Page 3 Complete Your CE Test Online - Click Here ● ● “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 clients at practices where an advanced practice registered nurse is authorized to sign prescription drug orders as provided by Subchapter B, Chapter 157. ● ● The performance of an act delegated by a physician under Section 157.0512, 157.054, 157.058, or 157.059. ● ● The development of the nursing care plan.” Role of the Texas BON The Texas Board of Nursing establishes and enforces state standards via rules that implement Texas statutes as well as explanatory documents such as position statements, interpretive guidelines, and frequently asked questions (FAQ) available on BON website at http://www.bon. These resources can inform decision-making, assisting nurses in navigating ethical and/or legal dilemmas. Here are some examples of frequently asked questions and answers from the Texas Board of Nursing clarifying CPR policy, lack of Board authority over staffing and hours of work, and provisions of the Safe Harbor Peer Review program (Texas Board of Nursing, 2013): ● ● Is current cardiopulmonary resuscitation (CPR) certification a licensure requirement for nurses in Texas? The Texas BON does not require CPR for licensure renewal. But employers may have specific requirements for achieving/maintaining current CPR certification as a condition of employment. ● ● Do all nurses have an obligation to initiate CPR for a client? The BON notes that all nurses have an obligation or duty to initiate CPR for clients who require resuscitative measures. Furthermore, “in all healthcare settings, nurses must initiate CPR immediately in the absence of a client’s do-not-resuscitate/out of hospital do-not- resuscitate order… A do-not-resuscitate/out of hospital do-not- resuscitate order 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.” ● ● What authority or statement does the BON have regarding staffing and work hour issues? ○ ○ The Texas BON does not have authority over work-place issues such as schedules or number of hours worked, either consecutively, in a given time period or “on-call.” ○ ○ The Texas BON has no authority over workplace or employment issues, such as staffing ratios or floating. ● ● What is a Safe Harbor Peer Review? “Request for Peer Review Committee Determination or Safe Harbor applies to all nurses when the nurse believes an assignment may place clients at risk of harm, thus violating the nurse’s duty to the client. Safe Harbor provides a means by which a nurse protects his or her nursing license from board action, as well as has nursing peers in the same practice setting review the requested assignment. Nursing Peer Review of the Board’s website contains safe harbor forms, a Frequently Asked Question (FAQ), and the peer review rules. Nursing associations that represent Licensed Vocational Nurses, Registered Nurses, and Advanced Practice Registered Nurses may also have information about Safe Harbor Peer Review for their members and other nurses.” Texas BON rules All aspects of Texas BON roles and responsibilities focus on facilitating the delivery of safe and effective nursing care. The BON rules and regulations relate to nurse education, licensure, and practice. As part of its mission statement, the Texas BON states that it is “to protect and promote the welfare of the people of Texas by ensuring that each person holding a license as a nurse in the State of Texas is competent to practice safely. The Board fulfills its mission through the regulation of the practice of nursing and the approval of nursing education programs. This mission, derived from the Nursing Practice Act, supersedes the interest of any individual, the nursing profession, or any special interest group (Texas Board of Nursing, 2013c).” The Texas NPA and BON emphasize that it is the nurse’s responsibility and duty to the client to provide safe and effective nursing care. The Texas BON mandates that nurses must “know and conform” with the NPA and Board Rules as well as the laws, rules, and regulations for their particular practice setting (Texas Board of Nursing, 2013). Complying with this mandate requires a thorough understanding of Board of Nursing Rules that affect practice. Rule 217.11: Standards of Nursing Practice Rule 217.11: Standards of Nursing Practice is among the most critical for nursing professionals. It applies to all vocational nurses, registered nurses, and registered nurses with advanced practice authorization, and states that failure to meet minimum standards established by the BON may result in action against the nurse’s license, even if no actual client injury results.” Rule 217.11 requires that nurses (Texas Board of Nursing, 2013d): ● ● Know and conform to the Texas NPA. ● ● Know and conform to the BON rules and regulations as well as to federal, state, or local laws, rules, or regulations that affect nurses’ current area of nursing practice. ● ● Implement measures to promote a safe environment for clients and others. ● ● Know the rationale for and effects of mediations and treatments and correctly administer them. ● ● Accurately and completely report and document client’s status, nursing care, physician, dentist or podiatrist orders, administration of medications and treatments, client responses, and contact with other healthcare team members concerning significant events regarding client status. ● ● Respect the client’s right to privacy by protecting confidential information, unless required or allowed by law to disclose the information. ● ● Promote and participate in education and counseling to client(s), and, where applicable, the family/significant other(s) based on needs. ● ● Obtain instruction and supervision as necessary. ● ● Make a reasonable effort to obtain orientation/training for competency when encountering new equipment and technology or unfamiliar care situations. ● ● Notify the appropriate supervisor when leaving a nursing assignment. ● ● Know, recognize, and maintain professional boundaries of the nurse-client relationship. ● ● Comply with mandatory reporting requirements of Texas occupations Code Chapter 301 that include reporting a nurse who violates the NPA or a board rule and contributed to the death or serious injury of a client, whose conduct causes a person to suspect that the nurse’s practice is impaired by chemical dependency or drug or alcohol abuse, whose actions constitute abuse, exploitation, fraud, or a violation of professional boundaries, or whose actions indicate that the nurse lacks knowledge, skill, judgment, or conscientiousness to such an extent that the nurse’s continued practice of nursing could reasonably be expected to pose a risk of harm to a client or another person, regardless of whether the conduct consists of a single incident or a pattern of behavior. ● ● Provide, without discrimination, nursing services regardless of the age, disability, economic status, gender, national origin, race, religion, health problems, or sexual orientation of the client served. ● ● Institute appropriate nursing interventions that might be required to stabilize a client’s condition and/or prevent complications.