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Occasionally nurses have, currently can, and probably will continue to lie on occasion about being treated or diagnosed with a reportable condition. Any nurse who falsifies information relating to the practice of nursing or nursing licensure runs the risk of being "caught"— possibly years in the future, should the nurse be reported to the Board and investigated for possible practice violations. Nurses face stiffer sanctions from the Board when it is discovered that a nurse falsified information to the BON. Is current CPR certification a licensure requirement for nurses?
Nurses have a responsibility to maintain continued competency in nursing practice through educational opportunities that promote individual professional growth [Board Rule Do all nurses have an obligation to initiate CPR for a client? All nurses have an obligation or duty to initiate CPR for clients who require resuscitative measures [Board Rule BON licensure laws and rules do not specifically require a nurse to have a current CPR card in order to perform CPR or utilize other life-saving interventions for a client. This position statement is specific to long-term care facilities and is not to be construed as applicable to other healthcare settings in which nurses are employed.
In the case of an unwitnessed resident arrest without DNR orders in a long-term care facility, determination of the appropriateness of CPR initiation should be undertaken by the registered nurse through a resident assessment; and, interventions appropriate to the findings should be initiated. After assessment of the resident is completed and appropriate interventions are implemented, documentation of the circumstances and the assessment of the resident in the medical record are required.
The American Heart Association recommends that all clients receive CPR immediately unless attempts at CPR would be futile, such as when clients exhibit obvious clinical signs of irreversible death. Obvious clinical signs of irreversible death include decapitation separation of head from body , decomposition putrefactive process; decay , dependent lividity dark blue staining of the dependent surface of a cadaver, resulting from blood pooling and congestion , transection, or rigor mortis body stiffness that occurs within two to four hours after death and may take 12 hours to fully develop.
Does the Texas Board of Nursing have purview over the pronouncement of death? The Board of Nursing does not have purview over physician practice, employment settings or the laws regulating the pronouncement of death in Texas. Is there a difference between the decision to initiate CPR and the decision to pronounce death? The decision to initiate CPR for all nurses should be a spontaneous clinical decision and nursing intervention for a client in cardiac or respiratory arrest. Texas Health and Safety Code Chapter requires the facility, institution, or entity to have a written policy that is jointly developed and approved by the medical staff or medical consultant and the nursing staff, specifying under what circumstances an RN can make a pronouncement of death in order for an RN to pronounce death.
An RN may not sign a death certificate under any circumstances. However, an APRN may sign a death certificate under the following circumstances: Licensed vocational nurses LVNs do not have the authority to legally determine death, diagnose death, or otherwise pronounce death in the State of Texas. Regardless of practice setting, the importance of initiating cardiopulmonary resuscitation CPR in cases where no clear Do Not Resuscitate DNR orders exist is imperative. What additional references are available should be considered when establishing policies and procedures for nursing staff in my facility?
The Board recommends employers consider the following references when establishing policies and procedures in the healthcare setting:. I will be graduating from a vocational nurse training program in a few months, and am beginning to seek out employment options once I graduate. I am attracted to the area of home health nursing, and I wondered if LVNs can work in home health settings?
The same answer applies to graduates of registered nurse training programs. Should I work in this environment as a new nurse? When you graduate from your vocational training program or your professional nursing program, you will likely be eligible for a temporary permit to practice as a Graduate Vocational Nurse GVN or Graduate Nurse GN. The Board strongly discourages newly licensed nurses from accepting employment in any independent living environment setting until the new nurse achieves twelve 12 to eighteen 18 months of nursing experience in an acute health care setting such as a hospital.
The Board believes that the newly licensed nurse LVN or RN needs adequate time to apply newly learned nursing knowledge and clinical skills, as well as time to develop clinical judgment and decision-making skills. In addition, the Board believes that this process occurs most effectively in a structured health care environment where resources and supervision are immediately available to the new nurse. The NPA and rules may be viewed in their entirety on this site. Specifically, Board Rule I am answering the question on my licensure application: Have you used your nursing knowledge, skills and abilities within the past four 4 years?
I'm not sure what this means, can I include volunteer positions or caring for a disabled family member? The practice of nursing requires specialized judgment and skill, which is based on knowledge and application of the principles of biological, physical, and social science as acquired by a completed course in an approved professional or vocational nursing program of study [NPA Section The practice of nursing is not limited to the traditional roles, such as providing hands on, direct patient care, or teaching in a nursing program, or working as a nurse administrator.
There are many more activities that nurses perform that comprise nursing practice, that are not in these traditional roles. Whether a nurse is in a paid or volunteer role, the nurse must know and comply with the Nursing Practice Act, Board Rules and Regulations, and any laws, rules, or regulations applicable to the nurse's area of practice [Board Rule A nurse is responsible to maintain professional boundaries and confidentiality in relation to the nursing care being provided [Board Rule Nurses use their specialized nursing knowledge, skills and abilities for example, when a nurse is in the role of a nurse researcher performing health related research in support of improved practice and patient outcomes.
Other examples of non-traditional nursing roles include health education, utilization review, health information technology, policy and rule writing, consulting, and writing for nursing publications such as journal articles, books or continuing nursing education programs. If a nurse uses their knowledge, skills and abilities acquired from a nursing program, then the nurse is said to be practicing nursing and should be licensed as a nurse, regardless of whether or not the employment position uses the title of nurse or requires a nursing license. The Board does not have regulatory purview over employment practices and most policies and procedures.
There is not a requirement for a specific number of hours of nursing practice within a licensure cycle for the LVN or the RN to maintain active licensure status. Area of practice is defined as "any activity, assignment, or task in which the nurse utilized nursing knowledge, judgment, or skills during the licensing period" and may provide additional guidance in answering this licensure application question.
What is appropriate supervision? Each LVN is required to ensure that he or she has the appropriate supervisor prior to accepting an assignment, a position, or employment.
Supervision is the process of directing, guiding, and influencing the outcome of an individual's performance of an activity. LVNs provide valuable and essential nursing care in different types of health care settings. When LVNs work in settings, such as hospitals, long-term care facilities, rehabilitation centers, or skilled nursing facilities, RNs are likely to serve as the LVN's supervisor.
LVNs also work in private physician or dentist offices, where physicians, dentists and podiatrists function as the LVN's supervisor. These types of clinical supervisors oversee the nursing practice of an LVN by monitoring the health status of patients and then directing the LVN's actions to ensure the delivery of safe and effective nursing care. What does predictable health care needs mean?
The LVN in Texas provides nursing care to patients with health care needs that are predictable in nature, under the direction and supervision of a registered nurse, advanced practice registered nurse, physician, physician assistant, podiatrist, or dentist. A predictable health condition does not mean that the patient is always stable. Instead, predictable health conditions follow an expected range or pattern that allows the LVN, with his or her clinical supervisor, to anticipate and appropriately plan for the needs of patients.
For example, it is appropriate for an LVN to care for a patient with a diagnosis of asthma. The disease process for asthma, while sometimes acute in nature, is predictable or well-known, and the symptoms can be anticipated. The LVN assists his or her clinical supervisor in the development of a plan, in which the LVN provides care, prevents possible complications, and stabilizes the symptoms of asthma.
In addition, when complications arise or events occur that are outside the predicted range, the LVN must be able to recognize this change in condition and notify his or her clinical supervisor. As such, Board staff recommends contacting the agency that regulates the specific type of practice setting to determine if other laws and regulations apply to the completion of an initial assessment. For example, acute care facilities such as hospitals are licensed by the Texas Department of State Health Services www.
RNs conduct comprehensive health assessments. Licensed vocational nurses may only conduct focused health assessments. In situations requiring comprehensive assessments by a RN, the LVN cannot begin by performing a focused assessment and have the RN follow up with an assessment of only those parameters not assessed by the LVN.
Likewise, when a nurse makes assignments to another person s , the nurse must consider the educational preparation, experience, knowledge, and skills of the person s receiving the assignment [Board Rule LVNs may not initiate care plans; however, they may contribute to the planning and implementation of the nursing care plan. Only the RN may develop the initial nursing care plan and make nursing diagnoses [Board Rule Board staff recommends review of Board Rule Can LVNs in any practice setting be "on-call" to deal with after-hours issues??
Can an LVN perform "triage" duties either telephone triage, such as for home health, or on-site triage, such as in an Emergency Room? Triage is defined as the sorting of patients and prioritizing of care based on the degree of urgency and complexity of patient conditions. Telephone triage is the practice of performing a verbal interview and making a telephonic assessment with regard to the health status of the caller.
Of concern to the Board are situations where the LVN would be required to independently engage in assessment either telephonically or face-to-face for purposes of triaging a patient. The Board's concerns are based on the fact that LVNs are not educationally prepared to perform triage assessments, either telephonically or in the role of the health care professional initially assessing a patient face-to-face to determine treatment priorities in any setting.
The Differentiated Essential Competencies of Graduates of Texas Nursing Programs DECs states in part that LVN nursing programs in Texas prepare entry-level LVN graduates to care for patients with predictable health care needs within structured health care settings through a supervised, directed scope of practice.
In either telephone or face-to-face triage, the LVN is likely to be dealing with a situation where the patient's condition is not predictable. Further, LVNs are educated in focused assessment skills using the senses of sight, smell, touch, and hearing; and, triage requires comprehensive assessment skills which are taught at the RN level of education. While LVNs may expand their practice to a certain degree with post-licensure Continuing Nursing Education, this does not permit LVNs to expand their practice to the extent that additional formal education and another level of licensure is required such as performance of comprehensive assessments.
This standard supersedes any doctor's order or facility policy; thus, a nurse cannot avoid his or her "duty" to maintain patient safety by placing responsibility for nursing actions on another party. Triage is not taught in one-year vocational nurse education programs. The LVN has not received education in the complex details of comprehensive assessment as provided in a professional registered nurse education program that would include the knowledge base necessary for on-site and telephone triage.
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It is not acceptable to have either an RN or advanced practice registered nurse APRN serving as "backup on-call" to assist an LVN who is also responding only telephonically to patients in need. Regardless of the number of years of practice experience, an LVN does not have the educational background equivalent to that of an RN and is not educated or trained to analyze and synthesize symptoms or otherwise conduct a comprehensive assessment telephonically with a patient.
Additionally, if emergent action is needed and the LVN is unable to discern this need due to limited assessment abilities, intervention that may be necessary to save the patient's life could be delayed. Even under supervision and direction, LVNs may not perform comprehensive nursing assessments. A hospital is required to stabilize a patient if an emergency medical condition exists. For more information, please visit https: The Board believes that RN educational preparation and licensure constitutes the minimum acceptable level of competence necessary to serve as the qualified medical personnel to conduct a MSE.
As defined in Board Rule Other Practice Setting Examples e. The Board is aware that LVNs may also practice in "call centers" such as a poison control center , physician's offices, or other similar settings. In settings where a physician is present, there may be a set of standardized guidelines approved by the physician to establish treatment priorities within the office environment under the supervision of the physician.
Such practice settings may be appropriate for a qualified LVN. Please see Position Statement In call centers, the LVN typically has access to computer systems that guide the LVN in asking specific symptom-driven, decision-tree questions that then dictate what action the LVN recommends to the caller.
The BON cannot provide legal advice or counsel to nurses. A nurse may wish to seek his or her own legal counsel for advice on the best course of action for her or himself. Emergency Nurses Association Triage Qualifications and Competency.
The NPA and Board rules and regulations prevent a LVN from practicing in a completely independent manner that is, without a licensed supervisor ; however, the NPA and rules are silent as to the proximity of the licensed supervisor. There are many factors to be considered in determining how quickly the licensed supervisor needs to be available to the LVN.
Factors to be considered should include: The appropriate licensed supervisor must be accessible to the LVN at least telephonically or by similar means. To illustrate, compare the LVN who performs routine nursing tasks or nursing tasks learned through ongoing continuing education such as intravenous therapy with a LVN who performs a delegated medical act such as Botox administration. These are different situations and will differ in who RN or physician is appropriate to supervise the LVN as well as the proximity of the licensed supervisor.
Other regulations, such as those related to reimbursement, may also be a factor in the latter situation. This position statement along with other scope of practice documents may be accessed in Nursing Practice , then Scope of Practice on the BON web page. The Emergency Medical Treatment and Active Labor Act EMTALA is a federal law established in that requires hospitals or other acute care facilities who offer emergency services to provide a medical screening examination to each person presenting to the emergency department.
A medical screening exam is done to determine whether or not an emergency medical, not nursing, condition exists. EMTALA requires the assessment of a patient for the existence of an emergency medical condition before the patient can be transferred or released from the emergency department. The MSE may be delegated by the physician to other qualified medical personnel according to the physician delegation rules found in the Texas Administrative Code, Chapter In addition to being permitted by an employing facility, however, the RN must also be competent to carry out the assigned task in a manner that complies with the NPA and board Rules.
The Board of Nursing does not have purview over specific employment policies, procedures or site-based requirements. There may be laws, rules, or regulations applicable to your practice setting that may impact your practice. The referenced position statement is important for nurses to understand that they must intervene or advocate on behalf of their patients and establishes that a nurse has a responsibility and duty to a patient to provide and coordinate the delivery of safe, effective nursing care, through the NPA and Board Rules.
This duty supersedes any facility policy or physician order. The Six-Step Decision-Making Model guides nurses in deciding if a task is within the nurse's scope of practice. The steps combine BON references and resources with additional references and resources policies and procedures from the employment setting, and nursing and healthcare research and literature and uses reflective questions to guide a nurse's practice decisions. A "no" answer, on any step, usually means the activity in question is not within the nurse's scope of practice.
Each nurse is accountable for the assignments the nurse accepts [Board Rule RNs who do not hold advanced practice authorization cannot independently engage in medical diagnosis or prescription of therapeutic or corrective measures, as this is beyond the scope of practice for an RN. The board believes that the performance of a medical screening exam is not within the scope of practice for an LVN, regardless of years of experience or post-licensure continuing nursing education at the LVN level.
No, a medical screening exam is not the same as triage. This guideline to states in part that "individuals coming to the emergency department must be provided a medical screening examination beyond initial triaging. Triage is not equivalent to a medical screening examination. Triage merely determines the order in which patients will be seen, not the presence or absence of an emergency medical condition.
Some of the standards in Rule Regardless of practice setting, the nurse's duty to keep patients safe cannot be superseded by physician orders, facility policies, or administrative directives; see Position Statement To assist in determining if a task is within an individual nurse's scope of practice; nurses may utilize the board's "Six-Step Decision-Making Model for Determining Nursing Scope of Practice.
Advanced practice licensure is not sufficient on its own to qualify an APRN to perform all types of medical screening exam. The APRN would have to be licensed in an appropriate role and population focus, e. The appropriately licensed APRN should have a signed protocol or collaborative agreement with a physician that specifically delegates medical aspects of care to the APRN.
Although the laws regarding immunizations are not within the BON's authority, an Attorney General opinion in MW determined immunizations are preventative, thus no medical diagnosis is required or made when a person receives an immunization. Board staff recommends that a facility have standing physician delegation orders that guide the nurse when to give pneumococcal or influenza vaccines. Board staff recommend review of documents located on our web site.
In general, vaccination administration would be prohibited from delegation by an RN to unlicensed assistive personnel UAP. The delegation rules in Chapter are more restrictive than the rules in Chapter All medication administration and routes of medication administration are prohibited from delegation in the acute delegation rules with the exception of the medication aide permit holder. RNs may supervise UAPs performing tasks delegated by other licensed healthcare providers.
Nurses have a duty to promote safety for their patients. Can a nurse do a medical screening exam in the ER during a pandemic? If the purpose of a medical screening is to determine a medical diagnosis, this would be beyond the parameters of nursing practice. One way to accomplish this standard is to identify incoming patients who might be infectious and provide them with a separate waiting area so as not to expose others to communicable conditions.
When a physician is delegating to a nurse, the nurse is expected to comply with the Standards of Nursing Practice just as if performing a nursing procedure. Is it mandatory for a nurse to receive a flu vaccination? Nurses are to implement measures to prevent patient exposure to infectious pathogens and communicable conditions as stated in Board Rule Nurses may choose to receive a vaccination to prevent exposing patients to the flu and to protect them from possible infection.
A person may be contagious prior to developing symptoms with seasonal flu and thus may expose others to the disease. The following web sites have information on the seasonal influenza: Centers for Disease Control and Prevention - Influenza: Can an LVN be a school nurse? Can an LVN train unlicensed diabetes care assistants UDCAs or serve in other roles consultative relationship, administratively responsibility? The BON does not preclude LVNs from being employed in school settings; however, the BON regulates the nurse, not the setting, and has no jurisdiction over employment practices.
In all cases, LVN practice is a directed scope of nursing practice under the supervision of a registered nurse, advanced practice registered nursed, physician assistant, physician, podiatrist, or dentist [ Board Rule The LVN participates in the planning of nursing care needs of patients and contributes to the development and implementation of nursing care plans for patients and their families with common health problems and well-defined health needs.
LVNs may teach from a developed education plan as well as contribute to its development. Who is responsible for determining which school employees will be trained as unlicensed diabetes care assistants UDCAs and who is responsible for training UDCAs in schools? In schools that do not have a registered nurse, the principal assures that training is provided by a health care professional with expertise in diabetes care. Can a healthcare provider with expertise in diabetic care be contracted to do all of the training for an individual school or a school district?
A school nurse RN is assigned to 3 different elementary schools within one district and rotates between the schools. The principals also assume administrative responsibility for these staff whether they are functioning within their job descriptions or in the "extra" role of UDCA. Working with the principals at all 3 schools, the school RN coordinates training of all UDCAs through another RN with expertise in all aspects of the care of children with diabetes.
How does the RN provide adequate communication and information to the UDCAs at each school related to the diabetic care needs of each child? What is the LVNs role? Congruent with the diabetes management and treatment plan and the individualized health plan IHP for each child with diabetes, the RN can develop information sheets with emergency contact numbers, reportable conditions, and how to intervene in a number of possible emergency situations that could occur with each child.
Health and Safety Code, Chapter and school policy mandate that this information be given to any school employee transporting a child or supervising a child during an off-campus activity. Based on maturity, intellectual understanding, or other factors, if a student with diabetes is unable to safely accomplish self-management, then the nurse should assure that this issue is addressed in discussions with the principal, parents, physician, and teacher s in revising the IHP as necessary to protect both the child with diabetes as well as others, including children, in the school setting.
The IHP may require multiple revisions as the child's ability to engage in responsible self-management increases. Who is required to conduct the training of the unlicensed diabetes care assistants? Texas Health and Safety Code Section Who will oversee that the evaluation of competency is acceptable?
The school nurse or the healthcare professional who conducts the training will determine if competence of clinical tasks is acceptable and safe. Can a nurse train unlicensed diabetes care assistants UDCAs , teachers, and other school personnel in the administration of glucagon? Glucagon is prescribed to thousands of students with diabetes. Both students and their parents or guardians are instructed by providers and pharmacists on administration of glucagon should a hypoglycemic reaction occur. Even during an emergency situation in the school setting, the RN cannot delegate tasks that require unlicensed persons to exercise professional nursing judgment; but, the unlicensed person may take any action that a reasonable, prudent non-health care professional would take in an emergency situation.
Additionally,a series of algorithms that serve to provide delegation decision making guidance for RNs in the school setting along with BON Position Statement Each nurse will need to exercise sound nursing judgment to decide when it is appropriate and safe to delegate in emergency situations, remembering the supervision requirements of delegation as well.
The BON does not have a list of tasks that nurses can perform because each nurse has a different background, knowledge and level of competence. All prescription drugs marketed in the U. The label provides detailed instructions regarding approved uses and doses which are based on the results of clinical studies that have been submitted by the drug maker to the FDA. Off label use of a medication may be supported by research and literature that addresses the necessary knowledge, required safeguards and risks associated with the off label use of the medication.
When making these decisions, the model encourages a nurse to consider the six reflective questions using a yes or no answer. If a yes answer is reached on any step, the nurse should proceed to the next step of the decision making model. If the nurse reaches step six with yes answers, then the task is most likely within the nurse's scope of practice. Keep in mind, the answer may not be the same for each nurse. While there is nothing specific in the Nursing Practice Act or Board Rules and Regulations that allows or prohibits the off-label administration of medications, there are laws and rules that licensed vocational nurses LVN and registered nurses RN should consider in this decision.
The LVN cares for patients whose healthcare needs are predictable. When considering the administration of a medication, the predictability of the patient, the patient's response and the nurse's skill set required to address the needs of the patient must be considered. If any of these cannot be addressed by the LVN, then it would be beyond the scope of practice of the LVN to administer off-label medications. When a nurse is considering performing a task, such as the off-label administration of medications, several standards in section one of this rule, will apply to all LVNs and RNs.
Patient safety must be considered in every assignment a nurse accepts. A nurse must know about the medication, why it is being used, what effects can be expected, and how to administer the medication correctly in order to administer it safely [ Board Rule Some medications may require an assessment, vital signs, and a pain description and level provided by the patient.
Certain medications require the presence of equipment or monitoring during and following the medication administration due to the potential or known effects of the medication8. Some medications require the nurse administering the medication to have specific skills and current competencies to include emergency interventions should adverse outcomes occur. Last, but not least, medication administration is not complete without accurate documentation [ Board Rule There are several Position Statements that apply to the off label administration of a medication.
There are two position statements that specifically address either the RN or LVN scope of practice in broad terms. Facility policy may identify specific levels of licensure for the administration of certain medications, or specific areas or units within the facility where the administration of medications may occur. There may be specific requirements related to current competencies of the personnel who will be administering medications, and for monitoring the patient after the administration of medications.
There may be a policy distinction between label uses and off-label uses of medications. When a nurse identifies the safety issues involved in administering any off-label medication correctly, looking for an employer's policy support of the safety measures required may assist a nurse in determining if off-label administration of medications will be safe in a specific setting.
Nurses are required to administer medications correctly, using evidence to support or refute giving a medication. Step four asks if the nurse has the current competencies to perform the task. If a medication is being given via the IV route, having current skills to assess and intervene are important. If a pump is being used to administer the IV medication, then being familiar with the pump is essential.
Step five is for the nurse to consider whether a reasonable and prudent nurse of the same or similar education and similar circumstance would administer the off-label medication. Finally, step six is a personal reflective question and asks the nurse to accept accountability for the actions the nurse takes. Both the mission of the Board and the nurse's duty to the patient align in favor of patient safety.
Are there rules regarding nurses performing radiologic procedures?
Yes, BON Rule These laws require a RN to demonstrate competency in performing radiologic procedures. Some radiologic procedures may be considered delegated medical acts. BON staff recommends caution when performing a task as a delegated medical act and the Board's Position Statement Delegated medical acts do not diminish the responsibility in any way of the nurse to adhere to the Board's Standards of Nursing Practice, Rule Included in BON Rule Nurses must accept only those assignments that are within the nurse's knowledge, skills, and abilities, and seek instruction as necessary in order to maintain competency when performing tasks in any practice setting [BON Rule For general information on nurses practicing in the area of radiology, BON staff recommends contacting professional nursing organizations, such as the Radiological Society of North America at http: Other nursing organizations related to a nurse's specialty practice setting may provide further guidance.
In addition to other nursing organizations related to a nurse's specialty practice setting, national patient safety organizations may provide resource information and procedure guidelines for evidence-based practice. Texas Senate Bill amended Section There was legislation some time ago that allowed nurses to pronounce death in long-term care and hospice facilities.
During the Legislative Session, registered nurses were given the legal authority to determine and pronounce a person dead in situations not involving artificial life support, if permitted by written policies of a licensed health care facility, institution, or entity providing services to that person. The bill specifically states that if the RN's employing health care facility has an organized nursing staff and an organized medical staff or medical consultant, the nursing staff and medical staff or consultant shall jointly develop and approve those policies.
If a nurse from another state provides nursing to a resident of Texas, except as excluded in the Nursing Practice Act, Section The most current list of states belonging to the Nurse Licensure Compact is located on the web page for the National Council of State Boards of Nursing www. Using Nursing Titles Applies to Telephonic Nursing Practice Any title that would lead a member of the public to believe that a person is licensed as a nurse is prohibited from use unless the person indeed holds a valid nursing license either in Texas or in one of the compact states.
This is specified in the Nursing Practice Act, Section This includes titles that apply to advanced practice registered nurses as defined in Rule The Position Statement Who is required to have forensic evidence collection continuing education? This is a onetime requirement. While some practice settings may have the luxury of always having a specialty certified RN such as a SANE nurse available to perform specific types of forensic evidence collection, there will be settings where this is not the case, and where the nurse who "floats" to the emergency department may be the professional responsible for collecting or assisting with collection of evidence.
As the Board has no jurisdiction over facilities, the BON has no control over staffing plans, job descriptions, how nurses may or may not be rotated through or floated to the ED, or to establish a minimum number of hours a nurse must work in an ED setting. It would be up to facility or unit policy to determine which nurses will perform forensic evidence collection and how the facility will assure ongoing competency of the nurses engaging in this practice. Content may also include, but is not limited to, documentation, history-taking skills, and use of sexual assault kit, survivor symptoms, and emotional and psychological support interventions for victims.
In addition to obtaining approval to sit for the NCLEX, a student who has successfully completed a nursing program must also hold a current valid temporary permit from the Board to practice as a GN or GVN in the state of Texas. Although the GN or GVN may not practice in an independent setting such as home care until licensed, the BON has no requirements for co-signatures on anything. These two examinations are used by all U. The nurse must then submit an application to the Board for licensure in the advanced practice role and population focus.
The nursing shortage is creating ever-greater challenges for those who must fill nursing vacancies at all levels of licensure and in various specialties.
The formal education for entry into nursing practice in Texas is differentiated between vocational and professional registered nursing. The Board believes that for a nurse to successfully make a transition from one level of nursing licensure to the next requires the completion of a formal program of education as defined in the applicable board rule [Board Rules The Board also believes that completion of on-going, informal continuing education offerings, such as workshops or online offerings in a specialty area, serve to expand and maintain the competency of the nurse at the current level of licensure.
No amount of informal or on-the-job-training can qualify a LVN to perform the same level of care as the RN. For example, a LVN with 10 years of home care experience cannot perform the comprehensive assessment and initiate the nursing care plan on a patient newly admitted to the services of a home care agency where the LVN is employed.
In other words, a nurse's duty is to keep a patient safe and uphold the standards of nursing practice. A nurse never works under the license of another provider. In carrying out orders from physicians, podiatrists, or dentists for the administration of medications or treatments, nurses are usually engaged in the practice of vocational or professional nursing in accordance with the applicable licensure of the individual nurse. In carrying out some physician orders, however, LVNs or RNs may perform acts not usually considered to be within the scope of vocational or professional nursing practice, respectively.
Such tasks are delegated and supervised by physicians, podiatrists, or dentists. RNs who lack licensure as advanced practice registered nurses in a specified role and population focus, and LVNs may not engage in "acts of medical diagnosis or prescription of therapeutic or corrective measures" [ NPA, Section In carrying out the delegated medical function, the nurse is expected to comply with the Standards of Nursing Practice just as if performing a nursing procedure. The Board recognizes that nursing practice is dynamic and that acts which today may be considered delegated medical acts may in the future be considered within the scope of either vocational or professional nursing practice.
The Diagnostic and Statistical Manual of Mental Disorders DSM diagnoses are multi-disciplinary psychiatric diagnoses used for the purpose of applying objective criteria, establishing a practice framework and communicating findings with other health care professionals. The Board of Nursing BON recognizes the complexity of nursing in the school health setting and the need to protect the youth of Texas. Although students come to school with complex and diverse health care needs, they should be provided an education in the least restrictive environment.
The BON recognizes that the school children of Texas have the right to receive safe, appropriate, and specialized health services that may be required to assure the child's inclusion in the school environment. School nursing requires comprehensive assessment skills to promote student health, prevent illness and intervene in accordance with the nursing care plan.
The RN has the educational preparation and critical thinking skills as well as clinical expertise that are essential to nursing in the school setting. The provision of these services by the RN contributes directly to the students' education and to the successful outcome of the educational process. The vocational nurse has a directed scope of practice under supervision of a registered nurse, advanced practice registered nurse, physician, physician assistant, podiatrist, or dentist. The RN monitors, coordinates, and evaluates the provision of health services necessary to meet individual student health needs essential in achieving educational objectives.
Due to the growing number of students entering the school system with special health care needs, the BON recognizes that not all health-related services can be provided by a RN or LVN. School is considered an independent living environment as defined in Chapter 3 ; however, acute or emergency situations in the school setting may be delegated in accordance with the rules in both Chapter and Chapter The RN may decide to delegate to an unlicensed person the emergency administration of medications or treatments. Examples include, but are not limited to, Epi-pens, Glucagon, Diastat, oxygen, metered dose inhalers or nebulizer treatments for the relief of acute respiratory symptoms, and the use of a hand held magnet to activate a vagus nerve stimulator to prevent or control seizure activity.
In a school setting, the administration of medication may be assigned to an unlicensed person by the public school official in accordance with the Texas Education Code. If the RN is unable to assure these criteria have been met, the RN must notify the public school official. Given the complexity, the current number, and the future projections of increasing numbers of children entering the school system with complex nursing and health-related needs, the BON believes that the RN must establish an individualized nursing care plan for each child as applicable.
The RN may be assisted by LVNs and unlicensed assistive personnel in the delivery of services to ensure the delivery of safe, effective health care to the school children of Texas. The nurse, by virtue of a rigorous process of education and examination leading to either LVN or RN licensure, is accountable to the Board to assure that nursing care meets standards of safety and effectiveness. An individual who holds licensure as a licensed vocational nurse LVN or as a registered professional nurse RN or as an advanced practice registered nurse APRN in Texas is responsible and accountable to adhere to the Nursing Practice Act and Board Rules which have the force of law with regard to licensed nursing practice in the state of Texas.
However, a nurse, who is also licensed by another state agency, is required to comply with the NPA and Board Rules for any acts that are also within the scope of nursing practice [ Tex. The Board holds a licensed registered professional nurse, who is working in an unlicensed or technical position, or other role, responsible and accountable to the level of education and competency of a RN. Likewise, a LVN working as an unlicensed or technical person, or in another role, is responsible and accountable to the educational preparation and knowledge of a LVN.
This expectation does not apply to individuals formerly licensed as LVNs or RNs or APRNs whose nursing license has been retired, placed on inactive status, surrendered, or revoked. The use of titles implying that an individual holds licensure as a nurse in the State of Texas is restricted by law Tex. Use of any protected nursing title by an individual who is not licensed to practice either licensed vocational nursing or professional nursing in accordance with the licensing requirements in Texas, or who does not hold a valid compact license to practice nursing poses a potential threat to public safety related to this act of deception and misrepresentation to the public who may be seeking the services of a licensed nurse.
As stated in Rule Approval of nursing education programs is one of the primary functions of the Texas Board of Nursing Board or BON in fulfilling its mission to protect and promote the welfare of the people of Texas. These standards require adequate human, fiscal, and physical resources, including qualified nursing faculty and clinical learning facilities, to initiate and sustain a program that prepares graduates to practice competently and safely as nurses.
The Texas BON recognizes that when health care facilities experience difficulties in recruiting and retaining sufficient nurses, education institutions and facilities within the affected geographical region frequently respond to this workforce need by proposing new nursing education programs. The proposal should include, but not be limited to, extensive rationale which supports establishing the new program with demographic and community data, employment needs for nurses in the area, evidence of support from stakeholders, established agreements with clinical affiliating agencies, adequate qualified nursing administrator and faculty to begin the program, and an acceptable curriculum as identified in the guidelines.
An initial approval fee shall be submitted with the proposal [Rule A program is allowed up to one year from the date of receipt of the proposal in the Board office to finalize all aspects of the proposal for presentation to the Board. The actual length of time until Board approval depends upon the completeness of the proposal and compliance with Board standards.
A timeline is included in the Resource Packet. The proposed director should attend at least one Informal Information Session for Proposal Development. The Informal Information Session is provided by board staff several times each year. Representatives from the institution should also attend at least one regularly scheduled Board meeting in order to gain familiarity with Board proceedings.
After the proposal is determined to be ready to be presented to the Board, a preliminary survey visit will be conducted by board staff. The equipment and educational spaces in the physical facility should be ready for the program to begin at this time.
However, the legislature and the Governor delegate to state agency boards, like the Board of Nursing, the tasks of carrying out the laws applicable to the profession the agency is responsible for regulating. Can you please help with these questions. Do all nurses have an obligation to initiate CPR for a client? The Board receives questions frequently about whether cosmetic procedures are within the scope of practice for an advanced practice registered nurse APRN. The complex nature of the problem requires that there be a comprehensive approach to reducing these errors.
The Board may approve the proposal and grant initial approval to the new program, may defer action on the proposal, or may deny further consideration of the proposal. Medication errors occur when a drug has been inappropriately prescribed, dispensed, or administered. Medication errors are a multifaceted problem that may occur in any health care setting.
Consistent with their common mission to promote and protect the welfare of the people of Texas, the Board of Nursing and the Board of Pharmacy issued this joint statement for the purpose of increasing awareness of some of the factors which contribute to medication errors. The Boards note that there are numerous publications available which examine the many facets of this problem, and agree that all elements must be examined in order to identify and successfully correct the problem.
This position paper has been jointly developed because the Boards acknowledge the interdisciplinary nature of medication errors and the variety of settings in which these errors may occur. Traditionally, medication errors have been attributed to the individual practitioner. Building a Safer Health System," suggest the majority of medical errors do not result from individual recklessness, but from basic flaws in the way the health system is organized.
It is the joint position of the Boards that a comprehensive and varied approach is necessary to reduce the occurrence of errors. The Boards agree that a comprehensive approach includes three major elements: Each of these three elements of this comprehensive approach are discussed below. Professional competence has long been targeted as a source of health care professional errors. To reduce the probability of errors, all professionals must accept only those assignments for which they have the appropriate education and which they can safely perform. Professionals must continually expand their knowledge and remain current in their specialty, as well as be alerted to new medications, technologies and procedures in their work settings.
Professionals must be able to identify when they need assistance, and then seek appropriate instruction and clarification. Professionals should evaluate strengths and weaknesses in their practice and strive to improve performance. This ultimate accountability on the part of individual practitioners is a critical element in reducing the incidence of medication errors. The second element resources available to all professionals centers on the concept of teamwork and the work environment.
The team should be defined as all health care personnel within any setting. Health care professionals must not be reluctant to seek out and utilize each other as resources. Taking the time to learn about the resources available in any practice setting is the individual professional's responsibility, and can help decrease the occurrence of medication errors.
Adequate staffing and availability of experienced professionals are key factors in the delivery of safe effective medication therapy. In addition, health care organizations have the responsibility to develop complete and thorough orientation for all employees, maintain adequate and updated policies and procedures as guidelines for practice, and offer relevant opportunities for continuing staff development.
Systems which may have been in place for a long period of time may need to be re-examined for effectiveness. New information and technological advances must always be taken into account, and input should be solicited from all professionals. In addition, the system should contain a comprehensive quality program for the purpose of detecting and preventing problems and failures.
The quality program must encourage all health care professionals to be alert for problems encountered in their daily tasks and to advocate for changes when necessary. In addition, the quality program should include a method of reporting all errors and problems within the system, a system for tracking and analysis of the errors, and an interdisciplinary review of the incident s. Eliminating systems problems is vital in promoting optimal performance. The table on the following page, while not an exhaustive list, specifies areas that can be reviewed when medication errors occur.
These areas encompass all three of the aforementioned contributing elements to the problem of medication errors and can be applied to individuals or systems. Communication is a common thread basic to all of these factors. Effective verbal or written communication is fundamental to successfully resolving breakdowns, either individual or system wide, that frequently contribute to medication errors. The Boards agree that health care regulatory entities must remain focused on public safety.
It is imperative that laws and rules are relevant to today's practice environment and that appropriate mechanisms are in place to address medication errors. The complex nature of the problem requires that there be a comprehensive approach to reducing these errors.
It is vital to the public welfare that medication errors be identified, addressed, and reduced. To view and print the Table: To err is human: Building a safer health system. Joint Commission on Accreditation of Healthcare Organizations. High-alert medications and patient safety.
Sentinel Event Alert, 11 , [On-line]. Journal of the American Medical Association, 23 , Advanced practice registered nurses APRNs are registered nurses who hold licensure from the Texas Board of Nursing to practice as advanced practice registered nurses based on completion of an advanced educational program acceptable to the Board. The term includes a nurse practitioner, nurse-midwife, nurse anesthetist, and a clinical nurse specialist. Advanced practice registered nurses utilize mechanisms, including Protocols, prescriptive authority agreements, or other written authorization, that provide them with the authority to provide medical aspects of care, including the ordering of dangerous drugs, controlled substances, or devices that bear or are required to bear the legend: The Protocols, prescriptive authority agreements, or other written authorization may vary in complexity based on the educational preparation and advanced practice experience of the individual advanced practice registered nurse.
Protocols, prescriptive authority agreements, or other written authorization are not required to describe the exact steps that an advanced practice registered nurse must take with respect to each specific condition, disease, or symptom. Protocols, prescriptive authority agreements, or other written authorizations are not required for nursing aspects of care. The Board recognizes that in many settings, nurses and advanced practice registered nurses work together in a collegial relationship. A physician is not required to be physically present at the location where the advanced practice registered nurse is providing care.
The order is not required to be countersigned by the physician. In response to Senate Bill enacted in during the 74th Legislative Session, the Texas State Board of Pharmacy and the Texas Medical Board TMB entered into a joint rule-making effort to delineate the processes by which a pharmacist could engage in drug therapy management DTM as delegated by a physician.
According to definitions listed in the Pharmacy Act [ Tex. The protocol under which a pharmacist initiates DTM orders for a patient should be available to the nurse at the facility, agency, or organization in which it is carried out. TheTexas Board of Nursing BON has approved this position statement, only applicable to long term care settings , in an effort to provide guidance to registered nurse in long-term care facilities and to clarify issues of compassioinate end-of-life care. There is a growing sentiment on the part of the long-term care nurse community that the initiation of CPR would appear futile and in appropriate given the nursing assessment of the resident.
This position statement is intended to provide guidance, for registered nurses, in the management of an unwitnessed resident arrest without a DNR order in a long-term care LTC setting. This position statement also addresses the related issues of:. These related issues are addressed in this position statement because the BON is often required to investigate cases of death where it appears there is a lack of clarity about a registered nurse's obligation when there is no DNR order.
A DNR is a medical order that must be given by a physician and in the absence thereof, it is generally outside the standard of nursing practice to determine that CPR will not be initiated. However, there may be instances when LTC residents without a DNR order experience an unwitnessed arrest, and it is clear according to the comprehensive nursing assessment that CPR intervention would be a futile and inappropriate intervention given the condition of the resident.
In the case of an unwitnessed resident arrest without DNR orders, determination of the appropriateness of CPR initiation should be undertaken by the registered nurse through a resident assessment, and interventions appropriate to the findings initiated. Assessment of death in which CPR would be a futile and inappropriate intervention requires that all seven of the following signs be present and that the arrest is unwitnessed:. There may be other circumstances and assessments that could influence a decision on the part of the registered nurse not to initiate CPR.
However, evaluation of the prudence of such a decision would occur on a case-by-case basis by the BON. After assessment of the resident is completed and appropriate interventions are taken, documentation of the circumstances and the assessment of the resident in the resident record are a requirement. Examples of important documentation elements include:. Documentation should be adequate to give a clear picture of the situation and all of the actions that were taken or not taken on behalf of the resident.
Even if the registered nurse's decision not to initiate CPR was appropriate, failure to document can result in an action against a nurse's license by the BON. Furthermore, lack of documentation places the nurse at a disadvantage should the nurse be required to explain the circumstances of the resident's death. Registered nurses should be aware that actions documented at the time of death provide a much more credible and accurate clinical description. Documentation that is absent, incomplete or inaccurate reveals gaps in care, requiring the nurse to prove actions not appropriately documented were actually taken.
As stated in Position Statement Whether CPR is initiated or not, it is important for the nurse to understand that the nurse may be held accountable if the nurse failed to meet standards of care to assure the safety of the resident, prior to the arrest such as:. Proactive policies and procedures, that acknowledge the importance of care planning with the inclusion of advanced directives, are also important. Evidence indicates that establishing the resident's wishes at the end of life and careful care planning prevents confusion on the part of nursing staff and assures that the resident's and family's wishes in all aspects of end of life care are properly managed.
Facilities are required to have policies and adequate resources to assure that every resident and resident's family upon admission to a long term care facility not only receive such information, but have sufficient support to make an informed decision about end of life issues. It is further expected that advanced care planning is an ongoing component of every resident's care and that the nursing staff should know the status of such planning for each resident.
The Board recognizes that end of life decisions on the part of residents and families can be difficult. However, the Board believes that principled and ethical discussion about the CPR issue with the resident and family, is an essential element of the resident care plan. The law requires that in order for a registered nurse to pronounce death, the facility must have a written policy that is jointly developed and approved by the medical staff or medical consultant and the nursing staff, specifying under what circumstances a RN can make a pronouncement of death.
It is important that nurses understand that the assessment that death has occurred and that CPR is not an appropriate intervention are not the equivalent to the pronouncement of death. Texas statutory law governs who can pronounce death, and only someone legally authorized to pronounce death may do so. If the RN does not have the authority to pronounce death, upon assessment of death the RN must notify a person legally authorized to pronounce death.
This position statement is intended to guide registered nurses in long-term care facilities who encounter an unwitnessed resident arrest without a DNR order. It is hoped that by clarifying the responsibility of the registered nurse, and using supportive facility policies and procedures, that registered nurses will be better able to provide compassionate end of life care. Consequently, RNs deciding not to initiate CPR when not all seven signs of death are present must assure themselves that not initiating CPR complies with their respective standards of practice.
Depending on the circumstances, a nurse's failure to initiate CPR when not all seven signs are present may constitute failure to comply with standards of nursing care. This position statement is limited to situations when all seven signs are present and should not be construed as providing guidance on the appropriateness of not initiating CPR when not all seven signs are present. Approved by the Board of Nursing on October 24, Revised: Advanced Practice Registered Nurses APRN often find themselves in situations where they may feel compelled to provide medical aspects of care or prescribe medications for themselves, their family members, or other individuals with whom they have a close personal relationship.
When ordering, prescribing, or dispensing a medication or a device for any person, the APRN is expected to meet all standards of care including assessment, documentation of the assessment, diagnosis, and documentation of the plan of care prior to ordering, prescribing, dispensing, or administering a medication or device [ 22 TAC The practice of providing medical aspects of care for individuals with whom an APRN has a close personal relationship raises a number of ethical questions.
The Board is concerned that APRNs in these situations risk allowing their personal feelings to cloud their professional judgment and objectivity. It is the opinion of the Board of Nursing that APRNs should not provide medical treatment or prescribe medications for any individual with whom they have a close personal relationship. Nursing is a dynamic profession. The scope of practice for one nurse may differ from the scope of practice for another nurse; therefore, it is impractical to create an exhaustive list of tasks that may or may not be performed by a nurse in any setting.
A number of complementary therapeutic modalities have long been incorporated into standard nursing practice to assist patients in meeting identified health needs and goals. Educational preparation to practice complementary modalities may be acquired through formal academic programs or continuing education.
The nursing practice of an LVN requires supervision with oversight from an RN, advanced practice registered nurse, physician, physician assistant, podiatrist, or dentist. The LVN performs focused assessments and contributes to care planning, interventions, and evaluations. The RN is responsible for the overall coordination of care and performs comprehensive assessments, initiates the nursing care plan, and implements and evaluates care of the client or patient.
Additional references related to the topics of supervision, assessment, and the nursing process may be found in the following resources on the BON web site:. Depending upon the practice setting and modality considered, complementary modalities may be used alone or in conjunction with conventional modalities.
Additional standards may apply depending upon the specific practice situation. In order to show accountability when providing integrated or complementary modalities as nursing interventions, the LVN or RN should be able to articulate and provide evidence of:. The Board of Nursing Board or BON approved curriculum for both licensed vocational nurses LVNs and registered nurses RNs does not provide graduates with sufficient instruction to provide the nurse with the necessary knowledge, skills and ability to re-insert and determine correct placement of a permanently placed feeding tube such as gastrostomy or jejunostomy tubes.
The Board does allow LVNs and RNs to expand their practice beyond the basic educational preparation through post-licensure continuing education and training for certain tasks and procedures. One of the main considerations in determining whether a nurse should consider re-insertion of a gastrostomy, jejunostomy or similar feeding tube, is how long the original tube was in place before becoming dislodged. The method of initial insertion surgical, endoscopy, or radiographic guidance may affect the length of healing.
It is the opinion of the Board that LVNs and RNs should not engage in the reinsertion of a permanently placed feeding tube through an established tract until the LVN or RN successfully completes a competency validation course congruent with prevailing nursing practice standards. Training should provide instruction on the nursing knowledge and skills applicable to tube replacement and verification of correct and incorrect placement. The BON does not define nor set qualifications for competency validation courses; however, inclusion of the following factors is encouraged:.
The term does not include acts of medical diagnosis or the prescription of therapeutic or corrective measures. According to the DECs, educational preparation for Vocational Nurses includes the following related to administration of medications:. Each LVN has different experiences, knowledge, level of competence, and abilities; therefore, it is up to the individual LVN to use sound judgment when determining the individual.
The Texas Board of Nursing BON is authorized by the Texas Legislature to regulate the nursing profession to ensure that every licensee is competent to practice safely. The LVN scope of practice is a directed scope of practice and requires appropriate supervision. The LVN, with a focus on patient safety, is required to function within the parameters of the legal scope of practice and in accordance with the federal, state, and local laws, rules, and regulations.
In addition, the LVN must comply with policies, procedures and guidelines of the employing health care institution or practice setting. The LVN is responsible for providing safe, compassionate and focused nursing care to assigned patients with predictable health care needs. The purpose of this position statement is to provide direction and recommendations for nurses and their employers regarding the safe and legal scope of practice for licensed vocational nurses and to promote an understanding of the differences between the LVN and RN levels of licensure.
The RN scope of practice is interpreted in Position Statement These competencies are included in the program of study so that every graduate has the knowledge, clinical behaviors and judgment necessary for LVN entry into safe, competent and compassionate nursing care. The DECs serve as a guideline for employers to assist LVNs as they transition from the educational environment into nursing practice.
Because the LVN scope of practice is based upon the educational preparation in the LVN program of study, there are limits to LVN scope of practice expansion parameters. The Board believes that for a nurse to successfully make a transition from one level of nursing practice to the next requires the completion of a formal program of education.
LVN scope of practice does not include acts of medical diagnosis or the prescription of therapeutic or corrective measures. An appropriate clinical supervisor may need to be physically available to assist the LVN should emergent situations arise. The setting in which the LVN provides nursing care should have well defined policies, procedures, and guidelines, in which assistance and support are available from an appropriate clinical supervisor.
The Board recommends that newly licensed LVNs work in structured settings for a period of months, such as nursing homes, hospitals, rehabilitation centers, skilled nursing facilities, clinics or private physician offices. The LVN uses a systematic problem-solving process in the care of multiple patients with predictable health care needs to provide individualized, goal-directed nursing care. The essential components of the nursing process are described in a side-by-side comparison of the different levels of education and licensure see Table.
The LVN assists in determining the physical and mental health status, needs, and preferences of culturally, ethnically, and socially diverse patients and their families based on interpretation of health-related data. The LVN collects data and information, recognizes changes in conditions and reports this to the RN supervisor or another appropriate clinical supervisor to assist in the identification of problems and formulation of goals, outcomes and patient-centered plans of care that are developed in collaboration with patients, their families, and the interdisciplinary health care team.
Also known as a focused assessment, this appraisal may be considered a component of a more comprehensive assessment performed by a RN or another appropriate clinical supervisor. The LVN reports the data and information collected either verbally or in writing. Written documentation must be accurate and complete, and according to policies, procedures and guidelines for the employment setting. The second step in which the LVN participates and contributes to the nursing process is planning.
After the focused assessment, the LVN reports data and other information such as changes in patient conditions to the appropriate clinical supervisor, such as a RN. This information may be considered in planning, problem identification, nursing diagnoses, and formulation of goals, teaching plans and outcomes by the RN supervisor or another appropriate clinical supervisor. A nursing plan of care for patients is developed by the RN and thus the RN has the overall responsibility to coordinate nursing care for patients.
Implementing the plan of care is the third step in the nursing process. The LVN may implement aspects of the plan of care within legal, ethical, and regulatory parameters and in consideration of patient factors. The LVN organizes aspects of patient care based on identified priorities. For example, the RN may have trained, verified competency and delegated the tasks to a UAP and the LVN may then proceed to assign those tasks that need to be accomplished for that day. Teaching and counseling are interwoven throughout the implementation phase of the nursing process and LVNs can participate in implementing established teaching plans for patients and their families with common health problems and well defined health learning needs.
A critical and fourth step in the nursing process is evaluation. The LVN participates in the evaluation process identifying and reporting any alterations in patient responses to therapeutic interventions in comparison to expected outcomes. The LVN may contribute to the evaluation phase by suggesting any modifications to the plan of care that may be necessary and making appropriate referrals to facilitate continuity of care. Communication is a fundamental component in the nursing process.
The LVN must communicate verbally, in writing, or electronically with members of the healthcare team, patients and their families on all aspects of the nursing care provided to patients. Communications must be appropriately documented in the patient record or nursing care plan. Because LVNs are members of the healthcare team, provide nursing care, and contribute to the nursing process, collaboration is a quality that is crucial to the communication process.
Clinical reasoning is another integral component in the nursing process. LVNs must use clinical reasoning and established evidence-based policies, procedures or guidelines as the basis for decision making in nursing practice. LVNs are accountable and responsible for the quality of nursing care provided and must exercise prudent nursing judgment to ensure the standards of nursing practice are met at all times. When an employer hires a nurse to perform a job, the nurse must assure that it is safe and legal.
For instance, the LVN must have a clinical supervisor who is knowledgeable and aware of his or her role. Caution must be exercised not to overstep the legal parameters of nursing practice when an employer may not understand the limits of the LVN scope of practice and makes an assignment that is not prudent or safe. The LVN must determine before he or she engages in an activity or assignment whether he or she has the education, training, skill, competency and the physical and emotional ability to safely carry out the activity or assignment.
It is not appropriate and is beyond the scope of practice for a LVN to supervise the nursing practice of a RN. However, in certain settings, i. Timely and readily available communication between the supervising LVN and the clinical supervisor is essential to provide safe and effective nursing care. The LVN, with a focus on patient safety, is required to function within the parameters of the legal scope of practice and in accordance with the federal, state, and local laws, rules, regulations, and policies, procedures and guidelines of the employing health care institution or practice setting.
The LVN functions under his or her own license and assumes accountability and responsibility for quality of care provided to patients and their families according to the standards of nursing practice. The table below offers a brief synopsis of how the scope of practice for nurses differs based on educational preparation and level of licensure.
These are minimum competencies, but also set limits on what the LVN or RN can do at his or her given level of licensure, regardless of experience. Scope of Practice for Nurses - Poster. Six-step decision-making model for determining nursing scope of practice. Differentiated essential competencies of graduates of Texas Nursing Programs evidenced by knowledge, clinical judgements, and behaviors DECs.
Limitations for expanding scope of practice. Rules and guidelines governing the graduate vocational and registered nurse candidates or newly licensed vocational or registered nurse. Kentucky Board of Nursing. National Council of State Boards of Nursing. North Carolina Board of Nursing. LPN scope of practice- Clarification: Position statement for LPN practice. RN and LPN scope of practice components of nursing comparison chart. RN scope of practice- Clarification: Position statement for RN practice.
The RN, with a focus on patient safety, is required to function within the parameters of the legal scope of practice and in accordance with the federal, state, and local laws, rules and regulations. The RN is responsible for providing safe, compassionate, and comprehensive nursing care to patients and their families with complex healthcare needs.
The purpose of this position statement is to provide direction and recommendations for nurses and their employers regarding the safe and legal scope of practice for RNs and to promote an understanding of the differences in the RN education programs of study and between the RN and LVN levels of licensure. These competencies are included in the program of study so that every graduate has the knowledge, clinical behaviors and judgment necessary for RN entry into safe, competent and compassionate nursing care.
The DECs serve as a guideline for employers to assist RNs as they transition from the educational environment into nursing practice. Because the RN scope of practice is based upon the educational preparation in the RN program of study, there are limits to the expansion of the scope. The RN provides nursing services that require substantial specialized judgment and skill.
The planning and delivery of professional nursing care is based on knowledge and application of the principles of biological, physical and social science as acquired by a completed course of study in an approved school of professional nursing. Unless licensed as an advanced practice registered nurse, the RN scope of practice does not include acts of medical diagnosis or the prescription of therapeutic or corrective measures. The comprehensive assessment is the first step, and lays the foundation for the nursing process. The comprehensive assessment is the initial and ongoing, extensive collection, analysis and interpretation of data.
Nursing judgment is based on the assessment process. The RN uses clinical reasoning and knowledge, evidence- based outcomes, and research as the basis for decision-making and comprehensive care. Based upon the comprehensive assessment the RN determines the physical and mental health status, needs, and preferences of culturally, ethnically, and socially diverse patients and their families using evidence-based health data and a synthesis of knowledge.
Surveillance is an essential step in the comprehensive assessment process. The RN must anticipate and recognize changes in patient conditions and determines when reassessments are needed. The second step in the nursing process is planning. The RN synthesizes the data collected during the comprehensive assessment to identify problems, make nursing diagnoses, and to formulate goals, teaching plans and outcomes.
A nursing plan of care for patients is developed by the RN, who has the overall responsibility to coordinate nursing care for patients. Teaching plans address health promotion, maintenance, restoration, and prevention of risk factors. The RN utilizes evidence-based practice, published research, and information from patients and the interdisciplinary health care team during the planning process. The RN may begin, deliver, assign or delegate certain interventions within the plan of care for patients within legal, ethical, and regulatory parameters and in consideration of health restoration, disease prevention, wellness, and promotion of healthy lifestyles.
The RN is responsible for reasonable and prudent decisions regarding assignments and delegation. The RN may determine when it is appropriate to delegate tasks to unlicensed personnel and maintains accountability for how the unlicensed personnel perform the tasks. The RN is responsible for supervising the unlicensed personnel when tasks are delegated. The proximity of supervision is dependent upon patient conditions and skill level of the unlicensed personnel. In addition, teaching and counseling are interwoven throughout the implementation phase of the nursing process.
The RN evaluates and reports patient outcomes and responses to therapeutic interventions in comparison to benchmarks from evidence-based practice and research findings, and plans any follow-up care and referrals to appropriate resources that may be needed. The evaluation phase is one of the times when the RN reassesses patient conditions and determines if interventions were effective and if any modifications to the plan of care are necessary. Communication is an essential and fundamental component used during the nursing process.
The RN must communicate verbally, in writing, or electronically with members of the healthcare team, patients and their families in all aspects of the nursing care provided to patients. These communications must be appropriately documented in the patient record or nursing care plan. RNs use critical thinking skills to problem-solve and make decisions in response to patients, their families and the healthcare environment.