Page 5 Complete Your CE Test Online - Click Here ○ ○ The final version of the bill stripped the provisions in the introduced version requiring APRNs to check the Prescription Monitoring Program (PMP) before prescribing a controlled substance. However, APRNs need to be aware that similar provisions requiring all prescribers to check the PMP are in the Texas State Board of Pharmacy Sunset Bill HB 2561. ○ ○ The Board of Nursing (BON) will no longer be able to overturn the findings of an administrative law judge, and is required to remove disciplinary actions from its website by March 1, 2019, if the violation was not related to the practice of nursing, or, if the violation did not involve a suspension or revocation of the license, after the nurse completes the terms of a disciplinary order. This bill will go into effect on September 1, 2017. ● ● Texas State Board of Pharmacy Sunset Bill (HB 2561) contains requirements for BON and other agencies that license prescribers to monitor prescribing practices of licensees. It requires APRNs and other practitioners who prescribe controlled substances to check the Prescription Monitoring Program prior to writing a prescription for a controlled substance. It goes into effect September 1, 2017. ● ● Senate Bill 1107 Telemedicine and Telehealth modifies the definitions of telemedicine and telehealth, and allows a telemedicine visit to be provided without a face-to-face visit. The bill also requires insurers to display reimbursement policies on their website. Primary potions of the bill take immediate effect. The portion requiring insurers to post telemedicine and telehealth reimbursement policies takes effect January 1, 2018. ● ● House Bill 2886 Liability Exemption (Eye Ointment Bill) exempts health care providers that attend births from civil or criminal prosecution for not administering prophylactic eye drops or ointment if the parents object and the objection is documented. The bill goes into effect September 1, 2017. Standards of nursing practice critical thinking questions A nurse’s place of employment mandates that she earn 20 continuing education hours annually to maintain her status as a pediatric intensive care nurse. She has only earned ten hours this year. The nurse believes that it is her employer’s responsibility to make sure that she has received the adequate number of continuing education hours. Is she correct? No, she is not correct. The NPA clearly states that nurses are responsible for their own continuing competence in nursing practice and individual professional growth. Additionally, most employers have standards specifically stating that nurses and other employees are responsible for their own continuing competence, including obtaining continuing education. A client has been diagnosed with ovarian cancer. She does not want to disclose her diagnosis to anyone, including her husband and daughters. Her family members are extremely concerned and frightened, and beg the nurse to tell them what is wrong with their loved one. The nurse believes that the client needs the support of her family, and that her family has the right to know about the diagnosis. May the nurse disclose the diagnostic information to the family? No, the nurse may not. Although the nurse may be tempted to relay information to the family, the nurse has an obligation to respect the client’s privacy by protecting confidential information, unless required or allowed by law to disclose such information. In this case, the information may not be disclosed. A nurse arrives for his shift looking a bit disheveled, has slurred speech, and smells of alcohol. Another nurse is concerned that his ability to provide safe and effective nursing care is compromised. However, these two nurses are close friends. Must the nurse report her coworker? Yes. According to Rule 217.11 a nurse must comply with mandatory reporting requirements of Texas occupations Code Chapter 301 (Nursing Practice Act) Subchapter I, which includes reporting a nurse whose conduct causes a person to suspect that the nurse’s practice is impaired by chemical dependency and/or drug or alcohol abuse. The preceding examples should trigger an examination of not only the standards of nursing practice, but also of the nurse’s role in compliance with such standards. Compliance may also pose emotional dilemmas for nurses, such as the case of the nurse who is obligated to report a co- worker and friend who reported for duty smelling of alcohol and with slurred speech. The NPA and standards of nursing practice are intertwined with each other and with position statements issued by the Texas BON. Texas BON position statements Although BON Position Statements do not have the force of law, they are a means of providing directions for nurses on Board issues of concern relevant to the public. Board position statements are reviewed annually for relevance and accuracy to current practice, the NPA, and the BON rules (Texas Board of Nursing, 2017). Position statements address a wide variety of nursing actions. The following queries are based on information taken from Texas BON position statements (Texas Board of Nursing, 2017): ● ● 15.1. May nurses carry out orders from physician’s assistants (PA)? Nurses may carry out physician orders relayed by a physician assistant (PA) when the PA is compliant with laws regulating the practice of the PA. The nurse is expected to clarify any order the nurse questions by communicating with the PA or the physician.15.2. May an LVN pronounce death? LVNs must initiate CPR in the absence of a clear do-not-resuscitate (DNR) order. Laws regarding the pronouncement of death are not in the NPA or Board Rules. LVNs cannot pronounce death. ● ● 15.3. Can licensed vocational nurses (LVNs) engage in IV therapy, venipuncture, or PICC lines? LVNs must complete post-licensure training to engage in IV therapy/venipuncture (not typically included in LVN curriculum). Insertion of PICC lines is beyond the scope of practice for LVN. ● ● 15.9. Can RNs or LVNs perform laser therapy? A nurse must have the appropriate education, knowledge, and experience to perform laser therapy. There are criteria to be followed by the nurse who accepts physician delegation in the use of non-ablative laser therapy. There are specific regulations related to laser hair removal (from the Texas Department of State Health Services). ● ● 15.15. What is the BON’s jurisdiction over a nurse’s practice in any role and use of the nursing title? If an RN or LVN functions in a role lower than that for which s/he is licensed, or in another are with an overlapping scope of practice, the nurse is still held to the level of education and competency of their highest licensure. The BON also restricts the use of the titles LVN or RN or any designation implying nursing licensure by non-nurses. ● ● 15.18. What is the BON’s position regarding nurses carrying out orders from advanced practice registered nurses (APRNs)? Nurses may carry out orders issued by APRNs as long as such orders are within the APRN’s scope of practice in their role and population focus. ● ● 15.19. May nurses carry out orders from pharmacists for drug therapy management? The BON notes that there are current rules that permit pharmacists to write orders for Drug Therapy Management (DTM) while working under physician delegation. Nurses may carry out these orders, as long as the orders originate from a written protocol authorized by a physician. ● ● 15.12. What is the BON’s position on the use of American Psychiatric Association Diagnoses by LVNs, RNs, or APNs? LVNs and RNs cannot determine medical diagnoses. Use of multi-disciplinary psychiatric diagnoses is “permitted by advanced practice nurses designated as clinical nurse specialists (CNS) or nurse practitioners (NPs) whose population focus area is psych/mental health. Client problems beyond the scope of training and education of the CNS/NP are to be referred to an appropriate medical provider.” ● ● 15.29 May a nurse establish an interpersonal relationship with a client or a client’s family member? May a nurse use social media? Nurses have an obligation to maintain professional boundaries. Professional boundaries are defined as the spaces between the nurses’ power and the client’s vulnerability. “Common to the definition of professional boundaries from the Texas Board of Nursing and from the National Council of State Boards of Nursing is that a nurse abstains from personal gain at the client’s expense