How many patients can a nurse have

This record must be maintained for a minimum of three consecutive renewal periods, or 6 years, for auditing purposes. Some radiologic procedures may be considered delegated medical acts. BON staff recommend caution when performing a task as a delegated medical act. The Board's Position Statement Delegated medical acts do not diminish the responsibility of the nurse in any way to adhere to the Board's Standards of Nursing Practice, found in Board Rule Included in Board Rule Other nursing organizations related to a nurse's specialty practice setting may provide further guidance.

Additionally, national patient safety organizations may provide resources and procedure guidelines for evidence-based practice. Examples include:. The Nursing Practice Act and Board Rules and Regulations do not address LVNs performing radiologic procedures; therefore, an LVN would need to obtain the required license or permit necessary to perform radiologic procedures, such as, a medical radiologic technologist license regulated by the Texas Medical Board.

Texas Senate Bill amended Section There was legislation some time ago that allowed nurses to pronounce death in long-term care and hospice facilities. Texas laws and regulations regarding pronouncement of death may be found in Texas Health and Safety Code Chapters and respectively. Even though the Texas Board of Nursing BON does not have purview over the laws surrounding pronouncement of death and death records, because Board Rule In addition to obtaining approval to sit for the NCLEX, a student who has successfully completed a nursing program must also hold a current valid temporary permit from the Board to practice as a GN or GVN in the state of Texas.

Although the GN or GVN may not practice in an independent setting such as home care until licensed, the BON has no requirements for co-signatures on anything. Co-signatures may be necessary for certain nursing tasks, such as witnessing the wastage of a unit-dosed amount of a narcotic. Such requirements are beyond the jurisdiction of the BON. For example, if a patient requires a comprehensive assessment performed by an RN, the assignment or a portion thereof may not be given to an LVN.

Each nurse has a duty to maintain client safety [Board Rule As discussed above, each licensed nurse is responsible for accepting assignments that are within the educational preparation, experience, knowledge, and physical and emotional ability of the individual nurse [ Board Rule Both LVNs and RNs are required to document the nursing care they render; each is held accountable for doing it accurately and completely [Board Rule What is the difference between the Texas Board of Nursing and professional nursing organizations?

Although the Texas Board of Nursing BON or Board and professional nursing associations are both involved in the arena of nursing, nursing associations serve a different purpose and provide different services to their nursing membership and the public. The mission of the BON is to protect and promote the welfare of the people of Texas by ensuring that each person licensed as a nurse is competent to practice safely.

The Board fulfills its mission by regulating the practice of professional and vocational nursing and the approval of nursing education programs. Thus, the BON is the state agency empowered by the Texas Legislature to regulate nurses and the practice of nursing in the State of Texas. The Board does not draft legislation or introduce new bills in the Texas Legislature, nor can the Board or Board staff support or oppose proposed bills during a legislative session. Board Members and Board staff are prohibited from lobbying the legislature regarding any bill that may go before the Texas Legislature and amend the Nursing Practice Act or other statutes, in or outside the authority of the BON, that otherwise impacts nurses.

The Board fulfills its mission of protecting the public by carrying out the applicable statutes in the Occupations Code, and by establishing rules which are published in the Administrative Code.

In Texas government, policy making duties are divided between the legislature and the governor. The legislature writes the laws and appropriates the funds for state agency operations. The Governor, the State's Chief Executive Officer, has a major voice in setting the legislative agenda and vetoing bills. However, the legislature and the Governor delegate to state agency boards, like the Board of Nursing, the tasks of carrying out the laws applicable to the profession the agency is responsible for regulating.

The Board meets regularly to execute its responsibilities for administering the law governing nursing practice and education. The Board employs professional and support staff to carry out the provisions of the law along with the rules and regulations established by the Board. The Board pursues its mission by upholding minimum standards for nursing pre-licensure educational programs, licensing qualified individuals as nurses, educating licensed nurses regarding current nursing regulations and any changes in the law, investigating alleged violations, and imposing appropriate discipline on the licenses of those found to be in violation of the NPA or Board rules.

Unlike the Board of Nursing, a professional nursing association is a private organization whose members must pay dues to receive the benefits of membership. One of the primary functions of a nursing association is to represent its members in legislative, political, and practice matters.

It provides a central voice and avenue for advocacy for its nurse membership. A nursing association can lobby the legislature and Governor for the interests of its members and the profession of nursing. In addition, a nursing association provides leadership in other areas such as improving working conditions and benefits for nurses. A nursing association also may lead the way in developing public health policies. Summary: The Board and nursing associations have separate but equally important roles.

Revised One of the hallmarks of nursing is the approach to lifelong learning. As nurses earn advanced degrees, the number of nurses earning doctoral degrees is increasing According to TOC Chapter Based on requirements in the referenced Texas laws, doctorally prepared nurses could not simply identify themselves as Dr.

Nurses must also include licensure level with appropriate APRN title, if applicable. Communication takes many forms. Some verbal communications occur in person and have associated visual cues such as a name badge.

Other verbal communications may occur by telephone, presenting unique challenges in assuring the parties are correctly identified. The information exchanged should include the name and licensure level of the parties involved. Written communications are required to include the name, licensure level, and the appropriate advanced practice title, if applicable, and may include academic degrees and certifications. The academic credential cannot replace the licensure credential. Inadequate identification of a nurse can be confusing to the public.

Failure to comply with laws, rules, and regulations can result in disciplinary action. The Board receives questions frequently about whether cosmetic procedures are within the scope of practice for a licensed vocational nurse LVN. Because each nurse has a different background, knowledge, and level of competence, the Board does not have an all-purpose list of tasks that every nurse can or cannot perform, and it is up to each individual nurse to use sound judgment when deciding whether or not to perform any particular procedure or act.

The following resources, however, are intended to provide you guidance in determining if cosmetic procedures are within your scope of practice. What is the LVN scope of practice in regards to cosmetic procedures? Vocational nursing is a directed scope of nursing practice, including the performance of an act that requires specialized judgment and skill, the proper performance of which is based on knowledge and application of the principles of biological, physical, and social science as acquired by a completed course in an approved school of vocational nursing.

The term does not include acts of medical diagnosis or the prescription of therapeutic or corrective measures. Vocational nursing involves:. Additionally, Vocational nursing must be performed under the supervision of a registered nurse, advanced practice registered nurse, physician assistant, physician, dentist, or podiatrist [Tex. Below are some examples of what you should consider when evaluating whether a cosmetic procedure is within your scope of practice:.

An LVN should not perform a cosmetic procedure if the LVN lacks the necessary educational preparation, knowledge, competency, or skill to safely perform the procedure; lacks an order for the procedure; or lacks appropriate supervision. To further assist you in determining whether a cosmetic procedure is within your scope of practice, Board Staff recommend review of several resources available on the Texas BON website.

These resources include:. In addition, depending on the range of services you plan to provide, there may be specific licensure requirements including, but not limited to, Cosmetology Licensing. Additionally, there may be applicable guidance related to the practice setting; e. One example of this may be performing a lower leg wax for a client who has diabetes and peripheral neuropathy; this client may not be able to feel if the wax is too hot and there may be associated burns and a poor outcome.

In this example, you would be held responsible for applying your nursing knowledge and judgment with this particular client. It is important to remember that there is more to this topic than simply learning how to perform a particular procedure. In many cases, on-the-job training will not include this type of content. The Board receives questions frequently about whether cosmetic procedures are within the scope of practice for a registered nurse RN.

What is the RN scope of practice in regards to cosmetic procedures? Registered nursing, also known as professional nursing, is 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 biological, physical, and social science as acquired by a completed course in an approved school of professional nursing.

Professional nursing involves:. An RN should not perform a cosmetic procedure if the RN lacks the necessary educational preparation, knowledge, competency or skill to safely perform the procedure; lacks an order for the procedure; or lacks appropriate supervision. To further assist you in evaluating whether a cosmetic procedure is within your scope of practice, Board Staff recommend review of several resources available on the Texas BON website. May a nurse practitioner who is educated to practice in a primary care population focus area e.

The Nursing Practice Act and Board rules are written broadly to apply to all nurses, including advanced practice registered nurses APRNs , across all practice settings. Neither are prescriptive to specific tasks or services APRNs may perform or provide. Likewise, they do not address specific practice settings for specific categories of APRNs. Board Rules When making scope of practice determinations, it is important to consider the patient's condition and patient care needs.

Primary care educated APRNs may provide care in the acute care setting for patients with similar patient care needs and diseases and conditions to those they diagnose and manage in the outpatient setting. For example, a family nurse practitioner may be part of a group practice in a specialty such as orthopedics or palliative care and required to round in an inpatient setting in collaboration with the delegating physician.

When reading the Consensus Model , it is important to bear in mind that it contemplates licensure and education based on an APRN role and a population focus. Nothing in the Consensus Model requires scope of practice be specific to a practice setting.

Telenursing involves nursing practice via any electronic means such as telephone, satellite, or computer. Examples of telenursing practice may include but are not limited to teaching, consulting, triaging, advising, or providing direct services.

All of these actions constitute the practice of nursing, even when there is no face-to-face or physical contact with a person or patient. An indication that a position involves the practice of nursing can be found in the job description. If the position requires a person to hold a valid nursing license, then the job duties therein involve the practice of nursing.

When providing telehealth nursing services with patients residing within the geographical boundaries of Texas all nurses must practice in accordance with the Texas Nursing Practice Act and Board Rules. The practice of nursing via telenursing to patients in Texas should be no different than providing care to patients in an in person encounter. As such the minimum standards of nursing practice found in Board Rule Telenursing may also involve practicing nursing across state lines.

For example:. If a nurse from another state provides nursing services to a patient located in Texas, except as excluded in the Nursing Practice Act, Section Using Nursing Titles Applies to Telephonic Nursing Practice Any title that would lead a member of the public to believe that a person is licensed as a nurse is prohibited from use unless the person indeed holds a valid nursing license either in Texas or a valid nursing license with compact privileges in one of the compact states.

This is specified in the Nursing Practice Act, Section This includes titles that apply to advanced practice registered nurses as defined in Board Rule Additionally, nurses must identify themselves to patients through the display of their designations.

Similarly, Board Rule Board Rule As the utilization of telenursing services increases, it remains important for nurses to communicate their name and licensure level to the public, when interacting in a nursing role via technology. LVNs and Telephonic Nursing. APRNs must be aware that a prescription issued as a result of a telemedicine medical service is determined to be valid by the same standards that would apply to an in-person setting where a prescription is issued.

What do I need to know? Is this within my scope of practice? However, Board staff recommends that nurses exercise caution and critical thinking when considering practicing in a setting that offers elective IV hydration and vitamin therapy. As new trends emerge in health care, nurses are called upon to deliver safe nursing care, and must realize their responsibility to stay abreast of current evidence-based practice standards, along with all applicable laws and rules related to their area of nursing practice.

This ensures that patients are receiving the safe, high quality health care they deserve. A nurse must follow the NPA and Board rules when practicing nursing regardless of the setting.

There is a comprehensive description of the registered nurse RN scope of practice on the BON website that may be of further assistance.

The initiation of IV therapy is a learned skill practiced by many Texas nurses. There are, however, necessary considerations for the safe performance of this skill outside of a traditional facility setting. All nurses licensed to practice nursing in Texas must adhere to the Nursing Practice Act NPA and Board rules, as well as other regulations pertinent to the setting.

Therefore, the performance of IV hydration in a non-traditional setting, such as a mobile unit or wellness clinic, should be consistent with applicable regulations, prevailing standards of care, and current national nursing guidelines specific to IV therapy. When initiating IV therapy services, including the administration of medications, such as isotonic IV fluids, a valid provider order is required. An IV therapy order may come from a provider who has examined the patient or may be established in other settings where a physician utilizes standing delegation orders.

Even if all criteria for initiating physician standing delegation orders are met, nurses are required to act in the best interest of their patients, and this duty supersedes any physician order or employer policy.

In all practice settings, nurses must clarify any order or treatment regimen that the nurse has reason to believe is inaccurate, non-efficacious, or contraindicated by consulting with the appropriate licensed practitioner and notifying the ordering practitioner when the nurse makes the decision not to administer the medication or treatment [ Board Rule Board staff recommend review of the rule in its entirety, but some specific standards are highlighted below.

All nurses must:. Board staff also recommend review of the following resources that may be of further assistance:. Please note that Board staff can only speak to the requirements for nursing practice in the State of Texas. The Board does not have rules regarding business ownership, so we cannot advise you on this. We would recommend you seek your own legal counsel for assistance with these matters.

If you do not have legal counsel, the State Bar of Texas not affiliated with the Texas Board of Nursing has a Lawyer Referral and Information Service that may also be able to assist you. Texas Board of Nursing. Nursing practice act. Scope of practice decision-making model. Standards of nursing practice.

For more information on these and other topics, use the search field at the top right corner of the page. Should you have further questions or are in need of clarification, please feel free to contact the Board. Nursing Statistics Expenditures. Meet the Board. Board Staff recommend review of Board Rule This requirement supersedes any agency policy or physician order; also see Board Position Statement In situations where nurses are floating, working double or extra shifts, taking charge duties, or working short-staffed, clear communication between staff and supervisors is essential to manage patient care and decrease conflicts in the work setting.

This applies to charge nurses or nurses who are in management positions who make assignments. While the Board cannot address employment issues, specialty nursing organizations exist to serve their members and may be able to provide nurses with additional guidance. The Texas Hospital Association at www. References Good, E. Revised: The confidentiality rule also known as the Health Insurance Portability and Accountability Act HIPAA does not prevent nurses, when acting in "good faith", from reporting necessary information about a patient to those who may be able to prevent or lessen a danger to a patient or the public.

The confidentiality rule is balanced to protect a patient's health information while allowing information to be disclosed that could protect both the public and a patient from harm. Texas Health and Safety Code Chapter requires the facility, institution, or entity to have a written policy that is jointly developed and approved by the medical staff or medical consultant and the nursing staff, specifying under what circumstances an RN can make a pronouncement of death in order for an RN to pronounce death.

However, an APRN may sign a death certificate under the following circumstances: The patient has executed a written certification of terminal illness, has elected to receive hospice care, and is receiving hospice services from a qualified hospice provider; or The patient is receiving palliative care. References: Nursing Practice Act, Section Advanced Practice Nurses September It is recommended that a newly licensed nurse not practice in independent settings, such as group homes, assisted living facilities and home or school health, where access to a clinical supervisor is limited, for a period of months post-licensure.

This allows the newly licensed nurse sufficient practice experience in more structured settings and the opportunity to assimilate knowledge learned in school consistently into practice. The Board believes it is essential for newly licensed nurses to seek and receive direction, supervision, consultation and collaboration from experienced nurses during the transition into nursing practice.

In any practice setting where newly licensed LVNs and RNs are employed, experienced nurses should be willing to supervise and mentor novice nurses. Direct supervision should be continued for a period of six 6 months or, if agreed upon by the newly licensed nurse and the supervising nurse, a lesser period of time when appropriate.

Competence to practice without direct supervision should be mutually determined by the newly licensed nurse and the supervising nurse. This competency should be both demonstrated and supported by documentation.

Once the above mentioned period of direct supervision has been completed, the newly licensed LVN must ensure that he or she has the appropriate continued supervision as required by their level of licensure. It is recommended that a newly licensed nurse not hold a position as a charge nurse or nurse manager for a period of six 6 months, unless a lesser time period is mutually agreed upon by the newly licensed nurse and the supervising nurse based upon the evaluation of competency of the newly licensed LVN or RN.

Newly licensed nurses are permitted to perform any function that falls within the scope of nursing practice for which they are licensed. Additionally, newly licensed nurses should obtain instruction, supervision, orientation and training to demonstrate competency when implementing nursing procedures or practices and when encountering new equipment and technology or unfamiliar care situations. The rule requires an RN who performs radiologic procedures, in settings other than a hospital that participates in the federal Medicare program or that is accredited by The Joint Commission, to register with the Texas Board of Nursing BON or Board by submitting certain information to the BON.

In other words, the requirement to register with the Board does not apply to RNs performing radiologic procedures in a hospital that participates in the Medicare program or that is accredited by The Joint Commission. Review Date: May Revised May The number of healthcare professionals with earned doctoral degrees may contribute to confusion for the public and for members of the healthcare team.

Communication Communication takes many forms. References Board Rule Below are some examples of what you should consider when evaluating whether a cosmetic procedure is within your scope of practice: Whether you have the necessary educational preparation and knowledge to perform the task safely.

Was the procedure taught to you as a part of your formal educational curriculum in a school of vocational nursing? Does the task or procedure require a higher level of licensure or a different level of authorization? Whether you have the competency and skill to safely perform the task or procedure. Response from states has varied, with California being the only state to officially establish comprehensive laws and regulations that dictate minimum nurse-to-patient ratio minimums.

On a smaller scale, Massachusetts has taken steps toward formalizing its requirements by passing a law that stipulates safe staffing practices for Intensive Care Units ICU in the state. Of those states, Connecticut, Illinois, Nevada, Ohio, Oregon, Texas, and Washington require hospitals to form staffing committees to develop plans and policies to direct the implementation of optimal staffing practices.

Beyond these states, New Mexico and North Carolina have also started the assessment process by requesting studies that will gather and report information that can be used to develop future staffing mandates and policies. Additionally, Illinois, New Jersey, New York, Rhode Island, and Vermont have all initiated programs to increase public reporting on the impact of strategic staffing. While other states may be considering statewide regulations, none have released official statements or passed laws specifically aimed at regulating nurse staffing, which leaves nurse-to-patient ratios in the hands of individual medical facilities.

By taking this step, facility leaders can elevate their care level with benefits that impact patients and nurses alike. These benefits include:. While they are not strictly regulated, the nurse-to-patient staffing ratios of long-term care LTC facilities are just as important as those in acute care facilities.

In a typical nursing home or assisted living setting, nurses care for patients or residents across broad age ranges with extremely diverse medical needs. With this in mind, the Federal government established regulations for long-term care facilities by passing The Nursing Home Reform Law of While there have been no updates in almost four decades, the measure dictates that long-term care facilities comply with the following requirements:. While these Federal regulations provide an official baseline for staffing standards, several states have gone a step further and introduced statutes and regulations to govern nurse staffing in nursing homes.

In , a University of California San Francisco study reviewed state-specific requirements for Sufficient, Licensed, and Direct Care staff levels in nursing homes, and the results showed direction that varies widely from state to state.

Just as with acute care facilities, long-term care facilities can improve care and nurse satisfaction by implementing strategic nurse-to-patient ratios based on the specific needs of the facility and its residents. If you are a healthcare facility executive or manager looking for a simple, effective way to ensure your nurse-to-patient ratios are consistently met, Gale Healthcare offers a powerful tool.

Nurses in New York are championing legislation that would increase the number of providers on the floor across the state, but industry experts say these requirements would essentially bankrupt struggling facilities. Researchers have been studying the effects of different nurse to patient ratios for years. Statistics show that putting more providers on the floor can be beneficial in more ways than one. According to the Journal of the American Medical Association , going from a nurse-patient ratio to can make all the difference in the world.

Hospitals with ratios experience five additional deaths per 1, patients than those with ratios. A ratio means every nurse is responsible for up to 8 patients at a time, so they need to do twice the amount of work as those working in a facility with a nurse-to-patient ratio of Safe staffing ratios also lead to increased patient satisfaction in the nursing unit, along with fewer medical errors made by overstretched health care professionals.

In most states, facilities have the power to set their own nurse-to-patient staffing ratios. Fourteen states have passed what are known as Safe Staffing Laws, but in 13 of these states, the law only requires facilities to come up with a plan for managing these nurse staffing levels. It does not regulate how many providers should be on the floor.

The only exception is California, which became the only state to pass sweeping regulations in Under the law, facilities must have at least one nurse for every 5 patients on average in medical-surgical units, and one nurse for every two patients in ICUs. The legislation, which is currently under review, would require facilities to increase the number of providers on the floor, including at least one nurse for every two patients in the ICU.

Providers up and down the state are hoping to enact such legislation before what they see as a possible second wave of COVID New York City was ravaged by the pandemic when it first hit the U. Now, nurses are doing everything they can to prevent such an event from happening again. Nurses and their advocates say having such a law in the books at the height of the pandemic could have helped save thousands of lives.

Many nurses and frontline workers were falling ill at the time due to a lack of PPE. Extra staff members could have increased the demand for live-saving face masks, gloves, and other essential safety equipment. The state also brought in thousands of registered nurses and other providers from all over the country, but many arrived several weeks into the crisis.

The debate over nurse-to-patient ratios almost always leads to the issue of cost. Hiring more providers costs a lot of money, which could put some facilities in the red.