The Texas Board of Nursing (BON) licenses and regulates all nurses, including registered nurses (RNs). A violation of the Texas Nursing Practice Act or Board rules by an RN, including violations related to the scope of practice, can result in disciplinary proceedings and severe sanctions. As a result, if you are facing disciplinary proceedings resulting from alleged scope of practice or any other rule violations, consulting a nursing license defense lawyer to defend your license can be critical to a successful outcome.
Understanding the Scope of Practice for RNs
RNs, like all nurses, must act within the legal scope of their practice. They also must comply with all local, state, and federal laws, rules, regulations, policies, and guidelines of the BON and their employer and/or practice setting. Functioning outside the scope of practice can lead to disciplinary action.
RNs engage in professional nursing within the meaning of the Nursing Practice Act (NPA) Sec. 301.002(2). Professional nursing is “the performance of an act that requires substantial specialized judgment and skill, the proper performance of which is based on knowledge and application of biological, physical, and social science principles as acquired by a completed course in an approved school of professional nursing. The term does not include acts of medical diagnosis or the prescription of therapeutic or corrective measures.”
Furthermore, professional nursing involves the following:
- the observation, assessment, intervention, evaluation, rehabilitation, care and counsel, or health teachings of a person who is ill, injured, infirm, or experiencing a change in normal health processes;
- the maintenance of health or prevention of illness;
- the administration of a medication or treatment as ordered by a physician, podiatrist, or dentist;
- the supervision or teaching of nursing;
- the administration, supervision, and evaluation of nursing practices, policies, and procedures;
- the requesting, receiving, signing for, and distribution of prescription drug samples to patients at practices at which an advanced practice registered nurse is authorized to sign prescription drug orders;
- the performance of acts delegated by a physician; and
- the development of the nursing care plan.
The BON also has issued Position Statement 15.28 – The Registered Nurse Scope of Practice, which defines the scope of practice for RNs in greater detail. In its position statement, the BON recommends that all nurses use the Scope of Decision-Making Model (DMM) when determining whether an action is within their scope of practice.
The RN advocates for the patient and their family by providing nursing services that require substantial specialized judgment and skill. RNs use the nursing process to establish the plan of care to deliver nursing services for the patient.
Initially, the RN completes a comprehensive assessment and uses the findings of that assessment to make nursing judgments. Next, the RN must analyze data gathered during the assessment to identify problems, formulate goals or outcomes, and develop care plans. The RN’s overall responsibility is to coordinate nursing care for patients.
Next, the RN must implement the plan of care, which may include the provision, delivery, assignment, and delegation of certain nursing tasks as appropriate. The RN must make reasonable and prudent decisions concerning the assignment and delegation of tasks and is responsible for supervising unlicensed personnel when delegating tasks to those persons.
Finally, the RN must evaluate and report patient outcomes and responses to therapeutic interventions compared to research-based benchmarks. Furthermore, the RN must plan any necessary follow-up care and resource referrals. The evaluation period may also result in modifications to the existing care plan if needed.
RN Standards of Nursing Practice and Disciplinary Action
22 Tex. Admin. Code Sec. 217.11(3) echoes the RN scope of practice elements in the RN standards of nursing practice. Failure to meet these standards can result in the BON taking disciplinary action against your license, which can have serious consequences. Under these standards, RNs must assist in the determination of healthcare needs of clients and take the following actions:
- Utilize a systematic approach to provide individualized, goal-directed nursing care by:
- performing comprehensive nursing assessments regarding the health status of the client;
- making nursing diagnoses that serve as the basis for the strategy of care;
- developing a plan of care based on the assessment and nursing diagnosis;
- implementing nursing care; and
- evaluating the client’s responses to nursing interventions;
- Delegate tasks to unlicensed personnel relating to clients with acute conditions or in acute environments relating to independent living environments for clients with stable and predictable conditions.
Disciplinary Actions Against RNs
Many of the grounds for disciplinary actions against nurses by the BON that relate to the scope of practice and standard of care focus on safety. For instance, under 22 Tex. Admin. Sec. 217.12, “unsafe practice” includes “delegating or assigning nursing functions or a prescribed health function when the delegation or assignment could reasonably be expected to result in unsafe or ineffective client care.” Likewise, “unsafe practice” includes any conduct that might endanger a client’s life, health, or safety. Since the entire premise of the scope of practice was created to safeguard patient safety, the scope of practice violations inherently may be seen as dangerous to patients and thus merit disciplinary action.
Conclusion
Navigating the scope of practice as a registered nurse in Texas demands a comprehensive understanding of the Nursing Practice Act and Board rules. Any deviation from these guidelines can lead to disciplinary proceedings and severe consequences for your license. Seeking guidance from a skilled nursing license defense lawyer when facing allegations related to the scope of practice violations is crucial for safeguarding your professional reputation and livelihood. Remember, adherence to the standards of nursing practice is paramount, as any misstep could jeopardize patient safety and invite disciplinary action from the Texas Board of Nursing.
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We Will Represent Your Interests in Your Disciplinary Proceedings Before the BON
We know how important it is for you to continue working in the nursing field. A simple misstep or oversight can lead to disciplinary proceedings threatening your license and livelihood. The experienced nursing license defense attorney at Bertolino LLP, will advocate on your behalf to help you protect your license and career. Together, we will work to put you in the best position possible to maintain your license and professional future. Call us at (512) 515-9518 or contact us online.
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