Nursing Jurisprudence and Ethics Texas Nurses

Nursing Procedures and Responsibilities

• A nurse can replace a gastrostomy tube after 8-12 weeks if they have a physician's order and completed specific competency training.
• The Board of Nursing (BON) protects the welfare of Texas residents and differs from associations that may lobby for nursing legislation.
• Licensed Vocational Nurses (LVNs) may participate in the modification and development of nursing care plans but cannot initiate them independently.
• Contacting a physician to clarify medication orders is part of a nurse's duty to ensure patient safety.
• Job abandonment is addressed under Board Rule 217.12, specifically in Paragraph (12).

Professional Boundaries and Ethics

• A nurse maintains appropriate professional boundaries by rewarding progress in rehabilitation rather than personalizing the relationship.
• For certain responsibilities, a nurse requires a Registered Nurse license, signifying the minimum competencies needed.
• Upon admitting to substance dependence, the nurse must be monitored by a Peer Review Committee, according to the NPA.

Safety and Patient Care

• Continuous practice errors reported to the BON may indicate risk to patient safety.
• A nurse with a first-degree murder conviction must wait five years post-release from supervision to apply for a nursing license.
• A report to the BON isn’t required for minor incidents unless they pose significant risks to patients.

Licensing and Reporting

• Nurses must be aware of the implications of questioning a physician's orders, supported by the Position Statement 15.14 highlighting their duty to patient safety.
• Practicing nursing in Texas necessitates holding a valid nursing license; an applicant must comply with specific education and licensing criteria.
• Quitting a job at the end of a shift is not considered patient abandonment, countering potential misconceptions.

Continuing Education and Competence

• Nurses must answer questions about any criminal background during the licensure renewal process, impacting their eligibility.
• The BON's rules advocate for accountability regarding narcotic management, requiring action if practices indicate impairment or substance use issues.

Scope of Practice

• Registered Nurses (RNs) are necessary for delegating tasks to unlicensed personnel, ensuring that patient care standards are maintained.
• The BON enforces statutes from the Texas Occupations Code, shaping the nursing profession's operational standards and practice laws.

Instructional Roles in Nursing

• An RN is contracted to teach staff how to monitor blood glucose levels, demonstrating the application of nursing expertise outside direct patient care contexts.### Nurse Delegation and Scope of Practice
• RN is responsible for training staff to monitor blood glucose effectively.
• A prudent nurse evaluates tasks against the Scope of Practice Decision-Making Model.
• The Board of Nursing (BON) provides a list of tasks specific to nursing practice.

Substance Use and Nursing Licensure

• A nurse's history of substance use disorder is crucial for evaluating fitness for duty.
• Disciplinary actions from BON focus on the nurse's ability to serve clients' best interests.

Continuing Competency and Education Requirements

• Rule 216 mandates RNs to complete 20 contact hours of continuing education biennially.

Incident Based Peer Review (IBPR)

• CNO must report practice errors to the IBPR Committee, which evaluates external factors impacting care.

RN Practice Autonomy

• Unlike LVNs, RNs can practice independently within their designated scope.

Violations of Nursing Practice

• Practicing without a qualified supervisor is a violation of nursing standards for LVNs.

Professional Character and Ethical Standards

• Adherence to the Nursing Practice Act reflects on an individual’s professional character.

Reporting Ethical Violations

• Nurses are protected from discipline for reporting ethical breaches, such as observing a physician violating sterile technique.

Sexual Misconduct Policy

• Sexual misconduct is a critical concern; it questions the nurse's ability to provide safe care.

Professional Boundaries

• Nurses borrowing money from patients significantly breach professional boundaries.

Confidentiality in Complaints

• The identity of individuals filing complaints against nurses remains confidential throughout the investigation.

Mental Health and Fitness for Practice

• Conduct raising concerns regarding fitness to practice, such as making threats, may trigger disciplinary actions.

Chemical Dependency and Licensing

• Individuals with chemical dependency histories must demonstrate current sobriety and fitness to practice for licensure.

APRN Delegation Authority

• In Texas, APRNs can delegate daily activities and health maintenance tasks to unlicensed assistive personnel according to BON rules.