in practices that require a license. To engage in practices, they need to apply to renew their license and since it is past the renewal date, late charges will apply. Nurses who continue to practice with an expired license are subject to having their nursing license suspended or revoked. Inactive Nursing Status Nurses not actively engaging in medical practices can request the Texas Board of Nursing to give them an inactive nursing status. They need to submit a written request to the Texas Board of Nursing. If approved, their inactive status will start on their license s expiration date. A person with an inactive status is prohibited by law to practice nursing. The person can ask the board to remove them from the inactive status, which the board will do once they pay fee and meet the board s requirements. General Delegation Criteria of Nursing Tasks Before delegating care to others, the Registered Nurse must analyze the patient s requirements for nursing care. When the patient s condition is stable, the RN needs to consult with them as well as their immediate family members or significant other to determine the nursing requirements of the patient before delegating tasks. RNs need to ensure the nursing task is within the range of sound nursing decision to delegate. The nursing task, according to the RN, is one that unlicensed nurses can safely and properly perform without endangering the welfare of the patient. The nursing task should not require the unlicensed individual to make a professional nursing decision. Conversely, Always Practice Five Rights of Delegation 1. The right task 2. The right person to delegate the task to 3. The right situation 4. The right direction and communication the RN should follow 5. The right supervision as established by the RN unlicensed individuals may take an initiative that a practical non-healthcare professional may take during an emergency. The unlicensed individual given the responsibility to carry out a task must be properly identified. The identification of a person can be their name, training, education, permit, or certification. The RN should have either provided instruction to the unlicensed person on how to perform a task or verified their ability to perform the task. The identification of a person s ability to perform a task can be done by their training, experience, education, certification, or permit. The RN is responsible for supervising the performance of a nursing task delegated to an unlicensed person to ensure they are performing it in agreement with the requirements. If the RN continually delegates tasks over time, they can periodically evaluate and review the person s ability to perform certain tasks, using that information to reevaluate them and delegate them other tasks when the patient s condition improves.

16 Supervision Criteria of Nursing Tasks Registered nurses delegating nursing tasks to unlicensed people must meet the supervision criteria of nursing tasks delegation. The supervision criteria pertain to patients suffering from acute conditions or patients in an acute care setting. The RN determines the level of supervision required after evaluating all factors involved. The following is a list of factors that can be included in the supervision criteria: Stability of the patient s condition in association with the task(s) to be delegated Experience, training, and the ability of the unlicensed person to whom the RN decides to delegate a certain task(s) Nature of the nursing task the RN delegates Proximity and availability of the RN during the duration the unlicensed person performs the nursing task Commonly Delegated Nursing Tasks Nursing tasks RNs most delegate to unlicensed people include: Non-sterile and non-invasive treatments Gathering, reporting, and recording of data that includes: Vital signs, weight, height, output and intake, urine test and blood test for sugar, and stool test for occult blood results Patient or remarks of relatives pertaining to patient care Behaviors associated with the plan of care Environmental conditions Positioning, ambulation, and turning Transportation of patients within a facility Personal hygiene and elimination such as cleansing enemas and vaginal irrigations Cutting up food, feeding, or giving meal trays Socialization activities Daily living activities Reinforcement of health teaching plan the RN provides Nursing Tasks Forbidden from Delegation RNs are forbidden to delegate the following nursing tasks to unlicensed people: Psychological, social, and physical assessment which needs professional and sound nursing judgment, intervention, follow-up, or referral Developing of the nursing care plan and assessing the patient s response to the care performed Specific nursing tasks involved in the incorporating of the nursing care plan which need professional and sound nursing judgment or intervention Responsibility and accountability for the patient s health education and counseling which allows the patient and their relatives to accomplish health goals Administration of medicine such as intravenous fluids with the exception being medication aides

17 Principles Applicable for All Nurses The Texas Administrative Code provides principles for all registered, vocational, and advanced practice nurses to follow. The standards stated in the Texas Administrative Code, but not limited to, include: Understand and conform to the Texas Board of Nursing and the Texas Nursing Practice Act s regulations, policies, and rules as well as all local, state, and federal laws influencing the nursing practice Incorporate measures to promote a safe working environment for patients, staff, and relatives of patients Comprehend the rationale for and the effects of treatments and medicines and properly administer them Correctly and fully report and record: Patient status such as symptoms and signs Nursing care delivered Dentist, physician, or podiatrist directives Patient responses Contacts with other members of the healthcare team regarding important events concerning the patient s health status Respect the privacy of the patient by protecting their confidential information unless the nurses are required or permitted by law to reveal the information Promote and participate in education and counseling to a client and family/significant other 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 Alert the correct supervisor when leaving a nursing task Understand, identify, and maintain professional boundaries of the nurse and patient relationship Comply with mandatory reporting requirements, mentioned in the Chapter 301, Subchapter I, of the Texas Occupations Code Practice nursing without discrimination Introduce proper nursing interventions that may be needed to stabilize the condition of a patient or prevent further complications Clarify a treatment or order routine that the nurse has reason to suspect is incorrect, contraindicated, nonefficacious by discussing it with a licensed practitioner and alerting them when they decide not to administer the treatment or medicine Incorporate measures to avoid contact to infectious pathogens and transmissible conditions Collaborate with the client, members of the health care team and, when appropriate, the client s significant others 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 practices provided by other nurses that the nurse is responsible for overseeing

18 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 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. The licensed vocational nurse shall assist in the determination of predictable healthcare needs of clients within healthcare settings and: (A) Shall utilize a systematic approach to provide individualized, goal-directed nursing care by: a. collecting data and performing focused nursing assessments b. participating in the planning of nursing care needs for clients c. participating in the development and modification of the comprehensive nursing care plan for assigned clients d. implementing appropriate aspects of care within the LVN s scope of practice e. assisting in the evaluation of the client s responses to nursing interventions and the identification of client needs (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. (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.

19 Standards Specific to Registered Nurses The registered nurse shall assist in the determination of healthcare needs of clients and shall: (A) Utilize a systematic approach to provide individualized, goal-directed, nursing care by: a. performing comprehensive nursing assessments regarding the health status of the client b. making nursing diagnoses that serve as the basis for the strategy of care c. developing a plan of care based on the assessment and nursing diagnosis d. implementing nursing care e. evaluating the client s responses to nursing interventions (B) Delegate tasks to unlicensed personnel in compliance relating to clients with acute conditions or in acute care environments, and relating to independent living environments for clients with stable and predictable conditions. 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. A registered nurse who holds authorization to practice as an advanced practice nurse (APN) shall: (A) Practice in an advanced nursing practice role and specialty in accordance with authorization granted under Board Rule Chapter 221 of this title (relating to practicing in an APN role; 22 TAC Chapter 221) and standards set out in that chapter. (B) Prescribe medications in accordance with prescriptive authority granted under Board Rule Chapter 222 of this title (relating to APNs prescribing; 22 TAC Chapter 222) and standards set out in that chapter and in compliance with state and federal laws and regulations relating to prescription of dangerous drugs and controlled substances.

20 The Six-Step Decision Making Model The Board of Nursing established a decision-making model consisting of six steps to help nurses make sound professional decisions about the nursing procedures or tasks they select to undertake. The model references aspects of the Nurse Practice Act and rules. It informs the nurses to apply questions to address certain situations. Furthermore, the Texas Board of Nursing utilizes this exact six-step decision-making model when nurses contact them to inquire if a certain procedure or task is in their scope of nursing practice. However, the Texas Board of Nursing does not state that this is the only model a nurse should rely on to make a decision, but they do state that all nurses working in Texas must comply with the Texas Board of Nursing and the Nursing Practice Act s rules and policies (TXBON, n.d.). Answer the following questions with a yes or a no before moving to the next step. If a nurse answers a question with a no, they should not perform the nursing task or procedure. Step 1: Is the nursing practice consistent with the Texas Nursing Practice Act, Texas Board of Nursing policies, position statements, and guidelines? Step 2: Is the practice properly authroized by legitimate protocol or order and in agreement with the established procedures and policies? Step 3: Is the practice supported by either literature related to health and research mentioned in researching or in the range of the national nursing organizations practice statements? Step 4: Do you have the required knowledge and skills and have you verified the competency needed to execute the practice safely? Step 5: Is the performance of the practice within the accepted standard of nursing care that would be applied in similar situations by practical and reasonable nurses with the same experience and training as you? Step 6: Are you prepared to accept the repercussions of your actions?

21 Understanding the Difference Between Ethics and Laws Nurses are required to follow laws and ethical laws while carrying out a task, procedure, or making a decision at all times. Therefore, it is critical for nurses to comprehend the jurisprudence of the United States and on how law relates to ethics in their profession. Ethical principles provide nurses with general guidelines for behavior whereas laws are derived from ethical principles and include policies about certain situations. The governing authority enforces the policies and takes measures to ensure they are followed and obeyed. Defining Ethics Ethics concerns the unfairness or fairness of human behavior and the effects of good and bad behavior. In the medical practice, nurses are seen making ethical decisions every day. People rely on two types of ethical perspective when making a decision, teleological and deontological. Teleological perspective confirms that the unfairness or fairness of a practice is determined by the outcome of an action. If the outcome causes harm to a person, the practice is considered as bad. If the outcome benefits a person, the practice is considered as good. Deontological perspective promotes morality by educating people to accept and follow fixed laws. The term indicates that specific acts are naturally wrong or right to commit regardless of the outcome or the circumstance. This perspective eliminates the issue of extenuating circumstances, thus simplifying the ethical decision-making process. Five Ethical Principles People use ethical principles to make decisions, using them to measure their behavior. Health professionals such as nurses utilize the following five ethical principles to make a decision: 1. Respect for human life and self-respect Treating everyone as equals. The Nurse must: Refrain from harassment, abuse, and discrimination Respect the belief system, personhood, and lifestyle of patients Consider the physical, socioeconomic, and psychological wellbeing of a patient Strive to maintain dignity and human life Respect the privacy of a patient by not disclosing their personal information Require certain legal justifications for interfering with the civil liberties of a patient

22 2. Beneficence If an individual cannot do anything good, they should not do anything bad. The Nurse must: Communicate to patients objectively and professionally Follow treatment care plan in consultation with other professionals Select the option that will result in a good outcome and take measures to avoid putting the patient s life in danger Recognize that under specific circumstances beneficence overrides integrity and that required treatment may be justified 3. Autonomy Gives people the freedom and independence to comprehend a situation, make a choice, and execute that choice. The Nurse must: Ensure patients comprehend the accessible options concerning their treatment Respect and acknowledge the choices patients make about their care or the care of a person they are legally responsible for looking after Incorporate and examine the interventions patients choose Respect the information of patients, only revealing it when the patient or persons legally responsible for them give permission to disclose it 4. Integrity Conveying truthful information even when it is bad about a treatment or condition. The Nurse must: Correctly report and document important data Place the wellbeing of patients above professional and personal achievements Maintain promises and follow contracts Provide scientific, accurate, and applicable information about treatment such as risks and benefits 5. Justice Involves parity and equality and requires unbiased treatment of patients. The Nurse must: Examine the needs of patients with equal attentiveness and professionalism Attend to the needs of patients without discrimination (race, age, lifestyle, gender, disability, personality, and religion) Assess and communicate information about nurse health care plans without partiality Deal equally and fairly with professional colleagues, supervisors, and subordinates Forbidden Boundaries Nurses Cannot Cross with Patients Disclose intimate details of their life Engage in secretive talks with the patient Believe they are the only one who can meet the treatment and care needs of a patient Visit the patient when off-duty, swapping tasks to be with the patient, giving gifts to the patient. If the patient gives special attention to the nurse, the nurse should inform their supervisor The nurse leaves information out when explaining the behavior of the patient, gives double messages, or fails to explain the specific aspects of care and actions. The patient may do the same by only talking to the nurse because other staff members are occupied The nurse flirts with the patient, using sexual innuendo, off-color jokes, or inappropriate language The nurse begins to view the patient in a protective manner and sides with them despite the circumstances The nurse fails to realize their intimate feelings for the patient and in this case, should consult with their supervisor or transfer the patient s care to another nurse

23 The Ethical Decision-Making Process An ethical dilemma requires a person to make a decision between two conflicting choices. To resolve an ethical dilemma, the person must evaluate all the facts of the scenario, consider applicable laws, consult with all the concerned parties, and refer to the teleological and deontological laws of ethics. In a professional setting, an ethics committee consisting of ethicists, medical professionals, clergy, and lawyers act as decision-makers to resolve an ethical dilemma. The ethical decision-making process is made up of four steps: 1. Collection of relevant facts about the age of the patient, advanced healthcare instructions, diagnosis, and pertinent laws 2. Determining and stating possible actions to take with the ethical principles corresponding to each possible action 3. Identifying the person(s) who can make the decision and help the person(s) to select it 4. Offer emotional support for people who participated in resolving the ethical dilemma Nine Provisions of ANA Code of Ethics The American Nurses Association updates and revises the Code of Ethics for Nurses with Interpretive Meaning on a regular basis. The following are the nine provisions as stated in the ANA Code of Ethics (Nursing World, n.d.): Provision 1: Nurses practice with respect and empathy for the inherent worth, dignity, and individuality of each individual, unbound by considerations of economic or social standing, personal characteristics, or the nature of the illness. Provision 2: Nurses main obligation is to the patient, whether a person, group, family, or community. Provision 3: Nurses support, advocate for, and strive to defend the safety, health, and rights of the patient in their care. Provision 4: Nurses are accountable and liable for their own nursing practice and to identify the suitable delegation of tasks consistent with their commitment to provide the patient with optimal care. Provision 5: Nurses owe the similar duties to self and other people and this includes the duty to maintain safety and integrity, to sustain competency, and to continue professional and personal growth. Provision 6: Nurses contribute in developing, sustaining, and enhancing healthcare settings and situations of service advantageous to the prerequisite of quality care and constant with the values of the occupation through individual and shared practice. Provision 7: Nurses contribute in the progression of the occupation through involvement in education, practice, knowledge and, administrative growth. Provision 8: Nurses collaborate with other medical professionals and the public to encourage community, national, and international efforts to achieve the health requirements. Provision 9: The association and their members, who represent the nursing profession, are responsible for communicating nursing values, for sustaining the veracity of the occupation and its practice, and for determining social policy.