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Anticipating the Future,
Maintaining Your License
Texas Occupations Code
Chapter 301
Chapter 301 - Law that establishes & empowers
Many different occupations are governed by this
code.
 Provides direction to the BON (Board of
Nursing) ,and other such Boards, about
requirements
 Nurse Practice Act
BON Rules and Regulations
 Provides more detail on how the requirements
of the Occupations Code are to be carried out
Texas Administrative Code
Provides more detail on how the
requirements of the Occupations Code are
to be carried out.
 Appointment of members, meetings,
proceedings, investigations, disciplinary
actions, etc.

Texas Administrative Code
TITLE 22 EXAMINING BOARDS
PART 11 Texas BOARD OF NURSING
Chapters
CHAPTER 211 GENERAL PROVISIONS CHAPTER
213 PRACTICE AND PROCEDURE CHAPTER
214 VOCATIONAL NURSING EDUCATION CHAPTER
215 PROFESSIONAL NURSING EDUCATION CHAPTER
216 CONTINUING EDUCATION CHAPTER
217 LICENSURE, PEER ASSISTANCE AND PRACTICE CHAPTER
219 ADVANCED NURSE PRACTITIONER PROGRAM CHAPTER
220 NURSE LICENSURE COMPACT CHAPTER
221 ADVANCED PRACTICE NURSES CHAPTER
222 ADVANCED PRACTICE NURSES WITH PRESCRIPTIVE AUTHORITY CHAPTER 223
FEES CHAPTER
224 DELEGATION OF NURSING TASKS BY REGISTERED PROFESSIONAL NURSES
TO UNLICENSED PERSONNEL FOR CLIENTS WITH ACUTE CONDITIONS OR IN
ACUTE CARE ENVIRONMENTS CHAPTER
225 RN DELEGATION TO UNLICENSED PERSONNEL AND TASKS NOT REQUIRING
DELEGATION IN INDEPENDENT LIVING ENVIRONMENTS FOR CLIENTS WITH STABLE
AND PREDICTABLE CONDITIONS CHAPTER
226 PATIENT SAFETY PILOT PROGRAMS ON NURSE REPORTING SYSTEMS
CHAPTER
227 PILOT PROGRAMS FOR INNOVATIVE APPLICATIONS TO PROFESSIONAL
NURSING EDUCATION
Texas Administrative Code
TITLE 22 EXAMINING BOARDS
PART 11 Texas Board of Nursing
CHAPTER 211 GENERAL PROVISIONS
RULE §211.1 Introduction
Name. Decision-making board appointed by Governor (Texas Occupations
Code).
(b) Location. Austin, Texas
(c) Legal Authority. Chapters 301, 303 and 304 - Texas Occupations Code.
(d) Composition. Persons appointed by Governor with Senate approval.
(Source Note: The provisions of this §211.1 adopted to be effective March 31,
2002, 27 TexReg 2236; amended to be effective May 17, 2004, 29 TexReg
4884
Texas Administrative Code
GENERAL PROVISIONS
RULE §211.3 Organization and Structure
(b) Terms of office for Board members.
Six years in length with staggered terms.
Members may be reappointed by the Governor.
(c) Eligibility. Board member eligibility is governed by the Texas
Occupations Code §§301.052 and 301.053.
(d) Compensation.
Per diem as provided by law for each day that the member engages in
the business of the board
Travel expenses
Source Note: The provisions of this §211.3 adopted to be effective
March 31, 2002, 27 TexReg 2236; amended to be effective May 17,
2004, 29 TexReg 4884
TEXAS OCCUPATIONS CODE AND
STATUTES REGULATING
THE PRACTICE OF NURSING
As Amended September, 2005
AGENCY MISSION
The mission of the Texas Board of Nursing is to protect and
promote the welfare of the people of Texas by ensuring that
each person holding a license as a nurse in the State of
Texas is competent to practice safely.
This mission, derived from the Nursing Practice Act,
supersedes the interest of any individual, the nursing
profession, or any special interest group.
BON
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Primary function is to protect the public
 Defines the scope of practice for RN and LVN
 Law and Rules differ from state to state
What activities by BON protect public?
Contacting the Texas Board of
Nursing
Location of Board’s office:
333 Guadalupe, Ste. 3-460
Austin, Texas 78701
Telephone:
512/305-7400
Web page:
www.bne.state.tx.us.
Protecting the People of Texas
Nurse Licensure Compact
Chapter 304 NPA
Agreement among states to mutually recognize
each others’ licenses
Texas among first to adopt
Premise: current licensure requirements
essentially the same from state to state
Does not interfere with each state defining scope
of practice
Only defines requirements to hold license
Nurse Licensure Compact
Administrators
Updated October 2007
Definitions
Party states – states who have adopted
the compact
Home state license – where you
permanently reside
Remote state – where you practice
using multistate privilege (must be a
party state)
Compact Requirements
Nurse must
Maintain home state license
 Adhere to state practice laws of state in which
patient is located at the time care is provided
 Use multistate privilege only in party states
 Hold home state license in only one party
state at a time. If nurse changes permanent
residence to another party state, he/she must
relinquish previous state license, apply for
and meet requirements of new home state
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Practicing in a Non-Party
State
To practice in a state that is not part of the
Compact, the nurse must obtain license
from the non-party state
 May concurrently hold a home state
license and a license to practice in a nonparty state
 If you live in a non-party state, you must
obtain a non-resident Texas license in
order to practice in Texas
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Impact of Model
Compact created a shared information
system - includes licensing and disciplinary
action for each nurse
Gives public more choice in qualified nurses
Protects public health and safety
More mobile workforce for employers
Allows nurses to be more mobile
Provides for new forms of practice
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Online practice
Telephone practice
Peer Review
Nursing Peer Review
Chapter 303
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A process mandated by BON more than 15 years
ago, updated in 80th legislative session.
Provides mechanism for nurse’s actions to be
reviewed by peers
In place for RN’s and LVN’s
Any facility that regularly employs 10 or more
RN’s and/or LVN’s must have a Peer Review
Committee
Incident-Based Nursing Peer Review
Evaluation of
 Nursing services
 Qualifications of a nurse
 Quality of care provided
 Merits of a complaint about a nurse
 Recommendations about a complaint
Nurse under review given written notice to attend with
info about complaint
Fact finding process, analysis studying events that
occurred - due process as right to question witnesses
and confidentiality
Climate of collegial problem solving
Not a legal proceeding but can have lawyer/peer
If fault is found nurse is subject to Reporting
Requirements
Grounds for Reporting
(Duty to Patient)
Employers of 10 or more licensed nurses
must have a peer review committee
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Unnecessary or likely exposure by nurse of patient or
other person to risk/harm;
Unprofessional conduct by nurse – see rule 217.12
Failure by nurse to adequately care for patient
Failure by nurse to conform to minimum standards of
acceptable professional practice – see detail in
217.11
Impairment or likely impairment of nurse’s practice by
chemical dependency
The Nurse’s Duty to Report
Licensed care giver, agency, or facility
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Exposing a patient to substantial risk of harm due
to
lack of minimum standard of nursing care
Another nurse
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Impairment, lack of minimum standard of care,
unprofessional conduct, or unnecessary exposure
of pt. to risk for harm
Nursing student
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Chemical impairment
Ability to perform professional service within
reasonable expectations
Reporting
Report must be written/signed
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Include identity of nurse or student, and
any other information required by BON
Nurse may make report to employer of
nurse, or to nursing school of student
Peer Review Committee
If nurse reports to employer, Peer Review
Committee will review case, and if committee
finds “cause” they are required to report to
BON.
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Identity of the nurse
Any corrective action taken against the nurse
Recommendation re: Board action
Any additional information required by the BON
Peer Review Proceedings are confidential!
“Minor” Incidents
Conduct that does not indicate that continuing
practice of nursing by the involved nurse poses a
risk of harm to client
Potential risk of harm is very low
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 Incident is singular
 Nurse exhibits a conscientious and accountable
approach to his/her practice
 Nurse has knowledge and skill to practice safely
5 minor incidents in any consecutive 12 month period
must be reported to Peer Review Committee (rule 217.16 d)
If no Peer Review Committee is available, the incident
must be reported to BON
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Peer Assistance Rule 217.13
Required by law
Identifies, assists, and monitors professional
colleagues experiencing mental health,
alcohol or drug problems that are likely to be
job impairing so they may return to safe
practice.
BON contracts TNA to provide this service
TPAPN
Texas Peer Assistance Program for Nurses
 Voluntary
 Confidential
 Available for substance abuse/dependency,
anxiety disorders, major depression,
schizophrenia, schizoaffective
and bipolar disorders.
 Self or employer referral
Safe Harbor Peer Review
Safe Harbor Peer Review
Protects nurses asked to engage in conduct
which they believe violates duty to patient
“Duty to Patient” – means conduct including
administrative decisions directly affecting a
nurse’s ability to comply with that duty required
by:
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Standards of practice
Professional conduct adopted by the Board in
Section 303.005 (a)
Required by facilities employing/contracting at
least 10 nurses
Protections
If nurse requests a
Safe Harbor Peer Review:
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May not be disciplined/discriminated against for making
request
May engage in requested conduct pending the peer
review – (that is- continue working)
Is not subject to reporting requirement just covered
May not be disciplined by board for engaging in that
conduct while the peer review is pending
Requesting Safe Harbor
Must be done in good faith
Must notify supervisor making the assignment
that he/she is invoking safe harbor
Use form on BON web site
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Include all info. on required form
If used to question a medical order
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Medical staff/director will make a determination
Nurse invoking Safe Harbor will get a copy of
Peer Review Committee’s determination and the
administrator’s review
Other
If used to question a physician order,
the medical staff or medical director will
make a determination
Nurse invoking Safe Harbor responsible
for keeping a copy – will get a copy of
peer review committee’s determination
and administrator’s review
Applying for your License
http://www.ncsbn.org/
www.pearsonvue.com/nclex
Forms, all info is on BON website.
See the checklist at end of application
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Application by NCLEX-RN Examination form
completed and $200.00
Two FBI fingerprint cards
$139.00 fee to BON
Affidavit of Graduation from Nursing Program
2x2 passport photo; signature, date taken
Registration for NCLEX-RN Exam
Assuring Competence
NCLEX–RN exam = assurance of knowledge base,
decision-making competence
Graduation from an accredited school = assurance of
psychomotor/technical, legal/ethical, interpersonal,
decision-making skills.
 Evaluation criteria used by school is related to the
“Standards of Nursing Practice” and “Unprofessional
Conduct “ in the BON Rules and Regulations
NCLEX and Success
Web sites in syllabus/Module
Take Review course or purchase NCLEX book to:
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help practice with NCLEX type questions,
identify areas of needs
practice at least 2500 ?’s
get 85% correct before taking boards!!
Close correlation of grades within program and
lev4 exam results and “pass” on the NCLEX.
If one exam score is low, remediate!
HESI – if score is below 85% - remediate
Taking the NCLEX
Type of Testing
CAT – Computer Adaptive Testing
Identifies 95% chance of safe practice
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Various types of questions
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Don’t make wild guesses to finish items
Each test is different
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Pictures, fill in the blank, multiple answer, etc.
Computer selects items for candidate’s skill level
Level of question based on answer to previous question
Different questions each time applicant tests
Contains some items that are not graded
Instructions, sample items, and breaks are included in
testing time period allowed
www.pearsonvue.com/nclex
Test Plan
4 major categories of client needs
 Safe and effective care environment
 Management of care
 Safety and Infection Control
 Health Promotion and Maintenance
 Psychosocial Integrity
 Physiologic Integrity
 Basic Care and Comfort
 Pharmacological and parenteral therapies
 Reduction of risk potential
 Physiological Adaptation
Processes
Integrated into every category
Nursing Process
 Caring – interaction of nurse and client;
collaborative environment
 Communication and documentation
 Teaching/learning
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Across life span in a variety of settings
Some questions will apply knowledge
from 2 different areas
Study, practice!
Plan
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Tips
You can now test in AUSTIN, TX
Schedule carefully- $50.00 to reschedule
Sleep, eat, take precautions so you can stay calm!
Master test-taking strategies
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Read carefully 1-2 minutes/question
Think through carefully
Remember your ABC’s
Do not read into the question
Remember Nurse Practice Act: what can LVN’s and CNA’s
do
Remember ‘textbook’ patient and ‘Utopia’ hospital
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(in ‘a perfect world’ scenarios)
Use your breaks to rest!
pearsonvue.com/nclex
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What to Expect/Prepare
• Arrive 30 minutes early, if you are more
than 30 late test will need to be
rescheduled and fee paid again
• Come alone no children/family/friends
waiting or calling
• No hats, scarves, coats, calculators,
pencils, etc. permitted in testing area
• Bring
– Authorization to Test (ATT) form – needed to schedule testing session –
Name same as on ID
– Valid non-expired Photo ID with your signature
• Finger print, photo, & signature will be
taken on admission to test
What to Expect
May take up to 6 hours to complete test –
raise hand when done, do not get up
Must us computer calculator
75-265 questions- 15 unscored
Number of questions does not predict
pass/fail–
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75 high pass/fail as computer determines trends
Must answer each item to continue on
through test – after hitting ENTER, you may
not go back
What to Expect
Results come from BON
– approx 21 days
 – or pay $8 to check score in 48 hours
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Retest every 50 days for 4 years in TX
Section 301.255 (Reexaminations)
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Texas Occupations Code- BON may
require additional education requirements
of deny testing
Texas Nursing Jurisprudence Exam (NJE)
Effective Sept. 08, all persons applying
to take NCLEX must first pass the NJE
Details re exam are still being
finalized…per BON
Access BON Bulletin information
Guidelines for New Grad Employment
GN Verification Letter from BON (issued after
graduation and completion of application for licensure
and examination processes and fees complete) and
NCLEX testing date set
No outstanding eligibility issues
75 day time period specified on GN
Verification letter, OR results of first NCLEX
If first NCLEX exam is failed, practice as GN
must stop – no longer eligible.
Must know and comply with Nurse Practice
Act, and Rules and Regulations
Temporary Authorization to Practice
GN must work under the direct supervision of
an RN (physically available, on same unit)
GN shall not be placed in a charge or
supervisory position, no independent settings
GN’s permitted to perform any function that
falls within scope of nursing practice for which
they have received educational preparation
and have demonstrated minimal competency
After Being Licensed
Direct supervision should be continued for
6 months, or less if agreed upon by new
grad and supervising RN. Competence to
work independently should be mutually
determined and be demonstrated and
supported by documentation
Newly licensed nurse should not act as
charge or be in supervisory position for 6
months – or less with same criteria as
above
THESE GUIDELINES PROTECT YOU!!
The 1-2-3s of CE- Continuing Competency
(301.303 TOC)
•Required completion of targeted cont ed. programs
•Professional portfolio including certifications
•Twenty (20) clock contact hours (or 2
Continuing Education Units-CEUs) required
every 2 years coinciding with nurse’s license renewal.
•A Continuing Education Unit (CEU) equals 10
contact hours
•CE hours must be earned within the two-year period
immediately preceding the license renewal, beginning
with the first day after the renewal month until the
last day of subsequent renewal.
Acceptable CE courses
Program must be approved by an approved credentialing
agency recognized such as
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American Association of Critical-Care Nurses;
Education and Service (NAPNES)
Other State Boards of Nursing
Academic courses are approved – proved within framework
that that leads to an academic degree in nursing or relevant
nursing practice.,
Self-Paced/Online CE Programs are acceptable for CE credit if
approved by approved credentialing program.
Activities Not Acceptable for CE Credit
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Basic CPR;
In-service programs that provide specific information about the work
setting's philosophy, procedures;
On-the-job training and equipment demonstration;
Refresher courses designed to update knowledge ETC.;
First Time Renewal
A nurse newly licensed in Texas either by
examination or by endorsing from another
state is exempt from continuing education
requirement for first licensure renewal.
A nurse's initial license may be valid for a
period ranging from six (6) to 29 months,
depending on the Licensee's birth date.
Following first license renewal, nurse must
meet CE requirements for subsequent
biannual renewal periods.
Entry into Practice
1965 ANA paper recommended
Baccalaureate Degree
One of most contentious issues in nursing
50 years of debate
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Same licensing exam
2000 ANA reaffirmed it’s recommendation
Public Health Nursing usually requires BSN
Specialist positions may require masters
degree
Differentiated Practice
Structured nursing roles based on:
Education
 Experience
 Competence
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Education based – different prep = different
roles
 Assessment based – all facets, competency
focused
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Differentiated Practice Models
Numerous studies and projects have worked on
this issue over the last 20 years
 Roles delineated according to educational
preparation: correlating compensation has not
been widely used
 Competency models
 Some incorporate ANA’s standards of care
with “levels of practice”; novice to expert.
RN I to RN V
 Can be linked to job descriptions and
evaluation
Regulatory Agencies
BON
Certification- standards of a government
agency and Accreditation
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Medicare/Medicaid
Accreditation – non-government
JCAHO
 CHAP – Community Health Accreditation
Program
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Advisory Groups
Provide expert advice to organizations,
government
Examples
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Secretary of Health, Congress – National
Advisory Council on Nurse Education and
Practice
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Workforce diversity goals – increase recruitment,
retention and graduation of minority students;
promote minority nurse leadership; develop practice
environments that promote diversity; prepare nurses
to provide culturally competent care
JCAHO – Nursing Advisory Council
Legislation
Texas Legislature
Has addressed nursing shortages in past
 Hepatitis C continuing education
requirement
 Current proposal to increase Hepatitis C
requirement to 2 contact hours per renewal
period: Nursing groups opposing this.
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ANA
Advocates for Nursing
Defines standards of practice for RN
 General
 Specialty
Provides avenue for nursing to be involved in
decision making at national level
Texas Nurses Association
Mission:
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Promoting excellence through leadership,
advocacy and innovation.
Advocate for nursing with the legislature
Continuing Ed
Current information on legal issues,
interpretation of legal, BON
Go out there and give them
health!!