Page 4 nursing.elitecme.com Complete Your CE Test Online - Click Here ● ● Clarify any order or treatment regimen that the nurse has reason to believe is inaccurate, non-efficacious, or contraindicated by consulting with the appropriate licensed practitioner and notifying the ordering practitioner when the nurse makes the decision to administer the medication or treatment. ● ● Implement measures to prevent exposure to infectious pathogens and communicable conditions. ● ● Collaborate with the client, members of the healthcare team, and, when appropriate, the client’s significant others in the interest of the client’s health care. ● ● Consult with, utilize, and make referrals to, appropriate community agencies and health care resources to provide continuity of care. ● ● Be responsible for one’s own continuing competence in nursing practice and individual professional growth. ● ● Make assignments to others that take into consideration client safety and that are commensurate with the educational preparation, experience, knowledge, and physical and emotional ability of the person to whom the assignments are made. ● ● Accept only those nursing assignments that take into consideration client safety and that are commensurate with the nurse’s educational preparation, experience, knowledge, and physical and emotional ability. ● ● Supervise nursing care provided by others for whom the nurse is professionally responsible. ● ● Ensure the verification of current Texas licensure or other Compact State licensure privilege and credentials of personnel for whom the nurse is administratively responsible, when acting in the role of nurse administrator. Recent amendments to Texas nursing law and ethical guidelines Growing concern regarding unprofessional behavior in healthcare professions encouraged passage of new ethical and legal provisions for Texas nursing law in recent years. New laws passed in the 83rd Regular Session of the Texas Legislature addressed nurses’ rights in legal proceedings, revised disciplinary measures for transgressions, established nursing student screening, and amended scope of practice for APRNs, among others important issues. Some of the most significant amendments to the Texas Nursing Practice Act (NPA) are associated with: ● ● 2013-96 (SB 743): Relating to the penalties prescribed for repeated violations of certain court orders or conditions of bond in a family violence case. This law requires the BON to suspend a nurse’s license or refuse to issue a license to an applicant on proof that the nurse or applicant has been initially convicted of an offense involving a violation of certain court orders or conditions of bond under Section 25.07, 25.071, or 25.072, Penal Code, punished as a felony, or other offenses. ● ● 2013-418 (SB 406): Relating to the practice of advanced practice registered nurses and physician assistants and the delegation of prescriptive authority by physicians to and the supervision by physicians of certain advanced practice registered nurses and physician assistants. This law delineated the requirement for on-site physician supervision of Advanced Practice Registered Nurses (APRNs) and increased the number of APRNs a physician can supervise from four to seven. Additionally, physicians are allowed to delegate authority to prescribe Schedule II controlled substances in hospitals and hospice settings and this law requires periodic face-to-face meetings between APRNs and the delegating physician. For more detailed information about changes related to 2013-418 affecting nursing practice, see http://www.tmb.state.tx.us/ page/prescriptive-delegation and http://www.texasnp.org/resource/ resmgr/Advocacy/changes_SB406.pdf ● ● 2013-1189 (SB 1058: Relating to the regulation of the practice of nursing. This law: ○ ○ Made criminal background checks mandatory for students accepted for enrollment in a nursing education program and permits the Board of Nursing (BON or Board) to initiate declaratory orders for eligibility proceedings based on positive criminal background checks. ○ ○ Made permanent the Board’s authority to impose deferred disciplinary action; clarified that action may be taken against a nurse’s license based on action taken by a division of the United States Military; authorized the BON, in conjunction with a disciplinary action, to require a nurse to abstain from use of alcohol and drugs and submit to random drug testing. ○ ○ Provided for limited non-disclosure of disciplinary proceedings that result in a Board order requiring the nurse to participate in a Board-approved peer assistance program to address a problem that the nurse is experiencing with mental illness or chemical dependency, as well as made other changes relating to disciplinary action taken by the Board. ● ● 2013-1258 (HB 581): Relating to the waiver of sovereign immunity in certain employment lawsuits by nurses. This law: ○ ○ Authorizes a nurse employed by a hospital operated by or on behalf of a state or local entity to sue the governmental entity to recover limited damages for certain retaliatory actions taken against the nurse for fulfilling obligations as a licensed nurse practicing under Texas law. ○ ○ Specified that sovereign immunity of the state or local governmental entity from suit and from liability is waived for the limited purpose of allowing the nurse to maintain a lawsuit in state court to obtain such relief. The Board adopted the following Rules associated with these new Laws: ● ● 22 Tex. Admin. Code §213.27 (Good Professional Character). ● ● 22 Tex. Admin. Code §213.28 (Licensure of Persons with Criminal History). ● ● 22 Tex. Admin. Code §213.29 (Fitness to Practice). And amended: ● ● 22 Tex. Admin. Code §§213.30 (Declaratory Order of Eligibility for Licensure). ● ● 22 Tex. Admin. Code §§213.33 (Factors Considered for Imposition of Penalties/Sanctions). The new and amended sections may be viewed at: http://www.sos.state. tx.us/texreg/pdf/backview/1023/1023adop.pdf In 2016, the following rule was adopted pertaining to registered nurses who perform radiologic procedures (Texas Secretary of State, 2016). Adopted Rule Title 22 Rule 217.14: Adopted §217.14 requires registered nurses performing radiologic procedures to comply with the training requirements and limitations established by the Medical Radiologic Technologist Certification Act and the rules of the Texas Medical Board. Additionally, the registered nurse must also comply with the Texas Medical Practice Act, the Texas Pharmacy Act, and any other applicable laws of the State of Texas. Because SB 202 transferred the responsibilities for establishing training requirements to the Texas Medical Board, the adopted amendment is necessary to alert registered nurses performing radiologic procedures to this statutory change so they may comply with the requirements promulgated by the Texas Medical Board. The particular requirements and/or limitations established by the Texas Medical Board will be included in a separate rulemaking procedure, conducted by the Texas Medical Board. Adopted §217.14(d) requires a registered nurse, whose functions include radiologic procedures, to comply with the training requirements and limitations of the Medical Radiologic Technologist Certification Act and the rules of the Texas Medical Board. Additionally, the subsection requires the registered nurse to be in compliance with the Texas Medical Practice Act, the Texas Pharmacy Act, and any other applicable laws of the State of Texas. Effective Date: August 12, 2016. The 2017 Texas legislative session addressed a number of issues that impact APRNs. These include (Coalition for Nurses in Advanced Practice, 2017): ● ● Senate Bill 654 goes into effect on 9/1/2017. It specifies that APRNs may be primary care providers in Medicaid managed care networks, whether or not the delegating physician is in-network. ● ● Senate Bill 919 went into immediate effect on June 1, 2017. It allows APRNs and PAs to sign medical certifications on death certificates for their hospice and palliative care clients. ● ● BON Sunset Bill includes some important protections for all nurses and enacts the new Interstate Nursing (RN & LVN) Licensure compact language. Important points include: