Scope of Nursing Practice

Requirements : Rule 217.11
The nurse must adhere to these standards:

• Promote patient safety
  
• Correctly administer medications and treatments,
  
• Complete and accurately report and document ( if it is not documented; it is not done),
  
• Protect confidential information (HIPPA),
  
• Participate in education and counseling,
  
• Comply with mandatory reporting
  
• Provide nursing care without bias/discrimination
  
• Stabilize and prevent complications
  
• Clarify physicians orders
  
• Prevent infections through appropriate infection control measures
• Communicate and advocate for the patient

Nurses are accountable for maintaining their continuing competency and safely executing the assignments that are accepted. They may be responsible for making assignments and supervising others, while nursing directors and managers are responsible for verifying a current unencumbered license for the staff they supervise. https://www.bon.texas.gov/practice_scope_of_practice_rn.asp

The Texas Nursing Practice Act (NPA) defines the legal scope of practice for professional registered nurses (RNs).  “Professional nursing” means the 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 bioloical, 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 corrective measures. 

Professional nursing involves:

1. The 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;
2. The maintenance of health or prevention of illness;
3. The administration of a medication or treatment as ordered by a physician, podiatrist, or dentist;
4. The supervision or teaching of nursing;
5. The administration, supervision, and evaluation of nursing practices, policies, and procedures;
6. The requesting, receiving, signing for, and distribution of prescription drug samples to patients at practices at which an advanced practice registered nurse is authorized to sign prescription drug orders as provided by Subchapter B, Chapter 157;
7. The performance of an act delegated by a physician under Sections 157.0512, 157.054, 157.058, or 157.059; and the development of the nursing care plan.

The RN takes responsibility and accepts accountability for practicing within the legal scope of practice, and may engage in independent nursing practice without supervision by another health care 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 regulations; and policies, procedures and guidelines of the employing health care institution or practice setting. The RN is responsible for providing safe, compassionate, and comprehensive nursing care to patients and their families with complex healthcare needs.

Standards Specific to LVNs

LVN practice is a directed scope of nursing practice under the supervision of an RN, APRN, physician’s assistant, physician, podiatrist, or dentist. Supervision is the process of directing, guiding, and influencing the outcome of an individual’s performance of an activity.

The LVN shall assist in determining predictable healthcare needs of clients within healthcare settings and perform the following:

Use a systematic approach to provide individualized, goal-directed nursing care by:

• Collecting data and performing focused nursing assessments.
  
• Participating in the planning of nursing care needs for clients.
  
• Participating in the development and modification of the comprehensive nursing care plan for assigned clients.
  
• Implementing appropriate aspects of care within the LVN’s scope of practice.
  
• Assisting in evaluating the client’s responses to nursing interventions and identifying client needs.
  
• Assign specific tasks, activities, and functions to unlicensed personnel commensurate with the educational preparation, experience, knowledge, and physical and emotional ability of the person to whom the assignments are made and maintain appropriate supervision unlicensed personnel.
  
• May perform other acts that require education and training as prescribed by Board rules and policies commensurate with the licensed vocational nurse’s experience, continuing education, and demonstrated licensed vocational nurse competencies.

Professional nursing organizations influence statutory and administrative laws. These groups advocate for safety and the advancement of nursing practice. Professional organizations tackle a variety of issues, such as workplace safety, violence protections, expansion of advanced practice registered nurse (APRN) authority, whistleblower protections, and workplace staffing, etc.

References:

Texas Board of Nursing Rules and regulations, https://www.bon.texas.gov/laws_and_rules_rules_and_regulations.asp

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