INTEGRATIONS - Texas Nurse Practice Act (PART 1&2) COMPLETE
What if the BON sends the notice to the nurse but the nurse never receives it?
Any notice to the nurse is considered effective even if the nurse does not get it because evidently they did file a change of address which is also a violation.
What does the RN need to do FIRST before delegating?
Assessment of nursing needs
According to the notes, how long should new graduates wait before practicing unsupervised?
At least 12-18 months
At the same time as notifying his or her supervisor for safe harbor, what else does he or she need to do?
At this same time the nurse must submit a written request for safe harbor utilizing the Safe Harbor form provided on the BON web site.
What is delegation by an RN?
Authorizing an unlicensed person to provide nursing services while retaining accountability for how the unlicensed person performs task.
What are the 8 guidelines a nurse should follow when delegating?
1. The R.N. must first make an assessment of the nursing needs and then use professional judgment before deciding to delegate tasks. 2. The nursing task must be one that a reasonable and prudent R.N. would find within the scope of nursing to delegate 3. The nursing task must be one that (in the opinion of the delegating R.N.) can be safely delegated. 4. The nursing task must not require professional nursing judgment. 5. The unlicensed person must be adequately identified. 6. The R.N must have either instructed the unlicensed person or verified competency to perform nursing task 7. The R.N. shall supervise the performance of delegated task 8. If the delegation occurs over time the R.N shall evaluate the delegation of task on a regular basis
What are the 5 rights of delegation?
1. The right task. 2. The right person to whom the delegation is made. 3. The right circumstance. 4. The right direction/ communication with R.N. 5. Right supervision of the task.
How many members is the Texas Board of Nursing consist of? Who are they appointed and approved by?
13 members appointed by governor and approved by Texas Senate
If the accused employee is an RN, how many members of the peer review committee must be an RN?
2/3
How long does the nurse have to the written notice for disciplinary action?
20 days
For the TPAPN program, how many meetings do you have to attend?
90 meetings in 90 days
When does safe harbor need to be invoked?
BEFORE THE NURSE ACCEPTS THE ASSIGNMENT OR CONDUCT OR IF THE ASSIGNMENT CHANGES
Who regulates making and accepting assignments?
BON
Where can Nursing be found in the Texas Occupation Code?
Chapters 301, 303, 304, 305 (which are the occupation codes)
What is the difference b/t LVN & RN?
LVN ▪Collecting data and focused assessments. ▪Participate in planning care. ▪Development & modification of the plan. ▪Implement the plan under the scope of practice. ▪Assist in evaluation of response to nursing interventions. RN: ▪Systematic approach to individualized, goal-oriented care ▪Obtain a comprehensive assessment. ▪Develop nursing diagnoses. ▪Develop a plan of care based on assessments and diagnoses. ▪Implement the plan. ▪Evaluate the responses.
What happens if you do not complete the TPAPN program?
Loss of nursing licensure
What also happens to the nurse experiencing problems with chemical dependency or mental illness ?
May be referred to peer assistance in lieu of continuation of disciplinary process
For the graduate nurse to provide care for patients, what kind of supervision is needed?
Must be under direct supervision of appropriate nurse who must be on the same "unit" and readily available for 6 months.
Who is required when a report is made?
Must be written and signed Must be submitted in "Good faith"
What rules does the incident-based peer review has to follow?
Must follow the rules of the NPA. Including the timeline specified in NPA.
What is the minimum amount of nurses needed for safe harbor?
Need a minimum of 10 nurses with 2/3 RN and 1 from practice area
Is peer review a legal proceeding?
No
Is there a state regulation on the size of the committee?
No
Is delegation r/t LVNs too???
No delegation is r/t UP only
Does the LVN need to be supervised on-site?
No it can be by phone; the supervisor just need to be easily reached.
Is the results of the disciplinary action private?
No it will be public knowledge
What restriction for TPAPN require of you while you're working?
No narcotic keys
Can LVN's delegate?
No, LVN may only assign tasks because they must be under the supervision of a RN.
Do new graduates have to do more continuing education?
No, they do not have any continuing education at their first renewal because school was the CE
Who does the nurse notify if he or she believes he or she is requested to engage in conduct believed to be in violation of the nurse's practice?
Notify the supervisor making the assignment that the nurse is invoking safe harbor in good faith
Once the nurse receives the written notice of the evaluation of his or her conduct, what does the nurse have the opportunity to do?
Nurse then has opportunity to provide written rebuttal statement within 10 calendar days of the written notice of results from committee.
When delegating, the degree of supervision is determined by?
The RN
What is the definition of professional boundaries?
The appropriate limits which should be established by the nurse/client relationship due to the nurse's power and the patient's vulnerability.
What was set in 2007 legislature about how the board determines "present fitness to practice" when a criminal hx is involved (which is evaluation by psychologist or psychiatrist or polygraph)?
The evaluation is voluntary and the nurse can refuse.
How does the facility notify the nurse about being evaluated (minor IBPR process)?
The facility must: ▪Provide written notice to nurse in person or certified mail that his/her practice is being evaluated. Must include a copy of the facility's Peer Review plan. ▪Written notice must state that peer review committee will be in 21- 45 calendar days from date of notice.
What does the facility must do for the minor IBPR process?
The facility must: ▪Provide written notice to nurse in person or certified mail that his/her practice is being evaluated. Must include a copy of the facility's Peer Review plan. ▪Written notice must state that peer review committee will be in 21- 45 calendar days from date of notice.
What does the letter that the facility sends to the nurse about being evaluated (minor IBPR process) must include?
The letter should also include: ▪Description of incident including the date, time, location and persons involved. ▪Name, address, and phone number of a contact person. ▪A copy of this BON rule.
What other specification does the make-up of the peer review committee needs?
at least 1 person from the nursing practice area, such as OB, ICU, etc
How long should a new RN wait before charging?
at least 1 year
Why is ethical conduct necessary for nurses?
because of the relationship of the nurse to vulnerable populations.
BON requires Good Professional Conduct. How is this assessed by the BON?
determined by CONSISTENT BEHAVIORS in personal, academic, and occupational history.
What are standards of nursing practice?
establish a minimum acceptable level of nursing practice in any setting for each level of nursing licensure.
What is an incident-based nursing peer review?
evaluates an incident or a nurse's practice to ascertain the nurse's accountability.
How often can the NPA be changed??
every 2 years for 140 days or in special sessions called by the GOVERNOR
How long does the nurse have to wait after a license has been revoked for disciplinary action?
for 1 year
What is assignment making?
from one licensed nurse to another licensed nurse.
When does the reportable conduct does not have to be reported to the BON?
if the committee determines that the reported conduct was a minor incident. Or if the person has already been reported to BON, but committee must still keep the records.
If the accused employee is an RN, what is the make-up of the peer review committee?
may include RN and LVN members
What is a requirement to enroll into the TPAPN program?
nurses must submit to both random and for cause drug testing at any time.
What does the Nursing Texas Occupation Codes define?
nursing practice and gives BON authority to make rules which are then implemented and interpreted in Texas NPA
What is safe harbor nursing peer review?
peer review requested by a nurse to determine if the nurse has been asked to engage in conduct that would violate his/her practice.
What is a sunset review?
process by which Texas Legislature determines if state agencies should continue to exist or be "sunset" (Discontinued).
What is the Texas Peer Assistance Program for Nursing (TPAPN)?
provides assistance for nurses with substance abuse or have certain mental illness with treatment for their individual problems It allows them to safely transition back to safe nursing practice. RN&LVN - 3 years APRN - 5 years
What will the board also consider that may have contributed to deficiency in care in regards to disciplinary action?
system problems
What are the behaviors that subject the RN to discipline including license revocation?
▪Any conviction of a felony or misdemeanor involving moral turpitude. ▪Any felony with deferred adjudications is conclusive and considered evidence of guilt. ▪ Anything related to Texas Occupations Code 53.
What are some examples of unacceptable education hours?
▪Basic CPR ▪Equipment use ▪Orientation ▪Nurse Refresher courses ▪Self-improvement courses ▪Finance planning courses ▪Music, art philosophy
How does the BON handle disciplinary action?
▪Board will conduct an investigation that is based on priorities like dangers to the patient if indicated. ▪Board tries to resolve the issue informally but if this does not work a date for a formal hearing is set.
Who can find the findings of safe harbor incorrect and make it not binding if he or she finds that safe harbor was not done in good faith? What could happen to that nurse if the CNO finds it incorrect?
▪CNO ▪Employer may decide to discipline nurse for not engaging in requested conduct.
How long does the peer review committee have to conduct the evaluation on the nurse's conduct? What do they need to do once they finish their evaluation?
▪Committee must conclude its review in 14 calendar days. ▪Committee must provide written notice to nurse during that 14 days.
What is the definition of a minor incident?
▪Conduct by a nurse that may be a violation of the Nursing Practice Act or a Board of Nursing rule but does not indicate the nurse's continued practice poses a risk of harm to a patient or another person. ▪Is less than 5 incidents in a 12 month period and if it does not cause harm or death it is still a minor incident.
Nursing ethics
▪DUTY TO REPORT ▪UNPROFESSIONAL CONDUCT ▪Professional Boundaries ▪Criminal Behaviors ▪MENTAL ILLNESS ▪SUBSTANCE ADDICTTION ▪INCLUDING INTEMPARTE USE
Who else besides nurses have a duty to report?
▪Employers. ▪Professional organizations which expels or takes disciplinary action against a nurse. ▪State agencies such as Department of Health and Human Services, Child protective, etc. ▪Liability insurer. ▪Prosecuting attorney.
When does a nurse usually need to renew their license?
▪Every 2 years; based on birth month and year (even years renew in even years and odd years in odd years) ▪Expires last day of month
What is expected of the nurse by the BON in regards to ethical conduct?
▪Expected behaviors include but are not limited to honesty, accountability, trustworthiness, reliability, and integrity. And the nurse should be able to ▪Distinguish right from wrong. ▪Think and act rationally. ▪Keep promises and honor obligations. ▪Be accountable for his or her own behaviors. ▪Practice autonomously. ▪Recognize and honor interpersonal boundaries. ▪Promptly and fully relate facts, circumstances, events, errors, etc. which might effect health and well-being of patients/clients.
How are the formal hearings for disciplinary action like? Who determines the fines and penalties? What kind of fine and penalty does the nurse usually get?
▪Formal hearings are like a trial and are conducted by lawyers. ▪The BON determines fines and penalties. ▪Licenses may be suspended, remediated, or revoked. ▪If a license is revoked it can not be reinstated for 1 year.
What are the four major areas of disciplinary and eligibility sanctions?
▪Fraud, Theft, and Deception ▪Lying and Falsification ▪Sexual Misconduct ▪Substance Abuse or Misuse, including intemperate use
What happens if the nurse fails to respond to the written notice for disciplinary action?
▪If the nurse fails to respond, the board can issue a default judgment against the nurse which means that the nurse has admitted to alleged charges and therefore the license may be revoked for 1 year. ▪The nurse may have an attorney for representation or use just self.
What does a professional nurse do?
▪Includes- the observation, assessment, intervention, evaluation, rehabilitation, care/counsel, or health teachings of a person who is ill, injured, infirm, or experiencing a health change from the normal. ▪Maintenance of health/prevention of illness. ▪ Administration of medication. ▪Supervision of teaching. ▪The requesting/receiving/signing for/ and distribution of prescription drug. ▪Performance of act delegated by physician. ▪Development of a nursing care plan.
What can a disciplinary process by the BON result from?
▪May result from a peer review decision or straight reporting to the BON.
What are 2 types of incident based nursing peer review?
▪Minor: means no harm is done to patient and the occurrences of incidents is infrequent (less than 5 in 12 months). ▪Other: causes harm or death.
When should a nurse maintain professional boundaries?
▪Must remain within professional boundaries at all times. ▪Know, recognize and maintain professional boundaries. ▪Nurses must refrain from inappropriate involvement in the client's personal relationships and or the obtainment of the nurse's personal gain at the client's expense.
What do you need to do to be endorsed by another state (to work there)?
▪Must still meet educational, legal and all other requirements by new state. ▪Relatively easy due to similar licensing laws and same licensing exam. ▪Still need to apply to the new Board for endorsement. ▪May or may not be able to work on a temporary endorsement.
What information usually goes on your name badge?
▪Name according to nurse's preference First or last name ▪Must include type of license (RN, LVN) ▪May also include Degrees Certifications Position Picture Employer
What are some tasks that are most often delegated?
▪Non- invasive and non-sterile treatments. ▪Collecting, reporting, and documenting of data -->V/S, pulse oxymeter results, height/ weight, I&O, -->Blood test and urine test for sugar, -->Environmental situations, -->Client/family comments related to patient care, ▪Turning/positioning/ ambulation. ▪Transportation of client in the facility. ▪Personal hygiene, elimination, vaginal irrigations/ enemas. ▪Feeding. ▪Socialization activities. ▪ADLs-( note unlicensed person can assist with self- medication , this is defined as an ADL).
When making an initial request for safe harbor process, what must be included in the written request?
▪Nurse's name and signature. ▪Date and time of request. ▪Location of assignment or conduct. ▪Name of person making assignment or requesting conduct. ▪A brief description of why the nurse is requesting safe harbor. ▪Rationales for request based ▪Based on either lack of basic, knowledge, skills, or abilities or it is listed as unprofessional conduct rules. ▪Any other documentation. ▪Nurse's name, title, and signature along with supervisor or person making the request relationship to the nurse.
Who does the incident based peer review protect? What does it require?
▪Patients' Protection from unsafe or unprofessional nursing care. ▪Requires a Peer Review Committee
What are nursing tasks prohibited from delegation?
▪Physical, psychological, and social assessment ▪Formulation/ evaluation of the nursing care plan ▪Specific tasks within the care plan that require nursing judgment The responsibility for health teaching to client and family ▪Administration of medications- including I.V. fluids except as permitted to the title of Medication Aide ( long term care facilities/ home health)
How does TPAPN program help the nurse?
▪Preferably the addicted nurse is paired with another nurse with similar problems who has completed the TPAPN program. ▪Monitoring of treatment compliance, attendance at meetings, following work restrictions. -->90 meetings in 90 days. -->No narcotic keys. (when you're working)
What does professionalism promote and what is the nurse's responsibility?
▪Professionalism always promotes the client's dignity, independence, and best interests and avoids involvement in client's personal life. ▪Maintaining professional boundaries is always the nurse's responsibility.
What does the facility do in regards to the incident based nursing peer review?
▪Provide guidance to any one who uses the services of nurses in the development and application of a incident-based peer-review plan. ▪Assure that all nurses have knowledge of the incident-based peer-review plan. ▪Provide guidance for the incident-based peer-review committee in its fact finding mission.
What is multi-state or compact licensing?
▪Receives license in home state ▪That license is recognized by other party states who are part of the program ▪Texas does have some multi-state agreements ▪Shared disciplinary actions - all reports to board along with all judgments will be reported to every compact member state
What mental illness diagnosis or treatment (within the last 5 years) must you report to the BON?
▪Schizophrenia, ▪Bi-polar, ▪Paranoid personality disorder, ▪Antisocial personality, or ▪Borderline personality ▪Substance abuse or addiction (of any mind altering substance)
Who can refer you to TPAPN?
▪Self ▪Employer ▪Coworkers
What are some example of factors that the RN need to consider before delegating?
▪Stability of patient. ▪Training and experience of UP. ▪Nature of task being delegated. ▪Proximity and availability of the RN to the UP.
What are tasks which usually should not be delegated?
▪Sterile procedures (wound care). ▪Non-sterile procedures (dressing changes) which requires judgement about the wound. ▪Invasive procedures such as putting tubes into a cavity, instilling or inserting substances into an indwelling tubes. ▪Care of broken skin except for first aid.
What is the purpose of incident-based peer review (IBPR)?
▪The evaluation of nursing services, qualifications of the nurse, quality of patient care rendered by the nurse, and the merits of a complaint about the nurse. ▪To identify external factors and system inadequacies that may have contributed to the problem. It is not a fault finding mission.
What is the nurse's rights in regards to IBPR?
▪The nurse can call and question witnesses and be present when testimony is being given. ▪The nurse has the right to have an attorney present. ▪The nurse has the right to make an open statement. ▪To ask the committee questions and respond to questions. ▪The nurse has the right to make a closing statement.
Why is there disciplinary action?
▪The nurse must exhibit good professional character, current sobriety, and fitness to practice because their clients involved, their families, and significant others in many different settings. ▪Nurses are in autonomous roles and are working with vulnerable populations. ▪Nurses also have access to all kinds of personal information. ▪Chemical dependency, mental illness or diminished mental capacity can alter the nurse's ability for discernment of issues and timely responses to problems.
What is provided/offered for the nurse who reports another nurse to the peer review committee or BON?
▪The reporting nurse may not be disciplined, suspended, terminated, or discriminated against for reporting. ▪Whistleblower Protection if done in Good Faith
Examples of duty to report
▪Violations of the NPA or a BON rule which results or contributes to the death or serious injury of a client. ▪Suspicions of a nurse who may be impaired due to drugs or alcohol. ▪Commissions of abuse, neglect, fraud, exploitation. ▪Ignored a substantial risk that exposed a patient or other person to significant physical, emotional or financial harm or the potential for such harm. ▪Actions which indicate the nurse lacks the knowledge, skill or judgment, or consciousness that continuing practice may result in harm to a client. ▪Indications that nurse lacks knowledge, skill, judgment or conscientiousness which may lead to harm and may be either a single incident or a pattern of behavior. ▪Error has contributed to death or serious harm to patient. ▪Serious violation of the Unprofessional Conduct Rules. ▪Criminal Conduct violation from TOC 301.4535. ▪Lacked a conscientious approach to or accountability for his/her practice. ▪Indication the nurse has engaged in a pattern of multiple minor incidents that demonstrate the nurse's continued practice would pose a risk of harm to patients or others. ▪Any peer review committee results except for minor incidents.
Is there a policy required for safe harbor due process?
▪Yes ▪Minimum requirements the same as IPR ▪Need a minimum of 10 nurses with 2/3 RN and 1 from practice area ▪The review must be completed in 14 days and the nurse must be notified within 48 hours of decision regardless.
What is the RN subject to if she does any criminal behaviors?
Subject to discipline including license revocation and there is also a process if nurse has been subject to discipline in another state
Can the findings of the peer review committee be changed?
THE FINDINGS OF THE COMMITTEE CAN NOT BE OVERTURNED, CHANGED, OR DISMISSED BY ADMINISTRATION.
Who is responsible for all the costs which includes random and for cause drug testing?
TPAPN
If the RN had a substance abuse or trouble managing their mental illness, what program will they be referred to?
Texas Peer Assistance Program for Nursing (TPAPN)
What is needed to practice as a Professional Nurse (RN) or Vocational Nurse (VN)?
Texas licensure
What happens when you fail to adhere to standards of nursing practice?
FAILURE TO ADHERE STANDARDS MAY RESULT IN ACTION AGAINST THE NURSE'S LICENSE EVEN IF NO HARM OCCURRED TO PATIENT
What does the facility need to have when they are using discretionary delegation??
Facility must have a protocol or policy which addresses ▪The complexity of the task ▪How the UP demonstrates competency ▪A method and frequency for revaluation of the competency ▪A method to determine who should be allowed to do the task
What happens if you fail to notify the board about a change in address?
Failure to do so can result in a lapse of your license and potential disciplinary action.
Who is safe harbor for????
For YO PROTECTION
What does ethical conduct equals?
Good professional character
As a nursing student who works as a UP or extern or PCA, what do you need to consider before doing a task/procedure delegated by the RN to CYA?
I WOULD MAKE SURE MY JOB TITLE WAS LISTED ON THE POLICY FOR ANY PROCEDURE.
If an attorney is used for the peer review, what must be done?
If either party uses an attorney they must notify the other party 7 days before the hearing and equal representation is allowed.
Where are changes to the law and Board's rule and regulations reported?
In BON quarterly newsletter which is mailed to all nurses in Texas
How does the peer review committee evaluate a nurse's conduct?
In evaluating a nurse's conduct the committee shall review the evidence to determine extent to which any deficiency in care by nurse was the result of system problem.
What is the Texas Nurse Practice Act apart of?
In the Texas Occupation Code which consists of statues established by Texas legislature
What is the minimum due process for IBPR?
Is guaranteed and includes that ▪The facility have a written plan for peer review. ▪The nurse or the representative meet or exceed ▪the level of participation in the process set out by the rules. ▪Is based on confidentiality and safeguards to prevent impressible disclosures including a written agreement to abide by the rules. ▪Reporting to BON according to statues. ▪Effective date of any changes to the policy. ▪There is no guarantee of privacy for the nurse under review. Information may be shared in the Quarterly Bulletin or with legal authorities.
What is disciplinary action based on?
It is based on the BON's mission that it must investigate the possibility of factors which might make a nurse unsafe such as: ▪Eligibility Issues ▪Declaratory Orders
For the TPAPN program to help the nurse, what is required of the nurse to do?
It requires total abstinence of any addictive drug that can be abused.
What if another nurse reports a nurse for facility peer review?
It will satisfy his or her requirement to report to the BON
Do LVNs need to be delegated tasks?
L.V.N.s operate under authority of their own license and delegation is not required for them to perform tasks falling within scope of their practice.
What is endorsement?
Process of obtaining a license in a new state
Who can only do the delegation to a UP in acute care setting?
RN
Who is responsible for the patient under discretionary delegation?
RN
How long do RN, LVN, and APRN have to do the TPAPN program for?
RN&LVN - 3 years APRN - 5 years
What are the only titles that may use the term "Nurse"?
RN, GN, or Professional Nurse LVN, GVN, Vocational Nurse (LPN)
What is the nurse manager and nurse supervisor responsibility in regards to IBPR?
Regardless of the time frame or number of minor incidents, if a nurse manager or supervisor believes the incidents indicate a pattern of practice that poses a risk of harm that cannot be remediated, the nurse should be reported to the Peer Review Committee or BON immediately.
If you work with an expired license, what could happen?
Result in revocation of license
When does a nursing peer review committee needs to be developed?
Shall be developed if the employer regularly employs 10 or more LVN's or RN's of whom at least 5 are RNs.
What is an example of delegation in independent living situations and how is it different?
Similar but some differences because patient is considered in a stable condition i.e. Home Health Care Long term Care
What is safe harbor frequently associated with?
This is frequently associated with staffing issues such as a floating to another unit or with a lack of nurses for the number of patients to safely provide nursing care.
What is discretionary delegation?
This is the rule which applies to all unlicensed nursing students who are working as a UP in a health care facility or company. (Nurse extern, PCA, etc.)
What are many criminal behaviors considered as ?
To be professional misconduct
What is the primary purpose of the BON?
To protect and promote the welfare of the people of Texas by the use of regulation to ensure that every one with a nursing license is competent and can practice safely (webpage).
What are the exclusions to minimum due process?
▪After a report has already been made to the BON. ▪Anything requiring a direct reporting to the BON. ▪Practice is suspected of impaired by chemical dependency, drug or alcohol abuse, substance abuse/misuse, "intemperate use", mental illness, or diminished mental status.
In what form are complaints made and how does the BON notify the nurse?
▪All complaints must be made in writing. ▪A written notice is sent to the nurse.
What are mandatory reporting responsibilites for IBPR?
▪All nurses, employers, peer review committees, ▪Nursing schools, ▪Certifying organizations, ▪Liability carriers, ▪Any state agencies, and ▪Prosecuting attorneys have stipulations for reporting.
What does "good faith" mean?
A reasonable factual or legal basis for the request
How is ASSIGNING different from assignment making?
Administratively directing a person to perform a task that they have the legal authority to perform.
For compact licenses, who are the disciplinary actions reported to?
All reports to the board along with all judgments will be reported to every compact member state
What does the BON say about making and accepting assignments?
BON regulates both making and accepting assignments in that the nurse should only make and accept assignments in coordination with their EDUCATIONAL PREPARATION, EXPERIENCE AND KNOWLEDGE AND ARE CAPABLE OF DOING BASED ON THE NURSE'S PHYSICAL AND EMOTIONAL HEALTH.
Accepting assignments
Be careful Floating
Why would the BON require you to do a CE on ebola as a CE topic?
Be more aware of national concerns
If you got your license in Texas, how can you work as an RN in another state?
Endorsement!!!
What is required when renewing your license?
Every licensed nurse must complete 20 hrs of continuing education related to their practice area every 2 years to update clinical skills and knowledge.
What are the exceptions in Texas about the only titles that may use the term nurse?
Exceptions are authorized by the state or federal government or under the delegation of RN (i.e. CNA and titles in Dr's office and clinic)
What is intemperate use?
Excessive or Immoderate indulgence of substance(s). i.e. Weekend use Social media
What is the standard specific to RNs?
Nursing process-R.Ns utilize a systematic approach to care for patients
If a nursing student fails to meet the standards of duty to report, what happens?
Nursing schools: We are legally and ethically obligated to report students who break of any of these standards.
What about delegation to nursing students?
Nursing students performing tasks as part of educational program (clinical only) are exempted from the application of delegation rules".
Definition of a professional nurse
Only an RN is called a professional nurse who performs or acts applying substantial specialized judgment and skill.
When can unlicensed personnel use the term "Nurses' Aide"?
Only when they are supervised by a licensed nurse
Who do RNs assign tasks to?
Other RNs and LVNs
What is the definition of incident-based peer review (IBPR)?
Peer review process is one of fact finding, analysis, and study of events by nurses in a collegial atmosphere for problem solving that looks beyond the nurse.
When does the review need to be finish for safe harbor?
The review must be completed in 14 days and the nurse must be notified within 48 hours of decision regardless.
How are unprofessional conduct rules different?
The rules are different because these rules place emphasis on BLAMEWORTHY BEHAVIOR RATHER THAN A NURSE FAILING TO COMPLY WITH STANDARD.
What if nursing students perform tasks outside of educational program (such as money or volunteer or as an extern)?
They are functioning as a UP so breaking the rules...
Unprofessional Conduct Examples
Unsafe practices: such as Failure to comply with accepted standards. (Infection control principles, etc.) ▪Improper record management. (documentation or storage of data). ▪Falsifying records but okay to make late entries. ▪Improper assignment making or delegation. Improper acceptance of assignments. ▪Practicing with the inability to practice safely due to physical or mental health issues. ▪Inappropriate leaving assignments (patient abandonment). Once you accepted an assignment you must stay. However, in cases of extreme emergency you must notify the supervisor and give him time to find a replacement. Endangering patients (actual injury does not have to be established). ▪Failure to comply with any license restrictions. ▪Unlawful practice: violating board order, violating duty to report. ▪Patient neglect or abuse. ▪Failure to cooperate with any BON investigation. ▪Violating professional boundaries such as financial or sexual misconduct. Improper solicitation or referral. ▪Violent or threatening behavior toward patients, families or in the workplace. ▪Misappropriation of funds, payments, or materials. ▪Failure to pay student loans/ child support. ▪Giving false information including false employment information ▪Diverting narcotics. Includes meds , prescriptions, or pads. ▪Drug related misconduct: improper record keeping, improper medication wastage, positive drug screen, falsifying prescriptions. ▪Dismissal from peer assistance (for noncompliance related to drugs/alcohol. ▪Improper supervision by faculty (failure to supervise students). ▪Lack of responsible oversight by chief nursing officer.
What is offered by the BON if reports are made in good faith?
Whistleblower protections
Whose responsibility to be aware of changes to the law and Board's rule and regulations?
YOU
Is crossing professional boundaries considered unprofessional conduct?
Yes
Can you use any method to provide written notification for safe harbor?
Yes, May use a quick response form for this information or write by hand as long as it includes all necessary information.
Why is it important to keep all records of every CE you attended or did online until you retire?
You could be randomly audited
What must you do when you have a change in address?
You must keep the Board informed of your current address at all times. Do this by sending written notice, clearly marked "change of address" to the Board's office any time you move.
What are unprofessional conduct rules intended for?
to protect the public from unethical and illegal conduct.
What are the breakdown of the 13 members of the Texas BON?
▪ 6 nurse members: 1 APN and 2 Rns who are not APN or Nurse educators and 3 vocational nurses who are not educations ▪ 3 faculty members - 1 each VN, AD, and BSN ▪ 4 consumers
What is the role of the legislature in regards to the Texas NPA?
▪ NPA can only be changed by the Texas legislature which convenes every 2 years for 140 days or in special sessions called by the Governor (2007, 2009, etc.) ▪ Legislature gives the BON general rule-making authority which allows them to develop more details. ▪ Lobbying by interested parties is done by professional organizations such as TNA ▪ Sunset review- process by which Texas Legislature determines if state agencies should continue to exist or be "sunset" (Discontinued).
What must the facility must do in regards to minor IBPR process?
▪ Provide a list of witnesses, their written testimony, and evidence 48 hours before meeting. ▪Provide the nurse or his or her attorney the opportunity to review any documents at least 15 calendar days before the meeting. ▪Provide the opportunity to submit a written statement about the incident.
What are some other purposes of the BON?
▪ Regulation of the practice for both professional (PN) and vocational nursing (VN) to ensure that HC professional are competent. -->Examine and license qualified applicants of GVN,GN, and APN. -->License qualified applicants. by endorsement. --> Receive complaints and investigate violations of the NPA. ▪ Establish standards of nursing practice and regulate the practice of PN and VN. ▪ Discipline violators through appropriate legal actions. ▪ Provide a mechanism for public comment about rules and regulations. ▪ Recommend to the legislature changes to the NPA to remain current with public needs. ▪ Establish standards for nursing education and accredit or deny accreditation to schools of nursing. -->Recommendations -->Commendations ▪ Monitor NCLEX results to determine effectiveness of school programs- (reason ▪ for Exit Exam). ▪ Provide advice and counsel to faculty of educational programs to continually improve. ▪ Implement and manage all other programs and responsibilities authorized and mandated by legislature.
What are you required to know under the standards of nursing practice?
▪You must know the laws, regulations, standards of TX NPA and the Patient's Bill of Rights, Code of Ethics, Abuse laws, etc. ▪You must be able to identify how the LVN and RN Scope of Practice are alike and how they differ. ▪Implement measures to insure a safe environment ▪This may come partly from institutional policies But nurses have a direct duty to the patient and following policies is not enough. ▪Know purpose and side effects of every medication and treatment the patient receives. ▪Duty is to the patient so do not blindly follow orders or policies. ▪Accurately and thoroughly document aspects of care. ▪Provide for privacy and confidentiality. ▪Promote and provide education and counseling. ▪Be responsible for your orientation, supervision, and training. ▪Provide care without discrimination. -->Clarify orders. -->Duty to question incomplete or questionable orders ▪Implement appropriate infection control policies. ▪Implement appropriate nursing interviews. ▪Collaboration with other HC Providers. ▪Coordination of Care with health care team. ▪Consultation/referrals- nurses should be familiar with community resources. ▪Your own Professional Growth.
Who must the continuing education be approved by and how long is one CE credit?
▪approved by TNA Continuing Education committee or by an approved person/facility ▪60 minutes equal one CE credit
If a facility is conducting peer view, what does the facility must have written policies and procedures regarding?
▪level of participation ▪confidentiality materials and meetings ▪handling of cases ▪reporting of nurses to BON
What is vocational nursing?
▪means directed scope of practice ▪This means a LVN must always be under the supervision of a licensed practitioner such as RN, physician, podiatrist, etc.
Boundaries include any exploitation of client or client's family related to...
▪physical needs ▪emotional needs ▪financial areas: forging checks, stealing items, referrals ▪sexual conduct even if consensual
What happens if the peer review committee finds that a nurse has engaged in reportable conduct?
▪the committee's report must include a description of action taken against nurse including disciplinary action. ▪Findings must be submitted to BON in writing.
What do nurses have a duty to patients based on?
▪the patient's vulnerability ▪nurse's position of power