Texas Nurse Practice Act: Facility Guide

The Texas Nurse Practice Act (NPA) outlines the rules and regulations for nurses practicing in the state. While these rules and regulations are required for nursing professionals across the country, the profession was poorly regulated in the U.S. prior to the early 1900s. There were no laws in place that set standards for care and without clinician registering or licensing, it was challenging to provide oversight on care quality.

The Texas Nursing Practice Act, as it’s formally named, holds nursing professionals accountable for the care they provide. It also specifies licensure requirements, degree expectations, and law violation penalties for nursing professionals practicing in the state of Texas.

In this article, we summarize the rules set by the Texas NPA, outline key elements that affect nursing practice, and provide tips for Texas healthcare leaders looking to better understand their Nursing Practice Act and promote safer nursing care within their facilities.

What Are the Components of the Nurse Practice Act?

Texas RNs, LVNs, and APRNs are required to follow certain guidelines to ensure high-quality care under the state’s nurse practice act. In Texas, this legislation influences nursing practice by:

• Establishing Texas Board of Nursing rules and regulations.
• Describing requirements for Texas nursing education programs.
• Setting minimum care standards that must be met.
• Regulating the maintenance and renewal of a Texas nursing license.
• Clarifying and setting penalties for violations.

The Texas Nurse Practice Act: Laws at a Glance

Most state Nurse Practice Acts have similar processes for regulating their nursing board and establishing legal requirements for obtaining a license. Additionally, each state NPA outlines specific laws for delegating tasks and establishing penalties for rule violation.

Understanding the intricacies of your state’s nursing practice law is essential to providing exceptional patient care. In the chart below, we list some of the key components unique to the Texas Nurse Practice Act.

Texas Administrative Code, Title 22, Part 11, Chapters 211-288: Texas Board of Nursing

Texas Occupational Code, Chapter 304: Nurse Licensure Compact

• Graduate from a Texas approved or accredited nursing education program.
• Submit an application with the appropriate fees to the board of nursing and begin registration with Pearson VUE, the testing vendor.
• Register for the NCLEX exam with Pearson VUE.

• Graduate from an accredited nursing education program in the US.
• Pass the NCLEX examination.
• Present a valid license to practice nursing in another state (An RN with any previous disciplinary action by any licensing authority is not eligible for licensure until completion of further eligibility determination).
• Show proof of practicing nursing experience within the 4 years preceding licensure request. If the RN doesn’t have recent practicing experience, they’re required to complete a state-sanctioned refresher course.
• Once administrative fees are paid, the candidate will receive their RN license by endorsement, which is active for up to 29 months.

A task that the registered nurse determines the unlicensed employee is competent to perform, including:

• Activities of daily living (ambulation, toileting, getting dressed, brushing teeth and hair, etc.).
• Non-invasive and non-sterile treatments.
• Collecting and documenting health data (vital signs, height, weight, intake/output, etc.).
• Reinforcement of previous teaching provided by the RN.
• Insertion of urinary catheters or feeding tubes.
• Ventilator and tracheostomy care (instilling normal saline and suctioning the breathing tube).
• Care of broken skin with minimal risk of infection.
• The administration of oral, sublingual, topical, vaginal, rectal, and inhaled prescription medications can be delegated to qualified nursing assistants under certain circumstances.
• Oxygen administration for non-acute respiratory maintenance.
• Subcutaneous administration of insulin or other diabetes mellitus medication.

Nursing activities not within the delegating or supervising nurse’s scope of practice or activities that include the use of the nursing process, including:

• Physical, psychological, and social assessments that require the completion of the nursing process.
• Formulation and evaluation of a nursing care plan.
• Implementing tasks that require professional nursing judgment or intervention.
• Teaching and counseling patients on health goals.
• The calculation of medication doses.
• Administration of any new medication not previously given, as well as any injectable (except for subcutaneous insulin), intravenous, or intraosseous medication.
• Receiving or requesting verbal telephone orders from a prescribing clinician.

• Obtaining, furnishing, or selling a fraudulent nursing diploma, license or other related record or assisting someone else in doing so.
• Practicing nursing under a diploma, license or related record that was unlawfully or fraudulently obtained.
• Practicing nursing with a suspended or revoked license.
• Using nursing titles, abbreviations, or other nursing designations with their name without appropriate licensure.

Note that repeated offenses of the above can constitute a Third Degree Felony and each day of a violation constitutes a separate offense. A conviction of any of the above can result in forfeiture of a nursing license.

Under Section 301.452, a nursing professional can face disciplinary action for, among other things:

• Behaviors that increase the risk of harm
• Violations of the Texas Nurse Practice Act scope of practice
• Unprofessional conduct by the nurse, as defined by Section 217.12
• Failure to adequately care for a patient
• Failure to conform to the minimum standards of acceptable nursing practice, as defined by 22 Tex. Admin. Code Section 217.11
• Impairment or likely impairment of the nurse’s practice by chemical dependency, alcohol, or mental illness

Promoting Safe Nursing Practice: 3 Strategies for Facilities

By adhering to the laws specified in the Nursing Practice Act, Texas clinicians and facility leaders can enhance regulatory compliance and ensure their team performs to the highest standards.

However, familiarizing yourself with the Texas NPA is only the first step to improving care. It’s equally important to incorporate the laws into facility policies and procedures to support your team and optimize care quality. Here are three strategies for getting started.

1. Review Key Components of the NPA During Staff Training

Reviewing the components of the NPA during employee onboarding and annual competency training sessions can improve staff engagement and compliance. Provide all nursing professionals with an electronic copy of the Texas Nurse Practice Act and post information on any legal updates in your facility’s common areas.

2. Educate Patients on Care Provider Roles

Staff members often feel obligated to perform duties outside of their scope of practice when asked to do so by patients and family members. Conversely, patients may feel that their health is at risk if they witness a care provider practicing outside of their legal scope. The easiest way to prevent this from happening is by educating patients on the responsibilities of each of their care providers.

Empower staff to say “no” or ask for assistance from another clinician when asked to do something outside of specified role requirements. Let patients know that it’s okay to speak up to healthcare management if they witness a staff member performing an inappropriate or unusual task. Promoting these practices can help you build a culture of safety that protects patients and keeps employees from unintentionally breaking state practice laws.

3. Encourage Shared Governance in Nursing

This leadership model involves nurses in the process of developing facility-wide nursing policies. It also promotes collaboration and teamwork among your clinical providers. Empowering clinical nurses with decision-making power promotes nurse engagement and encourages them to manage their own professional practice.

Discover More Ways to Improve Care and Stay Compliant

Now that you’ve taken the time to understand the Texas Nurse Practice Act, you may be wondering what additional steps you can take to improve regulatory compliance at your facility. Follow our newsletter to find out more about healthcare policy changes and regulatory updates — sent straight to your inbox.

Legal Disclaimer: This article contains general legal information, but it is not intended to constitute professional legal advice for any particular situation and should not be relied on as professional legal advice. Any references to the law may not be current, as laws regularly change through updates in legislation, regulation, and case law at the federal and state level. Nothing in this article should be interpreted as creating an attorney-client relationship. If you have legal questions, you should seek the advice of an attorney licensed to practice in your jurisdiction.