Texas Nursing Jurisprudence and Ethics _________________________________________________________
Advanced Practice Registered Nursing APRNs are registered nurses who have completed additional accredited advanced-practice education and internship as recognized by the Board of Nursing [6]. The Board of Nursing specifies that APRNs must practice within their individual scope in the advanced role, meaning the particular specialty and population focus that the nurse trained for in an advanced program [7]. The scope of practice may be defined by APRN organizations; however, in many instances, it can be up to the APRN’s employer or supervisor to determine what duties he or she can perform and what types of patients can be treated [7]. This decision may be based on the nurse’s clinical experience and his/her knowledge, skills, and competencies. APRNs may or may not practice the full scope of the professional role and specialty for which they trained, and an APRN is allowed to perform the full scope of duties of an RN. The Board suggests asking the following questions in order to help decide if an activity is within an individual APRN’s scope of practice [7]: • Is it consistent with the scope of one’s recognized title or does it evolve into another advanced practice title recognized by the Board requiring additional formal education and legal recognition? • Is it consistent with the Standards of Nursing Practice outlined in Board Rule 217.11? • Are you willing to accept accountability and liability for the activity and outcomes? • Is it consistent with one’s education in the role and specialty? • Is it consistent with one’s professional scope of practice? • Is it consistent with reasonable and prudent practice? • Is it consistent with statutory or regulatory laws? • Is it consistent with evidence-based care? APRNs may assign tasks to RNs and LVNs, but the task must be within the RN’s/LVN’s scope of practice [8]. The Texas Board of Nursing states (in Position Statement 15.18) that RNs are expected to carry out orders issued by APRNs if the orders are within the APRN’s scope of practice for their specialty [9]. RNs are expected to question an order if it is believed to be non-efficacious or contraindicated. TEXAS NURSING PRACTICE RULES In addition to the Nursing Practice Act, there are several chap- ters of the Texas Administrative Code (i.e., Chapters 211–228) that contain rules pertinent to nursing. Texas Administrative Code Rule 217.11 (Standards of Nursing Practice) contains the minimum acceptable standards for all licensed nurses. It states that the Board of Nursing is responsible for regulating the practice of nursing within the State of Texas for LVNs, RNs, and APRNs, and that action against the nurse’s license may result from a failure to meet the minimum acceptable level of practice, even if no patient injury results from a nurse’s actions or inactions [10]. All nurses practicing in Texas must meet the minimum acceptable standards specified in Rule 217.11, which includes requirements to [10]:
Additionally, the Board of Nursing and the Nursing Practice Act state that an LVN requires appropriate supervision of an RN, APRN, physician assistant, physician, dentist, or podiatrist [2]. The LVN is required to function within the parameters of the legal scope of practice and in accordance with the federal, state, and local laws, rules, regulations, and policies, proce- dures, and guidelines of the employing healthcare institution or practice setting. LVNs are “responsible for providing safe, compassionate, and focused nursing care to assigned patients with predictable healthcare needs” [4]. PROFESSIONAL NURSING The practice of professional nursing is defined as “the perfor- mance of an act that requires substantial specialized judgment and skill, the proper performance of which is based on knowl- edge and application of the principles of biologic, physical, and social science as acquired by a completed course in an approved school of professional nursing. The term does not include acts of medical diagnosis or the prescription of therapeutic or cor- rective measures.” Professional nursing involves [2]: • 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 • Administration of a medication or treatment as ordered by a physician, podiatrist, or dentist • Maintenance of health or prevention of illness • Performance of an act delegated by a physician • The development of the nursing care plan • Supervision or teaching of nursing • Administration, supervision, and evaluation of nursing practices, policies, and procedures • Requesting, receiving, signing for, and distribution of prescription drug samples to patients at practices at which an APRN is authorized to sign prescription drug orders The Board of Nursing further defines the scope of practice of professional nursing [5]: The RN takes responsibility and accepts account- ability for practicing within the legal scope of practice and is prepared to work in all healthcare settings, and may engage in independent nursing practice without supervision by another healthcare provider. The RN, with a focus on patient safety, is required to function within the parameters of the legal scope of practice and in accordance with the federal, state, and local laws; rules and regula- tions; and policies, procedures and guidelines of the employing healthcare institution or practice setting. The RN is responsible for providing safe, compas- sionate, and comprehensive nursing care to patients and their families with complex healthcare needs.
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