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Texas Board of Nursing - Practice - Nursing Practice
Peripherally inserted central catheters PICC. Insertion, maintenance and removal of peripherally inserted central catheters PICC. The role of the license practical nurse in intravenous infusion therapy. Furthermore, the Board encourages existing nursing education programs approved by the Texas Board of Nursing to develop articulation arrangements that specify their policies regarding transfer of academic credits to facilitate educational mobility, especially in underserved areas of the state.
The Board honors and supports military personnel and veterans and their educational mobility. This rule delineates two methods by which nurses may follow a pre-approved set of orders for treating patients: Such written instructions, orders, rules, regulations or procedures shall delineate under what set of conditions and circumstances action should be instituted.
As used in this chapter, standing delegation orders do not refer to treatment programs ordered by a physician following examination or evaluation by a physician, nor to established procedures for providing of care by personnel under direct, personal supervision of a physician who is directly supervising or overseeing the delivery of medical or health care. As used in this chapter, standing delegation orders are separate and distinct from prescriptive authority agreements as defined in this chapter.
Such standing delegation orders should be developed and approved by the physician who is responsible for the delivery of medical care covered by the orders.
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Such standing delegation orders, at a minimum, should: These orders, rules, regulations or procedures are authority and direction for the performance for certain prescribed acts for patients by authorized persons as distinguished from specific orders written for a particular patient or delegation pursuant to a prescriptive authority agreement.
The term protocols is separate and distinct from prescriptive authority agreements as defined under the Act and this chapter. However, prescriptive authority agreements may reference or include the terms of a protocol s. Protocols shall be defined to promote the exercise of professional judgment by the advanced practice registered nurse and physician assistant commensurate with their education and experience.
The protocols used by a reasonable and prudent physician exercising sound medical judgment need not describe the exact steps that an advanced practice registered nurse or a physician assistant must take with respect to each specific condition, disease, or symptom.
Based on the above definitions in the TMB rules, RNs who do not have advanced practice licensure from the BON may not utilize "protocols" to carry out physician orders. A nurse responsible for initiating physician's standing medical orders or standing delegation orders may select specific tasks or functions for patient management, including the administration of a medication required to implement the selected order provided such selection be within the scope of the standing orders.
The selection of such tasks or functions for patient management constitutes a nursing decision that may be carried out by a LVN or RN. The nurse initiating any form of standing orders must act within the scope of the Nursing Practice Act, Board Rules and Regulations, and any other applicable local, state, or federal laws.
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- Getting Your Driver's Licence
Board of Nurse Examiners, S. Persons who are especially vulnerable include the elderly, children, the mentally ill, sedated and anesthetized patients, those whose mental or cognitive ability is compromised, and patients who are physically disabled, immobilized, restrained, or secluded. The distinction between a nurse leaving employment versus a nurse violating a duty to a patient through leaving an assignment is often confused.
The first is an employment issue; the other is potentially a licensure issue. From a BON standpoint, the focus for disciplinary sanctions is on the relationship and responsibility of the nurse to the patient, not to the employer or employment setting.
Employment Issues Though the Board has no jurisdiction over employers or employment-related issues, other laws regulating facility licensure may apply certain responsibilities to the employer for provision of patient safety, such as development of effective patient care systems or provision of adequate numbers of qualified staff.
Specific requirements for a given facility may be obtained by contacting the applicable licensing authority for the institution. The Board believes that the following additional examples of employment issues would not typically involve violations of the NPA or Board Rules: The Board believes nurses should be vigilant and exercise sound professional judgment when accepting assignments that may be requested by employers who need nurses to fill vacant shifts for licensed nursing staff or other staffing-related situations.