reglab/statecodes huggingface dataset:
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 11 - TEXAS BOARD OF NURSING › Chapter 222 - ADVANCED PRACTICE REGISTERED NURSES WITH PRESCRIPTIVE AUTHORITY › Section 222.3 - Renewal of Prescriptive Authority

Current through Reg. 49, No. 28; July 12, 2024
(a) The
				APRN shall renew the privilege to sign prescription drug orders and medication
				orders in conjunction with the RN and advanced practice license renewal
				application.
(b) The APRN seeking
				to maintain prescriptive authority shall attest, on forms provided by the
				Board, to completing at least five contact hours of continuing education in
				pharmacotherapeutics within the preceding biennium.
(c) The continuing education requirements in
				subsection (b) of this section shall be in addition to continuing education
				required under Chapter 216 of this title (relating to Continuing Competency)
				for APRNs.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 11 - TEXAS BOARD OF NURSING › Chapter 222 - ADVANCED PRACTICE REGISTERED NURSES WITH PRESCRIPTIVE AUTHORITY › Section 222.4 - Minimum Standards for Prescribing or Ordering Drugs and Devices

Current through Reg. 49, No. 28; July 12, 2024
(a) The APRN with full licensure and a valid
				prescription authorization number shall:
(1)
				order or prescribe only those drugs or devices that are:
(A) authorized by a prescriptive authority
				agreement or, if practicing in a facility-based practice, authorized by either
				a prescriptive authority agreement or protocols or other written authorization;
				and
(B) ordered or prescribed for
				patient populations within the accepted scope of professional practice for the
				APRN's license; and
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 11 - TEXAS BOARD OF NURSING › Chapter 222 - ADVANCED PRACTICE REGISTERED NURSES WITH PRESCRIPTIVE AUTHORITY › Section 222.5 - Prescriptive Authority Agreement

Current through Reg. 49, No. 28; July 12, 2024
(a) The
				prescriptive authority agreement is a mechanism by which an APRN is delegated
				the authority to order or prescribe drugs or devices by a physician.
(b) An APRN with full licensure and a valid
				prescriptive authorization number and a physician are eligible to enter into or
				be parties to a prescriptive authority agreement only if the APRN:
(1) holds an active license to practice in
				this state that is in good standing. For purposes of this chapter, an APRN is
				in good standing if the APRN's license and prescriptive authorization number
				are not encumbered by a disciplinary action;
(2) is not currently prohibited by the Board
				from executing a prescriptive authority agreement; and
(3) before executing the prescriptive
				authority agreement, the APRN and the physician disclose to the other
				prospective party to the agreement any prior disciplinary action by the
				applicable licensing board.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 11 - TEXAS BOARD OF NURSING › Chapter 222 - ADVANCED PRACTICE REGISTERED NURSES WITH PRESCRIPTIVE AUTHORITY › Section 222.6 - Prescribing at Facility-Based Practices

Current through Reg. 49, No. 28; July 12, 2024
(a) An
				APRN with full licensure and a valid prescriptive authorization number may
				order or prescribe a drug or device at a facility based practice pursuant to a
				prescriptive authority agreement or through protocols or other written
				authorization developed in accordance with facility medical staff policies.
(1) If ordering or prescribing at a facility
				based practice pursuant to a prescriptive authority agreement, the APRN must
				maintain a prescriptive authority agreement that meets the requirements of
				§
										222.5(relating
				to Prescriptive Authority Agreement) of this chapter.
(2) If ordering or prescribing at a facility
				based practice pursuant to protocols or other written authorization developed
				in accordance with facility medical staff policies, the APRN must:
(A) review the authorizing documents with the
				appropriate medical staff at least annually;
(B) order or prescribe drugs and devices in a
				hospital based facility in which the delegating physician is the medical
				director, the chief of medical staff, the chair of the credentialing committee,
				or a department chair, or a physician who consents to the request of the
				medical director or chief of the medical staff to delegate;
(C) order or prescribe drugs and devices in a
				long term care facility in which the delegating physician is the medical
				director; and
(D) order or
				prescribe drugs and devices for the care or treatment of only those patients
				for whom physicians have given their prior consent.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 11 - TEXAS BOARD OF NURSING › Chapter 222 - ADVANCED PRACTICE REGISTERED NURSES WITH PRESCRIPTIVE AUTHORITY › Section 222.7 - Authority to Order and Prescribe Non-Prescription Drugs, Dangerous Drugs, and Devices

Current through Reg. 49, No. 28; July 12, 2024
An APRN who has been issued full licensure and a valid
				  prescription authorization number by the Board may order or prescribe
				  non-prescription drugs, dangerous drugs, and devices, including durable medical
				  equipment, in accordance with the standards and requirements set forth in this
				  chapter. However, if the APRN wishes to also order or prescribe controlled
				  substances, the APRN must also meet the additional requirements of §
									222.8(relating
				  to Authority to Order and Prescribe Controlled Substances) of this
				  chapter.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 11 - TEXAS BOARD OF NURSING › Chapter 222 - ADVANCED PRACTICE REGISTERED NURSES WITH PRESCRIPTIVE AUTHORITY › Section 222.8 - Authority to Order and Prescribe Controlled Substances

Current through Reg. 49, No. 28; July 12, 2024
(a) APRNs with full licensure and a valid
				prescription authorization number are eligible to obtain authority to order and
				prescribe certain categories of controlled substances. The APRN must comply
				with all federal and state laws and regulations relating to the ordering and
				prescribing of controlled substances in Texas, including but not limited to,
				requirements set forth by the United States Drug Enforcement
				Administration.
(b) Orders and
				prescriptions for controlled substances in Schedules III through V may be
				authorized, provided the following criteria are met:
(1) Prescriptions for a controlled substance
				in Schedules III through V, including a refill of the prescription, shall not
				exceed a 90 day supply. This requirement includes a prescription, either in the
				form of a new prescription or in the form of a refill, for the same controlled
				substance that a patient has been previously issued within the time period
				described by this subsection.
(2)
				Beyond the initial 90 days, the refill of a prescription for a controlled
				substance in Schedules III through V shall not be authorized prior to
				consultation with the delegating physician and notation of the consultation in
				the patient's chart.
(3) A
				prescription of a controlled substance in Schedules III through V shall not be
				authorized for a child less than two years of age prior to consultation with
				the delegating physician and notation of the consultation in the patient's
				chart.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 11 - TEXAS BOARD OF NURSING › Chapter 222 - ADVANCED PRACTICE REGISTERED NURSES WITH PRESCRIPTIVE AUTHORITY › Section 222.9 - Conditions for Obtaining and Distributing Drug Samples

Current through Reg. 49, No. 28; July 12, 2024
The APRN with full licensure and a valid prescription
				  authorization number may request, receive, possess, and distribute prescription
				  drug samples provided:
(1) all
				requirements for the APRN to order and prescribe medications and devices are
				met;
(2) a prescriptive authority
				agreement or facility-based protocols or other written authorization authorizes
				the APRN to order and prescribe the medications and devices;
(3) the samples are for only those drugs or
				devices that the APRN is eligible to order or prescribe in accordance with the
				standards and requirements set forth in this chapter; and
(4) a record of the sample is maintained and
				samples are labeled as specified in the Dangerous Drug Act (Chapter 483, Health
				and Safety Code) or the Texas Controlled Substances Act (Chapter 481, Health
				and Safety Code) and 37 Texas Administrative Code Chapter 13.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 11 - TEXAS BOARD OF NURSING › Chapter 222 - ADVANCED PRACTICE REGISTERED NURSES WITH PRESCRIPTIVE AUTHORITY › Section 222.10 - Enforcement

Current through Reg. 49, No. 28; July 12, 2024
(a) Any APRN who violates the sections of
				this rule or orders or prescribes in a manner that is not consistent with the
				standard of care shall be subject to removal of the authority to order or
				prescribe under this section and disciplinary action by the Board. Behaviors
				associated with ordering and prescribing medications for which the Board may
				impose disciplinary action include, but are not limited to:
(1) ordering, prescribing, dispensing, or
				administering medications or devices for other than evidenced based therapeutic
				or prophylactic purposes that meet the minimum standards of care;
(2) ordering, prescribing, or dispensing
				medications or devices for personal use;
(3) failing to properly assess and document
				the assessment prior to ordering, prescribing, dispensing, or administering a
				medication or device;
(4) selling,
				purchasing, trading, or offering to sell, purchase, or trade a prescription
				drug sample;
(5) delegation of
				authority to any other person to order, prescribe, or dispense of an order or
				prescription for a drug or device; and
(6) failing to access and review the
				prescription monitoring program (PMP) authorized by Chapter 481, Health and
				Safety Code, before prescribing opioids, benzodiazepines, barbiturates, or
				carisoprodol, unless a statutory exemption contained in that chapter has been
				documented. If an APRN has made a good faith effort to comply with the
				requirement and is unable to do so because of circumstances beyond the APRN's
				control, documentation of this effort shall be made on the patient's
				prescription or in the patient's electronic prescription record.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 11 - TEXAS BOARD OF NURSING › Chapter 223 - FEES › Section 223.1 - Fees

Current through Reg. 49, No. 28; July 12, 2024
(a) The Texas Board of Nursing has
				established reasonable and necessary fees for the administration of its
				functions.
(1) Examination: $50;
(2) Endorsement: $125 ;
(3) Licensure renewal (each biennium):
(A) Registered Nurse (RN): $68;
(B) Licensed Vocational Nurse (LVN):
				$45;
(4) reactivating
				from inactive status:
(A) less than four
				years--$10 plus current renewal fee;
(B) more than four years--$20 plus current
				renewal fee;
(5) late
				fee for reactivation from delinquent status:
(A) less than 90 days--$60 plus current
				licensure renewal fee;
(B) more
				than 90 days--$120 plus current licensure renewal fee;
(6) approval of new nursing education
				programs: $2,500;
(7) bad checks:
				$30;
(8) Advanced Practice Nurse
				initial credentials: $100;
(9)
				declaratory order of eligibility: $150;
(10) eligibility determination: $150;
(11) Advanced Practice Nurse
				renewal: $54;
(12) Initial
				Prescriptive Authority: $50;
(13)
				outpatient anesthesia registry renewal: $35;
(14) outpatient anesthesia inspection and
				advisory opinion: $625;
(15) fee
				for Federal Bureau of Investigations (FBI) and Department of Public Safety
				(DPS) criminal background check for licensees, initial licensure applicants and
				endorsement applicants as determined by fees imposed by the Criminal Justice
				Information Services (CJIS) Division and the Texas Department of Public
				Safety;
(16) Disciplinary
				monitoring fees as stated in a Board order;
(17) Nursing Jurisprudence Examination fee:
				not to exceed $25;
(18) approval of
				remedial education course: $300 per course;
(19) renewal of remedial education course:
				$100 per course;
(20) approval of a
				nursing education program outside Texas' jurisdiction to conduct clinical
				learning experiences in Texas: $500; and
(21) Prescriptive Authority Renewal
				Surcharge: Not to exceed $15.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 11 - TEXAS BOARD OF NURSING › Chapter 223 - FEES › Section 223.2 - Charges for Public Records

Current through Reg. 49, No. 28; July 12, 2024
In accordance with Texas Government Code §
									552.262,
				  the Board of Nurse Examiners will make copies of public records and charge the
				  fees established by the Attorney General's Office.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 11 - TEXAS BOARD OF NURSING › Chapter 224 - DELEGATION OF NURSING TASKS BY REGISTERED PROFESSIONAL NURSES TO UNLICENSED PERSONNEL FOR CLIENTS WITH ACUTE CONDITIONS OR IN ACUTE CARE ENVIRONMENTS › Section 224.1 - Application of Chapter

Current through Reg. 49, No. 28; July 12, 2024
This chapter applies to situations where:
(1) the client has an acute health condition
				that is unstable or unpredictable; or
(2) the client is in an acute care
				environment where nursing services are continuously provided. Settings include
				, but are not limited to, hospitals, rehabilitation centers, skilled nursing
				facilities, clinics, correctional health, private practice physician offices
				and settings that do not otherwise meet the definition of independent living
				environment {§225.4(9)}.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 11 - TEXAS BOARD OF NURSING › Chapter 224 - DELEGATION OF NURSING TASKS BY REGISTERED PROFESSIONAL NURSES TO UNLICENSED PERSONNEL FOR CLIENTS WITH ACUTE CONDITIONS OR IN ACUTE CARE ENVIRONMENTS › Section 224.2 - Exclusions from Chapter

Current through Reg. 49, No. 28; July 12, 2024
This chapter does not apply to:
(1) tasks provided in compliance with
				Government Code §
									531.051(e)
				relating to Consumer Direction of Certain Services for Persons With Disability
				and Elderly Persons; or
(2) RNs
				who:
(A) supervise or instruct others in the
				gratuitous nursing care of the sick;
(B) are qualified nursing faculty or
				preceptors directly supervising or instructing nursing students in the
				performance of nursing tasks while enrolled in accredited nursing
				programs;
(C) instruct and/or
				supervise an unlicensed person in the proper performance of nursing tasks as a
				part of an education course designed to prepare persons to obtain a state
				license, certificate or permit that authorizes the person to perform such
				tasks; and
(D) assign tasks to or
				supervise LVNs or other licensed practitioners practicing within the scope of
				their license.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 11 - TEXAS BOARD OF NURSING › Chapter 224 - DELEGATION OF NURSING TASKS BY REGISTERED PROFESSIONAL NURSES TO UNLICENSED PERSONNEL FOR CLIENTS WITH ACUTE CONDITIONS OR IN ACUTE CARE ENVIRONMENTS › Section 224.3 - Purpose

Current through Reg. 49, No. 28; July 12, 2024
(a) The Texas Board of Nursing (BON or Board)
				recognizes that changes in health care delivery have and will continue to
				influence the way nursing care is delivered. The Board believes that the
				registered nurse (RN) is in a unique position to develop and implement a
				nursing plan of care that incorporates a professional relationship between the
				RN and the client. The Board recognizes that the RN's responsibility may vary
				from that of the nurse providing care at the bedside of an acutely ill client
				to that of the nurse managing health care delivery in institutional and
				community settings. Assessment of the nursing needs of the client, the plan of
				nursing actions, implementation of the plan, and evaluation are essential
				components of professional nursing practice and are the responsibilities of the
				RN.
(b) The full utilization of the
				services of a RN, to include advanced practice registered nurses (APRN), may
				require delegation of selected nursing tasks to unlicensed personnel. The scope
				of delegation and the level of supervision by the RN may vary depending on the
				setting, the complexity of the task, the skills and experience of the
				unlicensed person, and the client's physical and mental status. The following
				sections govern the RN in delegating nursing tasks to unlicensed personnel
				across a variety of settings where nursing care services are
				delivered.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 11 - TEXAS BOARD OF NURSING › Chapter 224 - DELEGATION OF NURSING TASKS BY REGISTERED PROFESSIONAL NURSES TO UNLICENSED PERSONNEL FOR CLIENTS WITH ACUTE CONDITIONS OR IN ACUTE CARE ENVIRONMENTS › Section 224.4 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following words and terms, when used in this chapter,
				  shall have the following meanings, unless the context clearly indicates
				  otherwise.
(1) Activities of daily
				living--Limited to the following activities: bathing, dressing, grooming,
				routine hair and skin care, meal preparation, feeding, exercising, toileting,
				transfer/ambulation, positioning, and range of motion.
(2) Client--the individual receiving
				care.
(3) Delegation--Authorizing
				an unlicensed person to provide nursing services while retaining accountability
				for how the unlicensed person performs the task. It does not include situations
				in which an unlicensed person is directly assisting a RN by carrying out
				nursing tasks in the presence of a RN.
(4) Unlicensed person--An individual, not
				licensed as a health care provider:
(A) who
				is monetarily compensated to provide certain health related tasks and functions
				in a complementary or assistive role to the RN in providing direct client care
				or carrying out common nursing functions;
(B) including, but is not limited to, nurse
				aides, orderlies, assistants, attendants, technicians, home health aides,
				medication aides permitted by a state agency, and other individuals providing
				personal care/assistance of health related services; or
(C) who is a professional nursing student,
				not licensed as a RN or LVN, providing care for monetary compensation and not
				as part of their formal educational program shall be considered to be
				unlicensed persons and must provide that care in conformity with this
				chapter.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 11 - TEXAS BOARD OF NURSING › Chapter 224 - DELEGATION OF NURSING TASKS BY REGISTERED PROFESSIONAL NURSES TO UNLICENSED PERSONNEL FOR CLIENTS WITH ACUTE CONDITIONS OR IN ACUTE CARE ENVIRONMENTS › Section 224.5 - RN Accountability for Delegated Tasks

Current through Reg. 49, No. 28; July 12, 2024
(a) The RN's accountability to the BON with
				respect to its taking disciplinary action against the RN's license is met when
				the delegating RN has complied with and can verify compliance with this chapter
				and specifically with §
									224.6
				and §
									224.8(b)(1)
				of this title (relating to General Criteria for Delegation and Discretionary
				Delegation Tasks) as appropriate.
(b) This chapter does not change or apply to
				a RN's civil liability.
(c) The RN
				nurse administrator or the RN who is responsible for nursing services in
				settings that utilize RN delegation in clients with acute care conditions or
				acute care environments shall be responsible for knowing the requirements of
				this rule and for taking reasonable steps to assure that registered nurse
				delegation is implemented and conducted in compliance with the Texas Nursing
				Practice Act and this chapter.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 11 - TEXAS BOARD OF NURSING › Chapter 224 - DELEGATION OF NURSING TASKS BY REGISTERED PROFESSIONAL NURSES TO UNLICENSED PERSONNEL FOR CLIENTS WITH ACUTE CONDITIONS OR IN ACUTE CARE ENVIRONMENTS › Section 224.6 - General Criteria for Delegation

Current through Reg. 49, No. 28; July 12, 2024
The following standards must be met before the RN delegates
				  nursing tasks to unlicensed persons. These criteria apply to all instances of
				  RN delegation. Additional criteria, if appropriate to the particular task being
				  delegated, may also be found in §
									224.8(b)(1)
				  of this title (relating to Discretionary Delegation Tasks).
(1) The RN must make an assessment of the
				client's nursing care needs. The RN should, when the client's status allows,
				consult with the client, and when appropriate the client's family and/or
				significant other(s), to identify the client's nursing needs prior to
				delegating nursing tasks.
(2) The
				nursing task must be one that a reasonable and prudent RN would find is within
				the scope of sound nursing judgment to delegate. The RN should consider the
				five rights of delegation: the right task, the right person to whom the
				delegation is made, the right circumstances, the right direction and
				communication by the RN, and the right supervision as determined by the
				RN.
(3) The nursing task must be
				one that, in the opinion of the delegating RN, can be properly and safely
				performed by the unlicensed person involved without jeopardizing the client's
				welfare.
(4) The nursing task must
				not require the unlicensed person to exercise professional nursing judgment;
				however, the unlicensed person may take any action that a reasonable, prudent
				non-health care professional would take in an emergency situation.
(5) The unlicensed person to whom the nursing
				task is delegated must be adequately identified. The identification may be by
				individual or, if appropriate, by training, education, and/or
				certification/permit of the unlicensed person.
(6) The RN shall have either instructed the
				unlicensed person in the delegated task, or verified the unlicensed person's
				competency to perform the nursing task. The verification of competence may be
				done by the RN making the decision to delegate or, if appropriate, by training,
				education, experience and/or certification/permit of the unlicensed
				person.
(7) The RN shall adequately
				supervise the performance of the delegated nursing task in accordance with the
				requirements of §
									224.7 of
				this title (relating to Supervision).
(8) If the delegation continues over time,
				the RN shall periodically evaluate, review, and when a change in condition
				occurs reevaluate the delegation of tasks. For example, the evaluation would be
				appropriate when the client's Nursing Care Plan is reviewed and revised. The
				RN's evaluation of a delegated task(s) will be incorporated into the client's
				Nursing Care Plan.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 11 - TEXAS BOARD OF NURSING › Chapter 224 - DELEGATION OF NURSING TASKS BY REGISTERED PROFESSIONAL NURSES TO UNLICENSED PERSONNEL FOR CLIENTS WITH ACUTE CONDITIONS OR IN ACUTE CARE ENVIRONMENTS › Section 224.7 - Supervision

Current through Reg. 49, No. 28; July 12, 2024
The registered professional nurse shall provide supervision
				  of all nursing tasks delegated to unlicensed persons in accordance with the
				  following conditions. These criteria apply to all instances of RN delegation
				  and supervision of delegation for clients with acute conditions or in acute
				  care environments.
(1) The degree of
				supervision required shall be determined by the delegating RN or the RN who
				assumes supervisory responsibilities after an evaluation of appropriate factors
				involved including, but not limited to, the following:
(A) the stability of the client's status in
				relation to the task(s) to be delegated;
(B) the training, experience, and capability
				of the unlicensed person to whom the nursing task is delegated;
(C) the nature of the nursing task being
				delegated; and
(D) the proximity
				and availability of the RN to the unlicensed person when the nursing task will
				be performed.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 11 - TEXAS BOARD OF NURSING › Chapter 224 - DELEGATION OF NURSING TASKS BY REGISTERED PROFESSIONAL NURSES TO UNLICENSED PERSONNEL FOR CLIENTS WITH ACUTE CONDITIONS OR IN ACUTE CARE ENVIRONMENTS › Section 224.8 - Delegation of Tasks

Current through Reg. 49, No. 28; July 12, 2024
(a) Tasks Which are
				Most Commonly Delegated. By way of example, and not in limitation, the
				following nursing tasks are ones that are most commonly the type of tasks
				within the scope of sound professional nursing practice to be considered for
				delegation, regardless of the setting, provided the delegation is in compliance
				with §
									224.6
				of this title (relating to General Criteria for Delegation) and the level of
				supervision required is determined by the RN in accordance with §
									224.7 of
				this title (relating to Supervision):
(1)
				non-invasive and non-sterile treatments;
(2) the collecting, reporting, and
				documentation of data including, but not limited to:
(A) vital signs, height, weight, intake and
				output, capillary blood and urine test;
(B) environmental situations;
(C) client or family comments relating to the
				client's care; and
(D) behaviors
				related to the plan of care;
(3) ambulation, positioning, and
				turning;
(4) transportation of the
				client within a facility;
(5)
				personal hygiene and elimination, including vaginal irrigations and cleansing
				enemas;
(6) feeding, cutting up of
				food, or placing of meal trays;
(7)
				socialization activities;
(8)
				activities of daily living; and
(9)
				reinforcement of health teaching planned and/or provided by the registered
				nurse.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 11 - TEXAS BOARD OF NURSING › Chapter 224 - DELEGATION OF NURSING TASKS BY REGISTERED PROFESSIONAL NURSES TO UNLICENSED PERSONNEL FOR CLIENTS WITH ACUTE CONDITIONS OR IN ACUTE CARE ENVIRONMENTS › Section 224.9 - The Medication Aide Permit Holder

Current through Reg. 49, No. 28; July 12, 2024
(a) An RN
				may delegate to medication aides the administration of medication to clients in
				correctional health, long term care facilities, home health agencies, and other
				facilities as authorized by law if:
(1) the
				medication aide holds a valid permit issued by the appropriate state agency to
				administer medications in that facility or agency;
(2) the RN assures that the medication aide
				functions in compliance with the laws and regulations of the agency issuing the
				permit; and
(3) the route of
				administration is oral, via a permanently placed feeding tube, sublingual or
				topical including eye, ear or nose drops and vaginal or rectal
				suppositories.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 11 - TEXAS BOARD OF NURSING › Chapter 224 - DELEGATION OF NURSING TASKS BY REGISTERED PROFESSIONAL NURSES TO UNLICENSED PERSONNEL FOR CLIENTS WITH ACUTE CONDITIONS OR IN ACUTE CARE ENVIRONMENTS › Section 224.10 - Supervising Unlicensed Personnel Performing Tasks Delegated by Non RN Practitioners

Current through Reg. 49, No. 28; July 12, 2024
(a) The following
				applies to the registered professional nurse who practices in a collegial
				relationship with another licensed practitioner, who has delegated tasks to an
				unlicensed person over whom the RN has supervisory responsibilities. The RN's
				accountability to the BON, with respect to its taking disciplinary action
				against the RN's license, is met if the RN:
(1) verifies the training of the unlicensed
				person;
(2) verifies that the
				unlicensed person can properly and adequately perform the delegated task
				without jeopardizing the client's welfare; and
(3) adequately supervises the unlicensed
				person.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 11 - TEXAS BOARD OF NURSING › Chapter 224 - DELEGATION OF NURSING TASKS BY REGISTERED PROFESSIONAL NURSES TO UNLICENSED PERSONNEL FOR CLIENTS WITH ACUTE CONDITIONS OR IN ACUTE CARE ENVIRONMENTS › Section 224.11 - Application of Other Laws and Regulations

Current through Reg. 49, No. 28; July 12, 2024
(a)
				BON §
									217.11(1)(A)
				of this title (relating to Standards of Nursing Practice) requires RNs to know
				and conform to all laws and regulations affecting their area of
				practice.
(b) The RN delegating
				tasks to an unlicensed person should be aware that, in addition to this
				chapter, various laws and regulations may apply to, including but not limited
				to, laws and regulations governing facility licensing, home and community
				support services agencies, Medicare and Medicaid regulations, and Medication
				Aide regulations.
(c) In situations
				where an RN's practice is governed by multiple laws and regulations that impose
				different requirements, the RN must comply with them all and if inconsistent,
				the most restrictive requirement(s) governs. For example, if one regulation
				requires an RN to make a supervisory visit every 14 days and another leaves it
				to the RN's professional judgment, the RN would have to visit at least every 14
				days or more frequently, if that is what the RN's professional judgment
				indicated.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 11 - TEXAS BOARD OF NURSING › Chapter 225 - RN DELEGATION TO UNLICENSED PERSONNEL AND TASKS NOT REQUIRING DELEGATION IN INDEPENDENT LIVING ENVIRONMENTS FOR CLIENTS WITH STABLE AND PREDICTABLE CONDITIONS › Section 225.1 - Application of Chapter

Current through Reg. 49, No. 28; July 12, 2024
(a) This chapter
				applies only to situations meeting the following criteria:
(1) the client is in an independent living
				environment;
(2) the client, if 16
				or older, or client's responsible adult is willing and able to participate in
				decisions about the overall management of the client's health care;
				and
(3) the task is for a stable,
				predictable condition as defined by §
										225.4 of
				this title (relating to Definitions).
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 11 - TEXAS BOARD OF NURSING › Chapter 225 - RN DELEGATION TO UNLICENSED PERSONNEL AND TASKS NOT REQUIRING DELEGATION IN INDEPENDENT LIVING ENVIRONMENTS FOR CLIENTS WITH STABLE AND PREDICTABLE CONDITIONS › Section 225.2 - Exclusions from Chapter

Current through Reg. 49, No. 28; July 12, 2024
This chapter does not apply to:
(1) tasks performed for acute, unstable, or
				unpredictable conditions;
(2)
				settings where nursing services are continuously provided;
(3) tasks performed under authority of
				Government Code §
									531.051(e)
				relating to Consumer Direction of Certain Services for Persons With Disability
				and Elderly Persons;
(4) RNs who:
(A) supervise or instruct others in the
				gratuitous nursing care of the sick;
(B) are qualified nursing faculty or
				preceptors directly supervising or instructing nursing students in the
				performance of nursing tasks while enrolled in accredited nursing
				programs;
(C) instruct and/or
				supervise an unlicensed person in the proper performance of nursing tasks as a
				part of an education course designed to prepare persons to obtain a state
				license, certificate or permit that authorizes the person to perform such
				tasks; and
(D) assign tasks to or
				supervise LVNs or other licensed practitioners practicing within the scope of
				their license.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 11 - TEXAS BOARD OF NURSING › Chapter 225 - RN DELEGATION TO UNLICENSED PERSONNEL AND TASKS NOT REQUIRING DELEGATION IN INDEPENDENT LIVING ENVIRONMENTS FOR CLIENTS WITH STABLE AND PREDICTABLE CONDITIONS › Section 225.5 - RN Accountability

Current through Reg. 49, No. 28; July 12, 2024
(a) The RN is
				responsible for proper performance of the assessment required by §
									225.6
				of this title (relating to RN Assessment of the Client) and for the RN's
				decisions made as a result of that assessment including determining that
				performance of a particular ADL or HMA for a particular client qualifies as not
				requiring delegation.
(b) The RN is
				responsible for documenting the delegation assessment and delegation
				decision(s), and must provide the rationale for the delegation decisions upon
				request of the client or the client's responsible adult. When delegation
				decisions conflict or are in disagreement with the client or the client's
				responsible adult, the RN should collaborate with the client or the client's
				responsible adult through a dispute resolution process if available.
(c) The RN is not accountable for an
				unlicensed person's actual performance of ADLs or HMAs not requiring
				delegation.
(d) The RN's
				accountability to the BON with respect to its taking disciplinary action
				against the RN's license is met when the RN can verify compliance with this
				chapter.
(e) This chapter does not
				change a RN's civil liability.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 11 - TEXAS BOARD OF NURSING › Chapter 225 - RN DELEGATION TO UNLICENSED PERSONNEL AND TASKS NOT REQUIRING DELEGATION IN INDEPENDENT LIVING ENVIRONMENTS FOR CLIENTS WITH STABLE AND PREDICTABLE CONDITIONS › Section 225.6 - RN Assessment of the Client

Current through Reg. 49, No. 28; July 12, 2024
(a) The
				RN, in consultation with the client if 16 or older, and when appropriate the
				client's responsible adult, must make an assessment to determine if the care:
(1) qualifies as an ADL or HMA not requiring
				delegation;
(2) can be delegated to
				an unlicensed person; or
(3) should
				not be delegated and only performed by a nurse.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 11 - TEXAS BOARD OF NURSING › Chapter 225 - RN DELEGATION TO UNLICENSED PERSONNEL AND TASKS NOT REQUIRING DELEGATION IN INDEPENDENT LIVING ENVIRONMENTS FOR CLIENTS WITH STABLE AND PREDICTABLE CONDITIONS › Section 225.7 - Activities of Daily Living Not Requiring Delegation

Current through Reg. 49, No. 28; July 12, 2024
(a) Activities of daily living (ADLs), as
				defined in this chapter, that do not fall within the practice of professional
				nursing may be performed by an unlicensed person in accordance with this
				section without being delegated. The Board has determined that in situations
				governed by this chapter ADLs do not fall within the practice of professional
				nursing when:
(1) performed for a person with
				a functional disability and the client would perform the task(s) but for the
				functional disability; and
(2) the
				RN determines, based on an assessment under §
										225.6
				of this title (relating to RN Assessment of the Client) that the task(s) is
				such that it could be performed by any unlicensed person without RN
				supervision.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 11 - TEXAS BOARD OF NURSING › Chapter 225 - RN DELEGATION TO UNLICENSED PERSONNEL AND TASKS NOT REQUIRING DELEGATION IN INDEPENDENT LIVING ENVIRONMENTS FOR CLIENTS WITH STABLE AND PREDICTABLE CONDITIONS › Section 225.8 - Health Maintenance Activities Not Requiring Delegation

Current through Reg. 49, No. 28; July 12, 2024
(a) Health Maintenance Activities (HMAs), as
				defined in this chapter that do not fall within the practice of professional
				nursing, may be performed by an unlicensed person in accordance with this
				section without being delegated. The Board has determined that in situations
				governed by this chapter HMAs do not fall within the practice of professional
				nursing when:
(1) performed for a person with
				a functional disability;
(2) in
				addition to the client assessment under §
										225.6
				of this title (relating to RN Assessment of the Client), a RN determines all of
				the following conditions exist:
(A) the
				client would perform the task(s) but for her/his functional
				disability;
(B) the task(s) can be
				directed by the client or client's responsible adult to be performed by an
				unlicensed person without RN supervision;
(C) the client or client's responsible adult
				is able, and has agreed in writing, to participate in directing the unlicensed
				person's actions in carrying out the HMA; and
(D) Either
(i) the client is willing and able to train
				the unlicensed person in the proper performance of the HMA, or
(ii) the client's responsible adult is
				capable of training the unlicensed person in the proper performance of the task
				and
(I) will be present when the task is
				performed, or
(II) if not present,
				will have observed the unlicensed person perform the task at least once to
				assure he/she can competently perform the task and will be immediately
				accessible in person or by telecommunications to the unlicensed person when the
				task is performed.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 11 - TEXAS BOARD OF NURSING › Chapter 225 - RN DELEGATION TO UNLICENSED PERSONNEL AND TASKS NOT REQUIRING DELEGATION IN INDEPENDENT LIVING ENVIRONMENTS FOR CLIENTS WITH STABLE AND PREDICTABLE CONDITIONS › Section 225.9 - Delegation Criteria

Current through Reg. 49, No. 28; July 12, 2024
(a) When
				determining whether to delegate a nursing task or those ADLs or HMAs requiring
				delegation, the RN, in addition to the assessment under §
									225.6
				of this title (relating to RN Assessment of the Client), shall:
(1) determine that the task does not require
				the unlicensed person to exercise nursing judgment;
(2) verify the experience and competency of
				the unlicensed person to perform the task, including the unlicensed person's
				ability to recognize and inform the RN of client changes related to the task.
				The RN must have either:
(A) instructed the
				unlicensed person in the delegated task; or
(B) verified the unlicensed person's
				competency to perform the nursing task based on personal knowledge of the
				training, education, experience and/or certification/permit of the unlicensed
				person.
(3) determine,
				in consultation with the client or the client's responsible adult, the level of
				supervision and frequency of supervisory visits required, taking into account:
(A) the stability of the client's
				status;
(B) the training,
				experience and capability of the unlicensed person to whom the nursing task is
				delegated;
(C) the nature of the
				nursing task being delegated;
(D)
				the proximity and availability of the RN to the unlicensed person when the
				nursing task will be performed; and
(E) the level of participation of client or
				client's responsible adult; and
(4) consider whether the five rights of
				delegation can be met: the right task; the right person to whom the delegation
				is made; the right circumstances; the right direction and communication by the
				RN; and the right supervision.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 11 - TEXAS BOARD OF NURSING › Chapter 225 - RN DELEGATION TO UNLICENSED PERSONNEL AND TASKS NOT REQUIRING DELEGATION IN INDEPENDENT LIVING ENVIRONMENTS FOR CLIENTS WITH STABLE AND PREDICTABLE CONDITIONS › Section 225.10 - Tasks That May Be Delegated

Current through Reg. 49, No. 28; July 12, 2024
A RN may delegate the following tasks unless the RN's
				  assessment under §
									225.6
				  of this title (relating to RN Assessment of the Client) and §
									225.9 of this
				  title (relating to Delegation Criteria) determines that the task is not a task
				  a reasonable and prudent nurse would delegate. Tasks include:
(1) an ADL the RN has determined requires
				delegation under §
									225.7
				of this title (relating to Activities of Daily Living Not Requiring
				Delegation);
(2) a HMA the RN has
				determined requires delegation under §
									225.8
				of this title (relating to Health Maintenance Activities Not Requiring
				Delegation);
(3) non-invasive and
				non-sterile treatments with low risk of infection;
(4) the collecting, reporting, and
				documentation of data including, but not limited to:
(A) vital signs, height, weight, intake and
				output, capillary blood and urine test;
(B) environmental situations/living
				conditions that affect the client's health status;
(C) client or significant other's comments
				relating to the client's care; and
(D) behaviors related to the plan of
				care;
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 11 - TEXAS BOARD OF NURSING › Chapter 225 - RN DELEGATION TO UNLICENSED PERSONNEL AND TASKS NOT REQUIRING DELEGATION IN INDEPENDENT LIVING ENVIRONMENTS FOR CLIENTS WITH STABLE AND PREDICTABLE CONDITIONS › Section 225.11 - Delegation of Administration of Medications From Pill Reminder Container

Current through Reg. 49, No. 28; July 12, 2024
In addition to all previous criteria listed, when delegating
				  the administration of oral unit dose medications from the client's daily pill
				  reminder container, the RN must:
(1)
				ensure that the unit dose medication(s) are placed in the client's daily pill
				reminder container, from properly dispensed prescription bottle(s), by the RN
				or a person mutually agreed upon by the RN and client or client's responsible
				adult who has demonstrated the ability to complete the task properly;
(2) instruct the client or client's
				responsible adult and the unlicensed person involved in such delegation
				activity about each medication placed in such a container with regard to
				distinguishing characteristics of each medication, proper time, dose, route and
				adverse effects which may be associated with the medication;
(3) provide to the client, client's
				responsible adult if applicable, and the unlicensed person(s) instructions to
				contact the RN before the medication is administered when there are questions
				concerning the medications or changes in the client's status related to the
				medication being given. An example is when the medications appear to be
				rearranged or missing.
(4) make
				supervisory visits in the event there are changes in the client's status
				related to the medication being given and determine the frequency of
				supervisory visits in consultation with the client or the client's responsible
				adult to assure that safe and effective services are being provided;
				and
(5) ensure the client or
				client's responsible adult acknowledges in writing that the administration of
				medication(s) under this section will be delegated to an unlicensed
				person.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 11 - TEXAS BOARD OF NURSING › Chapter 225 - RN DELEGATION TO UNLICENSED PERSONNEL AND TASKS NOT REQUIRING DELEGATION IN INDEPENDENT LIVING ENVIRONMENTS FOR CLIENTS WITH STABLE AND PREDICTABLE CONDITIONS › Section 225.13 - Tasks Prohibited From Delegation

Current through Reg. 49, No. 28; July 12, 2024
The following are nursing tasks that are not within the scope
				  of sound professional nursing judgment to delegate:
(1) physical, psychological, and social
				assessment, which requires professional nursing judgment, intervention,
				referral, or follow-up;
(2)
				formulation of the nursing care plan and evaluation of the client's response to
				the care rendered;
(3) specific
				tasks involved in the implementation of the care plan that require professional
				nursing judgment or intervention;
(4) the responsibility and accountability for
				client or client's responsible adult health teaching and health counseling
				which promotes client or client's responsible adult education and involves the
				client's responsible adult in accomplishing health goals; and
(5) the following tasks related to medication
				administration:
(A) calculation of any
				medication doses except for measuring a prescribed amount of liquid medication
				and breaking a tablet for administration, provided the RN has calculated the
				dose;
(B) administration of
				medications by an injectable route except for subcutaneous injectable insulin
				or other injectable medication prescribed in the treatment of diabetes mellitus
				as permitted by §
										225.12
				of this title (relating to Delegation of Administration of Insulin) or other
				injectable medication prescribed in the treatment of diabetes mellitus and in
				emergency situations as permitted by §
										224.6(4)
				of this title (relating to General Criteria for Delegation) and §
										225.10(13)
				of this title (relating to Tasks That May Be Delegated);
(C) administration of medications by way of a
				tube inserted in a cavity of the body except as permitted by §
										225.10(10)
				of this title;
(D) responsibility
				for receiving or requesting verbal or telephone orders from a physician,
				dentist, or podiatrist; and
(E)
				administration of the initial dose of a medication that has not been previously
				administered to the client unless the RN documents in the client's medical
				record the rationale for authorizing the unlicensed person to administer the
				initial dose.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 11 - TEXAS BOARD OF NURSING › Chapter 225 - RN DELEGATION TO UNLICENSED PERSONNEL AND TASKS NOT REQUIRING DELEGATION IN INDEPENDENT LIVING ENVIRONMENTS FOR CLIENTS WITH STABLE AND PREDICTABLE CONDITIONS › Section 225.14 - Supervising Unlicensed Personnel Performing Tasks Delegated by Other Practitioners

Current through Reg. 49, No. 28; July 12, 2024
(a) The following
				applies to the registered nurse who practices in a collegial relationship with
				another licensed practitioner who has delegated tasks to an unlicensed person
				over whom the RN has supervisory responsibilities. The RN's accountability to
				the BON, with respect to its taking disciplinary action against the RN's
				license, is met if the RN:
(1) verifies the
				training of the unlicensed person;
(2) verifies that the unlicensed person can
				properly and adequately perform the delegated task without jeopardizing the
				client's welfare; and
(3)
				adequately supervises the unlicensed person.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 11 - TEXAS BOARD OF NURSING › Chapter 225 - RN DELEGATION TO UNLICENSED PERSONNEL AND TASKS NOT REQUIRING DELEGATION IN INDEPENDENT LIVING ENVIRONMENTS FOR CLIENTS WITH STABLE AND PREDICTABLE CONDITIONS › Section 225.15 - Application of Other Laws and Regulations

Current through Reg. 49, No. 28; July 12, 2024
BON §
									217.11(1)
				  of this title (relating to Standards of Nursing Practice) requires RNs to know
				  and conform to all laws and regulations affecting their area of practice. The
				  RN authorizing an unlicensed person to perform tasks in independent living
				  environments should be aware that, in addition to this chapter, various laws
				  and regulations may apply including, but not limited to, laws and regulations
				  governing home and community support service agencies and Medicare and Medicaid
				  regulations. In situations where a RN's practice is governed by multiple laws
				  and regulations that impose different requirements, the RN must comply with
				  them all and if inconsistent, the most restrictive requirement(s) governs. For
				  example, if one regulation requires a RN to make a supervisory visit every 14
				  days and another leaves it to the RN's professional judgment, the RN would have
				  to visit at least every 14 days or more frequently, if that is what the RN's
				  professional judgment indicated.
Texas Administrative Code › Title 22 - EXAMINING BOARDS › Part 11 - TEXAS BOARD OF NURSING › Chapter 226 - PATIENT SAFETY PILOT PROGRAMS ON NURSE REPORTING SYSTEMS › Section 226.1 - Patient Safety Pilot Programs on Nurse Reporting Systems

Current through Reg. 49, No. 28; July 12, 2024
The purpose of this rule is to establish the procedures to
				  assure that patient safety pilot programs conducted under Tex. Occ. Code §
				  301.1606 are conducted in a manner consistent with the Board's role of
				  protection of the public and are structured appropriately to evaluate the
				  efficacy and effect on protection of the public of reporting systems designed
				  to encourage identification of system errors.