NJ Basics
Licensure and Regulation
Licensure and Regulation
The guiding philosophy, as expressed in the mission of the Texas BON is protection and promotion of this population.
Who are the people of Texas?
This protection and promotion ensures that each person holding a license as a nurse in the state is competent to practice safely.
Making nursing diagnosis, developing nursing care plans, and performing comprehensive assessments.
What are standards that apply to Registered Nurse practice?
These require performance of an act that requires substantial specialized judgment and skill, the proper performance of which is based on knowledge and application of the principles of biological, physical, and social science as acquired by a completed course in an approved school of professional nursing.
These are "Incident Based" and "Safe Harbor"
What are the two types of Nursing Peer Review?
There are two kinds of nursing peer review:
Incident-based (IBNPR), in which case peer review is initiated by a facility, association, school, agency, or any other setting that utilizes the services of nurses.
Safe Harbor (SHNPR) may be initiated by a LVN, RN or APRN prior to accepting an assignment or engaging in requested conduct that the nurse believes would place patients at risk of harm, thus potentially causing the nurse to violate his/her duty to the patient(s). Invoking safe harbor in accordance with Rule 217.20 protects the nurse from licensure action by the BON as well as from retaliatory action by the employer.
This standard of practice does not apply to ALL licensed nurses.
What is delegation?
Only an RN may delegate. All licensed nurses (RN, LVN, APRN) are expected to possess knowledge of Of knowledge of BON rules, task delegation, and patient advocacy, and to advocate for patient safety.
Actual injury to a patient need not be established – the act itself is a violation!
What is unprofessional conduct?
Unprofessional conduct may include:
•Drug diversion
•Unsafe Practice
•Dismissal from peer assistance program
•Drug-related actions
•Criminal conduct
This statute sets forth specific requirements to practice nursing in each state.
What is the Nurse Practice Act?
The NPA is a statute that defines, in general terms, the practice of registered nurses, advance practice nurses, midwives, certified nurse anesthetists, and licensed practical nurses.
This rule covers standards of nursing practice applying to ALL nurses.
What is Rule 217.11?
"Standards of Nursing Practice", Rule 217.11, covers standards of nursing practice that apply to all nurses (LVN, RN, APRN)
Safe Harbor does protect the nurse’s license, but does NOT protect the nurse from this action.
What is "Civil Action"?
A civil action is a noncriminal lawsuit that begins with a complaint and usually involves private parties.
The plaintiff is the party filing the complaint, and the defendant is the party defending against the complaint's allegations.
These two rules respectively address delegation for acute care clients and for stable clients in independent living environments.
What are BON delegation "Rules 224 and 225"?
Rule 224 - NO ASSIGNMENT - Acute Care / Unstable
Rule 225 - Limited Delegation - Predictable / Stable
Notice of investigation, fair and impartial hearing, and proper decision based on substantial evidence are observed before a license is revoked.
What is "Due Process"?
If an investigation does take place, nurses have due process rights, which means that they have a right to formal proceedings before they can be disciplined or lose their licenses.
They also have the right to an attorney during the process, who can help defend nurses against BON actions.
At least 35 states are known to have language in their Nurse Practice Act limiting use of this term.
What is "Nurse"?
The American Nurses Association (ANA) has requested that all state Boards of Nursing amend their Nurse Practice Acts to include specific language as to who can use the term.
At least 35 states are known to have language in their Nurse Practice Act; either explicit in restricting use of the title "nurse" to only those who are licensed or; implicit language restricting use of any words implying the individual is a licensed nurse.
Texas courts have upheld that this obligation supersedes facility policies.
What is the nurse’s obligation to the patient?
Texas courts have upheld that the nurse’s obligation to the patient supersedes facility policies.
As the case of Lunsford points out, when a nurse knows, or should have known that a situation potentially places a patient at risk of harm, the nurse has a duty to intervene.
This process protects a nurse from employer retaliation, suspension, termination, discipline, discrimination, and licensure sanction.
What is "Safe Harbor Nursing Peer Review"?
Applies when a nurse makes a good faith request for nursing peer review of an assignment or conduct the nurse is requested to perform. The nurse believes the request could result in a violation of the NPA or Board rules.
The routine care, activities, and procedures that are within the authorized scope of practice of the RN or LVN or part of the routine functions of the UAP.
What is Assignment?
Patient safety and the abilities of the person to whom the assignment is being made are important criteria to consider when making an assignment.
The assignments that may be made are influenced and guided by the education, knowledge, experience, and physical and emotional abilities of the person to whom assignments are made [§217.11(1)(S)].
Remedial education, probation / supervision, change in work environment, fines, license suspension and / or revocation.
What "Corrective" actions may be taken by the BON?
§213.32. Corrective Action Proceedings and Schedule of Administrative Fines. A corrective action may be imposed by the Board.
For the 24th consecutive year, this profession has been rated first in 2025's Gallup Poll as most ethical and trusted!
What is Nursing?
This step asks, "Would a reasonable and prudent nurse perform the activity or intervention in a similar circumstance?
What is Step 6 of the Texas Board of Nursing Eight Step Decision Making Model?
Is the performance of the act within the accepted “standard of care” which would be provided in similar circumstances by reasonable and prudent nurses who have similar training and experience?
An additional related question to ask is, "If an untoward event/reaction occurs as a result of your nursing actions, can the untoward consequences/reaction be resolved through nursing intervention alone?".
This conduct that does not indicate the nurse’s continuing to practice professional nursing poses a risk of harm to the client or other person.
What is a "Minor Incident"?
A nurse involved in a minor incident need not be reported to the Board unless the conduct indicates the nurse creates a significant risk of physical, emotional or financial harm to the client, lacks a conscientious approach or accountability, lacks knowledge and competency and can not be easily remediated, or demonstrates a pattern of multiple minor incidents.
Five minor incidents within a 12 month period must be reported to peer review.
This is defined in the NPA as a requirement to work shifts or hours that are in addition to the hours or days scheduled regardless of the length of a scheduled shift or the number of scheduled shifts each week, does not include time immediately before or after a shift (report or documentation) or pre-scheduled and compensated on-call time.
What is mandatory overtime?
Following the 81st Legislative Session, nurses are allowed to refuse to work mandatory overtime in hospitals. SB 476, took effect on September 1, 2009, and changed the NPA by adding Section 301.356, Refusal of Mandatory Overtime. This law permits nurses working in a hospital to refuse to work mandatory overtime and that such refusal “does not constitute patient abandonment”.
Any violation of the Board’s rules must be reported through this mechanism.
What is the facility’s Chain of Command?
The report must be written and signed by person making the report and include the identity of the nurse being reported.
The report must also contain any addition information required by the Board
All complaint information is confidential
Duty to patient and mandatory reporting requirement take precedence over facility or individual.
Failure to report – violation NPA 301.402(b)
“The application of the principles of law as they relate to the practice of nursing."
What is Nursing Jurisprudence?
As defined in the "Medical Dictionary, © 2009 Farlex and Partners", this is “the application of the principles of law as they relate to the practice of nursing, to the obligations of nurses to their patients, and to the relations of nurses with each other and with other health care professionals”.
This step asks, "Is there documented evidence of your current competence (education, knowledge, skills, abilities, experience and judgements) to perform the activity or intervention safely & effectively, in accordance with the accepted nursing standard of care”?
What is Step 5 of the Texas Board of Nursing Eight Step Decision Making Model?
Is your knowledge and / or skill competency come from knowledge acquired in a basic nursing education program, post-basic program, or continuing education program?
Documentation to validate competency should be maintained in accordance with agency/facility policy and procedure.
Each nurse is also encouraged to maintain his/her own copies of competency forms.
Must be done in good faith, before engaging in the activity, or anytime an assignment has changed that the nurse believes, in good faith, may result in patient harm.
When is "Safe Harbor" invoked?
The nurse must notify the supervisor in writing or verbally (2019 change).
The supervisor may not refuse to accept the form
May use Quick Request Form to make initial written request
Comprehensive Written Request must be completed before leaving the work setting
Defined as authorizing an unlicensed person to provide nursing services while retaining accountability for how the unlicensed person performs the task.
What is delegation?
Delegation does not include situations in which an unlicensed person is directly assisting a RN by carrying out nursing tasks in the presence of a RN.
This is the amount of time BON Rule 220.2 permits a nurse to practice on former home state license while waiting for new license.
What is 90 days?
BON Rule 220.2 permits a nurse to practice on former home state license for 90 days while waiting for new license.
If the nurse moves to a non-party state, the license converts to a single state license.